Ukrainian refugee crisis management in the Local Health Authority Roma 1: the challenges of implementing public health policies and lessons learned.

BACKGROUND: The conflict between Russia and Ukraine has strained the health systems of countries that welcome war refugees on all levels, from national to local. Despite the Public Health guidelines regarding assistance being published on the topic, the scientific literature currently lacks evidence on the experience of applying theory in practice. This study aims to describe evidence-based practices that were implemented and to provide a detailed description of emerging problems and solutions pertaining Ukrainian refugee assistance in the context of one of the biggest Local Health Authorities in Italy (LHA Roma 1). METHODS: LHA Roma 1 developed a strategic plan based on local expertise, national and international guidelines to ensure infectious disease prevention and control, as well as continuity of care for non-communicable diseases and mental health. RESULTS: The insertion of Ukrainian refugees in the National Health System through an identification code assignment and other services such as COVID-19 swab and vaccination were provided either in one of the three major assistance hubs or in local district level ambulatories spread throughout the LHA. Many challenges were faced during the implementation phase of the outlined practice guidelines, which required sensible and timely solutions. These challenges include the necessity of rapid resource provision, overcoming linguistic and cultural barriers, guaranteeing a standard of care across multiple sites and coordination of interventions. Public Private Partnerships, the creation of a centralized multicultural and multidisciplinary team and the mutually beneficial collaboration with the local Ukrainian community were essential to guarantee the success of all operations. CONCLUSIONS: The experience of LHA Roma 1 helps shed light on the importance of leadership in emergency settings and how a dynamic relationship between policy and practice would allow each intervention to be modulated according to the local environment, to better realize the potential of local realities to provide appropriate health interventions to all those in need.

Racial and Ethnic Differences in Bullying: Review and Implications for Intervention.

Despite increased research on bullying over the past few decades, researchers still have little understanding of how bullying differentially affects racial and ethnic minority and immigrant youth. To facilitate efforts to better evaluate the impact of bullying among racial and ethnic minority youth and improve interventions, we integrated research from multiple disciplines and conducted a systematic search to review relevant cross-cultural research on the prevalence of bullying, risk and protective factors, and differences in behaviors and outcomes associated with bullying in these populations. Studies measuring differences in bullying prevalence by racial and ethnic groups are inconclusive, and discrepancies in findings may be explained by differences in how bullying is measured and the impact of school and social environments. Racial and ethnic minorities and immigrants are disproportionately affected by contextual-level risk factors associated with bullying (e.g., adverse community, home, and school environments), which may moderate the effects of individual-level predictors of bullying victimization or perpetration (e.g., depressive symptoms, empathy, hostility, etc.) on involvement and outcomes. Minority youth may be more likely to perpetrate bullying, and are at much higher risk for poor health and behavioral outcomes as a result of bias-based bullying. At the same time, racial and ethnic minorities and immigrants may be protected against bullying involvement and its negative consequences as a result of strong ethnic identity, positive cultural and family values, and other resilience factors. Considering these findings, we evaluate existing bullying interventions and prevention programs and propose directions for future research.

[Pregnancies with somatic, psychiatric and social entanglements: a complex clinical presentation]. / Grossesses à intrications somatiques, psychiatriques et sociales : une clinique de la complexité.

The mother-infant programme of Delafontaine hospital in Saint-Denis operates in a territory characterised by psychosocial deprivation and multiculturalism. The account of the immediate post-partum care of a patient with epilepsy having given birth to twins illustrates the possible unease of the healthcare manager and the need for coordination between the hospital and community teams to offer the mother and infant optimal safety and wellbeing.

Belonging and Mental Wellbeing Among a Rural Indian-Canadian Diaspora: Navigating Tensions in "Finding a Space of Our Own".

Belonging is linked to a variety of positive health outcomes. Yet this relationship is not well understood, particularly among rural immigrant diasporas. In this article, we explore the experiences of community belonging and wellbeing among a rural Indian-Canadian diaspora in the Interior of British Columbia, Canada, our central research questions being, "What are the experiences of belonging in this community? How does a sense of belonging (or lack of) shape mental health and wellbeing among local residents?" Using a situational analysis research approach, our findings indicate that local residents must navigate several tensions within an overarching reality of finding a space of our own. Such tensions reveal contradictory experiences of tight-knitedness, context-informed notions of cultural continuity, access/acceptability barriers, particularly in relation to rural agricultural living, and competing expectations of "small town" life. Such tensions can begin to be addressed through creative service provision, collaborative decision making, and diversity-informed program planning.

Blindness, deafness, silence and invisibility that shields racism in nursing education-practice in multicultural hubs of immigration.

