The effects of long-term high-altitude exposure on cognition: A meta-analysis

Long-term high altitudes (HA) exposure's impact on cognition has yielded inconsistent findings in previous research. To address this, we conducted a meta-analysis of 49 studies (6,191 individuals) to comprehensively evaluate this effect. Moderating factors such as cognitive task type, altitude (1,500-2,500m, 2,500-4,000m, and above 4,000m), residential type (chronic and lifelong), adaptation level and demographic factors were analyzed. Cognitive tasks were classified into eight categories: perceptual processes, psychomotor function, long-term memory, working memory, inhibitory control, problem-solving, language, and others. Results revealed a moderate negative effect of HA on cognitive performance (g = -.40, SE =.18, 95% CI = -.76 to -.05). Psychomotor function and long-term memory notably experience the most pronounced decline, while working memory and language skills show moderate decreases due to HA exposure. However, perceptual processes, inhibitory control, and problem-solving abilities remain unaffected. Moreover, residing at altitudes above 4,000m and being a HA immigrant are associated with significant cognitive impairment. In summary, our findings indicate a selective adaptation of cognitive performance to HA conditions.

Depression and loneliness among Sub-Saharan immigrants living in the greater Paris area: results from the MAKASI empowerment stepped wedge cluster randomised controlled trial

PURPOSE

The MAKASI intervention aimed to empower Sub-Saharan African immigrants living in precarious situations in the Paris metropolitan area. Because there are factors specifically related to immigration that may increase the risk for common mental disorders, the present study aimed to examine participants' levels of depression and loneliness and analyze the effect of the intervention on depression and loneliness.

METHODS

The MAKASI study was designed as a stepped wedge cluster randomized trial. Study participants were recruited through an outreach program led by a nongovernmental organization and randomly assigned to two clusters, with an intervention delay of 3 months between them. Participants were assessed for 6 months after inclusion and the effect of the intervention on depression and loneliness was assessed using generalized linear mixed models. The study was conducted from 2018 to 2021 and took in consideration whether being interviewed during one of the Covid-19 confinement had an effect on the results.

RESULTS

Between 2018 and 2021 a total of 821 subjects participated in the Makasi study. High levels of depression and loneliness were found in the study population. We found no effect of the intervention on depression [95% CI 0.77 to 2.40]. Similarly, no effect of the intervention was found on loneliness [95% CI 0.87 to 2.54].

CONCLUSIONS

The intervention tested did not appear to improve the level of depression and loneliness among participants. However, the high prevalence of mental and emotional problems in the study population suggests a public health crisis among immigrants in the greater Paris area.

CLINICAL TRIAL REGISTRATION NUMBER

 Trial registration Clinicaltrials.gov, NCT04468724 (July 13, 2020).

Vision Loss in Children from Immigrant and Nonimmigrant Households: Evidence from the National Survey of Children's Health 2018-2020

The aim of this study was to determine whether immigrant generation is associated with caregiver-reported vision loss in children adjusting for sociodemographic characteristics. Nationally representative data from the National Survey of Children's Health (2018-2020) was used. The primary exposure was immigrant generation defined as: first (child and all reported parents were born outside the United States); second (child was born in the United States and at least one parent was born outside the United States); third or higher (all parents in the household were born in the United States). The main outcome was caregiver-reported vision loss in child. Adjusted odds ratios (aOR) and 95% confidence intervals were computed based on immigration generation. The study sample included 84,860 US children aged 3-17 years. First generation children had higher adjusted odds of caregiver-reported vision loss (aOR 2.30; 95% CI 1.21, 4.35) than third or higher generation children after adjusting for demographic characteristics and social determinants of health. For Hispanic families, first generation (aOR 2.99; 95% CI 1.34, 6.66), and second-generation children (aOR 1.70; 95% CI 1.06, 2.74) had a higher adjusted odds of vision loss compared with third or higher generation children. Even when adjusting for sociodemographic characteristics, first generation children had greater odds of vision loss, especially in Hispanic households, than third generation children. Immigration generation should be treated as an independent risk factor for vision loss for children and is a social determinant of eye health.

The Association Between Perceived Discrimination, Age and Proportion of Lifetime in the United States Among Somali Immigrants: A Cross-Sectional Analysis

Discrimination is detrimental to health. Little is known about perceived discrimination among Somali immigrants. We examined whether age or proportion of lifetime in the United States was associated with perceived discrimination among Somali immigrants. Guided by Intersectionality, we described a secondary analysis of Everyday Discrimination Scale (EDS) survey data from the Healthy Immigrant Community study. Younger participants ( ≤40 years) experienced more discrimination than older participants ( >40 years). Higher education, being male, and earning $20,000-$39,999 was associated with more perceived discrimination. These findings suggest that Somali immigrants who are younger, more formally educated, male, and/or earn $20,000-$39,000 report more discrimination than their counterparts. Possible explanations include exposure to discrimination outside the Somali community or more awareness about racism. Alternatively, the EDS may not capture the discrimination experienced by Somali women or older adults. Further research is needed to address the discrimination experienced by Somali immigrants. Clinical Trial Registration: NCT05136339, November 29,2021.

The Profile of Stress and Coping Related to Successful Aging Among Chinese Migrant and Nonmigrant Grandparents

BACKGROUND AND OBJECTIVES

Around eight million older adults have internally migrated to take care of grandchildren in China. This study aimed to explore how Chinese migrant and nonmigrant grandparents perceived successful aging and how they coped with challenges to successful aging.

RESEARCH DESIGN AND METHODS

Based on ecological systems theory, semistructured interviews were conducted among 21 grandparents (12 migrants, median age = 59 years old) from urban areas in China who provided noncustodial grandchild care. Deductive content analysis was employed to examine the data pertaining to the definition of successful aging, the stressors encountered, and coping strategies employed by both groups.

RESULTS

Findings revealed that both migrant and nonmigrant grandparents placed a higher emphasis on family prosperity than their own physical health, in their definitions of successful aging. Although both groups experienced common stressors in the microsystem (e.g., intergenerational conflicts), migrant grandparents uniquely encountered stressors in the mesosystem (e.g., hardships in their close relationships) and in the macrosystem (e.g., uncertainty in aging preparation). In terms of coping, migrant grandparents exhibited a distinctive pattern of utilizing avoidant coping strategies when navigating intergenerational conflicts and planning for their later life, compared to nonmigrant grandparents.

DISCUSSION AND IMPLICATIONS

Our findings suggested that although migration was not associated with grandparents' definition of successful aging, migrant grandparents encountered specific challenges in achieving successful aging. This highlights the necessity of providing more support to grandparents through the family, community, or state, particularly to those who are migrants.

Barriers and enabling factors for utilizing physical rehabilitation services by Afghan immigrants and refugees with disabilities in Iran: a qualitative study

INTRODUCTION

Individuals with a migrant background often underutilize physical rehabilitation services (PRS) compared to the host population. This disparity is attributed to various barriers, including limited access to information, language barriers, illiteracy, and cultural factors. To improve PRS utilization by Afghan immigrants and refugees in Iran, it is crucial to identify these barriers and enabling factors. In response, this study explored the barriers and enabling factors for utilizing PRS among Afghan immigrants and refugees with disabilities in Iran.

METHODS

This qualitative study was conducted in Iran between January and March 2023. Participants were selected through convenient and snowball sampling. Individual, semi-structured interviews were carried out both in face-to-face and online formats. Data analysis occurred concurrently with data collection, using the directed content analysis approach.

RESULTS

Findings from our research indicate that common barriers to PRS utilization among Afghan immigrants and refugees include insufficient insurance coverage, high service costs, expensive transportation and accommodation, limited knowledge about Iran's health system, inadequate awareness of available supports, restricted access to PRS in remote areas, impatience among PRS providers, fear of arrest and deportation, a lack of trust in modern treatments, stringent immigration rules, high inflation rates limiting the ability to pay for PRS, and limited social support. On the other hand, several enabling factors were identified, such as strengthening insurance coverage, utilizing the capacities of charities and NGOs, providing information about available services, promoting respectful behavior by healthcare providers towards patients, facilitating cultural integration, and increasing immigrants' awareness of available services and eligibility criteria.

CONCLUSION

The barriers and enabling factors uncovered in this study offer valuable insights into the complexities surrounding PRS utilization by Afghan immigrants and refugees with disabilities in Iran. Understanding and addressing these factors is essential for developing targeted interventions and policies that can improve access and utilization, ultimately leading to enhanced health outcomes for this vulnerable population.

Reaching the unheard: overcoming challenges in health research with hard-to-reach populations

PURPOSE

Addressing obstacles such as logistical complexities, social stigma, and the impact of historical traumas is essential for the successful inclusion of underrepresented groups in health research.

METHODS

This article reviews engagement and interview techniques used to ethically engage recently settled Afghan refugees in Oklahoma and rural Mexican-born women in Illinois in research. The paper concludes with a reflective discussion on the challenges and lessons learned.

RESULTS

Creative strategies to engage hard-to-reach populations in research included considering the participants' socioeconomic and cultural contexts in their interactions and developing community partnerships to establish trust and obtain reliable data. Other engagement strategies were communicating in the participants' preferred language, providing assistance with reading and responding to study questions for those with low literacy, employing research staff from the population of interest, and recruiting in specific locations where the populations of interest live.

