Health care provided to recent asylum-seeking and non-asylum-seeking pediatric patients in 2016 and 2017 at a Swiss tertiary hospital - a retrospective study

Health care provided to recent asylum-seeking and non-asylum-seeking pediatric patients in 2016 and 2017 at a Swiss tertiary hospital - a retrospective study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research article Health care provided to recent asylum-seeking and non-asylum-seeking pediatric patients in 2016 and 2017 at a Swiss tertiary hospital - a retrospective study Julia Brandenberger, Christian Pohl, Florian Vogt, Thorkild Tylleskär, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-22231/v4 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 07 Jan, 2021 Read the published version in BMC Public Health → Version 4 posted 2 You are reading this latest preprint version Show more versions Abstract Background Asylum-seeking children represent an increasing and vulnerable group of patients whose health needs are largely unmet. Data on the health care provision to asylum-seeking children in European contexts is scarce. In this study we compare the health care provided to recent asylum-seeking and non-asylum-seeking children at a Swiss tertiary hospital. Methods We performed a cross-sectional retrospective study in a pediatric tertiary care hospital in Basel, Switzerland. All patients and visits from January 2016 to December 2017 were identified, using administrative and medical electronic health records. The asylum-seeking status was systematically assessed and the patients were allocated accordingly in the two study groups. Results A total of 202,316 visits by 55,789 patients were included, of which asylum-seeking patients accounted for 1674 (1%) visits by 439 (1%) individuals. The emergency department recorded the highest number of visits in both groups with a lower proportion in asylum-seeking compared to non-asylum-seeking children: 19% (317/1674) and 32% (64,315/200,642) respectively. The median number of visits per patient was 1 (IQR 1-2) in the asylum-seeking and 2 (IQR 1-4) in the non-asylum-seeking children. Hospital admissions were more common in asylum-seeking compared to non-asylum-seeking patients with 11% (184/1674) and 7% (14,692/200,642). Frequent visits (>15 visits per patient) accounted for 48% (807/1674) of total visits in asylum-seeking and 25% (49,886/200,642) of total visits in non-asylum-seeking patients. Conclusions Hospital visits by asylum-seeking children represented a small proportion of all visits. The emergency department had the highest number of visits in all patients but was less frequently used by asylum-seeking children. Frequent care suggests that asylum-seeking patients also present with more complex diseases. Further studies are needed, focusing on asylum-seeking children with medical complexity. Health Policy Infectious Diseases Health Economics & Outcomes Research migrant and refugee health children use of health care migration patterns Europe health care delivery Figures Figure 1 Figure 2 Figure 3 Figure 4 Background Globally, an estimated 68.5 million individuals and 35.5 million children were forcibly displaced in 2017 [ 1 ]. This number has reached a historical record high, with child refugees having increased by 21% in the past decade [ 2 ]. In Europe, 209 756 children have claimed asylum in 2017, of which 6595 lodged their application in Switzerland [ 3 ]. In the same year, a further 16,350 children were registered as temporarily accepted refugees in Switzerland [ 4 ]. The remarkable increase of asylum-seeking children and adults arriving in Europe may challenge the health care systems. Thus, concerns about the quality of medical care provided to asylum-seekers have led to several international reports and action plans [ 5 , 6 ]. These highlight that asylum-seeking children are a particularly vulnerable group whose health needs are largely unmet [ 6 , 7 ]. The majority of available data on health care provision and needs in asylum-seekers focuses on adults or originates from the late 1990s. Current asylum-seeking populations in Europe are, however, distinctly different compared to 1990s when the majority of asylum-seekers originated from the Balkan states and the proportion of children was reaching only 10% [ 8-12 ]. In recent years, however, the majority of asylum-seekers originate from the horn of Africa and middle Eastern countries and on average 30% are children and adolescents [ 13 ]. A systematic literature review on the health of migrant children in Switzerland including evidence until 2011 concluded that migrant children had important differences in health needs compared to their local peers reflected in higher hospital admission rates, intensive care admissions, dental care and mental health consultations [ 14 ]. In contrast to this, a recent study of asylum-seeking hospitalized children showed that a large proportion was admitted with infections similar to those prevalent in the local population. However, a direct comparison between the groups was not done [ 15 ]. Only one recent study from Germany included health care delivery data from both asylum-seeking and non-asylum seeking children [ 16 ]. The study showed that asylum-seeking children were more frequently admitted for diseases with the potential for outpatient care, when detected early. In summary, there is a knowledge gap on recent health data of asylum-seeking children in comparison with non-asylum-seeking children. This absence of information has been highlighted as a research priority by several international organizations including the World Health Organization (WHO) and the International Society for Social Pediatrics and Child Health (ISSOP) [ 5 , 17 , 18 ]. The aim of this study was therefore to fill an important knowledge gap by comparing health visits from asylum-seeking and non-asylum-seeking children to analyze and understand differences in their health needs. Methods Study area The study was done at the University Children’s Hospital Basel (UKBB). Located in Switzerland on the border to France and Germany, the University Children’s Hospital Basel delivers health care to a multicultural population, aged between 0 and 16 years ans exceptionally to older patients. The hospital is part of the Swiss hospitals for equity program [ 19 ] and the only tertiary pediatric health care provider for two regions in North-West Switzerland with on average 200,000 consultations per year. Since March 2019, Switzerland is divided into six asylum regions. Basel has the only federal asylum center (FAC) with processing facilities within the asylum region. It is run by the Swiss state secretary of migration. All children lodging at the federal asylum center in need of urgent medical care are referred to the university children’s hospital. In addition, asylum-seeking families relocated to apartments within the region can spontaneously present themselves at the hospital. Study population In this cross-sectional study data of all visits at the University Children’s Hospital Basel occurring between the two previous years, namely from 1 st Jan 2016 and 31 st Dec 2017 were extracted from the administrative electronic health records. The asylum-seeking status was systematically assessed and recorded at our institution for all patients. Patients were registered as asylum-seeking if any of the following conditions were met: (i) referred from one of the reception and processing centers run by the State Secretary for Migration; (ii) referral sheet stating that the patient is asylum-seeking; (iii) asylum-seeking identity card, which is routinely issued to all individuals lodging an asylum request in Switzerland. As the health profile of asylum-seeking persons is assimilating to the local population in many health related aspects like infectious diseases or risk behavior [ 20 ]. To prevent the dilution of important differences, only recently arrived asylum-seeking patients were included. Children that had visits recorded one year or longer before the study period (i.e. before 1 st January 2015) were excluded from the current analysis. Data collection and analysis Data extraction for all identified patients was done in 2018 and 2019 using administrative and medical electronic health records for the following variables: number of visits per group as primary outcome and asylum status, nationality, age, gender, date of visit, department visited, time of visit (office hour visit defined as 7:00 - 5:59 pm), hospital admission or outpatient treatment. Extracted data was transferred to a Redcap-database (Vanderbilt University/IC 6.9.4). Data cleaning and quality control tests were performed. STATA (Stata/IC 13.1 2013) was used for the statistical analysis as for the generation of graphs. The statistical analysis was mainly descriptive. Inferential statistics were used to analyze key differences between the two groups, using the two sample Chi-square test. Confidence intervals were provided to describe the precision around the summary statistic using a confidence level of 95%. To provide information about the completeness of the dataset, records with missing data were not excluded from analysis but reported as such. Ethics The study was approved by the Ethics committee of North-West Switzerland (EKNZ 2017-01585). Informed consent was not required as per EKNZ as not deemed feasible for the analysis of the large dataset. No further administrative permissions were required to access the raw data for the study. Results Primary outcome The final study population included 202,316 visits by 55,789 patients of which 1674 (1%) visits by 439 (1%) patients were in asylum-seeking and 200,642 (99%) visits by 55,350 (99%) patients were in non-asylum-seeking children (Figure 1). A total of 294 visits by 33 asylum-seeking patients were excluded as these had records of visits prior to 1 st Jan 2015 (Table 1). Nationality Asylum-seeking patients originated from 38 countries and the most frequent nationalities were Eritrea (14%), Afghanistan (13%), and Syria (9%). In the non-asylum-seeking patients 141 countries were noted with the majority from Switzerland (64%), followed by Germany (7%), Turkey and Italy (4% each). (Table 1; Figure 3). Age and sex The median age was higher in the asylum-seeking compared to the non-asylum seeking patients: 13 (IQR 3-16) years and 7 years (IQR 2-12), respectively. In both groups, visits from children < 3 years of age were most frequent with 39% (646/1674) and 23% (45,478/200,642) in the asylum-seeking and non-asylum-seeking patients; with the proportion being significantly higher in asylum-seeking patients (p-value < 0.001, 95% CI difference in proportion: 0.14-0.18) ( Figure 2 ). A bimodal age-distribution was seen in the asylum-seeking patients with a second peak in adolescent aged 15 to 17 years. Visits from adolescents represented 25% (421/1674) in the asylum-seeking and 13% (25,736 / 200,642) in the non-asylum-seeking group (p < 0.001, 95% CI difference in proportion: 0.1-0.14). There was a predominance of male patients among the asylum-seeking compared to the non-asylum-seeking patients, 70% versus 55% of visits (p < 0.001, 95% CI difference in proportion: 0.13-0.17). This difference was highest in the adolescent group with 87% (366/421) of visits by males in the asylum-seeking and 50% (12,922/25,736) in the non-asylum-seeking group, respectively. The sex distribution in children < 3 years was similar in both groups; 54% males (352/646) in asylum-seeking and 56% (25,347/45,478) in non-asylum-seeking patients, respectively. Visits stratified by departments Outpatient visits were most frequent in both groups with 89% (1490/1674) in the asylum-seeking and 93% (185,950/200,642) in the non-asylum-seeking patients, respectively. The emergency department was most frequently visited in both groups with a significantly lower proportion in the asylum-seeking patients with 19% (317/1674, CI: 0.15-0.23) compared 32% (64,315/200,642; CI: 0.32-0.32) in the non-asylum-seeking patients (p <0.001, 95% CI of difference in proportion: -0.17- -0.09). The proportion of hospital admissions was higher in asylum-seeking patients with 11% (184/1674) compared to 7% (14,692/200,642) in the non-asylum-seeking children (p <0.00, 95% CI difference in proportion: 0.02-0.06). Asylum-seeking patients were most frequently admitted to the pediatric department (36% (67/184)) and non-asylum-seeking patients to the surgical/orthopedic department (40% (5857/ 14,692)). Hospital admissions to psychiatry were infrequent in both groups with 4% (7/184) in asylum-seeking and 2% (282/14,692) in non-asylum-seeking patients. Frequency of health care visits The median number of visits per patient was 1 (IQR 1-2; range 1-179) in the asylum-seeking and 2 (IQR 1-4; range 1-221) in the non-asylum-seeking children. The frequency of visits per patient was 15 visits per patient), these occurred in 4% (16/439) of the asylum-seeking and in 3% (1482/55 350) of the non-asylum-seeking patients. Frequent visits accounted for 48% (807/1674) and 25% (49,886/200,642) of the total visits in the asylum-seeking and non-asylum-seeking patients, respectively ( Figure 4 ). Discussion This is the first comprehensive analysis of hospital visits comparing pediatric asylum-seeking with non-asylum-seeking patients in Europe. Overall, the number of visits by asylum-seeking patients was small but