The Use of Art Therapy in Alleviating Mental Health Symptoms in Refugees: A Literature Review

There are over thirty million refugees globally with severe experiences of trauma.Art therapy intervention allows for nonverbal expression and could alleviate mental health symptomatology among refugees.The present review’s aim was to integrate and summarize the previous research which examined the effects of visual arts on alleviating psychological conditions of refugees.However,due to the paucity of studies which solely used visual arts,we included studies that used visual arts alongside other modalities as part of an expressive arts therapy intervention.The present review synthesizes studies that examined the effect of art therapy on mental health issues of refugees from January 2000 to March 2021.Seven studies(child and adolescent sample,N=5 and adult sample,N=2)with a total of 298 refugee participants(n=298)met our inclusion criteria.The participants were from the Middle East and North Africa(MENA),Southeast Asia,and Europe.We found three commonly reported mental health disorders,namely Post Traumatic Stress Disorder(PTSD),anxiety,and Major Depression Disorder.The research highlights how art therapy interventions could be a great starting point to alleviate symptomatology among refu-gees.Four additional benefits of art therapy which were commonly reported across the seven studies emerged from this review:working with traumatic experience/loss,rebuilding social connection and trust,nonverbal com-munication and self-expression of loss and trauma,and retelling stories.Art therapy interventions could be used as a starting point in the healing process of traumatized refugees to encourage verbal articulation of their feelings and reduce mental health symptoms.Despite these promisingfindings,due to a dearth of robust methodologies,further research is required to assess the long-term effectiveness of art therapy.

Clinical Audit on the Provision of Diabetes Care in the Primary Care Setting by United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA)

OBJECTIVE: United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) provides primary health care services including care for diabetes and hypertension, with limited resources under difficult circumstances in Gaza, West Bank, Jordan, Lebanon and Syria. A total of 114,911 people with diabetes were registered with UNRWA health centres in 2011. The aim of this cross-sectional observational study was to assess the quality of diabetes care in the UNRWA primary health care centres. METHOD: The study population consisted of 1600 people with diabetes attending the 32 largest UNRWA health centres and treated there for at least one year. Between April and Sept. 2012 data from medical records, including results of clinical examinations and laboratory tests performed during the last one year, current management including self-care education and evidence of diabetes complications were collected and recorded in a previously validated data collection form (DCF). Patients were interviewed and clinically examined on the day of the audit and blood collected for HbA1c testing which was done at a central lab using High-performance liquid chromatography (HPLC) method (HLC&reg-723G8 Tosoh Corporation, Japan). Data was transferred from paper records into a computer and analysed with Epi-info 2000. RESULTS: Type 1 diabetes was present in 4.3% and type 2 diabetes in 95.7%. Co-morbid hypertension was present in 68.5%;90.3% were either obese (64.0%) or overweight (26.3%). Clinical management of diabetes was largely in line with UNRWA’s technical instructions (TI) for diabetes. Records for 2 hour postprandial glucose (2 h PPG), serum cholesterol, serum creatinine, and urine protein analysis were available in 94.7%, 96.4%, 91.4% and 87.5%, cases, respectively. Records of annual fundoscopic eye examination were available in 47.3% cases but foot examinations were less well documented. Most patients (95.6%) were on anti-diabetic drugs—68.2% oral anti diabetic drugs (OAD) only, 14.4% combination of OAD and insulin, and 12.9% insulin only. While 44.8% patients had 2 h PPG ≤ 180 mg/dl, only 28.2% had HbA1c ≤ 7%;55.5% and 28.2% had BP ≤ 140/90 and ≤130/80 mm of Hg respectively. Serum cholesterol ≥ 200 mg/dl, serum creatinine ≥ 1.2 mg/dl and macro albuminuria were noted in 39.8%, 6.4% and 10.3% cases respectively. Peripheral neuropathy (52.6%), foot infections (17%), diabetic retinopathy (11%) and myocardial infarction (9.6%) were the most common long term complications. One or more episodes of hypoglycaemia were reported by 25% cases in total and in 48% of those using insulin. 17.7% and 22.6% cases received no or ≥4 self-care education sessions respectively. CONCLUSION: The study confirmed that UNRWA doctors and nurses follow TI for diabetes and hypertension fairly well. Financial constraints and the consequent effects on UNRWA TI and policies related to diabetes care were important constraints. Key challenges identified were: reliance on 2 h PPG to measure control;non-availability of routine HbA1c testing, self-monitoring of blood glucose (SMBG) and statins within the UNRWA system;and high levels of obesity in the community. Addressing these will further strengthen UNRWA health system’s efforts of providing services for diabetes and hypertension at the primary care level. Given that most developing countries either have no or only rudimentary services for diabetes and hypertension at the primary care level, UNRWA’s efforts can serve as an inspiration to others.

