Introduction: Prevalence rates of trauma-related mental disorders such as posttraumatic stress disorder (PTSD) or major depression (MD) are high in asylum seekers. The PROTECT Questionnaire (PQ) was designed to detect indications of those disorders in asylum seekers. Empirical data are needed to evaluate the PQ psychometrically. The objective of this study is to investigate the reliability, validity, sensitivity, and specificity of the PQ. Method: The PQ and validated questionnaires for PTSD (Posttraumatic Diagnostic Scale, PDS) and depression (Patient Health Questionnaire-9, PHQ- 9) were filled in by a sample of recently arrived asylum seekers in Germany (n=141). A sub-sample of 91 asylum seekers took part in a structured clinical interview to diagnose PTSD or MD (SCID-I). Results: The PQ showed a one-factor structure and good reliability (Cronbach’s ⍺= .82). It correlated highly with the PDS and the PHQ-9 (rs=.53-.77; ps≤.001). Diagnostic accuracy with regard to PTSD (AUC=.74; SE=.06; p<.001; 95%-CI=.63-.84) and MD (AUC=.72; SE=.06; p<.001; 95%-CI=.61- .83) was adequate, suggesting an optimal cut-off of 8 or 9. By categorizing participants into a low- and high-risk category, the PQ differentiated well between asylum seekers who fulfilled a PTSD or MD diagnosis and those who did not. Discussion: The results support the use of the PQ as a reliable and valid instrument for the purpose of detecting signs and symptoms of the two most common mental disorders in asylum seekers. Persons found to be at risk of mental disorders should be referred to a clinical diagnostic procedure.

Introduction: If asylum applicants need to prove that they have been persecuted in their home country, expert judgment of the psychological and physical consequences of torture may support the judicial process. Expert medico-legal reports can be used to assess whether the medical complaints of the asylum seeker are consistent with their asylum account. It is unclear which factors influence medical expert judgement about the consistency between an asylum seeker’s symptoms and story, and to what extent expert medico-legal reports are associated with judicial outcomes. Methods: We analysed 97 medico-legal reports on traumatised asylum seekers in the Netherlands. First, we evaluated the impact of trauma-related and other variables on experts’ judgments of the consistency of symptoms and story. Second, we evaluated the effect of experts’ judgments of symptom-story consistency on subsequent judicial outcomes. Results: Gender, receipt of mental health care and trauma-related variables were associated with symptomstory consistency. Positive asylum decisions were predicted by expert judgments about the presence of physical signs and symptoms of torture, and ill-treatment and their consistency with the refugee’s story, but not psychological symptoms. Conclusion: These results suggest that standardised procedures for the documenting of medical evidence by independent experts can improve judicial decision quality and the need to improve psychological and psychiatric assessments.

Purpose This study is oriented towards getting insight into the perspectives, knowledge and practices among Syrian refugees regarding antibiotic use and prescribing in Dutch primary care. Design/methodology/approach A thematic qualitative study was carried out using semi-structured interviews with 12 Syrian refugees living in the Netherlands. Data analysis consisted of three steps and was oriented towards the development of themes. Findings Participants were confronted with restricted access to antibiotics in the Netherlands which was contrary to their experiences in Syria. Some of them continued to self-prescribe antibiotics, while others adhered to the Dutch General Practitioner (GP)’s advice. Especially mothers with young children took up the Dutch GP’s advice. Syrian refugees expressed health beliefs about the healing effects of antibiotics which are related to their past experiences of use and which influenced their current use. Respondents complained about the Dutch health-care system and expressed a preference for the one in Syria. Research limitations/implications Syrian refugees vary in their way of dealing with restricted access to antibiotics in Dutch primary care. More in-depth knowledge is required to improve refugee patient–doctor communication about antibiotic use. Practical implications The message that antibiotics are not needed may be challenging. Additional communication seems to be necessary to persuade Syrian refugees from self-prescribing antibiotics. Therefore, identifying refugee patient concerns and carefully counseling and communicating it with them is substantial. Developing educational toolkits consisting of various experiences of antibiotic use and ways of dealing with it can equip doctors to more adequately react to migrants’ needs for care. Social implications Primary care professionals seem insufficiently equipped to tackle issues related to antibiotic use amongst newly arrived migrants. Therefore, it is important to support professionals in their communication with this patient group about the proper use of antibiotics. Originality/value This study shows that more in-depth knowledge is needed about the strategies of newly arrived migrants and their complex reactions to treatment prescriptions with which they are not familiar.

