Michela Martini | International Organization for Migration (original) (raw)

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Papers by Michela Martini

Journal of Migration and Health, 2020

Background: Little is known about how pregnant refugee women, and the frontline health care worke... more Background: Little is known about how pregnant refugee women, and the frontline health care workers who serve them, are affected by the COVID-19 pandemic in terms of health, and health service access. Women refugees are classified as a vulnerable group with regard to pregnancy outcomes and access to maternal care, and may be disproportionally at risk for COVID-19 infection as they are likely to face unique barriers to information and access to reproductive health services during the pandemic. Few studies identify gaps that could inform potential interventions to improve service uptake for refugee women, particularly in the context of COVID-19. Yet, understanding how pregnant refugees are impacted in the context of the pandemic is critical to developing and implementing strategies and measures that can help in their care and the delivery of health services. Aims: This study aimed to improve understanding of the impact of COVID-19 on women refugees' access to and utilisation of antenatal care, delivery and postnatal care in Eastleigh, Kenya. Methods: The study was conducted in Eastleigh, a semi-urban centre in Nairobi. We conducted 25 in-depth interviews with facility and community health care staff (n = 10) and women attending antenatal (n = 10) and postnatal care services (n = 5) in October 2020. Data was analysed using NVIVO 12 software. Findings: Our findings suggest that within the first eight months of COVID-19, preferences for home deliveries by refugee women increased and health care workers reported having observed reduced utilisation of services and delayed care. Fear, economic challenges and lack of migrant-inclusive health system policies were key factors influencing home deliveries and delayed and low uptake of facility-based care. Conclusions: The findings highlight the need to mitigate and lower barriers that prevent refugee women from seeking care at health facilities. One approach includes the development of refugee-inclusive public health policies, particularly during a pandemic, and the need to tailor health care services for refugees at facilities and in the communities.

Quality of Life Research, 2006

Objective: To design a Health-related Quality of Life (HRQoL) instrument for HIV-infected people ... more Objective: To design a Health-related Quality of Life (HRQoL) instrument for HIV-infected people in the era of highly active antiretroviral therapy (HAART). Methods: The self-administered questionnaire was developed by an Italian network including researchers, physicians, people living with HIV, national institutions and community-based organizations (CBO) through several steps: (1) review of existing HRQoL literature and questionnaires for HIV-infected people; (2) selection of relevant domains measuring HRQoL in HIV-infected people, and identification of new domains related to new aspects of HRQoL concerning HAART-treated individuals; (3) conduction of two pre-test analyses in independent groups of Italian HIV-positive people (n @ 100) distributed throughout the country. The objectives of the first pre-test were to verify the usefulness of the questionnaire, to construct a form easily understandable by everyone, to define the domains and their significance; the second pre-test aimed at evaluating and reshaping the questionnaire based on a statistical analysis of the outcomes of first pre-test; (4) validation analysis. A large cohort of people with HIV infection was recruited for the last step. Results: The internal consistence reliability (Cronbach's a) was ‡0.70 for all domains. Most domains had Cronbach's coefficient >0.80. All domains demonstrated convergent and discriminant validity. The final version of ISSQoL includes two sections: HRQoL Core Evaluation Form (9 domains) and Additional Important Areas for HRQoL (6 domains). The ISSQoL was administered together with two additional forms: a Daily Impact of Symptoms Form and a Demographic Information Form. The Additional Important Areas for HRQoL include social support, interaction with medical staff, treatment impact, body changes, life planning, and motherhood/fatherhood. Conclusion: The data reported in the present paper provide preliminary evidence of the reliability and validity of the ISSQoL questionnaire for the measurement of HRQoL in HIV-infected people. The direct involvement of HIV-positive people in all the phases of the project was a key aspect of our work.

