Geographical accessibility of medical resources, health status, and demand of integrated care for older people: a cross-sectional survey from Western China.

BACKGROUND: The World Health Organization (WHO) published the Integrated Care for Older People (ICOPE) framework to help healthcare providers cope with the population aging crisis. However, the relevant evidence on the demands of older people and the compensatory capacity of the environment is limited. This study reports for the first time the level of the ICOPE demand in Western China that includes the impact of geographic accessibility of medical resources (GAMR) on ICOPE demand and the potential mechanism of health status. METHODS: A cross-sectional questionnaire survey was conducted among 1200 adults aged 60 years and older selected through multi-stage stratified cluster sampling to obtain relevant data, including ICOPE demand, health status, and GAMR. Propensity score matching (PSM) was used to analyze the impact of GAMR on ICOPE demand among older people and those with different health statuses. RESULTS: Among the prospective research participants, 1043 were eligible for the study. The mean score of ICOPE demand among all participants was 3.68 (standard deviation [SD] = 0.78). After adjusting for covariates between high and low GAMR groups (1:1 match), ICOPE demand was significantly higher in the low GAMR group than in the high GAMR group (average treatment effect on the treated [ATT] = 0.270, p < 0.05). For both good and poor self-rated health status, the ICOPE demand of the low GAMR group was significantly higher than that in the high GAMR group (ATT = 0.345, p < 0.05; ATT = 0.190, p < 0.05). For chronic diseases, the ICOPE demand of older people with multimorbidity in the low GAMR group was significantly higher than that in the high GAMR group (ATT = 0.318, p < 0.01). CONCLUSIONS: The older population in Western China has a relatively high demand for ICOPE. Low GAMR is a key factor in ICOPE demand growth in this region. It accelerates demand release for both older people with multimorbidity and self-perceptions of health.

Lessons learned from COVID-19: improving breast cancer care post-pandemic from the patient perspective.

BACKGROUND: Since the onset of the pandemic, breast cancer (BC) services have been disrupted in most countries. The purpose of this qualitative study is to explore the unmet needs, patient-priorities, and recommendations for improving BC healthcare post-pandemic for women with BC and to understand how they may vary based on social determinants of health (SDH), in particular socio-economic status (SES). METHODS: Thirty-seven women, who were purposively sampled based on SDH and previously interviewed about the impact of COVID-19 on BC, were invited to take part in follow-up semi-structured qualitative interviews in early 2023. The interviews explored their perspectives of BC care since the easing of COVID-19 government restrictions, including unmet needs, patient-priorities, and recommendations specific to BC care. Thematic analysis was conducted to synthesize each topic narratively with corresponding sub-themes. Additionally, variation by SDH was analyzed within each sub-theme. RESULTS: Twenty-eight women (mean age = 61.7 years, standard deviation (SD) = 12.3) participated in interviews (response rate = 76%). Thirty-nine percent (n = 11) of women were categorized as high-SES, while 61% (n = 17) of women were categorized as low-SES. Women expressed unmet needs in their BC care including routine care and mental and physical well-being care, as well as a lack of financial support to access BC care. Patient priorities included the following: developing cohesion between different aspects of BC care; communication with and between healthcare professionals; and patient empowerment within BC care. Recommendations moving forward post-pandemic included improving the transition from active to post-treatment, enhancing support resources, and implementing telemedicine where appropriate. Overall, women of low-SES experienced more severe unmet needs, which in turn resulted in varied patient priorities and recommendations. CONCLUSION: As health systems are recovering from the COVID-19 pandemic, the emphasis should be on restoring access to BC care and improving the quality of BC care, with a particular consideration given to those women from low-SES, to reduce health inequalities post-pandemic.

Deconstructing subjective unmet healthcare needs: a South Korean case study with policy implications.

