Journal of Immigrant and Minority Health最新文献

Asylum medicine clinics that train clinicians to conduct forensic medical and mental health evaluations (FME) have proliferated in the United States, but there is still significant unmet need in training. We created a 12-week curriculum to develop the core skills needed to conduct effective, trauma-informed FME. Our course used a "flipped classroom" model; participants reviewed didactics in advance from a national, peer-reviewed training program, the Asylum Medicine Training Initiative, and used in-class time for case-based practice as experiential learning. Participants completed feedback surveys after each session in addition to pre-and post-course assessments. Sixteen clinicians with diverse geographic, professional, and demographic backgrounds participated in the course from January-March 2023. The three key themes that emerged from qualitative feedback were high participant satisfaction with the course model; participant desire for additional opportunities for practice; and participant desire for community-building. Post-course surveys showed that most participants felt only "somewhat comfortable" with the core skills emphasized in the course. Taken together, these findings suggest that curricula in asylum medicine should focus on experiential learning, skills practice, and building longitudinal mentorship. This curriculum is an innovative educational model that differs from the traditional didactic training that has been the mainstay in asylum medicine education. The curriculum is replicable and can be tailored to local environments or broad virtual communities.

Healthcare providers (HCPs) play a critical role in the care of women with experience of FGM/C although there is limited research on knowledge about FGM/C among HCPs in Canada and USA. Research evidence suggests that many women with experience of FGM/C have negative care experiences. We sought to investigate the knowledge, attitudes, and practices of Canadian and USA HCPs regarding FGM/C, along with women's healthcare experiences with FGM/C in both countries. We conducted a scoping review guided by Arksey & O'Malley's framework. We exported 4054 peer-reviewed records from Embase, Global Health PubMed, Medline, and Scopus databases. After screening titles, abstracts and full texts using inclusion criteria such as publication between 2000 and 2023, a focus on FGM/C and studies conducted in USA and Canada, we included 13 articles in the final review. Care provider studies revealed that HCPs reported a desire for more knowledge and training to enable them to provide high-quality care for women with FGM/C. Majority of the studies have revealed reliance of HCPs on informal learning channels to gain knowledge on FGM/C. Findings reveal that many women with experiences of FGM/C have reported insensitive comments from HCPs including some nurses' unsympathetic behavior toward FGM/C related postpartum discomfort. In some studies, majority of the women felt their doctors were unable to care for them while other women noted that shame and discomfort deterred them from further care seeking. HCPs play an important role in caring for FGM/C patients. Nonetheless HCPs often receive no training or training that is inadequate (insufficient to make providers feel confident to provide care) on how to provide high-quality, culturally competent care leading to poor experiences for women. This necessitates concerted efforts to provide high-quality training of HCPs for better care for women with FGM/C.

We investigated whether ethnocultural inequality in rates of gestational diabetes was prevalent in Canada. We compared the Anglophone minority with the Francophone majority in Quebec. We conducted a retrospective cohort study of 853,595 pregnancies between 2008 and 2020 in Quebec, Canada. The exposure was ethnocultural status, with patients classified as either Anglophone or Francophone based on the maternal language. The outcome was gestational diabetes. We calculated risk ratios (RR) and 95% confidence intervals (CI) for the association between ethnocultural status and risk of gestational diabetes using log-binomial regression models adjusted for maternal age, parity, comorbidity, education, country of origin, material deprivation, urban residence, and time period. Anglophones had a higher rate of gestational diabetes compared with Francophones (99.0 vs 81.0 per 1000 pregnancies; RR 1.07, 95% CI 1.05-1.10). Anglophones aged less than 25 years (RR 1.31, 95% CI 1.21-1.41), living in rural areas (RR 1.73, 95% CI 1.64-1.82), lacking a high school diploma (RR 1.48, 95% CI 1.37-1.61), or with material disadvantage (RR 1.33, 95% CI 1.27-1.39) had greater risks of gestational diabetes compared with Francophones. Risk of gestational diabetes among Anglophones increased over time, especially among disadvantaged subgroups of the population. The findings suggest that the Anglophone ethnocultural minority in Quebec has an increasing risk of gestational diabetes over time compared with the Francophone majority. Risks are particularly elevated for Anglophones from disadvantaged subgroups of the population.

The mental health of asylum seekers and refugees (ASRs) is a pressing global concern, with complex trauma histories and environmental stressors contributing to heightened vulnerability. This study investigates the mental health and service utilization patterns of ASRs in Hong Kong, where unique policy landscapes pose additional challenges to this population. A cross-sectional survey was conducted with 100 ASRs in Hong Kong. Participants completed measures assessing displacement-related stressors, trauma exposure, mental health symptoms (depression, anxiety, stress, PTSD/CPTSD), and mental health service utilization. Participants reported high levels of displacement-related stressors and trauma exposure. The majority exhibited symptoms of depression, anxiety, and stress, with a significant proportion screening positive for PTSD/CPTSD. Despite high mental health needs, their service utilization rates were low. Trauma exposure and displacement-related stressors were significantly associated with poorer mental health outcomes, but not with service utilization. ASRs in Hong Kong face significant mental health challenges, influenced by both pre- and post-migration factors. Findings underscore higher rates of mental distress in the present sample compared to prior studies in ASRs and other local surveys. While trauma-informed care is crucial, efforts to improve mental health service access and reduce systemic barriers are needed with targeted strategies and policy changes.