BACKGROUND: This paper relies on data from the multilevel, sectoral discussions held among professional nursing and sociology individuals. PURPOSE: To present the outcomes of a reflective process on racism in nursing education and practice in the cities of Toronto and Paris. METHOD: The method used was a reflection on research conducted by eight individuals dealing with racism at distinct stages of their professional career. The reflections are organized as a systematic description of facts, noted feelings, appraisal of issues, analysis of learned lessons, and lead to recommendations for nursing education and practice. RESULTS: The promotion of social justice and social inclusion has become a matter of nursing practice, yet a lack of critical discussion about racism with racialized students may result in feelings of being silenced. Increased awareness of racial negligence within a clinical setting can instigate change and allow nursing professionals to advocate for more culturally-sensitive care for a multicultural clientele. Insight from nurses with different professional status and from different racial backgrounds will garner an understanding of how the experiences of racism are in some ways individualized. CONCLUSION: A collective reflection is required to understand the factors that underpin racism in nursing and can be used to elicit dialogue on a national and international scale in order to address racism in global nursing.

Levers and Barriers to Vaccinate against COVID-19 in the Multicultural Context of French Guiana: A Qualitative Cross-Sectional Survey among Health Care Workers.

In French Guiana, a French overseas territory in South America facing a fourth wave of COVID-19, vaccination coverage is very low, both in the population and among health care workers (HCWs). Vaccine hesitancy concerned 35.7% of the latter in early 2021. The objective of this complementary study is to understand barriers and levers and to adapt messages to increase vaccination coverage among HCWs. We conducted a regional cross-sectional survey of HCWs with a questionnaire containing open-ended questions exploring factors associated with vaccine hesitancy and the needs to adapt the vaccination campaign in French Guiana. The discourses were analyzed using a qualitative approach based on grounded theory, with open coding of data by themes and construction of abstract categories. The analysis of the 357 responses collected from January to March 2021 reveals several trends. The ethical aspect of the HCWs' role emphasizes the importance of getting vaccinated themselves (to protect patients, to set an example...) and of vaccinating as many people as possible, including the most geographically or socially distant, such as undocumented migrants. However, some HCWs remain suspicious of the vaccine with concerns over the efficacy and side effects, of health institutions, and of the pharmaceutical industry. The role of fake news circulating on social networks has been widely discussed. Efforts to explain and convince HCWs must be continued in French Guiana using the identified levers to improve the acceptability of vaccination.

Toward the Development of Antiracist and Multicultural Graduate Training Programs in Behavior Analysis.

Racist policies and inequity are prevalent in society; this includes higher education institutions. Many behavior-analytic training programs have been complicit in omitting cultural humility and antiracist ideas from their curricula and institutional practices. As societal demands for allyship and transformational change increase, programs must rise to the challenge and act as agents of change in our clinical, professional, and personal communities. The current article offers a multitude of strategies for institutions to develop an antiracist and multicultural approach. These recommendations encompass policies that may be promoted at the following levels: (a) in organizational infrastructure and leadership, (b) within curricula and pedagogy, (c) in research, and (d) with faculty, students, and staff.

La salud pública en contextos pluriculturales. Avances y retrocesos / Public health in pluricultural contexts. Advances and setbacks

La cultura constituye un complejo dinámico de conocimientos, creencias, conductas aprendidas y transmitidas por generaciones, a través del lenguaje y la vida cotidiana. El concepto de cultura se relaciona con el proceso salud-enfermedad puesto que el bienestar social, espiritual, psicológico y biológico de individuos y comunidades es expresión del medio ambiente, estilo de vida, vivienda, alimentación, educación y acceso adecuado a bienes y servicios. En el campo de salud se identifican la medicina tradicional desarrollada por pueblos indígenas; la medicina popular basada en creencias de la familia y la comunidad y la medicina profesional, basada en el estudio científico. La medicina indígena se caracteriza por la atención holística del sujeto, asequibilidad y acceso en poblaciones donde los sistemas de salud oficiales no tienen presencia, no obstante, presenta bajo reconocimiento por parte de los gobiernos. Con el presente estudio se pretende reflexionar acerca de la importancia de fomentar la interculturalidad en salud con base en las necesidades, organización y visión del mundo de los pueblos indígenas a partir del enfoque intercultural. Se expone una panorámica que aborda con mirada actual, las particularidades de la interculturalidad y la multiculturalidad en el contexto pluricultural, que contribuye a un mejor entendimiento de la necesidad de redimensionamiento de los sistemas de salud a partir de los elementos que aporta el enfoque intercultural como modelo de franca concepción humanista, en contraposición con el modelo hegemónico de salud actual, que favorece las desigualdades en salud(AU)

