Search

Background Digital health interventions are effective for hypertension self-management, but a comparison of the effectiveness and implementation of the different modes of interventions is not currently available. This study aimed to compare the effectiveness of SMS, smartphone application, and website interventions on improving blood pressure in adults with hypertension, and to report on their reach, uptake, and feasibility. Methods In this systematic review and meta-analysis we searched CINAHL Complete, Cochrane Central Register of Controlled Trials, Ovid Embase, Ovid MEDLINE, and APA PsycInfo on May 25, 2022, for randomised controlled trials (RCTs) published in English from Jan 1, 2009, that examined the effectiveness of digital health interventions on reducing blood pressure in adults with hypertension. Screening was carried out using Covidence, and data were extracted following Cochrane's guidelines. The primary endpoint was change in the mean of systolic blood pressure. Risk of bias was assessed with Cochrane Risk of Bias 2. Data on systolic and diastolic blood pressure reduction were synthesised in a meta-analysis, and data on reach, uptake and feasibility were summarised narratively. Grading of Recommendations, Assessment, Development, and Evaluation criteria were used to evaluate the level of evidence. The study was registered with PROSPERO CRD42021247845. Findings Of the 3235 records identified, 29 RCTs from 13 regions (n=7592 participants) were included in the systematic review, and 28 of these RCTs (n=7092 participants) were included in the meta-analysis. 11 studies used SMS as the primary mode of delivery of the digital health intervention, 13 used smartphone applications, and five used websites. Overall, digital health intervention group participants had a –3·62 mm Hg (95% CI –5·22 to –2·02) greater reduction in systolic blood pressure, and a –2·45 mm Hg (–3·83 to –1·07) greater reduction in diastolic blood pressure, compared with control group participants. No statistically significant differences between the three different modes of delivery were observed for both the systolic (p=0·73) and the diastolic blood pressure (p=0·80) outcomes. Smartphone application interventions had a statistically significant reduction in diastolic blood pressure (–2·45 mm Hg [–4·15 to –0·74]); however, there were no statistically significant reductions for SMS interventions (–1·80 mm Hg [–4·60 to 1·00]) or website interventions (–3·43 mm Hg [–7·24 to 0·38]). Due to the considerable heterogeneity between included studies and the high risk of bias in some, the level of evidence was assigned a low overall score. Interventions were more effective among people with greater severity of hypertension at baseline. SMS interventions reported higher reach and smartphone application studies reported higher uptake, but differences were not statistically significant. Interpretation SMS, smartphone application, and website interventions were associated with statistically and clinically significant systolic and diastolic blood pressure reductions, compared with usual care, regardless of the mode of delivery of the intervention. This conclusion is tempered by the considerable heterogeneity of included studies and the high risk of bias in most. Future studies need to describe in detail the mediators and moderators of the effectiveness and implementation of these interventions, to both further improve their effectiveness as well as increase their reach, uptake, and feasibility.

Introduction: Evidence on sexual behaviour and COVID-19 shows a change in sexual habits; however, there is no research on the association between mental health and sexual activity. Aim: To examine the relationship between mental health and sexual activity during the quarantine in Spanish adults. Methods: A sample of 305 adults filled out an online questionnaire. Sexual activity was assessed with one question. Anxiety and depression symptoms were assessed using the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory (BDI), respectively. To check associations between levels of both anxiety and depressive symptoms (exposure) and weekly prevalence of sexual activity (outcome), we conducted multiple logistic regression adjusted for control variables (marital status, employment, average household annual income, place of living, pre-COVID-19 sexual activity, current smoking, current alcohol consumption, chronic physical conditions, chronic psychiatric conditions, physical symptoms, and days of confinement). Results: Higher depression level was associated with lower weekly sexual activity in a dose-response fashion in the three implemented models. Participants with higher levels of depression were associated with significantly lower sexual activity in the fully adjusted model (OR: 0.09, 95% CI 0.01–0.61). Mild anxiety-level participants consistently presented significantly lower ORs for lower sexual activity than their minimal-anxiety category counterparts. Particularly, the fully adjusted model showed the lower values (OR: 0.40, 95% CI 0.19–0.84). Conclusion: The results of this study support existing evidence stressing the association between mental health and sexual activity in quarantined adults.

Summary: The value-based integrated health and social care for older adults supported by ICT solutions (ValueCare) project aims to develop and implement efficient outcome-based, integrated health and social care for older adults and it will be tested in 7 different health and social care regimes. The model will be adopted and tested with older adults living with multimorbidity, and/or frailty, and/or living with mild to moderate cognitive impairment. By focusing on the transferability of the model to different contexts, this workshop will be aiming at maximising the impact of the VALUECARE model to be scaled-up to the whole aging population group across Europe.Background: ValueCare is a 54-month project funded under Horizon2020 by the EC. ValueCare aims to deliver technology-enabled, outcome-based integrated health and social care for older adults to improve their quality of life, thus supporting the sustainability of care systems.Aims and Objectives: The aim is to demonstrate the potential for transferability of the VALUECARE model across Europe. In order to accelerate the scaling-up of the model, the ValueCare model and the adaptation plans for its piloting in 7 different countries will be presented. The workshop aims to raise awareness about the adaptation needs before the implementation of the pilot and the challenges raised by its deployment in real life settings; and contributes to understanding local readiness, needs and priorities for the adoption and scaling-up of the VALUECARE model across different organisations and regions in Europe.Target audience: The workshop will be of interest of professionals, researchers, service managers and policymakers. Facilitators / speakers -Hein Raat – Project Coordinator – Moderator-Alejandro Gil-Salmerón – Moderator-Vanja Vasiljev – Croatian Pilot Representative-Andrew Darley – Irish Pilot Representative -Natalia Machado – Portuguese Pilot Representative -Oscar Zanutto/Elena Procaccini - Italian Pilot Representative-Mirian Fernández – Spanish Pilot Representative-Anastasios Rentoumis – Greek Pilot Representative -Oscar Mayora – Virtual Coach developer Format: -VALUECARE project overview by coordinator (5 min)-VALUECARE model presentation by partner (10 min)-Pilot Plans Presentation by pilot representatives (35 min)-Group exercise to assess health and social care systems to map the challenges for the integration of health and social care systems and plan the adoption of the VALUECARE model in its countries, moderated by partner (35 min)-Conclusions and final statements by project coordinator (5 min)Key Learnings/Take away: Learn about VALUECARE project. Raise awareness on the need for a change towards coordinated health and social care systems and the challenges related to the systems’ integration. Gain knowledge on how the VALUECARE is adopted and contribute to the scaling up of the model by discussing its adoption.