Background: Despite widespread efforts by many countries to reduce the prevalence of unmet healthcare needs within their populations, there remains a scarcity of research systematically exploring the components of these needs. Objectives: This study aims to deconstruct subjective unmet healthcare needs into two distinct components: the experience of subjective healthcare needs (the "Needs" component) and the experience of unmet needs contingent on those healthcare needs (the "Unmet" component). Methods: This analysis utilizes data from 13,359 adults aged 19 or older, collected through the 2018 Korea Health Panel survey, with the aim of minimizing the influence of the coronavirus disease 19 pandemic. The two dependent variables are the experience of subjective healthcare needs and whether these needs have been met. The independent variables include 15 socio-demographic, health, and functional characteristics. The study employs both a population proportion analysis and a multivariable bivariate probit model with sample selection. Results: In South Korea, 11.6% (CI [confidence interval] = 11.0-12.3%) of the population experienced subjective unmet healthcare needs. Upon deconstructing these, 96.7% (CI = 96.2-97.1%) of the population exhibited the Needs component, and 12.0% (CI = 11.4-12.7%) displayed the Unmet component. Each independent variable showed different associations between the two components. Furthermore, effective interventions targeting the characteristics associated with each component could reduce the proportion of the population experiencing subjective unmet healthcare needs from 11.6 to 4.0%. Conclusion: South Korea faces a significant challenge due to the considerable prevalence of subjective unmet healthcare needs. To address this challenge effectively, the universal healthcare coverage system should adapt its approach based on the characteristics associated with both the Needs and Unmet components of subjective unmet healthcare needs. To achieve this goal, it is highly recommended that the government prioritize strengthening community-based primary healthcare, which currently suffers from insufficient resources.

Unmet rehabilitation needs in the first 6 months post-injury in a trauma centre population with moderate-to-severe traumatic injuries.

OBJECTIVE: To describe the needs for subacute inpatient rehabilitation and community-based healthcare services, rehabilitation, and social support in patients with moderate-to-severe traumatic injury in the first 6 months post-injury. Further, to explore associations between sociodemographic and clinical characteristics and unmet needs. DESIGN: Multicentre prospective cohort study. SUBJECTS: Of 601 persons (75% males), mean (standard deviation) age 47 (21) years, admitted to trauma centres in 2020 with moderate-to-severe injury, 501 patients responded at the 6-month follow-up and thus were included in the analyses. METHODS: Sociodemographic and injury-related characteristics were recorded at inclusion. Estimation of needs was assessed with the Rehabilitation Complexity Scale Extended-Trauma and the Needs and Provision Complexity Scale on hospital discharge. Provision of services was recorded 6 months post-injury. Multivariable logistic regressions explored associations between baseline variables and unmet inpatient rehabilitation and community-based service needs. RESULTS: In total, 20% exhibited unmet needs for subacute inpatient rehabilitation, compared with 60% for community-based services. Predictors for unmet community-based service needs included residing in less central areas, profound injury severity, severe head injury, and rehabilitation referral before returning home. CONCLUSION: Inadequate provision of healthcare and rehabilitation services, particularly in the municipalities, resulted in substantial unmet needs in the first 6 months following injury.

Birang Daruganora: what do Aboriginal and Torres Strait Islander communities need in a new hospital? A qualitative study.

OBJECTIVES: To elicit the Aboriginal community's cultural and healthcare needs and views about six prominent and emerging models of care, to inform the development of a new hospital. DESIGN: Cross-sectional qualitative study co-designed and co-implemented by Aboriginal team members. SETTING: Western Sydney, New South Wales, Australia. PARTICIPANTS: Aboriginal and Torres Strait Islander healthcare providers (n=2) and community members (n=18) aged between 21 and 60+ years participated in yarning circles (20 participants; 14 female, 6 male). RESULTS: Handwritten notes from yarning circles were inductively analysed to synthesise the cultural and healthcare needs of providers and community members in relation to a new hospital and six models of care. Three primary themes emerged in relation to future hospitals. These were 'culturally responsive spaces', 'culturally responsive systems' and 'culturally responsive models of care'. Strengths (eg, comfort, reduced waiting time, holistic care), barriers (eg, logistics, accessibility, literacy) and enablers (eg, patient navigator role, communication pathways, streamlined processes) were identified for each of the six models of care. CONCLUSIONS: Aboriginal and Torres Strait Islander community members and providers are invested in the co-creation of an innovative, well-integrated hospital that meets the needs of the community. Common themes of respect and recognition, relationships and partnering, and capacity building emerged as important consumer and provider considerations when developing and evaluating care services. Participants supported a range of models citing concerns about accessibility and choice when discussing evidence-based models of care.