CONCLUSIONS

Community engagement is essential at all stages of research for building trust in hard-to-reach populations, achieving inclusivity in health research, and ensuring that interventions are culturally sensitive and effective.

Incidence and risk factors for HIV-tuberculosis coinfection in the Cologne-Bonn region: a retrospective cohort study

PURPOSE

The risk of developing active tuberculosis (TB) is considerably increased in people living with HIV/AIDS (PLWH). However, incidence of HIV/TB coinfection is difficult to assess as surveillance data are lacking in many countries. Here, we aimed to perform a quantitative analysis of HIV/TB coinfections within the Cologne/Bonn HIV cohort and to determine risk factors for active TB.

METHODS

We systematically evaluated data of patients with HIV/TB coinfection between 2006 and 2017. In this retrospective analysis, we compared HIV/TB-coinfected patients with a cohort of HIV-positive patients. The incidence density rate (IDR) was calculated for active TB cases at different time points.

RESULTS

During 2006-2017, 60 out of 4673 PLWH were diagnosed with active TB. Overall IDR was 0.181 cases/100 patient-years and ranged from 0.266 in 2006-2009 to 0.133 in 2014-2017. Patients originating from Sub-Saharan Africa had a significantly (p < 0.001) higher IDR (0.694/100 patient-years of observation, 95% CI [0.435-1.050]) in comparison to patients of German origin (0.053/100 patient-years of observation, 95% CI [0.028-0.091]). In terms of TB-free survival, individuals originating from countries with a TB incidence higher than 10/100,000 exhibited a markedly reduced TB-free survival compared to those originating from regions with lower incidence (p < 0.001). In 22 patients, TB and HIV infection were diagnosed simultaneously.

CONCLUSION

Overall, we observed a decline in the incidence density rate (IDR) of HIV/TB coinfections between 2006 and 2017. Patients originating from regions with high incidence bear a higher risk of falling ill with active TB. For PLWH born in Germany, the observed risk of active TB appears to be lower compared to other groups within the cohort. These findings should be considered when developing TB containment and screening strategies for PLWH in low-incidence countries.

Influence of biopsychosocial factors on self-reported anxiety/depression symptoms among first-generation immigrant population in the U.S

BACKGROUND

Despite increasing studies on mental health among immigrants, there are limited studies using nationally representative samples to examine immigrants' mental health and its potential biopsychosocial contributing factors, especially during the COVID-19 pandemic. We explored and estimated the influence of life satisfaction, social/emotional support, and other biopsychosocial factors on self-reported anxiety/depression symptoms among a nationally representative sample of first-generation immigrants in the U.S.

METHODS

We conducted a secondary data analysis using the 2021 National Health Interview Survey among first-generation adults aged ≥ 18 years (n = 4295). We applied survey weights and developed multivariable logistic regression model to evaluate the study objective.

RESULTS

The prevalence of daily, weekly, or monthly anxiety/depression symptoms was 10.22% in the first-generation immigrant population. There were 2.04% daily, 3.27% weekly, and 4.91% monthly anxiety/depression among the population: about 8.20%, 9.94%, and 9.60% experienced anxiety symptoms, whereas 2.49%, 3.54%, and 5.34% experienced depression symptoms daily, weekly, and monthly, respectively. The first-generation population aged 26-49 years were less likely to experience anxiety/depression daily, weekly, or monthly compared to those aged 18-25. Females (versus males) were more likely to experience anxiety/depression daily, weekly, or monthly. Those who identified as gay/lesbian had higher odds of experiencing anxiety/depression daily, weekly, or monthly compared to heterosexual persons. Relative to non-Hispanic White individuals, non-Hispanic Asian, Black/African American, and Hispanic individuals had lower odds, while other/multi-racial/ethnic groups were more likely to experience anxiety/depression daily, weekly, or monthly. A higher life satisfaction score was associated with lower odds of experiencing anxiety/depression daily, weekly, or monthly. Having social/emotional support sometimes/rarely or using healthcare within the past one/two years was associated with experiencing anxiety/depression daily, weekly, or monthly.

CONCLUSIONS

The findings reveal significant burden of anxiety and depression among first-generation population in the U.S., with higher risks among subgroups like young adults, females, sexual minorities, and non-Hispanic White and other/multi-racial individuals. Additionally, individuals with lower life satisfaction scores, limited social/emotional support, or healthcare utilization in the past one or two years present increased risk. These findings highlight the need for personalized mental health screening and interventions for first-generation individuals in the U.S. based on their diversity and health-related risks.

Exploring the burden, prevalence and associated factors of chronic musculoskeletal pain in migrants from North Africa and Middle East living in Europe: a scoping review

BACKGROUND

Immigrants are exposed to numerous risk factors that may contribute to the development of chronic musculoskeletal pain. Recent political and environmental crises in North Africa and the Middle East have led to an increase in immigration to Europe that has challenged the healthcare system and especially the management of chronic conditions.

OBJECTIVE

The aims of this scoping review are to investigate the burden, prevalence, and associated factors of chronic musculoskeletal pain in immigrants from North Africa and the Middle East in Europe during the last decade. The intentions of the review are to inform healthcare policymakers, to identify gaps in the literature, and aid the planning of future research.

DESIGN

Online databases Medline, Embase, PubMed and Web of Science were used to identify epidemiological studies published from2012-2022 examining chronic pain in populations from North Africa and the Middle East with a migration background residing in Europe.

RESULTS

In total eleven studies were identified conducted in Norway (n = 3), Denmark (n = 3), Germany (n = 1), Austria (n = 1), Sweden (n = 1), and Switzerland (n = 1). Among the identified studies, eight studies were cross-sectional (n = 8), two were prospective cohort studies (n = 2) and one was a retrospective cohort study (n = 1). Data suggested that chronic pain is more prevalent, more widespread, and more severe in people with than without a migration background. Furthermore, immigrants who have resided in the destination country for a longer period experience a higher prevalence of chronic pain compared to those in the early phases of migration. The following factors were found to be associated with chronic pain in this population: female gender, lower education, financial hardship, being underweight or obese, time in transit during migration, experience of trauma, immigration status, anxiety, depression, and post-traumatic stress disorder.

CONCLUSION

Several gaps in the literature were identified. Research is limited in terms of quantity and quality, does not reflect actual immigration trends, and does not account for immigration factors. Prospective cohort studies with long follow-ups would aid in improving prevention and management of chronic pain in populations with a migration background. In particular, they should reflect actual immigration trajectories, account for immigration factors, and have valid comparison groups in the countries of origin, transit and destination.

Management and outcome in foreign-born vs native-born patients with myocardial infarction in Sweden

BACKGROUND

Previous studies on disparities in healthcare and outcome have shown conflicting results. The aim of this study was to assess differences in baseline characteristics, management, and outcome in myocardial infarction (MI) patients, by country of birth.

METHODS

In total, 194 259 MI patients (64% male, 15% foreign-born) from the nationwide SWEDEHEART registry were included and compared by geographic region of birth. The primary outcome was one-year major adverse cardiovascular events (MACE) including all-cause death, MI, and stroke. Secondary outcomes were long-term MACE (up to 12 years), the individual components of MACE, 30-day mortality, management, and risk factors. Logistic regression, Cox proportional hazard models and propensity score matching (PSM), accounting for baseline differences, were used.

RESULTS

Foreign-born patients were younger, often male, and had a higher cardiovascular (CV) risk factor burden, including smoking, diabetes, and hypertension. In PSM analyses, Asia-born patients had higher likelihood of revascularisation (OR 1.16, 95% CI 1.04-1.30), statins and betablocker prescription at discharge and a 34% lower risk of 30-day mortality. Furthermore, no statistically significant differences were found in the primary outcomes except for Asia-born patients having lower risk of one-year MACE (HR 0.85, 95% CI 0.73-0.98), driven by lower mortality (HR 0.72, 95% CI 0.57-0.91). The results persisted over long-term follow-up.

CONCLUSIONS

This study shows that in a system with universal healthcare coverage in which acute and secondary preventive treatments do not differ by country of birth, foreign-born patients, despite higher CV risk factor burden, will do at least as well as native-born patients.

Outcome in methadone maintenance treatment of immigrants from the former Union of Soviet Socialist Republics

CONTEXT

Immigrants from the former Union of Soviet Socialist Republics (USSR) are more prevalent in Methadone maintenance treatment (MMT) in Israel than their percentage in the general population.

AIMS

To compare their characteristics and outcomes to those of Israeli-born and other immigrant patients.

METHODS

Retention and survival since admission (June/1993-Dec/2022) until leaving treatment (for retention), or at the end of follow-up were analyzed. Vital data was taken from a national registry. Predictors were estimated using Kaplan-Meier and Cox regression models.