Blinding trachoma among refugees:complicating social disaster

Objective:To determine the prevalence of blinding trachoma among refugees in South Western Ethiopia.Methods:A cross-sectional outreach clinic based descriptive study was conducted on 1054 refugees in Southwest Ethiopia.A basic eyelid and cornea examination for signs of trachoma was done by using 2.5× binocular magnifying loupe.The findings were classified by using the World Health Digitization simplified trachoma grading system and data were analyzed by using SPSS version 16.0.Results:A total of 1054 refugee patients were examined for trachoma.179(16.98%) of them had clinical signs of trachoma.About 6(3.35%) patients had active trachoma with trachomatous trichiasis(TT),47(26.26%) patients had TT only and the rest 126(70.39%)patients had TT with trachomatous corneal opacity.All of the trachoma patients had blinding trachoma(TT with or without trachomatous corneal opacity),and about 60.89% of them had visual impairment.Blinding trachoma was significantly more common among females.patients in age group of 16-59 years,married patients,illiterates and Fugnido camp settlers(P<0.05).Conclusions:There is a very high burden of blinding trachoma among refugees.Urgent surgical intervention is needed to prevent blindness and low vision in the study subjects,and targeted regular outreach-based eye care service should be commenced.

Culture- and evidence-based health promotion group education perceived by new-coming adult Arabic-speaking male and female refugees to Sweden—Pre and two post assessments

Objective: According to a theoretical approach, events that elicit stress after arrival in the reception country, i.e., post-migration stress, have a negative impact on health-related quality of life among newly-arrived refugees. With the aim of paying attention to such symptoms, a revised culturally-tailored clinical health promotion model developed at Harvard Program in Refugee Trauma was used for invited groups of new-coming adult refugees in a town south of the Swedish capital. Methods: A coordinator administered the five-weekly sessions, 2 hours/week, with a professional interpreter. It covered major topics from Western and Arabic worldviews: 1) introduction;2) health care: organisation and access to;3) exercises;4) stress management and coping, 5) medical doctor-patient communication. Each topic was led by a nurse, a physiotherapist, a psychologist and a physician with experience of encounters with this target group in health care. Data cover results from 70 participants attending six groups;39 participants with pre-course findings and, post-course and six-month follow-ups. There were no significant differences in background factors between the participants and the drop-outs. Results: Participants’ perceptions of their health, measured by EQ-5D, changed positively over time, above all immediately after the course, with no significant differences between the two follow-ups. In the follow-ups, female participants perceived their health as significantly worse than males. Qualitative data at the six-month follow-up assessed the course as useful but expressed a wish to continue a similar course with a focus on post- migration stress. Conclusion: The results sup- port earlier findings. A course, administered to a small group in a dialogue setting, has value for the participants’ empowerment and perception of health. It is recommended that reception be more adapted to coping of post-migration stress of new-coming refugees. Practical Implications: The results have implications for education in clinical health promotion, intercultural communication and inter-professional collaboration in refugee reception.

