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1.
J Interpers Violence ; 39(17-18): 3904-3931, 2024 Sep.
Article in English | MEDLINE | ID: mdl-39119648

ABSTRACT

It is well-established within the hate studies literature that the majority of hate crimes and incidents of targeted hostility are perpetrated by those in the "majority" society. In the UK, academic and official research consistently shows that young White, British males are most commonly the culprits of all forms of targeted victimization, especially racist hate. However, urban areas of "super-diversity" offer researchers an opportunity to understand hate crime victimization and perpetration in a more nuanced and comprehensive way. Hate studies research has slowly begun to highlight instances of people from marginalized and stigmatized groups being targeted on the basis of their identity by individuals who are also members of minority groups, sometimes even the same minority group as the victim. Very little is understood about this particular victimizing dynamic other than it appears to be an attempt by minority group members to "fit in" by adopting what they perceive to be majority group values and attitudes. By drawing from 44 qualitative in-depth interviews exploring the experiences of new migrants and refugees and observations from 20 months of grassroots engagement, this article challenges established theories of "othering" that overwhelmingly refer to binary, static majority/minority tensions. The stories of these too-often "hidden" victims of targeted hostility offer a fresh perspective on the relationships between victims of hate and perpetrators. The article also contributes new explanations as to why those who are often targeted go on to target others.


Subject(s)
Crime Victims , Hate , Hostility , Humans , Crime Victims/psychology , Male , Female , Minority Groups/psychology , Adult , United Kingdom
3.
Ethn Health ; : 1-24, 2024 Aug 01.
Article in English | MEDLINE | ID: mdl-39087316

ABSTRACT

OBJECTIVES: Forced migration and its subsequent sequelae have caused refugees to face significant adversities throughout the displacement process, making them susceptible to significant health issues. Refugees displaced in Africa are a group especially vulnerable to poor health outcomes, experiencing a documented decline in overall physical and mental health status and rise in mortality from non-communicable diseases (NCDs). Despite the heightened health risks experienced by Somali refugees, particularly women, research into their complex illness experiences and co-/multimorbid health conditions is scarce, leaving a gap in our understanding of the multifaceted health challenges of this population. DESIGN: Using structural vulnerability theory, this study explores how the broader host context shapes illness experiences for Somali refugee women in Kenya. Specifically, we describe the factors associated with illness experiences of urban Somali refugee women and how this compares with women with other similarly situated identities, such as Somali Kenyan women, other/non-Somali refugees, and Kenyan women. In-depth interviews were conducted with 43 women in Eastleigh, Kenya. RESULTS: Using hybrid thematic analysis, the emergent themes were grouped into three distinct domains: (1) multimorbid, complex illness experiences, (2) embodiment of structural vulnerability, and (3) distinct/shared vulnerability among refugee/non-refugee women. Results suggest that illness experiences of displaced refugee women are inextricably linked to traumatic experiences before displacement, as well as the experiences of transmigration stressors and the hostile socio-legal dynamics encountered post-displacement. CONCLUSIONS: Our findings also have implications for the need to consider intersectional identities when examining for differential exposure to structural risks and the susceptibility to poor health experiences as well as supports the need for urgent change and improvement in systems of social protection and basic care for refugees experiencing prolonged displacement.

4.
J Migr Health ; 10: 100249, 2024.
Article in English | MEDLINE | ID: mdl-39132290

ABSTRACT

Purpose: To survey community-based migrant-serving organizations (MSOs) in New York City (NYC) regarding their early experiences during the COVID-19 pandemic and perspectives on academic collaborations. Methods: We developed and emailed a survey via Qualtrics (12/2020-1/2021) to 122 MSOs in NYC collecting data about the organizations; challenges posed by COVID-19; and interest in potential intersectoral collaboration. Descriptive analysis focused on the pandemic's impact on service provision, type of MSO, and organizational capacity. Results: Thirty-eight MSOs participated (RR=31%). COVID-19-related challenges included limited staff capacity, organizational funding, and technological and resource limitations of communities served. Organizational capacity correlated with types of services offered: smaller organizations offered health and social services, while larger organizations focused on education and employment. MSOs indicated interest in collaboration on migrant policy advocacy and communications, access to interns, and resources regarding best practices and policies. Conclusions: MSOs in NYC have struggled with funding, staffing, and service provision. They specified fruitful areas for collaboration with academic research institutions. Implications: Development of an academic-based migrant health resource hub will serve an identified need among MSOs in NYC.

