Journal of Migration and Health最新文献

Background

The 1.5 generation, brought to the U.S. prior to age 16, faces barriers that the second generation, U.S.-born to immigrant parents, does not, including only temporary legal protection through the Deferred Action for Childhood Arrivals (DACA) Program. Little is known about how legal status and uncertainty shape cisgender immigrant young women's reproductive aspirations.

Methods

Drawing on the Theory of Conjunctural Action with attention to the immigrant optimism and bargain hypotheses, we conducted an exploratory qualitative study using semi-structured interviews with seven 1.5 generation DACA recipients and eleven second generation Mexican-origin women, 21-33 years old in 2018. Interviews focused on reproductive and life aspirations, migration experiences, and childhood and current economic disadvantage. We conducted a thematic analysis using a deductive and inductive approach.

Results

Data resulted in a conceptual model on the pathways through which uncertainty and legal status shape reproductive aspirations. Participants aspired to complete higher education and have a fulfilling career, financial stability, a stable partnership, and parents’ support prior to considering childbearing. For the 1.5 generation, uncertainty of their legal status makes the thought of parenting feel scary, while for the second generation, the legal status of their parents makes parenting feel scary. Achieving desired stability before childbearing is more challenging and uncertain for the 1.5 generation.

Conclusions

Temporary legal status constrains young women's reproductive aspirations by limiting their ability to achieve desired forms of stability prior to parenting and making the thought of parenting frightening. More research is needed to further develop this novel conceptual model.

Introduction

South Asian migrants in western countries have a high risk for diet related diseases post-migration. Hence knowledge on food habits that change post-migration, which are detrimental to health, are critical for health promotion initiatives to reduce this disease burden.

Objective

to describe food consumption changes post-migration according to sex and duration of residence in New Zealand among South Asian migrants.

Methods

A cross-sectional mail survey of 150 self-selected people of South Asian ethnicity aged 25–59 years in New Zealand.

Results

The study achieved responses from 112 participants (75%) with a mean age of 36 (7.5) years. Consumption of green leafy vegetables reduced post-migration for females and in new migrants (P < 0.05). Fruit consumption increased in both genders and across duration of residence (P < 0.05). Only 15% of males and 36% of females met the 3 + a day recommendation for vegetable consumption. Consumption of traditional breads, breakfast items and rice (males) decreased whilst that of breakfast cereals increased (P < 0.05). Consumption of low-fat milk, cheese, ice-cream, butter (females) and margarine increased, whilst ghee decreased (P < 0.05). Consumption of fish, lentils, traditional sweets and savouries decreased, whilst meat, processed meat, chicken, potato chips, cakes and pastries (females) and alcohol (males) increased (P < 0.05), post-migration. Thirty-three percent of males and 24% of females consumed takeaways “weekly or more often”, with the majority (male: 51%; female: 36%) consuming European foods such as pizzas and pastas. Thirteen percent of males and 26% of females consumed festival foods “weekly or more often.” More than half the participants were obese with BMI increasing with duration of residence (P = 0.025).

Conclusions

A food-based health promotion initiative focused on inadequate consumption of fruits and vegetables, increased consumption of dairy foods such as cheese and ice cream, and high fat European takeaway foods would be warranted particularly in new South Asian migrants.

Background

Refugees and asylum seekers often experience traumatic events resulting in a high prevalence of post-traumatic stress disorder (PTSD). Undiagnosed PTSD can have detrimental effects on resettlement outcomes. Immigration medical exams provide an opportunity to screen for mental health conditions in refugee and asylum seeker populations and provide links to timely mental health care.

Objective

To assess the diagnostic accuracy of screening tools for PTSD in refugee and asylum seeker populations.

Methods

We systematically searched Medline, Embase, PsycINFO, CENTRAL and CINAHL up to 29 September 2022. We included cohort-selection or cross-sectional study designs that assessed PTSD screening tools in refugee or asylum seeker populations of all ages. All reference standards were eligible for inclusion, with a clinical interview considered the gold standard. We selected studies and extracted diagnostic test accuracy data in duplicate. Risk of bias and applicability concerns were addressed using QUADAS-2. We meta-analyzed findings using a bivariate random-effects model. We partnered with a patient representative and a clinical psychiatrist to inform review development and conduct.