the comparison to visits of non-asylum-seeking patients showed important differences. Asylum-seeking patients originated from a considerable number of countries with Afghanistan, Eritrea and Syria being the most frequent countries of origin in the period studied. Compared to our previous analysis of asylum-seeking patients in 2015 the main difference is that Syrian patients have become more frequent. This shift is a result of current migration patterns in which Syrians represented 54% of the total number of recorded arrivals in Europe in 2015 and 2016. In 2018, 2.7 million Syrian refugee children were living outside of Syria [ 21 ]. Due to the severity and complexity of the armed conflict, Syria has shifted from a temporary to a permanent country of origin of refugees. This results in a continuously decreasing health status of Syrian citizens as also demonstrated that by a recent study in which only 64% had access to general pediatric care, 28% had up-to-date vaccination status and 16% access to healthy nutrition [ 22 ]. The Syrian context is contrasted by Afghanistan, which has been one of the top 20 countries of origin of refugees since the 1980s [ 1 ]. These changing trends in nationalities, contexts and demographics of the asylum-seeking population influence the health needs of asylum-seekers and highlight the need for host countries to continuously monitor their practice of health provision. A substantial number of visits by asylum-seeking patients were by male adolescents. This is an important patient group reflecting the current age and sex distribution among refugees in Europe. In 2017, 82% of the first-time asylum seekers were less than 35 years old and 75% of the 14 to17 years old asylum-seekers were male, many being unaccompanied minor refugees [ 23 ]. The frequency of this age group in hospital visits may be a surrogate for poor health or limited access to health care in this group of refugees. The Unaccompanied Refugee Minors Program of the United States showed that and that long-term health care remained challenging in this group [ 24 ]. The results of our study show that most visits in this age group were in somatic departments and relatively few admissions to the psychiatric department were noted. This is somewhat surprising in the light of literature describing the importance of mental health problems in asylum-seeking adolescents [ 24-29 ]. One explanation may be cultural differences in expressing mental health needs. Symptoms may appear somatic to health care providers in high-resource countries and underlying mental health problems may have passed undetected [ 24 ]. A further important age group in the asylum-seeking patients was children below three years of age; however, this was also the case in the non-asylum-seeking patients. In both groups a considerable number of emergency department visits were noted. A similar age distribution in pediatric emergency department visits was seen in other parts of the world. A Californian and a Korean study both showed frequent visits to emergency departments were more common in children aged 1 to 4 years [ 30 , 31 ]. However, these studies did not detail if asylum-seeking children were included. Interestingly, in our study the asylum-seeking children had a lower proportion of emergency department visits compared to non-asylum-seeking children. This finding contrasts to a recently published study, showing that asylum-seeking children were 5 times more likely to use emergency services [ 16 ]. One explanation for the lower proportion in our setting may be that the nurse-led health care system present at Swiss asylum-seeking reception centers which may help to prevent visits to the emergency department, as diseases are detected early. Alternatively, it is possible that asylum-seeking children did not have sufficient access to the emergency department, as health care delivery to migrants includes particular challenges in health care delivery[ 32 ]. The generally low proportion of 1% of visits by asylum-seeking patients and the lower proportion of emergency department visits are in line with results from a recent report by the University College London Lancet Commission on Migration [ 33 ]. The results underline that public statements in current debates about asylum-seekers disproportionately burdening the health care system are not true for all settings [ 33 ]. A study done at an emergency department at the inner city of London also echoed these results, showing that asylum-seekers were only a minority group [ 34 ]. Improved access to community-based physicians was described as an option to improve health care and lower the impact of migrants on emergency departments in general [ 34 ]. Current health care delivery models to asylum-seekers vary substantially between regions and countries. In our research context, asylum-seeking children are fully covered for all health care visits by the national health insurance. As mentioned in a German study, presentations with ambulatory care sensitive conditions at tertiary health care facilities could be used as an indicator to compare primary care delivery models for asylum-seekers in different regions [ 16 ]. One further important finding of our study is that a small proportion of asylum-seeking patients had an outsized number of visits accounting for almost half of the visits. An emerging area of pediatric research focuses on “children with medical complexity”, which typically need frequent health care visits and high financial resources [ 35 ]. One likely explication is that asylum-seeking patients presented with serious and inadequately treated medical problems, as their health needs had not sufficiently been addressed in their country of origin and while being on the escape. Once arrived in the host country, they required more intense and prolonged treatment compared to their local peers with the same conditions. Alternatively, the spectrum of disease in asylum-seeking and non-asylum-seeking patients with frequent visits may be different and asylum-seeking patients may suffer from particularly complex or rare diseases [ 36 ]. A study analyzing adults with multiple chronic diseases showed that their average annual health care expenditures were three times higher compared to patients without chronic diseases [ 37 ]. Despite costs, investment in pediatric patients is generally considered to be cost effective, as it is preventing expensive chronic conditions in adulthood [ 38 ]. A third explication for more frequent visits could be that they the asylum-seeking patients had less access to primary care pediatricians, resulting in more frequent presentations at the tertiary health care facility. This study has several limitations. First, it is a single-center study. The generalizability of the results is therefore limited. The systematic registration of patients as “asylum-seeking” allowed identifying the health information of this study population. This is considered as strength of the study and described as urgently needed in more settings [ 39 ]. However, some asylum-seeking patients might have been missed by administration staff and the number of asylum-seeking patients was potentially underestimated. This study focused on recent asylum-seekers and therefore excluded visits by asylum-seeking children who visited the hospital before 2015. This helped to prevent the dilution of differences between recent asylum-seekers and non-asylum-seekers. The exclusion of these visits might however limit the results and excludes data from long-term asylum-seeking children. Of note, the proportion of children with non-Swiss nationality in the comparison group with 36% is considerable. Potential differences between Swiss nationals and non-asylum-seekers without Swiss nationality were missed. In addition, migrant children without official documents are not represented in this study. Another limitation was that the retrospective nature of the study resulted in missing data. Important questions, such as transition countries of asylum-seeking patients before they reached Switzerland could not be included in the analysis as the percentage of missing data was too high. Contacting patients to gather additional information was not deemed feasible due to the size of the dataset. This limited an in-depth analysis of many aspects like analyzing the main diagnosis leading to the visits, the family structure or describing the socio-economic background of the study population, but allowed to include all visits, providing a comprehensive overview of health visits by asylum-seeking patients. To address some of the research questions mentioned in the limitations, further studies are analyzing smaller subgroups of the study population. This allows the comparison of main diagnosis in asylum-seeking and non-asylum-seeking inpatients [ 40 ], an in-depth analysis of the subgroup of frequently visiting patients [ 41 ] as the investigation of potentially preventable hospital admissions and emergency department visits [ 42 ]. Further to this an earlier qualitative study from our institution was done to understand the perspective of the asylum-seeking families on including on aspects for the escape and the quality of care provided at the hospital. [ 43 ]. Finally, patients which required a change of wards were counted as separate hospital admission. This allowed us to correctly identify all wards where patients were admitted, however, this may have resulted in overestimation of hospital admissions in both groups. Conclusions In summary, hospital visits by asylum-seeking children represented a small proportion of all visits. The emergency department had the highest number of visits in all patients but was less frequently used by asylum-seeking children. Nationalities, age and sex distributions of asylum-seeking patients vary over time and should be considered to identify important specific health needs in asylum-seeking patients. Higher admission rates and a larger proportion of visits from frequently visiting patients suggest that some asylum-seeking children present with more complex diseases. Further studies are needed, focusing on asylum-seeking children with medical complexity Abbreviations CI Confidence interval ED Emergency department EKNZ ethics committee of North-West Switzerland FAC federal asylum centre ICD 10 International Classification of Diseases 10 IOM International Organization for Migration IQR Interquartile Range ISSOP International Society for Social Pediatrics and Child Health REDCap Datamanagement software SDG Sustainable Development Goal STATA statistical analysis software UCL University College London UKBB Universitäts- Kinderspital beider Basel ( University Children’s Hospital Basel) UN United Nations UNHCR United Nations High Commissioner for Refugees WHO World Health Organization Declarations Ethics approval and consent to participate The study was approved by the Ethics committee of North-West Switzerland (EKNZ 2017-01585). Consent for publication Not applicable Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no conflict of interest. Funding JB received a personal one year research grant from the “Botnar foundation” to conduct the study. Authors’ contributions JB: Conceived the study, performed data analysis, drafted the initial manuscript and approved the final manuscript as submitted. CP, FV and TT: Contributed to the interpretation of data, reviewed the manuscript and approved the final manuscript as submitted. NR: Conceived the study, supervised analysis, reviewed and revised the manuscript and approved the final manuscript as submitted. Acknowledgements We want to kindly thank Matthias Tschudin (Application and Services), Robert Kopf (Controlling) and Angelika Fix (Accounting) for their support during the study. 