RESULTS

The USSR patients (N = 262) compared with other immigrants (N = 132) and Israeli-born (N = 696) were more educated (≥ 12y) (p < 0.001), admitted to MMT at a younger age (p < 0.001), following a shorter duration of opioid usage (p < 0.001). More of them ever injected drugs (p < 0.001) and ever drank alcohol (p < 0.001). One-year retention was comparable (77.2% vs. 75.6% and 72%, p = 0.2) as did opioid discontinuation in those who stayed (p = 0.2). Former USSR patients had longer cumulative retention of their first admission (p = 0.05) with comparable overall retention since first admission, and survival, although the age of death was younger. Specific origin within the former USSR found immigrants from the Russian Federation with the best outcome, and those from Ukraine as having high HIV seropositive and shorter retention.

CONCLUSIONS

Despite several characteristics known to be associated with poor outcomes, former USSR immigrants showed better adherence to MMT, reflected by their longer cumulative retention in their first admission, lower rate of readmissions, and a comparable survival and overall retention in treatment. An in depth study is needed in order to understand why they decease at a younger age.

Reasons for Migration and Their Associations with HIV Risk and Prevention Among Cisgender Sexual Minority Men: A Latent Class Analysis

The immigrant population in the United States (U.S.) is rapidly growing; yet there is limited knowledge about how reasons for migrating to the U.S. are associated with HIV prevention behaviors. Using data from the American Men's Internet Survey (2018-2020), we performed a Latent Class Analysis (LCA) to identify patterns in reasons for migration among cisgender gay, bisexual, and other sexual minority men (SMM) who born outside the U.S. We used multivariable logistic regression controlling for demographic characteristics to assess class associations with the following in the past 12 months: condomless anal sex (CAS), illicit drug use, marijuana use, HIV testing, and PrEP use. LCA identified six distinct patterns in reasons for migration among the sample (n = 1,657): (1) Family and friends (14%); (2) Financial (17%); (3) Personal freedom related to being gay (10%); (4) Pursuit of opportunities while living openly as SMM (12%); (5) Educational purposes (18%); (6) Not my decision (29%). While HIV testing (range = 57.6-65.4%) and PrEP use (range = 15.6-21.4%) did not vary by class (p > .05 for all), CAS and illicit drug use were significantly different (p < .05). SMM who migrated to pursue opportunities while living openly and whose reasons were not their decision had greater odds of CAS than SMM who migrated for educational purposes (aOR:1.72, 95% confidence interval [95%CI]:1.15-2.59; 1.57, 1.13-2.19, respectively). Reasons for migration among SMM were associated with behaviors that can increase HIV risk, but not testing or PrEP. Push and pull factors related to migration should be considered when developing behavioral HIV interventions for immigrant SMM.

[Initial assessment of immigrant patients in primary care]

The clinical interview of immigrant patients requires cultural competence to ensure good understanding and correct communication, in addition to collecting specific information that differs from that of native patients, such as origin and migratory route or cultural identity. Screening for latent tuberculosis infection is recommended in certain cases and screening for other infections, both cosmopolitan with a higher prevalence in migrants (HIV, syphilis, hepatitis B and C) and imported (Chagas, intestinal parasites, strongyloidiasis, schistosomiasis), depending on origin. It is essential to check the vaccination status and complete the vaccination schedule, adapting it to the current calendar, prioritizing vaccines such as measles, rubella and poliomyelitis. We propose preventive activities to be carried out when traveling to countries of origin, due to their special characteristics and risks: general advice, exploring the risk of malaria, assessing specific vaccinations, advice regarding sexually transmitted infections and special considerations if they have chronic diseases; and addressing, if appropriate, the risks of female genital mutilation.

Stress Among Immigrants in the United States

BACKGROUND

Immigrants comprise a sizable proportion (15%) of the population living in the United States (U.S.). Given these proportions, it is imperative that we understand immigrant experiences of well-being and stress toward improved well-being and integration.

METHODS

To examine the experiences of first- and second-generation immigrants using a comparative approach, we utilized data from two surveys collected under Trump (n = 490) and Biden (n = 306) administrations. Both studies employed non-probability quota and convenience sampling techniques. Questions about experiences of stress (PSS-4), discrimination (Everyday Discrimination Scale), resilience (Brief Resilience Scale), border stress (Border Community and Immigration Stress Scale), immigration policies (general questions) were included in the surveys. Each study sample included diverse racial groups across both immigrant generations. We report frequencies, descriptive statistics, and ANOVAs/post hoc test results.

RESULTS

Findings highlight that levels of both stress and discrimination among non-White participants under the Trump administration were significantly higher than those of White participants, though neither relationship was significant under the Biden administration. Further, White participants exhibited higher resilience under the Trump administration, but not under the Biden administration.

DISCUSSION AND CONCLUSION

To our knowledge, this is the first study to comparatively examine immigrant experiences under the two most recent federal administrations. This study is seminal in highlighting discussions and making policy recommendations to limit immigrant exclusion, curtail exclusionary policies regarding travel bans, and improve pathways to citizenship, enhancing immigrant integration in the U.S. Roles of social workers in supporting immigrant communities and pathways for future research with immigrants are discussed.

Exploring knowledge of autism, its causes and treatment among immigrant and nonimmigrant parents in Somalia\Somaliland

BACKGROUND

The prevalence of autism spectrum disorders (ASDs) has increased over the recent years; however, little is known about the experience of parents of children with autism in Africa such as Somalia. The aim of this study is to understand the knowledge on autism of Somali parents of children with autism and their perceptions of causes and treatment of ASD.

METHODS

We conducted a qualitative study involving 22 parents of children with autism who lived in Mogadishu and Hargeisa; the two largest cities in Somalia. In-depth interviews were used to collect the data. Of the 22 participants, 9 were returned immigrants and 13 were local people (non-immigrants). Data were analysed using thematic analysis.

RESULTS

The data revealed that most of the parents hold the belief that their children's autism were caused by the measles vaccine. The findings demonstrated that parents sought diagnosis and treatment care from outside Somalia due to the lack of experience of health providers in the diagnosis and treatment of autism. The data also revealed a lack of knowledge about autism among the public with resultant stigma and discrimination against children with autism and their families.

CONCLUSIONS

Efforts to increase public knowledge on autism, its causes and treatments are of paramount importance, while a public health campaign designed to eliminate the stigma subjected to children with autism is necessary to improve the quality of life of children with autism and their caregivers. Finally, to counteract vaccine hesitancy, particularly in response to the measles vaccine, health policy makers should take steps to separate the cooccurrence of the onset of autism symptoms and the provision of the measles vaccine.

Latina immigrants' breast and colon cancer causal attributions: genetics is key

Latinos in the US suffer health disparities including stage of disease at time of breast or colon cancer diagnosis. Understanding Latinas' causal attributions of breast and colon cancer may provide insight into some of the individual level determinants of cancer disparities in this population. Cultural consensus analysis (CCA) is one way to study causal beliefs. The objective of this study was to describe Latina immigrants' causal attributions of breast and colon cancer. We conducted Spanish-language interviews with 22 Latina immigrants using a qualitative exploratory design comprised of freelisting, ranking, and open-ended questions. Participants freelisted causes and risk factors for breast and colon cancer then ranked risk factors according to their perceived role in the development of each cancer. CCA was conducted on rank orders to identify whether a cultural consensus model was present. Participants answered semi-structured, open-ended questions regarding the risk factors and rankings. Interviews were transcribed and subjected to thematic analysis. CCA showed no consensus around rank of causes for either cancer, and residual agreement analysis suggested the presence of two subcultural groups. "Genetics" and "hereditary factors" ranked first and second on average across participants for both cancers. Based on interview data, participants were less aware of colon cancer than breast cancer. Participants' endorsement of heredity as a cause of breast and colon cancer was similar to beliefs reported in studies of primarily non-Latina populations.

Cancer mortality in Germany-born Americans and Germans

INTRODUCTION

Comparing cancer mortality and associated risk factors among immigrant populations in a host country to those in their country of origin reveals disparities in cancer risk, access to care, diagnosis, and disease management. This study compares cancer mortality between the German resident population and Germany-born individuals who migrated to the US.

METHODS

Cancer mortality data from 2008-2018 were derived for Germans from the World Health Organization database and for Germany-born Americans resident in four states (California, Florida, Massachusetts, and New York) from respective Departments of Vital Statistics. We calculated age-standardized mortality rates (ASMRs) using the European standard population and standardized mortality ratios (SMR) compared to the German resident population along with 95% confidence intervals (CIs).

RESULTS

Germany-born American males had lower ASMRs (253.8 per 100,000) than German resident population (325.6 per 100,000). The difference in females was modest, with ASMRs of 200.7 and 203.7 per 100,000, respectively. For all cancers, Germany-born American males had an SMR of 0.72 (95% CI: 0.70-0.74) and females 0.98 (95% CI: 0.95-1.00). Male SMRs among Germany-born Americans were significantly below one for oral cavity, stomach, colorectal, liver, lung, prostate, and kidney cancer. Among females, SMRs were below one for oral cavity, stomach, colorectal, gallbladder, breast, cervix uteri, and kidney cancer. For both sexes, SMRs were over one for bladder cancer (1.14 for males, 1.21 for females). Mortality was higher for lung cancer (SMR: 1.68), non-Hodgkin's lymphoma (1.18) and uterine cancer (1.22) among Germany-born American females compared to the German resident population.

