Journal of Immigrant and Minority Health最新文献

Health literacy is essential for navigating healthcare systems and making informed decisions. Migrant and minority ethnic populations often face barriers that impact their health literacy and access to care. This study explored the health literacy profiles and lived experiences of African and Latin American communities in England. A mixed-methods study was conducted using Phase 1 of the Ophelia (Optimising Health Literacy and Access) process. Sixty-five participants completed the Health Literacy Questionnaire (HLQ), and hierarchical cluster analysis identified distinct health literacy profiles. Two focus groups (n = 7 each) were held to explore participants' experiences in greater depth. Qualitative data were analysed using thematic analysis. While participants demonstrated strengths in accessing and understanding health information, significant disparities emerged in areas requiring institutional engagement, trust in healthcare providers, and emotional support. Key barriers included digital exclusion, limited interpreter availability, fear of immigration consequences, and experiences of being dismissed or misunderstood in clinical settings. These challenges disproportionately affected asylum seekers and those with insecure immigration status, reflecting structural vulnerability and institutional racism. The study highlights the limitations of individual-level interventions and calls for system-wide changes to address the relational and structural barriers that undermine health equity. Improving health literacy among migrant populations requires more than accessible information. Equity-focused, co-designed interventions that confront institutional racism, invest in culturally safe communication, and prioritise emotional safety are essential to reducing racial and ethnic health disparities.

Undocumented immigrants experience profound disparities in access to life-sustaining kidney dialysis care due to exclusion from federal insurance programs. In most states, these individuals receive dialysis only under emergency conditions, a practice associated with higher mortality, increased hospitalizations, and significant psychosocial burden compared to scheduled outpatient dialysis. Immigration policy volatility further complicates care delivery and introduces unique challenges for clinical research involving this population. We examine the intersection of immigration policy, dialysis access, and research ethics in the current political climate in the United States, highlighting how systemic barriers and fear of deportation contribute to underrepresentation of undocumented patients in clinical trials. We review current policy frameworks, summarize evidence on health outcomes under emergency-only dialysis, and propose strategies to maintain scientific rigor and equity in research during periods of policy instability.

Forced migration, as exemplified by the ongoing Syrian refugee crisis, has been consistently associated with elevated rates of psychiatric conditions, including post-traumatic stress disorder (PTSD), depression, anxiety, and increased suicide risk. However, the psychological mechanisms linking trauma-related symptoms to suicide risk in refugee populations remain insufficiently understood. The present study examines the mediating role of anxiety sensitivity in the relationship between PTSD symptoms and suicide risk among Syrian refugees residing in Turkey. Data were collected from 627 Syrian refugees aged 18-65 years living in Bursa province. Participants completed validated self-report measures assessing PTSD symptoms (Impact of Event Scale-Revised; IES-R), depression (Beck Depression Inventory; BDI), anxiety sensitivity (Anxiety Sensitivity Index-3; ASI-3), and suicide risk (Suicide Probability Scale; SPS). Elevated PTSD symptom levels were observed in 81.2% of the sample. Logistic regression and mediation analyses were conducted to examine associations between PTSD symptom clusters, anxiety sensitivity dimensions, and suicide risk. Results indicated that intrusion and hyperarousal symptoms were positively associated with suicide risk, whereas avoidance symptoms and physical concern (ASI-3 subscale) were negatively associated. Mediation analysis revealed that cognitive concern-defined as fear of losing mental control-partially mediated the association between PTSD symptoms and suicidal ideation (SPS suicidal ideation subscale). Taken together, these findings suggest that maladaptive interpretations of cognitive distress may represent a clinically relevant target for reducing suicide risk in trauma-exposed refugee populations. In contrast, avoidance and heightened awareness of bodily sensations may function as temporary protective strategies in the context of overwhelming stress. Overall, the findings underscore the importance of trauma-informed interventions that prioritize suicide stabilization in forcibly displaced individuals prior to the initiation of PTSD-focused treatment.

Despite being eligible for transplant, undocumented transplant recipients have reported being told they were ineligible for transplantation due to their citizenship status, delaying access to transplant. The objective of this nationally representative survey-based study was to understand nephrology trainees' knowledge of transplant eligibility, transplant benefits, and clinical experience working with undocumented immigrants, utilizing an existing annual survey instrument by the American Society of Nephrology in May 2023. The main outcome was responses to survey items, and logistic regression and Chi-square tests were used to evaluate associations between transplant eligibility knowledge and transplant referral practices. Of 954 nephrology fellows, 450 responded (response rate 47%). A minority correctly identified undocumented individuals were eligible for transplant (39.1% for living donor and 31.7% for deceased donor). 45% of trainees were unsure of the available insurance options for undocumented immigrants. Correctly identifying living and deceased donor transplant eligibility was significantly associated with referring undocumented people to transplant (p<0.001). To our knowledge, this is the first study to examine clinicians' knowledge and experiences regarding transplant eligibility for undocumented individuals. These findings highlight the need for targeted educational interventions to improve trainees' understanding of transplant eligibility and insurance barriers for undocumented immigrants, ultimately fostering more equitable access to kidney transplantation for this vulnerable population.