Results

Our review includes 28 studies (4,373 participants) capturing 16 different screening tools. Nine of the 16 tools were developed specifically for refugee populations. Most studies assessed PTSD in adult populations, but three included studies focused on detecting PTSD in children. Nine studies looked at the Harvard Trauma Questionnaire (HTQ) with diagnostic cut-off points ranging from 1.17 to 2.5. Meta-analyses revealed a summary point sensitivity of 86.6% (95%CI 0.791; 0.917) and specificity of 78.9% (95%CI 0.639; 0.888) for these studies. After evaluation, we found it appropriate to pool other screening tools (Posttraumatic Stress Disorder Checklist, the Impact of Event Scale, and the Posttraumatic Diagnostic Scale) with the HTQ. The area under the curve for this model was 79.4%, with a pooled sensitivity of 86.2% (95%CI 0.759; 0.925) and a specificity of 72.2% (95%CI 0.616; 0.808).

Conclusions

Our review identified several screening tools that perform well among refugees and asylum seekers, but no single tool was identified as being superior. The Refugee Health Screener holds promise as a practical instrument for use in immigration medical examinations because it supports the identification of PTSD, depression, and anxiety across diverse populations. Future research should consider tool characteristics beyond sensitivity and specificity to facilitate implementation in immigration medical exams.

Registration

Open Science Framework: 10.17605/OSF.IO/PHNJV

Background

Utilization of interpreters to facilitate communication between health care providers and non-native speaking patients is essential to provide the best possible quality of care. Yet use and policy on the subject vary widely, as does knowledge on the effect of different types of interpreters. This paper systematically reviews the literature on use of interpreters in the medical setting to evaluate their effects on the quality of care.

Material and methods

We conducted a literature search of PubMed and Embase, supplemented with references from relevant previous literature. We included any report in a medical setting comparing one type of interpretation to any other, including no interpretation and measuring a patient outcome. No limit was set on time or language. Risk of bias was assessed using the Evidence Project Risk of Bias assessment tool and the CASP checklist for qualitative studies. Results were synthesized using REDCap and presented in tables.

Results

We identified 29 reports represented by five types of studies. Types of interpreter intervention examined were professional, ad hoc, relational, any and no interpreter. Outcomes measured were satisfaction, communication, utilization and clinical outcomes. Results were indicative of in-person professional interpreter resulting in highest satisfaction and communication, reaffirming that any interpreter is better than none and relational interpreters can be a valuable interpreter resource for patients in the private practice setting. To be able to further differentiate on outcome for interventions of ad-hoc or relational interpreters, further data is needed.

Discussion

In-person Professional interpreter is the interpreter type resulting in greatest satisfaction and best communication outcome for the patients. This review is limited by most data originating from one country, interpretation from mainly Spanish to English and in one cultural setting.

Funding

No funding was provided for this review.

Introduction

Since the outbreak of the Covid-19 pandemic the scientific community had expressed its concerns about increased transmission of the virus within asylum seeker accommodation centers due to substandard living conditions and poor sanitation. Studies regarding management of Covid-19 cases in such facilities are urgently needed in order to guide international strategies on future pandemics within the humanitarian setting. Our study's paradigm of Covid-19 case management in a Greek migrant camp aims to add on existing data.

Data and Methods

A retrospective analysis of epidemiological and demographical data collected as part of a healthcare intervention in a Greek migrant camp during three Covid-19 epidemic waves is presented in this study. Descriptive statistics were generated using STATA 12.

