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1.
Z Psychosom Med Psychother ; 66(1): 20-31, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32066348

RESUMO

Objectives: Intercultural opening of the health care system is supposed to optimize health services for migrants. It is part of the National Integration Plan and promoted by medical societies in Germany. This study examines its state of implementation at hospitals and rehabilitation centres for psychosomatic medicine and psychotherapy in Bavaria. Methods: A written survey was conducted using a modified version of the questionnaire for the implementation of intercultural opening in the mental health care system IKÖ-P (Penka et al. 2012a). Results: Altogether 18 institutions responded. Migrants were underrepresented among patients and employees excluding physicians. Specialized psychotherapeutic interventions for migrants were rarely available, but frequently used when offered. Conclusions: Intercultural opening was poorly implemented in a structural level. Due to the low response-rate of 21.7 % the survey is not representative. Participation of institutions interested in intercultural opening could have led to biased results. To provide adequate psychosomatic medical care for migrants, intercultural opening should be further developed.


Assuntos
Competência Cultural/organização & administração , Hospitais , Transtornos Psicofisiológicos/terapia , Medicina Psicossomática/organização & administração , Psicoterapia/organização & administração , Centros de Reabilitação/organização & administração , Alemanha , Humanos , Transtornos Psicofisiológicos/etnologia , Migrantes/psicologia
2.
Artigo em Alemão | MEDLINE | ID: mdl-31802152

RESUMO

BACKGROUND AND AIM: Reasons for lower use of medical services by children and adolescents with migration background have not yet been investigated. The aim is therefore to identify factors that are related to the utilization of outpatient medical care and subjective patient satisfaction as well as explain differences according to migration background. METHODS: On the basis of the "German Health Interview and Examination Survey for Children and Adolescents" (KiGGS, baseline study: 2003-2006), in which 17,640 children and adolescents participated, prevalences with 95% confidence intervals as well as multivariate binary logistic regression analyzes on the relationship between migration background, country of origin, the use of outpatient medical care services in the last 12 months, and satisfaction with the last medical treatment were calculated. RESULTS: Children up to age 13 with two-sided migration background had lower utilization of specialist doctors compared to those without migration background (OR = 0.64 [0.56-0.74]). However, among the 14- to 17-year-olds, the utilization did not differ significantly (OR = 0.79 [0.60-1.03]). The lower use of outpatient medical care is associated with a shorter length of stay and limited German language skills. In addition, parents from Poland and the former Soviet Union are less likely to be very satisfied with the last outpatient treatment of their 0­ to 13-year-old child, even after adjustments for German language skills and length of stay. CONCLUSION: To make it easier for children with migration background to access specialist services, it is important to reduce language barriers in outpatient medical care and to promote processes of intercultural opening.


Assuntos
Pacientes Ambulatoriais , Satisfação Pessoal , Migrantes/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Alemanha , Inquéritos Epidemiológicos , Humanos , Lactente , Recém-Nascido , U.R.S.S.
3.
Int J Dent Hyg ; 18(1): 84-91, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31380599

RESUMO

OBJECTIVE: To investigate the disparity in dental caries between native and migrant children in Shanghai, China. METHODS: Between 2013 and 2015, a random cluster sample of native and migrant children aged 5, 9, 12 and 15 years was collected from each district in Shanghai. Oral examination was performed following the World Health Organization (WHO) method, and findings were reported as decayed-missing-filled teeth of primary dentition (dmft) and permanent dentition (DMFT). RESULTS: A total of 10 150 children were examined, and 33.6% of them were migrants. Migrant children had a higher prevalence of deciduous caries than native children (the 5-year-old age group, 67.8% vs 63.0%, P = 0.024; the 9-year-old age group, 75.9% vs 66.1%, P < 0.001), and higher dmft values were found in migrant children. But with respect to permanent teeth, no statistical differences were found between the two groups in caries prevalence or DMFT. After controlling for potential confounders by logistic regression, migrant children showed a higher risk of deciduous caries (odds ratio 1.42, 95% confidence interval 1.25-1.61, P < 0.001) but not of permanent caries. Migrant children exhibited relatively lower deciduous Restorative Care Index (RCI). However, 9- and 15-year-old migrant children had a higher permanent RCI than their native counterparts. CONCLUSIONS: Dental caries prevalence in migrant children was higher in the deciduous teeth but not in the permanent teeth compared to that in their native counterparts. School-based dental public health services may contribute to reducing the disparity in dental health status between migrant and native children.