Objective: To design a Health-related Quality of Life (HRQoL) instrument for HIV-infected people ... more Objective: To design a Health-related Quality of Life (HRQoL) instrument for HIV-infected people in the era of highly active antiretroviral therapy (HAART). Methods: The self-administered questionnaire was developed by an Italian network including researchers, physicians, people living with HIV, national institutions and community-based organizations (CBO) through several steps: (1) review of existing HRQoL literature and questionnaires for HIV-infected people; (2) selection of relevant domains measuring HRQoL in HIV-infected people, and identification of new domains related to new aspects of HRQoL concerning HAART-treated individuals; (3) conduction of two pre-test analyses in independent groups of Italian HIV-positive people (n @ 100) distributed throughout the country. The objectives of the first pre-test were to verify the usefulness of the questionnaire, to construct a form easily understandable by everyone, to define the domains and their significance; the second pre-test aimed at evaluating and reshaping the questionnaire based on a statistical analysis of the outcomes of first pre-test; (4) validation analysis. A large cohort of people with HIV infection was recruited for the last step. Results: The internal consistence reliability (Cronbach's a) was ‡0.70 for all domains. Most domains had Cronbach's coefficient >0.80. All domains demonstrated convergent and discriminant validity. The final version of ISSQoL includes two sections: HRQoL Core Evaluation Form (9 domains) and Additional Important Areas for HRQoL (6 domains). The ISSQoL was administered together with two additional forms: a Daily Impact of Symptoms Form and a Demographic Information Form. The Additional Important Areas for HRQoL include social support, interaction with medical staff, treatment impact, body changes, life planning, and motherhood/fatherhood. Conclusion: The data reported in the present paper provide preliminary evidence of the reliability and validity of the ISSQoL questionnaire for the measurement of HRQoL in HIV-infected people. The direct involvement of HIV-positive people in all the phases of the project was a key aspect of our work.

Retrospective study of male lichen sclerosus and outcome in Leicester: 1995-9 inclusive: experien... more Retrospective study of male lichen sclerosus and outcome in Leicester: 1995-9 inclusive: experience of a genitourinary medicine clinic EDITOR,-We have studied retrospectively 76 male cases of lichen sclerosus (LS) (formerly called balanitis xerotica obliterans), that presented over the period 1995-9 inclusive, in Leicester.

Chemical Research in Toxicology, 1997

The peroxy radical (ROO) is unique among reactive oxygen species implicated in the production of ... more The peroxy radical (ROO) is unique among reactive oxygen species implicated in the production of DNA damage in that it possesses an extremely long half-life (order of seconds) and is predicted to have a relatively greater chemical selectivity in its reactions relative to other radical intermediates. Yet no product studies of the reactions of ROO with bases, nucleosides, or DNA have appeared, and thus no meaningful predictions can be made regarding its potential involvement in the production of DNA base damage and the mutagenic process. We report here on the reaction products formed by peroxy radical with thymidine, major target of oxidative base damage. ROO reacts with thymine to yield predominantly 5-Me oxidation products. The highly mutagenic 5-(hydroperoxymethyl)-2'-deoxyuridine, 5-formyl-2'-deoxyuridine, and 5-(hydroxymethyl)-2'-deoxyuridine are produced by peroxy radical oxidation. In contrast, 5Me oxidation products are minor products of thymidine oxidation by OH, which yields predominantly saturated derivatives via addition to the 5,6 double bound. A plausible mechanistic scheme for the formation of the base oxidation products of thymidine by peroxy radicals is presented. Attach at the deoxyribose moiety resulting in oxidative depyrimidination is also found to occur, as indicated by free base release. Phosphodiester backbone cleavage resulting in single and double strand breaks is also catalyzed by peroxy radical, as demonstrated using a plasmid nicking assay.

European Journal of Epidemiology, 2004

This study analysed the level of adherence to anti-HIV therapies in illegal drug users compared t... more This study analysed the level of adherence to anti-HIV therapies in illegal drug users compared to non-users. Out of 214 patients interviewed, 60 (28%) reported current use of one or more illegal drugs (heroin, cocaine), alcohol (>6 U/day), psychoactive drugs and others. Within the two groups reporting use of heroin and cocaine, the percentage of patients achieving good levels of compliance was higher than among patients who reported not using any substance (50 and 46% vs. 42.3%), among the users of psychoactive pharmaceuticals and alcohol the percentage of high-compliant patients tended to be lower (respectively 26.6 and 30%), but the difference was not significant.