Brazilians are a rapidly growing immigrant population in the United States (U.S.), yet little is known about their mental health and access to mental healthcare. Our goal was to access associations between the pursuit of- and access to-mental healthcare with mental health status and socio-demographic characteristics among Brazilian immigrant women. We conducted an online survey of Brazilian women aged 18 or older who reported being born in Brazil and currently residing in the U.S. We recruited respondents via Brazilian cultural media, community organizations serving Brazilian immigrants, and social media. We assessed respondents' perceived access to mental healthcare, self-reported mental health (CES-D-10), and socio-demographic characteristics and conducted multivariable logistic regression. Our analysis included 351 participants. Half (52%) had CES-D-10 scores indicating high levels of depressive symptomatology. A third (33%) reported seeking care for their mental health in the past 12 months, 87% of whom reported obtaining care. Results of multivariable logistic regression determined that respondents who sought mental healthcare were more likely to have higher CES-D-10 scores (OR = 1.09, 95% CI 1.03-1.15), very low incomes (<$10,000 per year; OR = 0.34, 95% CI 0.12-0.96), and were marginally more likely to have a primary care provider (OR = 2.11, 95% CI 1.00, 4.46). We found that despite a high level of depressive symptomology, only one-third reported accessing care. While difficulty accessing care for mental issues is a widespread issue, our findings suggest that efforts are needed to ameliorate mental health issues for Brazilian women to reduce systemic, interpersonal, and individual barriers to seeking care among the 13% who sought healthcare but were unable to receive it.

Higher concentrations of heavy metals were reported mainly among adult Asian persons compared to other racial/ethnic groups in earlier NHANES cycles' studies. We aimed to examine concentrations of metals among Asian children/adolescents compared to children/adolescents identifying with other racial/ethnic groups, considering socio-demographic factors and potential mediation by fish/shellfish consumption. Using NHANES data (2015-2018), 5293 participants (1-19 years) with blood/urinary measurements of lead, cadmium, mercury and arsenic were included. Survey-weighted adjusted generalized linear models assessed differences in log-transformed metal concentrations between Asian and non-Asian participants, considering potential effect measure modification by parental education. Causal mediation effects of recent fish/shellfish consumption were estimated. Log-transformed metal concentrations were higher among Asian than among non-Asian children/adolescents. Lower parental education was associated with higher concentrations of cadmium and methylmercury among Asian participants, and effect measure modification was suggested. Proportions of the mercury exposure disparity mediated by recent fish/shellfish consumption were 9.1% (95% CI 2.6, 17.3%) for fish, and 5.7% (0.5, 12.0%) for shellfish, with similar findings for methylmercury. Overall, Asian identification was associated with higher toxic metal exposure, and among Asian children/adolescents those with parents with lower education were particularly affected. Dietary fish/shellfish intake explained a portion of the disparities. Prevention efforts should identify sources of elevated metal exposure focusing children and adolescents while considering diverse backgrounds and dietary habits including high fish consumption.

Based on the Reserve Capacity Model, this study examined the effect of SES(socioeconomic status) on health status on the health status of menopausal mothers of multicultural families, focusing on mediating effects of self-esteem, assimilation, integration, separation, marginalization, and daily life stress. This is a cross-sectional survey study with secondary analysis of national data on 683 perimenopausal mothers in multicultural families from the 9th Multicultural Adolescents Panel Study surveyed by the Korea Youth Policy Institute in 2019. The subjects were women aged 45-55 years and foreign nationals by origin. For path analysis using observed variables, the Mplus 8.4 program was used. Self-esteem and integration were positively related to health status and negatively related to marginalization and daily life stress. Health status was higher when self-esteem and integration were high, and work-life stress and marginalization were low. To improve the perceived health status of menopausal women in multicultural families, rather than simply focusing on SES through support for employment status and income, it is necessary to improve self-esteem by resolving difficulties caused by SES and cultural adaptation to relieve stress in daily life and to provide multidimensional coping resources that can improve health by lowering risk.

Immigrants intended to more rely on self-medication because of the difficulty of accessing formal healthcare in host countries. Negative consequences could occur when self-medication was inappropriate. This study aimed to systematically explore the prevalence, sources and determinants of immigrants' self-medication and the extent of their inappropriate self-medication episodes. PubMed, Scopus, SpringerLink, and ScienceDirect were used for data searching. The search date was 10th June 2023, with no beginning date to limit searching articles. Thirty-two studies were included. The prevalence of immigrants' self-medication presented from 18 studies ranged between 20.2% and 94.6%. Major sources of immigrants' self-medication were commonly obtained from their home countries, local markets or shops, and informal networks. The determinants of immigrants' self-medication were systematically collated into four themes: (1) illness and self-medication perception, (2) access to healthcare and medication, including 6 dimensions: accessibility, availability, affordability, acceptability, awareness and accommodation, (3) worry, and (4) predisposing factors of immigrants. About 46% of immigrant's self-medication episodes were inappropriate, especially antibiotic use. About 66% of the included studies described antibiotic self-medication. Prevalence rates of self-medication among different immigrantsvaried based on different time frames, context of diseases and migrated countries. Immigrants' cultural health belief, facing significant worry about job security, legal status, and cultural barriers influenced their self-medication. When immigrants have greater availability, accommodation, awareness, accessibility, acceptability, and affordability of health services in host countries, they are less likely to use self-medication. The predisposing factors like age, income, work status and immigrants' language also influenced their self-medication.