5.
Ann Glob Health ; 90(1): 48, 2024.
Article in English | MEDLINE | ID: mdl-39114344

ABSTRACT

Refugees usually face a disproportionate burden of infectious diseases. Recently, Brazil has experienced an influx of refugees which demands the need for scaling up public health efforts to address the challenges. The research sought to study the burden and risk factors associated with infectious diseases among refugees received in the city of Porto Alegre. This was a cross-sectional study of 261 newly arrived refugees. The study sample was predominantly composed of Venezuelans (50.6%) and Haitians (44%), male (146: 56.7%), single (30.7%), with an average age of 33.38 (± 7.30) years. The average schooling was 10.42 (± 2.09) years. Diseases with the highest prevalence were influenza, whooping cough, diphtheria, and tuberculosis. There was significant association between the country of origin and presence of symptoms for infectious and contagious diseases, which warrants targeted interventions for reducing the incidence of these diseases among refugees in Brazil.


Subject(s)
Communicable Diseases , Diphtheria , Influenza, Human , Refugees , Humans , Cross-Sectional Studies , Male , Refugees/statistics & numerical data , Adult , Female , Brazil/epidemiology , Risk Factors , Communicable Diseases/epidemiology , Influenza, Human/epidemiology , Diphtheria/epidemiology , Young Adult , Tuberculosis/epidemiology , Whooping Cough/epidemiology , Whooping Cough/prevention & control , Prevalence , Refugee Camps , Middle Aged , Haiti/epidemiology , Haiti/ethnology , Cost of Illness , Adolescent
6.
Trauma Violence Abuse ; : 15248380241262262, 2024 Aug 03.
Article in English | MEDLINE | ID: mdl-39096106

ABSTRACT

People with refugees and asylum seeker status (R/AS) have been forced to leave their home and resettle in new countries due to political unrest, conflict, and violence. This review aimed to describe the nature and extent of cultural adaptations to psychological interventions for adults with R/AS experiencing clinically significant psychological distress, and the acceptability and efficacy of these interventions. A search was conducted in October 2023 and February 2024 across five electronic databases: PsycINFO, Medline, Embase, PubMed, and Cochrane. Eligible studies were randomized controlled trials of psychological interventions conducted in any geographic context. Studies reporting on interventions with minimal adaptations only to facilitate treatment access, with no clear evidence for cultural adaptation, were excluded. Eighteen studies were identified, and cultural adaptations were described in line with the Ecological Validity Model. Studies investigating transdiagnostic interventions, cognitive behavioral therapy (CBT) interventions, and other psychotherapies were synthesized. Analysis and reporting of acceptability were limited across intervention groups, highlighting a need for more robust research in this area. CBT interventions and other psychological therapies were found to be most efficacious with moderate to large effects across validated psychological measures. Small to moderate effect sizes were observed across transdiagnostic interventions. The evidence quality was generally of some concerns. While the evidence requires further developments, the current review provides a timely synthesis of culturally adapted interventions for adults with R/AS to inform intervention development and clinical practice. Strengths, limitations, and recommendations for future research are discussed.

7.
Healthcare (Basel) ; 12(15)2024 Jul 31.
Article in English | MEDLINE | ID: mdl-39120228

ABSTRACT

OBJECTIVES: The issue of oral health problems among refugees, not only during their journey but also once they arrive at their destination, is a current one. This study aimed to evaluate the oral health-related quality of life (OHRQoL) of refugees, with the intention of highlighting a potential need for improved education and easier access to dental care. MATERIALS AND METHODS: A questionnaire based on the Oral Health Impact Profile (OHIP-14) was distributed via hyperlink on social media, targeting individuals with a refugee background to collect data on their OHRQoL. RESULTS: A total of 401 participants completed the questionnaire. The median OHIP score for all participants was 8 (IQR 2-17) out of a maximum of 56, with 0 representing the best possible OHRQoL. The median OHIP score was 6 (IQR 2-16) for male and 8 (IQR 2-18) for female participants. CONCLUSIONS: A comparison of the OHIP score from this study with reference values from non-refugee populations shows an elevated score and, thus, a lower oral quality of life. CLINICAL RELEVANCE: The findings of this study indicate a clear need for enhanced access to dental care for refugees, coupled with an educational initiative aimed at fostering an appreciation of the importance of daily dental hygiene.