CONCLUSION

Germany-born American males but not females showed lower cancer mortality than German resident population. Disparities may stem from variations in risk factors (e.g., smoking and alcohol use) as well as differences in screening practices and participation, cancer treatment, besides some residual potential "healthy immigrant effect".

Impact of English Proficiency on Health Literacy in Older Korean Immigrants: Mediating Effects of Social Support and Acculturation

Limited English proficiency (LEP) is one of the most influencing factors of personal health literacy (PHL) in the older immigrant population. Over the years, the proportion of older Korean immigrants with LEP has not improved and it is still noted as a major barrier to PHL. Therefore, organizational approaches are needed to enhance the PHL of older immigrants with LEP. This study aims to find the mediating effect of social support and acculturation between LEP and PHL by conceptualizing social support and acculturation as an organizational health literacy strategy. Data from 244 older Korean immigrants living in the states of Alabama and Georgia, USA, were used to conduct the study. Korean version of the Multidimensional Scale of Perceived Social Support (MSPSS), East Asian Acculturation Measure (EAAM), and Health Literacy Survey-12 Questionnaires (HLS-Q12) were used to measure the variables. The path analysis was conducted to find the serial mediation effects of social support and acculturation. The results showed that 77.5% of the participants reported not having fluent English proficiency. English proficiency (β =- 0.21, p = 0.007), social support (β = 0.17, p = 0.004), and acculturation (β = 0.18, p = 0.011) significantly predicted the PHL, and social support (β = 0.04, p = 0.028) and acculturation (β = 0.14, p < 0.001) mediated the relationship between LEP and PHL. Discussion: Health-related organizations and communities are encouraged to provide external social support and acculturation opportunities to enhance PHL in older Korean immigrants with LEP.

The relative pay for foreign work: A novel evidence from home and host countries

The literature has robustly documented a negative migrant-native wage gap in developed economies. Yet empirical evidence of pay differences has been elusive for developing countries. We approach this question by leveraging internationally harmonised microdata with 1.5 million individuals from 6 transition and developing countries and 15 OECD economies spanning from 1995 to 2016 and employ counterfactual decomposition techniques which allow us to control for individual-productivity and job-specific characteristics, and explain up to 74% of the observed immigrant-native wage gap. The Blinder-Oaxaca baseline results indicate that, vis-à-vis comparable workers born in developed economies, the pay for workers born in transition and developing economies is discounted both in their home country labour markets and - if migrating - also in developed host country labour markets. However, the unexplained native-to-migrant wage gap remains sizeable in most countries even after controlling for productivity differentials (26% and more). Cross-country correlation analyses provide a direct empirical evidence of the link between variation in unobserved job characteristics and skills among foreign-born and native-born workers and wage gap, while the labour market institutions and especially the labour market discrimination environment are of a second-order importance.

Vulnerability or Resiliency? A Two-Wave Panel Analysis of Social Network Factors Associated with Glycemic Levels among Mexican Immigrants in the Bronx, NYC, Before and During COVID-19

Latinos have high rates of type 2 diabetes mellitus (T2DM) yet are characterized as having health-promoting social networks. The impacts of COVID-19 on personal networks were complex, especially in urban areas with high proportion of immigrants such as the Bronx in NYC. Our objective was to test the extent to which network characteristics increase vulnerability or resiliency for glycemic control based on data gathered from Mexican-origin Bronx dwellers. We used two-wave panel study analyzing self-reported personal social networks (n=30participants; 600network members) and HbA1c levels via dried blood spots in 2019, before the COVID-19 pandemic, and in 2021, a time after initial lockdowns and when the pandemic was still ravaging the community of study. Regression models adjusted for individual-level variables including sociodemographic and health indicators (i.e., physical health including COVID-19 and mental health). We found that an increase in the proportion of network members with diabetes predicted an increase in participant's HbA1c levels from 2019 to 2021 (β=0.044, p < 0.05). Also, a greater proportion of network members consuming "an American diet" in 2019 predicted a decrease in participant's HbA1c levels (β=-0.028, p < 0.01), while a greater proportion of network members that encouraged participants' health in 2019 predicted an increase in participant's HbA1c levels (β=0.033, p < 0.05). Our study sheds light on specific social network characteristics relevant to individual diabetes outcomes, including potential longitudinal mechanistic effects that played out at the peak of the COVID-19 crisis.

Norwegian "dugnad" as a rhetorical device in public health communication during the COVID-19 pandemic. A qualitative study from immigrant's perspectives

BACKGROUND

During the COVID-19 pandemic, the Norwegian government appealed to the term "national dugnad" in the communication of containment measures as a call for collective action to fight the spread of infection. "Dugnad" is traditionally associated with solidarity, social responsibility, and a communal spirit in the form of volunteer work carried out by a local community. Although the word "dugnad" is difficult to translate to other languages, it was used as a rhetorical device by the government to communicate health-related information during the pandemic. This study aims to explore how immigrants understood and related to the term "dugnad" as used in the context of the COVID-19 pandemic in Norway.

METHODS

We conducted 55 semi-structured interviews in 2020 with immigrants from Poland (10), Syria (15), Somalia (10), Sri Lanka (10), and Chile (10). Interviews were conducted in participants' mother-tongues. We used systematic text condensation following Malterud's four steps to analyze the data.

RESULTS

The results are organized into three themes corresponding to: (1) meaning making of the term "dugnad"; (2) attitudes towards the term "dugnad"; and (3) reactions to the use of "dugnad" in a public health context. Overall, participants were familiar with the term "dugnad" and positively associated it with volunteering, unity, and a sense of community. However, we found a variety of reactions towards using this term in a public health context, ranging from agreement to disagreement and irritation.

CONCLUSION

Health communication during pandemics is crucial for maximizing compliance and gaining control of disease spread. In multicultural societies, governments and authorities should be aware of the linguistic and cultural barriers to public health communication if they are to effectively reach the entire population. The use of culturally specific concepts in this context, specially as rhetorical devices, may hinder effective health communication and increase health inequalities.

Mixed methods approach to understanding COVID-19 vaccine hesitancy among immigrants in the Chicago

BACKGROUND

COVID-19 vaccine hesitancy has been particularly high among immigrant populations, whose experience is shaped by a history of racism and discriminations, and distrust of the healthcare system. In this study we draw from the Theory of Planned Behavior to examine COVID-19 vaccine hesitancy among immigrants in Chicago.

METHODS

A mixed-methods approach comprising of both focus groups and a health survey was conducted from February to August 2022. Five focus groups were held (N = 35) among Black, Asian and Arab/Palestine participants to understand attitudes and beliefs around the COVID-19 vaccine. Focus groups were analyzed using a modified template approach to text analysis. Based on these findings and themes, we developed a survey that was conducted among 413 immigrants from the mentioned communities. We used hierarchical ordinal regression analyses to examine the relationship between COVID-19 vaccine hesitancy and vaccination status.

RESULTS

Qualitative analysis suggest that the major factors influencing COVID-19 vaccine hesitancy included fear of adverse reactions, misinformation around COVID-19 and the vaccine, negative social norms around vaccination, and external pressure to get vaccinated. From our quantitative analysis we found that 24% of participants were unvaccinated, 5% were partially vaccinated, 32.3% were vaccinated but not boosted, and 39% were vaccinated and boosted for COVID-19. Hierarchical regression models suggest that immigrants who hold negative attitudes and social norms around the COVID-19 vaccine are less likely to vaccinate.

CONCLUSIONS

Understanding vaccine hesitancy among immigrants allows for the creation of culturally and linguistically tailored education that can be utilized to increase vaccine confidence and uptake.

Disparities in kidney transplantation accessibility among immigrant populations in Europe: A systematic review and meta-analysis

BACKGROUND AND OBJECTIVES

Disparities in access to healthcare for patients with an immigration background are well-known. The aim of this study was to determine whether disparities among immigrant populations translate into a relative difference in the number of kidney transplants (KT) performed in documented immigrant patients (first and second generation) relative to native-born patients in Europe.

METHODS

A literature search was performed in PubMed from inception to 11-10-2022. Studies were eligible if: (1) written in English, (2) included immigrant and native-born KT patients, (3) performed in countries registered as Council of Europe members, (4) focused on documented first- and second-generation immigrant populations [1]. Systematic reviews, literature reviews, and case reports or articles about emigration, non-KT, and undocumented immigrants were excluded. The outcome measurement was a relative percentage of KTs to the total population per 100.000 residents. By dividing the immigrant percentages by the native-born resident percentages, the odds ratio (OR) was calculated in a meta-analysis. The risk of bias was assessed; articles with high risk of bias were excluded in a second meta-analysis.

RESULTS

Out of 109 articles, 5 were included (n = 24,614). One Italian study (n = 24,174) had a ratio below 1, being 0.910 (95%CI 0.877-0.945). The other four articles (n = 196, n = 283, n = 77, n = 119) had ratios above 1: 1.36 (95%CI 0.980-1.87), 2.04 (95%CI 1.56-2.68), 2.23 (95%CI 1.53-3.25) and 2.64 (95%CI 1.68-4.15). After performing a meta-analysis, the OR did not show a significant difference: 1.68 (95%CI 1.03-2.75). After bias correction, this remained unchanged: 1.78 (95%CI 0.961-3.31).