Journal of Migration and Health, 2020

Background: Little is known about how pregnant refugee women, and the frontline health care worke... more Background: Little is known about how pregnant refugee women, and the frontline health care workers who serve them, are affected by the COVID-19 pandemic in terms of health, and health service access. Women refugees are classified as a vulnerable group with regard to pregnancy outcomes and access to maternal care, and may be disproportionally at risk for COVID-19 infection as they are likely to face unique barriers to information and access to reproductive health services during the pandemic. Few studies identify gaps that could inform potential interventions to improve service uptake for refugee women, particularly in the context of COVID-19. Yet, understanding how pregnant refugees are impacted in the context of the pandemic is critical to developing and implementing strategies and measures that can help in their care and the delivery of health services. Aims: This study aimed to improve understanding of the impact of COVID-19 on women refugees' access to and utilisation of antenatal care, delivery and postnatal care in Eastleigh, Kenya. Methods: The study was conducted in Eastleigh, a semi-urban centre in Nairobi. We conducted 25 in-depth interviews with facility and community health care staff (n = 10) and women attending antenatal (n = 10) and postnatal care services (n = 5) in October 2020. Data was analysed using NVIVO 12 software. Findings: Our findings suggest that within the first eight months of COVID-19, preferences for home deliveries by refugee women increased and health care workers reported having observed reduced utilisation of services and delayed care. Fear, economic challenges and lack of migrant-inclusive health system policies were key factors influencing home deliveries and delayed and low uptake of facility-based care. Conclusions: The findings highlight the need to mitigate and lower barriers that prevent refugee women from seeking care at health facilities. One approach includes the development of refugee-inclusive public health policies, particularly during a pandemic, and the need to tailor health care services for refugees at facilities and in the communities.

Quality of Life Research, 2006

Objective: To design a Health-related Quality of Life (HRQoL) instrument for HIV-infected people ... more Objective: To design a Health-related Quality of Life (HRQoL) instrument for HIV-infected people in the era of highly active antiretroviral therapy (HAART). Methods: The self-administered questionnaire was developed by an Italian network including researchers, physicians, people living with HIV, national institutions and community-based organizations (CBO) through several steps: (1) review of existing HRQoL literature and questionnaires for HIV-infected people; (2) selection of relevant domains measuring HRQoL in HIV-infected people, and identification of new domains related to new aspects of HRQoL concerning HAART-treated individuals; (3) conduction of two pre-test analyses in independent groups of Italian HIV-positive people (n @ 100) distributed throughout the country. The objectives of the first pre-test were to verify the usefulness of the questionnaire, to construct a form easily understandable by everyone, to define the domains and their significance; the second pre-test aimed at evaluating and reshaping the questionnaire based on a statistical analysis of the outcomes of first pre-test; (4) validation analysis. A large cohort of people with HIV infection was recruited for the last step. Results: The internal consistence reliability (Cronbach's a) was ‡0.70 for all domains. Most domains had Cronbach's coefficient >0.80. All domains demonstrated convergent and discriminant validity. The final version of ISSQoL includes two sections: HRQoL Core Evaluation Form (9 domains) and Additional Important Areas for HRQoL (6 domains). The ISSQoL was administered together with two additional forms: a Daily Impact of Symptoms Form and a Demographic Information Form. The Additional Important Areas for HRQoL include social support, interaction with medical staff, treatment impact, body changes, life planning, and motherhood/fatherhood. Conclusion: The data reported in the present paper provide preliminary evidence of the reliability and validity of the ISSQoL questionnaire for the measurement of HRQoL in HIV-infected people. The direct involvement of HIV-positive people in all the phases of the project was a key aspect of our work.