Assuntos
Cárie Dentária , Migrantes , Adolescente , Criança , Pré-Escolar , China , Estudos Transversais , Índice CPO , Humanos , Prevalência
5.
BMJ ; 367: l7001, 2019 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-31848154
7.
BMC Public Health ; 19(1): 1485, 2019 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-31703660

RESUMO

BACKGROUND: Refugees are particularly vulnerable to poor mental health outcomes due to exposure to pre migration trauma and post migration stressors. Research has demonstrated evidence to suggest that the professional help-seeking among refugee groups is low or problematic. This study seeks to examine help-seeking for emotional problems in two large samples of Iraqi and Afghan refugees in Australia. METHODS: This study uses data from two waves of the Building a New Life in Australia, the longitudinal study of Humanitarian migrants. The data was collected face-to-face between 2013 and 2016, among humanitarian migrants. All participants held a permanent protection visa and had arrived in Australia or been granted their visa between period of May to December 2013. The study sample included 1288 participants born in Iraq and Afghanistan (aged 15 and over). In the Wave 3 interview (2015-2016) participants reported on professional help received to deal with emotional problems. RESULTS: Approximately 36 and 37% of the Iraqi and Afghan groups respectively, reported seeking help for emotional problems. Within the Iraqi group, associations between mental health status, namely general psychological distress and PTSD and help-seeking were found but this was not present in the Afghan group, where age seemed to play a role in help-seeking. Frequency of help received was low with approximately 47% of the Iraqi and 57% of the Afghan groups reporting having received help 5 times or less in the last 12 months. CONCLUSIONS: Findings from this study provide clear directions on areas where culturally tailored mental health promotion programs should target in these two refugee communities. Further, the differences in help-seeking behaviour of these communities should be noted by both clinicians and policy makers as efforts to provide culturally responsive mental health services.


Assuntos
Transtornos Mentais/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Refugiados/psicologia , Migrantes/psicologia , Adolescente , Adulto , Afeganistão/etnologia , Austrália , Bases de Dados Factuais , Feminino , Humanos , Iraque/etnologia , Estudos Longitudinais , Masculino , Transtornos Mentais/etnologia , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Adulto Jovem
8.
BMC Public Health ; 19(1): 1513, 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31718594

RESUMO

BACKGROUND: Discrimination is a major driver of health disparities among minority groups and can impede the reach of public health programs. In the Dominican Republic, residents of bateyes, or agricultural 'company towns,' often face barriers to health care. This study examined the extent of perceived discrimination among batey populations and places the findings within the context of disease elimination efforts. METHODS: In March-April 2016, a stratified, multi-stage cluster survey that included the 9-item Everyday Discrimination Scale (EDS) was conducted among residents (n = 768) of bateyes across the Dominican Republic. Exploratory factor analysis, differential item functioning, and linear and logistic regression were used to assess associations between EDS scores, ethnic group status, reasons for discrimination, and healthcare-seeking behavior. RESULTS: Three ethnic groups were identified in the population: Haitian-born persons (42.5%), Dominican-born persons with Haitian descent (25.5%), and Dominican-born persons without Haitian descent (32.0%). Mean EDS scores (range 0-45) were highest among persons born in Haiti (18.2, 95% confidence interval [CI] = 16.4-20.1), followed by persons with Haitian descent (16.5, 95% CI = 14.9-18.0), and those without Haitian descent (13.3, 95% CI = 12.1-14.5). Higher EDS scores were significantly associated with Haitian birth (ß = 6.8, 95% CI = 4.2-9.4; p < 0.001) and Haitian descent (ß = 6.1, 95% CI = 3.2-9.0; p < 0.001). Most respondents (71.5%) had scores high enough to elicit reasons for their discrimination. Regardless of ethnic group, poverty was a common reason for discrimination, but Haitian-born and Haitian-descended people also attributed discrimination to their origin, documentation status, or skin color. EDS scores were not significantly associated with differences in reported care-seeking for recent fever (ß = 1.7, 95% CI = - 1.4-4.9; p = 0.278). CONCLUSION: Perceived discrimination is common among batey residents of all backgrounds but highest among Haitian-born people. Discrimination did not appear to be a primary barrier to care-seeking, suggesting other explanations for reduced care-seeking among Haitian populations. Public health community engagement strategies should avoid exacerbating stigma, build active participation in programs, and work towards community ownership of disease control and elimination goals.


