Reducing Menopausal Symptoms With Mindfulness-Based Meditation.

Midlife women often experience menopausal symptoms despite being treated according to clinical guidelines. The consequences of not addressing menopausal symptoms holistically are that 55% of women see primary care providers frequently with menopausal symptom complaints. The problem was women's lack of coping strategies to deal with their symptoms effectively. The interventions aimed to (1) develop a protocol to provide point-of-care mindfulness-based meditation intervention as a standard of care, (2) evaluate improvements in coping self-efficacy skills, and (3) demonstrate the intervention's impact on menopausal symptoms. Twenty women participated in a short meditation intervention at a micro practice in Oregon from January to May 2022 and continued an 8-week home practice. Self-reported measures of menopausal symptoms, coping self-efficacy, and demographic data were collected pre- and pos-tprogram. A percentage of women determined improvements, and t tests evaluated differences between pre-and postintervention assessments. Pearson correlation coefficients identified associations between the Menopausal Rating Scale (MRS), its subscales, and the Coping Self-Efficacy Scale (CSES) postintervention. The women showed 78% improved coping self-efficacy and 89% alleviated menopausal symptoms. The t test revealed a statistically significant change between pre- and post-CSES scores (t17 = 4.19, P < .001) and MRS scores (t17 = 4.78, P < .001). The post-MRS total score was significantly negatively correlated with the post-CSES score (r = -0.49, P = .039), indicating that symptoms decreased as self-efficacy improved. The outcomes of this project show that menopausal women can cope and alleviate their symptoms with an easy and feasible mindfulness-based meditation intervention.

The Impact of Parent Torture and Family Functioning on Youth Adjustment in War-Affected Families: A Path Analysis Describing Intergenerational Trauma and the Family System.

The direct exposure to physical or psychological trauma from torture or war leads to well-documented individual health consequences. Less understood are the inclusive and intergenerational effects of war trauma on family systems and youth adjustment. The purpose was to examine mechanisms in war-affected families that explained the significant emotional and behavioral consequences of intergenerational trauma in youth through the use of multiple methods. Quantitative assessments of maternal and paternal caregivers and youth characterized associations between parent torture, parent mental health distress, parent physical health problems, family functioning, and youth adjustment. Narrative statements further contextualized processes through which the trauma of a parent impacted youth and family systems. The research was conducted in partnership with local, refugee-serving community-based organizations. The study sample included parents and youth in 96 Karen families, originating from Burma in Southeast Asia, who had been resettled to the United States through the U.S. Refugee Admissions Program. Path analysis results indicated that parent torture (ß = -0.173) had statistically significant negative direct effects on youth adjustment. Parent torture had a negative indirect effect on youth adjustment through the mental health (ß = -0.345) and physical health problems of parents (ß = -0.305), and youth gender (ß = 0.126) and trauma exposure of youth (ß = -0.048). Family functioning type demonstrated a positive direct effect on youth adjustment (ß = 0.449). Family type had an indirect effect on youth adjustment through youth gender (ß = 0.142), youth trauma exposure (ß = -0.165), parent physical health problems (ß = -0.202), and parent mental health (ß = 0.509). The current study developed and tested the first model of intergenerational trauma's effects on the adjustment of Karen refugee youth. Results emphasize that individual recovery from torture must be accompanied by adjunct interventions focused on family systems and youth adjustment, to holistically address intergenerational sequala of trauma.

Health of war-affected Karen adults 5 years post-resettlement.

BACKGROUND: An estimated 140 000 refugees from Burma have resettled to the USA since 2009, comprising 21% of total resettlement in the USA over the last decade. Our objective was to describe patterns of longitudinal health outcomes in a cohort of Karen refugees resettled in the USA for 5 years, and to translate these findings to a primary healthcare context. METHODS: The study was a retrospective cohort study focused on the analysis of the first 5 years of electronic health records of a sample of 143 Karen refugees who were initially resettled between May 2011 and May 2013. RESULTS: Through descriptive, inferential and survival statistics, we described patterns of retention in primary care, biometric trends, condition prevalence and survival probabilities. Highest prevalence health conditions documented at any point in the 5-year period included diagnoses or symptoms associated with pain (52%); gastrointestinal disturbance (41%); metabolic disorder (41%); infectious process (34%); mental health condition (31%) and central nervous system disorder (24%). CONCLUSIONS: This study is the first retrospective longitudinal analysis of patterns of health in Karen refugees originating from Burma and resettled to the USA. Findings identified in the 5-year, the post-resettlement period provided important clinical insights into the health trajectories of war-affected populations. Burden of illness was high although results did not demonstrate the extent of trauma-associated physical health conditions reported in the literature. Indicators such as significant increases in body mass index (BMI), the overall prevalence of dyslipidaemia and others suggested that the cohort may be exhibiting an early trajectory towards the development of these conditions. Authors summarize potential protective factors experienced by the cohort that promoted aspects of health frequently challenged in forced migration.

