Retos de la investigación en la evaluación de la nutrición y la salud de los inmigrantes: Una revisión narrativa / Research challenges in the assessment of immigrants' nutrition and health: A narrative review

Introducción: Esta revisión narrativa examina los métodos de investigación utilizados para comprender los hábitosalimentarios y el acceso a la salud de los migrantes vulnerables. A menudo se enfrentan a retos que afectan a sus hábitosalimentarios y a su bienestar general. Esta revisión plantea cuestiones metodológicas que los investigadores debenabordar, como la sensibilidad cultural, las barreras lingüísticas, la orientación de los investigadores sobre la selección deherramientas y estrategias adecuadas para garantizar la solidez de su investigación. Objetivos: Esta revisión contribuye a mejorar el rigor metodológico de futuros estudios e informa las intervencionesbasadas en la evidencia, dirigidas a abordar las disparidades en salud y nutrición dentro de las poblaciones inmigrantes vulnerables y destaca la colaboración interdisciplinaria para mejorar las intervenciones dirigidas a promover hábitosalimentarios más saludables entre esta población. Métodos: Se realizó una búsqueda sistemática en bases de datos académicas para identificar bibliografía relevantecentrada en los métodos de investigación y nutrición y salud en inmigrantes. Se incluyeron tanto estudios cualitativoscomo cuantitativos publicados en la última década. Los estudios seleccionados se revisaron críticamente para analizarlas metodologías empleadas, los retos afrontados y los principales hallazgos obtenidos. Conclusiones: Esta revisión destaca la necesidad de adaptaciones metodológicas específicas para cada contexto ysubraya la importancia de la sensibilidad cultural y la colaboración entre investigadores, profesionales y responsablespolíticos para desarrollar intervenciones específicas que promuevan prácticas alimentarias más saludables y mejoren elbienestar de los inmigrantes en circunstancias vulnerables.(AU)

Introduction: This narrative review examines the research methods and analytical approaches used to understand thedietary habits and health access of vulnerable migrants. They often face unique challenges that affect their eating habitsand overall well-being. This review raises methodological issues that researchers must grapple with, including culturalsensitivity, language barriers, the collection of accurate nutrition data, and guidance to researchers on selectingappropriate tools and strategies to ensure the robustness of their research. Objectives: This review contributes to enhancing the methodological rigor of future studies and informs evidence-basedinterventions aimed at addressing healthcare and nutrition disparities within vulnerable immigrant populations, andhighlights the potential for interdisciplinary collaboration to enhance the effectiveness of interventions targeted at promotinghealthier eating habits among vulnerable immigrants from different countries. Methods: A systematic search of academic databases was conducted to identify relevant literature focusing on theresearch methods and nutrition and health in immigrants. Both qualitative and quantitative studies published within the lastdecade were included. The selected studies were critically reviewed to analyze the methodologies employed, thechallenges faced, and the key findings obtained. Conclusion: This review highlights the need for context-specific methodological adaptations, and emphasizes theimportance of cultural sensitivity and collaboration among researchers, practitioners, and policymakers to develop targetedinterventions that promote healthier dietary practices and improve the well-being of immigrants in vulnerable circumstances.(AU)

Social Work and Social Justice: A Conceptual Review.

As a profession, social work has codified within its ethical guidance and educational policies a commitment to social justice. While a commitment to social justice is asserted in several of our profession's guiding documents, social work continues to lack consensus on both the meaning and merit of social justice, resulting is disparate and sometimes discriminatory practice even under a "social justice" label. This study examines how social justice has been operationalized in social work via a conceptual review of the literature. Findings show that social work leans heavily on John Rawls's definition of social justice, Martha Nussbaum's and Amartya Sen's capabilities approach, and the definition of social justice included in The Social Work Dictionary. Unfortunately, none of these adequately align with the National Association of Social Workers' Code of Ethics, which drives the profession. This conceptual review is a call to social workers to join together in defining the guiding principle of the profession.

Boundary Crossers: How Providers Facilitate Ethnic Minority Families' Access to Dementia Services.