CONCLUSIONS

In our meta-analysis we did not find a significant difference in the relative number of KTs performed in immigrant versus native-born populations in Europe. However, a lesser likelihood for immigrants to receive a pre-emptive kidney transplantation was found. Large heterogeneity between studies (e.g. different sample size, patient origins, study duration, adult vs children patients) was a shortcoming to our analysis. Nevertheless, our article is the first review in this understudied topic. As important questions (e.g. on ethnicity, living donor rate) remain, future studies are needed to address them.

The influence of modern living conditions on the human microbiome and potential therapeutic opportunities for allergy prevention

Modern living conditions and the recent surge in global urbanization have transformed the human microbiome. This transformation is believed to be a significant factor in the recent spike of common chronic inflammatory diseases like asthma and allergies worldwide, evident in both developed and developing nations. Immigrants from less developed regions who settle in highly urbanized and affluent areas present an ideal demographic for research. Investigating immigrant populations can yield valuable insights, particularly when studying microbiome changes that occur as individuals transition from areas with low asthma prevalence to regions with a high prevalence of the condition. The application of prebiotics and probiotics as potential treatments for asthma and allergies faces challenges. This is due to the complex interplay of numerous factors that contribute to their aetiology. Exploring the interaction between the human microbiome and potential epigenetic changes in specific populations, such as immigrants adapting to new, urbanized environments, may offer crucial insights. Such research could underscore the role of prebiotics and probiotics in preventing allergic conditions. Recognizing the changes in the human microbiome in the context of a Western/modern environment might be essential in addressing the increasing prevalence of allergic diseases. Persistent research in this domain is pivotal for devising effective interventions such as dietary supplementation with prebiotics and probiotics.

Fertility and immigration: Do immigrant mothers hand down their fertility pattern to the next generation? Evidence from Norway

We examined whether the fertility pattern of immigrant mothers is handed down to the next generation. Our analyses were carried out on population register data. These data contained information on all immigrants to Norway from 123 countries during the period 1935-1995. We examined whether there was a relationship between the fertility rate in the country of origin and the number of children for generations 1.5 and 2 in Norway. We estimated three models: fixed effects for country of origin, fixed effects for region, and no fixed effects. The three specifications yielded estimates with overlapping confidence intervals. We interpret the estimates from the models with fixed effects for region, and the model with no fixed effects as upper-bound estimates. They show that an increase of 1.00 in the fertility rate in the country of origin leads to an average increase in the number of children of 0.12 (no fixed effects) or 0.14 (fixed effects for region) for immigrant women in generations 1.5 and 2. The estimate from the model with fixed effects for country of origin was small and not statistically significant at the conventional level. We interpret this as a lower-bound estimate. Our upper-bound estimates for generations 1.5 and 2 are smaller than the estimates for generation 1, i.e. there has been a decrease in the fertility rate from the first to the second generation. As a result, if the proportion of the population with an immigrant background continues to increase, it may increase at a slower rate in the future.

Cultural Aspects of Health care for Ethiopian Jewish Immigrants in Israel: A Literature Review

The unique health-related traditions, perceptions, and communication patterns of Ethiopian immigrants are challenging to Israeli healthcare providers who are trained in western medicine. The aim of this review was to conduct a survey of traditions, beliefs, and symptom reporting by Ethiopian immigrants and culturally oriented interventions to improve the care of Ethiopian immigrants. We used the keywords "Ethiopian immigrants Israel" and "Ethiopian Jews." Of 418 articles initially retrieved, 35 satisfied the inclusion and exclusion criteria. We described health-related traditions and their possible complications. Possession syndrome was frequently misdiagnosed as a neurological or psychiatric disorder. The medical staff was unfamiliar with these health and illness beliefs, somatization patterns, and the communication style of Ethiopian immigrants. There were successful interventions that involved liaisons from the Ethiopian community and community-based educational activities. Medical professionals working with African immigrants worldwide can use the Israeli experience to develop effective, culturally oriented interventions to optimize the health care for these immigrants.

Socio-Demographic and Disability Disparities in Stroke by Citizenship Status: A Cross-Sectional Analysis

This study aims to assess relationships between previous stroke diagnosis and demographic or disability status variables, stratified by U.S. citizenship status. The 2019 and 2021 National Health Interview Survey data were analyzed for both descriptive statistics and logistic regression models. Age, sex, income level, race/ethnicity, health insurance status, and indicators of disability common after stroke were predictor variables of interest. For each disability predictor variable, higher odds of having stroke were seen regardless of citizenship status, except for the 'difficulty remembering' variable. For U.S. citizens, increasing age corresponded with higher odds of stroke diagnosis. For noncitizens, odds ratios decreased from 40.3 (95% CI 38.88-41.82) for the 40-65 age group to 29.6 (95% CI 28.38-30.77) in the 80 + group, when compared with the 18-39 age reference group. Female noncitizens had higher odds of stroke, while male citizens had higher odds. Non-Hispanic Black citizens had higher odds of stroke, while the other racial/ethnic groups had higher odds for noncitizens. The results indicated the existence of several socio-demographic disparities in stroke. Notably, noncitizens experienced stroke at a younger age and reported more severe disability outcomes after stroke diagnosis than citizens.

Hepatitis C Screening and Antibody Prevalence Among Newly Arrived Refugees to the United States, 2010-2017

Six refugee screening sites collaborated to estimate the prevalence of hepatitis C virus (HCV) antibodies among newly arrived refugees in the United States from 2010 to 2017, identify demographic characteristics associated with HCV antibody positivity, and estimate missed HCV antibody-positive adults among unscreened refugees. We utilized a cross-sectional study to examine HCV prevalence among refugees (N = 144,752). A predictive logistic regression model was constructed to determine the effectiveness of current screening practices at identifying cases. The prevalence of HCV antibodies among the 64,703 refugees screened was 1.6%. Refugees from Burundi (5.4%), Moldova (3.8%), Democratic Republic of Congo (3.2%), Burma (2.8%), and Ukraine (2.0%) had the highest positivity among refugee arrivals. An estimated 498 (0.7%) cases of HCV antibody positivity were missed among 67,787 unscreened adults. The domestic medical examination represents an opportunity to screen all adult refugees for HCV to ensure timely diagnosis and treatment.

Differences in mammography screening attendance among non-Western immigrants in Denmark, Finland, Iceland and Norway

Several studies have shown that attendance rates are lower among non-Western immigrants than among natives. As the Nordic countries have quite similar health systems and populations but also differences in the organisation of their organised mammography screening programmes, differences in attendance rates could highlight organisational factors that might increase the attendance rates. Mammography screening is offered free of charge in Denmark and Finland, but not in Iceland and Norway. Contrarily to the other countries, Iceland do not send out pre-booked appointment. The study population included natives and non-Western immigrants aged 50-69 years, who had at least one invitation to the national mammography screening programmes in Denmark (2008-2017), Finland (2001-2017), Iceland (2001-2020) or Norway (2001-2015). Relative risks (RRs) of attendance were estimated and adjusted for age group and calendar period. The study population included 116.033 non-Western immigrants and more than 2 million natives. The attendance rates were significantly lower among non-Western immigrants than among natives, with an adjusted relative risk of 0.81/0.80 in Denmark and Finland, 0.62 in Norway, and 0.40 in Iceland. The lower attendance rates among immigrants in Norway and Iceland did not seem to be due to differences in birth country, immigration age, or educational level, but might be explained by organisational factors. Offering free-of-charge mammography screening in Norway and Iceland and/or including a pre-booked appointment in the invitation letters in Iceland might increase the attendance rate among non-Western immigrants.

Immigrants' health empowerment and access to health coverage in France: A stepped wedge randomised controlled trial

Throughout Europe, migration-related health inequalities are mirrored by large inequalities in health coverage. There is a need to develop novel strategies to secure access to health insurance for immigrants in Europe, in order to meet the shared Sustainable Development Goal of universal health coverage. We evaluated the impact of an original health-related empowerment intervention on access to health coverage among vulnerable, mostly undocumented immigrants in France. As part of the MAKASI study, we adopted an outreach approach and developed a community-based intervention with and for immigrants from sub-Saharan Africa living in precarious conditions in the Greater Paris area. This participatory intervention was grounded in the theory of individual empowerment. Using a stepped wedge randomised design, we first conducted a robust evaluation of the effect of the intervention on access to health coverage at three and six months post-intervention. We then investigated whether the intervention effect was mediated by a health empowerment process. Between 2018 and 2021, a total of 821 participants - 77% of whom were men - were recruited in public spaces and followed up for six months. Participants had been living in France for four years on average, 75% of them had no residence permit, and 44% had no health coverage at the time of inclusion. The probability of accessing health coverage increased by 29 percentage points at six months post-intervention (p < 0.01). This improvement was partially mediated by a health empowerment process, namely a reinforcement of participants' knowledge of and capacity to access available social and health resources. A health empowerment intervention largely improved access to health insurance among vulnerable immigrants in France. Our findings may be transferred to other settings where immigrants are entitled to health insurance. This study offers promising perspectives - beyond information provision and direct referral - to reduce migration-related inequalities in health coverage.