The Power of Theater Expression and Communication:A Psychological Theraputical Intervention in a Refugee Camp:An IPA Study Into the Narratives of Women Refugees’Experience With Drama Therapy

Forced displacement poses a major global crisis that must be tackled at all levels:political,socio-economic,and psychological.This paper describes the psychological impact of forced displacement on women and explains the significance of drama therapy intervention(DTI)in treating and empowering trauma impacted refugee women.Frequently used to treat immigrant and refugee adolescents and children in many host communities,DTI is seldom applied to women refugees who suffer from psychological disorders compounded by fleeing their home country and by difficulties faced in host communities.This makes our study the first on women refugees leaving a zone of war and residing in dire conditions in refugee camps.To best analyze the impact of DTI,this study(1)utilizes a qualitative approach to explain the effects of drama therapy intervention on Syrian and Palestinian-Syrian refugee women in Lebanon;(2)It applies a modified five-phase DTI program to fit the experiment setting and conducts post-DTI interviews;(3)It uses interpretative phenomenological analysis(IPA)method to identify emergent themes and to analyze the effectiveness of DTI;(4)Finally,the study concludes that drama therapy can both help refugee women deal with war-related/post-migration emotional trauma and can implement positive changes and help its participants form social bonds among each other.

The Politics of Repatriation: Rwandan Refugees in Uganda, 2003-2017

Uganda hosts refugees from neighboring countries including Rwanda.According to United Nations High Commissioner for Refugees(UNHCR),by the end of 2018,Uganda was the 3rd and 1st top refugee hosting country in the world and Africa respectively.It hosted over 1.2 million refugees.In 2003,a tripartite agreement was signed to repatriate 25,000 Rwandan refugees.Only 850 of them accepted to return and many of them came back almost immediately to Uganda claiming insecurity and human rights violations in Rwanda.The Rwandan repatriation was not devoid of politics.It was influenced by political interests of various actors:the international community,regional geo-politics,Uganda,and Rwanda.This article analyzes the politics of repatriation of Rwandan refugees by focusing on politics at international and regional levels as well as in Uganda and Rwanda.

Sociodemographic Predictors of Health-Related Quality of Life and Healthcare Service Utilisation among Young Refugees in South Australia

Although refugee adolescents and children are recognised as a health risk population, few studies have explored their Health-related Quality of Life (HRQOL). The present study investigated 1) the sociodemographic predictors of HRQOL such as ethnicity, trauma exposure, and length of residency in Australia in a multiethnic paediatric population with refugee experiences and 2) the relationship between mental healthcare utilisation and HRQOL. Method: Participants were 458 adolescents and children, aged 4 - 17 years, living in South Australia. Parents provided data across the sample and adolescents also completed questionnaires. Overall HRQOL and its composite functional dimensions were assessed using the Paediatric Quality of Life (PedsQL) instrument. Questions from the Child and Adolescent Component of the Australian National Survey of Mental Health and Wellbeing were used to assess service utilisation. Results: Migration region/ethnicity predicted better HRQOL as well as physical, emotional and psychosocial functioning for both children and adolescents. African youths indicated higher HRQOL than those from the former Yugoslavia and the Middle East/South Asia respectively. Pre-migration trauma exposure was associated with lower HRQOL;and longer stay in Australia was related to lower emotional functioning in children. There was a negative association between healthcare service utilisation and PedsQL scores, with participants accessing services demonstrating lower HRQOL. Conclusion: Using more rigorous methods, future research is needed to investigate additional sociodemographic predictors of HRQOL, and protective/risk factors that impact on HRQOL of young refugees.