8.
Confl Health ; 18(Suppl 1): 49, 2024 Aug 05.
Article in English | MEDLINE | ID: mdl-39103863

ABSTRACT

BACKGROUND: With the increasing number of protracted refugee crises globally, it is essential to ensure strong national health information systems (HIS) in displacement settings that include refugee-sensitive data and disaggregation by refugee status. This multi-country study aims to assess the degree of integration of refugee health data into national HIS in Jordan, Lebanon, and Uganda and identify the strengths and weaknesses of their national HIS in terms of collecting and reporting on refugee-related health indicators. METHODS: The study employs a comparative country analysis approach using a three-phase framework. The first phase involved reviewing 4120 indicators compiled from global health organizations, followed by a multi-stage refinement process, resulting in 45 indicators distributed across five themes. The second phase consisted of selecting relevant criteria from the literature, including data sources, annual reporting, disaggregation by refugee status, refugee population adjustments, accuracy, and consistency. The third phase involved assessing data availability and quality of the selected indicators against these criteria. RESULTS: Our analysis uncovered significant challenges in assessing the health status of refugees in Jordan, Lebanon, and Uganda, primarily stemming from limitations in the available health data and indicators. Specifically, we identified significant issues including incomplete local data collection with reliance on international data sources, fragmented data collection from various entities leading to discrepancies, and a lack of distinction between refugees and host populations in most indicators. These limitations hinder accurate comparisons and analyses. In light of these findings, a set of actionable recommendations was proposed to guide policymakers in the three countries to improve the integration of refugee health data into their national HIS ultimately enhancing refugees' well-being and access to healthcare services. CONCLUSION: The current status of refugee-related health data in Jordan, Lebanon, and Uganda indicates the need for improved data collection and reporting practices, disaggregation by refugee status and better integration of refugee health data into national HIS to capture the health status and needs of refugees in host countries. Key improvement strategies include establishing a centralized authority for consistent and efficient data management, fostering transparent and inclusive data governance, and strengthening workforce capacity to manage refugee health data effectively.

9.
Front Psychol ; 15: 1394014, 2024.
Article in English | MEDLINE | ID: mdl-39105148

ABSTRACT

Introduction: The Global Psychotrauma Screen (GPS) is a brief transdiagnostic screener that covers a broad range of trauma-related disorders as well as risk factors known to influence the course of symptoms. Methods: We analyzed data from African war refugees in Australia (n = 70), including the GPS, the Structured Clinical Interview for DSM-5 Disorders (SCID-5), the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), and the Brief Resilience Scale (BRS). Results: Using the Youden's J Index to examine the clinical validity of the GPS subscales measuring PTSD, dissociation, depression, and generalized anxiety disorder (GAD), we found that a PTSD subscale score of 3 or higher, and a depression and dissociation subscale score of 1 or higher, was optimally efficient for detecting a probable diagnosis (Youden's J = 0.76, J = 0.72, and J = 0.90, respectively) with high sensitivity and specificity. We were unable to test the GPS clinical validity for GAD due to the low GAD occurrence. The GPS resilience item was not related to the total score (r = 0.02), indicating low convergent validity for resilience. Risk factors, including current stressors and childhood trauma history, were related to more severe GPS symptom scores, while lack of resilience, social support, and history of mental illness were not. Conclusion: We conclude that the GPS may be a useful screening tool for PTSD, depression, and the dissociative subtype in refugees.

