PLoS currents最新文献

{"title":"Community Perspective on Policy Options for Resettlement Management: A Case Study of Risk Reduction in Bududa, Eastern Uganda.","authors":"Stella Neema,&nbsp;Grace Mongo Bua,&nbsp;Doreen Tuhebwe,&nbsp;Julius Ssentongo,&nbsp;Nathan Tumuhamye,&nbsp;Roy William Mayega,&nbsp;James Fishkin,&nbsp;Lynn M Atuyambe,&nbsp;William Bazeyo","doi":"10.1371/currents.dis.49e8e547de25ca1c1f9edbbfc8b9efa5","DOIUrl":"https://doi.org/10.1371/currents.dis.49e8e547de25ca1c1f9edbbfc8b9efa5","url":null,"abstract":"<p><strong>Introduction: </strong>Despite existing policy actions on Disaster Risk Reduction (DRR), many community members in Bududa still continue to settle in high-risk areas re-zoned for nonsettlement. There seems to be an apparent information asymmetry on expectations between the community and Government. The challenge then is '<i>how to consult communities and seek their opinion in an adequately representative unbiased way</i>'. This paper sets out to explore policy options on resettlement management as a DRR approach and how engaging with communities in a public discourse using the Deliberative Polling (DP) approach; to obtain their opinions and insights on these policy issues, revealed underlying challenges to policy implementation.</p><p><strong>Methods: </strong>A qualitative study was conducted in Bududa in eastern Uganda with fourteen group discussions; comprising 12-15 randomly assigned participants of mixed socio-economic variables. Trained research assistants and moderators collected data. All discussions were audio taped, transcribed verbatim before analysis. Data were analyzed using latent content analysis by identifying codes from which sub-themes were generated and grouped into main themes on policy options for resettlement management.</p><p><strong>Results and discussion: </strong>We used Deliberative Polling, an innovative approach to public policy consultation and found that although the community is in agreement with most government policy options under resettlement management, they lacked an understanding of the rationale underlying these policy options leading to challenges in implementation. The community members seemed uncertain and had mistrust in government's ability to implement the policies especially on issues of compensation for land lost. Key Words: Policy, Deliberative Polling, Climate change, risk-reduction, landslides, Uganda.</p>","PeriodicalId":74464,"journal":{"name":"PLoS currents","volume":"10 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6100022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36470232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying Areas at Greatest Risk for Recent Zika Virus Importation - New York City, 2016.","authors":"Sharon K Greene,&nbsp;Sungwoo Lim,&nbsp;Annie Fine","doi":"10.1371/currents.outbreaks.00dd49d24b62731f87f12b0e657aa04c","DOIUrl":"https://doi.org/10.1371/currents.outbreaks.00dd49d24b62731f87f12b0e657aa04c","url":null,"abstract":"<p><strong>Introduction: </strong>The New York City Department of Health and Mental Hygiene sought to detect and minimize the risk of local, mosquito-borne Zika virus (ZIKV) transmission. We modeled areas at greatest risk for recent ZIKV importation, in the context of spatially biased ZIKV case ascertainment and no data on the local spatial distribution of persons arriving from ZIKV-affected countries.</p><p><strong>Methods: </strong>For each of 14 weeks during June-September 2016, we used logistic regression to model the census tract-level presence of any ZIKV cases in the prior month, using eight covariates from static sociodemographic census data and the latest surveillance data, restricting to census tracts with any ZIKV testing in the prior month. To assess whether the model discriminated better than random between census tracts with and without recent cases, we compared the area under the receiver operating characteristic (ROC) curve for each week's fitted model versus an intercept-only model applied to cross-validated data. For weeks where the ROC contrast test was significant at <i>P <</i> 0.05, we output and mapped the model-predicted individual probabilities for all census tracts, including those with no recent testing.</p><p><strong>Results: </strong>The ROC contrast test was significant for 8 of 14 weekly analyses. No covariates were consistently associated with the presence of recent cases. Modeled risk areas fluctuated across these 8 weeks, with Spearman correlation coefficients ranging from 0.30 to 0.93, all <i>P <</i> 0.0001. Areas in the Bronx and upper Manhattan were in the highest risk decile as of late June, while as of late August, the greatest risk shifted to eastern Brooklyn.</p><p><strong>Conclusion: </strong>We used observable characteristics of areas with recent, known travel-associated ZIKV cases to identify similar areas with no observed cases that might also be at-risk each week. Findings were used to target public education and <i>Aedes</i> spp. mosquito surveillance and control. These methods are applicable to other conditions for which biased case ascertainment is suspected and knowledge of how cases are geographically distributed is important for targeting public health activities.