Refugee Stigma and Its Association with Depression Symptom Severity: Findings from Urban Refugees Living in Mbarara City, Southwestern Uganda

Introduction: Refugees in urban areas often face acculturation challenges, stigma, and stereotypes that impact their mental well-being. The aim of the present study was to examine the prevalence of stigma and its association with depressive symptoms among urban refugees living in Mbarara city, southwestern Uganda. Methods: This cross-sectional study used snowball sampling and interviewed 343 refugees residing in Mbarara city, southwestern Uganda. The Discrimination and Stigma Scale was used to assess stigma, whereas the Patient Health Questionnaire (PHQ-9) was used to screen for depression symptoms severity. Linear regression models determined the associations between stigma and depression symptoms severity. Data were collected between June 2019 and March 2020. Findings: Of the 343 participants, 198 were males and 145 were females;their mean age was 28.8 years (SD = 11.0). Most of the participants (95.3%) had attained formal education. Our findings show that 84% (n = 288) of the participants had symptoms of stigma. Stigma had a statistically significant positive association with depressive symptoms severity (b = 0.11;95% CI, 0.08 to 0.15). Age had statistically significant positive association with depression symptoms severity (b = 0.08;95% CI, 0.02 to 0.14). Education level had a statistically significant negative association with depressive symptoms severity (b = -0.53;95% CI, -0.97 to -0.09). Conclusions: Urban refugees experience high levels of both stigma and depression. Interventions aimed at reducing stigma could subsequently reduce depression among refugees living in urban areas.

A Comprehensive Programme for the Resettlement of Climate Refugees

The placement of environmentally displaced persons is imminent.Involving as many countries as possible in the resettlement of environmentally displaced persons,while protecting their culture and human rights,are the primary goal of the resettlement program.However,countries may refuse to participate in resettlement programs if their interests are not fully considered.The rights of the environmentally displaced persons cannot be protected.The model involves the interests of all parties to ensure the wide participation of all countries in the world.Then,we use quantitative assessment to assess the risk of cultural loss and protect culture and human rights of environmentally displaced persons by controlling this risk.Firstly,in order to calculate the number of people who are likely to be environmentally displaced persons in the future,we build a prediction model based on Markov Chain.By analyzing the average altitude of each country and the predicted sea level rise,we calculate the number of countries likely to be submerged over time.Combining the projected future population of each country,we calculate the total number of people at risk of becoming environmentally displaced persons.Secondly,we link the number of environmentally displaced persons that countries should place with the two goals of human rights protection.Establish Double-Score model to allocate the number of people that each country should place reasonably.The model takes into account countries’carbon emissions and their suitability for migration.The two integral indexes in the model are as follows:Score of carbon dioxide emission.The higher a country’s score,the more responsibility it has to accommodate environmentally displaced persons.The index is converted from the country’s per capita carbon emissions and total carbon emissions,using the Paris Climate Agreement’s calculation of carbon emissions.Score of suitability for immigration.The lower the Score of a country,the higher the Score of carbon emission can be deducted.Meanwhile,the better a country’s cultural and human rights protection of environmentally displaced persons,the higher the score.We encourage countries to actively protect the human rights and culture of refugees.As a part of its commitment to the Paris Climate Agreement,the countries of the world must keep their total score below the set threshold.

Contribution of Agriculture in the Enhancement of Refugees Livelihoods in Nakivale Settlement

Uganda has significantly continued to receive a large number of refugees in the region and this is positively correlated with its proportional increase in peace and stability. The presence of favorable climatic conditions enhances agricultural productivity and this has triggered redirecting refugees into agricultural production as the major source of livelihood. However, in Ugandan setting, it has not yet been clearly established how agriculture has practically enhanced the livelihoods of the refugees. The study therefore aimed at identifying the agricultural activities practiced by refugees living in Nakivale refugee settlement, identifying the challenges faced by refugees involved in agriculture and their possible solutions as well as examining the contribution of agriculture towards livelihoods of refugees in Nakivale Refugee settlement. The study utilized a case-study approach to analyze the contribution of agriculture in the enhancement of livelihoods in the context of a single settlement and a sample size of 80 respondents was chosen using simple random sampling and an interview guide was used to collect primary data from the respondents. It was revealed from the study that crop production is the main agricultural activity practiced by refugees living in Nakivale refugee settlement in a bid to improve on their food security and household incomes. The study further revealed that climate change, diseases/parasites and diseases, limited land and low prices for the produce are the most serious challenges facing refugees’ farmers. It is concluded that food security in Nakivale refugee settlement is rather influenced by agricultural production and the associated dynamics that ultimately determine the well-being of the refugee communities. It is important to appreciate that any variation in factors of production, weather and produce prices will determine livelihood status of the community for such a specific period of time. It’s recommended that farmers should adopt climate smart farming to mitigate effects of climate change, supporting farmers with agricultural credit and other agricultural inputs like fertilizers, pesticides, farming tools, land, farmers training, improved seeds which are high yielding and quick maturing, market linkages for improved productivity and production.