OBJECTIVES: Providers who work closely with ethnic minority people with dementia and their families are pivotal in helping them access services. However, few studies have examined how these providers actually do this work. Using the concept of "boundary crossers," this article investigates the strategies applied by these providers to facilitate access to dementia services for ethnic minority people with dementia and their families. METHODS: Between 2017 and 2020, in-depth video-recorded interviews were conducted with 27 health, aged care, and community service providers working with ethnic minority people living with dementia across Australia. Interviews were conducted in one of seven languages and/or in English, then translated and transcribed verbatim into English. The data were analyzed thematically. RESULTS: Family and community stigma associated with dementia and extra-familial care were significant barriers to families engaging with services. To overcome these barriers, participants worked at the boundaries of culture and dementia, community and systems, strategically using English and other vernaculars, clinical and cultural terminology, building trust and rapport, and assisting with service navigation to improve access. Concurrently, they were cognizant of familial boundaries and were careful to provide services that were culturally appropriate without supplanting the families' role. DISCUSSION: In negotiating cultural, social, and professional boundaries, providers undertake multidimensional and complex work that involves education, advocacy, negotiation, navigation, creativity, and emotional engagement. This work is largely undervalued but offers a model of care that facilitates social and community development as well as service integration across health, aged care, and social services.

Evaluation of a Community Health Worker Social Prescribing Program Among UK Patients With Type 2 Diabetes.

Importance: Despite lacking robust evidence of effectiveness, health care systems in developed countries are funding holistic community health worker (CHW) social prescribing programs that address social needs and health behaviors as adjuncts to clinical care. Objective: To determine whether a UK National Health Service (NHS) CHW social prescribing program was associated with improved hemoglobin A1c (HbA1c) levels among patients with type 2 diabetes. Design, Setting, and Participants: This cohort study with difference-in-differences analysis was conducted among 8086 patients (4752 in the referral program, 3334 in the control group) in 24 NHS primary care practices in a city in North East England. Patients aged 40 to 74 years with a diagnosis of type 2 diabetes were observed for 8 years, from 2011 through 2019. The statistical analysis was conducted between June 1, 2019, and January 31, 2021. Interventions: A social prescribing program, launched in April 2015, enabling primary care staff to refer patients to CHW support to identify condition management and social needs goals and access voluntary and community sector support to address these goals. Intervention referral was only available in primary care practices in the city's west. The control group included patients in the city's east where referral was unavailable. Main Outcomes and Measures: HbA1c level, a marker of glycemic control. Results: A total of 8086 patients were included in the analysis (mean [SD] age, 57.8 [8.78] years; 3477 women [43%]; 6631 White patients [82%]). Mean (SD) baseline HbA1c levels were 7.56% (1.47%) in the referral program group and 7.44% (1.43%) in the control group. Following introduction of the social prescribing referral program, the referral group experienced an HbA1c reduction of -0.10 percentage points (95% CI, -0.17 to -0.03 percentage points) compared with the control group. The association increased over time: after 3 years the estimated association was -0.14 percentage points (95% CI, -0.24 to -0.03 percentage points). The association was stronger for White patients compared with non-White patients (-0.15 percentage points [95% CI, -0.26 to -0.04 percentage points] after 3 years), those with fewer additional comorbidities (-0.16 percentage points [95% CI, -0.29 to -0.04 percentage points] after 3 years), and those living in the most socioeconomically deprived areas (-0.19 percentage points [95% CI, -0.32 to -0.07 percentage points] after 3 years). Conclusions and Relevance: In this study of UK adults with type 2 diabetes, a social prescribing program with referral to CHWs targeting patients' social needs and health behaviors was associated with improved HbA1c levels, suggesting that holistic CHW interventions may help to reduce the public health burden of type 2 diabetes.

(De)criminalization of Survivors of Domestic Minor Sex Trafficking: A Social Work Call to Action.

Survivors of domestic minor sex trafficking (DMST) are failing to be identified and are frequently criminalized. Examining the linkages between DMST and the juvenile legal system is important, as many trafficked youths are only identified after entry into the child welfare or juvenile court system as a result of being arrested or detained on related delinquency charges. Due to legacies of structural violence, marginalized youths are reluctant to approach police officers for help. Therefore, social workers have an opportunity to identify, intervene, and advocate for trafficked youths. In this article, the author provides an overview of existing research related to the demographic profile of DMST, homelessness and survival sex, recruitment and entry, barriers to effective community response, and prevention and intervention strategies. This article represents a call to broaden our view of young people in the sex trade and supports the decriminalization of trafficked youths. Interventions and policies must be designed to fit their complex needs and experiences, resulting in empowerment, opportunity, and new beginnings.