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Brandenberger J, Bozorgmehr K, Vogt F, Tylleskär T, Ritz N: Preventable admissions and emergency-department-visits in pediatric asylum-seeking and non-asylum-seeking patients . Int J Equity Health 2020, 19 (1):58. Brandenberger J: Perspective of asylum-seeking caregivers on the quality of care provided by a Swiss paediatric hospital: a qualitative study . BMJ Open 2019, 9 (9):e029385. Table Table 1: baseline characteristics, nationality and most visited departments by asylum-seeking and non-asylum-seeking patients 2016-2017 at University Children’s Hospital Basel Asylum-seeking Non-asylum-seeking Characteristics Visits n = 1674 Patients n = 439 Visits n = 200,642 Patients n = 55,350 N % N % N % N % Age groups: 0-2 3-14 15-17 > 17 646 575 421 32 39 34 25 2 96 152 171 20 22 34 39 5 45,478 117,546 25,736 11,882 23 58 13 6 13,297 32,819 5938 3296 24 59 11 6 Total 2016 812 49 243 55 100,842 50 36,560 66 Total 2017 862 51 243 55 99,800 50 36,767 66 Male gender 1172 70 307 70 110,567 55 29,520 53 Most frequent nationalities: Syria Eritrea Afghanistan Algeria Armenia Other Missing Data* 442 210 192 182 157 371 120 26 13 11 11 9 22 7 41 60 58 4 4 154 118 9 14 13 1 1 35 27 Switzerland Germany Turkey Italy Kosovo Other Missing Data 124,714 12,961 9310 7292 5368 40,973 24 62 6 5 4 3 20 0 35,381 3853 2080 1984 1325 10,714 13 64 7 4 4 2 19 0 Outpatient visits 1490 89 ns ns 185,950 93 ns ns Office hour visits (7.00 am – 5.59 pm) 1505 90 ns ns 167,901 84 ns ns Most visited outpatient departments: Emergency Exercise therapy Radiology Occupational therapy Haemato-oncology 317 200 173 144 141 19 12 10 9 8 ns ns ns ns ns ns ns ns ns ns Emergency Surgery Orthopedics Ear, nose, throat Neurology 64,315 18,507 16,225 15,775 10,338 32 9 8 8 5 ns ns ns ns ns ns ns ns ns ns ns = not specified * Missing data nationality asylum-seeking: in 95% of cases patients only seen for radiological examination as part of a State Secretary of Migration age estimation-programme. Supplementary Files STROBEchecklistoverview.doc Cite Share Download PDF Status: Published Journal Publication published 07 Jan, 2021 Read the published version in BMC Public Health → Version 4 posted Submission checks completed at journal 16 Dec, 2020 Editorial decision: Accept 15 Dec, 2020 You are reading this latest preprint version Show more versions Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-22231","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research article","associatedPublications":[],"authors":[{"id":6594222,"identity":"3f142e9f-94b2-4051-bc00-656f6a7dc0ee","order_by":0,"name":"Julia Brandenberger","email":"data:image/png;base64,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","orcid":"https://orcid.org/0000-0001-7169-8184","institution":"University Children's Hospital Basel","correspondingAuthor":true,"prefix":"","firstName":"Julia","middleName":"","lastName":"Brandenberger","suffix":""},{"id":6594223,"identity":"05e22881-1e5a-46d8-9b64-7b3e3b41e2b0","order_by":1,"name":"Christian Pohl","email":"","orcid":"","institution":"Perth Children's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Christian","middleName":"","lastName":"Pohl","suffix":""},{"id":6594224,"identity":"e1ca11f5-877d-42ed-a541-2d149e27ce70","order_by":2,"name":"Florian Vogt","email":"","orcid":"","institution":"Instituut voor Tropische Geneeskunde","correspondingAuthor":false,"prefix":"","firstName":"Florian","middleName":"","lastName":"Vogt","suffix":""},{"id":6594225,"identity":"2878e20c-be67-4fa0-8b04-801a243fc146","order_by":3,"name":"Thorkild Tylleskär","email":"","orcid":"","institution":"Universitetet i Bergen","correspondingAuthor":false,"prefix":"","firstName":"Thorkild","middleName":"","lastName":"Tylleskär","suffix":""},{"id":6594226,"identity":"03b983d5-ba45-46f0-90f0-4d9c92be7475","order_by":4,"name":"Nicole Ritz","email":"","orcid":"","institution":"UKBB Universitats-Kinderspital","correspondingAuthor":false,"prefix":"","firstName":"Nicole","middleName":"","lastName":"Ritz","suffix":""}],"badges":[],"createdAt":"2020-04-09 11:46:25","currentVersionCode":4,"declarations":"","doi":"10.21203/rs.3.rs-22231/v4","doiUrl":"https://doi.org/10.21203/rs.3.rs-22231/v4","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12889-020-10082-z","type":"published","date":"2021-01-07T15:01:16+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":4625188,"identity":"7fbd8aee-ed79-41c7-9439-c1bf41b3637b","added_by":"auto","created_at":"2020-12-31 11:38:04","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":10234,"visible":true,"origin":"","legend":"Flow-diagram showing the process of inclusion of the study population. The flow-diagram was created by the first author of this study.","description":"","filename":"Fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-22231/v4/283801888f30e947aa9e5fd5.png"},{"id":4625216,"identity":"449ae0cf-a519-4442-b702-2625fa3bd4bc","added_by":"auto","created_at":"2020-12-31 11:41:04","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":287493,"visible":true,"origin":"","legend":"Age distribution of visits of asylum-seeking children (n = 1674; panel A) and non-asylum-seeking children (n = 200,642; panel B) in the years 2016 and 2017. Some few patients aged above 20 years are not depicted. The graph was created by the first author of this study. ","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-22231/v4/a87f8d9f440ce9ad5e2cb420.png"},{"id":4625275,"identity":"08e2a3bf-613f-464c-8c6c-bba024f4d5e1","added_by":"auto","created_at":"2020-12-31 11:44:04","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":45321,"visible":true,"origin":"","legend":"Number of visits by asylum-seeking patients per country. The map was created by the first author of this study. \nNote: The designations employed and the presentation of the material on this map do not imply the expression of any opinion whatsoever on the part of Research Square concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. This map has been provided by the authors.\n","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-22231/v4/a8d54218b985765380a5ca71.png"},{"id":4625310,"identity":"a7ad6356-25c8-4668-bc80-caa5f2edc304","added_by":"auto","created_at":"2020-12-31 11:47:04","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":340520,"visible":true,"origin":"","legend":"Pie charts depicting frequency of visits and proportions of total visits by (A) asylum-seeking (n = 439 with 1674 visits) and (B) non-asylum-seeking children (n = 55,350 with 200,642 visits) in 2016 and 2017. The graph was created by the first author of this study.","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-22231/v4/2f316f12911515f56c163911.png"},{"id":13640949,"identity":"5d460d0f-7b1b-47d3-bd6d-9bc4838b73b8","added_by":"auto","created_at":"2021-09-17 09:02:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1580134,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-22231/v4/4e282003-5efc-416b-b899-7316ed40b779.pdf"},{"id":4625184,"identity":"e2cd2e79-a295-44bf-a072-51c3651605f2","added_by":"auto","created_at":"2020-12-31 11:38:04","extension":"doc","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":99328,"visible":true,"origin":"","legend":"","description":"","filename":"STROBEchecklistoverview.doc","url":"https://assets-eu.researchsquare.com/files/rs-22231/v4/1098543e986f2d091c402649.doc"}],"financialInterests":"","formattedTitle":"Health care provided to recent asylum-seeking and non-asylum-seeking pediatric patients in 2016 and 2017 at a Swiss tertiary hospital - a retrospective study","fulltext":[{"header":"Background","content":"\u003cp\u003eGlobally, an estimated 68.5 million individuals and 35.5 million children were forcibly displaced in 2017\u0026nbsp;[\u003ca href=\"#_ENREF_1\" title=\"The UN Refugee Agency, 2017 #756\"\u003e1\u003c/a\u003e]. This number has reached a historical record high, with child refugees having increased by 21% in the past decade\u0026nbsp;[\u003ca href=\"#_ENREF_2\" title=\"United Nations International Children's Emergency Fund, 2017 #751\"\u003e2\u003c/a\u003e]. In Europe, 209 756 children have claimed asylum in 2017, of which 6595 lodged their application in Switzerland\u0026nbsp;[\u003ca href=\"#_ENREF_3\" title=\"UNICEF, 2018 #30\"\u003e3\u003c/a\u003e]. In the same year, a further 16,350 children were registered as temporarily accepted refugees in Switzerland\u0026nbsp;[\u003ca href=\"#_ENREF_4\" title=\"Staatssekretariat für Migration, 2018 #757\"\u003e4\u003c/a\u003e].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe remarkable increase of asylum-seeking children and adults arriving in Europe may challenge the health care systems. Thus, concerns about the quality of medical care provided to asylum-seekers have led to several international reports and action plans\u0026nbsp;[\u003ca href=\"#_ENREF_5\" title=\"World Health Organization, 2018 #906\"\u003e5\u003c/a\u003e,\u0026nbsp;\u003ca href=\"#_ENREF_6\" title=\"The Lancet, 2016 #27\"\u003e6\u003c/a\u003e]. These highlight that asylum-seeking children are a particularly vulnerable group whose health needs are largely unmet\u0026nbsp;[\u003ca href=\"#_ENREF_6\" title=\"The Lancet, 2016 #27\"\u003e6\u003c/a\u003e,\u0026nbsp;\u003ca href=\"#_ENREF_7\" title=\"Ritz, 2015 #943\"\u003e7\u003c/a\u003e].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe majority of available data on health care provision and needs in asylum-seekers focuses on adults or originates from the late 1990s. Current asylum-seeking populations in Europe are, however, distinctly different compared to 1990s when the majority of asylum-seekers originated from the Balkan states and the proportion of children was reaching only 10%\u0026nbsp;[\u003ca href=\"#_ENREF_8\" title=\"Bischoff, 2009 #766\"\u003e8-12\u003c/a\u003e]. In recent years, however, the majority of asylum-seekers originate from the horn of Africa and middle Eastern countries and on average 30% are children and adolescents\u0026nbsp;[\u003ca href=\"#_ENREF_13\" title=\"United Nations International Children's Emergency Fund, 2015 #39\"\u003e13\u003c/a\u003e].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA systematic literature review on the health of migrant children in Switzerland including evidence until 2011 concluded that migrant children\u0026nbsp;had important differences in health needs compared to their local peers reflected in higher hospital admission rates, intensive care admissions, dental care and mental health consultations\u0026nbsp;[\u003ca href=\"#_ENREF_14\" title=\"Jaeger, 2012 #24\"\u003e14\u003c/a\u003e]. In contrast to this, a recent study of asylum-seeking hospitalized children showed that a large proportion was admitted with infections similar to those prevalent in the local population. However, a direct comparison between the groups was not done\u0026nbsp;[\u003ca href=\"#_ENREF_15\" title=\"Pohl, 2017 #30\"\u003e15\u003c/a\u003e]. Only one recent study from Germany included health care delivery data from both asylum-seeking and non-asylum seeking children\u0026nbsp;[\u003ca href=\"#_ENREF_16\" title=\"Lichtl, 2017 #933\"\u003e16\u003c/a\u003e]. The study showed that asylum-seeking children were more frequently admitted for diseases with the potential for outpatient care, when detected early.\u003c/p\u003e\n\u003cp\u003eIn summary, there is a knowledge gap on recent health data of asylum-seeking children in comparison with non-asylum-seeking children. This absence of information has been highlighted as a research priority by several international organizations including the World Health Organization (WHO) and the International Society for Social Pediatrics and Child Health (ISSOP)\u0026nbsp;[\u003ca href=\"#_ENREF_5\" title=\"World Health Organization, 2018 #906\"\u003e5\u003c/a\u003e,\u0026nbsp;\u003ca href=\"#_ENREF_17\" title=\"International Society for Social Pediatrics and Child Health, 2018 #759\"\u003e17\u003c/a\u003e,\u0026nbsp;\u003ca href=\"#_ENREF_18\" title=\"Baauw, 2018 #944\"\u003e18\u003c/a\u003e].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe aim of this study was therefore to fill an important knowledge gap by comparing health visits from asylum-seeking and non-asylum-seeking children to analyze and understand differences in their health needs.\u0026nbsp;\u003c/p\u003e"},{"header":"Methods","content":"\u003ch3\u003e\u003cem\u003eStudy area\u003c/em\u003e\u003c/h3\u003e\n\u003cp\u003eThe study was done at the University Children\u0026rsquo;s Hospital Basel (UKBB). Located in Switzerland on the border to France and Germany, the University Children\u0026rsquo;s Hospital Basel delivers health care to a multicultural population, aged between 0 and 16 years ans exceptionally to older patients. The hospital is part of the Swiss hospitals for equity program\u0026nbsp;[\u003ca href=\"#_ENREF_19\" title=\"Houmard, 2018 #827\"\u003e19\u003c/a\u003e]\u0026nbsp;and the only tertiary pediatric health care provider for two regions in North-West Switzerland with on average 200,000 consultations per year. Since March 2019, Switzerland is divided into six asylum regions. Basel has the only federal asylum center (FAC) with processing facilities within the asylum region. It is run by the Swiss state secretary of migration. All children lodging at the federal asylum center in need of urgent medical care are referred to the university children\u0026rsquo;s hospital. In addition, asylum-seeking families relocated to apartments within the region can spontaneously present themselves at the hospital.\u003c/p\u003e\n\u003ch3\u003e\u003cem\u003eStudy population\u003c/em\u003e\u003c/h3\u003e\n\u003cp\u003eIn this cross-sectional study data of all visits at the University Children\u0026rsquo;s Hospital Basel occurring between the two previous years, namely from 1\u003csup\u003est\u003c/sup\u003e Jan 2016 and 31\u003csup\u003est\u003c/sup\u003e Dec 2017 were extracted from the administrative electronic health records. The asylum-seeking status was systematically assessed and recorded at our institution for all patients. Patients were registered as asylum-seeking if any of the following conditions were met: (i) referred from one of the reception and processing centers run by the State Secretary for Migration; (ii) referral sheet stating that the patient is asylum-seeking; (iii) asylum-seeking identity card, which is routinely issued to all individuals lodging an asylum request in Switzerland. As the health profile of asylum-seeking persons is assimilating to the local population in many health related aspects like infectious diseases or risk behavior\u0026nbsp;[\u003ca href=\"#_ENREF_20\" title=\"Salas-Wright, 2016 #1079\"\u003e20\u003c/a\u003e]. To prevent the dilution of important differences, only recently arrived asylum-seeking patients were included. Children that had visits recorded one year or longer before the study period (i.e. before 1\u003csup\u003est\u003c/sup\u003e January 2015) were excluded from the current analysis.