10.
Adv Exp Med Biol ; 1458: 201-216, 2024.
Article in English | MEDLINE | ID: mdl-39102198

ABSTRACT

COVID-19 challenged countries in addressing population and raising awareness about mask-wearing during pandemic; Lebanon is a refugee hotspot, with humanitarian responsibility for their protection. The goal of this study is to emphasize the need of raising awareness among vulnerable populations and studying their mask-wearing behavior and intentions. This research draws on findings from a survey characterized by refugees' representatives from NGO, focusing on the behaviors and implications of refugees' mask-wearing. To address the study question, a customized survey based on Theory of Interpersonal Behavior was undertaken, in which the behavior of refugees was impacted by their desire to engage in an activity. The findings show that refugees are influenced by other people's mask-wearing behavior; they view masks as providing protection and aim to use them in the future provided all enabling conditions are met. Artificial intelligence might be a better monitor for this behavior in the future.


Subject(s)
COVID-19 , Intention , Masks , Refugees , Humans , COVID-19/prevention & control , COVID-19/psychology , COVID-19/epidemiology , Refugees/psychology , Lebanon/epidemiology , Male , Adult , Female , SARS-CoV-2 , Surveys and Questionnaires , Middle Aged , Young Adult
11.
Soc Sci Med ; 357: 117195, 2024 Aug 08.
Article in English | MEDLINE | ID: mdl-39128248

ABSTRACT

BACKGROUND: The MENA region has experienced extraordinary events in recent years, resulting in an influx of refugees and displaced people who are vulnerable to mental disorders. Several previous studies have examined their prevalence, but none have focused on this region. This systematic review provided an estimate of the prevalence of mental illness and associated risk factors in the MENA region, and overcame the methodological limitations of individual studies. METHODS: Thorough searches of the relevant databases were carried out to locate relevant published articles. Furthermore, cross-sectional studies were conducted to assess mental disorders in refugees, asylum seekers, migrants, or internally displaced people residing in the MENA region. Only studies meeting the aforementioned criteria were considered. For this purpose, RStudio software version 2023.12.0 + 369 with netmeta package was used for measurement and data analysis. JBI used to assess study quality. RESULTS: The results, including 32 cross-sectional studies with a total of 21659 participants were obtained and discussed. The overall prevalence was 42% (95% CI; 30%, 54%) for depression, 43% (95% CI; 31%, 57%) for anxiety, 22% (95% CI; 11%, 39%) for stress, and 45% (95% CI; 36%, 53%) for PTSD. As a result, it was noted that being female was associated with depression, and being female and unemployed was associated with PTSD, however being married was protective against this later. CONCLUSION: Compared to the rest of the globe, MENA has a greater rate of mental illness among refugees. Nevertheless, much effort should be devoted on listing causes associated, as well as their management and prevention.

12.
Cult Med Psychiatry ; 2024 Jul 08.
Article in English | MEDLINE | ID: mdl-38976177

ABSTRACT

The refugee experience has been associated with increased rates of psychosocial challenges. At the same time, evidence suggests that those who resettled in Western countries including Canada underutilize the formal mental health services in these countries. The low uptake has been attributed to barriers such as language, complexity of the health systems, and differing explanatory models of illness. The same is true for Somali refugees in the West. Studies suggest that Somali refugees prefer spiritual healing for psychosocial illness and that some return to East Africa for such healing. However, little is known about Somali Canadian's experiences with the Canadian mental health services and transnational health seeking. The study aimed to understand psychosocial challenges faced by Somali Canadians, their health seeking behaviors, and service utilization. Because some sought psychosocial services outside the country, fieldwork was conducted in Kenya to provide new evidence on transnational healing services. Ethnographic fieldwork and in-depth interviews were utilized. Thirty-seven interviews of about an hour each were undertaken. Fieldwork in Nairobi focused on spiritual healing centers and medical clinic. The findings reveal important findings regarding psychosocial challenges experienced by participants. It discusses psychosocial illnesses as variedly experienced, challenges with accessing Canadian healthcare services, and seeking culturally appropriate services in East Africa. The study highlights participants and their families struggle with psychosocial distress, the challenges of accessing culturally appropriate services within Canada, the role of spiritual healers and the existence of transnational health seeking practices.