Into the Fold Refugees, internally displaced persons, returnees and the challenge of integration in Africa

Refugees,internally displaced persons,returnees and the challenge,of integration in Africa.

Textile Enterprises Support the Refugees by Tents

In recent days,the tent manufacturers in ZhenJiang,JiangSu and TianJin have made all-out efforts to produce the relief tents,which are in urgent need of refugees in quake-hit areas,to show their human’s love to refugees in quake-hit area by their actual actions.

Microbiological screenings for infection control in unaccompanied minor refugees： the German Armed Forces Medical Service＇s experience

Background:The German Military Medical Service contributed to the medical screening of unaccompanied minor refugees(UMRs)coming to Germany in 2014 and 2015.In this study,a broad range of diagnostic procedures was applied to identify microorganisms with clinical or public health significance.Previously,those tests had only been used to screen soldiers returning from tropical deployments.This instance is the first time the approach has been studied in a humanitarian context.Methods:The offered screenings included blood cell counts,hepatitis B serology and microscopy of the stool to look for protozoa and worm eggs as well as PCR from stool samples targeting pathogenic bacteria,protozoa and helminths.If individuals refused certain assessments,their decision to do so was accepted.A total of 219 apparently healthy male UMRs coming from Afghanistan,Egypt,Somalia,Eritrea,Syria,Ghana,Guinea,Iran,Algeria,Iraq,Benin,Gambia,Libya,Morocco,Pakistan,and Palestine were assessed.All UMRs who were examined at the study department were included in the assessment.Results:We detected decreasing frequencies of pathogens that included diarrhoea-associated bacteria[Campylobacter(C.)jejuni,enteropathogenic Escherichia(E.)coli(EPEC),enterotoxic E.coli(ETEC),enteroaggregative E.coli(EAEC),enteroinvasive E.coli(EIEC)/Shigella spp.),Giardia(G.)duodenalis,helminths(comprising Schistosoma spp.,Hymenolepis(H.)nana,Strongyloides(S.)stercoralis]as well as hepatitis B virus.Pathogenic microorganisms dominated the samples by far.While G.duodenalis was detected in 11.4%of the assessed UMRs,the incidence of newly identified cases in the German population was 4.5 cases per 100,000 inhabitants.Conclusion:We conclude that the applied in-house PCR screening systems,which have proven to be useful for screening military returnees from tropical deployments,can also be used for health assessment of immigrants from the respective sites.Apparently healthy UMRs may be enterically colonized with a broad variety of pathogenic and apathogenic microorganisms.Increased colonization rates,as shown for G.duodenalis,can pose a hygiene problem in centralized homes for asylum seekers.

Obstetric Care among Refugees: The Complex Interplay of Barriers to Care, Culture, Health Resources and the Healthcare Infrastructure of Host Countries

There is a worldwide increase in the rate of caesarean sections. With recent migration patterns and the influx of refugees into high-income countries, migrants and refugees are also subjected to the increase in caesarean section rates. This article explores known information about the obstetrical experiences of refugee and displaced women. Pregnancy care varies depending on the location of the displaced women. Obstetrical care in refugee centers in Greece is examined as an example of the overall challenges facing European countries as they juggle the influx of refugees. Challenges to obstetrical care include physician shortage and the ongoing economic crisis in Greece. Refugees are some of the world’s most vulnerable populations and overall their obstetrical outcomes are worse than women of the host communities. Providers in refugee centers must be supported and educated in best obstetrical practices including labor management and a judicious use of caesarean deliveries. Increased outreach and training of maternal health worker can improve reproductive healthcare for refugees in non-camp environments.