Patient and caregiver characteristics associated with differential use of primary care for children and young people in the UK: a scoping review.

OBJECTIVE: To systematically map evidence to answer the research question: What is the relationship between the characteristics of children and young people (CYP) or their caregivers and primary care service use in the UK, taking into account underlying healthcare needs? DESIGN: Scoping review. SETTING: Primary care. ELIGIBILITY CRITERIA: English-language quantitative or mixed-methods studies published between 2012 and 2022. DATA SOURCES: Medline, Embase, Scopus and Web of Science Social Sciences Citation Index, and grey literature. RESULTS: 22 eligible studies were identified, covering general practice (n=14), dental health (n=4), child mental health (MN) services (n=3) and immunisation (n=1). Only eight studies (36%) controlled for variables associated with healthcare need (eg, age, birth weight and long-term conditions). In these, evidence of horizontal inequity in primary care use was reported for CYP living in deprived areas in England, with and without complex needs. Horizontal inequity was also identified in primary care MN referrals for CYP in England identifying as mixed-race, Asian or black ethnicity, compared with their white British peers. No evidence of horizontal inequity was observed, however, in primary care use for CYP in England exposed to parental depression, or for CYP children from low-income households in Scotland. Increasing CYP's age was associated with decreasing primary care use across included studies. No studies were found regarding CYP from Gypsy or Traveller communities, children in care, or those with disabilities or special educational needs. CONCLUSIONS: There is evidence that socioeconomic factors impact on CYP's primary care use, in particular age, ethnicity and deprivation. However, better quality evidence is required to evaluate horizontal inequity in use and address knowledge gaps regarding primary care use for vulnerable CYP populations and the impact of policy and practice related 'supply side' of primary care.

Dermatology workforce projections in the United States, 2021 to 2036.

BACKGROUND: There has been a growing imbalance between supply of dermatologists and demand for dermatologic care. To best address physician shortages, it is important to delineate supply and demand patterns in the dermatologic workforce. The goal of this study was to explore dermatology supply and demand over time. METHODS: We conducted a cross-sectional analysis of workforce supply and demand projections for dermatologists from 2021 to 2036 using data from the Health Workforce Simulation Model from the National Center for Health Workforce Analysis. Estimates for total workforce supply and demand were summarized in aggregate and stratified by rurality. Scenarios with status quo demand and improved access were considered. RESULTS: Projected total supply showed a 12.45% increase by 2036. Total demand increased 12.70% by 2036 in the status quo scenario. In the improved access scenario, total supply was inadequate for total demand in any year, lagging by 28% in 2036. Metropolitan areas demonstrated a relative supply surplus up to 2036; nonmetropolitan areas had at least a 157% excess in demand throughout the study period. In 2021 adequacy was 108% and 39% adequacy for metropolitan and nonmetropolitan areas, respectively; these differences were projected to continue through 2036. CONCLUSIONS: The findings suggest that the dermatology physician workforce is inadequate to meet the demand for dermatologic services in nonmetropolitan areas. Furthermore, improved access to dermatologic care would bolster demand and especially exacerbate workforce inadequacy in nonmetropolitan areas. Continued efforts are needed to address health inequities and ensure access to quality dermatologic care for all.

Mapping the supportive care needs and quality of life of adult survivors of childhood cancer at a comprehensive cancer center in the Middle East.