</p>","PeriodicalId":74464,"journal":{"name":"PLoS currents","volume":"10 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6126530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36525027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Post-pleistocene Calibrated Mutation Rate from Insect Museum Specimens.","authors":"Gideon Ney,&nbsp;Katy Frederick,&nbsp;Johannes Schul","doi":"10.1371/currents.tol.aba557de56be881793261f7e1565cf35","DOIUrl":"https://doi.org/10.1371/currents.tol.aba557de56be881793261f7e1565cf35","url":null,"abstract":"<p><p>Quantifying the age of recent species divergence events can be challenging in the absence of calibration points within many groups. The katydid species <i>Neoconocephalus lyristes</i> provides the opportunity to calibrate a post-Pleistocene, taxa specific mutation rate using a known biogeographic event, the Mohawk-Hudson Divide. DNA was extracted from pinned museum specimens of <i>N. lyristes</i> from both Midwest and Atlantic populations and the mitochondrial gene COI sequenced using primers designed from extant specimens. Coalescent analyses using both strict and relaxed molecular clock models were performed in BEAST v1.8.2. The assumption of a strict molecular clock could not be rejected in favor of the relaxed clock model as the distribution of the standard deviation of the clock rate strongly abutted zero. The strict molecular clock model resulted in an intraspecific calculated mutation rate of 14.4-17.3 %/myr, a rate substantially higher than the common rates of sequence evolution observed for insect mitochondrial DNA sequences. The rate, however, aligns closely with mutation rates estimated from other taxa with similarly recent lineage divergence times.</p>","PeriodicalId":74464,"journal":{"name":"PLoS currents","volume":"10 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6072552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36404314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Implementation of the World Health Organization Emergency Medical Teams: Minimum Technical Standards and Recommendations for Rehabilitation.","authors":"Jody-Anne Mills,&nbsp;James Gosney,&nbsp;Fiona Stephenson,&nbsp;Peter Skelton,&nbsp;Ian Norton,&nbsp;Valerie Scherrer,&nbsp;Geraldine Jacquemin,&nbsp;Barbara Rau","doi":"10.1371/currents.dis.76fd9ebfd8689469452cc8c0c0d7cdce","DOIUrl":"10.1371/currents.dis.76fd9ebfd8689469452cc8c0c0d7cdce","url":null,"abstract":"<p><p>Emergency medical teams provide urgent medical and surgical care in emergencies characterized by a surge in trauma or disease. Rehabilitation has historically not been included in the acute phase of care, as teams have either not perceived it as their responsibility or have relied on external providers, including local services and international organizations, to provide services. Low- and middle-income countries, which often have limited rehabilitation capacity within their health system,  are particularly vulnerable to disaster and are usually  ill-equipped to address the increased burden of rehabilitation needs that arise. The resulting unmet needs for rehabilitation culminate in unnecessary complications for patients, delayed recovery, reduced functional outcomes, and often impede return to daily activities and life roles. Recognizing the systemic neglect of rehabilitation in global emergency medical response, the World Health Organization, in collaboration with key operational partners and experts, developed technical standards and recommendations for rehabilitation which are integrated into  the WHO verification  process for EMTs. This protocol report presents: 1) the rationale for the development of the standards and accompanying recommendations; 2) the methodology of the development process; 3) the minimum standards and other significant content included in the document; 4) challenges encountered during development and implementation; and 5) current and next steps to continue strengthening the inclusion of rehabilitation in emergency medical response.</p>","PeriodicalId":74464,"journal":{"name":"PLoS currents","volume":"10 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6050053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36348739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Promotion of 'Grab Bags' as a Disaster Risk Reduction Strategy.","authors":"Christina J Pickering,&nbsp;Tracey L O'Sullivan,&nbsp;Alessia Morris,&nbsp;Carman Mark,&nbsp;David McQuirk,&nbsp;Emily Yy Chan,&nbsp;Emily Guy,&nbsp;Gloria Kw Chan,&nbsp;Karen Reddin,&nbsp;Ralph Throp,&nbsp;Shinya Tsuzuki,&nbsp;Tiffany Yeung,&nbsp;Virginia Murray","doi":"10.1371/currents.dis.223ac4322834aa0bb0d6824ee424e7f8","DOIUrl":"10.1371/currents.dis.223ac4322834aa0bb0d6824ee424e7f8","url":null,"abstract":"<p><strong>Introduction: </strong>An all-of-society approach to disaster risk reduction emphasizes inclusion and engagement in preparedness activities. A common recommendation is to promote household preparedness through the preparation of a 'grab bag' or 'disaster kit', that can be used to shelter-in-place or evacuate. However, there are knowledge gaps related to how this strategy is being used around the world as a disaster risk reduction strategy, and what evidence there is to support recommendations.