\u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003ch3\u003e\u003cem\u003eData collection and analysis\u003c/em\u003e\u003c/h3\u003e\n\u003cp\u003eData extraction for all identified patients was done in 2018 and 2019 using administrative and medical electronic health records for the following variables: number of visits per group as primary outcome and asylum status, nationality, age, gender, date of visit, department visited, time of visit (office hour visit defined as 7:00 - 5:59 pm), hospital admission or outpatient treatment. Extracted data was transferred to a Redcap-database (Vanderbilt University/IC 6.9.4). Data cleaning and quality control tests were performed.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSTATA (Stata/IC 13.1 2013) was used for the statistical analysis as for the generation of graphs. The statistical analysis was mainly descriptive. Inferential statistics were used to analyze key differences between the two groups, using the two sample Chi-square test. Confidence intervals were provided to describe the precision around the summary statistic using a confidence level of 95%. To provide information about the completeness of the dataset, records with missing data were not excluded from analysis but reported as such.\u003c/p\u003e\n\u003ch3\u003e\u003cem\u003eEthics\u003c/em\u003e\u003c/h3\u003e\n\u003cp\u003eThe study was approved by the Ethics committee of North-West Switzerland (EKNZ 2017-01585). Informed consent was not required as per EKNZ as not deemed feasible for the analysis of the large dataset. No further administrative permissions were required to access the raw data for the study.\u003c/p\u003e"},{"header":"Results","content":"\u003ch3\u003e\u003cem\u003ePrimary outcome\u003c/em\u003e\u003c/h3\u003e\n\u003cp\u003eThe final study population included 202,316 visits by 55,789 patients of which 1674 (1%) visits by 439 (1%) patients were in asylum-seeking and 200,642 (99%) visits by 55,350 (99%) patients were in non-asylum-seeking children \u003cem\u003e(Figure 1).\u0026nbsp;\u003c/em\u003eA total of 294 visits by 33 asylum-seeking patients were excluded as these had records of visits prior to 1\u003csup\u003est\u003c/sup\u003e Jan 2015 \u003cem\u003e(Table 1).\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003e\u003cem\u003eNationality\u003c/em\u003e\u003c/h3\u003e\n\u003cp\u003eAsylum-seeking patients originated from 38 countries and the most frequent nationalities were Eritrea (14%), Afghanistan (13%), and Syria (9%). In the non-asylum-seeking patients 141 countries were noted with the majority from Switzerland (64%), followed by Germany (7%), Turkey and Italy (4% each). \u003cem\u003e(Table 1; Figure 3).\u003c/em\u003e\u003c/p\u003e\n\u003ch3\u003e\u003cem\u003eAge and sex\u003c/em\u003e\u003c/h3\u003e\n\u003cp\u003eThe median age was higher in the asylum-seeking compared to the non-asylum seeking patients: 13 (IQR 3-16) years and 7 years (IQR 2-12), respectively. In both groups, visits from children \u0026lt; 3 years of age were most frequent with 39% (646/1674) and 23% (45,478/200,642) in the asylum-seeking and non-asylum-seeking patients; with the proportion being significantly higher in asylum-seeking patients (p-value \u0026lt; 0.001, 95% CI difference in proportion: 0.14-0.18) (\u003cem\u003eFigure 2\u003c/em\u003e). A bimodal age-distribution was seen in the asylum-seeking patients with a second peak in adolescent aged 15 to 17 years. Visits from adolescents represented 25% (421/1674) in the asylum-seeking and 13% (25,736 / 200,642) in the non-asylum-seeking group (p \u0026lt; 0.001, 95% CI difference in proportion: 0.1-0.14).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThere was a predominance of male patients among the asylum-seeking compared to the non-asylum-seeking patients, 70% versus 55% of visits (p \u0026lt; 0.001, 95% CI difference in proportion: 0.13-0.17). This difference was highest in the adolescent group with 87% (366/421) of visits by males in the asylum-seeking and 50% (12,922/25,736) in the non-asylum-seeking group, respectively. The sex distribution in children \u0026lt; 3 years was similar in both groups; 54% males (352/646) in asylum-seeking and 56% (25,347/45,478) in non-asylum-seeking patients, respectively.\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003e\u003cem\u003eVisits stratified by departments\u003c/em\u003e\u003c/h3\u003e\n\u003cp\u003eOutpatient visits were most frequent in both groups with 89% (1490/1674) in the asylum-seeking and 93% (185,950/200,642) in the non-asylum-seeking patients, respectively. The emergency department was most frequently visited in both groups with a significantly lower proportion in the asylum-seeking patients with 19% (317/1674, CI: 0.15-0.23) compared 32% (64,315/200,642; CI: 0.32-0.32) in the non-asylum-seeking patients (p \u0026lt;0.001, 95% CI of difference in proportion: -0.17- -0.09).\u003c/p\u003e\n\u003cp\u003eThe proportion of hospital admissions was higher in asylum-seeking patients with 11% (184/1674) compared to 7% (14,692/200,642) in the non-asylum-seeking children (p \u0026lt;0.00, 95% CI difference in proportion: 0.02-0.06). Asylum-seeking patients were most frequently admitted to the pediatric department (36% (67/184)) and non-asylum-seeking patients to the surgical/orthopedic department (40% (5857/ 14,692)). Hospital admissions to psychiatry were infrequent in both groups with 4% (7/184) in asylum-seeking and 2% (282/14,692) in non-asylum-seeking patients.\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003e\u003cem\u003eFrequency of health care visits\u003c/em\u003e\u003c/h3\u003e\n\u003cp\u003eThe median number of visits per patient was 1 (IQR 1-2; range 1-179) in the asylum-seeking and 2 (IQR 1-4; range 1-221) in the non-asylum-seeking children. The frequency of visits per patient was \u0026lt; 4 times in 84% (369/439) and 72 % (40 451/55,350), of the asylum-seeking and non-asylum-seeking children, respectively. When analyzing patients with frequent visits (\u0026gt; 15 visits per patient), these occurred in 4% (16/439) of the asylum-seeking and in 3% (1482/55 350) of the non-asylum-seeking patients. Frequent visits accounted for 48% (807/1674) and 25% (49,886/200,642) of the total visits in the asylum-seeking and non-asylum-seeking patients, respectively (\u003cem\u003eFigure 4\u003c/em\u003e).\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis is the first comprehensive analysis of hospital visits comparing pediatric asylum-seeking with non-asylum-seeking patients in Europe. Overall, the number of visits by asylum-seeking patients was small but the comparison to visits of non-asylum-seeking patients showed important differences.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAsylum-seeking patients originated from a considerable number of countries with Afghanistan, Eritrea and Syria being the most frequent countries of origin in the period studied. Compared to our previous analysis of asylum-seeking patients in 2015 the main difference is that Syrian patients have become more frequent. This shift is a result of current migration patterns in which Syrians represented 54% of the total number of recorded arrivals in Europe in 2015 and 2016. In 2018, 2.7 million Syrian refugee children were living outside of Syria\u0026nbsp;[\u003ca href=\"#_ENREF_21\" title=\"United Nations International Children's Emergency Fund, 2018 #772\"\u003e21\u003c/a\u003e].\u0026nbsp;Due to the severity and complexity of the armed conflict, Syria has shifted from a temporary to a permanent country of origin of refugees. This results in a continuously decreasing health status of Syrian citizens as also demonstrated that by a recent study in which only 64% had access to general pediatric care, 28% had up-to-date vaccination status and 16% access to healthy nutrition\u0026nbsp;[\u003ca href=\"#_ENREF_22\" title=\"Elsafti, 2016 #773\"\u003e22\u003c/a\u003e]. The Syrian context is contrasted by Afghanistan, which has been one of the top 20 countries of origin of refugees since the 1980s\u0026nbsp;[\u003ca href=\"#_ENREF_1\" title=\"The UN Refugee Agency, 2017 #756\"\u003e1\u003c/a\u003e]. \u0026nbsp;These changing trends in nationalities, contexts and demographics of the asylum-seeking population influence the health needs of asylum-seekers and highlight the need for host countries to continuously monitor their practice of health provision.\u003c/p\u003e\n\u003cp\u003eA substantial number of visits by asylum-seeking patients were by male adolescents. This is an important patient group reflecting the current age and sex distribution among refugees in Europe. In 2017, 82% of the first-time asylum seekers were less than 35 years old and 75% of the 14 to17 years old asylum-seekers were male, many being unaccompanied minor refugees\u0026nbsp;[\u003ca href=\"#_ENREF_23\" title=\"Eurostat;, 2018 #774\"\u003e23\u003c/a\u003e]. The frequency of this age group in hospital visits may be a surrogate for poor health or limited access to health care in this group of refugees. The Unaccompanied Refugee Minors Program of the United States showed that and that long-term health care remained challenging in this group\u0026nbsp;[\u003ca href=\"#_ENREF_24\" title=\"Geltman, 2008 #627\"\u003e24\u003c/a\u003e]. The results of our study show that most visits in this age group were in somatic departments and relatively few admissions to the psychiatric department were noted. This is somewhat surprising in the light of literature describing the importance of mental health problems in asylum-seeking adolescents\u0026nbsp;[\u003ca href=\"#_ENREF_24\" title=\"Geltman, 2008 #627\"\u003e24-29\u003c/a\u003e]. One explanation may be cultural differences in expressing mental health needs. Symptoms may appear somatic to health care providers in high-resource countries and underlying mental health problems may have passed undetected\u0026nbsp;[\u003ca href=\"#_ENREF_24\" title=\"Geltman, 2008 #627\"\u003e24\u003c/a\u003e].\u003c/p\u003e\n\u003cp\u003eA further important age group in the asylum-seeking patients was children below three years of age; however, this was also the case in the non-asylum-seeking patients. \u0026nbsp;In both groups a considerable number of emergency department visits were noted. \u0026nbsp;A similar age distribution in pediatric emergency department visits was seen in other parts of the world. A Californian and a Korean study both showed frequent visits to emergency departments were more common in children aged 1 to 4 years [\u003ca href=\"#_ENREF_30\" title=\"Kim, 2018 #935\"\u003e30\u003c/a\u003e, \u003ca href=\"#_ENREF_31\" title=\"Supat, 2018 #936\"\u003e31\u003c/a\u003e]. However, these studies did not detail if asylum-seeking children were included. Interestingly, in our study the asylum-seeking children had a lower proportion of emergency department visits compared to non-asylum-seeking children. This finding contrasts to a recently published study, showing that asylum-seeking children were 5 times more likely to use emergency services\u0026nbsp;[\u003ca href=\"#_ENREF_16\" title=\"Lichtl, 2017 #933\"\u003e16\u003c/a\u003e]. One explanation for the lower proportion in our setting may be that the nurse-led health care system present at Swiss asylum-seeking reception centers which may help to prevent visits to the emergency department, as diseases are detected early. Alternatively, it is possible that asylum-seeking children did not have sufficient access to the emergency department, as health care delivery to migrants includes particular challenges in health care delivery[\u003ca href=\"#_ENREF_32\" title=\"Brandenberger, 2019 #1012\"\u003e32\u003c/a\u003e].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe generally low proportion of 1% of visits by asylum-seeking patients and the lower proportion of emergency department visits are in line with results from a recent report by the University College London Lancet Commission on Migration\u0026nbsp;[\u003ca href=\"#_ENREF_33\" title=\"Abubakar, 2018 #940\"\u003e33\u003c/a\u003e]. The results underline that public statements in current debates about asylum-seekers disproportionately burdening the health care system are not true for all settings\u0026nbsp;[\u003ca href=\"#_ENREF_33\" title=\"Abubakar, 2018 #940\"\u003e33\u003c/a\u003e]. A study done at an emergency department at the inner city of London also echoed these results, showing that asylum-seekers were only a minority group\u0026nbsp;[\u003ca href=\"#_ENREF_34\" title=\"Hargreaves, 2006 #32\"\u003e34\u003c/a\u003e]. Improved access to community-based physicians was described as an option to improve health care and lower the impact of migrants on emergency departments in general\u0026nbsp;[\u003ca href=\"#_ENREF_34\" title=\"Hargreaves, 2006 #32\"\u003e34\u003c/a\u003e]. Current health care delivery models to asylum-seekers vary substantially between regions and countries. In our research context, asylum-seeking children are fully covered for all health care visits by the national health insurance. As mentioned in a German study, presentations with ambulatory care sensitive conditions at tertiary health care facilities could be used as an indicator to compare primary care delivery models for asylum-seekers in different regions\u0026nbsp;[\u003ca href=\"#_ENREF_16\" title=\"Lichtl, 2017 #933\"\u003e16\u003c/a\u003e].