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Aim: There is limited knowledge on the prevalence, risk factors, and coping strategies of food insecurity among women refugees. The aim of this study was to determine the prevalence, severity, and risk factors of food insecurity among Syrian women refugees living in Türkiye (Turkey) and to evaluate the various coping strategies they use to manage food insecurity., Methods: This descriptive cross-sectional study was conducted with 251 Syrian women refugees aged 18-64 years living in Türkiye. Data were collected by native Arabic-speaking researchers through online and face-to-face surveys. Sociodemographic data, anthropometric measurements, food insecurity status, and coping strategies were analyzed. 'Food Insecurity Experience Scale (FIES)' was used to determine the food insecurity status., Results: It was found that 28% of the women who participated in the study had food security, 35% had mild, 24% had moderate, and 13% had severe food insecurity. In the group with food insecurity, age, number of children in the family, and average body mass index (BMI) were higher, while education and income level were lower (p < 0,05). For each 1-unit increase in BMI, there was a 0.122 increase in the total FIES score. A 1-unit increase in the number of children was associated with a 0.333 increase in the total FIES score. The most preferred strategies to cope with food insecurity were found to be purchasing less preferred and cheaper foods, and reducing portion sizes., Conclusion: It was found that food insecurity is common among Syrian women refugees living in Türkiye. Women who are older, have more children, lower income, lower education, and higher BMI are more likely to experience food insecurity. Studies with larger samples and longer follow-up periods are needed to investigate the causes and effects of food insecurity among women refugees., Competing Interests: Declarations Ethics approval and consent to participate The study procedures were carried out following the ethical standards of the institutional research committee and the Helsinki Declaration. Ethics committee approval was obtained from the Social and Human Sciences Ethics Committee of Tokat Gaziosmanpaşa University (Number: 01–65).Not applicable. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Adequate maternity care and appropriate clinical interventions during labour and delivery can reduce adverse perinatal outcomes, but unnecessary interventions may cause harm. While studies have shown that refugees and asylum seekers face important barriers when accessing maternity care, there is a lack of high-quality quantitative data on perinatal health interventions, such as induction of labour or caesarean sections, among refugees and asylum seekers and the findings reported in the literature tend to be inconsistent. Our goal was to examine and synthesise the evidence regarding the rates of intrapartum clinical interventions in women who are refugees and asylum seekers in high-income countries compared to other population groups., Methods: We conducted a scoping review of peer-reviewed studies published in English since 2011 that report original quantitative findings regarding intrapartum clinical interventions among refugees and asylum seekers in high-income countries compared to those in non refugee, non asylum seeker populations. We examined reported rates of clinical pain relief, labour induction and augmentation, episiotomies, instrumental deliveries, and caesarean sections., Results: Twenty-five papers were included in the review. Findings indicate that refugees and asylum seekers were less likely to receive pain relief, with 16 out of 20 data points showing unadjusted ORs ranging from 0.20 (CI: 0.10-0.60) to 0.96 (CI: 0.70-1.32). Similarly, findings indicate lower odds of instrumental delivery among refugees and asylum seekers with 14 of 21 data points showing unadjusted ORs between 0.25 (CI: 0.15-0.39) and 0.78 (CI: 0.47-1.30); the remaining papers report no statistically significant difference between groups. There was no discernable trend in rates of labour induction and episiotomies across studies., Conclusions: The studies included in this review suggest that asylum seekers and refugees are less likely to receive clinical pain relief and experience instrumental delivery than non-refugee groups in high-income countries. This review strengthens our understanding of the links between immigration status and maternity care, ultimately informing policy and practice to improve perinatal health and the provision of care for all., Competing Interests: Declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: More than 35 000 refugees from Ukraine applied for temporary collective protection in Norway during 2022. Previous studies have shown that the refugees have poor health in several domains, and crude reports have suggested that those fleeing Ukraine at later stages have even poorer health. However, more systematic knowledge is lacking. This study aimed to analyse trends in self-reported health in a sample of adult refugees from Ukraine, by month of arrival to Norway during 2022., Methods: Data were collected via an online, digital questionnaire, in a cross-sectional study design between 28.10.22-31.01.23. Recruitment was via multiple physical and social media contact points, including asylum reception centres, municipalities, non-profit organisations, and Facebook groups for refugees