Addressing Emotional Wellness During the COVID-19 Pandemic: the Role of Promotores in Delivering Integrated Mental Health Care and Social Services.

INTRODUCTION: The disproportionate impact of the COVID-19 pandemic on Latino communities has resulted in greater reports of depression, anxiety, and stress. We present a community-led intervention in Latino communities that integrated social services in mental health service delivery for an equity-based response. METHODS: We used tracking sheets to identify 1,436 unique participants (aged 5-86) enrolled in Latino Health Access's Emotional Wellness program, of whom 346 enrolled in the pre-COVID-19 period (March 2019-February 2020) and 1,090 in the COVID-19 period (March-June 2020). Demographic characteristics and types of services were aggregated to assess monthly trends using Pearson χ2 tests. Regression models were developed to compare factors associated with referrals in the pre-COVID-19 and COVID-19 periods. RESULTS: During the pandemic, service volume (P < .001) and participant volume (P < .001) increased significantly compared with the prepandemic period. Participant characteristics were similar during both periods, the only differences being age distribution, expanded geographic range, and increased male participation during the pandemic. Nonreferred services, such as peer support, increased during the pandemic period. Type of referrals significantly changed from primarily mental health services and disease management in the prepandemic period to affordable housing support, food assistance, and supplemental income. CONCLUSION: An effective mental health program in response to the pandemic must incorporate direct mental health services and address social needs that exacerbate mental health risk for Latino communities. This study presents a model of how to integrate both factors by leveraging promotor-led programs.

Insights from homeless men about PRISM, an innovative shelter-based mental health service.

PRISM (Projet Réaffiliation Itinérance Santé Mentale-mental health and homelessness reaffiliation project), is a new shelter-based mental health service in Montreal, Canada. It offers short-term residential services in a shelter with the aim of housing and connecting the person to the appropriate services in the community. This qualitative research project was designed to gain a rich understanding of service-user experience within this program, and to apply these impressions to a broader reflection concerning how to best serve the needs of homeless people living with severe mental illness. We conducted in-depth interviews with 20 clients from the all-male PRISM-Welcome Hall Mission at program intake and departure between May 2018 and March 2019. We used methods stemming from grounded theory to analyze themes emerging from the interviews. Analysis revealed three core aspects endorsed by PRISM clients as helpful to their recovery: first, the community-based and flexible PRISM structure allows for continuity in daily routine through the preservation and expansion of the client's existing informal resource network; second, the secure environment is conducive to improving one's physical and mental health; and third, the multimodal mental health and social service approach used at PRISM is appreciated and stands in contrast to what most have experienced during other inpatient experiences. This led us to reflect more broadly on the benefits of a shelter-based intervention, as a catalyst to the achievement of longer-term goals such as housing, as well as flexible care adapted to the specific needs of these individuals. Even though this study took place in a specific program in Quebec, it sheds light more broadly on how to best meet the needs of individuals with mental illness living in homeless situations and contributes to the growing literature on men's mental health.

The Crisis Facing Older People Living with Neurodiversity and Their Aging Family Carers: A Social Work Perspective.

This commentary addresses barriers to care among older adults living with neurodiversity (ND), and their aging family carers in the context of the COVID-19 pandemic in Canada. Factors contributing to inequities are described and the significant negative consequences of current policy decisions on the social and mental health of older adults with ND and their aging family carers are highlighted. The commentary calls for a collective social work response that highlights the critical role of support and advocacy necessary to redress social exclusion.

Healthcare and education networks interaction as an indicator of social services stability following natural disasters.