Assessing unmet needs is crucial to achieving quality care and patient satisfaction. Between September and December 2021, we assessed unmet supportive care needs in a consecutive sample of adult survivors of childhood cancer at KHCC (King Hussien Cancer Center). Two hundred and ninety-seven adult survivors of childhood cancer completed the study questionnaire. The average needs score across all domains was 24.80 (SD = 19.65), with the financial domain scoring the highest 30.39 (SD = 31.95) and sexuality scoring the lowest 7.67 (SD = 19.67). Using a multivariate linear regression model, female gender was independently associated with significantly high scores in all need domains (p < 0.001), except for sexuality. Monthly income, comorbidities, socioeconomic challenges, time since diagnosis, and age at diagnosis have emerged as predictors of needs in many domains. Mean quality of life (QoL) was significantly and inversely associated with the mean score in multiple domains: psychological (p < 0.001), sexuality (p = 0.038), financial (p < 0.001), and overall needs (p = 0.004). Following a content analysis of qualitative data, educational difficulties, and work-related challenges were identified as other unmet needs. Cancer experiences during childhood significantly influence supportive care needs in adulthood. There is a need for more tailored studies assessing different populations of cancer survivors and avoiding the one-size-fits-all survivorship care.

Medical needs during the Kumamoto heavy rain 2020: analysis from emergency medical teams' responses.

BACKGROUND: Rainfall-induced floods represented 70% of the disasters in Japan from 1985 to 2018 and caused various health problems. To improve preparedness and preventive measures, more information is needed on the health problems caused by heavy rain. However, it has proven challenging to collect health data surrounding disasters due to various inhibiting factors such as environmental hazards and logistical constraints. In response to the Kumamoto Heavy Rain 2020, Emergency Medical Teams (EMTs) used J-SPEED (Japan-Surveillance in Post Extreme Emergencies and Disasters) as a daily reporting tool, collecting patient data and sending it to an EMTCC (EMT Coordination Cell) during the response. We performed a descriptive epidemiological analysis using J-SPEED data to better understand the health problems arising from the Kumamoto Heavy Rain 2020 in Japan. METHODS: During the Kumamoto Heavy Rain 2020 from July 5 to July 31, 2020, 79 EMTs used the J-SPEED form to submit daily reports to the EMTCC on the number and types of health problems they treated. We analyzed the 207 daily reports, categorizing the data by age, gender, and time period. RESULTS: Among the 816 reported consultations, women accounted for 51% and men accounted for 49%. The majority of patients were elderly (62.1%), followed by adults (32.8%), and children (5%). The most common health issues included treatment interruption (12.4%), hypertension (12.0%), wounds (10.8%), minor trauma (9.6%), and disaster-related stress symptoms (7.4%). Consultations followed six phases during the disaster response, with the highest occurrence during the hyperacute and acute phases. Directly disaster-related events comprised 13.9% of consultations, indirectly related events comprised 52.0%, and unrelated events comprised 34.0%. As the response phases progressed, the proportions of directly and indirectly related events decreased while that of unrelated events increased. CONCLUSION: By harnessing data captured by J-SPEED, this research demonstrates the feasibility of collecting, quantifying, and analyzing data using a uniform format. Comparison of the present findings with those of two previous analyses of J-SPEED data from other disaster scenarios that varied in time, location, and/or disaster type showcases the potential to use analysis of past experiences to advancing knowledge on disaster medicine and disaster public health.

Leveraging web search data in Germany to identify unmet needs of contraceptives on a population-based level: A longitudinal retrospective study.

BACKGROUND: There are a variety of possible contraceptives available. While medical advice is an important resource for selecting the individual contraceptive, previous research has shown that the Internet has become an increasingly important source of health care information. OBJECTIVES: This study aims to identify key trends in contraception-related web searches in Germany and thus allows conclusions about preferences and unmet needs with regard to pregnancy prevention. DESIGN: Longitudinal retrospective study. METHODS: Google Ads Keyword Planner was used to identify contraception-related keywords and their search volume in Germany and all federal states between 2018 and 2021. The keywords were categorized based on gender, hormonal/non-hormonal, and different contraceptive methods. Search volume and categories were analyzed for temporal trends, regional differences, and underlying socioeconomic variables. RESULTS: The 1481 contraception-related keywords corresponded to 15,081,760 searches. In total, a 56% increase in searches/100,000 inhabitants was observed. Highest mean search volume was observed in categories "woman," "woman/non-hormonal" and "woman/non-hormonal/barrier," respectively, and in the federal state Hamburg, while the lowest was seen in North Rhine-Westphalia. CONCLUSION: The increase in search volume reflects a high interest in contraception, particularly in non-hormonal female methods. This stands in contrast to the limited number of effective non-hormonal contraceptives available and points to an unmet need. In addition, the low search volume for male contraceptives demonstrates gender-specific responsibilities regarding family planning in German society.