Objective: To design a Health-related Quality of Life (HRQoL) instrument for HIV-infected people ... more Objective: To design a Health-related Quality of Life (HRQoL) instrument for HIV-infected people in the era of highly active antiretroviral therapy (HAART). Methods: The self-administered questionnaire was developed by an Italian network including researchers, physicians, people living with HIV, national institutions and community-based organizations (CBO) through several steps: (1) review of existing HRQoL literature and questionnaires for HIV-infected people; (2) selection of relevant domains measuring HRQoL in HIV-infected people, and identification of new domains related to new aspects of HRQoL concerning HAART-treated individuals; (3) conduction of two pre-test analyses in independent groups of Italian HIV-positive people (n @ 100) distributed throughout the country. The objectives of the first pre-test were to verify the usefulness of the questionnaire, to construct a form easily understandable by everyone, to define the domains and their significance; the second pre-test aimed at evaluating and reshaping the questionnaire based on a statistical analysis of the outcomes of first pre-test; (4) validation analysis. A large cohort of people with HIV infection was recruited for the last step. Results: The internal consistence reliability (Cronbach's a) was ‡0.70 for all domains. Most domains had Cronbach's coefficient >0.80. All domains demonstrated convergent and discriminant validity. The final version of ISSQoL includes two sections: HRQoL Core Evaluation Form (9 domains) and Additional Important Areas for HRQoL (6 domains). The ISSQoL was administered together with two additional forms: a Daily Impact of Symptoms Form and a Demographic Information Form. The Additional Important Areas for HRQoL include social support, interaction with medical staff, treatment impact, body changes, life planning, and motherhood/fatherhood. Conclusion: The data reported in the present paper provide preliminary evidence of the reliability and validity of the ISSQoL questionnaire for the measurement of HRQoL in HIV-infected people. The direct involvement of HIV-positive people in all the phases of the project was a key aspect of our work.

Retrospective study of male lichen sclerosus and outcome in Leicester: 1995-9 inclusive: experien... more Retrospective study of male lichen sclerosus and outcome in Leicester: 1995-9 inclusive: experience of a genitourinary medicine clinic EDITOR,-We have studied retrospectively 76 male cases of lichen sclerosus (LS) (formerly called balanitis xerotica obliterans), that presented over the period 1995-9 inclusive, in Leicester.

Chemical Research in Toxicology, 1997

The peroxy radical (ROO) is unique among reactive oxygen species implicated in the production of ... more The peroxy radical (ROO) is unique among reactive oxygen species implicated in the production of DNA damage in that it possesses an extremely long half-life (order of seconds) and is predicted to have a relatively greater chemical selectivity in its reactions relative to other radical intermediates. Yet no product studies of the reactions of ROO with bases, nucleosides, or DNA have appeared, and thus no meaningful predictions can be made regarding its potential involvement in the production of DNA base damage and the mutagenic process. We report here on the reaction products formed by peroxy radical with thymidine, major target of oxidative base damage. ROO reacts with thymine to yield predominantly 5-Me oxidation products. The highly mutagenic 5-(hydroperoxymethyl)-2'-deoxyuridine, 5-formyl-2'-deoxyuridine, and 5-(hydroxymethyl)-2'-deoxyuridine are produced by peroxy radical oxidation. In contrast, 5Me oxidation products are minor products of thymidine oxidation by OH, which yields predominantly saturated derivatives via addition to the 5,6 double bound. A plausible mechanistic scheme for the formation of the base oxidation products of thymidine by peroxy radicals is presented. Attach at the deoxyribose moiety resulting in oxidative depyrimidination is also found to occur, as indicated by free base release. Phosphodiester backbone cleavage resulting in single and double strand breaks is also catalyzed by peroxy radical, as demonstrated using a plasmid nicking assay.

European Journal of Epidemiology, 2004

This study analysed the level of adherence to anti-HIV therapies in illegal drug users compared t... more This study analysed the level of adherence to anti-HIV therapies in illegal drug users compared to non-users. Out of 214 patients interviewed, 60 (28%) reported current use of one or more illegal drugs (heroin, cocaine), alcohol (>6 U/day), psychoactive drugs and others. Within the two groups reporting use of heroin and cocaine, the percentage of patients achieving good levels of compliance was higher than among patients who reported not using any substance (50 and 46% vs. 42.3%), among the users of psychoactive pharmaceuticals and alcohol the percentage of high-compliant patients tended to be lower (respectively 26.6 and 30%), but the difference was not significant.