in Norway. The survey included the following self-reported health outcomes: overall health, oral health, presence of long-term illnesses or disabilities, and a short version of the Hopkins Symptom Checklist (HSCL-5)., Results: Among the 727 respondents, 82% were female, 65% were aged 30-49 years, 69% had higher education and 53% were responsible for children in Norway. There were 383 respondents who arrived between February-April (T1), 200 between May-August (T2) and 144 between September-December (T3). Compared to T1, respondents who arrived in the two later time periods were more often male, had younger age distributions, and were less likely to have completed higher education. The proportions of respondents reporting poor/very poor overall health, presence of long-term illnesses and long-term disabilities were highest in T3. Oral health and HSCL-5 showed the opposite trend, with lower proportions reporting poorer health among respondents in both later periods. Respondents in T3 were still more likely to report poor/very poor health and long-term illnesses after adjusting for sex, age group and education (adjusted odds ratio, aOR: 2.71 [95%CI 1.51-4.89]) and 1.74 [1.14-2.65], respectively)., Conclusions: Respondents who arrived later in 2022 generally reported poorer long-term health, but less psychological distress than those who arrived earlier in the year. These findings may help inform the planning of health services for refugees from Ukraine, especially in areas receiving large numbers of refugees., Competing Interests: Declarations Ethics approval and consent to participate The Regional Committee for Medical and Health Research Ethics (South-East Norway) reviewed the project and deemed it to fall outside of the scope of the Health Research Act, and therefore the need for ethics approval was deemed unnecessary according to national regulations (Reference number 491497). The project was approved by NIPH’s Data Protection Officer after reviewing the project’s data protection impact assessment (DPIA). All participants were required to give informed consent before accessing the questionnaire. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: The burden of displacement makes child refugees, asylum seekers, and migrant children less resistant to medical problems. On February 6, 2023, the southeast and the southcentral regions of Türkiye were struck by two sequential large earthquakes. The study aimed to analyze the characteristics of musculoskeletal injuries and the initial orthopedic surgery data resulting from the earthquake and compare the differences between Turkish and displaced children, particularly those who underwent major musculoskeletal interventions at the four state hospitals of the Adana metropolitan region., Methods: The retrospective study analyzed the medical records of the survivors admitted to the four general hospitals run by the government in the Adana, Türkiye metropolitan area between February 06, 2023, and February 13, 2023, the first seven days following the earthquake. The analysis data included age, gender, nationality, time of admission, types and localization of injuries, and treatment methods., Results: The number of cases under 18 years of age requiring orthopedic intervention was 969. The distribution of the cases based on nationality was as follows: there were 517 Turkish (53.35%), 371 Syrian (32.71%), and 81 children of unknown nationality (CUN) (8.36%). The files show that the patients requiring surgery, including fasciotomy, fracture surgery, and amputation (n = 281), were mainly treated at the level I trauma center (n = 171, 60.85%). In terms of the daily distribution of admissions based on the type of musculoskeletal injuries, the admissions of children with foot fractures in the first days were significantly increased (p = 0.0134). Regarding surgery rates, the fracture surgery and fasciotomy rates were significantly higher in cases admitted earlier. (p < 0.0001 and p = 0.0009, respectively). In terms of nationality, there were no significant differences regarding the date of admission, the number of cases who underwent amputations, and the discharge number and types., Conclusion: The study revealed that after the severe earthquake disaster, the state hospitals of the Adana metropolitan region provided unbiased healthcare for all the region's children. Regarding orthopedic care, the response was given accordingly in this particular disaster, highlighting that level I trauma centers should always be ready for such intensity due to the short preparation time in case of a severe disaster., Competing Interests: Declarations Ethics approval and consent to participate The ethical approval of the study was given by the Clinical Research Ethics Committee of the Adana City Training and Research Hospital on December 7, 2023, with decision no: 2980. Written informed consent is not applicable. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Objective: The study aims to evaluate anxiety and depression levels and access to mental health services among internally displaced persons (IDPs) in Mogadishu, Somalia., Design: A community-based, cross-sectional survey was carried out in IDP camps. Face-to-face interviews were conducted using a modified Hospital Anxiety and Depression Scale. Data were analysed using SPSS V.25.0, incorporating univariate and logistic regression analyses., Setting: The study was conducted in 10 IDP camps located in the districts of Daynile and Kahda in the Banadir region of Somalia between November and December 2023., Participants: The study included 522 randomly sampled individuals aged 18-70 years living in the selected IDP camps., Results: The study revealed high prevalence rates of anxiety (43.7%) and depression (35.8%) among IDPs in the selected districts. Of those with anxiety, 54% were categorised as borderline cases and 46% as severe cases. Similarly for depression, 72.7% were classified as borderline cases and 27.3% as severe cases. Significant associations were found between anxiety symptoms and variables such as camp residence (OR: 3.872, 95% CI 2.333 to 6.424), female gender (OR: 2.387, 95% CI 1.604 to 3.552), young age (OR: 6.319, 95% CI 4.309 to 9.267), marriage contract (OR: 4.569, 95% CI 2.850 to 7.325), lack of education (OR: 1.92, 95% CI 1.349 to 2.737) and past experiences of trauma (OR: 5.207, 95% CI 3.274 to 8.281). Depressive symptoms were significantly associated with younger age (OR: 1.536, 95% CI 1.069 to 2.208), lack of formal education (OR: 1.661, 95% CI 1.153 to 2.395) and history of trauma (OR: 3.695, 95% CI 2.529 to 5.400). Additionally, the study highlighted a grave shortage of mental health and psychosocial support (MHPSS) services. User evaluations of MHPSS services varied, indicating room for improvement., Conclusion: The study revealed elevated levels of anxiety and depression among IDPs in the districts of Kahda and Daynile in the Banadir region of Somalia, underscored by a critical shortage of MHPSS services, emphasising the need for tailored mental health interventions., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aims: Humanitarian migrants are at increased risk of post-traumatic stress disorder (PTSD) and elevated psychological distress. However, men and women often report varying degrees of stress and experience different challenges during migration. While studies have explored PTSD, psychological distress, gender, and resettlement stressors, they have not explored the interplay between these factors. This study aims to address that gap by investigating gender disparities in PTSD and psychological distress among humanitarian migrants in Australia, with a focus on the moderating role of socioeconomic factors., Methods: This study used data from five waves of the Building a New Life in Australia (BNLA) survey, a longitudinal study of 2,399 humanitarian migrants who arrived in Australia in 2013. PTSD and psychological distress were measured using the PTSD-8 and Kessler-6 (K6) scales, respectively. We conducted generalised linear mixed-effect logistic regression analyses stratified by gender., Results: Female humanitarian migrants exhibited a significantly higher prevalence of PTSD and psychological distress than males over five years of resettlement in Australia. Women facing financial hardship, unemployment, or residing in short-term housing reported greater levels of PTSD and distress compared to men., Conclusions: Women facing financial hardship, inadequate housing, and unemployment exhibit higher rates of PTSD and psychological distress, underscoring the significant impact of socioeconomic factors. Addressing these challenges at both individual and systemic levels is essential for promoting well-being and managing mental health among female humanitarian migrants.

Aims: Forcibly displaced people, such as refugees and asylum-seekers (RAS), are at higher risk of mental disorders, mainly post-traumatic stress disorder (PTSD), depression and anxiety. Little is known about the complex relationships between these mental disorders among culturally and linguistically diverse RAS. To investigate this, the present study applied a novel network analytical approach to examine and compare the central and bridge symptoms within and between PTSD, depression and anxiety among Afghan and Syrian RAS in Türkiye., Methods: A large-scale online survey study with 785 Afghan and 798 Syrian RAS in Türkiye was conducted in 2021. Symptoms of PTSD (the short form of Post-Traumatic Stress Disorders Checklist [PCL-5]), depression and anxiety (Hopkins Symptoms Checklist-25) [HSCL-25]) were measured via self-administrated validated instruments. We conducted network analysis to identify symptoms that are most strongly connected with other symptoms (central symptoms) and those that connect the symptoms of different disorders (bridge symptoms) in R Studio using the qgraph package., Results: Overall, Afghans and Syrians differed in terms of network structure, but not in network strength. Results showed that feeling blue, feeling restless and spells of terror or panic were the most central symptoms maintaining the overall symptom structure of common mental disorders among Afghan participants. For Syrian participants, worrying too much, feeling blue and feeling tense were identified as the central symptoms. For both samples, anger and irritability and feeling low in energy acted as a bridge connecting the symptoms of PTSD, depression and anxiety., Conclusion: The current findings provide insights into the interconnectedness within and between the symptoms of common mental disorders and highlight the key symptoms that can be potential targets for psychological interventions for RAS. Addressing these symptoms may aid in tailoring existing evidence-based interventions and enhance their effectiveness. This contributes to reducing the overall mental health burden and improving well-being in this population.