Healthcare and education systems have been identified by various national and international organizations as the main pillars of communities' stability. Understanding the correlation between these main social services institutions is critical to determining the tipping point of communities following natural disasters. Despite being defined as social services stability indicators, to date, no studies have been conducted to determine the level of interdependence between schools and hospitals and their collective influence on their recoveries following extreme events. In this study, we devise an agent-based model to investigate the complex interaction between healthcare and education networks and their overall recovery, while considering other physical, social, and economic factors. We employ comprehensive models to simulate the functional processes within each facility and to optimize their recovery trajectories after earthquake occurrence. The results highlight significant interdependencies between hospitals and schools, including direct and indirect relationships, suggesting the need for collective coupling of their recovery to achieve full functionality of either of the two systems following natural disasters. Recognizing this high level of interdependence, we then establish a social services stability index, which can be used by policymakers and community leaders to quantify the impact of healthcare and education services on community resilience and social services stability.

Collaborative Responses to Commercial Sexual Exploitation as a Model of Smart Decarceration.

Historically, youths who are affected by commercial sexual exploitation (CSE) in the United States have been implicated as perpetrators of crime and overrepresented in the juvenile justice system. As an intriguing example of the "smart decarceration" social work grand challenge, policy and practice initiatives have converged to decriminalize cisgender girls and young women experiencing CSE by reframing them as victims of exploitation rather than as criminals. To date, these efforts have largely focused on gender-specific programming for cisgender girls and young women. In this article, the authors describe how federal, state, and local policy and practice innovations have supported reframing CSE as a form of child maltreatment and rerouted girls and young women from the juvenile justice system to specialized services. Using Los Angeles County as a case example, the authors detail how innovative prevention, intervention, and aftercare programs can serve as models of smart decarceration for CSE-affected cisgender girls and young women with the potential to address the needs of youths with diverse gender and sexual identities.

Gender Matters: Infusing a Gender Analysis into the "Healthy Development of All Youth" Grand Challenge.

The social work grand challenge to ensure healthy youth development necessarily involves a focus on violence prevention, including the prevention of sexual and dating violence during adolescence. The experience of sexual and dating violence is associated with numerous and often long-lasting detrimental mental, physical, and social outcomes, many of which this grand challenge seeks to prevent. Although evidence shows that gender is a critical axis of identity to consider in violence prevention research and practice efforts, gender is not a central lens applied in the field's approach to such issues within this grand challenge. First, this article articulates a rationale for infusing a gender analysis into understanding sexual and dating violence and conceptualizing effective violence prevention strategies. Second, authors describe gender-transformative (GT) approaches to sexual and dating violence prevention, a promising practice for both ensuring the healthy development of youths and reducing violence perpetration by focusing on engaging boys and young men. Third, authors discuss the potential for GT strategies to be used in prevention efforts targeting adolescent social issues more broadly. Last, authors call for practitioners and researchers focused on healthy youth development to apply a gender analysis in their efforts and articulate concrete ways to do so.

Assessment of Social Risk Factors and Interest in Receiving Health Care-Based Social Assistance Among Adult Patients and Adult Caregivers of Pediatric Patients.

