Journal of Immigrant and Minority Health最新文献

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.

Hepatitis C virus (HCV) infection is increasingly reported among Rohingya refugees in Cox's Bazar, with active infection rates in adults reaching 20% by 2023. The risk of liver disease progression and hepatocellular carcinoma (HCC) may be amplified by coexisting factors such as chronic malnutrition, coinfections, aflatoxin exposure, metabolic disorders, and environmental toxins. Despite WHO-led efforts, data on these risk factors remain fragmented, and access to care is limited. This study underscores the need for comprehensive surveillance, epidemiological research, and long-term prevention strategies to reduce HCV-related morbidity and the future burden of HCC in displaced Rohingya populations.

Domestic Abuse [DA] is a pattern of behavior that is used to gain or maintain power and control over a partner or family member. Despite the prevalence of DA in African communities across Canada, little is known about their level of DA knowledge, or the causes and perceptions about DA in these communities. Our study sought to investigate the level of DA knowledge held by African communities in Canada, and identify what they believe to be the causes and solutions to DA. A cross-sectional survey was conducted with members of African communities in Alberta Canada. Participants were recruited using convenience and snowball sampling. A pilot tested survey questionnaire was used for data collection. Using Slovin's formula, the minimum sample size was determined to be 385 participants. Out of 478 participants, 370 (77.4%) had high DA knowledge. The association between sociodemographic variables and knowledge of DA-related behaviors was not statistically significant. Involvement of community and faith leaders was most popular for raising DA awareness, and DA education was most popular for preventing DA. Economic and cultural factors were deemed the main causes of DA, while counselling was most popular for DA intervention. The findings suggest a knowledge-attitude gap in DA awareness, emphasizing the need for education that addresses deeper sociocultural and systemic contributors to abuse. Applying a socio-ecological lens, interventions should target multiple levels of influence to be culturally relevant and effective.