Access to Vaccination for Newly Arrived Migrants: Developing a General Conceptual Framework for Understanding How to Improve Vaccination Coverage in European Countries.

Objectives: Access to vaccination for newly arrived migrants (NAMs) is a relevant concern that requires urgent attention in EU/EEA countries. This study aimed to develop a General Conceptual Framework (GCF) for understanding how to improve vaccination coverage for NAMs, by characterizing and critically analyzing system barriers and possible strategies to increase vaccination. Methods: A theoretical conceptualization of the GCF was hypothesized based on conceptual hubs in the immunization process. Barriers and solutions were identified through a non-systematic desktop literature review and qualitative research. The GCF guided the activities and facilitated the integration of results, thereby enriching the GCF with content. Results: The study explores the vaccination of NAMs and proposes strategies to overcome barriers in their vaccination process. It introduces a framework called GCF, which consists of five interconnected steps: entitlement, reachability, adherence, achievement, and evaluation of vaccination. The study also presents barriers and solutions identified through literature review and qualitative research, along with strategies to enhance professionals' knowledge, improve reachability, promote adherence, achieve vaccination coverage, and evaluate interventions. The study concludes by recommending strategies such as proximity, provider training, a migrant-sensitive approach, and data collection to improve vaccination outcomes for NAMs. Conclusion: Ensuring equitable access to healthcare services, including vaccination, is crucial not only from a humanitarian perspective but also for the overall public health of these countries.

Risk of Covid-19 Severe Outcomes and Mortality in Migrants and Ethnic Minorities Compared to the General Population in the European WHO Region: a Systematic Review.

The Covid-19 pandemic has had a major impact on migrants and ethnic minorities (MEMs). Socio-economic factors and legal, administrative and language barriers are among the reasons for this increased susceptibility. The aim of the study is to investigate the impact of Covid-19 on MEMs compared to the general population in terms of serious outcomes. We conducted a systematic review collecting studies on the impact of Covid-19 on MEMs compared to the general population in the WHO European Region regarding hospitalisation, intensive care unit (ICU) admission and mortality, published between 01/01/2020 and 19/03/2021. Nine researchers were involved in selection, study quality assessment and data extraction. Of the 82 studies included, 15 of the 16 regarding hospitalisation for Covid-19 reported an increased risk for MEMs compared to the white and/or native population and 22 out of the 28 studies focusing on the ICU admission rates found an increased risk for MEMs. Among the 65 studies on mortality, 43 report a higher risk for MEMs. An increased risk of adverse outcomes was reported for MEMs. Social determinants of health are among the main factors involved in the genesis of health inequalities: a disadvantaged socio-economic status, a framework of structural racism and asymmetric access to healthcare are linked to increased susceptibility to the consequences of Covid-19. These findings underline the need for policymakers to consider the socio-economic barriers when designing prevention plans. Supplementary Information: The online version contains supplementary material available at 10.1007/s12134-023-01007-x.

Risk of SARS-CoV-2 infection in migrants and ethnic minorities compared with the general population in the European WHO region during the first year of the pandemic: a systematic review.

BACKGROUND: Migrants and ethnic minorities have suffered a disproportionate impact of the COVID-19 pandemic compared to the general population from different perspectives. Our aim was to assess specifically their risk of infection in the 53 countries belonging to the World Health Organization European Region, during the first year of the pandemic. METHODS: We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO CRD42021247326). We searched multiple databases for peer-reviewed literature, published on Medline, Embase, Scisearch, Biosis and Esbiobase in 2020 and preprints from PubMed up to 29/03/2021. We included cross-sectional, case-control, cohort, intervention, case-series, prevalence or ecological studies, reporting the risk of SARS-CoV-2 infection among migrants, refugees, and ethnic minorities. RESULTS: Among the 1905 records screened, 25 met our inclusion criteria and were included in the final analysis. We found that migrants and ethnic minorities during the first wave of the pandemic were at increased exposure and risk of infection and were disproportionately represented among COVID-19 cases. However, the impact of COVID-19 on minorities does not seem homogeneous, since some ethnic groups seem to be more at risk than others. Risk factors include high-risk occupations, overcrowded accommodations, geographic distribution, social deprivation, barriers to access to information concerning preventive measures (due to the language barrier or to their marginality), together with biological and genetic susceptibilities. CONCLUSIONS: Although mixed methods studies will be required to fully understand the complex interplay between the various biological, social, and cultural factors underlying these findings, the impact of structural determinants of health is evident. Our findings corroborate the need to collect migration and ethnicity-disaggregated data and contribute to advocacy for inclusive policies and programmatic actions tailored to reach migrants and ethnic minorities.

Dental students’ overall knowledge regarding oral antiseptics / Conhecimento geral de estudantes de odontologia a respeito de antissépticos bucais

O objetivo deste estudo observacional transversal foi avaliar o conhecimento de estudantes de Odontologia a respeito de antissépticos bucais. De um total de 93 estudantes elegíveis, 80 (média de idade 22,3 anos; 66,2% mulheres) participaram respondendo a um questionário estruturado de perguntas fechadas sobre antissépticos bucais. Estudantes do 5o e 8o semestres participaram do estudo respondendo ao questionário em sala de aula durante um dia regular de aulas. Os antissépticos avaliados foram clorexidina, óleos essenciais, cloreto de cetilpiridíneo e triclosan por serem dominantes no mercado brasileiro e possuírem maior número de artigos científicos disponíveis na literatura. 46,2% dos estudantes responderam que raramente indicam ou indicariam antissépticos a um paciente com gengivite, sem diferença significativa entre os semestres. Cerca de 85% dos estudantes consideraram clorexidina o agente com maior substantividade, sendo que houve maior variabilidade nas respostas dos alunos do 5o comparados aos do 8o semestre (Qui-quadrado p=0,02). Todos os alunos consideraram clorexidina o agente padrão-ouro para prescrição após cirurgias bucais. Triclosan foi considerado por 62,8% dos estudantes como o antisséptico com maior benefício clínico, todavia, mais de um quarto dos estudantes não soube responder qual o agente mais benéfico. Mas 62,5% dos estudantes não souberam responder qual a prescrição correta de óleos essenciais. Pode-se concluir que existiu alta variabilidade no conhecimento de estudantes de odontologia sobre ntissépticos bucais

The aim of the present cross-sectional observational study was to evaluate the knowledge of dental students regarding oral antiseptics. From a total of 93 students, 80 (mean age 22.3 years; 66.2% women) participated in thestudy by answering to a structured questionnaire with closed questions regarding oral antiseptics. Students from the 5th and 8th semesters participated by answering the questionnaire into the class room in an ordinary class day. Evaluated antiseptics were chlorhexidine, essential oils, cetylpyridine chloride and triclosan, since these agents dominate the Brazilian market and have the highest number of published scientific papers in the literature. 46.2% of the students answered that they rarely indicate an oral antiseptic for a patient with gingivitis, whit no significant difference between semesters. Approximately 85% considered chlorhexidine the agent with the largest substantivity, and a higher variability of answers was observed in the 5th compared to the 8th semester (Chi-square p=0.02). All students considered chlorhexidine the gold-standard agent to be prescribed after oral surgery. Triclosan was considered by 62.8% of students as the antiseptic with the largest clinical benefit, although more than one fourth of them did not know to answer. 62.5% of the students did not know the correct posology of essential oils. It can be concluded from the present study that dental students present high variability regarding the knowledge about oral antiseptics.