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOne further important finding of our study is that a small proportion of asylum-seeking patients had an outsized number of visits accounting for almost half of the visits. An emerging area of pediatric research focuses on \u0026ldquo;children with medical complexity\u0026rdquo;, which typically need frequent health care visits and high financial resources\u0026nbsp;[\u003ca href=\"#_ENREF_35\" title=\"Cohen, 2018 #1081\"\u003e35\u003c/a\u003e]. One likely explication is that asylum-seeking patients presented with serious and inadequately treated medical problems, as their health needs had not sufficiently been addressed in their country of origin and while being on the escape. Once arrived in the host country, they required more intense and prolonged treatment compared to their local peers with the same conditions. Alternatively, the spectrum of disease in asylum-seeking and non-asylum-seeking patients with frequent visits may be different and asylum-seeking patients may suffer from particularly complex or rare diseases\u0026nbsp;[\u003ca href=\"#_ENREF_36\" title=\"Schiergens, 2018 #965\"\u003e36\u003c/a\u003e]. A study analyzing adults with multiple chronic diseases showed that their average annual health care expenditures were three times higher compared to patients without chronic diseases\u0026nbsp;[\u003ca href=\"#_ENREF_37\" title=\"Hayes, 2016 #777\"\u003e37\u003c/a\u003e]. Despite costs, investment in pediatric patients\u0026nbsp;is generally\u0026nbsp;considered to be cost effective, as it is preventing expensive chronic conditions in adulthood\u0026nbsp;[\u003ca href=\"#_ENREF_38\" title=\"Viner, 2018 #779\"\u003e38\u003c/a\u003e]. A third explication for more frequent visits could be that they the asylum-seeking patients had less access to primary care pediatricians, resulting in more frequent presentations at the tertiary health care facility.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study has several limitations. First, it is a single-center study. The generalizability of the results is therefore limited.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe systematic registration of patients as \u0026ldquo;asylum-seeking\u0026rdquo; allowed identifying the health information of this study population. This is considered as strength of the study and described as urgently needed in more settings\u0026nbsp;[\u003ca href=\"#_ENREF_39\" title=\"Blitz, 2017 #928\"\u003e39\u003c/a\u003e]. However, some asylum-seeking patients might have been missed by administration staff and the number of asylum-seeking patients was potentially underestimated.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study focused on recent asylum-seekers and therefore excluded visits by asylum-seeking children who visited the hospital before 2015. This helped to prevent the dilution of differences between recent asylum-seekers and non-asylum-seekers. The exclusion of these visits might however limit the results and excludes data from long-term asylum-seeking children. Of note, the proportion of children with non-Swiss nationality in the comparison group with 36% is considerable. Potential differences between Swiss nationals and non-asylum-seekers without Swiss nationality were missed.\u0026nbsp;In addition, migrant children without official documents are not represented in this study.\u003c/p\u003e\n\u003cp\u003eAnother limitation was that the retrospective nature of the study resulted in missing data. Important questions, such as transition countries of asylum-seeking patients before they reached Switzerland could not be included in the analysis as the percentage of missing data was too high. Contacting patients to gather additional information was not deemed feasible due to the size of the dataset. This limited an in-depth analysis of many aspects like analyzing the main diagnosis leading to the visits, the family structure or describing the socio-economic background of the study population, but allowed to include all visits, providing a comprehensive overview of health visits by asylum-seeking patients. To address some of the research questions mentioned in the limitations, further studies are analyzing smaller subgroups of the study population. This allows the comparison of main diagnosis in asylum-seeking and non-asylum-seeking inpatients\u0026nbsp;[\u003ca href=\"#_ENREF_40\" title=\"Gmünder, 2020 #1094\"\u003e40\u003c/a\u003e], an in-depth analysis of the subgroup of frequently visiting patients\u0026nbsp;[\u003ca href=\"#_ENREF_41\" title=\"Buser, 2020 #1247\"\u003e41\u003c/a\u003e]\u0026nbsp;as the investigation of potentially preventable hospital admissions and emergency department visits\u0026nbsp;[\u003ca href=\"#_ENREF_42\" title=\"Brandenberger, 2020 #1245\"\u003e42\u003c/a\u003e]. Further to this an earlier qualitative study from our institution was done to understand the perspective of the asylum-seeking families on including on aspects for the escape and the quality of care provided at the hospital.\u0026nbsp;[\u003ca href=\"#_ENREF_43\" title=\"Brandenberger, 2019 #1010\"\u003e43\u003c/a\u003e].\u003c/p\u003e\n\u003cp\u003eFinally, patients which required a change of wards were counted as separate hospital admission. This allowed us to correctly identify all wards where patients were admitted, however, this may have resulted in overestimation of hospital admissions in both groups.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn summary, hospital visits by asylum-seeking children represented a small proportion of all visits. The emergency department had the highest number of visits in all patients but was less frequently used by asylum-seeking children. Nationalities, age and sex distributions of asylum-seeking patients vary over time and should be considered to identify important specific health needs in asylum-seeking patients. Higher admission rates and a larger proportion of visits from frequently visiting patients suggest that some asylum-seeking children present with more complex diseases. Further studies are needed, focusing on asylum-seeking children with medical complexity\u003c/p\u003e\n"},{"header":"Abbreviations","content":"\u003ctable style=\"border: none;width:501.55pt;border-collapse:collapse;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 167.3pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;line-height:150%;vertical-align:baseline;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eCI\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 334.25pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;line-height:150%;vertical-align:baseline;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eConfidence interval\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 167.3pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;line-height:150%;vertical-align:baseline;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eED\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 334.25pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;line-height:150%;vertical-align:baseline;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eEmergency department\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 167.3pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;line-height:150%;vertical-align:baseline;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eEKNZ\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 334.25pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;line-height:150%;vertical-align:baseline;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eethics committee of North-West Switzerland\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 167.3pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;line-height:150%;vertical-align:baseline;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eFAC\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 334.25pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;line-height:150%;vertical-align:baseline;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003efederal asylum centre\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 167.3pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;line-height:150%;vertical-align:baseline;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eICD 10\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 334.25pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;line-height:150%;vertical-align:baseline;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eInternational Classification of Diseases 10\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 167.3pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;line-height:150%;vertical-align:baseline;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eIOM\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 334.25pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;line-height:150%;vertical-align:baseline;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eInternational Organization for Migration\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 167.3pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;line-height:150%;vertical-align:baseline;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eIQR\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 334.25pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;line-height:150%;vertical-align:baseline;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eInterquartile Range\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 167.3pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n 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software\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 167.3pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;line-height:150%;vertical-align:baseline;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eUCL\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 334.25pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;line-height:150%;vertical-align:baseline;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eUniversity College London\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 167.3pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;line-height:150%;vertical-align:baseline;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eUKBB\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 334.25pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;line-height:150%;vertical-align:baseline;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eUniversit\u0026auml;ts- Kinderspital beider Basel (\u003c/span\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eUniversity Children\u0026rsquo;s Hospital Basel)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 167.3pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp 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Roman\",serif;'\u003eUNHCR\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 334.25pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;line-height:150%;vertical-align:baseline;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eUnited Nations High Commissioner for Refugees\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 167.3pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;line-height:150%;vertical-align:baseline;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eWHO\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 334.25pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;line-height:150%;vertical-align:baseline;'\u003e\u003cspan style='font-size:16px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eWorld Health Organization\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003ch2\u003e\u003cem\u003eEthics approval and consent to participate\u0026nbsp;\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eThe study was approved by the Ethics committee of North-West Switzerland (EKNZ 2017-01585).\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interest.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eJB received a personal one year research grant from the \u0026ldquo;Botnar foundation\u0026rdquo; to conduct the study.\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eAuthors\u0026rsquo; contributions\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eJB: Conceived the study, performed data analysis, drafted the initial manuscript and approved the final manuscript as submitted.\u003c/p\u003e\n\u003cp\u003eCP, FV and TT: Contributed to the interpretation of data, reviewed the manuscript and approved the final manuscript as submitted.\u003c/p\u003e\n\u003cp\u003eNR: Conceived the study, supervised analysis, reviewed and revised the manuscript and approved the final manuscript as submitted.\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eWe want to kindly thank Matthias Tschudin (Application and Services), Robert Kopf (Controlling) and Angelika Fix (Accounting) for their support during the study.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003e\u003cstrong\u003eglobal trends - forced displacement in 2017 \u003c/strong\u003e[\u003ca href=\"www.unhcr.org/statistics\"\u003ewww.unhcr.org/statistics\u003c/a\u003e ]\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003e A child is a child \u003c/strong\u003e[\u003ca href=\"https://www.unicef.org/publications/files/UNICEF_A_child_is_a_child_May_2017_EN.pdf\"\u003ehttps://www.unicef.org/publications/files/UNICEF_A_child_is_a_child_May_2017_EN.pdf\u003c/a\u003e]\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eLatest statistics and graphics on refugee and migrant children \u003c/strong\u003e[\u003ca 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A Population-Based Comparison of Demographics, Health Care Use, and Expenditures\u003c/strong\u003e. \u003cem\u003eIssue brief (Commonwealth Fund) \u003c/em\u003e2016, \u003cstrong\u003e26\u003c/strong\u003e:1-14.