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      Violence as the Most Frequent Cause of Oral and Maxillofacial Injuries among the Patients from Low- and Middle-Income Countries—A Retrospective Study at a Level I Trauma University Emergency Department in Switzerland

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          Abstract

          Preventive strategies can be developed by gathering more information about oral and maxillofacial injuries and oral pathologies in immigrants from low- to middle-income countries (LMIC). Additional information on the quality of care can also improve the allocation of clinical resources for the management of these patients. We studied immigrants from LMIC who presented in the emergency department (ED) at Berne University Hospital with dental problems or oral or maxillofacial injuries. The patient data included age, gender, nationality, the etiology and type of trauma and infection in the oral-maxillofacial area, and overall costs. The greatest incidence of maxillofacial injuries was observed in the age group of 16–35 years ( n = 128, 63.6%, p = 0.009), with males outnumbering females in all age groups. Trauma cases were most frequent in the late evening and were mostly associated with violence ( n = 82, 55.4%, p = 0.001). The most common fracture was fracture of the nose ( n = 31). The mean costs were approximately the same for men (mean = 2466.02 Swiss francs) and women (mean = 2117.95 Swiss francs) with maxillofacial injuries but were greater than for isolated dental problems. In conclusion, the etiology of dental and maxillofacial injuries in immigrants in Switzerland requires better support in the prevention of violence and continued promotion of oral health education.

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          Epidemiology of dental trauma: a review of the literature.

          This article reviews recent reports describing the aetiology of dental trauma from national and international studies as well as the different classifications currently used to report dental injuries. It also discusses possible preventive measures to reduce the increasing frequency of dental trauma. Reported studies demonstrate that males tend to experience more dental trauma in the permanent dentition than females, however, there does not appear to be a difference between the sexes in the primary dentition. Accidents within and around the home were the major sources of injury to the primary dentition, while accidents at home and school accounted for most of the injuries to the permanent dentition. The most frequent type of injury was a simple crown fracture of the maxillary central incisors in the permanent dentition while injuries to the periodontal tissues were more common in the primary dentition. When preventive measures are being planned, knowledge of aetiology is important. More prospective studies from representative populations are required to understand the complexities of dental trauma epidemiology and to allow implementation of preventive strategies to reduce the increasing frequency of dental trauma.
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            A systematic literature review of reported challenges in health care delivery to migrants and refugees in high-income countries - the 3C model

            Background Migrants and refugees have important health needs and face inequalities in their health status. Health care delivery to this patient group has become a challenging public health focus in high income countries. This paper summarizes current knowledge on health care delivery to migrants and refugees in high-income countries from multiple perspectives. Methods We performed a systematic literature review including primary source qualitative and quantitative studies between 2000 and 2017. Articles were excluded if the study setting was in low- or middle-income countries or focused on skilled migration. Quality assessment was done for qualitative and quantitative studies separately. Predefined variables were extracted in a standardized form. Authors were approached to provide missing information. Results Of 185 identified articles, 35 were included in the final analysis. We identified three main topics of challenges in health care delivery: communication, continuity of care and confidence. All but one study included at least one of the three main topics and in 21/35 (60%) all three topics were mentioned. We further developed the 3C model and elaborated the interrelatedness of the three topics. Additional topics identified showed that the specific regional context with legal, financial, geographical and cultural aspects is important and further influences the 3C model. Conclusions The 3C model gives a simple and comprehensive, patient-centered summary of key challenges in health care delivery for refugees and migrants. This concept is relevant to support clinicians in their day to day practice and in guiding stakeholders in priority setting for refugee and migrant health policies. Electronic supplementary material The online version of this article (10.1186/s12889-019-7049-x) contains supplementary material, which is available to authorized users.
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              Impact on and use of health services by international migrants: questionnaire survey of inner city London A&E attenders