Objective: To examine the association between neighborhood socioeconomic disadvantage and birth outcomes among refugee women in Denmark, leveraging a natural experiment., Methods: This register-based study included 15 118 infants born to women who arrived in Denmark as refugees during 1986 to 1998, when a dispersal policy was in place that quasirandomly assigned newcomers to neighborhoods with varying degrees of socioeconomic disadvantage. Neighborhood disadvantage was measured using a composite index representing neighborhood-level income, education, unemployment, and welfare assistance. These data were linked to individual-level birth register data. Outcomes included low birth weight, preterm birth, and small-for-gestational-age infants. Associations between neighborhood disadvantage at resettlement and birth outcomes up to 20 years after resettlement were examined using multivariable regressions adjusting for characteristics of the women at resettlement., Results: Each SD of increase in neighborhood disadvantage was associated with an 18% increase in low birth weight risk (0.61 percentage points [pp], 95% confidence interval [CI]: 0.19-1.02), 15% increase in preterm birth risk (0.64 pp, 95% CI: 0.22-1.07), and 7% increase in small-for-gestational-age risk (0.78 pp, 95% CI: 0.01-1.54) 5 years after resettlement. Results did not differ after adjusting for urbanicity and conational density, but associations were attenuated after adjusting for municipality-level fixed effects, suggesting that local government characteristics may partially explain the associations., Conclusions: Resettling in a disadvantaged neighborhood is associated with higher risk of adverse birth outcomes among refugee women. This highlights how policy decisions affecting settlement of refugees can have long-term consequences, including on the health of the next generation., (Copyright © 2024 by the American Academy of Pediatrics.)

Background: Epidemic forms of hepatitis E cause high mortality among pregnant people, with case fatality risks over 30% and adverse fetal outcomes. In 2022, the first mass reactive vaccination campaign against hepatitis E was conducted in South Sudan with the HEV239 vaccine. We aimed to assess whether vaccination against hepatitis E in pregnancy increases the risk of fetal loss in a cohort of vaccinated and unvaccinated pregnant people., Methods: In this emulated target trial, an exhaustive pregnancy census was conducted in Bentiu internally displaced persons camp after the second of three vaccination rounds. Women and girls aged 14-45 years with no current jaundice or acute illness were eligible for participation. Individuals who consented were revisited 28 days after their delivery date to document the pregnancy outcome. We used an emulated target trial framework to address biases inherent in observational studies. We matched vaccinated to unvaccinated participants on age, gestational age, and vaccination propensity score and estimated cumulative incidence functions for fetal loss in vaccinated compared to unvaccinated women in a competing risks framework using the Aalen-Johansen estimator., Findings: Between May 16 and June 30, 2022, 3421 participants were enrolled and followed up for inclusion in analysis. Among 2741 women who had a pregnancy outcome after the start of the vaccination campaign, 67 (2·4%) were vaccinated before conception, 2036 (74·3%) were vaccinated during pregnancy, and 638 (23·2%) were not vaccinated. Among the 2407 women retained in the matched analyses, the cumulative risk of fetal loss among individuals vaccinated during pregnancy was 7·2% (95% CI 5·6-8·7) compared with 6·1% (3·7-9·2) among unvaccinated individuals, implying a risk ratio of 1·2 (95% CI 0·7-1·9)., Interpretation: No evidence of increased risk of fetal loss was found among individuals vaccinated during pregnancy., Funding: Médecins Sans Frontières., Competing Interests: Declaration of interests Médecins Sans Frontières provided support in the form of salaries for ASA, VKA, PGi, PN, JD, MH, PGa, NS, MA, MR, and IC and indirectly provided salary support for Epicentre employees RCN and EG. All other authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background: Gaza has long been subjected to food insecurity; however, little was known about the influence of food insecurity on the nutritional wellbeing of schoolchildren. To fill this gap, the UN Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), which provides humanitarian relief to Palestine refugees, assessed the nutritional status, diet, and food security of refugee children about to enter first grade (aged 4-10 years, mean age 72·1 months) in mid-2023 during a required health examination., Methods: As part of an annual School Entrance Health Examinations that began in May, a cross-sectional food security and nutritional assessment was