13.
Afr J Reprod Health ; 28(6): 66-74, 2024 06 30.
Article in English | MEDLINE | ID: mdl-38979874

ABSTRACT

Dysmenorrhea, the most common gynecological pain syndrome reported in women, is understudied in refugee communities. In addition, the association between dysmenorrhea self-medication and mental health symptoms in this population is poorly understood. We aimed to examine whether the use of dysmenorrhea analgesic self-medications and other clinical factors are associated with post-traumatic stress disorder (PTSD), depression, anxiety and insomnia severity in female war refugees residing in Zaatari Camp. This study followed a cross-sectional design and was performed on a cohort of women with predefined inclusion criteria. The severity of PTSD, depression, anxiety and insomnia were assessed using Davidson Trauma Scale, the Patient Health Questionnaire-9, the General Anxiety Disorder-7, and the Arabic version of the Insomnia Severity Index, respectively. Data were analysed from 386 participants. Using OTC paracetamol was significantly associated with higher PTSD severity (B=4.16, t= 2.43, p=0.01), and severe depression (OR=1.88, 95% CI= 1.07-3.28, p=0.03), while OTC non-steroidal anti-inflammatory drugs (NSAIDs) was significantly associated with severe insomnia (OR=1.62, 95% CI= 1.05-2.49, p= 0.02). In conclusion, self-medication with analgesics was correlated with poor mental health; close medical and psychiatric follow-up are required to supervise pain self-medication and implement non-pharmacological strategies to manage dysmenorrhea in this fragile community.


La dysménorrhée, le syndrome douloureux gynécologique le plus fréquemment signalé chez les femmes, est peu étudiée dans les communautés de réfugiés. De plus, l'association entre l'automédication de la dysménorrhée et les symptômes de santé mentale dans cette population est mal comprise. Nous avions pour objectif d'examiner si l'utilisation d'automédicaments analgésiques contre la dysménorrhée et d'autres facteurs cliniques sont associés au trouble de stress post-traumatique (SSPT), à la dépression, à l'anxiété et à la gravité de l'insomnie chez les réfugiées de guerre résidant dans le camp de Zaatari. Cette étude a suivi une conception transversale et a été réalisée sur une cohorte de femmes avec des critères d'inclusion prédéfinis. La gravité du SSPT, de la dépression, de l'anxiété et de l'insomnie a été évaluée à l'aide de l'échelle de traumatisme de Davidson, du questionnaire sur la santé du patient-9, du trouble d'anxiété général-7 et de la version arabe de l'indice de gravité de l'insomnie, respectivement. Les données ont été analysées auprès de 386 participants. L'utilisation de paracétamol en vente libre était significativement associée à une gravité plus élevée du SSPT (B = 4,16, t = 2,43, p = 0,01) et à une dépression sévère (OR = 1,88, IC à 95 % = 1,07-3,28, p = 0,03), tandis que les médicaments non stéroïdiens en vente libre les anti-inflammatoires (AINS) étaient associés de manière significative à l'insomnie sévère (OR = 1,62, IC à 95 % = 1,05-2,49, p = 0,02). En conclusion, l'automédication avec des analgésiques était corrélée à une mauvaise santé mentale ; un suivi médical et psychiatrique étroit est nécessaire pour encadrer l'automédication de la douleur et mettre en œuvre des stratégies non pharmacologiques pour prendre en charge la dysménorrhée dans cette communauté fragile.


Subject(s)
Refugees , Self Medication , Humans , Female , Refugees/psychology , Adult , Dysmenorrhea/psychology , Mental Health , Young Adult , Refugee Camps
14.
Article in English | MEDLINE | ID: mdl-39083242

ABSTRACT

Immigrants, nearly half of whom prefer a language other than English (LOE), face structural barriers to healthcare. This subgroup is believed to be at increased risk for reduced access to quality healthcare, yet few studies have examined the health needs and utilization patterns of LOE-preferring patients who seek care in the Emergency Department (ED). Given that the ED is often an entry point to the health system, we sought to characterize the health patterns of this population in an urban ED setting. We conducted a retrospective chart review of the electronic medical records of 1,566 patients who utilized interpreter services in the ED or Urgent Care) at an urban safety net hospital. We found that LOE-preferring patients had high levels of chronic disease. We also found that the majority of these patients had not seen a primary care provider (PCP) within the study period. PCP visits were positively associated with ED utilization suggesting that those without a PCP are less likely to receive ED care. These findings point to a need for greater policy and community health solutions addressing the high burden of chronic disease and underutilization of healthcare for those with LOE preferences.