Prevalence and genetic diversity of Blastocystis sp. among autochthonous and immigrant patients in Italy

The prevalence of Blastocystis sp., its genetic diversity and the distribution of circulating subtypes (STs) were molecularly investigated in a cohort of autochthonous and immigrant patients with gastrointestinal symptoms hospitalized over the period February 2022-June 2023 at the Policlinico Ospedaliero-Universitario "Riuniti", Foggia, in Southern Italy. The population variables, including patient geographical origin, gender and age classes were reported. Out of the 927 investigated patients, 36 (3.9%) were positive for Blastocystis sp. A statistically significant association with African origin and age classes >18 years old was found. ST1 (allele 4), ST2 (alleles 9, 13), ST3 (alleles 34, 36) and ST4 (allele 92) were the subtypes detected with a different distribution between autochthonous and immigrant patients. Co-infections with enteric protozoa such as Giardia duodenalis and Dientamoeba fragilis, pathogenic bacteria as Clostridioides difficile, Campylobacter jejuni and Aeromonas sp. and viral infections such as Norovirus were found in 33% of cases. This is the first study of Blastocystis sp., its circulating subtypes and allele variability among patients with different geographical origin in an area of Southern Italy, in the Central Mediterranean, characterized by high immigrant pressure. These results provide baseline data to better investigate a potential interaction between Blastocystis sp. and other risk factors in patients with gastrointestinal symptoms.

Impact of trauma, support, and control perceptions during childbirth on post-traumatic stress disorder among Syrian immigrant adolescent pregnant women

OBJECTIVE

The probability of experiencing mental health problems in the perinatal period is high for adolescent women. Immigration is a complicated phenomenon that increases the risk of encountering temporary or permanent psychological problems. This study aims to determine Syrian immigrant adolescent women's support and control perception levels during childbirth, birth trauma levels, and posttraumatic stress disorder incidence and affecting factors.

METHODS

This study used a prospective cohort design and was conducted in a hospital in Adana, a city in southern Turkey, between February and April 2022. It included 122 Syrian adolescent immigrant women, and data were collected in two interviews. While the first interview was conducted within the first 24 hours following birth, the second interview was conducted one month after birth. Data were collected through structured interviews using standardized questionnaires, including the Personal Information Form, the City Birth Trauma Scale, the Support and Control in Birth Scale, and the Post-traumatic Stress Disorder Checklist for DSM-5.

FINDINGS

The average age of participating women was 17.40±0.94. The participants' Perceived Support and Control in Birth Scale total score was 100.55±20.12, the City Birth Trauma Scale total score was 43.11±13.29, and the Post-traumatic Stress Disorder Checklist total score was 30.36±16.86. Of all the participating women, 26% were found to have post-traumatic stress disorder symptoms in the postpartum period. A relationship was found between support and control perceptions during childbirth and post-traumatic stress disorder symptoms.

CONCLUSION

This study found that immigrant adolescent women's support and control perceptions during childbirth were better than expected, and they had a high level of perceived trauma during childbirth. The presence of birth trauma emerged as a robust predictive factor for posttraumatic stress disorder, underscoring its critical role in maternal mental health. A positive childbirth experience, which is important for all women, has become an increasing need for immigrant women. There is a need for developing and sustaining health policies guaranteeing culturally sensitive care to prevent immigrant women from having a traumatic birth experience.

Immigrant and ethnic minority patients` reported experiences in psychiatric care in Europe - a scoping review

BACKGROUND

There is little evidence on experiences in psychiatric care treatment among patients with immigrant or ethnic minority background. Knowledge about their experiences is crucial in the development of equal and high-quality services and is needed to validate instruments applied in national patient experience surveys in Norway. The aim of this scoping review is to assess and summarize current evidence on immigrant and ethnic minorities` experiences in psychiatric care treatment in Europe.

METHODS

Guidelines from the Joanna Briggs Institute were followed and the research process adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. The literature search was carried out in Medline, Cinahl, Web of Science, Cochrane database of systematic reviews, Embase, and APA PsychInfo, up to Dec 2022, for articles on immigrant patients` experiences in psychiatric care. Reference lists of included articles were screened for additional relevant articles. Titles and abstracts were screened, and potentially relevant articles read in full-text, by two researchers. Evidence was extracted using an a priori extraction form and summarized in tables and text. Any disagreement between the reviewers regarding inclusion of articles or extracted information details were resolved through discussion between authors.

RESULTS

We included eight studies in the scoping review. Immigrant and ethnic minority background patients did not differ from the general population in quantitative satisfaction questionnaires. However, qualitative studies showed that they experience a lack of understanding and respect of own culture and related needs, and difficulties in communication, which do not seem to be captured in questionnaire-based studies.

CONCLUSION

Raising awareness about the importance of respect and understanding for patients` cultural background and communication needs for treatment satisfaction should be addressed in future quality improvement work.

Immigrants, health, and the impact of COVID-19: A narrative review

While the COVID-19 pandemic has gravely challenged health systems globally, countries that host a large number of refugees are finding themselves even more burdened as providing preventive and curative services to refugees, and, migrants has proved to be a challenging task. The aim of this narrative review is to discuss the impact COVID-19 pandemic on immigrants, and seek to understand how COVID-19 affects provision of health services, access to health care and the socioeconomic situation. Like any other health challenge, COVID-19 has also left migrants susceptible to adverse outcomes, both directly and indirectly. Several factors limit their ability to avoid infections, access healthcare, and cope with socio-psychological impacts. In addition, undocumented immigrants or people living on short-term visit visas do not have full access to healthcare services in most countries. It is evident that COVID-19 has also influenced these workers leaving them jobless or receiving low wages or no pay, hence, this has hugely impacted the remittance and economic situation in their country. Extending access to healthcare to the entire immigrant population, irrespective of their legal status, is the cornerstone of an effective response to counter the COVID-19 pandemic.

Can We Rely on Projections of the Immigrant Population? The Case of Norway

Demographic forecasters must be realistic about how well they can predict future populations, and it is important that they include estimates of uncertainty in their forecasts. Here we focus on the future development of the immigrant population of Norway and their Norwegian-born children ("second generation"), grouped by three categories of country background: 1. West European countries plus the United States, Canada, Australia, and New Zealand; 2. Central and East European countries that are members of the European Union; 3. other countries. We show how to use a probabilistic forecast to assess the reliability of projections of the immigrant population and their children. We employ the method of random shares using data for immigrants and their children for 2000-2021. We model their age- and sex-specific shares relative to the whole population. Relational models are used for the age patterns in these shares, and time series models to extrapolate the parameters of the age patterns. We compute a probabilistic forecast for six population sub-groups with immigration background, and one for non-immigrants. The probabilistic forecast is calibrated against Statistics Norway's official population projection. We find that a few population trends are quite certain: strong increases to 2060 in the size of the immigrant population (more specifically those who belong to country group 3) and of Norwegian-born children of immigrants. However, prediction intervals around the forecasts of immigrants and their children by one-year age groups are so wide that these forecasts are not reliable.

Comparing clinico-demographics and neuropsychiatric symptoms for immigrant and non-immigrant aged care residents living with dementia: a retrospective cross-sectional study from an Australian dementia-specific support service

BACKGROUND

Neuropsychiatric symptoms of dementia such as agitation and aggression are common in people living with dementia. The presentation of neuropsychiatric symptoms is influenced by the cultural background of people living with dementia. Further, identifying factors contributing to neuropsychiatric symptoms may be complicated if people living with dementia are immigrants or from non-English-speaking backgrounds. Most of what is known about differences in neuropsychiatric symptoms between racial and ethnic groups living with dementia come from community-based samples. This study investigated differences in clinico-demographics and neuropsychiatric symptoms between immigrants and non-immigrants living with dementia in residential aged care homes who were referred to two Dementia Support Australia programs.

METHODS

This was a retrospective observational cross-sectional study from 2018 to 2022 using data extracted from the Dementia Support Australia database. Immigrant status was identified by documented country of birth. We conducted exploratory subgroup analyses for English-speaking or non-English-speaking immigrants in comparison to non-immigrants. Neuropsychiatric Inventory and PainChek® were used to assess neuropsychiatric symptoms of dementia and pain, respectively.

RESULTS

Of the 23,889 referrals, 36% were immigrants living with dementia. Immigrants were 0.8 years older than non-immigrants on average. Immigrants had a slightly higher prevalence of mixed dementia (9.5%) than non-immigrants (8.2%). Overall, the groups had no difference in the severity of neuropsychiatric symptoms and associated caregiver distress. However, there was a significant difference in the total number of neuropsychiatric inventory domains (Cohen's d = -0.06 [-0.09, - 0.02], p <.001) between non-English-speaking immigrants and non-immigrants. Immigrants were more likely to present with agitation/aggression, while non-immigrants were more likely to present with hallucinations. Factors contributing to neuropsychiatric symptoms were common between the groups, with language barriers and cultural considerations frequently endorsed for immigrants.