Results

During the first wave, the camp's administration adopted a 2-month strict lockdown strategy and no positive cases were recorded. During the second wave, suspected coronavirus cases were referred for PCR testing and, in case of positivity were hospitalized. 3% (n = 28) of the camp's population were referred for PCR, with 1% of the population (n = 10) being tested positive for Covid-19 and admitted to hospital. Close contacts of positive cases were encouraged to comply with non-pharmaceutical interventions and were offered medical care if symptoms developed. During the third epidemic wave, in-camp management was decided by on-site operators, with rapid antigen testing of symptomatic individuals, daily monitoring of positive cases by the medical team and mass screening of their closed contacts. 4% (n = 33) of the camp's residents were tested positive, while none was hospitalized. 19% (n = 148) of the camp's population were considered close contacts, were advised to self-isolate and were offered mass screening with rapid antigen test, from which another 21 positive cases emerged. In total, 7% (n = 54) of the camp population, (n = 21) female adults, (n = 24) male adults and (n = 9) children, were infected with SARS-CoV-2 during the third epidemic wave, with no deaths being recorded. During the study period, only 50 residents had received one dose of Covid-19 vaccines.

Conclusion

We recommend an in-camp Covid-19 response featuring regular follow up of positive cases and prompt referral to tertiary centers based on clinical criteria, while overemphasizing the need for equitable access to primary healthcare for asylum seekers in Greece, primarily during the current pandemic. Prolonged camp lockdowns should be avoided as they pose substantial health risks for their vulnerable population.

Background

Switzerland is characterised by significant flows of migrants from different countries of origin and with different levels of education. More than half of recent migrants have reported experiencing prejudice or discriminatory practices in the last 24 months.

Methods

Based on a 2018 survey of 7,740 adult migrants (aged 24-64) who arrived in Switzerland in 2006 or later, we examine whether self-reported health is statistically associated with the perception of being a victim of prejudice or discrimination. Ordered logistic regressions are estimated using two indicators of discrimination: the frequency of discrimination and the number of places where discrimination occurs.

Results

The regression results show that discrimination, which is not necessarily based on ethnicity or migrant status, is associated with health status, even after controlling for possible confounding factors.

Discussion

Our results confirm those already observed in other countries of immigration. They suggest a likely association between perceived discrimination and self-reported health.

Background

Ensuring safety and wellbeing of all the minority populations of Pakistan is essential for collective national growth. The Pakistani Hazara Shias are a marginalized non-combative migrant population who face targeted violence in Pakistan, and suffer from great challenges which compromise their life satisfaction and mental health. In this study, we aim to identify the determinants of life satisfaction and mental health disorders in Hazara Shias and ascertain which socio-demographic characteristics are associated with post-traumatic stress disorder (PTSD).

Methods

We used a cross-sectional quantitative survey, utilizing internationally standardized instruments; with an additional qualitative item. Seven constructs were measured, including household stability; job satisfaction; financial security; community support; life satisfaction; PTSD; and mental health. Factor analysis was performed showing satisfactory Cronbach alpha results. A total of 251 Hazara Shias from Quetta were sampled at community centers through convenience method based on their willingness to participate.

Results

Comparison of mean scores shows significantly higher PTSD in women and unemployed participants. Regression results reveal that people who have low community support, especially from national and ethnic community, religious community, and other community groups, had higher risk of mental health disorders. Structural equation modeling identified that four study variables contribute to greater life satisfaction, including: household satisfaction (β = 0.25, p < 0.001); community satisfaction (β = 0.26, p < 0.001); financial security (β = 0.11, p < 0.05); and job satisfaction (β = 0.13, p < 0.05). Qualitative findings revealed three broad areas which create barriers to life satisfaction, including: fears of assault and discrimination; employment and education problems; and financial and food security issues.

Conclusions

The Hazara Shias need immediate assistance from state and society to improve safety, life opportunities, and mental health. Interventions for poverty alleviation, mental health, and fair education and employment opportunities need to be planned in partnership with the primary security issue.

Background

Forced displacement is associated with elevated risk for poor psychosocial wellbeing, yet there remains a lack of clarity around the effectiveness of commonly implemented psychosocial support interventions focused on preventing disorder and promoting wellbeing. This study aimed to synthesize the literature on evaluations of psychosocial support interventions for populations affected by forced displacement.