15.
Article in English | MEDLINE | ID: mdl-39085492

ABSTRACT

Unaccompanied young refugees (UYRs) are at an elevated risk of continuing psychological distress, including posttraumatic stress symptoms (PTSS), depression, and anxiety. The post-arrival situation in a host country plays an important role in increasing or reducing mental health risks for UYRs. This study aimed to examine the trajectory of psychological distress and post-migration factors experienced by UYRs in Germany with five assessments every six months over a two-year period.Standardised self-report questionnaires were used to assess PTSS (CATS-2), depression (PHQ-9), and anxiety (GAD-7) symptoms. Material and social stressors (DSSYR), sociocultural adjustment (BSAS), frequency of contact with family members, and distress regarding asylum status were included as post-migration factors. N = 131 UYRs (Mage = 17.04; SDage = 1.46; 81.1% male) living in residential care facilities in Germany were included in this study. There was a significant loss to follow up with n = 77 after 12 months at T2 (59% attrition), and n = 37 after 24 months at T4 (28% attrition).At baseline, clinically relevant symptom scores were found in 48.1% for PTSS, 42.0% for depression, and 22.9% for anxiety. Analysis of latent growth curve models revealed that the symptom severity of depression and anxiety did not change substantially over one year, but PTSS showed a significant decline. The number of traumatic events affected initial levels of mental health problems but not their trajectory over time. The impact of post-migration factors varied between measurement points and outcome measures and did not result in a homogeneous pattern.Despite limitations, this study demonstrated the persistence of high levels of psychological distress in UYRs. Effective interventions are required at an early stage to prevent chronic trajectories and support systems should adapt to constantly changing circumstances.Trial registration number/date of registration: DRKS00017453/11th December 2019.

16.
Eur J Psychotraumatol ; 15(1): 2383525, 2024.
Article in English | MEDLINE | ID: mdl-39082693

ABSTRACT

Background: Refugees and asylum seekers (ASRs) are frequently exposed to loss in addition to a variety of other stressors and often display high levels of various psychological symptoms.Objective: The study aimed to primarily determine clusters of prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and depression symptoms in bereaved ASRs and secondly identify predictors of cluster membership. Sociodemographic  - and flight-related variables were investigated in exploratory analyses.Method: ASRs in Germany (N = 92) with interpersonal loss exposure, i.e. at least one missing or deceased relative or friend, were assessed with interview-based questionnaires for PGD, PTSD, and depressive symptoms. We used k-means cluster analysis to distinguish symptom profiles and logistic regression analyses to identify predictors of cluster membership.Results: We found a three-cluster-solution. The PGD-cluster (30%) was characterised predominantly by PGD symptoms, while the PGD/PTSD-cluster (32%) had high PGD and PTSD and moderate depressive symptoms. The resilient cluster (38%) showed low symptoms overall. insecure residence status predicted membership in the PGD and PGD/PTSD clusters relative to the resilient cluster, whilst higher attachment anxiety predicted membership in the PGD/PTSD cluster relative to the other clusters. Explorative analysis revealed duration of stay as a significant predictor.Conclusion: Findings can extend the current knowledge about different symptom profiles among bereaved ASRs in Europe. Insights to attachment  - and migration-related variables distinguishing between these profiles offer starting points for interventions.


Bereaved asylum seekers and refugees in Germany can be grouped into three symptom clusters: (1) predominantly prolonged grief, (2) high prolonged grief, high posttraumatic stress, and moderate depressive symptoms, and (3) low symptom load.Attachment  ­ and migration-related variables (i.e. residence status, duration of stay, and attachment anxiety) distinguish between cluster membership.Results highlight the importance of attending to profiles and not only single categories of symptoms and attachment features in bereaved asylum seekers and refugees.