This study aimed to explore and gain insight from the dialogue and subjective perception of older people about loneliness and social support using a cross-cultural approach. A total of six focus gr...

Few studies have examined the differences between immigrant and native-born homeless populations. Our aim was to conduct an exploratory study to examine the differences in health status, health behaviour and healthcare utilisation in a sample of Spanish immigrant and native homeless people. Study was conducted in eight different temporary accommodations in the Valencia region in August 2018. Overall, 86 participants were included in the analysis who answered questionnaires concerning socio-demographic characteristics, immigration status, health status and behaviour, healthcare utilisation and experienced discrimination in healthcare and health literacy. In total, 76.7% were men with a mean age of 41.91 (14.17) years, with 60.4% having immigration background with an average of 4.8 (4.2) years since arrival in Spain. No differences were found in the subjective health status, however, native homeless participants reported significantly higher prevalence of heart disease (87.5% vs. 12.5%), hypertension (84.6% vs. 15.4%), psychological illness (63.6% vs. 36.4%) and were also more often smokers (73.5% vs. 28.8%), reported smoking more cigarettes per day (12.0 vs. 7.4) and were more often illegal drug users (17.6% vs. 2.0%). Immigrant participants were significantly more often not insured, reported more problems in healthcare access and had lower rates of visits to general practitioners and less hospital admissions. Differences were also observed in social status with the native homeless more often reporting receiving income, and living in less crowded accommodations. Our results show a variety of issues that the immigrant homeless population in Spain is confronted with that also prevents adequate social inclusion and achieving good health. However, the immigrant population engaged less often in risky health behaviour. More, and continuous, monitoring of social, mental and physical health of the homeless population is necessary. Public health interventions aiming at health promotion in the immigrant homeless populations need to focus on increasing overall social integration.

People experiencing homelessness are known to be at risk of disproportionately poor health outcomes and often face barriers in accessing healthcare. Patient navigation (PN) has been identified as a way to address health disparities and engage underserved populations with healthcare services . This scoping review aims to understand how PN models have been utilized with people experiencing homelessness and other comparable populations to date and more specifically identify (a) the defining features, (b) the barriers and facilitators in implementation, and (c) the outcomes associated with PN models. Database searches were conducted in Web of Science, PubMed and SCOPUS on 15th June 2021 and 21 papers, comprising nine reviews and 12 individual studies, were selected. Results indicate that PN has consistently been associated with improvements in a range of health-related outcomes, including timely access to healthcare. While the implementation and measurement of PN varies, a series of consistent features, facilitators and barriers are identified. Interventions to date have utilized a longitudinal approach and non-clinical navigators who share characteristics with the patient, and whose role is facilitatory. To maximize success in future use of PN, further research that focuses on the feasibility of the approach outside the USA is warranted.

Background: Discrimination based on ethnicity and the lack of translation services in healthcare have been identified as main barriers to healthcare access. However, the actual experiences of migrant patients in Europe are rarely present in the literature. Objectives: The aim of this study was to assess healthcare discrimination as perceived by migrants themselves and the availability of translation services in the healthcare systems of Europe. Methods: A total of 1407 migrants in 10 European Union countries (consortium members of the Mig-HealthCare project) were surveyed concerning healthcare discrimination, access to healthcare services, and need of translation services using an interviewer-administered questionnaire. Migrants in three countries were excluded from the analysis, due to small sample size, and the new sample consisted of N = 1294 migrants. Descriptive statistics and multivariable regression analyses were conducted to investigate the risk factors on perceived healthcare discrimination for migrants and refugees in the EU. Results: Mean age was 32 (±11) years and 816 (63.26%) participants were males. The majority came from Syria, Afghanistan, Iraq, Nigeria, and Iran. Older migrants reported better treatment experience. Migrants in Italy (0.191, 95% CI [0.029, 0.352]) and Austria (0.167, 95% CI [0.012, 0.323]) scored higher in the Discrimination Scale to Medical Settings (DMS) compared with Spain. Additionally, migrants with better mental health scored lower in the DMS scale (0.994, 95% CI [0.993, 0.996]), while those with no legal permission in Greece tended to perceive more healthcare discrimination compared with migrants with some kind of permission (1.384, 95% CI [1.189, 1.611]), as opposed to Austria (0.763, 95% CI [0.632, 0.922]). Female migrants had higher odds of needing healthcare assistance but not being able to access them compared with males (1.613, 95% CI [1.183, 2.199]). Finally, migrants with chronic problems had the highest odds of needing and not having access to healthcare services compared with migrants who had other health problems (3.292, 95% CI [1.585, 6.837]). Conclusions: Development of culturally sensitive and linguistically diverse healthcare services should be one of the main aims of relevant health policies and strategies at the European level in order to respond to the unmet needs of the migrant population.

Measures implemented to reduce the spread of SARS-CoV-2 have resulted in a decrease in physical activity (PA) while sedentary behaviour increased. The aim of the present study was to explore associations between PA and mental health in Austria during COVID-19 social restrictions. In this web-based cross-sectional study (April–May 2020) moderate-to-vigorous physical activity (MVPA), sitting time, and time spent outdoors were self-reported before and during self-isolation. Mental well-being was assessed with the Warwick-Edinburgh Mental Well-being Scale, and the Beck depression and anxiety inventories. The majority of the participants (n = 652) were female (72.4%), with a mean age of 36.0 years and a standard deviation (SD) of 14.4. Moreover, 76.5% took part in ≥30 min/day of MVPA, 53.5% sat ≥10 h/day, and 66.1% spent ≥60 min/day outdoors during self-isolation. Thirty-eight point five percent reported high mental well-being, 40.5% reported depressive symptoms, and 33.9% anxiety symptoms. Participating in higher levels of MVPA was associated with higher mental well-being (odds ratio = OR: 3.92, 95% confidence interval = 95%CI: 1.51–10.15), less depressive symptoms (OR: 0.44, 95%CI: 0.29–0.66) and anxiety symptoms (OR = 0.62, 95%CI: 0.41–0.94), and less loneliness (OR: 0.46, 95%CI: 0.31–0.69). Participants sitting &lt, 10 h/day had higher odds of mental well-being (OR: 3.58, 95%CI: 1.13–11.35). Comparable results were found for spending ≥60 min/day outdoors. Maintaining one’s MVPA levels was associated with higher mental well-being (OR = 8.61, 95%CI: 2.68–27.62). In conclusion, results show a positive association between PA, time spent outdoors and mental well-being during COVID-19 social restrictions. Interventions aiming to increase PA might mitigate negative effects of such restrictions.