Importance: Health care organizations are increasingly incorporating social risk screening into patient care. Studies have reported wide variations in patients' interest in receiving health care-based assistance for identified social risks. However, no study to date has examined the factors associated with patients' interest in receiving assistance, including whether interest in receiving assistance varies based on specific patient demographic characteristics. Targeted research on this topic could improve the success of health care-based programs that offer social care services. Objective: To identify participant characteristics associated with interest in receiving health care-based social risk assistance. Design, Setting, and Participants: This cross-sectional study was conducted in 7 primary care clinics and 4 emergency departments in 9 US states between July 2, 2018, and February 13, 2019. A convenience sample of adult patients and adult caregivers of pediatric patients completed a screening survey that measured social risk factors and participants' interest in receiving assistance for identified social risks. Participants were randomly selected to receive 1 of 2 versions of the survey, which differed based on the order in which questions about social risks and interest in receiving assistance were presented. Multivariable logistic regression analyses were used to evaluate the associations between covariates and participants' interest in receiving assistance, stratified by social risk screening results. Data were analyzed from September 8, 2019, to July 30, 2020. Exposures: Social risk screening questions assessed risk factors comprising housing, food, transportation, utilities, and exposure to interpersonal violence. Additional questions assessed participants' interest in receiving assistance and their perspectives on health care-based social risk screening. Main Outcomes and Measures: Participant interest in receiving health care-based social risk assistance. Results: A total of 1021 adult participants with complete survey responses were included in the analysis. Of those, 709 of 1004 participants (70.6%) were female, and 544 of 1007 participants (54.0%) were aged 18 to 44 years. Overall, 353 of 662 participants (53.3%) with positive screening results for 1 or more social risk factors were interested in receiving assistance, whereas 31 of 359 participants (8.6%) with negative screening results for all social risks were interested in receiving assistance. Participants with positive screening results for 1 or more social risk factors had a higher likelihood of being interested in receiving assistance if they answered the question about interest in receiving assistance before they answered the questions about social risk factors (adjusted odds ratio [aOR], 1.48; 95% CI, 1.05-2.07), had positive screening results for a higher number of social risk factors (aOR, 2.40; 95% CI, 1.68-3.42), reported lower household income levels (aOR, 7.78; 95% CI, 2.96-20.44), or self-identified as having non-Hispanic Black ancestry (aOR, 2.22; 95% CI, 1.37-3.60). Among those with negative screening results for all social risk factors, the interest in receiving assistance was higher if the participants reported lower household income levels (aOR, 12.38; 95% CI, 2.94-52.15), previous exposure to health care-based social risk screening (aOR, 2.35; 95% CI, 1.47-3.74), higher perceived appropriateness of social risk screening (aOR, 3.69; 95% CI, 1.08-12.55), or worse health status (aOR, 4.22; 95% CI, 1.09-16.31). Conclusions and Relevance: In this study, multiple factors were associated with participants' interest in receiving social risk assistance. These findings may have implications for how and when social risk assistance is offered to patients. As the health care system's role in addressing social risk factors evolves, an understanding of patients' perspectives regarding screening and their interest in receiving assistance may be important to implementing patient-centered interventions.

Indigenous Women, Water Protectors, and Reciprocal Responsibilities.

Indigenous women in North America have traditionally had reciprocal relationships with and responsibilities to the Earth. The process of colonization violently transformed both the treatment of the Earth and of Indigenous women. Current environmental crises highlight not only the vulnerability of Indigenous women, but also their long-standing leadership in resisting environmental injustices affecting their families, relationships, and nations. In this article, authors focus on the resistance of Dakota water protectors with the #NoDAPL movement in the United States and Anishinaabe water protectors in Mother Earth Water Walks in Canada. Recommendations for social workers in supporting Indigenous women in a thoughtful and effective way include incorporating a definition of a "social" response to more-than-human world relationships and responsibilities, supporting direct action as a necessary social response to environmental issues, and acting in solidarity with Indigenous women in these movements.

Adverse childhood experiences and mental and physical health disparities: the moderating effect of race and implications for social work.

Adverse childhood experiences (ACEs) have been linked to mental and physical health problems, leading to ACEs being viewed as a public health concern. Yet, less research has focused on the prevalence and impact of ACEs among diverse racial and ethnic groups. Given the increasing diversity in the USA, coupled with research that has found certain racial and ethnic groups to experience larger-scale adversity such as poverty or discrimination more frequently than White individuals, it is important to understand how ACEs are experienced by people of color. The current study examined the prevalence of ACEs among diverse racial and ethnic groups, and associations between ACE score and mental and physical health. Even after adjusting for sociodemographic factors, ACE scores of 3 or higher were linked to more physical and mental health problems. Furthermore, there was a significant interaction effect between ACE score and race on physical health, while none of the interaction terms were significant between ACE score and race on mental health. This suggests that higher ACE scores have a more detrimental impact on physical health for people of color. Implications for social work include implementing community-level ACE-informed responses, especially in communities that serve traditionally marginalized populations.

Effect of COVID-19 lockdown on child protection medical assessments: a retrospective observational study in Birmingham, UK.