CONCLUSION

This study reveals a mixed picture of neuropsychiatric symptoms between immigrants and non-immigrants. However, due to the exploratory nature of the hypotheses, our findings need to be replicated in future studies to confirm any conclusions. There is a need for increased awareness on the impact of culture and language on neuropsychiatric symptoms for people receiving residential care. Future studies investigating neuropsychiatric symptoms in different immigrant groups will help increase our understanding of neuropsychiatric symptoms for all people.

HIV Care Outcomes Among Non-US-Born Persons with Diagnosed HIV Infection, 2019

Despite the improvements in HIV care outcomes in the United States (US), non-US-born persons continue to be disproportionately affected by HIV. We analyzed National HIV Surveillance System (NHSS) data on HIV diagnoses, stage 3 (AIDS) at diagnosis, linkage to medical care, and viral suppression for non-US-born persons by region of birth (RoB) reported to the (NHSS) in 2020 to determine care outcomes among this population. Overall, a larger proportion of non-US-born persons received a late-stage diagnosis [stage 3 (AIDS)] classification. Among all non-US-born persons, African-born males, Asian-born females, and persons aged 55 + years had the highest proportions of late-stage diagnosis. Despite a late-stage of diagnosis, a higher proportion of non-US-born persons were linked to medical care and were virally suppressed compared to US-born persons. HIV care outcomes varied by RoB and selected characteristics. Knowing the RoB of non-US-born persons is necessary to identify culturally sensitive approaches for prevention planning and increasing testing activities to ultimately increase early diagnosis in this population.

Knowledge, psychological impacts, and protective behaviours during the first wave of the COVID-19 pandemic among Chinese residents in Canada with dependent school-age children: a cross-sectional online study

BACKGROUND

The purpose of this study was to describe the knowledge, protective behaviours, and psychological impact of COVID-19 on Chinese residents in Canada, as the emotional and behavioural impacts of the pandemic have not been intensively studied amongst these populations. It was important to determine whether having dependent school-age children (DSAC) aged 16 or under was associated with adverse psychological impacts amongst the Chinese residents living in the country.

METHODS

In April 2020, 757 eligible participants were recruited through a snowball sampling to complete an online survey related to the COVID-19 pandemic. Psychological, behavioural, and sociodemographic variables were collected and first analyzed using descriptive and univariate statistics. Multiple logistic regression analyses were performed to further confirm the observed significant associations in bivariate analyses for selected psychological outcome variables.

RESULTS

Seven hundred forty-two participants who responded to the "dependent school-age children" question were included in the analysis. Most of them identified as females (65.8%) and 77.2% included receiving a university degree or higher. There were no significant differences in COVID-19 knowledge between those living with or without DSAC. However, participants with DSAC were more likely to perceive themselves as being at greater risk of contracting COVID-19 (p = .023); therefore, having a higher chance of adopting protective behaviours (e.g., hand washing, sanitizing frequently or disinfecting work and living spaces (p < .05), elevated risks of depression (p = .007), and stress (p = .010), compared to those without DSAC.

CONCLUSIONS

Predominantly, the Chinese residents in Canada with dependent school-age children were more likely to report the negative psychological impacts of the pandemic. These findings warrant further investigations that may contribute to informing key stakeholders about the identification and implementation of policies and interventions to support the needs of parents with young children, during and after the pandemic.

Residence in Hispanic/Latino Immigrant Neighborhoods, Away-From-Home Food Consumption, and Diet Quality: The Hispanic Community Health Study/Study of Latinos

BACKGROUND

Hispanics/Latinos are disproportionately burdened by nutrition-related diseases but immigrants appear healthier than their US-born counterparts. Neighborhoods characterized by high Hispanic/Latino immigrant segregation may provide environments to support healthier diets.

OBJECTIVE

To examine whether or not Hispanic/Latino immigrant segregation is associated with frequency of away-from-home food consumption and diet quality in a large, diverse sample of Hispanic/Latino adults.

DESIGN

Cross-sectional baseline data from the Hispanic Community Health Study/Study of Latinos were analyzed (2008-2011). Residential addresses were geocoded and linked to census tract-level 2008-2012 American Community Survey data. Hispanic/Latino immigrant segregation was characterized using the local Getis-Ord Gi∗ statistic, a spatial clustering measure that quantifies the extent to which demographically similar neighborhoods group together.

PARTICIPANTS/SETTING

Participants were 15,661 adults in the Hispanic Community Health Study/Study of Latinos, a population-based study of Hispanic/Latinos aged 18 to 74 years from 4 US regions (Bronx, NY; Chicago, IL; Miami, FL; and San Diego, CA).

MAIN OUTCOME MEASURES

Away-from-home food consumption was assessed using a modified dietary behavior questionnaire. Diet quality was assessed using the Alternate Healthy Eating Index 2010 (range = 0 to 110) from two 24-hour recalls.

STATISTICAL ANALYSIS

Multilevel linear and logistic regression with multilevel weights were used to estimate associations between Hispanic/Latino immigrant segregation (low, medium, or high) with Alternate Healthy Eating Index 2010 score, and away-from-home food consumption (≥3 vs <3 times/week) in separate models, respectively. The mediating role of neighborhood poverty and whether or not associations differed by nativity were also assessed.

RESULTS

Higher levels of segregation were associated with higher adjusted mean Alternate Healthy Eating Index 2010 scores; estimates were further magnified after accounting for neighborhood poverty (low segregation: reference category; medium segregation: β = 2.43, 95% CI 1.10 to 3.77; and high segregation: β = 1.63, 95% CI .43 to 2.82). Associations were strongest among the foreign-born compared with the US-born. There was no association between segregation and away-from-home food consumption.

CONCLUSIONS

These results highlight the potential role of Hispanic/Latino immigrant neighborhoods in supporting healthy diets among residents, especially immigrants.

Multiple mediation effect of coping styles and self-esteem in the relationship between spousal support and pregnancy stress of married immigrant pregnant women

Background

The purpose of this study was to identify the total, direct, and indirect influence of spousal support on pregnancy stress among married immigrant pregnant women. The study aimed to determine the relative magnitudes of specific mediating effects of coping styles and self-esteem.

Method

A cross-sectional correlational survey was conducted in Jeonnam with 206 married immigrant pregnant women. Data were collected from September 7 to November 7 in 2019. A self-report questionnaire was used to measure spousal support, pregnancy stress, coping styles, and self-esteem. The study employed a linear multiple regression analysis to examine the potential multi-mediating effects. The effect size was set at 0.15, the significance level at 0.05, and the power at 0.95. Through the analysis, the researchers explored the mediating mechanisms among the variables and identified the presence of multi-mediating effects.

Results

The effect sizes (b) and statistical significance (p) for the predictors were as follows: problem-focused coping (b = 0.13, p = 0.001), emotion-focused coping (b = 0.11, p = 0.004), and self-esteem (b = 0.10, p < 0.001). Emotion-focused coping (b = 0.26, p = 0.001) and self-esteem (b = -0.20, p = 0.035) had a significant impact on pregnancy stress. The total effect of spousal support on pregnancy stress was significant at -0.25 (p < 0.001), and the direct effect was also significant at -0.26 (p < 0.001). We observed significant mediating effects for emotion-focused coping and self-esteem.

Conclusions

As a result of this study, the self-esteem of married immigrant pregnant women can have a protective effect by preventing the aggravation of pregnancy stress in the relationship between spousal support and pregnancy stress. Meanwhile, the emotion-focused coping style can balance out the effect of self-esteem. Therefore, in order to alleviate the stress of pregnancy for women, it is necessary to provide intervention to help improve self-esteem with spousal support. In addition, nursing professionals should help them use appropriate coping styles.

Results from "Live Well", a randomized controlled community-based participatory intervention to prevent obesity in new immigrant mother-child dyads

BACKGROUND

Upon arrival, the prevalence of overweight and obesity is lower in new immigrants than their native counterparts in the U.S. With longer residency in the U.S., these differences converge over time, followed by higher prevalence among immigrants than native U.S. residents. Results from the Live Well project in the Greater Boston area demonstrate the viability of utilizing a culturally adapted, community-based participatory research (CBPR) approach to reduce weight gain among newly immigrated mother-child dyads.

METHODS

Haitian, Latina, and Brazilian mother-child dyads (n = 390), new to the U.S. (fewer than 10 years) were enrolled in a one- to two-year long CBPR lifestyle intervention that targeted dietary and physical activity behaviors. Attendance was recorded to establish dose. Demographics, anthropometrics, and relevant covariates were collected from participants at baseline, 6, 12, 18, and 24 months. Body Mass Index (BMI) was calculated using objectively measured height and weight. Linear mixed regression models were used to assess change in BMI and BMI z-score of mothers and children respectively.

RESULTS

At baseline, nearly 75% of mothers and 50% of children were either overweight or obese (BMI ≥ 25.0 and BMI z-score ≥ 85th percentile, respectively). Only 20% of mothers attended all 12 intervention sessions in year 1. Using intent-to-treat analyses, no significant time, intervention, or time × intervention effects were observed for weight change of mothers or children at follow-up. Mothers in the highest quantile (those who attended all 12 intervention sessions) had significant reductions in BMI at 18 months (1.76 units lower, 95%CI: -3.14, -0.37) and 24 months (2.61 units, 95%CI -3.92, -1.29) compared to mothers in the lower quantiles, including those with no exposure. Such dose effects on BMI z-scores were not noted for children.