Background This is the first study analyzing levels of physical activity in a sample of quarantined adults with chronic conditions. The aim of this study was to compare moderate- and vigorous-intensity physical activity levels in Spanish adults with chronic conditions before and during coronavirus disease 2019 (COVID-19) quarantine. Methods A cross-sectional online survey was administered during the COVID-19 quarantine in Spain. A total of 163 participants with chronic conditions (113 females and 47 males; age range 18–64 years) completed the survey. A total of 26 chronic conditions were included. Participants self-reported average minutes/day of moderate and vigorous physical activity before and during quarantine. Differences in moderate- and vigorous-intensity physical activity levels before and during COVID-19 quarantine (overall, by gender, by age, by number of chronic conditions and by each chronic condition) were assessed by Wilcoxon-signed rank test. Results During COVID-19 quarantine, there was a significant decrease of moderate-intensity physical activity in Spanish people with chronic conditions (in both males and females, in those aged 18–24, 25–34, 35–44 and 55–64 years, in those with multimorbidity, in those with one/two chronic condition/s, and in those diagnosed with asthma/hypercholesterolaemia/chronic skin disease/haemorrhoids). Also, there was a significant decrease of vigorous-intensity physical activity in Spanish males with chronic conditions and in those with multimorbidity. Conclusions These results should be considered to develop effective strategies of physical activity promotion targeting these specific groups when new quarantine or restriction measures are implemented, in order to avoid new significant decreases of physical activity in these vulnerable populations.

Restrictions of free movement have been proven effective in tackling the spread of COVID-19 disease. However, sensitive populations submitted to longer periods of restrictions may experience detrimental effects in significant areas of their lifestyle, such as sexual activity. This study examines sexual activity during the COVID-19 confinement in Spain. A survey distributed through an institutional social media profile served to collect data, whereas chi-squared tests, t-tests, analyses of variance, and multiple logistic regression analysis were used to assess differences among sample subgroups. A total of 71.3% adults (N = 536) (72.8% female) reported engaging in sexual activity with a weekly average of 2.39 times (SD = 1.80), with significant differences favoring males, middle age, married/in a domestic relationship (p &lt, 0.001), employed (p &lt, 0.005), medium–high annual household income, living outside the Iberian Peninsula, and smoking and alcohol consumption. Analyses adjusted for the complete set of control variables showed significant odds for a lower prevalence of weekly sexual activity in women (OR = 0.44, 95% CI 0.27–0.72). Interventions to promote sexual activity in confined Spanish adults may focus on groups with lower sexual activity.

ObjectivesLesbian, gay, bisexual, transgender and intersex (LGBTI) individuals are often subjected to negative attitudes in the workplace, which may lead to non-disclosure of their sexual orientation and/or gender identities. We aimed to determine the prevalence of workplace disclosure of sexual or gender identity (ie, ‘outness’; being ‘out’) and to examine its associations with workplace characteristics in LGBTI workers in Austria.MethodsThis cross-sectional study analysed sociodemographic, work-related and well-being-related data from self-identifying gender and/or sexual minority participants elicited by an online questionnaire between February and June 2017. From the initial 1268 respondents, 1177 (93%) provided complete data and were included in the subsequent analyses.ResultsThe largest proportion of the sample were 26–35 years old (39.1%), cisgender gay men (40.0%) in full-time employment (63.9%). Overall, 51.7% of the sample were ‘out’ at the workplace. Being bisexual (OR=0.46, 95% CI 0.27 to 0.81), the provision of antidiscrimination guidelines in the workplace (OR=0.53, 95% CI 0.32 to 0.90), living alone (OR=0.50, 95% CI 0.32 to 0.79) and in shared households (OR=0.49, 95% CI 0.25 to 0.96) were associated with a decreased likelihood of being ‘out’ at work.Factors associated with being ‘out’ at work were being middle aged (36–45 years old; OR=1.74, 95% CI 1.07 to 2.85), having been in employment for >10 years (OR=2.03, 95% CI 1.08 to 3.81), an LGBTI-friendly work environment (OR 1.61, 95% CI 1.36 to 1.91), labour-management antidiscrimination contract (OR=2.02, 95% CI 1.23 to 3.32) and work council protections (OR=1.56, 95% CI 1.04 to 2.36).ConclusionsInstating antidiscrimination protections might facilitate ‘outness’ of LGBTI workers and lead to a better promotion of diversity in the workplace.

Freely available healthcare, universally accessible to the population of citizens, is a key ideal for European welfare systems. As labor migration of the twentieth century gave way to the globalize ...

Background The last global survey in 2005 of the United Nations estimated that 100 million people were homeless. Cancer is becoming one of the most important public health problems worldwide, but specifically, the prevalence of cancer-related mortality for the homeless population has been reported to be double compared to the average adult population. To date, health research pays insufficient attention to studying cancer and improving the delivery of cancer care for the homeless population. Methods A systematic literature review of relevant databases was employed to identify all the quantitative studies addressing cancer care for the homeless population in English, Spanish, French and Portuguese. A total of 11,740 publications were identified. Results A total of 17 studies were included in this literature review. The majority of the studies were based on the United States (n = 13; 76.5%). Nearly half of the studies targeted the general homeless population (n = 9; 52.9%), and most studies specifically targeted homeless women (n = 6; 35.3%). The majority of studies examined specific types of cancer (n = 13; 76,5%). By type of cancer explored, breast cancer (n = 4; 23.5%) and cervical cancer (n = 4; 23.5%) were the most researched. Screening is the most prevalent topic investigated (n = 14; 82.4%). Studies report unequal access and utilization of cancer screening services as well as advanced stages of cancer when diagnosed. Additionally, longer delays to treatment have been reported. On the other hand, community-based screening strategies have proven to be effective in increasing screening rates. Conclusions Currently, American researchers appear to be leading exponents of cancer research on the homeless population and most of the research is focused on cancer screening. In this regard, community-based screening strategies have proven to be effective in reducing health inequalities for this vulnerable group but less is known when a positive case is diagnosed for this population. Key messages Cancer is a major disease burden worldwide and evidence shows higher mortality rates among the homeless population but unequal access and utilization of cancer screening and treatment services. Community cancer screening programmes for the homeless population should be internationally adopted and specific cancer care pathways meeting their needs after cancer diagnose should be provided.

