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Aim: Refugee arrivals to Europe have numbered more than one million since 2015 with the majority arriving through Greece. The healthcare needs of refugees have placed strains on Greece’s healthcare system which has already been affected by its ongoing economic crisis. At the peak of arrivals during 2016, primary healthcare was primarily provided by humanitarian organizations with specialist referrals into the Greek healthcare system. There is little published literature on the type and impacts of specialist referrals for refugees in Greece. The aim of this retrospective review is to identify the type and impacts of specialist referrals for refugees into Greece’s health system. Methods: This retrospective study reviewed the number and type of specialty referrals from one humanitarian organization providing primary healthcare for refugees in Greece. All consultations during an 8-month period (December 1, 2016–July 31, 2017) were reviewed. Results: Of 4168 consultations, 42% were patients aged 17 years or younger, 52% were male, and 90% were Syrian. Two hundred and thirty-three patients (11%) required a specialist referral; 25% were for dental (provided by another humanitarian organization), 10% each for obstetrics and gynecology and pediatrics, and 8% for ophthalmology. Respiratory complaints were most frequently seen, and these were more predominant in the winter months. Pediatric consultations varied according to month, likely due to population movements. Conclusion: Dentistry was noted to be a gap in humanitarian response programming and accounted for the greatest need for specialist input with referrals for women and children accounting for a large proportion of referrals.

Introduction: Tamoxifen (TAM) is the most commonly used hormone therapeutic drug for the treatment of estrogen receptor-positive (ER+) breast cancer. 30%–70% of clinical breast cancer patients use natural products, which may increase the likelihood of drug interactions.Objective: To evaluate the evidence for the interactions between natural products and TAM in breast cancer.Methods: Electronic databases, including PubMed, CINAHL Plus (via EbscoHost), European PMC, Medline, and Google Scholar, were searched for relevant publications. The search terms include complementary and alternative medicine, natural products, plant products, herbs, interactions, tamoxifen, breast cancer, and their combinations.Results: Various in vitro and in vivo studies demonstrated that the combined use of natural products with TAM produced synergistic anti-cancer effects, including improved inhibition of tumor cell growth and TAM sensitivity and reduced side effects or toxicity of TAM. In contrast, some natural products, including Angelica sinensis (Oliv.) Diels [Apiaceae], Paeonia lactiflora Pall., Rehmannia glutinosa (Gaertn.) DC., Astragalus mongholicus Bunge, and Glycyrrhiza glabra L. [Fabaceae], showed estrogen-like activity, which may reduce the anti-cancer effect of TAM. Some natural products, including morin, silybin, epigallocatechin gallate (EGCG), myricetin, baicalein, curcumin, kaempferol, or quercetin, were found to increase the bioavailability of TAM and its metabolites in vivo. However, three are limited clinical studies on the combination of natural products and TAM.Conclusion: There is evidence for potential interactions of various natural products with TAM in pre-clinical studies, although the relevant clinical evidence is still lacking. Further studies are warranted to evaluate the potential interactions of natural products with TAM in clinical settings.

Stress is a non-specific response, the process of individual psychological disruption that can interfere with him in carrying out his job. This study aims to determine the effect of organizational and individual characteristics on the work stress of nurses in the inpatient room of Royal Prima Medan Hospital in 2019. This type of research is quantative with design cros-sectional. The sampling technique used the formula to take 25% of the total population, namely 60 nurses. Data collection techniques using questionnaires and research interview instruments. Data analysis was using the chi spearmen test if the p value .. Keywords: nurse, organizational, individual, work stress

Background: Healthcare is under attack in Syria with repeated air strikes on hospitals and ambulances and the largest death toll of health workers in any recorded conflict.1 Ambulances in Syria have been bombed, shot at, stolen, looted and obstructed, significantly impeding their ability to safely evacuate the wounded and provide medical aid., Methods: This article presents the summary of a literature review on attacks against ambulances in Syria from 2011 to 2018, as well as a descriptive secondary data analysis on individual attacks reported by the Syrian Network for Human Rights from January 2016 to December 2017. A peer-reviewed literature search included three databases (PubMed, ProQuest and Embase), and a grey literature search included reports from groups involved in the Syrian health response or human rights monitoring., Findings: From 2016 to 2017, there were 204 individual attacks involving 243 ambulances. Half (49%) were either heavily damaged or put out of service. The main perpetrators were the Syrian regime (60%) and the Russian armed forces (29%). Half (52%) of ambulances were directly targeted. The peer-reviewed literature search yielded 18 articles, from which the following themes were drawn: targeting of ambulances, 'double-tap' attacks, delays to care, obstruction and other forms of violence, and long-term consequences., Interpretation: Ambulances have been intentionally and repeatedly targeted throughout the Syrian conflict as part of a war strategy. Real challenges in monitoring and systematically tracking attacks on ambulances exist, but as a result, they are understudied and likely under-reported., Competing Interests: Competing interests: None declared.