Assuntos
Agricultura , Grupos Étnicos , Acesso aos Serviços de Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Pobreza , Discriminação Social , Migrantes , Adolescente , Adulto , Idoso , Erradicação de Doenças , República Dominicana , Feminino , Haiti , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Grupos Minoritários , Saúde Pública , Características de Residência , Inquéritos e Questionários , Adulto Jovem
9.
Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi ; 37(10): 752-756, 2019 Oct 20.
Artigo em Chinês | MEDLINE | ID: mdl-31726505

RESUMO

Objective: To explore the prevalence of occupational musculoskeletal disorders (OMD) and its influencing factors among rural migrant workers in Tianjin, with the aim of developing strategies to improve the health condition of this specific population. Methods: Questionnaire survey was conducted among 415 rural migrant workers working in Tianjin about their fundamental state and occupational musculoskeletal disorders (OMD) during January 2015 to January 2016. Statistical methods were utilized to analyze the influencing factor. Results: A total of 415 rural migrant workers were investigated, in which young Young adults and low education level were in the majority of rural migrant workers. The prevalence of OMD for whole population, male and female were 28.92% (120/415), 33.06% (81/245) and 22.94% (39/170), respectively. Prevalence showed significant differences njin and workplace hygiene. Multivariate logistic regression analysis showed that the risks of OMD increased with age group, and decreased with higher education level. The risk of OMD among rural migrant workers with monthly income between 3000 to 5000 yuan was 2.26 times (95%CI: 1.37-3.75) higher than that of low-income workers (<3000 yuan per month). Workers engaged in housekeeping service had 2.28 times higher risk of OMD than those in manufacturing industry (95%CI: 1.06-4.89) . Conclusion: Prevalence of OMD among rural migrant workers is higher than that of general people. Age, education, monthly income, occupation are the independent influencing factors for OMD among rural migrant workers.


Assuntos
Doenças Musculoesqueléticas/epidemiologia , Doenças Profissionais/epidemiologia , Migrantes , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Prevalência , Fatores de Risco , Inquéritos e Questionários , Adulto Jovem
10.
BMC Public Health ; 19(1): 1534, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31730454

RESUMO

BACKGROUND: Since Nepali cross-border migrants can freely enter, work and stay in India, they are largely undocumented. The majority is involved in semi-skilled or unskilled jobs with limited labour rights and social security, a fact which predisposes them to psychological distress. We aimed to assess the prevalence of and factors associated with psychological morbidity among Nepali migrants upon their return from India. METHODS: A community based cross-sectional study was conducted in six districts of Nepal between September 2017 and February 2018. A total of 751 participants who had worked at least six months in India and returned to Nepal were interviewed from 24 randomly selected clusters. The General Health Questionnaire (GHQ)-12 was used to measure the psychological morbidity. Data were analysed using Poisson regression analysis. RESULTS: The majority was younger than 35 years (64.1%), male (96.7%), married (81.8%), had at least a primary education (66.6%), and belonged to Dalit, Janajati and religious minorities (53.7%). The prevalence of psychological morbidity was 13.5% (CI: 11.2-16.1%). Participants aged 45 years and above (adjusted prevalence ratio (aPR) = 2.74), from the Terai (aPR = 3.29), a religious minority (aPR = 3.64), who received no sick leave (aPR = 2.4), with existing health problems (aPR = 2.0) and having difficulty in accessing health care (aPR = 1.88) were more likely than others to exhibit a psychological morbidity. CONCLUSION: This study demonstrated that psychological morbidity was prevalent in the study participants and varied significantly with individual characteristics, work conditions and health. Multifaceted approaches including psychological counselling for returnees and protection of labour and health rights in the workplace are recommended to help reduce psychological morbidity.


Assuntos
Emigração e Imigração , Transtornos Mentais/etnologia , Transtornos Mentais/epidemiologia , Migrantes/psicologia , Adolescente , Adulto , Análise por Conglomerados , Estudos Transversais , Emprego/psicologia , Feminino , Acesso aos Serviços de Saúde , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Nepal/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Distribuição de Poisson , Prevalência , Adulto Jovem
11.
BMC Health Serv Res ; 19(1): 779, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31675975