In the framework of the Mig-HealthCare project, a roadmap to community-based health care was developed including a toolbox and an algorithm. The Mig-HealthCare partners piloted parts of the roadmap in 8 EU countries. Piloting included actions on health promotion issues for migrants/refugees, mental health issues, non-communicable diseases, screening for breast and cervical cancer and vaccination issues. Two recommended practices were also piloted among migrants/refugees namely the 'circle of health' and health mentors while the Greek partner tested the developed algorithm in various health settings. All pilots were evaluated using common and pilot specific indicators for (a) appropriateness: the extent to which the piloted interventions were suitable for the target groups (service providers and/or migrants/refugees) (b) effectiveness: the extent to which the pilots' objectives were achieved, or are expected to be achieved, taking into account their relative importance (c) satisfaction: the extent to which pilots meet or surpass target groups and stakeholders (refugee/migrants, service providers and local population) expectation and needs (d) sustainability: the continuation of benefits from the pilot. Sustainability in the pilot implementation context is the ability of key target groups to sustain pilot benefits. Moreover, the impact of the interventions and their results should be sustainable in time. The impact of the pilots on the study population as well as implications for community-level health services are discussed.

The Mig-HealthCare roadmap & toolbox emphasize an approach that can be implemented at a local community level by local health professionals. The roadmap and toolbox were the main outcome of the project which combines evidence from original research and other information to present concrete steps in the provision of care to migrants and refugees at a community level. The vision of Mig-HealthCare for this roadmap & toolbox is to (1) Help the health professionals working primarily at the community health care level to familiarize themselves with the key areas of importance in refugee/migrant health (2) Provide health professionals with a valuable set of best practices and handy tools to facilitate their work and to increase their efficiency in delivering appropriate care to migrants/refugees (3) Create a network of professionals experienced in refugee/migrant health who through using this roadmap & toolbox will improve their related knowledge and experience. The roadmap & toolbox is a user-friendly online application which focuses on the key steps for optimal health care delivery to migrants & refugees. It comprises: (1) The necessary actions a health professional needs to engage in during delivery of care to migrants & refugees namely issues related to continuity of information and language, culture & communication issues (2) Health issues of particular importance for migrants & refugees that will pose challenges to health care services especially at the community level including Mental Health, Vaccinations, Maternal/ child health, Health promotion, Oral Health/ Dental Care, Non-Communicable Diseases (NCDs) & chronic conditions (3) an algorithm. Both the roadmap and the toolbox are connected to a toolbox comprising tools in various languages for health professionals or migrants/refugees.

Discrimination against migrants in healthcare settings and also the negative impact of this discrimination on their health are well documented. These experiences of discrimination may present a barrier to accessing or seeking appropriate health care. For this reason, the Mig-HealthCare project aimed to study the perceived feeling of discrimination against migrants and explore the perception of community members regarding health-related issues about migrants. In order to answer both questions, based on a mix-methods design, the Mig-Healthcare consortium collected data from 1,286 questionnaires completed by migrants/refugees in 10 EU countries and carried out 6 focus groups and 5 individual interviews in 7 countries. Quantitative results show increased levels of mental health-related symptoms among migrants/refugees as well as dental health problems. The majority of respondents in all countries of the interview, needed more information about their rights and the way to use the health care services, while in Greece migrants showed the biggest need for more information about several health topics. Moreover, qualitative results pointed out the presence of deeply rooted misconceptions towards migrants and refugees that span across different thematic areas: migrants and refugees represent a vector for the transmission of new or eradicated diseases and a burden for the already overstretched welfare system since they often demand preferential pathways to health or social services at the expenses of the local population. Implications for the quality of healthcare services available for migrants/refugees are discussed as well as health issues which are of particular importance to this population. Feelings of discrimination and the extent to which they influence the quality of care received are analysed in combination with health being a basic human right to which need to all people have equal rights.

This MigHealthCare Workshop will be a forum to present and discuss the project's final results with a wide range of health and social care professionals working on the field of migrant/refugee health. The Mig-HealthCare project is a collaboration of 14 partners, among them universities, national authorities and NGOs from 10 countries across Europe (Greece, France, Malta, Germany, Austria, Italy, Cyprus, Spain, Sweden and Bulgaria). The major aim of the project is to reduce health inequalities and improve the integration of vulnerable migrants and refugees into local communities in Europe. The project is co-funded by the III Health Programme of the European Commission from 2017-2020. The Mig-HealthCare project addresses the need for structural changes in the health systems to respond to the unmet needs of vulnerable migrants and refugees in Europe and promotes community-based care. Community-based health care has proven to be effective in reducing health inequalities in health, as well as improving accessibility to appropriate care. For this purpose, the consortium has produced an evidence-based Roadmap and Toolbox to reorient health care services to a community level which is a user-friendly online application focusing on the key steps for optimal health care delivery to migrants and refugees. In this regard and as part of these operative tools, within the Mig-HealthCare project, effective community-based care interventions focused on health promotion or prevention were designed and piloted in 8 different contexts and countries. As main results of the MigHealthCare project, the Roadmap and Toolbox comprise both the necessary factors that health policy and practice need to deliver culturally competent care as well as the particular health issues especially faced by migrants and refugees in order to better prepare public health response. Key messages Community-based care for vulnerable migrants and refugees has proven to be effective in reducing health inequalities. Evidence on the drivers of the success or failure of health promotion strategies for migrants and refugees should be considered when planning interventions.