Analyzing Google search volume to identify preferences and unmet needs in contraception in German societyContraception is a topic that occupies many people in their daily lives. There is a wide range of different contraceptives available. The decision for a particular contraceptive can be made with the help of a consultation with a gynecologist or through other sources, such as the Internet. Research has shown that the Internet has become an important source for obtaining health information. This study aims to identify key trends in contraception-related web searches in Germany and thus allows conclusions about preferences and unmet needs with regard to pregnancy prevention. Google Ads Keyword Planner was used to identify contraception-related keywords and their search volume in Germany and all federal states between 2018 and 2021. The keywords were assigned to different categories based on whether the woman or the man uses the contraceptive, whether the contraceptive methods contain hormones or no hormones, and which exact contraceptive methods are associated with the search term. The search volume was analyzed in terms of trends over time, regional differences in Germany and socioeconomic variables. A 56% increase in searches per 100,000 inhabitants was observed. The highest mean search volume was observed in the category woman, followed by female non-hormonal contraceptives and within that category, the contraceptive method "barrier." The study shows that there is a high interest in contraception, especially in non-hormonal female contraceptives. These results contrast with the limited number of non-hormonal and effective contraceptive methods available. In addition, the low search volume in the category man shows that women are the main responsible party in terms of contraception in German society.

Identification and assessment of factors that impact the demand for and supply of dental hygienists amidst an evolving workforce context: a scoping review.

BACKGROUND: This study involved a scoping review to explore factors influencing dental hygienist demand and supply in high-income countries. METHODS: A six-stage scoping review was conducted with separate search strategies tailored to four databases (MEDLINE, CINAHL, Google Scholar, and Google) plus a targeted scan of dental hygienist organization websites. This yielded 2,117 unique citations, leading to 148 articles included in the review. RESULTS: Nearly half of the articles (47%) focused on the United States, with 11% on Canada. Most articles (91%) were in English, alongside 13 in Korean and one in French. Journal articles comprised 62% of the publications, followed by reports/working papers (11%) and websites (11%). Other types included conference abstracts, policy briefs, and presentation slides. Content-wise, 47% were original research, with analysis articles (14%), commentaries (11%), and reviews (8%) also present. The articles were coded into three main categories: workforce characteristics/projections, factor-specific analyses, and workforce opportunities. The articles on workforce characteristics covered demographic, geographic, and employment aspects of dental hygienists, along with projections for supply and demand using simulation modelling and geospatial analyses. Factor-specific articles investigated the (1) working environment, (2) policy/regulatory/training environment, (3) job/career satisfaction and related human resource issues, and (4) scope of practice. The third key category of articles highlighted opportunities for expanding the workforce through alternative models in different sectors/settings (e.g., public health, primary care, long-term care, hospitals, mobile outreach, and non-clinical roles including research, education and leadership) and for a range of vulnerable or underserved populations (e.g., geriatric and pediatric populations, persons with disabilities, those living in rural/remote areas, Indigenous peoples, and incarcerated people). CONCLUSIONS: This review provides a comprehensive documentation of the current state of the dental hygienist workforce, compiling factors affecting demand and supply, and highlighting opportunities for the dental hygienist workforce in Canada and other high-income countries. The findings offer a foundation for future research, highlighting the need for more focused and rigorous reviews and underscoring the necessity of high-quality studies to verify the effectiveness of various interventions and policies. This is crucial to address dental hygienist workforce challenges and ensure the sustainability and effectiveness of oral health care delivery.