</p><p><strong>Methods: </strong>In this paper, we present an exploratory study undertaken to provide insight into how grab bag guidelines are used to promote preparedness in Canada, China, England, Japan, and Scotland, and supplemented by a literature review to understand existing evidence for this strategy.</p><p><strong>Results: </strong>There are gaps in the literature regarding evidence on grab bag effectiveness. We also found variations in how grab bag guidelines are promoted across the five case studies.</p><p><strong>Discussion: </strong> While there are clearly common items recommended for household grab bags (such as water and first aid kits), there are gaps in the literature regarding: 1) the evidence base to inform guidelines; 2) uptake of guidelines; and 3) to what extent grab bags reduce demands on essential services and improve disaster resilience.</p>","PeriodicalId":74464,"journal":{"name":"PLoS currents","volume":"10 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6050054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36348740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lessons Learnt from Epidemiological Investigation of Lassa Fever Outbreak in a Southwest State of Nigeria December 2015 to April 2016.","authors":"Elvis Efe Isere,&nbsp;Akinola Ayoola Fatiregun,&nbsp;Olayinka Ilesanmi,&nbsp;Ibidolapo Ijarotimi,&nbsp;Beatrice Egube,&nbsp;Adewale Adejugbagbe,&nbsp;Gboyega Adekunle Famokun","doi":"10.1371/currents.outbreaks.bc4396a6650d0ed1985d731583bf5ded","DOIUrl":"https://doi.org/10.1371/currents.outbreaks.bc4396a6650d0ed1985d731583bf5ded","url":null,"abstract":"<p><strong>Introduction: </strong>An outbreak of Lassa Fever (LF) reported and confirmed in Ondo state, Southwest Nigeria in January 2016 was investigated. This paper provides the epidemiology of the LF and lessons learnt from the investigation of the outbreak.</p><p><strong>Methods: </strong>The incidence management system (IMS) model was used for the outbreak coordination. Cases and deaths were identified through the routine surveillance system using standard definitions for suspected and confirmed cases and deaths respectively. Blood specimens collected from suspect cases were sent for confirmation at a WHO accredited laboratory. Active case search was intensified, and identified contacts of confirmed cases were followed up for the maximum incubation period of the disease. Other public health responses included infection prevention and control, communication and advocacy as well as case management. Data collected were analysed using SPSS 20, by time, place and persons and important lessons drawn were discussed.   Results: We identified 90 suspected LF cases of which 19 were confirmed by the laboratory. More than half (52.6%) of the confirmed cases were females with majority (73.7%) in the age group ≥ 15 years. The Case Fatality Rate (CFR) of 63.2% among the laboratory-confirmed positive cases where 9 of 19 cases died, was significantly higher compared to the laboratory confirmed negative cases where 6 of the 65 cases died ( CFR; 8.5%) p ≤ 0.05. Two hundred and eighty-seven contacts of the confirmed cases were identified, out of which 267(93.0%) completed  the follow-up without developing any symptoms and 2 (0.7%) developed symptoms consistent with LF and were confirmed by the laboratory. More than half of the contacts were females (64.5%) with most of them (89.2%) in the age group ≥ 25 years.   Discussion: One key lesson learnt from the investigation was that the confirmed cases were mainly primary cases; hence the needs to focus on measures of breaking the chain of transmission in the animal-man interphase during Lassa fever epidemic preparedness and response. In addition, the high case fatality rate despite early reporting and investigation suggested the need for a review of the case management policy and structure in the State. Key Words: Lassa fever, Outbreak Response, Incident Management System, Nigeria.</p>","PeriodicalId":74464,"journal":{"name":"PLoS currents","volume":"10 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6063375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36383631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Flood-Related Behaviour of River Users in Australia.","authors":"Amy E Peden, Richard C Franklin, Peter Leggat","doi":"10.1371/currents.dis.89e243413a0625941387c8b9637e291b","DOIUrl":"10.1371/currents.dis.89e243413a0625941387c8b9637e291b","url":null,"abstract":"<p><strong>Introduction: </strong>Flooding is a common natural disaster affecting 77.8 million people and claiming the lives of 4,731 people globally in 2016. During times of flood, drowning is a leading cause of death. Flooding is a known risk factor for river drowning in Australia. With little known about river usage in Australia, this study aimed to examine the links between person demographics and self-reported participation in two flood-related behaviours, driving through floodwaters and swimming in a flooded river.