added from July 8, to Sept 7, 2023, during which children being examined at six study-designated UNRWA clinics across Gaza were systematically sampled (in a 1:4 ratio) and parental or guardian consent sought for their participation. Household food security was assessed by a seven-point Arab Family food Security Scale score, and respondents were asked about family receipt of food assistance. The 1-week meal patterns of the children were probed, and intake frequencies of 49 foods in the past month categorised into ten nutritious food groups to assess diet diversity. The weight, height, and haemoglobin concentrations (assessed with a photometric analyser) of the children were measured. The UNRWA Research Review Board approved all study procedures., Findings: Approximately 34 000 children underwent the annual School Entrance Health Examination in Gaza in May, 2023 and approximately 16 000 children were estimated to have completed the additional food security and nutritional assessments from July 8, to early Sept 7, 2023, of whom 3814 were systematically sampled at six UNRWA clinics across Gaza, with 3229 (84·7%) parents or guardians consenting for their children to participate. 3155 were interviewed about household food security with a seven-point Arab Family Food Security Score, and 3212 were asked about food assistance receipt. 2694 (83·9%) of 3212 households were on food assistance, 787 (24·9%) of 3155 were classified as food secure (0-2 points), 1025 (32·5%) were classified as moderately (3-5 points) food insecure, and 1343 (42·6%) as severely food insecure (6-7 points). 219 (28·5%) of 768 children reported missing breakfast and 213 (28·4%) of 750 reported missing dinner in the food-secure group, 438 (47·2%) of 928 reported missing breakfast and 426 (45·6%) of 934 reported missing dinner in the moderately food-insecure group, and 956 (75·5%) of 1267 reported missing breakfast and 951 (74·8%) of 1272 reported missing dinner in the severely food-insecure group. Lunch was missed daily by 30 (3·8%) of 786 children in the food-secure group, 54 (5·3%) of 1023 in the moderately food-insecure group, and 193 (14·5%) of 1334 in the severely food-insecure group. Diets were poor in dairy items, meat, poultry, fish, pulses, eggs, and vitamin A-rich vegetables and fruit, and 2225 (68·9%) of 3229 children did not consume a minimally diverse diet every day (≥5 nutritious food groups). 72 (2·5%) of 2913 children had stunting and 129 (4·4%) of 2913 had wasting (less than -2 Z scores), and 963 (29·8%) of 3229 had anaemia (haemoglobin <11·5 g/dL). Boys and girls were similar in their diets, anthropometric Z scores, and prevalence of anaemia., Interpretation: Gazan families with children about to enter first grade were food insecure and reliant on food assistance, possibly protecting the anthropometric status of the children, whose diets however lacked diversity., Funding: Japan Ministry of Foreign Affairs and the Vitamin Angels Alliance, USA., Translation: For the Arabic translation of the abstract see Supplementary Materials section., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Despite an increased focus on the impact of post-migratory factors on the health of trauma-affected refugees, research on the influence of residence permit is limited. This influence may manifest on the outcome of psychiatric treatment. Accordingly, the aim of this study was to examine the role of temporary residence permit on symptom severity and treatment outcome among trauma-affected refugees in PTSD treatment. The sample consisted of 897 patients, who were allocated into three groups based on their residence permit: temporary residence permit, permanent residence permit, and Danish citizenship. The outcome measures were symptoms of PTSD (Harvard Trauma Questionnaire), depression and anxiety (Hopkins Symptom Checklist-25 and Hamilton Depression and Anxiety Rating Scales), quality of life (WHO-5 Well-being Index), and functioning (The Sheehan Disability Scale), evaluated before and after psychiatric treatment. Temporary residents tended to have less severe symptoms prior to treatment. Overall, no significant differences were observed between the three groups on treatment outcome. However, Danish citizens had a poorer treatment outcome on Hamilton Depression Scale compared with temporary residents. This study is one of the first to investigate treatment implications of residence permit in a clinical setting. The interactions between mental health and individual post-migratory factors are complex. Further research is still needed to understand how residence status affects mental health and treatment outcomes for refugees., Competing Interests: Declaration of competing interest Declarations of interest: none., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Refugees encounter multiple psychosocial stressors post-resettlement