Non-Communicable Diseases (NCDs) are prevalent in the migrant population with increased years of residency in the host country. In this regard, health education and lifestyle interventions have proven to be cost-effective modifying risk factors. The Spanish pilot of the Mig-HealthCare project directly aims to reduce the prevalence of NCDs reducing the well-known “healthy migrant effect” by increasing the levels of health literacy and also turning the lifestyles of the participants into healthier habits in the host country. The Mig-HealthCare pilot in Spain is a one-month group-based Health Education and Lifestyle Intervention to prevent the incidence of non-communicable diseases in Migrant and refugee populations addressing their Acculturation Process (HELP-MAP). Consequently, the pilot intervention addressing 4 topics: health literacy, physical activity, dietary patterns and strategies for coping with stress. The implementation of the pilot will be carried out in two different community services (i) one NGO providing care and accommodation for asylum seekers and (ii) three social care units within primary health care centres. Furthermore, following the Mig-Healthcare study protocol evaluation will focus on acculturation strategies, level of health literacy, physical exercise, change in diet, use of health care access and Quality-Adjusted life-years (QALY)

Introduction Health and social care services across Europe are facing diverse challenges meeting the specific needs of migrants and refugees [1]. In this regard, vulnerable migrants fall outside mental healthcare services [2]. Based on this, Mig-Healthcare project, funded by the European Commission, explores the health needs of the migrant population in an effort to strengthen EU community-based services. Methods A total of 20 focus groups and 19 individual interviews were conducted between November 2017 and April 2018 with different stakeholders involved in the provision of health and social care to the migrant population in the 10 countries (Greece, France, Malta, Germany, Austria, Italy, Cyprus, Spain, Sweden and Bulgaria). Results First of all, the results highlight that the reception models in the host country such as closed camps were reported as a negative factor for health, especially mental health. Consequently, the restriction of movement, live in ex-barracks, in a status of uncertainty and social deprivation augments the mental vulnerability of immigrants and refugees. In this regard, the feeling of isolation was acted as an important factor influencing the prevalence of mental health problems, and these problems were related to an aggravation of the integration process. Finally, informants reported that the cultural conception of mental health determinates the help-seeking behaviour of migrants and refugees, being one of the main barriers accessing adequate mental health services. Discussion Mental health is regarded as a health priority by all the informants. However, health and social care services in Europe are ill-suited to delivery health care for migrants and refugees, in especially mental health care. As a result of this, most vulnerable migrants and refugees are excluded from these services. Conclusion Mig-Healthcare results highlight the need for tailored mental health care delivery for the migrant population with the aim of achieving increasing their accessibility to these services as well as their psychosocial well-being. Furthermore, policies should take into consideration the impact of the migration reception policies as part of the continuum of care. Lessons learned Migration and integration policies may impact on the mental health of the migrant population and a shift in care models to meet their specific needs may improve mental health outcomes and integration of migrant and refugee population in local European societies. Limitations Differences between national systems in the participant countries appeared. Another limitation is the lack of representability but the large scale of the study gives a big picture of different realities of the European reception of the migrant population, its impact on their mental health as well as their need for better access to mental health services. Bibliography [1] Puchner, K., Karamagioli, E., Pilouli, A., Tsiamis, C., Kalogeropoulos, A., Kakalou, E. et al. Time to Rethink Refugee and Migrant Health in Europe: Moving from Emergency Response to Integrated and Individualized Health Care Provision for Migrants and Refugees. International Journal of Environ. Res. Public Health. 2018, 15(6):1100. [2] Lindert, J., Schouler-Ocak, M., Priebe, S. Mental Health, health care utilisation of migrants in Europe. European Psiquatry. 2008, 23(Suppl. 1): 14-20.

Migrant children are especially vulnerable to the challenges experienced during the migratory process and its integration in the host country, even more, if they are unaccompanied. Child-centred Health Systems responses are needed, for that reason, the Erasmsus+ project EUVETCARE aims to strengthen the capacity of the professionals and systems to meet the specific needs of this population. A qualitative study allowed a needs assessment of the health and social care professionals in 5 EU countries (Cyprus, Germany, Greece, Italy and Spain). A total of 15 focus groups were carried out (99 participants). Focus groups discussions were transcribed verbatim in local languages and transcripts were analyzed using thematic analysis. Moreover, a literature review informed about the current learning opportunities for professionals in the European context regarding migrant children. Focus groups discussions highlighted some general needs for all professionals such as communicative skills with migrant children and their families as well as cultural competence to deal with these cases. Moreover, participants stressed the need to deal with this population with low levels of health literacy too. Finally, strategies to provide integrated care and meet the major needs of these children were needed. Unaccompanied minors were highlighted as a vulnerable group by participants. In addition, the literature review revealed some gaps in the learning guidelines offer across Europe. Future training for professionals should stress the specific gaps in order to don't replicate existing materials. Furthermore, professionals' voices should be taken into account in the design of these new training to directly answer to their professional needs. Additionally, the needs of migrant children have to be differentiated and appropriated culturally-competent care delivered in order to minimize health inequalities for this group. Key messages Training of healthcare professionals should target culturally-competent case management strategies for minor migrants. The delivery of health care for minor migrants requires major intensity from the health care services.

Introduction Childhood care by its nature requires the integration of nurturing and protective services [1]. Furthermore, a lack of appropriate resources tackling the specific needs of migrants and refugees has put pressure on health care services [2]. In this regard, the European project EUVETCARE qualitatively explores how to strengthen care delivery for child migrants and refugees. Methods Between April and May of 2019, a total of 99 professionals involved in the health and social care delivery for migrant minors as well as policy-makers participated in fifteen focus groups were carried out in 5 EU countries (Greece, Italy, Spain, Cyprus and Germany). FGDs were transcribed verbatim in local languages and transcriptions were analyzed using thematic analysis. Results Different gaps in knowledge were reported in the following topics: 1) Awareness and Knowledge of the political, social and health situation by origin country. 2) Cultural competence and social skills, to maximise the sensitivity of health care providers in the service of care to culturally diverse groups. 3) Legal, social, and medical services pertaining to migrants/refugee and how to facilitate the interconnectedness with them. Discussion Provision of health care to children is a right in EU regardless of any condition. However, the findings highlighted that this right may be not guaranteed in terms of quality and equality. Training of healthcare professionals doesn’t lead with psychosocial aspects of migration forgetting the cultural aspects of the minors and their families. Finally, the delivery of health care for minor migrants and refugees requires major intensity from the healthcare services. In this regard, there is a lack of procedures on how to involve other agencies, services and professionals to effectively manage cases of minor migrants and refugees. Conclusion Findings suggest that future training for healthcare professionals should guarantee both a holistic understanding of the health of these minors as well as better coordination of professionals and services with an interdisciplinary approach. Consequently, the training of healthcare professionals should target culturally-competent case management strategies for minor migrants and refugees. Lessons learned Future training for healthcare professionals will aim to develop culturally competent services achieving improved experiences of minor migrants and refugees by interdisciplinary and coordinated care. Limitations The sample of this study is not representative, which does not permit the extrapolation of results, nevertheless, this study allows to capture commonalities in 5 different European health care systems. Bibliography [1] Eastwood, J. Integrating Care for Children, Young People and Their Families. Int J Integr Care, 2018, 18(2): 20. [2] Puchner, K., Karamagioli, E., Pilouli, A., Tsiamis, C., Kalogeropoulos, A., Kakalou, E. et al. Time to Rethink Refugee and Migrant Health in Europe: Moving from Emergency Response to Integrated and Individualized Health Care Provision for Migrants and Refugees. International Journal of Environ. Res. Public Health. 2018, 15(6):1100.

