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Background The re-emerging dominance of the Taliban in Afghanistan in 2021 caused a new wave of Afghan refugees heading Iran and neighboring countries. Iran in the Middle East and Germany in Europe are two major host countries to the largest populations of Afghan refugees. In both countries, several studies have been done to assess the health condition of refugees. Objectives To systematically review the existing literature to identify similarities and differences of health conditions of Afghan refugees living in the two countries, and to synthesize evidence on the health status and health care access of these populations. Methods Related electronic databases and grey literature of Iran and Germany on the health of Afghan refugees were scanned and searched up for the period 2000–2020. Key terms were formed by combining “Afghan refugees or immigrants or populations or asylum seekers”, “Physical or mental health”, “Healthcare service or access or use”, “Iran or Germany”. Empirical studies were considered if they contained samples of Afghan refugees with particular outcomes for Afghans. Results were categorized for both countries in the three main areas of physical health, mental health, and access/use of healthcare services. Results Nine hundred twenty-two documents were extracted, of which 75 full-texts were finally reviewed. 60 documents belonged to the health condition of Afghan refugees residing in Iran including 43 in physical health, 6 in mental health, 8 in healthcare access and use, and 3 in multiple aspects of health, and 15 belonged to Germany including 7 in physical health, 4 in mental health, 2 in healthcare access and use, and 2 in multiple aspects of health. A less explicit evaluation of the overall health condition of Afghan refugees was observable, particularly for Germany. While matches on the study subject exist for both countries, in comparison to Germany, we extracted more quantitative and qualitative health studies on Afghan refugees of the mentioned areas from Iran. German health studies were rare, less qualitative, and more on the health condition of diverse refugee groups in general. Conclusions Wide gaps and unanswered questions related to mental health and overall health status of the Afghan refugee population are observable, especially in Germany. Our systematic review identified the gap in evidence, which we would recommend to bridge using a wider lens to comprehensively assess the overall condition of refugees considering associations between health and socio-economic and cultural determinants instead of a one-dimensional approach. Further, within health studies on refugee populations, we recommend stratification of results by the country of origin to capture the within-group diversity among refugees with different countries of origin.

Background Since 2015, more than one million people fled to Germany – mainly from war-affected countries. Nevertheless, little is known about social determinants in refugees located in Germany. This study aims to test the mediation effect of loneliness between social relationships, comprising social integration and social support, and health-related quality of life among refugees living in North Rhine-Westphalia, Germany. Methods The investigation utilizes data from the FlueGe Health Study (N=326), a cross-sectional study conducted by Bielefeld University. The data was collected between February and November 2018 and included interviews and examinations. Participants were recruited from shared and private accommodation in several cities in North Rhine-Westphalia, Germany. We first analyzed correlations between social integration, social support, loneliness, and physical and mental component of health-related quality of life. We then conducted mediation analyses using structural equation modeling. Results The majority of respondents were socially isolated, perceiving a moderate degree of loneliness and social support. In addition, the physical and mental components of health-related quality of life indicate that participants predominantly experienced mental rather than physical impairments. Results from mediation analyses showed indirect effects of loneliness on the association between social integration and mental health (ß = 0.495, 95% bias-corrected and accelerated confidence interval (BCa CI) = [0.018, 0.972]), and between social support and both physical (ß = 0.022, 95% BCa CI = [0.004, 0.040]) and mental health (ß = 0.067, 95% BCa CI = [0.037, 0.097]). Conclusions Loneliness played a mediating role in the association between social relationships and health-related quality of life among refugees living in North Rhine-Westphalia, Germany. The results provide implications for both, health policy and the host society. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12303-5.

Background With the refugee movement in 2015, also forced migrated female and male medical professionals have arrived in Germany. The effect of occupation on the subjective health status of these physicians working in the German health care system was investigated on the basis of Antonovsky's sense of coherence (SOC) and the occupational science models of Siegrist and Karasek&Theorell. Methods Using a semi-structured interview guide, nine forced migrated physicians were interviewed before and nine forced migrated physicians were interviewed during their professional medical activity. Both interview groups had an Arabic cultural background. The transcribed interviews were analyzed according to Kuckartz's content structuring qualitative content analysis using the MAXQDA 2020 software tool. Results The SOC of migrated physicians is favorably influenced by meaningful occupational activity and the newly gained manageability of life. Positive influences are seen in professional appreciation and collegial support at all hierarchical levels. Negative effects are perceived in experiences of discrimination, insecurity and experienced injustice in the recognition of foreign qualifications. Physical stress results from occupational overload, unfamiliar work and time pressure. Conclusions The salutogenic effect of the work, the recognition in the profession and the collegial support are essential contributions to the promotion of especially mental health among forced migrated doctors. This speaks in favor of rapid and stringent integration into professional life. However, organizational barriers inherent in the German health care system should not be disregarded, which is why both legal and structural improvements should be made to the existing integration procedure before and during professional activity. Key messages