\u003c/li\u003e\n\u003cli\u003eViner RM: \u003cstrong\u003eNHS must prioritise health of children and young people\u003c/strong\u003e. \u003cem\u003eBMJ (Clinical research ed) \u003c/em\u003e2018, \u003cstrong\u003e360\u003c/strong\u003e:k1116.\u003c/li\u003e\n\u003cli\u003eBlitz BK, d'Angelo A, Kofman E, Montagna N: \u003cstrong\u003eHealth Challenges in Refugee Reception: Dateline Europe 2016\u003c/strong\u003e. \u003cem\u003eInternational journal of environmental research and public health \u003c/em\u003e2017, \u003cstrong\u003e14\u003c/strong\u003e(12).\u003c/li\u003e\n\u003cli\u003eGm\u0026uuml;nder M, Brandenberger J, Buser S, Pohl C, Ritz N: \u003cstrong\u003eReasons for admission in asylum-seeking and non-asylum-seeking patients in a paediatric tertiary care centre\u003c/strong\u003e. \u003cem\u003eSwiss medical weekly \u003c/em\u003e2020, \u003cstrong\u003e150\u003c/strong\u003e:w20252.\u003c/li\u003e\n\u003cli\u003eBuser S, Brandenberger J, Gm\u0026uuml;nder M, Pohl C, Ritz N: \u003cstrong\u003eAsylum-Seeking Children with Medical Complexity and Rare Diseases in a Tertiary Hospital in Switzerland\u003c/strong\u003e. \u003cem\u003eJournal of immigrant and minority health \u003c/em\u003e2020.\u003c/li\u003e\n\u003cli\u003eBrandenberger J, Bozorgmehr K, Vogt F, Tyllesk\u0026auml;r T, Ritz N: \u003cstrong\u003ePreventable admissions and emergency-department-visits in pediatric asylum-seeking and non-asylum-seeking patients\u003c/strong\u003e. \u003cem\u003eInt J Equity Health \u003c/em\u003e2020, \u003cstrong\u003e19\u003c/strong\u003e(1):58.\u003c/li\u003e\n\u003cli\u003eBrandenberger J: \u003cstrong\u003ePerspective of asylum-seeking caregivers on the quality of care provided by a Swiss paediatric hospital: a qualitative study\u003c/strong\u003e. \u003cem\u003eBMJ Open \u003c/em\u003e2019, \u003cstrong\u003e9\u003c/strong\u003e(9):e029385.\u003c/li\u003e\n\u003c/ol\u003e\n"},{"header":"Table","content":"\u003cp style='margin:0in;font-size:16px;font-family:\"Arial\",sans-serif;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eTable 1:\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;baseline characteristics, nationality and most visited departments by asylum-seeking and non-asylum-seeking patients 2016-2017 at University Children\u0026rsquo;s Hospital Basel\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;font-size:16px;font-family:\"Arial\",sans-serif;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"width: 89%;margin-left:5.4pt;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.82%;border: 1pt solid windowtext;background: rgb(188, 223, 240);padding: 0in 5.4pt;height: 18.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 24.68%;border-top: 1pt solid windowtext;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-image: initial;border-left: none;background: rgb(188, 223, 240);padding: 0in 5.4pt;height: 18.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;color:black;'\u003eAsylum-seeking\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width: 49.5%;border-top: 1pt solid windowtext;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-image: initial;border-left: none;background: rgb(188, 223, 240);padding: 0in 5.4pt;height: 18.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;color:black;'\u003eNon-asylum-seeking\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 25.82%;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;background: rgb(188, 223, 240);padding: 0in 5.4pt;height: 25.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;color:black;'\u003eCharacteristics\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 13.3446%; border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; background: rgb(188, 223, 240); padding: 0in 5.4pt; height: 25.65pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;color:black;'\u003eVisits \u003cbr\u003e\u0026nbsp;n = 1674\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 12.5%; border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; background: rgb(188, 223, 240); padding: 0in 5.4pt; height: 25.65pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;color:black;'\u003ePatients \u003cbr\u003e\u0026nbsp;n = 439\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 35.36%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(188, 223, 240);padding: 0in 5.4pt;height: 25.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;color:black;'\u003eVisits\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;color:black;'\u003en = 200,642\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 14.14%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(188, 223, 240);padding: 0in 5.4pt;height: 25.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:center;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;color:black;'\u003ePatients \u003cbr\u003e\u0026nbsp;n = 55,350\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7.4662%; border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; background: rgb(188, 223, 240); padding: 0in 5.4pt; height: 25.65pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;color:black;'\u003eN\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.7432%; border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; background: rgb(188, 223, 240); padding: 0in 5.4pt; height: 25.65pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;color:black;'\u003e%\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.419%; border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; background: rgb(188, 223, 240); padding: 0in 5.4pt; height: 25.65pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;color:black;'\u003eN\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.08%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(188, 223, 240);padding: 0in 5.4pt;height: 25.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;color:black;'\u003e%\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 28.3%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(188, 223, 240);padding: 0in 5.4pt;height: 25.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;color:black;'\u003eN\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.06%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(188, 223, 240);padding: 0in 5.4pt;height: 25.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;color:black;'\u003e%\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.06%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(188, 223, 240);padding: 0in 5.4pt;height: 25.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;color:black;'\u003eN\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.08%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;background: rgb(188, 223, 240);padding: 0in 5.4pt;height: 25.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;color:black;'\u003e%\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.82%;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 19.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eAge groups:\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e0-2\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e3-14\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e15-17\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026gt; 17\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.4662%; border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; padding: 0in 5.4pt; height: 19.6pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e646\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e575\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e421\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e32\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.7432%; border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; padding: 0in 5.4pt; height: 19.6pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e39\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e34\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e25\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e2\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.419%; border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; padding: 0in 5.4pt; height: 19.6pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e96\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e152\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e171\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e20\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.08%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 19.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e22\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e34\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e39\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 28.3%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 19.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;45,478\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e117,546\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e25,736\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e11,882\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.06%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 19.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e23\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e58\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e13\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.06%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 19.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e13,297\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e32,819\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e5938\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e3296\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.08%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 19.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e24\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e59\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e11\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.82%;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 18.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eTotal 2016\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.4662%; border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; padding: 0in 5.4pt; height: 18.65pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e812\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.7432%; border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; padding: 0in 5.4pt; height: 18.65pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e49\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.419%; border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; padding: 0in 5.4pt; height: 18.65pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e243\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.08%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 18.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e55\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 28.3%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 18.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e100,842\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.06%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 18.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e50\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.06%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 18.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e36,560\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.08%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 18.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e66\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.82%;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 19.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eTotal 2017\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.4662%; border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; padding: 0in 5.4pt; height: 19.6pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e862\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.7432%; border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; padding: 0in 5.4pt; height: 19.6pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e51\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.419%; border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; padding: 0in 5.4pt; height: 19.6pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e243\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.08%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 19.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e55\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 28.3%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 19.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e99,800\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.06%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 19.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e50\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.06%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 19.