which increases their risk of developing a mental illness. Loneliness and social isolation are commonly reported in the refugee population and have been demonstrated to be associated with multiple physical and mental health comorbidities in the general population. However, no study to date has systematically reviewed how loneliness and social isolation may affect refugees who have resettled in high-income countries. This systematic review aims to study the prevalence, risk factors, consequences, and interventions for loneliness and social isolation among refugees who have resettled in high-income countries. Systematic searches on five electronic databases yielded 2950 papers, of which 69 were deemed eligible following a double-blinded review by title and abstract then later by full text. From the included studies, it was found that the reported range of prevalence rates of loneliness (15.9-47.7%) and social isolation (9.8-61.2%) were higher than population norms. Risk factors associated with loneliness and social isolation included family separation, acculturative stress, being female or a parent and a current diagnosis of a mental illness. Loneliness and social isolation were found to be associated with depression, post-traumatic stress disorder (PTSD), psychological distress as well as physical health problems. Only three interventions addressing loneliness and social isolation were identified which demonstrates the importance of integrating social support in refugee psycho-social support programs. In summary, loneliness and social isolation were reported by a large proportion of refugees who have resettled in high-income countries. Whilst certain risk factors were pre-migratory and static, most were post-migratory in nature and were found to adversely affect mental and physical health. Thus, interventions focused on reducing loneliness and social isolation that are guided by the needs of refugee communities are urgently required., Competing Interests: Declaration of competing interest None declared., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Abstract: Migrants have accounted for more than 40% of new HIV diagnoses in Europe in 2022. Among the population of asylum seekers currently present in the Trento Province, screening for HIV infection is poorly carried out for various reasons. Here we report our experience about screening for HIV infection in asylum seekers present in that area using rapid self HIV-testing.

Purpose: International studies show conflicting evidence regarding the perinatal outcome of immigrant women with and without refugee status compared to non-immigrant women. There are few studies about the situation in Germany. The research question of this article is: Is the perinatal outcome (Apgar, UApH (umbilical artery pH), NICU (neontatal intensive care unit) transfer, c-section rate, preterm birth, macrosomia, maternal anemia, higher degree perinatal tear, episiotomy, epidural anesthesia) associated with socio-demographic/clinical characteristics (migration status, language skills, household income, maternal education, parity, age, body mass index (BMI))?, Methods: In the Pregnancy and Obstetric Care for Refugees (PROREF)-study (subproject of the research group PH-LENS), funded by the German Research Foundation (DFG), women giving birth in three centers of tertiary care in Berlin were interviewed with the modified Migrant Friendly Maternity Care Questionnaire between June 2020 and April 2022. The interview data was linked to the hospital charts. Data analysis was descriptive and logistic regression analysis was performed to find associations between perinatal outcomes and migration data., Results: During the research period 3420 women (247 with self-defined (sd) refugee status, 1356 immigrant women and 1817 non-immigrant women) were included. Immigrant women had a higher c-section rate (36.6% vs. 33.2% among non-immigrant women and 31.6% among women with sd refugee status, p = 0.0485). The migration status did not have an influence on the umbilical artery pH, the preterm delivery rate and the transfer of the neonate to the intensive care unit. Women with self-defined refugee status had a higher risk for anemia (31.9% vs. 26.3% immigrant women and 23.4% non-immigrant women, p = 0.0049) and were less often offered an epidural anesthesia for pain control during vaginal delivery (42.5% vs. 54% immigrant women and 52% non-immigrant women, p = 0.0091). In the multivariate analysis maternal education was explaining more than migration status., Conclusion: Generally, the quality of care for immigrant and non-immigrant women in Berlin seems high. The reasons for higher rate of delivery via c-section among immigrant women remain unclear. Regardless of their migration status women with low degree of education seem at increased risk for anemia., (© 2024. The Author(s).)