In response to the coronavirus disease 2019 (Covid-19) world pandemic, affected countries such as Spain enacted measures comprising compulsory confinement as well as restrictions regarding free movement. Such measures likely influence children's and adolescents' lifestyles. Our study aimed to investigate the impact that the Covid-19 confinement has on health-related behaviors (HRBs) among Spanish children and adolescents. An online survey was administered to 516 parents to collect data about 860 children and adolescents (49.2% girls) aged between 3 and 16 years in relation to physical activity, screen exposure, sleep time, and fruit and vegetable consumption during the Covid-19 confinement. Respectively, t-paired test and t-test between groups served to check differences between HRBs levels before and during the confinement as well as between strict and relaxed confinement. Significant differences were found for a reduction of weekly minutes of physical activity during the confinement (−102.5, SD 159.6) (p < 0.001), an increase of daily hours of screen exposure (2.9, SD 2.1) (p < 0.001), and a reduction of daily fruit and vegetable consumption (−0.2, SD 1.6) (p < 0.001). Sleep time showed a significant difference between strict and relaxed confinement (−0.3, SD 0.1) (p < 0.05), whereas binomial logistic regression adjusted for covariates (age, sex, education of the parents, siblings, current condition, exposure to Covid-19, and previous health risk behavior) showed significantly lower odds for screen exposure risk behavior with relaxed confinement (OR 0.60, 95%CI 0.40–0.91). The present study suggests that Covid-19 confinement reduced physical activity levels, increased both screen exposure and sleep time, and reduced fruit and vegetable consumption. Therefore, most HRBs worsened among this sample of Spanish children and adolescents. Closure of schools, online education, and the lack of policies addressing the conciliation between labor and family life could have played an important role in HRBs worsening among pupils, which might be mitigated with adequate conciliation policies, parental guidance, and community support.

Mig-healthCare has identified sources in the countries and languages of the consortium providing guidance for community-based healthcare for migrants and refugees. A total of 54 sources that refer to best practices in seven European countries were identified. Results were categorized along with the themes: organization, communication, training, education and facilities & services. Successful organizational measures were a close collaboration with different governmental authorities, NGOs, community organizations and various local service providers. Moreover, engagement with members from both the host community and the migrant/refugee community in the design and implementation phases is essential. The need to track all activities through data collection and periodic evaluations is important in order to evaluate the effectiveness of systems. Funding was mentioned as important to secure continuity of projects and systems. Bridging communication barriers is a major facilitator to reduce health disparities. Differences in the types of practices and challenges per country were noted. Translators and cultural mediators are a key element in successful implementation, but across EU there is a need for more specialized staff to face the cultural barriers of the large variation in refugee/migrant backgrounds. The empowerment of migrants/refugees in promoting well-being through the engagement of the host community to help reduce stigma and discrimination is a successful strategy facilitating the access to care due to the increase of their health literacy skills. Finally, tailored services to give an answer to the specific needs of migrants and refugees are important, for example at first reception centres, standard medical screening and psychosocial risk assessment was recommended. Through this analysis, we can distinguish community-based care models elements facilitating the access of migrants and refugees to healthcare.

The Mig-HealthCare systematically searched to identify the key health areas of refugee/migrant health in order to facilitate interventions that help access to care services for migrants and refugees. The literature review was carried out in March 2018 using 3 large scientific databases using a combination of search terms following the PRISMA methodology and a standard set of items used to report on systematic reviews. Based on the predefined inclusion and exclusion criteria, a total of 118 publications were used for data extraction. It is important to note, that in almost all of the sources identified, the following cross-cutting factors were described as influencing access to healthcare: Continuity of Information, how it relates to policy, how it differs between health services and across-borders. Furthermore, the organizational coordination among social and health care providers in the host country determinates the successful access to healthcare of migrants/refugees.Language & Communication takes into consideration both the healthcare service and its provision of translators and cultural mediators, and the host country language proficiency of the migrant/refugee.Organizational improvement of access and delivery of health care services for migrants and refugees in addition to Cultural Competence of the healthcare providers meaning the ability to maximize their sensitivity in the service of care to culturally diverse groups.Health literacy understood as the motivation and competences of the migrant population to access, understand, appraise, and apply health information. Additionally, the health issues of particular importance for migrants/refugees as emerged from the systematic review, including mental health, maternal/child health, health promotion, NCDs and chronic diseases, Oral/|Dental health, and Vaccinations should be included in planning future needs and healthcare access.

Based on the multiple levels of research conducted within the project the consortium developed a roadmap & toolbox which includes the following categories: Continuity of information, Language Culture & Communication, Mental Health, Vaccinations, Maternal/child health, Health promotion, Oral health/Dental Care and NCDs while the Toolbox contains tools on these categories in different languages. The roadmap & toolbox is accessible through the project website. In addition, different scenarios, giving a comprehensive picture of the foreseen situation and the evidence-based policies and actions needed to maximize the effective delivery and sensitivity in the service of care to culturally diverse population groups were developed focusing on mental health, chronic disease management and oral health. Refugees and migrants tend to have a higher prevalence of mental distress compared to non-refugees. For the challenge of lack of recording mental health of migrants/refugees, improving the collaboration between ‘migrant-specific’ organizations is needed. Health care systems in Europe will have to accommodate the high demand for health care services for chronic conditions among migrants/refugees in the coming years. Implications such as the impact of poverty, level of health literacy and/or the cultural adaption of the measures need to be considered when planning to address future trends related to non-communicable diseases including diabetes among migrants/refugees. The provision of oral care presents great variability across the European countries, but in most cases, it is characterized by high cost and restricted range of services if offered within the state health systems. Migrants /refugees will not be able to meet the high cost of private dental care. Local community interventions have been proven very effective.