CONCLUSIONS

Findings from Live Well demonstrate the viability of utilizing a CBPR approach to address overweight and obesity among immigrant mothers. Given the higher-than-expected prevalence of overweight and obesity among mother-child dyads by ~ 6 years of U.S. residency, and lower maternal participation rates in the intervention, additional research is necessary to identify the optimal intervention length, retention strategies, and approach to jointly support healthy maternal and child weight.

Evaluating an Interprofessional Trauma-Based Education Course to Advance the Care and Health of Refugees

Refugee patients benefit from interdisciplinary approaches that address trauma-related migration in culturally responsive ways. This qualitative evaluation assessed the interdisciplinary trauma-based course for refugee populations. The qualitative data comes from focus groups and surveys to evaluate medical, social work, and public health students' perceptions of the interprofessional education course of refugee patient care. The evaluators analyzed qualitative data through a thematic content analysis method. Following key themes emerged from students' reflections: (1) collaboration in interdisciplinary learning, (2) role of clinical learning, (3) skills and knowledge related to refugee population care, (4) improvements for interprofessional education, and (5) strengths of the interprofessional education course. The Interprofessional Refugee Health Elective course enhanced their knowledge and competence in refugee health care. Educators, students, and the patient population will benefit from investing in interprofessional education courses that focus on specific needs and complex care management for refugee patients.

Access to Virtual Mental Healthcare and Support for Refugee and Immigrant Groups: A Scoping Review

Immigrant and refugee populations face multiple barriers to accessing mental health services. This scoping review applies the (Levesque et al. in Int J Equity Health 12:18, 2013) Patient-Centred Access to Healthcare model in exploring the potential of increased access through virtual mental healthcare services VMHS for these populations by examining the affordability, availability/accommodation, and appropriateness and acceptability of virtual mental health interventions and assessments. A search in CINAHL, MEDLINE, PSYCINFO, EMBASE, SOCINDEX and SCOPUS following (Arksey and O'Malley in Int J Soc Res Methodol 8:19-32, 2005) guidelines found 44 papers and 41 unique interventions/assessment tools. Accessibility depended on individual (e.g., literacy), program (e.g., computer required) and contextual/social factors (e.g., housing characteristics, internet bandwidth). Participation often required financial and technical support, raising important questions about the generalizability and sustainability of VMHS' accessibility for immigrant and refugee populations. Given limitations in current research (i.e., frequent exclusion of patients with severe mental health issues; limited examination of cultural dimensions; de facto exclusion of those without access to technology), further research appears warranted.

Immigrants: A Systematic Review

Structural and cultural barriers have led to limited access to and use of mental health services among immigrants in the United States (U.S.). This study provided a systematic review of factors associated with help-seeking attitudes, intentions, and behaviors among immigrants who are living in the U.S. This systematic review was performed using Medline, CINAHL, APA PsycInfo, Global Health, and Web of Science. Qualitative and quantitative studies examining mental help-seeking among immigrants in the U.S. were included. 954 records were identified through a search of databases. After removing duplicates and screening by title and abstract, a total of 104 articles were eligible for full-text review and a total of 19 studies were included. Immigrants are more reluctant to seek help from professional mental health services due to barriers such as stigma, cultural beliefs, lack of English language proficiency, and lack of trust in health care providers.

Innovative Approaches to Improve COVID-19 Case Investigation and Contact Tracing Among Refugees, Immigrants, and Migrants: Lessons Learned from a Newly Established National Resource Center

Effective COVID-19 case investigation and contact tracing (CICT) among refugee, immigrant, and migrant (RIM) communities requires innovative approaches to address linguistic, cultural and community specific preferences. The National Resource Center for Refugees, Immigrants, and Migrants (NRC-RIM) is a CDC-funded initiative to support state and local health departments with COVID-19 response among RIM communities, including CICT. This note from the field will describe NRC-RIM and initial outcomes and lessons learned, including the use of human-centered design to develop health messaging around COVID-19 CICT; training developed for case investigators, contact tracers, and other public health professionals working with RIM community members; and promising practices and other resources related to COVID-19 CICT among RIM communities that have been implemented by health departments, health systems, or community-based organizations.

A Study of Immigrant Latinas Perspectives of Caring for their Diabetes

Hispanic-Americans are disproportionately affected by type 2 diabetes compared to non-Hispanic Whites. Five million adult Hispanic Americans are estimated to have been diagnosed with T2D. Among US Hispanics, Mexicans have the highest rate (14.4%) of diabetes. Further, Hispanics are also twice as likely as non-Hispanics Whites to die from diabetes, making it the fifth leading cause of their death and a serious health problem in Hispanic communities. Yet, little is understood of what rural immigrant Latinas do to care for their diabetes health. In-depth interviews (3 focus groups) and thematic analysis found 16 Latinas had T2D on average for 9 years; all emigrated to the USA from Mexico, lived in the USA for an average of 27 years, and worked (60%). Within the domain of "What do you do to take care of your health?" Latinas desired to adhere to exercise, controlled diet, and medications, but perceived a powerful barrier to a healthy life was the American lifestyle that included long work days, more money to purchase unhealthy foods and a desire for them, and a lack of time for other forms of exercise. Despite the Latina participants' years of experience about living with T2D in the US, they still struggled to adhere to healthy behaviors. Future research should address the longer time Hispanic immigrants live in the US with the more at-risk they become for diminished health.

The Intersection of State-Level Immigrant Policy Climates and Medicaid Expansion: an Examination Among Immigrants

States have broad discretion over the implementation of policies like Medicaid expansion and other policies that impact the well-being and integration of immigrants. While numerous studies document Medicaid expansion on immigrants' health insurance coverage and the role of state immigrant policy climates on immigrants' well-being, no research to date has studied whether the association between a state's Medicaid expansion on immigrants' health insurance coverage varies based on the inclusiveness or exclusiveness of a state's immigrant policy climate. We combine nationally representative data from the 2014-2018 American Community Survey (ACS) with state policy data and estimate multivariate regression models. The results reveal a state immigrant policy climate gradient whereby ACA Medicaid expansion on noncitizens is negative and most severe in exclusionary climates. This study highlights how state policies intersect as important structural forces that influence immigrant health and well-being.

Impacts of an interpretation fee on immigrants' access to healthcare: Evidence from a Danish survey study among newly arrived immigrants

In 2018, a fee for healthcare interpretation was introduced for immigrants living in Denmark for more than 3 years to incentivize learning Danish faster. Little is known about who is affected and how immigrants experience impacts of the fee. Using survey data from 2021 (n = 486), we analysed prevalence and socio-demographic background of immigrants reporting interpretation needs, and self-reports about whether the fee had impacted their access to healthcare. In the study population, 19% (n = 95) reported interpretation needs. Refugees and their families (OR: 10.2) more often reported interpretation need compared with EU/EEA immigrants, as did immigrants with low education (OR: 1.86), low income (OR: 2.63) or poor self-perceived health (OR: 3.18), adjusted for gender, age, region of residence and length of stay. among immigrants needing interpretation, 42% (n = 69) reported having refrained from seeking healthcare due to the fee, 73% (n = 119) using ad hoc interpreters, and 77% (n = 126) trying to learn Danish faster. Findings suggest that the policy aim of incentivizing host country language acquisition is partly met, but that the fee has unintended consequences in terms of hampered access to healthcare and increased use of ad hoc interpreters, raising concerns about unmet health needs and poorer quality of care for a substantial group. Potential benefits of the policy should be carefully evaluated against severe negative impacts on immigrants' access to healthcare.

Development and refinement of a corner-based injury prevention programme for Latino day labourers

Objective

Latino day labourers (LDLs) in the USA are at increased risk for non-fatal and fatal occupational injuries, which are compounded by stressors that include wage theft, job insecurity and discrimination. This paper describes the development and refinement of Vales+Tú (You are Worthy of More), an injury prevention programme currently being evaluated as part of a cluster randomised trial in which health promotion is taken directly to the 'corners' (e.g. street corners, home improvement store parking lots, and public parks) where workers gather to seek employment.

Design

Vales+Tú comprises two corner-based intervention approaches, group problem-solving (small group discussions) and brief motivational interviewing (one-on-one dialogue), that aim to activate LDL agency to control their safety and that of their peers.

Setting

Corners in Houston, Texas, where LDLs seek employment.

Method

Intervention Mapping informed the refinement of Vales+Tú for the current trial. We provide a narrative review of the development process based on needs assessment and formative development activities (surveys, focus group discussions and pilot tests).

Results

In addition to documenting the need for LDL injury prevention, with 20.2%-41.6% of Houston-based LDLs surveyed between 2013-2014 and 2019 reporting a severe work-related injury in the past year, we describe key facets of the Vales+Tú corner-based intervention approaches - including their theoretical basis and LDL-centred activities, as well as enhancements made informed by formative evaluation.

Conclusion

The community-engaged development process of Vales+Tú resulted in two practical intervention approaches that can be adopted by worker centres and other organisations to promote LDL worker safety.