              Background Changing immigration trends pose new challenges for the UK's open access health service and there is considerable speculation that migrants from resource-poor countries place a disproportionate burden on services. Data are needed to inform provision of services to migrant groups and to ensure their access to appropriate health care. We compared sociodemographic characteristics and impact of migrant groups and UK-born patients presenting to a hospital A&E/Walk-In Centre and prior use of community-based General Practitioner (GP) services. Methods We administered an anonymous questionnaire survey of all presenting patients at an A&E/Walk-In Centre at an inner-city London hospital during a 1 month period. Questions related to nationality, immigration status, time in the UK, registration and use of GP services. We compared differences between groups using two-way tables by Chi-Square and Fisher's exact test. We used logistic regression modelling to quantify associations of explanatory variables and outcomes. Results 1611 of 3262 patients completed the survey (response rate 49.4%). 720 (44.7%) were overseas born, representing 87 nationalities, of whom 532 (73.9%) were new migrants to the UK (≤10 years). Overseas born were over-represented in comparison to local estimates (44.7% vs 33.6%; p < 0.001; proportional difference 0.111 [95% CI 0.087–0.136]). Dominant immigration status' were: work permit (24.4%), EU citizens (21.5%), with only 21 (1.3%) political asylum seekers/refugees. 178 (11%) reported nationalities from refugee-generating countries (RGCs), eg, Somalia, who were less likely to speak English. Compared with RGCs, and after adjusting for age and sex, the Australians, New Zealanders, and South Africans (ANS group; OR 0.28 [95% CI 0.11 to 0.71]; p = 0.008) and the Other Migrant (OM) group comprising mainly Europeans (0.13 [0.06 to 0.30]; p = 0.000) were less likely to have GP registration and to have made prior contact with GPs, yet this did not affect mode of access to hospital services across groups nor delay access to care. Conclusion Recently arrived migrants are a diverse and substantial group, of whom migrants from refugee-generating countries and asylum seekers comprise only a minority group. Service reorganisation to ensure improved access to community-based GPs and delivery of more appropriate care may lessen their impact on acute services.
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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                07 July 2020
                July 2020
                : 17
                : 13
                : 4906
                Affiliations
                [1 ]Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, CH-3010 Bern, Switzerland; loutroukis@ 123456hotmail.com (T.L.); eloutrouki@ 123456hotmail.com (E.L.); Jolanta.klukowska-roetzler@ 123456insel.ch (J.K.-R.); Aristomenis.Exadaktylos@ 123456insel.ch (A.K.E.); michael.doulberis@ 123456ksa.ch (M.D.); DavidShiva.Srivastava@ 123456insel.ch (D.S.S.)
                [2 ]Department of Cranio-Maxillofacial Surgery, Inselspital, University Hospital Bern, University of Bern, CH-3010 Bern, Switzerland; koba.sabine@ 123456icloud.com (S.K.); fabian.schlittler@ 123456insel.ch (F.S.); benoit.schaller@ 123456insel.ch (B.S.)
                [3 ]Division of Gastroenterology and Hepatology, Medical University Department, Kantonsspital Aarau, CH-5001 Aarau, Switzerland
                [4 ]Department of Visceral Surgery and Medicine, Inselspital, University Hospital Bern, University of Bern, CH-3010 Bern, Switzerland; silvana.ingold@ 123456gmail.com
                Author notes
                [* ]Correspondence: jp.burkhard@ 123456insel.ch ; Tel.: +41-31-632-33-17
                [†]

                Equal contributions and equal shares in the first position.

                Author information
                https://orcid.org/0000-0001-7956-2724
                https://orcid.org/0000-0002-0396-5081
                https://orcid.org/0000-0002-2640-2652
                Article
                ijerph-17-04906
                10.3390/ijerph17134906
                7369963
                32646020
                8fd63c3c-9bb6-4937-ac56-c6699564232e
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 28 May 2020
                : 03 July 2020
                Categories
                Article

                Public health
                immigrants,low-income,middle income,facial trauma,maxillofacial trauma,oral health,dental trauma

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