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e36,767\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.08%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 19.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e66\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.82%;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 18.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eMale gender\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.4662%; border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; padding: 0in 5.4pt; height: 18.65pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e1172\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.7432%; border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; padding: 0in 5.4pt; height: 18.65pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e70\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.419%; border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; padding: 0in 5.4pt; height: 18.65pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e307\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.08%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 18.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e70\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 28.3%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 18.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e110,567\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.06%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 18.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e55\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.06%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 18.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e29,520\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.08%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 18.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e53\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.82%;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 102.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eMost frequent nationalities:\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eSyria\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eEritrea\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eAfghanistan\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eAlgeria\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eArmenia\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eOther\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eMissing Data*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.4662%; border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; padding: 0in 5.4pt; height: 102.6pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e442\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e210\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e192\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e182\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e157\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e371\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e120\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.7432%; border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; padding: 0in 5.4pt; height: 102.6pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e26\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e13\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e11\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e11\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e9\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e22\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.419%; border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; padding: 0in 5.4pt; height: 102.6pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e41\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e60\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e58\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e4\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e4\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e154\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e118\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.08%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 102.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e9\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e14\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e13\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e35\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e27\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.2%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 102.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eSwitzerland\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eGermany\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eTurkey\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eItaly\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eKosovo\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eOther\u003cbr\u003e\u0026nbsp;Missing Data\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.1%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 102.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e124,714\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e12,961\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e9310\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e7292\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e5368\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e40,973\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e24\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.06%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 102.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e62\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e6\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e5\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e4\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e3\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e20\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.06%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 102.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e35,381\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e3853\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e2080\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e1984\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e1325\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e10,714\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e13\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.08%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 102.6pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e64\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e7\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e4\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e4\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e2\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e19\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.82%;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 18.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eOutpatient visits\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.4662%; border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; padding: 0in 5.4pt; height: 18.65pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e1490\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.7432%; border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; padding: 0in 5.4pt; height: 18.65pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e89\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.419%; border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; padding: 0in 5.4pt; height: 18.65pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003ens\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.08%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 18.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003ens\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 28.3%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 18.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e185,950\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.06%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 18.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e93\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.06%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 18.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003ens\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.08%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 18.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003ens\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.82%;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 18.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eOffice hour visits (7.00 am \u0026ndash; 5.59 pm)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.4662%; border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; padding: 0in 5.4pt; height: 18.65pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e1505\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.7432%; border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; padding: 0in 5.4pt; height: 18.65pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e90\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.419%; border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; padding: 0in 5.4pt; height: 18.65pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003ens\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.08%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 18.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003ens\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 28.3%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 18.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e167,901\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.06%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 18.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e84\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.06%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 18.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003ens\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.08%;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid windowtext;padding: 0in 5.4pt;height: 18.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003ens\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25.82%;border-right: 1pt solid windowtext;border-bottom: 1pt solid windowtext;border-left: 1pt solid windowtext;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 18.65pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eMost visited outpatient departments:\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eEmergency\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eExercise therapy\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eRadiology\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eOccupational therapy\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eHaemato-oncology\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.4662%; border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; padding: 0in 5.4pt; height: 18.65pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e317\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e200\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e173\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e144\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e141\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.7432%; border-top: none; border-left: none; border-bottom: 1pt solid windowtext; border-right: 1pt solid windowtext; padding: 0in 5.4pt; height: 18.65pt; vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e19\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e12\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e10\u003c/span\u003e\u003c/p\u003e\n \u003cp 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Roman\",serif;color:black;'\u003ens\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.85pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;color:black;'\u003ens\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.85pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;color:black;'\u003ens\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:15px;font-family:\"Arial\",sans-serif;margin-right:2.7pt;text-align:right;'\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;color:black;'\u003ens\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style='margin:0in;font-size:16px;font-family:\"Arial\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;font-size:16px;font-family:\"Arial\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003ens = not specified\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin:0in;font-size:16px;font-family:\"Arial\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e* Missing data nationality asylum-seeking: in 95% of cases patients only seen for radiological examination as part of a State Secretary of Migration age estimation-programme.