Evaluating the Feasibility and Acceptability of a Community-Based Parenting Support Intervention for Refugee Parents From Burma.

Refugee families negotiate stressors as they adjust to communities of resettlement, which can result in shifting family dynamics. The purpose of this community-engaged, explanatory, mixed-methods pilot study was to evaluate the feasibility and acceptability of a culturally oriented, community-based parenting curriculum. Through a partnership with a prominent refugee-serving organization, the curriculum was delivered to 50 Karen refugee mothers and fathers of adolescent youth resettled in the United States. Results demonstrated the potential for impact on key constructs of family adaptability and cohesion, as well as parent self-efficacy. Participants were highly engaged with the program and attrition was low.

"Sleeping in a boundary" constructing the meaning of health in a refugee camp.

Sociopolitical discourses surrounding refugee migration and resettlement are characterized by divisiveness, assumptions, and fear. When these discussions are grounded in the narratives of women refugees a deeper understanding of issues impacting health, family, and resilience emerges. We examine how 26 Karen women living in camps along the Thai-Burma border construct meaning around health, in relation to livelihoods. Through directed content analysis, themes emerged: precursors to achieving health, health and livelihoods, and position and agency. Women identified barriers and facilitators to health, identified a dynamic relationship between health and livelihoods, and described their position and agency in the systems they navigate.

Utilizing rapid qualitative assessment and thematic analysis methods to identify and share promising case investigation and contact tracing practices with people in refugee, immigrant, and migrant communities during COVID-19.

In the early months of the COVID-19 pandemic The National Resource Center for Refugees, Immigrants and Migrants (NRC-RIM) was established. NRC-RIM initially sought to rapidly identify promising case investigation and contact tracing (CICT) practices within refugee, immigrant, and migrant communities. Between September 2020 and April 2021, the team conducted 60 interviews with individuals from cross-sector organizations (i.e., public health, health systems, community experts/organizations) working with refugee, immigrant and migrant communities in health and public health capacities related to COVID-19. The overarching aim was to identify and amplify innovative promising and best practices for CICT with refugee, immigrant, and migrant communities, including an exploration of barriers and facilitators. We utilized layered methods to rapidly assess, summarize and disseminate promising practices while simultaneously completing four thematic analyses including: (1) public health organizations; (2) health system organizations; (3) community leaders and organizations; and (4) vaccine planning and access across the three sectors. The primary objective of this article is to describe the project design, applied methods, and team science approach we utilized. We found that rapid identification and dissemination of promising practices, and barriers and facilitators for CICT with refugee, immigrant and migrant communities was feasible during a public health emergency. This approach was essential for identifying and widely sharing culturally and linguistically concordant public health practices.

Using a Constructivist-Oriented Modified Grounded Theory Approach in the Study of Intrafamily Trauma Communication Process in War-Affected Families: A Methodologic Example.

Grounded theory methodology is frequently applied in health research, yet studies contending with contextual constraints may require a more pragmatic approach, including potential methodologic divergence and modifications of method choice and application. Dissemination of a detailed documentation and justification of methodologic choices, and specific method modifications and/or innovations, are uncommon in extant literature; however, a more expansive approach to such reporting has the potential to enhance research practices, increase transparency, and contribute to the ongoing discourse around research approaches and rigor. Here, we articulate our methodologic decision-making and methods, including modifications, as applied to the qualitative strand of an explanatory mixed-methods study. The primary aim of this article is to contribute to the discourse and collective learning around methodology and method choices and modifications by presenting one approach to applying a constructivist-oriented, modified version of grounded theory analytic methods through a worked qualitative study example.

A Trauma-Informed Mentoring Framework for Forensic Nurses: An Overview of STEERR-Structure, Process, and Evaluation.

ABSTRACT: The STEERR Mentoring Framework, grounded in decolonized and feminist mentorship approaches, integrates foundational principles of mentoring with the unique and complex characteristics of the role of the forensic nurse. The primary objective of the program is to support a competent, sustainable, and resilient forensic nursing workforce. In this article, we describe the development process, framework structure, and evaluation approach implemented within a 1-year pilot initiative focused on forensic nurses in the sexual assault nurse examiner role. We reflect on strategies for broader application and replication in forensic nursing programs across the United States.

Associations between gender, torture, and health: A 5-year retrospective cohort analysis.

Our purpose was to identify longitudinal associations between torture exposure, physical and mental health outcomes, and gender in a cohort of 143 war-affected Karen adults five years post resettlement. Results showed that participants who self-reported primary torture experiences had higher rates of certain mental and physical health diagnoses. We observed gender differences in health over time in the cohort. Findings have implications for how primary care and public health providers implement war trauma screening tools and timelines, targeted healthcare services, and community resources to promote health and prevent disease in populations that have trauma from torture or war.