Methods

We searched for peer reviewed and gray literature in seven databases (PubMed, Embase, Global Health, CINAHL, SocIndex, PsychInfo, PILOTS), fifteen organizational websites, and via solicitation through multiple networks. Various study designs were included, with the criteria that they report an evaluation of a psychosocial intervention delivered to populations affected by forced displacement, and included quantitative or qualitative data on psychosocial outcomes. Records were screened independently by two reviewers at both title/abstract and full-text review; data was double-extracted and study quality assessed, with discrepancies resolved by consensus. Meta-analyses for seven outcomes were conducted on a subset of 33 studies.

Results

We identified 162 reports. Over half (55%) used a single-group study design, with fewer using non-random (19%) or randomized (21%) comparisons. Study designs incorporating comparison conditions were less likely to report positive findings than single-group studies. In the meta-analyses, a moderately strong overall effect was found for psychosocial wellbeing (ES: -0.534, 95% CI: [-0.870, -0.197], p=.005); small effects on both internalizing (ES: -0.152, 95% CI: [-0.310, 0.005], p= .057) and externalizing (ES: -0.249, 95% CI: [-0.515, 0.016], p=.064) problems were promising but not conclusive. Subgroup analysis suggested differential impacts on internalizing problems for adults (improvement; ES: -0.289, 95% CI: [-0.435, -0.143], p=.001) and children (worsening; ES: 0.129, 95% CI: [.054, 0.204], p=.002). Other subgroup analyses showed little meaningful variation by context, population, or intervention characteristics.

Conclusion

Pragmatic, field-driven program evaluations are dominated by single-group designs with significant risk of bias. Findings from controlled studies are promising but highlight a need for more rigorous research to support causal inference, align outcomes with theories of change, improve measurement of more positive or wellbeing-focused outcomes, examine subgroup differences, and report potentially negative impacts.

Introduction

Indianapolis is home to one of the largest Burmese communities in the United States; however, little is known of Burmese families’ experiences with medical providers. The complex health history of Burmese refugees, coupled with the necessity of quality childhood care for later development, demonstrates a need for medical residents to better understand their diverse patient populations. This study aimed to understand Burmese families’ perspectives on their interactions with their pediatric providers.

Material and methods

Semi-structured interviews were conducted with 15 Burmese refugee families, which were audio-recorded, transcribed, and translated. A patient-centered care framework guided interview questions and directed content analysis.

Results

Themes that emerged from individual interviews often related with cross-cultural communication, including patient engagement in care, challenges utilizing an interpreter, and concerns about discussing sensitive issues with healthcare workers. Overall, parents had positive perceptions of their child's pediatrician, but some distrusted interpreters and other members of the healthcare staff. Though parents reported a desire to be more involved in their child's care, they felt uncomfortable engaging with sensitive topics. A large barrier to care was lack of time during appointments.

Discussion

Through understanding the perspectives of Burmese refugee families, pediatricians and training programs for medical professionals may consider ways to enhance the patient-provider relationship and health outcomes for this population.

The psychosocial impact on people who were deported to Mexico from the United States or were forcibly returned tends to be greater than on those who return voluntarily. This text examines the way the emotional discomfort experienced by a group of Mexicans who were returned in these ways is constructed, through the analysis of anthropological interviews conducted with five women and thirteen men in which the following phases were explored: pre-migration, stay in the United States, return and reinsertion. This discomfort began in the pre-migration stage, during which they experienced various forms of disempowerment caused by the socioeconomic conditions of Mexico that determine the migratory trajectory, including reintegration. If, despite the disadvantages accumulated during the pre-migration phase, migrants manage to partly reverse their material and psychosocial disempowerment during their stay in the United States, on their return to a context such as Mexico, both their disempowerment and emotional discomfort are exacerbated. We therefore consider that the harm associated with the migratory saga will continue for an indefinite number of years following a person's return to Mexico and must be treated as a social rather than a clinical problem.