RESUMO

BACKGROUND: Despite extensive research concerning the impact of health insurance on the advancement of infant health in developed countries, few studies have adjusted their results for potential confounding due to adverse selection in insurance coverage, wherein those who anticipate a need for health services tend to be the ones that acquire insurance. The presence of compulsory health insurance in China, such as the Urban Employee Basic Medical Insurance (UEBMI) scheme may provide an opportunity to estimate the effect of health insurance on infant health, by reducing the endogeneity problem into insurance due to the adverse selection. The objective is to assess the relationship between UEBMI and infant health outcomes in one sizeable municipal-level obstetrics hospital in Shanghai, East China. METHODS: Medical records data from the Shanghai First Maternity and Infant Hospital from January 1, 2013 to April 30, 2019 were used to form an analysis dataset of 160,429 live births which was comprised of Shanghai residents with UEBMI coverage (n = 101,153) and women without any insurance coverage (n = 59,276). A propensity score matching approach using conjoint quantile regression and probit regression models was used to eliminate latent endogeneity of UEBMI coverage in order to garner robust results. Further analysis stratified by maternal migrant status was conducted to further assess the sensitivity of the findings to distinct patient subgroups. RESULTS: The UEBMI scheme was shown to be associated with improvements in infant birth outcomes. The scheme was associated with: an increase in birth weight of about 30 g (p <  0.001, 95% CI 23.908-35.295). This finding was evident in other five different birth outcomes (premature birth, low birth weight, very low birth weight, low Apgar score, and an abnormal health condition at birth). After stratifying by migrant status, the UEBMI was shown to have a greater effect on migrants compared to local residents of Shanghai. CONCLUSIONS: Our findings suggest that health insurance coverage for pregnant women, especially for migrants, has the potential to significantly and directly improve infant health outcomes. Further research is required to determine whether these findings can be replicated for other Chinese jurisdictions.


Assuntos
Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Resultado da Gravidez , Adulto , China , Feminino , Humanos , Recém-Nascido , Gravidez , Migrantes/estatística & dados numéricos , População Urbana/estatística & dados numéricos
12.
Artigo em Alemão | MEDLINE | ID: mdl-31650187

RESUMO

BACKGROUND: In Germany, reliable information on the health of people with migration background (PMB) is scarce. Therefore, the Robert Koch Institute initiated the project "Improving health monitoring in migrant populations (IMIRA)" to improve the inclusion of PMB into the federal health monitoring. OBJECTIVE: The objective of this article is to identify challenges and strategies in accessing migrant populations with epidemiological research. MATERIAL AND METHODS: A total of 24 guided interviews with experts from Germany were conducted. Experts were scientists from various disciplines with a research focus on migration, civil servants in the area of migration, and experts from the field. The interview focused on challenges and strategies regarding access to migrants in research. The written summaries of the interviews were analyzed. RESULTS: Challenges in accessing PMB include language, sociodemographic and cultural barriers, fears, structural, and practical difficulties. Further challenges arise from the heterogeneity and motivation of the groups. Strategies to increase accessibility among PMB can be found in the research process, methods, communication, and diversity-sensitive research culture. Confidence-building is considered significant. DISCUSSION: Experts report a variety of strategies that focus on addressing and including PMB directly: strengthening of participatory approaches, new forms of translation, and measures to increase trust in research should be the focus of future efforts. The willingness to participate in epidemiological research can be increased with appropriate strategies and thus data on the health of migrant populations can be improved sustainably.


Assuntos
Acesso aos Serviços de Saúde , Migrantes , Comunicação , Estudos Epidemiológicos , Alemanha , Humanos
13.
BMC Public Health ; 19(1): 1397, 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31660916

RESUMO

BACKGROUND: Travellers visiting friends and relatives (VFR) define a specific population of travellers exposed to higher risks for health and safety than tourists. The aim of this study was to assess differentials in pre-travel health care in VFR travellers compared to other travellers. METHODS: A retrospective cohort study was performed including attendees of the Travel Medicine Clinic of the Hospital Universitari de Bellvitge, Barcelona, Spain, between January 2007 and December 2017. RESULTS: Over the 10-year period, 47,022 subjects presented to the travel clinic for pre-travel health care, 13.7% of whom were VFR travellers. These showed higher rates of vaccination against yellow fever and meningococcus, but lower rates for hepatitis A, hepatitis B, influenza, rabies, cholera, polio, typhoid IM vaccine and tetanus vaccine boosters. Regarding malaria prevention measures, results highlighted that VFR travellers, when compared with tourists, were more likely to be prescribed with chemoprophylaxis, particularly with mefloquine, than with atovaquone/proguanil. CONCLUSIONS: Findings from this large-scale study indicated differences in vaccination rates and completion, as well as in chemoprophylaxis for malaria, between VFR and non-VFR travellers, fostering specific interventions for promoting adherence to pre-travel health advice among migrant travellers.