"Beyond just the four walls of the clinic": The roles of health systems caring for refugee, immigrant and migrant communities in the United States.

This article is part of the Research Topic 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict'. Introduction: Refugee, immigrant and migrant (hereafter referred to as "immigrant") communities have been inequitably affected by the COVID-19 pandemic. There is little data to help us understand the perspectives of health systems on their role, in collaboration with public health and community-based organizations, in addressing inequities for immigrant populations. This study will address that knowledge gap. Methods: This qualitative study used semi-structured video interviews of 20 leaders and providers from health systems who cared for immigrant communities during the pandemic. Interviewees were from across the US with interviews conducted between November 2020-March 2021. Data was analyzed using thematic analysis methods. Results: Twenty individuals representing health systems participated with 14 (70%) community health centers, three (15%) county hospitals and three (15%) academic systems represented. The majority [16 health systems (80%)] cared specifically for immigrant communities while 14 (70%) partnered with refugee communities, and two (10%) partnered with migrant farm workers. We identified six themes (with subthemes) that represent roles health systems performed with clinical and public health implications. Two foundational themes were the roles health systems had building and maintaining trust and establishing intentionality in working with communities. On the patient-facing side, health systems played a role in developing communication strategies and reducing barriers to care and support. On the organizational side, health systems collaborated with public health and community-based organizations, in optimizing pre-existing systems and adapting roles to evolving needs throughout the pandemic. Conclusion: Health systems should focus on building trusting relationships, acting intentionally, and partnering with community-based organizations and public health to handle COVID-19 and future pandemics in effective and impactful ways that center disparately affected communities. These findings have implications to mitigate disparities in current and future infectious disease outbreaks for immigrant communities who remain an essential and growing population in the US.

Experiences of American Health Departments, Health Systems, and Community Organizations in COVID-19 Vaccine Provision for Refugee, Immigrant, and Migrant Communities.

Effective provision of COVID-19 vaccines could mitigate the disproportionate impact of the COVID-19 pandemic experienced by many immigrant communities. To describe organizational experiences in using COVID-19 vaccination programs, qualitative interviews were conducted from September 2020 to April 2021 with representatives from public health, health system, and community organizations responding to the COVID-19 pandemic among immigrant communities across the United States. Interviews followed a semistructured interview guide and were audio recorded, transcribed, and coded. A latent thematic analysis was facilitated by Dedoose software. Interviews representative of 18 public health departments, 20 healthcare systems, and 18 community organizations were included in the analysis. Five identified themes referenced the importance of 1) appreciating community and individual heterogeneity in health priorities and attitudes; 2) addressing vaccine fears with trustworthy messages; 3) ensuring equitable access to vaccine opportunities; 4) making substantive investments in community partnerships and outreach; and 5) adapting to meet new needs. It is essential that vaccine efforts consider community heterogeneity, communicate in a trustworthy and culturally and linguistically appropriate manner, strive for equitable provision of care, build partnerships, and learn from prior experiences.

Examining Web-Based Learning to Enhance Nurse Training and the Standardization of Clinical Practice Within Complex Global Nursing Systems: A Quality Improvement Case Study.

Nurses are the backbone of health assessments and key to safeguarding health services for people who are displaced and migrating. Training and dissemination of information among an international workforce requires innovative delivery methods that address the barriers of traditional in-person training. This quality improvement project endorsed web-based learning as a viable platform to disseminate information and support a standardized approach to professional development of nurses working in a complex and dynamic international healthcare setting.

"How can you advocate for something that is nonexistent?" (CM16-17) Power of community in a pandemic and the evolution of community-led response within a COVID-19 CICT and testing context.

Formal and informal bilingual/bicultural organizations and networks form the backbone of support for refugee, immigrant, and migrant (RIM) communities in the United States. They are pivotal in mitigating barriers and inequities in social and structural determinants of health. These organizations and networks are situated within the communities they serve, and often are established and run by members of a community, to serve the community. In the United States, the COVID-19 pandemic surfaced and widened existing health inequities for some racial and ethnic communities. Our primary objectives were to: (1) describe the processes that underpinned the pivotal role of immigrant-serving community structures in developing and implementing culturally sustaining programming in the context of pandemic response, and (2) amplify the voices of community experts, as they shared experiences and perspectives around these humanistic and community-centered approaches. We applied a community case study approach to a national sample of RIM-serving community structures representing broad country/region-of-origin, cultural, and linguistic identities. Community engagement strategies utilized in the project period included engaging community partners to identify and facilitate connections, and consult on analysis and dissemination. The project team conducted 20 in-depth, semi-structured interviews with a purposive sample of community experts/community organizations. Sampling strategy was further informed by immigrant identity (i.e., characterization of status) and geography (i.e., United States Department of Health & Human Services, Office of Intergovernmental and External Affairs Regions). Through thematic analysis, results identified key contextual, process-, and impact-oriented themes inherent to community-led COVID-19 responses, that were situated within and around the public and health system response to the pandemic. As public health and health systems scrambled to address acute and unprecedented barriers to access, distribution of COVID-19-related health resources and services, and disparate health outcomes, community structures diligently and intentionally reimagined and reconceptualized their response to COVID-19, frequently in the setting of scarce resources. The grassroots response evolved as a counter-narrative to top-down equity processes, historically defined by systems and applied to the community.

