The aim of this study was to assess the characteristics of asylum-seeking children with medical complexity visiting a tertiary care hospital in Switzerland, detailing their underlying medical conditions and management. Asylum-seeking patients with frequent visits between January 2016 and December 2017 were identified using administrative and electronic health records. Of 462 patients, 19 (4%) fulfilled the inclusion criteria with 811 (45%) visits. The age of the 19 patients ranged from 0 to 16.7 years (median of 7 years) with two main age groups identified: < 2 years and > 12 years. Nine (47%) patients originated from Syria. A total of 34/811(4%) visits were hospital admissions, 66/811 (8%) emergency department visits and 320/811(39%) outpatient department visits. In children < 2 years genetic diseases (5/8; 63%) and nutritional problems (6/8; 75%) were most common; in adolescents, orthopedic diseases (4/8; 50%) and mental health problems (4/8; 50%). Asylum-seeking children with medical complexity represent a small but important group of patients requiring frequent medical consultations. The high proportion of young patients with genetic diseases and severe nutritional problems suggests that new strategies are required in the management of this specific group of asylum-seeking children. This could be achieved by improved co-ordination between hospital and non-hospital care exploring options for integrated care.

BACKGROUND: In the last decade an increasing number of asylum-seeking children arrived in Europe and local healthcare systems have been challenged to adapt to their health needs. The aim of this study was to compare the spectrum of disease and management of asylum-seeking and non-asylum-seeking children requiring hospital admission.METHODS: This was a retrospective cohort study including health data from recently arrived asylum-seeking and non-asylum-seeking children admitted between January 2016 and December 2017. Data were collected using electronic administrative and medical records. RESULTS: Of 11,794 admissions of 9407 patients, 149 (1%) were asylum-seeking and 11,645 (99%) from nonasylum-seeking children. In asylum-seeking children the median age was 4 years (interquartile range [IQR] 0-13) with 61% males and in non-asylum-seeking children 4 years (IQR 0-11) years with 56% males. Respiratory infections accounted for 17-19% of admissions in both groups. Rare infectious diseases were more frequent in asylum-seeking children (15 vs 7%; difference in proportions 0.08, 95% confidence interval [CI] 0.02-0.14; p <0.001,). Injuries were more frequent in non-asylum-seeking children (22 vs 13%; difference in proportions 0.09, 95% CI 0.04-0.014; p <0.01). Admissions for mental health disorders were infrequent but more common in asylum-seeking children (6 vs 3%; difference in proportions 0.03, 95% CI −0.01 -0.07; p = 0.02) Prescription of analgesics was lower in asylum-seeking than non-asylum-seeking children (3.4 vs 6.5 accounting units per admission). Antibiotic prescription was comparable in both groups.CONCLUSION: Asylum-seeking children represent a small number of total admissions. Age distribution and main reason for admission being diseases of the respi-ratory system were comparable in asylum-seeking and non-asylum-seeking children. Rare infections and mental health disorders are important diseases in asylum-seeking children and require special attention and training of staff working with paediatric asylum seekers.

Abstract. Gated Communities stellen eine Extremform der Privatisierung öffentlicher Räume dar, verbunden mit einer radikalen Veränderung der Stadtlandschaft. Insbesondere in Räumen wie Südkalifornien ist eine hohe Konzentration dieser Wohnform auszumachen. Dabei lassen sich anhand umzäunter Alters- oder Feriensiedlungen sowie familienorientierter Gated Communities unterschiedliche Entwicklungsmuster identifizieren. Gründe für den Erfolg von Gated Communities sind unter anderem der Sicherheitsaspekt, die starke Identifikation mit dem Wohnumfeld sowie eine Organisationsstruktur, welche sich in ausgeprägter Form an den Präferenzen der Bewohner orientiert. Die grössten Vorteile von Gated Communities gegenüber konventionellen Siedlungen liegen bei den auf Effizienz ausgerichteten siedlungsinternen Strukturen. Demgegenüber bestehen jedoch bedeutende räumliche Probleme im Zusammenhang mit der Segregation und der Fragmentierung der Stadtlandschaft. Eine Alternative zu Gated Communities insbesondere im Hinblick auf den Sicherheitsaspekt könnten siedlungsplanerische Konzepte wie Pedestrian Pockets oder Traditional Neighborhood Developments darstellen.