Assuntos
Migrantes/psicologia , Medicina de Viagem/estatística & dados numéricos , Viagem/estatística & dados numéricos , Adulto , Família , Feminino , Amigos , Hospitais Universitários , Humanos , Malária/prevenção & controle , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha , Migrantes/estatística & dados numéricos , Vacinação/estatística & dados numéricos
14.
Rev Prat ; 69(6): 668-669, 2019 Jun.
Artigo em Francês | MEDLINE | ID: mdl-31626430

RESUMO

Migrant populations, due to their condition of migrants, are exposed to structural vulnerability factors, which influence their health status. Globally, evidences on the negative impact of these structural factors on migrants' health are increasing. We hereby describe these structural factors, which exert their influence at health system's macro-, meso- and micro-levels. We then propose some solutions in order to mitigate the negative effects of these factors on migrants' health. We highlight some key attributes which would qualify an organization as "health literacy sensitive", which would constitute a step towards migrant's health equity.


Assuntos
Nível de Saúde , Migrantes , Humanos , Fatores de Risco
16.
Rev Prat ; 69(6): 672-675, 2019 Jun.
Artigo em Francês | MEDLINE | ID: mdl-31626432

RESUMO

Recently arrived migrants arriving in Europe have been particularly exposed to many difficult events, including potentially traumatic violence. Their pre-migratory experience, the conditions of their journey to Europe, the way they were received, and the intercultural situation are the different factors that, while interacting, weaken them. The available epidemiological data, although disparate and difficult to compare, show that more than a quarter of them have psychological disorders (post-traumatic stress disorder and depression in particular) that require care. Their access to care is difficult and psychological disorders are not always highlighted. Every doctor should be able to make the hypothesis of post-traumatic disorders in such a context and be able to refer to appropriate care if necessary. The future of patients, their ability to assert their rights, to find their place in our society and sometimes their survival depend on it.


Assuntos
Saúde Mental , Transtornos de Estresse Pós-Traumáticos , Migrantes , Europa (Continente) , Humanos , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/terapia , Migrantes/psicologia , Violência
17.
Rev Prat ; 69(6): 676-678, 2019 Jun.
Artigo em Francês | MEDLINE | ID: mdl-31626433

RESUMO

Today, people all over the world are on the move. Women and girls account for nearly half of the 244 million migrants. They are sometimes forced to leave their country of origin to flee physical, psychological or sexual violence and gender discrimination. Then the migratory route and the new life in the country of asylum expose them to situations of vulnerability and they are therefore at risk of physical, psychological or sexual abuse. The risk of HIV infection is high. Practitioners in host countries receive these women for various reasons in consultation. Knowing their background allows us to support them and offer them care adapted to their needs and requests. The first step is systematic screening by professionals. Secondly, multidisciplinary care is essential: social actors, psychologists, sexologists, infectiologists, gynaecologists, pain specialists, etc. This requires specific training for professionals confronted with these populations.


Assuntos
Violência Doméstica , Refugiados , Delitos Sexuais , Migrantes , Feminino , Infecções por HIV , Humanos , Refugiados/psicologia , Migrantes/psicologia , Violência
18.
Rev Prat ; 69(6): 679-682, 2019 Jun.
Artigo em Francês | MEDLINE | ID: mdl-31626434

RESUMO

The health of migrants is a complex issue in public health. In French Guyana, as elsewhere, globalization, through migrants in particular, has transformed the care of diseases previously geographically distant. In this context, the borders now concern the entire territory and not just the peripheries. These borders contribute to the aggravation of the migrants health determinants through the complex and sometimes risky paths that they generate. Transboundary areas are also areas of high vulnerability. However, these cross-border spaces and routes can also constitute health resources, in the original interfaces that they can produce in terms of cooperation promoting shared screening and monitoring programs.


Assuntos
Emigrantes e Imigrantes , Indicadores Básicos de Saúde , Programas de Rastreamento , Migrantes , Emigrantes e Imigrantes/estatística & dados numéricos , Guiana Francesa , Humanos , Migrantes/psicologia , Migrantes/estatística & dados numéricos , Populações Vulneráveis
20.
Rev Prat ; 69(5): 546-549, 2019 May.
Artigo em Francês | MEDLINE | ID: mdl-31626465

RESUMO

This paper introduces few concepts to help clinicians to get an idea of the health systems of the migrants they care for, on a daily basis. Health systems are complex to analyze, and is an open, dynamic system, facing diverse influences from multiple levels. Recent globalization has complexified an already complex system. The paper first sets some definitions and then describes succinctly the history of international health financing. It eventually compares several countries' health systems, drawing on few health indicators. Despite significant progresses in terms of global health, the gap between countries, and, within countries between wealthier and poorer people, is increasing. This is particularly worrying while the global aim is health equity.


Assuntos
Países em Desenvolvimento , Necessidades e Demandas de Serviços de Saúde , Migrantes , Saúde Global , Humanos
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