\u003c/span\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"migrant and refugee health, children, use of health care, migration patterns, Europe, health care delivery ","lastPublishedDoi":"10.21203/rs.3.rs-22231/v4","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-22231/v4","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground Asylum-seeking children represent an increasing and vulnerable group of patients whose health needs are largely unmet. Data on the health care provision to asylum-seeking children in European contexts is scarce. In this study we compare the health care provided to recent asylum-seeking and non-asylum-seeking children at a Swiss tertiary hospital. \u003c/p\u003e\u003cp\u003eMethods We performed a cross-sectional retrospective study in a pediatric tertiary care hospital in Basel, Switzerland. All patients and visits from January 2016 to December 2017 were identified, using administrative and medical electronic health records. The asylum-seeking status was systematically assessed and the patients were allocated accordingly in the two study groups. \u003c/p\u003e\u003cp\u003eResults A total of 202,316 visits by 55,789 patients were included, of which asylum-seeking patients accounted for 1674 (1%) visits by 439 (1%) individuals. The emergency department recorded the highest number of visits in both groups with a lower proportion in asylum-seeking compared to non-asylum-seeking children: 19% (317/1674) and 32% (64,315/200,642) respectively. The median number of visits per patient was 1 (IQR 1-2) in the asylum-seeking and 2 (IQR 1-4) in the non-asylum-seeking children. Hospital admissions were more common in asylum-seeking compared to non-asylum-seeking patients with 11% (184/1674) and 7% (14,692/200,642). Frequent visits (\u0026gt;15 visits per patient) accounted for 48% (807/1674) of total visits in asylum-seeking and 25% (49,886/200,642) of total visits in non-asylum-seeking patients. \u003c/p\u003e\u003cp\u003eConclusions Hospital visits by asylum-seeking children represented a small proportion of all visits. The emergency department had the highest number of visits in all patients but was less frequently used by asylum-seeking children. Frequent care suggests that asylum-seeking patients also present with more complex diseases. Further studies are needed, focusing on asylum-seeking children with medical complexity.\u003c/p\u003e","manuscriptTitle":"Health care provided to recent asylum-seeking and non-asylum-seeking pediatric patients in 2016 and 2017 at a Swiss tertiary hospital - a retrospective study","msid":"","msnumber":"","nonDraftVersions":[{"code":4,"date":"2020-12-31 11:38:02","doi":"10.21203/rs.3.rs-22231/v4","editorialEvents":[{"type":"communityComments","content":0},{"type":"checksComplete","content":"","date":"2020-12-16T16:03:41+00:00","index":"","fulltext":""},{"type":"decision","content":"Accept","date":"2020-12-16T00:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}},{"code":3,"date":"2020-12-16 13:19:28","doi":"10.21203/rs.3.rs-22231/v3","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Minor revision","date":"2020-12-11T00:00:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2020-12-02T00:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-12-01T23:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-12-01T23:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}},{"code":2,"date":"2020-09-11 17:58:55","doi":"10.21203/rs.3.rs-22231/v2","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Minor revision","date":"2020-11-25T00:00:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-11-18T00:00:00+00:00","index":2,"fulltext":"Recommendation: Accept after minor essential revisions\nForm responses:\n---\n\nComments to Author:\n---\nPEER REVIEWER ASSESSMENTS:\n\nOBJECTIVE - Full research articles: is there a clear objective that addresses a testable research question(s) (brief or other article types: is there a clear objective)?\nYes - there is a clear objective\n\nDESIGN - Is the current approach (including controls and analysis protocols) appropriate for the objective?\nYes - the approach is appropriate\n\nEXECUTION - Are the experiments and analyses performed with technical rigor to allow confidence in the results?\nYes - experiments and analyses were performed appropriately\n\nSTATISTICS - Is the use of statistics in the manuscript appropriate?\nYes - appropriate statistical analyses have been used in the study\n\nINTERPRETATION - Is the current interpretation/discussion of the results reasonable and not overstated?\nYes - the author's interpretation is reasonable\n\nOVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically sound? If not, can revisions be made to make the work technically sound?\nProbably - with minor revisions\n\nPEER REVIEWER COMMENTS:\n\nGENERAL COMMENTS:\nThe paper is well written. I regret that they did not provide the cause of the visits which would have increased the interest of the paper. Hence, this is more a short note. I shall advise keeping only Figure 1 and one table.\n\nREQUESTED REVISIONS:\nIn addition to my previous comments, add retrospective study and year in the title. Add the study place in the abstract. Check typo line 37 and large numbers with ' . You could probably shorten the paper, mostly the results and discussion. Consider using acronyms for asylum seeking and non-asylum seeking.* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. 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Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **No**\n* Declaration of competing interests: **This reviewer has been recruited by a partner organization, Research Square. Reviewers with declared or apparent competing interests are not utilized for these reviews. This reviewer has agreed to publication of their comments online under a Creative Commons Attribution License attributed to Research Square and was paid a small honorarium for completing the review within a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer recommendation.**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report. (default)**\n* Is the study design appropriate to answer the research question (including the use of appropriate controls), and are the conclusions supported by the evidence presented?: **Yes**\n* Are the methods sufficiently described to allow the study to be repeated?: **Yes**\n* Is the use of statistics and treatment of uncertainties appropriate?: **Yes**\n* Is the presentation of the work clear?: **No**\n* Are the images in this manuscript (including electrophoretic gels and blots) free from apparent manipulation?: **Yes**\n"},{"type":"reviewerAgreed","content":"","date":"2020-11-05T00:00:00+00:00","index":2,"fulltext":""},{"type":"reviewerAgreed","content":"","date":"2020-09-16T12:00:00+00:00","index":1,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-09-16T12:00:00+00:00","index":1,"fulltext":"Recommendation: Accept without revision\nForm responses:\n---\n\nComments to Author:\n---\nPlease include all comments for the authors in this box rather than uploading your report as an attachment. Please only upload as attachments annotated versions of manuscripts, graphs, supporting materials or other aspects of your report which cannot be included in a text format.\n\nPlease overwrite this text when adding your comments to the authors.* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **Yes**\n* Declaration of competing interests: **'I declare that I have no competing interests'**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report. (default)**\n* Is the study design appropriate to answer the research question (including the use of appropriate controls), and are the conclusions supported by the evidence presented?: **Yes**\n* Are the methods sufficiently described to allow the study to be repeated?: **Yes**\n* Is the use of statistics and treatment of uncertainties appropriate?: **Yes**\n* Is the presentation of the work clear?: **Yes**\n* Are the images in this manuscript (including electrophoretic gels and blots) free from apparent manipulation?: **Yes**\n"},{"type":"reviewersInvited","content":"","date":"2020-09-15T12:00:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2020-09-07T12:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-09-06T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-09-06T12:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}},{"code":1,"date":"2020-04-29 16:43:49","doi":"10.21203/rs.3.rs-22231/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2020-08-15T12:00:00+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2020-08-05T12:00:00+00:00","index":1,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-08-05T12:00:00+00:00","index":1,"fulltext":"Recommendation: Accept after discretionary revisions\nForm responses:\n---\n\nComments to Author:\n---\nThe author stated that the percentage of missing data was too high, primarily due to the dataset's size. However, the relevant policy regarding the asylum-seeking patients should be included in the discussion. For instance, the small proportion of hospital visits from asylum-seeking patients might be related to the health coverage policy. Or if the health care covers the hospital fee, it should be stated too in the discussion to encourage more in-depth analysis in future research.* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **Yes**\n* Declaration of competing interests: **I declare that I have no competing interests.**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report. (default)**\n* Is the study design appropriate to answer the research question (including the use of appropriate controls), and are the conclusions supported by the evidence presented?: **Yes**\n* Are the methods sufficiently described to allow the study to be repeated?: **Yes**\n* Is the use of statistics and treatment of uncertainties appropriate?: **Yes**\n* Is the presentation of the work clear?: **Yes**\n* Are the images in this manuscript (including electrophoretic gels and blots) free from apparent manipulation?: **Yes**\n"},{"type":"reviewerAgreed","content":"","date":"2020-08-05T12:00:00+00:00","index":2,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-08-05T12:00:00+00:00","index":2,"fulltext":"Recommendation: Major revisions required\nForm responses:\n---\n\nComments to Author:\n---\nThat was an interesting study knowing that asylum seeking has been on the rise in the last decade. Consequently, any study in this area will be useful especially in identifying health challenges encountered by asylum seekers and the health care needs of these people. These notwithstanding, there are some issues that need to be addressed in order for the paper to be relevant.\n\n1. The title of the paper \"Health care provided to recent asylum-seeking and non-asylum-seeking pediatric patients at a Swiss tertiary hospital\" suggests to me that it's a comparative study that was undertaken. What was the basis for that when the number of pediatric asylum seeking patients (1674) is no where near the number of non-asylum seeking patients.\n\n2. In the text, there is over emphasis on asylum seeking patients. That suggests that that was the main interest of the paper. If so then the comparison is not necessary.\n\n3. What informed the use of data from Jan, 2016 to 31 Dec, 2017. That was not clearly stated.\n\n4. Was there any information in the records to determine where else these asylum seekers had gone to before arriving at Switzerland?\n\n* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **No**\n* Declaration of competing interests: **I declare that I have no competing interests**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report. (default)**\n* Is the study design appropriate to answer the research question (including the use of appropriate controls), and are the conclusions supported by the evidence presented?: **No**\n* Are the methods sufficiently described to allow the study to be repeated?: **Yes**\n* Is the use of statistics and treatment of uncertainties appropriate?: **Yes**\n* Is the presentation of the work clear?: **No**\n* Are the images in this manuscript (including electrophoretic gels and blots) free from apparent manipulation?: **Yes**\n"},{"type":"reviewersInvited","content":"","date":"2020-05-24T12:00:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2020-04-27T12:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-04-24T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-04-23T12:00:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"","date":"2020-04-16T12:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c70eef64-8f47-44fa-881e-8960e0dd10c9","owner":[],"postedDate":"December 31st, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":1678433,"name":"Health Policy"},{"id":1678434,"name":"Infectious Diseases"},{"id":1678435,"name":"Health Economics \u0026 Outcomes Research"}],"tags":[],"updatedAt":"2021-01-10T15:05:29+00:00","versionOfRecord":{"articleIdentity":"rs-22231","link":"https://doi.org/10.1186/s12889-020-10082-z","journal":{"identity":"bmc-public-health","isVorOnly":false,"title":"BMC Public Health"},"publishedOn":"2021-01-07 15:01:16","publishedOnDateReadable":"January 7th, 2021"},"versionCreatedAt":"2020-12-31 11:38:02","video":"","vorDoi":"10.1186/s12889-020-10082-z","vorDoiUrl":"https://doi.org/10.1186/s12889-020-10082-z","workflowStages":[]},"version":"v4","identity":"rs-22231","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-22231","identity":"rs-22231","version":["v4"]},"buildId":"J0_U0BvcaRcwD8yVFaRlm","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}