Objectives: The present study aimed to observe how body composition differs between severe acute malnutrition (SAM) (treated with ready-to-use therapeutic food, RUTF) and well-nourished children., Methods: A longitudinal investigation was conducted among well-nourished and SAM children of 6-59 months in Rohingya refugee camps. These two groups (350 children in each group) of children were observed over 12 weeks and individual data were collected during admission, follow-up visits, and at the time of discharge. Anthropometric information was collected following standard procedures. The thicknesses of the biceps, triceps, subscapular, and supra iliac skinfolds were measured using a Herpenden-type skinfold caliper. Separate linear mixed models were conducted to assess associations of the independent variables (i.e., group and time) with each of the dependent variables (i.e., biceps, triceps, subscapular, supra-iliac skinfold thickness (ST), fat mass (FM), and fat-free mass (FFM))., Results: Both in well-nourished and SAM children, the mean biceps, triceps, subscapular, and supra-iliac ST, FM, and FFM increased over the 12 weeks. The increase in biceps ST was significantly faster in the SAM children compared to the well-nourished children (difference in slope = 0.366 mm every four weeks; p  < 0.001). The increment rate in triceps ST was also faster in the SAM children compared to the well-nourished children (difference in slope = 0.430 mm every four weeks; p  < 0.001). Moreover, the pace of increase in subscapular (difference in slope = 0.027 mm every four weeks; p  < 0.001), and supra-iliac (difference in slope = 0.211 mm every four weeks, p  < 0.001) ST was also significantly higher in the SAM group. Similarly, the change in FM (difference in slope = 0.065 kg every four weeks, p  < 0.001) and FFM (difference in slope = 0.152 kg every four weeks, p  = 0.023) was also significantly faster in SAM children compared to the well-nourished children over the treatment period. Furthermore, the girls gained significantly higher triceps ST, subscapular ST, FM, and FFM compared to the boys., Conclusion: The benefit of RUTF was evident from this longitudinal study in the recovery of FM and FFM contents among the SAM children of Rohingya refugee camps., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Manir and Huq.)

Background: Globally, teenage pregnancy is a public health problem. Low- and middle-income countries in the Sub-Saharan region are more affected with teenage pregnancy. It is worse with teenage girls who have other vulnerabilities like living in refugee camps. However, there is little information about teenage pregnancy in refugee camps especially in resource limited areas like Northern Uganda., Objective: To determine the prevalence and the factors associated with teenage pregnancy among refugees in Palabek refugee settlement, Northern Uganda., Methods: This was a cross-sectional study conducted among teenage girls in Palabek refugee settlement in Northern Uganda. The study estimated a total sample size of 316 teenage girls and they were sampled using systematic random sampling. Data was collected using researcher administered questionnaire. Conditional logistics regression was employed to identify the associated factors for teenage pregnancy., Results: A total of 306 teenagers participated in the study with a response rate of 98.6%. The study showed that the prevalence of teenage pregnancy among teenage girls in Palabek refugee settlement, Northern Uganda was 41.2%. The factors associated with teenage pregnancy among teenage girls in Palabek refugee settlement included: being in the 15-19 years age group (AOR = 6.3, 95%CI: 1.8-22.8), not being in school (AOR = 5, 95%CI: 2.3-10.9), not being married (AOR = 0.2, 95%CI: 0.1-0.5), delayed sexual debut (AOR = 2.4, 95%CI: 1.1-5.5), having multiple sexual partners (AOR = 0.3, 95% CI: 0.1-0.7), alcohol use (AOR = 6.7, 95%CI: 2.2-18.4), being aware of sexual reproductive health services (AOR = 0.4, 95%CI: 0.2-0.9), and having divorced families (AOR = 2.4, 95% CI: 1.2-4.9)., Conclusion: Study results reveal that 4 in 10 teenage girls in Palabek, Northern Uganda, are pregnant, influenced by individual, community, and health system factors. This highlights vulnerabilities in refugee camps, urging prioritization of sexual and reproductive health for adolescent girls in refugee camps., (© 2024. The Author(s).)

Introduction: Resettled refugees have been exposed to stressful and life-threatening events preresettlement and are among the most marginalized and vulnerable groups in society. Postresettlement, they face challenges when assimilating to an unfamiliar host country, which renders them vulnerable to adverse health outcomes including obesity, a major public health burden. This study was conducted to examine the association of mental health and sociodemographic factors, including language proficiency and educational attainment, with obesity in first-generation resettled refugees., Methods: We used data from electronic health records from the Adult Ambulatory Medicine Clinic of the State University of New York Upstate, Syracuse, NY. The probability of being overweight and obese (class I and class II) relative to normal weight was estimated using fully adjusted multinomial logistic regression models with relative risk ratios (RRRs)., Findings: Relative to male refugees, female refugees were more likely to have class I obesity (RRR=1.83; 95% confidence interval [CI]=1.19, 2.80) and class II obesity (RRR=4.07; 95% CI=2.41, 6.87). Limited English proficiency increased the risk of being overweight (RRR=2.02; 95% CI=1.29, 3.17) and having class II obesity (RRR=2.14, 95% CI=1.20, 3.81). A clinical mental health diagnosis increased the risk of class I (RRR=2.00; 95% CI=1.35, 2.96) and class II (RRR=1.76; 95% CI=1.15, 2.71) obesity. Having no formal education was associated with decreased risk of class II obesity (RRR=0.42; 95% CI=0.19, 0.90)., Discussion: Obesity prevalence and subsequent related morbidity continue to be major public health burdens in vulnerable, often underserved populations in the United States. Further investigation into social determinants of obesity in refugees in a community setting that captures the unique experiences of heterogenous refugee groups outside the clinical setting is warranted., Competing Interests: Conflict of Interest: No conflict of interest reported by authors.