Arts bij Pharos, kenniscentrum, vluchtelingen, nieuwkomers en gezondheid te Utrecht SamenvattingArtsen die zorg verlenen aan asielzoekers, vluchtelingen en migranten worden regelmatig geconfronteerd met het vreemdelingenbeleid. In deze bijdrage komen twee belangrijke documenten met richtlijnen voor artsen aan de orde. Het Istanbul-protocol geeft richtlijnen voor het medisch onderzoek van slachtoffers van marteling. Artsen kunnen via medische bevindingen bijdragen aan het aannemelijk maken van martelingen. Dit is met name van belang voor asielzoekers die afkomstig zijn uit landen waar martelen nog plaatsvindt. Het rapport Arts en vreemdeling ondersteunt artsen die bij hun medisch handelen belemmerd worden door de regelgeving bij de uitvoering van het vreemdelingenbeleid. Het betreft vooral de medische zorg aan asielzoekers en illegale vreemdelingen. InleidingProfessionele richtlijnen, gedragsregels en medisch-ethische principes leiden artsen in hun medische zorg. Hierbij staat het verlenen van gezondheidszorg zonder onderscheid des persoons centraal.Elke arts legt in Nederland bij het afstuderen de artseneed af: 'Ik zweer/beloof dat ik de geneeskunst zo goed als ik kan zal uitoefenen ten dienste van mijn medemens. Ik zal zorgen voor zieken, gezondheid bevorderen en lijden verlichten. Ik stel het belang van de patiënt voorop en eerbiedig zijn opvattingen.' In het kader van de medische zorg voor allochtonen en vluchtelingen zijn er twee documenten die aandacht behoeven, namelijk het Istanbul-protocol en het rapport Arts en vreemdeling.3,4 Het eerste geeft richtlijnen voor het medisch onderzoek van de gevolgen van martelingen en het tweede geeft richtlijnen voor artsen in situaties waarbij medische zorg in het gedrang komt door het BSL -BIJ -0000_BIJ051

Background: Antibiotic resistance is an international public health concern. Medical culture influences antibiotic use. Migrants, like Syrian refugees, are confronted with a different health care system in their new country and also with different culture regarding antibiotic prescription. The aim of this study is to get insight into the perspectives, knowledge and practices among Syrian refugees regarding antibiotic use and prescribing in Dutch primary care.Methods: A qualitative study using semi-structured interviews with 12 Syrian refugees living in the Netherlands was conducted. Results: participants stressed the easy access to antibiotics in Syria and reported storing antibiotics at home for emergencies. In the Netherlands, some of them still self-prescribed antibiotics while others adhered to the Dutch GP’s advice. Syrian refugees believed in having a weaker immunity compared to the Dutch inhabitants. For their young children, they adhered to the new health care system which resulted in not giving the children antibiotics without a prescription. Several complaints about the Dutch health care system were identified such as difficult access to the desired medication and lack of medical care for their complaints. Most respondents preferred the Syrian health care system.Conclusion: Syrian refugees experienced restricted access to antibiotics in Dutch primary care which was contrary to their experiences in Syria. As a reaction, they continued self-medicating with antibiotics. However, some of them adapted to the Dutch health care culture and accepted the alternative treatment proposal. For their children most participants adhered to the prescription policy of antibiotics in the Netherlands.