Background Health and care services are becoming increasingly strained and healthcare authorities worldwide are investing in integrated care in the hope of delivering higher-quality services while containing costs. The cost-effectiveness of integrated care, however, remains unclear. This systematic review and meta-analysis aims to appraise current economic evaluations of integrated care and assesses the impact on outcomes and costs. Methods CINAHL, DARE, EMBASE, Medline/PubMed, NHS EED, OECD Library, Scopus, Web of Science, and WHOLIS databases from inception to 31 December 2019 were searched to identify studies assessing the cost-effectiveness of integrated care. Study quality was assessed using an adapted CHEERS checklist and used as weight in a random-effects meta-analysis to estimate mean cost and mean outcomes of integrated care. Results Selected studies achieved a relatively low average quality score of 65.0% (± 18.7%). Overall meta-analyses from 34 studies showed a significant decrease in costs (0.94; CI 0.90–0.99) and a statistically significant improvement in outcomes (1.06; CI 1.05–1.08) associated with integrated care compared to the control. There is substantial heterogeneity in both costs and outcomes across subgroups. Results were significant in studies lasting over 12 months (12 studies), with both a decrease in cost (0.87; CI 0.80–0.94) and improvement in outcomes (1.15; 95% CI 1.11–1.18) for integrated care interventions; whereas, these associations were not significant in studies with follow-up less than a year. Conclusion Our findings suggest that integrated care is likely to reduce cost and improve outcome. However, existing evidence varies largely and is of moderate quality. Future economic evaluation should target methodological issues to aid policy decisions with more robust evidence on the cost-effectiveness of integrated care.

In Spain, shelters are the main public resource to provide housing to homeless people. The shelters provide housing to two target groups: local people who have been in an exclusion process that led them to homelessness, and an immigrant population consisting of mostly newcomers to the country and have no place to stay. In this regard, homelessness has been associated with poor health, morbidity and earlier mortality, but there is a lack of studies conducted comparing local and immigrant homeless populations. The “healthy immigrant effect” explains that immigrants arriving in the host country are, on average, healthier than comparable natives and that the length of time since immigration reduces this advantage. In this regard, the evidence shows that homeless newcomers are generally healthier than homeless locals and may have different service needs. This study aims to examine the relationship between immigrant status and the health status of homeless people in Valencia (Spain). Recruitment took place from August to September 2018 (ongoing). The sample consists of 80 homeless individuals recruited at shelters. Chi-square analyses were performed to examine the relationship between immigrant status and health status (assessed by whether they have no, one or more than one chronic conditions). The preliminary results show a relationship between immigration status and the number of chronic conditions they report. Specifically, the occurrence of comorbid conditions (more than one chronic condition) was more prevalent in the local homeless population compared to the immigrant homeless population. Although the impact of homelessness on health has been studied previously, the results of this study highlight the importance of continuing to evaluate the specific needs of the different homeless populations. In this regard, the results also support the “healthy immigrant effect”; comorbid health conditions were more prevalent in the local homeless population compared to the recent immigrant homeless population. These findings also may have implications for services organisation, highlighting the need to develop health and social care programmes tailored to newcomers, in order to avoid further risk factors associated with homelessness and its future deterioration in health.

The worldwide prevalence of insufficient physical activity (PA) and prolonged sedentary behavior (SB) were high before the coronavirus (COVID-19) pandemic. Measures that were taken by governments (such as home confinement) to control the spread of COVID-19 may have affected levels of PA and SB. This cross-sectional study among South American adults during the first months of COVID-19 aims to (i) compare sitting time (ST), screen exposure, moderate PA (MPA), vigorous PA (VPA), and moderate-to-vigorous PA (MVPA) before and during lockdown to sociodemographic correlates and (ii) to assess the impact of lockdown on combinations of groups reporting meeting/not-meeting PA recommendations and engaging/not-engaging excessive ST (≥7 h/day). Bivariate associations, effect sizes, and multivariable linear regressions were used. Adults from Argentina (n = 575) and Chile (n = 730) completed an online survey with questions regarding demographics, lifestyle factors, and chronic diseases. Mean reductions of 42.7 and 22.0 min./day were shown in MPA and VPA, respectively, while increases of 212.4 and 164.3 min./day were observed in screen and ST, respectively. Those who met PA recommendations and spent &lt, 7 h/day of ST experienced greatest changes, reporting greater than 3 h/day higher ST and more than 1.5 h/day lower MVPA. Findings from the present study suggest that efforts to promote PA to South American adults during and after COVID-19 restrictions are needed.

In Spain, immigration flows and diversity are one of the most important social phenomena in the 21st century, representing great challenges for public administrations and societies. In this regard, one of the issues that concerns most is how to reduce inequalities between nationals and immigrants, in particular in terms of access and utilization of medical care services. According to WHO, social determinants of health refer to the “different conditions in which people are born, grow, work, live, and age” and “these circumstances are shaped by the distribution of money, power and resources at global, national and local levels”. Moreover, social determinants of health help to explain health inequalities among individuals, groups/communities and nations. Health disparities between immigrant population and locals are a result of numerous factors, such as lower economic status, worse working conditions, or a poorer access to care. When one or more members of a socially established group are being treated differently pejoratively because of his/her/their belonging to that group is defined as discrimination, being a determinant of health and health inequalities. The immigrant population is especially vulnerable to discrimination. Scientific evidence associates experiences of discrimination with worse self-perceived health, physical health, mental health problems, a higher prevalence of chronic diseases and substance use. This research aimed i at studying the experience of discrimination in the health care system among immigrants; and ii at examining how discrimination affects immigrants’ health status, by analysing the relationship between perceived discrimination, and self-related health status among immigrant groups’. A cross-sectional survey was conducted in a non-randomized sample of 100 immigrants. The health outcomes were measured by self-perceived health-related indicators and the reported discrimination was assessed by means of a set of questions asking immigrants about their discrimination experiences in the past five years. The preliminary results of this study show that over 60% of the participants have experienced a situation in which they felt discriminated. Men reported more discrimination due to their immigrant condition. Immigrants reporting discrimination also reported a significantly poorest health status than those not reporting discrimination. Moreover, mental health problems are related to discrimination due to immigrant status. The results of this research show that immigrant population’s perceived discrimination is related to worse perceived health status and mental health problems. Discrimination is a risk factor in immigrant population and could explain some health inequalities between immigrants and nationals. This study helps to characterize the correlation of discrimination and health in an immigrant group. The reinforcement of healthcare systems towards immigrants has to be the first step to reduce migration-related inequities in health and to ensure the effective application of human rights.