Addressing the Healthcare Needs of Transgender Youth in the Emergency Department.

ABSTRACT: Transgender is a term that refers to individuals who identify with a gender that is different from the sex assigned to them at birth. In addition to gender dysphoria, many transgender youth experience a number of challenges including homelessness, violence, and mental health problems such as suicidality. Although transgender people represent a growing subset of the population, most providers receive very little training specific to the unique healthcare needs of transgender patients. In this CME review article, we define relevant terminology then discuss best practices for clinical encounters involving transgender youth in the emergency department. Finally, we review gender-affirming care including behavioral modifications, hormones, and surgeries for transfeminine and transmasculine individuals.

Hysteroscopy needs of indigenous communities in Northern Quebec: a retrospective cohort study.

We aimed to determine the surgical output for patients from Nunavik undergoing transfer to an urban centre for hysteroscopy, and associated costs. We performed a retrospective chart review of all patients from the 14 villages of Nunavik transferred for hysteroscopic surgery from 2016 to 2021. Diagnoses, surgical intervention, and nature of the procedure were all extracted from the patient charts, and costs/length of stay obtained from logisticians and administrators servicing the Nunavik region. Over a 5-year period, 22 patients were transferred from Nunavik for hysteroscopy, of which all were elective save one. The most common diagnosis was endometrial or cervical polyp and the most common procedure was diagnostic hysteroscopy. The average cost for patient transfer and lodging to undergo hysteroscopy in Montreal ranged from $6,000 to $15,000 CDN. On average, 4-5 patient transfers occur annually for hysteroscopy, most commonly for management of endometrial polyps, at a cost of $6,000 to $15,000 CDN, suggesting the need to investigate local capacity building in Nunavik and assess cost-effectiveness.

Perceptions on support, challenges and needs among parents and caregivers of children with developmental disabilities in Croatia, North Macedonia and Serbia: a cross-sectional study.

BACKGROUND: Parents/caregivers of children with developmental disabilities (CDD) have a wide range of support needs and there are various interventions available. Support, challenges, and needs among parents/caregivers of CDD likely vary in different geographical settings. This study aimed to analyze the perceptions of support, challenges, and needs among parents/caregivers of CDD in Croatia, North Macedonia, and Serbia. METHODS: We conducted a cross-sectional study in March-April 2023 within the Erasmus + SynergyEd project. The eligible participants were parents and caregivers of CDD in Croatia, North Macedonia, and Serbia, who filled out a modified Caregiver Needs Survey online. RESULTS: Among 953 participants, 542 (57%) were from Croatia, 205 (21%) were from North Macedonia and 206 (22%) were from Serbia. The most common diagnosis of participants' children was autism spectrum disorder (26%). The child most often received the first diagnosis at the median of 2 years, diagnosed by a team of professionals. More than half (58%) of children attended preschool and public school, while 22% did not attend any schooling. Additional support from the state/city/county was received by 66% of CDD. Most participants declared not participating in association/organization for family support. Participants mostly (68%) used experts who work with the child as a source of information about their child's condition, followed by the Internet (53%). In the last 12 months, 60% of participants had difficulties with the availability of services in their area or problems getting appointments. The biggest problem in getting support was ensuring the child's basic rights were protected. Participants stated that ensuring greater rights for CDD was the greatest need for their families. CONCLUSION: Parents/caregivers of CDD in Croatia, North Macedonia, and Serbia faced multiple challenges, but most of them were satisfied with the services provided to their children. Future efforts to develop policies and services related to CDD should consider the opinions of their parents/caregivers and disparities in access to services.

Identifying gaps in healthcare: a qualitative study of Ukrainian refugee experiences in the German system, uncovering differences, information and support needs.