</p><p><strong>Methods: </strong>A self-reported questionnaire was administered to adult river users at four high-risk river drowning locations; Alligator Creek, Townsville, Queensland; Murrumbidgee River, Wagga Wagga, New South Wales; Murray River, Albury, New South Wales; and Hawkesbury River, Windsor, New South Wales. Univariate and chi square analysis was undertaken with a 95% confidence interval (p<0.05). All river users surveyed, were also breathalysed to record an estimate of their blood alcohol content (BAC) on their expired breath. Results: 688 river users responded to the questionnaire; 676 (98.3%) answered the driving question and 674 (98.0%) answered the swimming in floodwaters questions. Of the respondents, 35.7% stated they had driven through floodwater and 18.7% had swum in a flooded river. Males were more likely (p<0.001) to report having undertaken both activities. Australian-born respondents were more likely to report having driven through floodwaters (p=0.006). Those aged 18-24 years old and those residing in outer regional areas were more likely (p<0.001) to have swum in a flooded river. Those who self-reported participating in both driving through floodwaters (p=0.001) and swimming in a flooded river (p<0.001) were significantly more likely to record contributory levels of alcohol (i.e. a BAC ≥0.05%) when breathalysed at the river.</p><p><strong>Discussion: </strong>Ensuring the safe movement of people during floods is difficult, particularly for those living in regional Australia, due in part to long distances travelled and reduced investment in infrastructure such as bridges. With males and females equally exposed, more effective prevention strategies must target both sexes and may include improved education on when it is safe to drive through (low depth, still water, stable road base) and when it is not (e.g. deep water, moving water and unstable road base). This study identified one in five respondents had swum in a flooded river, most commonly young people aged 18-24 years, with participants signficantly more likely to have recorded contributory levels of alcohol when breathalysed. Further research should examine the reasons behind participation in this behaviour, including the role of alcohol.</p><p><strong>Conclusion: </strong>Preventing drowning in floodwaters is an international challenge, made more difficult by people driving through or swimming in floodwaters. Strategies for driving through floodwat","PeriodicalId":74464,"journal":{"name":"PLoS currents","volume":"10 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6028280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36324665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Pilot Survey Study of Adherence to Care Considerations for Duchenne Muscular Dystrophy.","authors":"Kristin Conway,&nbsp;Christina Trout,&nbsp;Christina Westfield,&nbsp;Deborah Fox,&nbsp;Shree Pandya","doi":"10.1371/currents.md.5f533e6e60ee172d6bf6b2b8375dfadf","DOIUrl":"https://doi.org/10.1371/currents.md.5f533e6e60ee172d6bf6b2b8375dfadf","url":null,"abstract":"<p><p>Introduction Care Considerations supported by the Centers for Disease Control and Prevention for the management of Duchenne muscular dystrophy were published in 2010, but there has been limited study of implementation in the United States. Methods A questionnaire collecting information about standard care practices and perceived barriers was piloted by 9 clinic directors of facilities within the Muscular Dystrophy Surveillance, Tracking and Research network. Results Six clinic directors completed the questionnaire; 1 adult-only clinic was excluded. Over 80% adherence was found for 30 of 55 recommendations examined. Greatest variability was for initiation of corticosteroids, bone health monitoring, type of pulmonary function testing, and psychosocial management. Barriers included unclear guidelines, inadequate time and funding, family-specific barriers and lack of empirical support for some recommendations. Discussion This pilot study showed implementation of the 2010 Care Considerations, except for recommendations based largely on expert consensus. Complete adherence requires more studies and active promotion.</p>","PeriodicalId":74464,"journal":{"name":"PLoS currents","volume":"10 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6128678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36525028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Zika virus outbreak in Suriname, a report based on laboratory surveillance data.","authors":"John Codrington, Jimmy Roosblad, Amrish Baidjoe, Natanael Holband, Antoine Adde, Mirdad Kazanji, Claude Flamand","doi":"10.1371/currents.outbreaks.ff0f6190d5431c2a2e824255eaeaf339","DOIUrl":"10.1371/currents.outbreaks.ff0f6190d5431c2a2e824255eaeaf339","url":null,"abstract":"<p><strong>Introduction: </strong>Since the identification of ZIKV in Brazil in May 2015, the virus has spread extensively throughout the Americas. Cases of ZIKV infection have been reported in Suriname since October 2, 2015.