Introduction: Life expectancy has increased globally from 64 to 71 years. For many elderly people, hospitalization is followed by a fast decline of capacities and great mental challenges1. This progressive decline of the oldest age groups after hospitalization has triggered an increase in the prevalence of specific health and social conditions. Among these conditions, loneliness and cognitive impairment have been revealed among the most important causing dependency and re-hospitalization in elders2. In order to effectively address these issues, identifying frail elderly patients after hospitalization, and providing them with home-based care to fulfil their needs, may help to reduce readmissions at hospital facilities, and, thus, contribute to the sustainability of care systems as ultimate goal. Methodology – Intervention description: The intervention presented follows a holistic approach to hospital-at-home care, including the care of medical, social and psychological needs for elders. The intervention programme presented in this study targets older people aged 75 and above, who have been admitted at the hospital through the emergency department, and it starts after discharge from hospital to hospital-at-home. The programme is designed based on evidence, and is aimed to: 1 reduce loneliness and increase social participation; and 2 slow down the progressive cognitive impairment. As part of the intervention, the following care pathways are designed in order to complement the medical treatment and achieve the proposed aims: A motivational-based care pathway developed by social workers. This care pathway is intended to motivate the patient to take part in the community, based on patient’s personal likes, being the ultimate goal to reduce loneliness. The planned structure for this care pathway is a monthly face-to-face interview and telephone follow-up, in which the patient and the social worker check the accomplishment of a set of objectives and measures they have agreed-upon. A cognitive impairment care pathway guided by psychologists. This care pathway is based on attention and memory training for those patients suffering from mild cognitive impartment. The training is delivered using a workbook including a set of exercises to train cognitive strategies. The planned structure for this care pathway is performed by a psychologist by means of a face-to-face interview and two telephone interviews per month. Conclusion: The proposed intervention programme follows a population-oriented approach focus on each patient needs. The two care pathways on which this programme is based on provide a complementary intervention to medical care, ensuring that psychological and social aspects are also covered as a part of holistic healthcare delivery. This intervention offers an innovative care strategy of integrated care for those patients receiving hospital-at-home care. References: 1- Hengartner MP, Klauser M, Heim G, Passalacqua S, Andreae A, Rossler W, et al. Introduction of a Psychosocial Post-Discharge Intervention Program Aimed at Reducing Psychiatric Rehospitalization Rates and at Improving Mental Health and Functioning. Perspect Psychiatr Care. 2017 Jan 1;531:10–5. 2- Boaz TL, Becker MA, Andel R, McCutchan N. Rehospitalization risk factors for psychiatric treatment among elderly Medicaid beneficiaries following hospitalization for a physical health condition. Aging & Mental Health. 2017 Mar 4;213:297–303.

The Mig-HealthCare consortium conducted a qualitative study of the health care needs of vulnerable migrants/refugees in Europe. The research was conducted between Fall 2017 and Spring 2018. In total, 20 focus group discussions or, where necessary individual interviews (19), were organised with health care professionals and service providers; policymakers; and representatives from Non-Governmental Organisations - NGOs. Thematic qualitative analysis was employed. The main results of the analysis show that: Health care provision for migrants is uneven throughout the EU and variations exist even within the same country. Health care providers and NGOs agree that health care for migrants is inadequate and biased in favour of particular conditions and cases (minors, pregnant women and acute conditions). Challenges faced by different countries vary; while in some countries the main issue is legal access, in other basic needs such as sanitation and basic infrastructure were emphasised. Austerity measures following the 2008 financial crisis have negatively affected the health care system in general, which in turn has negatively affected the provision of health care for migrants/refugees. Discrimination linked to socio-economic and ethnic conditions is reported as a barrier to equal health care access. Knowledge, language and communication on both the demand and the supply side of health care provision emerge as crucial to ensure equal access for migrants/refugees. Gender may act as a barrier with women tending to be more marginalised in the host country, in terms of language proficiency and health literacy, lowering health care access. One of the main challenges for providing equal health care access for migrants has to do with the ability to balance a universal right to health with the particular means of achieving it. The evidence collected here shows how this tension between end and means is at work in different moments of the provision of health care for migrants/refugees.

This study discusses the main findings of the quantitative research conducted within the Mig-HealthCare consortium countries to explore the physical and mental health of migrants and refugees. The study population is defined as migrants/refugees who have been residing in Europe, for at least 6 months and up to 5 years. In order to be able to capture the recent migration flow, the analysis was based on 1169 questionnaires collected in 10 EU-Member States, answered by adult migrants residing less than 5 years in the specific country. A total of 29% of migrants stated that their health is poor or fair. Overall, 56.9% of migrants needed health care services during the last 6 months, however approximately one in four did not have access to them. The most frequent problems were long waiting times, not being able to organize an appointment, not knowing where to go, lack of communication and long distances. The most frequent chronic health problem migrants/refugees face is caries and headaches/migraines, followed by psychological disease and sleep disorders. Approximately one in three women have been pregnant since entering the current EU country, whereas one in four have had a miscarriage or abortion and 21.5% are currently pregnant. Summing up, most of the migrants face common medical problems such as bad teeth, headaches and psychological problems. However long waiting times, not knowing where to go and lack of communication are barriers to accessing healthcare. The fact that the immunization status of migrants/refugees is unclear, a significant number suffer from serious chronic diseases and the limited breast and cervical cancer screening of female migrants/refugees pose serious threats to their health and important challenges for the health services of Europe.

In this study, we collect and synthesize information on the health status of the refugee/migrant population in ten European countries in order to map refugee/migrant health needs. With this information, we identify areas of intervention and healthcare system strengthening to provide the basis for future health planning and effective healthcare provision to migrants, asylum-seekers and refugees in the European Union (EU). Methods: 1407 migrants in ten European Union countries (consortium members of the Mig-HealthCare project) were surveyed on general health, mental health, and specific diseases using an interviewer-administered questionnaire. Descriptive statistics and multivariable linear regression analyses were conducted to investigate the risk factors on general quality of life for migrants and refugees in the EU. Results: Mean age was 31.9 (&plusmn, 11.05) years and 889 (63.1%) participants were males. The majority came from Syria, Afghanistan, Iraq, Nigeria, and Iran. Having a mental health disorder or a chronic disease such as a heart or respiratory disease was associated with worse general health. On the other hand, having permission to stay in the country of interview and being interviewed in the country of final destination was associated with better general health. Access to health care services was fragmented or unavailable for some interviewees because of linguistic, cultural, or administrative barriers. Conclusions: The management of chronic diseases and mental health conditions in European migrants and refugees is a key priority for health service provision. Further efforts should be made to guarantee healthcare access for migrant and refugee populations.