Culture constitutes a dynamic complex of knowledge, beliefs, behaviors learned and transmitted through generations, through language and everyday life. The concept of culture is related to the health-disease process since the social, spiritual, psychological and biological well-being of individuals and communities is an expression of the environment, lifestyle, housing, food, education and adequate access to goods and services. In the field of health, traditional medicine developed by indigenous peoples is identified; folk medicine based on family and community beliefs; and professional medicine, based on scientific study. Indigenous medicine is characterized by the holistic care of the subject, affordability and access in populations where the official health systems do not have a presence, however, it is under recognition by governments. This study aims to reflect on the importance of promoting interculturality in health based on the needs, organization and worldview of indigenous peoples from the intercultural approach. A panorama is presented that addresses with a current perspective, the particularities of interculturality and multiculturalism in the multicultural context, which contributes to a better understanding of the need to resize health systems based on the elements provided by the intercultural approach such as model of frank humanist conception, in contrast to the current hegemonic model of health, which favors inequalities in health(AU)

The role of civil society organizations in the institutionalization of indigenous medicine in Bolivia.

December 2013 marked a significant shift in Bolivia with the enactment of a law for the inclusion of indigenous doctors in the National Health System. This article traces the constellation of forces that led to the institutionalization of indigenous medicine in Bolivia. It identifies three factors contributing to this health policy change. The first factor is the crystallization of a strong indigenous movement fighting for the recognition of cultural rights through the foundation of civil society organizations. Second is the rise to power of Evo Morales, the first Latin American president of indigenous origin, who has promoted multicultural policies, formally supported through the promulgation of a new constitution. Lastly is the influence of the global acceptance of alternative medicine. Indigenous doctor organizations in Bolivia have been highly involved throughout the entire process of institutionalization and have played a crucial role in it. An analysis of the relationship between these civil society organizations and the Bolivian government reveals a strong partnership. This dynamic can be described in terms of Interdependence Theory, as each party relied on the other in the promotion and practice of the law to achieve the integration of indigenous medicine as part of the Bolivian Health System.

Commentary on a framework for multicultural education.

Today's changing demographics require that multicultural factors be considered in the delivery of quality patient-centred health care in chiropractic. Yet minimal training in cultural competency in chiropractic education leaves graduates ill-equipped to treat a diverse population. This commentary examines cultural competency training in current literature, demonstrates frameworks for curriculum integration, and suggests how cultural competency might be included in a chiropractic college curriculum. A database search yielded little evidence that cultural competency is integrated into curricula of chiropractic schools. Some journal articles note that promoting multicultural education and cultural sensitivity is an important goal. However, they provide no mechanisms as to how this can be achieved within training programs. Thus, although an undeniable need exists for all healthcare practitioners to develop cultural competency in the face of an increasingly diverse population, cultural competency education has not kept pace. Chiropractic schools must review their curricula to develop the cultural competencies of their graduates and a basic framework is suggested.

Les changements démographiques de nos jours exigent la prise en considération de facteurs multiculturels dans l'administration de soins chiropratiques de qualité axés sur les patients. Pourtant, la formation minimale en compétences culturelles que les diplômés reçoivent pendant leurs études en chiropratique les laisse mal préparés pour soigner une population culturellement diverse. Cet article examine la formation en compétences culturelles dans la documentation spécialisée, indique des structures pour son intégration dans les programmes d'études, et propose les étapes d'intégrer les compétences culturelles dans un cursus de collège de chiropratique. Une recherche des bases de données a révélé peu de preuves indiquant que les compétences culturelles fassent partie du programme des écoles de chiropratique. Certains articles de journaux font remarquer que la promotion d'une éducation multiculturelle et d'une sensibilité culturelle est un objectif important. Cependant, ils ne mentionnent aucun mécanisme pour réaliser cet objectif dans les programmes de formation. Donc, malgré le besoin incontestable de développement de compétences multiculturelles chez les praticiens de soins de santé devant la diversité croissante de la population, la formation en compétences culturelles n'a pas suivi. Les écoles de chiropratique doivent revoir leurs programmes d'études afin de développer les compétences culturelles de leurs étudiants. Pour accomplir ceci, un système élémentaire est proposé.

Atención médica y diferencia cultural. Acceso a atención médica de mujeres musulmanas en Bogotá / Medical Care and Cultural Difference. Access to Medical Care by Muslim Women in Bogota / Atendimento médico e diferença cultural. Acesso a atendimento médico de mulheres muçulmanas em Bogotá

Resumen Desde 1991 Colombia se define constitucionalmente como un país multicultural. Sin embargo, la aplicación de esta definición es aún incierta. Sobre esta base, el texto explora la relación entre diversidad cultural y acceso a servicios de salud, a partir del caso de las mujeres musulmanas en la ciudad de Bogotá, Colombia. Se plantea cómo los estilos de vida, el género y los sistemas de creencias afectan las trayectorias de cuidado y el encuentro terapéutico de personas definidas como musulmanes en los servicios de atención médica. Se desarrolló un trabajo de corte cualitativo, donde se articulan la salud pública y la antropología médica. Se encontró que el acceso a la atención médica de las mujeres musulmanas está mediado por interacciones sociales que facilitan los desencuentros médicos. De allí que la promoción de la salud y la prevención de la enfermedad requieran la comprensión e integración de la cultura como categoría mediadora en la salud pública.