Subject(s)
Bereavement , Depression , Grief , Refugees , Stress Disorders, Post-Traumatic , Humans , Refugees/psychology , Refugees/statistics & numerical data , Stress Disorders, Post-Traumatic/psychology , Stress Disorders, Post-Traumatic/diagnosis , Female , Male , Depression/psychology , Germany , Adult , Cluster Analysis , Surveys and Questionnaires , Middle Aged
17.
BMC Womens Health ; 24(1): 427, 2024 Jul 26.
Article in English | MEDLINE | ID: mdl-39061042

ABSTRACT

INTRODUCTION: Contraceptive use is known to have a positive impact on maternal and child health outcomes; however, its use is still low in low-income countries, especially among people in humanitarian situations. This study explored decision-making processes towards the use of contraceptives by people in humanitarian situations to inform program design and uptake. METHODS: A qualitative exploratory study was conducted among women of reproductive age (15-49 years) and men (15-60 years) living in three refugee settlements of Pagirinya, Nyumanzi, and Mirieyi and the surrounding host communities in Adjumani district, Uganda. Data were collected using 49 in-depth interviews (IDIs), 11 Key Informant Interviews (KIIs,) and 20 Focus Group Discussions (FGDs). Inductive thematic analysis was done with the aid of Atlas ti. Version 14. RESULTS: We found that the decision-making processes entailed linear and nonlinear internalized cognitive and contextual processes involving four dynamic pathways. In the linear pathway, participants reported starting with 1) idea inception, 2) followed by cognitive processing, 3) consultation, and 4) decision-making for contraceptive use. The complex linear pathway happened when participants did not go through consultation but went straight to decision-making. However, participants who followed the non-linear pathway repeatedly went back to cognitive processing. Some women after consultation, or those already using and those not using contraceptives, decided to go back to cognitive processing to reconsider their current positions. This study found that some women who were not using contraceptives ended up using, while some who were using contraception ended up dropping out. CONCLUSIONS: This study showed dynamic decision-making processes involving both internal and external environments as triggers to decision-making for contraceptive use. Interventions to increase contraceptive use should target both users and significant others who influence the decision to use particularly among refugees. TRIAL REGISTRATION: This study was registered by Makerere University School of Public Health Higher Degrees Research and Ethic Committee (HDREC) #188 and approved by Uganda National Council of Science and Technology on 15th/7/2021, Registration number-SS809ES.


Subject(s)
Contraception Behavior , Decision Making , Qualitative Research , Refugees , Humans , Female , Refugees/psychology , Refugees/statistics & numerical data , Uganda , Adult , Adolescent , Young Adult , Middle Aged , Contraception Behavior/psychology , Contraception Behavior/statistics & numerical data , Male , Focus Groups , Contraception/psychology , Contraception/statistics & numerical data , Contraception/methods
18.
Behav Sci (Basel) ; 14(7)2024 Jun 26.
Article in English | MEDLINE | ID: mdl-39062358

ABSTRACT

The United States has a long history of welcoming refugees fleeing persecution, organized violence, and war. However, the welcome often does not come with adequate immigration infrastructure support necessary to rebuild life and promote family well-being. Approximately 157,000 Cambodians were accepted to resettle in the U.S. between 1975 and 1994 due to the countrywide genocide. Upon resettlement, Cambodians were placed in impoverished neighborhoods with little resources to heal and rebuild. The purpose of this study, grounded in a Human Ecological Model and guided by Critical Ethnography principles, was to conduct a formal needs assessment of Cambodian refugee families across the United States. Eighteen professionals were interviewed virtually in Khmer and/or English. The data were analyzed using the Developmental Research Sequence. The results emphasized a critical need to address mental health complications resulting from untreated mental health disorders such as posttraumatic stress, depression, anxiety-related disorders, and complicated grief, across generations. Severe disruptions in family relationships (i.e., parent-child and couple relationships) were also reported along with substance abuse in the absence of access to culturally responsive mental health treatments. Findings suggest the need for culturally tailored multilevel interventions to effectively address mental health and relational challenges of multigenerational Cambodian families.