Visual Manifestations of the European Discourse on Solidarity of Refugees and Migrants

The paper aims to examine different visual manifestations of the European discourse on solidarity during the immigration crisis (2015-2017). International Organizations such as UN (United Nations), IOM (International Organization for Migration), and EASO (European Asylum Support Office) following a set of European policies reflect solidarity in practice among the European Union (EU) states. Policy makers, apart from implementing and drafting different sets of policies in moments of emergency due to the immense migrant flow, have also accompanied these practices with visual representations in the form of posters and photos. These visual representations feature the organizations themselves and the discourse on solidarity towards the migrants. Hence, examining this material we can have a clear picture of the identity of the organizations but also, and most importantly, how they visualize their understanding of solidarity discourse. The paper is unfolded in the following way. Firstly, the theoretical framework of solidarity and the European Union’s perspective of solidarity are discussed in detail. Then, the focus is moved towards a theoretical discussion of emotion, the role of affect, and the role these Organizations play in the creation of European policies on migration. Thirdly, the analysis of the material, photos, posters, and a leaflet will be discussed in conjunction to the aforementioned theoretical framework of solidarity and affect.

Photographs of Refugees in Polish Daily Newspapers—Critical Discourse Analysis

This paper describes the way in which the European migrant crisis is depicted in the Polish daily press.This topic seems to be important because of the current political situation in Poland,which presents right-wing and anti-immigrant views,and because of the ongoing conflict concerning this matter between the Polish government and European institutions.The analysis includes articles about refugees published in the selected months of 2015 and 2017 in three daily newspapers presenting opposing political sympathies.The paper employs critical discourse analysis and its discourse-historical approach describing strategies of presenting refugees in press photography.The analysis encompasses types of photographs,their functions,the relationship with their captions,and most importantly,topoi which constitute the focal point when addressing the relationship of power,knowledge,and discourse which is significant for critical discourse analysis(CDA).

Assessing the Factors Influencing Migration Decision of Climate Refugees in Coastal Areas of Bangladesh

The major impacts of climate change play a substantial role in triggering human migration, especially in the coastal areas. The individual or combined effects of climate change are likely to trigger mass human movement both within and across international borders. People rarely move for a single reason;the motivation to migrate is complex of many factors. The main goal of this article is to identify the factors related to the decision to migrate taken by refugees in the coastal area. To assess this objective we employ exploratory factor analysis and structural equation modeling (SEM) and find that different factors influence refugees’ migration decision differently. From the findings, it is seen that loss of shelter, extreme events, decreasing soil fertility and food shortage, variability in temperature patterns and exhaustion of natural resources are the most important environmental factors that affect the decision to migrate of climate refugees. Low income, increasing price, decreasing purchasing power are the most important economic factors that influence migration decision. No social factors have significant effect on migration decision while safety as a political factor has a moderate influence on refugees’ decision to migrate. Finally, this article provides some recommendations for recognition of and protection for migrants forced to move to safer places due to certain direct impacts of climate change, notwithstanding the existence of multi-causality.

The“Erga Omnes”of the Protection of Fundamental Human Rights and the“Complementary Protection”of Refugees Not Prescribed by the UN Convention Relating to the Status of Refugees

The United Nations Convention Relating to the Status of Refugees 1951 and its Protocol in 1967 set Four Essentials to limit the definition of "refugee". The concept of complementary protection emerged in academia and practice for those who, though they do not have the essentials,are in need of protection. Complementary protection is considered not only a moral obligation, but also a legal obligation. Although as the result of developing the principle of "non-refoulement" in international law, "complementary protection" should be limited when economic and social rights are concerned. The development of the non-refoulement principle and the emergence of "complementary protection" are based on the Erga Omnes of human rights. The International Court of Justice has restricted the emergence and evolvement of obligations Erga Omnes within the scope of obligations concerning fundamental and non-derogable human rights, and therefore,the application of "complementary protection" in protecting economic and social rights has been limited. Only when the unbalance of economic and social rights has been serious enough to impact other fundamental human rights will the obligation of "complementary protection" ensue.