</p><p><strong>Methods: </strong>A laboratory-based surveillance system was quickly implemented according to previous experience with the emergence of chikungunya. General practitioners and public health centers located in different districts of Suriname were asked to send blood samples from suspicious cases to Academic Hospital for molecular diagnosis of Zika virus infection. We investigated Zika-related laboratory data collected during surveillance and response activities to provide the first outbreak report in Suriname in terms of time, location and person.</p><p><strong>Results: </strong>A total of 791 molecularly confirmed cases were reported during a 48-week interval from October 2015 to August 2016. The majority of ZIKV-positive cases involved women between 20 and 39 years of age, reflecting concern about Zika infection during pregnancy. The outbreak peaked in mid-January and gradually spread from the district of Paramaribo to western coastal areas.</p><p><strong>Discussion: </strong>This report provides a simple and comprehensive description of the outbreak in Suriname and demonstrates the utility of laboratory data to highlight the spatiotemporal dynamics of the outbreak in that country.</p>","PeriodicalId":74464,"journal":{"name":"PLoS currents","volume":"10 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5969994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36216911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Typology of Secondary Stressors Among Refugees of Conflict in the Middle East: The Case of Syrian Refugees in Jordan.","authors":"Khalifah Alfadhli,&nbsp;John Drury","doi":"10.1371/currents.dis.4bd3e6437bff47b33ddb9f73cb72f3d8","DOIUrl":"https://doi.org/10.1371/currents.dis.4bd3e6437bff47b33ddb9f73cb72f3d8","url":null,"abstract":"<p><strong>Introduction: </strong>As the years of displacement accumulate, the burden of secondary stressors (i.e., stressors not directly related to war) increase on the shoulders of millions of refugees, who do not have the option of either returning home due to war or having a sustainable livelihood in the host countries. This paper aims to shed light on the overlooked importance of secondary stressors among refugees of conflict in developing countries; it will do this by highlighting the experience of Syrian refugees in Jordan, and developing a typology of these stressors.</p><p><strong>Methods: </strong>We approached this issue using two levels of exploration. In study 1, we used participant observation and 15 in-depth interviews in Irbid, Jordan. Data were analysed qualitatively using thematic analysis to explore the different types of stressors. In study 2, a questionnaire survey among Syrian refugees in Jordan (n = 305) was used to collect data about a wide range of stressors. Responses were subjected to factor analysis to examine the extent to which the stressors could be organized into different factors.</p><p><strong>Results: </strong>The thematic analysis suggested three different types of secondary stressors: financial (money related), environmental (exile structures and feelings created by it), and social (directly related to social relations). The factor analysis of the survey data produced a similar typology, where secondary stressors were found to be grouped into four main factors (financial, services, safety, and relations with out-groups). The final result is a typology of 33 secondary stressors organised in three main themes.</p><p><strong>Discussion: </strong>Syrian refugees in Jordan suffer the most from financial stressors, due to loss of income and high living expenses. Environmental stressors arise from exile and are either circumstantial (e.g., services and legal requirements) or created by this environment (e.g., instability and lack of familiarity). Social stressors were observed among a considerable section of refugees, varying from stressors due to being targeted as a refugee by the locals (e.g., discrimination) to more traumatic stressors that came from both locals and other refugees (e.g., assault). The typology of secondary stressors suggested by the present analysis needs to be investigated in a larger sample of refugees of conflict in other countries in the Middle East, in order to determine its generality. We suggest that it is a basis for a framework for practitioners and academics working with refugees in the region.</p><p><strong>Key words: </strong>Armed conflict, Syrian, Jordan, refugees, forced displacement, exile, daily stressors, secondary stressors, trauma, typology.</p>","PeriodicalId":74464,"journal":{"name":"PLoS currents","volume":"10 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5959734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36189429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}