BACKGROUND: The 5.8 million Ukrainian refugees arriving in European countries must navigate varying healthcare systems and different and often unknown languages in their respective host countries. To date, there has been little exploration of the experiences, perceived differences, information and support needs of these refugees regarding the use of healthcare in Germany. METHODS: We conducted ten qualitative interviews with Ukrainian refugees living in Germany from February to May 2023, using Ukrainian, English and German language. The transcribed interviews were analysed using the qualitative content analysis method according to Kuckartz and Rädiker with the MAXQDA software. RESULTS: In general, participants consistently had a positive experience of the German healthcare system, particularly regarding the quality of treatments and insurance. Differences have been reported in the structure of the healthcare systems. The Ukrainian healthcare system is divided into private and state sectors, with no mandatory insurance and frequent out-of-pocket payments. Pathways differ and tend to focus more on clinics and private doctors. General practitioners, often working in less well-equipped offices, have only recently gained prominence due to healthcare system reforms. Initiating contact with doctors is often easier, with much shorter waiting times compared to Germany. Interviewees often found the prescription requirements for many medications in Germany to be unusual. However, the mentioned differences in healthcare result in unmet information needs among the refugees, especially related to communication, navigating the healthcare system, health insurance, waiting times and medication access. These needs were often addressed through personal internet research and informal (social media) networks because of lacking official information provided during or after their arrival. CONCLUSIONS: Despite the positive experiences of Ukrainian refugees in the German healthcare system, differences in the systems and language barriers led to barriers using healthcare and information needs among refugees. The dissemination of information regarding characteristics of the German health care system is crucial for successful integration but is currently lacking. TRIAL REGISTRATION: German Clinical Trials Register: DRKS00030942, date of registration: 29.12.2022.

Assessing the mental health needs of Yazidi adolescents and young adults in an Iraqi Kurdi IDP Camp: a focus group study.

BACKGROUND: Internally displaced people (IDP) in Iraq are 1.2 million (as March 2023). Protracted refugee status endangers the mental health, especially of minorities who survived persecution and conflict, such as the Yazidis. This study aims to identify the mental health needs of Yazidi adolescents and young adults (AYA) in the IDP camp of Bajed Kandala (Iraqi Kurdistan). METHODS: A focus group discussion (FGD) study was conducted between April and August 2022. The FGDs involved AYAs, as well as the staff of the clinic of the Bajed Kandala camp. An inductive approach was adopted referring to the 'theme' as the unit of content analysis of the text. All FGDs were recorded and transcribed. The analysis was carried out independently by two researchers. The inter-rater agreement was assessed through the Cohen's k. RESULTS: A total of 6 FGDs were conducted. The participants were 34 of whom 21 (61.8%) females with a median age of 18.5 years (IQR 17.0-21.0). A total of 156 themes were found as relevant to the objective of this study. Four main areas and twelve subareas of needs in mental health were identified. The interrater agreement over the main area and subareas was good (κ = 0.78 [0.95CI 0.69-0.88], κ = 0.82 [0.95CI 0.73-0.91], respectively). The four areas had a similar frequency: Activities (28.2%), Individual (27.6%), Social relationships (22.4%) and Places/setting (21.8%). The subareas 'community' and 'internal resources' were labelled as negative 85.7% and 61.9% of the time, respectively. These sub-areas referred to stigma and self-stigma towards mental health. The subarea 'female condition' was always considered as negative, as well as the subareas 'camp' and 'tent' referring to housing as an important social determinant of mental health. CONCLUSIONS: Community stigma and self-stigma are two still important factors preventing the achievement of mental well-being. Alongside these, a gender gap in mental health was identified in the FGDs. These factors should be taken into account in order to guide future mental health interventions in refugee camps.

Responding to the Health Needs of Newly Arrived Families Within Fractured Policy Environments.

The increase in forcibly displaced populations seeking refuge in the United States has been met with fragmented, chaotic, and highly politicized responses to the detriment of migrants and receiving communities alike. Migrants encounter compounding systemic barriers to accessing basic resettlement resources. Expanding on pandemic-era innovations can strengthen social safety net infrastructure as a whole. Pediatricians are a potential early touchpoint for newly arrived families, providing an opportunity to support their specific health needs, refer to critical safety net services, and advocate for improved systems and policies. [Pediatr Ann. 2024;53(5):e161-e166.].