19.
Article in English | MEDLINE | ID: mdl-39063405

ABSTRACT

Diabetes mellitus is a non-communicable disease which poses a great burden on refugee populations, who are confronted with limited access to healthcare services and disruption of pre-existing pharmacological treatment. AIMS: We sought to evaluate the degree of hyperglycaemia in refugees with known or recently diagnosed diabetes, to assess cardiovascular comorbidities and diabetes complications, to review and provide available therapeutic options, and to compare, if possible, the situation in Lesvos with other locations hosting refugee populations, thus raising our awareness towards barriers to accessing healthcare and managing diabetes in these vulnerable populations and to propose follow-up strategies. METHODS: We retrospectively studied 69 refugee patients (68% of Afghan origin, 64% female) with diabetes mellitus (81% with type 2 diabetes), who were referred to the diabetes outpatient clinics of the General Hospital of Mytilene, Lesvos, Greece, between June 2019 and December 2020. Age, Body Mass Index, diabetes duration, glycaemic control (HbA1c and random glucose), blood pressure, estimated renal function, lipid profile, diabetes complications and current medication were documented at presentation and during subsequent visits. RESULTS: For all patients with type 1 diabetes and type 2 diabetes, age at presentation was 17.7 and 48.1 years, BMI 19.6 kg/m2 and 28.9 kg/m2 and HbA1c 9.6% and 8.7%, respectively (all medians). One-third (29%) of patients with type 2 diabetes presented either with interrupted or with no previous pharmacological treatment. Insulin was administered to only 21% of refugees with poorly controlled type 2 diabetes. Only half of the patients (48%) with hypertension were taking antihypertensive medication and one-sixth (17%) were taking lipid-lowering medication. Forty-two per cent (42%) of patients were lost to follow-up. CONCLUSIONS: Our results showed that a significant portion of refugees with diabetes have either no treatment at all or have had their treatment discontinued, that insulin is still underutilised and that a significant portion of patients are lost to follow-up. It is essential to enhance our ability to identify refugees who may be at risk of developing diabetes or experiencing complications related to the disease. Additionally, it is important to expand access to crucial treatment and monitoring services. By improving our policies for managing non-communicable diseases, we can better support the health and well-being of these vulnerable populations. Furthermore, it is vital to recognize that Greece cannot bear the burden of the refugee crisis alone; international support and collaboration are necessary to address these challenges effectively.


Subject(s)
Diabetes Mellitus, Type 2 , Refugees , Humans , Female , Male , Refugees/statistics & numerical data , Retrospective Studies , Adult , Middle Aged , Diabetes Mellitus, Type 2/drug therapy , Diabetes Mellitus, Type 2/complications , Young Adult , Adolescent , Hospitals, General , Cost of Illness , Aged , Diabetes Mellitus, Type 1/drug therapy , Diabetes Mellitus, Type 1/complications
20.
J Clin Med ; 13(14)2024 Jul 13.
Article in English | MEDLINE | ID: mdl-39064146

ABSTRACT

Objectives: This study analyzed trends in HIV/AIDS in Poland over the time period of 2009-2021 and the potential impact of COVID-19 and the migration of war refugees from Ukraine. Methods: Long-term trends were assessed by joinpoint regression using data from Polish HIV/AIDS registries. The HIV/AIDS burden was also compared before and during the pandemic and refugee migration. Results: In 2009-2021, the upward tendency in the rate of new HIV infections until 2017 and decrease after 2017 was accompanied by a downward trend in new HIV/AIDS diagnoses and mortality. From the pandemic's beginning until March 2022, rates of new HIV/AIDS diagnoses dramatically decreased to later increase to pre-pandemic levels, which partially coincided with the wave of migration of refugees from Ukraine. Conclusions: Long-term analysis of HIV/AIDS in Poland showed a downward trend in new HIV/AIDS diagnoses and related mortality in 2009-2021. While the pandemic has reduced the number of detected HIV/AIDS cases, a subsequent increase in new HIV diagnoses in 2022 may be related to lifting the COVID-19 restrictions and war refugees' migration. These observations have implications for the WHO European Region, seeking to end AIDS as a public health problem by 2030.

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