Abstract Since 1991, Colombia has been defined as a multicultural country. However, the application of this definition is uncertain still. With this background, our text explores the relationship between cultural diversity and the access to health services based on the case of Muslim women in Bogota, Colombia. We propose how lifestyles, gender, and belief systems affect the path of care and the therapeutic meeting of people defined as Muslim in the health care services. We developed a qualitative work articulating public health and medical anthropology. We found that the access to medical care of Muslim women is mediated by social interactions facilitating medical disagreements. From there we surmise that health promotion and disease prevention require the understanding and integration of culture as a mediating category in public health.

Resumo Desde 1991 Colômbia é definida constitucionalmente como país multicultural. No entanto, a aplicação desta definição ainda tem incerteza. Sobre esta base, o texto explora a relação entre diversidade cultural e acesso a serviços de saúde, a partir do caso de mulheres muçulmanas na cidade de Bogotá, Colômbia. Coloca-se como os estilos de vida, o gênero e os sistemas de crenças afetam as trajetórias de cuidado e o encontro terapêutico de pessoas definidas como muçulmanos nos serviços de atenção médica. Um trabalho de tipo qualitativo onde é articulada a saúde pública e a antropologia médica foi desenvolvido. Encontrou-se que o acesso ao atendimento médico das mulheres muçulmanas está mediado por interações sociais que facilitam os desencontros médicos. Daí que a promoção da saúde e a prevenção de doença requeiram a compreensão e integração da cultura como categoria mediadora na saúde pública.

Acercamiento a las necesidades de salud de la mujer en una población multicultural / Approach to health needs in women belonging to a multicultural population

Resumen:

Objetivo: este trabajo pretende, desde una visión enfermera, acercarse a las necesidades de salud de la población multicultural actual. Los objetivos son conocer el perfil sociodemográfico que presentan las mujeres atendidas por la Unidad de Gestión Clínica de Tocoginecología y describir los motivos de ingreso y el tiempo de estancia media que presentan las mujeres inmigrantes y autóctonas en dicha unidad. Método: se ha realizado un estudio descriptivo transversal utilizando un enfoque cuantitativo. La población de estudio han sido las mujeres procedentes de diferentes regiones asistidas en la UGC de Tocoginecología del Hospital Juan Ramón Jiménez de Huelva, España.

Resultados: el tratamiento y análisis de los datos se ha realizado con el programa Spss 15. Los resultados evidencian que el mayor porcentaje de mujeres atendidas después de las autóctonas, corresponde a las procedentes de Marruecos y Rumanía, cuyos principales motivos de ingreso han sido obstétricos. La estancia media hospitalaria se encuentra en torno a los 2 o 3 días.

Abstract:

Objectives: The present work is aimed at approaching, from a nursing point of view, current health needs in a multicultural population. We set out at establishing socio-demographic profiles in women presenting at an Obstetrics and Gynecology Clinical Management Unit, and at describing the reasons for admission and mean stay duration in immigrant and autochthonous women in the Unit. Method: A descriptive cross-sectional study was conducted, based on a quantitative approach. Study population consisted of women from various regions attending the Obstetrics and Gynecology Unit, Hospital Juan Ramón Jiménez, Huelva, Spain. Results: Data management and analysis were performed with software package SPSS v. 15. Results show the following decreasing order for the proportion of women receiving care: autochthonous followed by women from Morocco and Rumania, mainly admission reasons being obstetrical. Mean hospital stay is about 2 to 3 days.

Objetivo: este trabalho procura, com a perspectiva de abordagem da Enfermagem, conhecer as necessidades de saúde da população multicultural atual. Os objetivos são: identificar o perfil sócio-demográfico das mulheres atendidas pela Unidade de Gestão Clinica de Obstetrícia e Ginecologia; descrever os motivos para a admissão e o tempo de permanência média apresentados pelas mulheres imigrantes e pelas mulheres espanholas. Método: foi realizado um estudo descritivo, transversal, com abordagem quantitativa. A população do estudo é constituída por mulheres de diferentes regiões, que são atendidas na UGC de Obstetrícia e Ginecologia do Hospital Juan Ramón Jiménez da cidade de Huelva. Resultados: o processamento e análise dos dados foram realizados usando o programa SPSS 15. Os resultados mostram que a maior porcentagem de mulheres atendidas corresponde às autóctones, seguidas de mulheres imigrantes provenientes de Marrocos e Romênia, respectivamente, cujos principais motivos para admissão foram os obstétricos. A média de tempo de internação hospitalar é de 2 a 3 dias.