Hepatitis B virus infection in undocumented immigrants and refugees in Southern Italy:demographic,virological,and clinical features

Background:The data on hepatitis b virus(HBV)infection in immigrants population are scanty.The porpoise of this study was to define the demographic,virological,and clinical characteristics of subjects infected with HBV chronic infection in a cohort of immigrants living in Naples,Italy.Methods:A screening for HBV infection was offered to 1,331 immigrants,of whom 1,212(91%)(831 undocumented immigrants and 381 refugees)accepted and were screened for hepatitis B surface antigen(HBsAg)and anti-hepatitis B core antibody(HBc).Those found to be HBsAg positive were further investigated at third-level infectious disease units.Results:Of the 1,212 immigrants screened,116(9.6%)were HBsAg positive,490(40.4%)were HBsAg negative/anti-HBc positive,and 606(50%)were seronegative for both.Moreover,21(1.7%)were anti-human immunodeficiency virus positive and 45(3.7%)were anti-hepatitis C virus positive.The logistic regression analysis showed that male sex(OR:1.79;95%CI:1.28-2.51),Sub-Saharan African origin(OR:6.18;95%CI:3.37-11.36),low level of schooling(OR:0.96;95%CI:0.94-0.99),and minor parenteral risks for acquiring HBV infection(acupuncture,tattoo,piercing,or tribal practices,OR:1.54;95%CI:1.1-2.16)were independently associated with ongoing or past HBV infection.Of the 116 HBsAg-positive immigrants,90(77.6%)completed their diagnostic itinerary at a third-level infectious disease unit:29(32.2%)were asymptomatic non-viremic HBsAg carriers,43(47.8%)were asymptomatic viremic carriers,14(15.6%)had chronic hepatitis,and four(4.4%)had liver cirrhosis,with superimposed hepatocellular carcinoma in two.Conclusions:The data illustrate the demographic,clinical and virological characteristics of HBV infection in immigrants in Italy and indicate the need for Italian healthcare authorities to enhance their support for providing screening,HBV vaccination,treatment,and educational programs for this populations.

Study on Evacuation Strategy of Commercial High-Rise Building under Fire Based on FDS and Pathfinder

With the development of economy and society and the growth of population,the high-rise and multi-function of commercial buildings have become an international trend.But it also poses huge fire hazards.Most of the existing studies’research objects are predominantly high-rise residential buildings,without considering the impact of different functional zones(Standard floor,entertainment zone,office zone,equipment room and so on)and personnel distribution of commercial buildings evacuation.And the influence of using elevators to carry evacuees on the refuge floor on personnel evacuation is rarely studied.In this work,the fire scenario of the Yangtze River InternationalConferenceCenter,a high-rise commercial building,is simulated with the Pyrosim programto get the necessary parameters under various fire scenarios and to calculate the available evacuation time TASET.At the same time,according to the complex functional zone of the commercial high-rise building and the distribution of people in different time periods,a reasonable evacuation strategy is developed and simulated by Pathfinder software.The results indicate that unorganized evacuation will lead individuals to take the erroneous evacuation route,resulting in a vast region of congestion;comprehensive consideration of the time staggering and the reasonable distribution of evacuation routes can significantly improve evacuation efficiency,and the TRSET of night and working hours is 36.6%–55.3%and 49.9%–79.6%of unorganized evacuation,respectively.For the night fire,60%of the people use elevator-refuge floor to evacuate is the optimal strategy;for the fire during working hours,half of the people on standard floors use the elevator to evacuate and people on multifunctional floors evacuate in four batches is the best plan.The results of this study can provide viable solutions and a foundation for analyzing the fire evacuation and safety of big commercial high-rise buildings.