The Role of Culture in Shaping Health Perceptions and Behaviors of Resettled Karen Refugees.

Introduction: While the many health vulnerabilities and challenges experienced by refugees have been previously documented, few studies have addressed the strengths-focused response strategies that women refugees, in particular, engage to navigate health systems and experiences associated with displacement. Our study attempts to document this among members of one group, the Karen, who represent a significant proportion of refugees resettled in the United States over the past decade. The purpose of this study was to explore how a sample of resettled Karen refugee women construct meaning around health, particularly in the context of cultural values, community, and migration. Methodology: This research took place in a series of ethnographic case studies documenting experiences of resilience, identity construction, and mothering among Karen refugee women from Burma. Data were collected through participant interviews with 12 Karen refugee women living in the United States. Interviews were transcribed, coded, and analyzed to identify themes relating to culturally influenced and newly emerging perceptions of health, identity, motherhood, and migration. Results: Participants identified correlates of doing, such as the ability to work and physical energy, as positively related to health, while the inability to do things was negatively related to health. Personal health also encompassed the health of family and community. Discussion: Women in this sample drew on broad, culturally informed ways of being to explain their health experiences. Implications of these findings are presented regarding how organizations and health providers can approach their work with refugees in culturally informed and relevant ways.

Narratives as Borders: Using an Adapted Narrative Approach to Understand the Retelling of the Physical Narratives of Trauma by Karen Women With Refugee Status Resettled in the United States.

The refugee narrative spans time, geography, and generations, enfolding the complexity of constructing identities through displacement and migration. Through adapted narrative analysis, we examined the physical narratives of war trauma which a sample of Karen refugee women constructed, as they claimed their experiences of war trauma and torture in interview discussions. We employed an adapted narrative method relevant to the analysis of field texts to interpret the remembering and retelling of trauma narratives. This method helped to elicit positional identities and physical/sensory memories that were prominent in women's experiences and to contextualized concurrently collected quantitative data. Accounts revealed key constructs relevant to the narrative function and orientation of the narratives: remembering childhood, being a mother, embodiment of trauma.

Four Kinds of Hard: An Understanding of Cancer and Death among Latino Community Leaders.

Early integration of palliative care after a diagnosis of cancer improves outcomes, yet such care for Latino populations is lacking in rural regions of the United States. We used a participatory action research design with Latino community leaders from emerging immigrant communities in North Carolina to explore sociocultural perspectives on cancer and death. Thematic analysis was conceptualized as Four Kinds of Hard represented by four themes: Receiving an Eviction Notice, Getting in the Good Book, Talking is (Sometimes) Taboo, and Seeing Their Pain Makes us Suffer. These themes captured fears of deportation, coping with cancer through faithfulness, ambivalence about advance care planning, and a desire to spare families from suffering. Findings suggest strategies to improve conversations about end-of-life wishes when facing advanced illness and death. This study demonstrates the importance of training Latino community leaders to improve palliative care and bridge service gaps for Latino families living in emerging rural communities.

Mechanisms Explaining the Relationship Between Maternal Torture Exposure and Youth Adjustment In Resettled Refugees: A Pilot Examination of Generational Trauma Through Moderated Mediation.

The intergenerational effects of trauma resulting from torture and war are complex and multi-faceted and have important implications for the family system. The current study aimed to identify key relationships between refugee maternal caregiver exposure to torture, mental health, and physical health with maternal-reported youth adjustment. Ninety-six Karen maternal caregivers originating from Burma and resettled in the United States participated in a cross-sectional, explanatory mixed methods study. Maternal mental health distress was found to mediate the relationship betweenmaternal torture experiences and youth adjustment, R2 = .357. Physical health problems was found to moderate the degree to which mental health distress mediated the relationship between torture and war trauma experiences and youth adjustment, R2 = .409. The current study is significant in that it enhances our mechanistic understanding of factors relevant to the intergenerational effects of trauma within families where maternal caregivers experienced trauma from torture and/or war.