OBJECTIVES: To determine any change in referral patterns and outcomes in children (0-18) referred for child protection medical examination (CPME) during the COVID-19 pandemic compared with previous years. DESIGN: Retrospective observational study, analysing routinely collected clinical data from CPME reports in a rapid response to the pandemic lockdown. SETTING: Birmingham Community Healthcare NHS Trust, which provides all routine CPME for Birmingham, England, population 1.1 million including 288 000 children. PARTICIPANTS: Children aged under 18 years attending CPME during an 18-week period from late February to late June during the years 2018-2020. MAIN OUTCOME MEASURES: Numbers of referrals, source of disclosure and outcomes from CPME. RESULTS: There were 78 CPME referrals in 2018, 75 in 2019 and 47 in 2020, this was a 39.7% (95% CI 12.4% to 59.0%) reduction in referrals from 2018 to 2020, and a 37.3% (95% CI 8.6% to 57.4%) reduction from 2019 to 2020. There were fewer CPME referrals initiated by school staff in 2020, 12 (26%) compared with 36 (47%) and 38 (52%) in 2018 and 2019, respectively. In all years 75.9% of children were known to social care prior to CPME, and 94% of CPME concluded that there were significant safeguarding concerns. CONCLUSIONS: School closure due to COVID-19 may have harmed children as child abuse has remained hidden. There needs to be either mandatory attendance at schools in future or viable alternatives found. There may be a significant increase in safeguarding referrals when schools fully reopen as children disclose the abuse they have experienced at home.

Exploring a social work lead mindfulness-based intervention to address burnout among inpatient psychiatric nurses: a pilot study.

Acute psychiatric nurses experience workplace stressors related to organizational factors including staffing shortages, along with interpersonal conflict with patients and colleagues. The pilot study examined the experience of burnout among acute care psychiatric nurses and the usefulness of a social work lead mindfulness-based intervention for reducing burnout elements. Findings indicated participants experienced emotional exhaustion associated with their work, but also a significant degree of personal accomplishment. Nurses identified the intervention as having the potential to promote better emotional regulation in the workplace and beyond. Social worker education on mindfulness techniques may represent an untapped resource for improving the emotional wellness and effective patient care.

Impact of bereavement care and pregnancy loss services on families: Findings and recommendations from Irish inquiry reports.

BACKGROUND: Pregnancy loss and the death of their baby can be overwhelming for families, especially when the loss is unexpected. The standard of bereavement care families receive around the time of pregnancy or early infant loss can have a significant impact on their psychological recovery. At times external inquiries are carried out to identify issues in the maternity care provided and make recommendations to improve its' standard. OBJECTIVE: This study aims to describe the impact of bereavement care provided to families around the time of pregnancy and/or early infant loss as stated in ten published inquiry reports related to Irish maternity services. METHODS: Using thematic analysis, issues with care encountered by bereaved parents as outlined in the reports were identified. These focussed around five main themes (communication, healthcare staff skills, maternity unit environment, post-mortem/coronial process, local incident reviews). FINDINGS: Bereavement care, as described by families in the ten reports, was not consistently individualised or respectful, resulting in additional feelings of anger and upset. Problems with clear communication of complex issues, in a manner that is understandable to bereaved families, were identified in several reports. Recommendations from the inquiry reports included that experienced and skilled staff should always be available to provide immediate support to bereaved families as appropriate, and assist families in understanding and processing information around the time of their loss. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Consistent, individualised bereavement care facilitates a seamless transition for bereaved families from diagnosis through the hospital stay to discharge and follow-up, allowing them to focus on their baby, their bereavement and their family's wellbeing. The process of consent for a perinatal post-mortem and associated concerns have evolved over the timeframe of the ten inquiries. We reflect further on this and the impacts of the other issues highlighted, as well as discussing possible improvements to address them as described in the scientific literature.

Medical social workers as mediators between patients, physicians, and the court: the case of former ringworm patients.

Facilitating benefit and resource acquisition to assist clients is a major responsibility of medical social workers, requiring them to have a thorough knowledge of community resources, legislation, and regulations. The aim of the current study was to examine knowledge of the Law for Compensation of Scalp Ringworm Victims and ringworm-related irradiation damage among 101 social workers employed in diverse healthcare settings in Israel. We found that 65.3% of the social workers were aware of the law, but only 40.6% were aware of the health effects of scalp ringworm irradiation. Media coverage and clients who underwent scalp ringworm irradiation were social workers' major sources of knowledge. Working with former ringworm patients had the strongest association with knowledge of the law and of ringworm-related irradiation damage. Results highlight the important contribution of exposure to clients' experiences and knowledge to expand social workers' knowledge of health issues.