Crystals : open access journal 11(9), 1021 (2021). doi:10.3390/cryst11091021 special issue: "Special Issue "Micromechanical Modelling and Its Applications to Polycrystals" / Special Issue Editors: Dr. Napat Vajragupta, Guest Editor; Prof. Dr. Junhe Lian, Guest Editor; Prof. Sebastian Münstermann, Guest Editor", Published by MDPI, Basel

BACKGROUND: This study aims to determine: (i) information on overweight and obesity, represented by body mass index using measured anthropometric data, among refugees living in North Rhine-Westphalia, Germany, (ii) how body mass index changed throughout the migratory journey to Germany, and (iii) factors influencing body mass index.; METHODS: The study utilizes data from the FlueGe health study, a cross-sectional study conducted by Bielefeld University. The data was collected between February and November 2018 in which participants were recruited in several cities in North Rhine-Westphalia (N=326). We analyzed differences in body mass index before the escape, upon arrival, and since arrival as well as correlations between body mass index since arrival and explanatory variables using linear regression models.; RESULTS: The overall prevalence of overweight and obesity beforethe escape (t0), upon arrival (t1) and since arrival (t2) were 55.2% (150/272), 45.6% (133/292) and 54.8% (171/312), respectively, with 16.2% (44/272), 12.0% (35/292) and 16.0% (50/312) being obese. There was a significant change between t0 and t1 (p

Metals : open access journal 11(4), 602 (2021). doi:10.3390/met11040602, Published by MDPI, Basel

Little is known about social determinants among refugees resettled in Germany. This study aims to examine the impact of family separation on refugees’ subjective time pressure and mental health. Data come from the FlueGe Health Study (n = 208), a cross-sectional study administered by Bielefeld University. We used logistic regression analysis to investigate the effect of family separation on (i) being time-stressed and (ii) having a high risk for adverse mental health, considering sociodemographic and postmigration factors. As a result, more than 30% of participants with a spouse or partner and about 18% with a child or children reported separation. Multiple logistic regression showed that family separation was not associated with being time-stressed, but separation from at least one child was associated with adverse mental health (OR = 3.53, 95% CI = [1.23, 10.11]). In conclusion, family separation primarily contributes to adverse mental health among refugees from the Middle East and Africa resettled in North Rhine-Westphalia, Germany. Therefore, policies and practices that facilitate family reunification can contribute significantly to the promotion of refugees’ mental health and well-being.

Although recommended infant and young child feeding (IYCF) practices have been found to be protective against undernutrition in some settings, there is no finality yet due to inconsistencies in the literature. A cross-sectional survey of 581 mother-child pairs was conducted in northern Ghana in June 2018. The association between IYCF indicators and child undernutrition (stunting and wasting) were assessed. The descriptive analysis showed that 66.4% of the children (6&ndash, 23 months) were introduced to complementary feeding in a timely manner, 69.4% met the minimum meal frequency, and 38.9% met the minimum acceptable diet daily. The prevalence of stunting, wasting, underweight and overweight was 33.2%, 14.1%, 27% and 2.6%, respectively. From the multivariable binary logistic regression, child gender, child age group and source of power for lighting the household were significantly associated with wasting. Intake of iron-rich foods, child age group, and maternal height were significantly associated with stunting after adjusting for confounders. The prevalence of the compliance with IYCF indicators was relatively high. None of the individual IYCF indicators showed significant association with undernutrition, except intake of iron-rich foods for stunting. Nutrition-specific interventions targeted at improving IYCF practices, dietary diversification and intake of nutrient-rich meals, should be adopted and scaled up to address undernutrition in northern Ghana.

The importance of the relationship between health and migration has been recognised for a long time with a more recent focus on refugee health. The experience of life threatening situations in countries of origin, the flight itself, but also the legal status of a refugee in the destination country brings about many health-related challenges. One area, in which these challenges become particularly visible, is the housing situation of refugees. In contrast to many voluntary migrants, refugees are often required to live in shared accommodations. These can be flats but also buildings constructed for other purposes, such as old factories, gyms, or hotels, container buildings, or tents. Thus, the living conditions of refugees in destination countries are often below the average housing standard of the native population. This situation can on the one hand reinforce challenges to refugees’ physical, psychological and social health, and on the other hand it can hinder the good provision of healthcare at home. This workshop addresses these challenges for the case of Germany - which had the highest number of asylum applications between 2015 and 2017 - by analysing different aspects of refugee health from an interdisciplinary perspective. The contributions bring together the results from theoretical/philosophical reflections, as well as qualitative and quantitative empirical data, including the perspective of refugees and health care providers. The contributions raise questions about the characteristics of accommodations that affect the subjective well-being and health of refugees. The results show that there are particular challenges for health and healthcare provision related to the general situation of accommodation of refugees in Germany. These include the potential transmission of germs and related risks for the physical health of refugees, the creation of a situation of exclusion from society which can worsen psychological stressors, as well as the distance from worshipping places, which can hinder the beneficial effects of communities of faith for the social health of refugees. In addition, the possibilities of maternity care in shared accommodations are often limited due to the lack of privacy, which can represent a stressor for pregnant women and young families. The results presented in this workshop are the outcomes of some projects developed in the graduate school “Challenges and Opportunities of Global Refugee Migration for Healthcare in Germany - FlüGe”. FlüGe encompasses 12 doctoral students, supervised by 12 professors from five faculties at Bielefeld University. It covers a broad range of disciplines (public health, psychology, microbiology, theology, and law) with an active involvement of practice partners, such as clinical and governmental institutions. In taking this approach, the graduate school aims to identify the short-, medium-, and long-term challenges and opportunities posed to global migration for healthcare in Germany and seeks to develop practical solutions. Key messages Despite the diversity in refugee accommodation in Germany, shared housing in general negatively affects refugee health in various ways. The accommodation of refugees poses challenges to the physical, mental and social health of refugees and to the efficient provision of healthcare at home.

Background A decline in the prevalence of secondhand smoke (SHS) exposure has been observed in the United States of America (USA) during the past few decades. Nevertheless, nearly half of non-smoking students are still exposed to SHS. This paper aims to describe the factors associated with SHS exposure stratified by type of exposure (overall, cigarettes and electronic cigarettes). Methods The analysis is based on secondary data taken from the National Youth Tobacco Survey 2014. Overall, 22,007 middle and high school students from the USA are included in the sample. Descriptive and bivariate statistics as well as binary logistic regression models were performed. Results Overall, 44.5% (n=9,798) of the study participants declared themselves to be exposed to SHS, 29.1% (n=6,394) declared to be exposed to SHS caused by cigarette smoke and 9.4% (n=2,067) claimed that a person who lives with them uses electronic cigarettes. There is a considerable overlap between the two types of SHS exposure, because 74.9% (n=1,548) of students declaring that a person within their household uses electronic cigarettes also declare a person in the household smoking cigarettes. The strengths of association between independent variables and SHS exposure differs by type of exposure and also by smoking status of respondents. Conclusions Although only small differences are obvious in the factors associated with SHS exposure stratified by the type of tobacco product, there are still some variations which should be considered in policy making to allow for a targeted approach in prevention campaigns or legislation.

Social transformation refers to major changes in the ways in which societies live. Globalisation and transnationalisation of today’s world are prime examples of such transformative understanding. While globalisation is considered as an economic interdependence of nation-states with macro level dynamics, transnationalisation refers to the sustained cross-border social and symbolic ties, social formations occurring at least between two nation-states, and their implications mainly due to international migration of people with an agency-oriented perspective. This chapter is set to introduce different conceptualisations of social transformation and argue that international migration is both a cause and consequence of it. In the light of these processes, this chapter focuses on the nexus of migration and health in particular reference to asylum seeking and refugee movements. The social and geographical contexts influence health and migration patterns of persons. Looking at interrelated macro-, meso-, and micro-levels, this chapter frames the nexus of migration and health in the broader understanding of social transformation.