Background: The influx of Ukrainian refugees to Lithuania due to the ongoing conflict has created substantial challenges in healthcare and social services., Objective: To identify the key challenges faced by Ukrainian refugees in accessing healthcare and social services in Lithuania., Methods: A qualitative study was conducted using semi-structured interviews with 22 Russian-speaking female Ukrainian refugees residing in various regions of Lithuania. Data were collected between July and October 2022 and analyzed using inductive qualitative content analysis to identify key themes related to healthcare access, social services, and integration., Findings: Refugees reported significant barriers, including language difficulties, long waiting times for healthcare services, and inconsistent access to social services, particularly in smaller municipalities. Despite access to free healthcare, the quality and timeliness of services were often inadequate, exacerbating challenges for those with pre-existing health conditions. Psychological support services were underutilized, and language barriers impeded access to both healthcare and employment opportunities. Coordination between social and healthcare services was lacking, creating further difficulties for refugees in navigating essential services., Conclusion: While Lithuanian authorities have provided critical support, significant gaps remain in healthcare access and social service coordination. Urgent improvements are needed in language support, psychological care, and healthcare accessibility, particularly in smaller municipalities. These findings highlight the need for targeted policies to address these challenges and ensure equitable access to services for all refugees. Future research should include more diverse refugee populations to guide comprehensive policy development., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Urbanavičė, El Arab, Hendrixson, Austys, Jakavonytė-Akstinienė, Skvarčevskaja and Istomina.)

Objective: Internally displaced persons (IDPs) can have limited access to HIV and hepatitis C Virus (HCV) treatment and prevention. IDPs comprise > 7% of Georgian population but prevalence and levels of HIV and HCV knowledge in this population remain unknown. We tested 100 IDPs in Georgia for HIV and HCV, many of whom had drug injecting experience, and interviewed them about their migration experience, sexual and drug injecting practices, and HIV/HCV transmission knowledge., Results: The average age of participants was 37.5 years (range 18-63); 31% were women. Almost half (N = 48) of participants reported ever injecting drugs; 17% of those (N = 8) started injecting drugs within the last year. Anti-HCV and HIV prevalence was 11% and 0%, respectively. Fewer people without drug use experience compared to people who inject drugs correctly answered all questions on the HIV knowledge test (13% vs. 35%, p = 0.015) or knew where to get tested for HIV (67% vs 98%, p < 0.001). There was no difference in HCV knowledge between the two groups. HIV and HCV prevalence remains low among Georgian IDPs, but levels of HIV knowledge were much lower than levels of HCV knowledge., (© 2024. The Author(s).)

Background: Gender-based violence is a serious public health concern and affects a large number of women and girls in humanitarian emergencies. Despite this, there is a dearth of the summary data to address the issue. Therefore, this study aimed to assess the estimated pooled magnitude and factors associated with gender-based violence among refugees and internally displaced women in Africa., Methods: PubMed/MEDLINE, Google Scholar, African Journals OnLine, PsycINFO, and EMBASE were among the databases that were used to search the primary articles. The reviewed papers were articles that evaluated the prevalence and contributing variables of gender-based violence against refugees and internally displaced women in Africa. We extracted the data using a Microsoft Excel spreadsheet, which we exported into Stata version 14 for further analysis. The I 2 test was applied to identify statistical heterogeneity. We used a random effect meta-analysis methodology because of the heterogeneity. A funnel plot and Egger's weighted regression test were used to examine publication bias., Results: This systematic review and meta-analysis reviewed 17 primary studies with a total of 6,161 refugees and internally displaced women in Africa. The findings of this study revealed that the estimated pooled prevalence of gender-based violence among refugees and internally displaced women was determined to be 48.20% (95% CI: 39.28, 57.12). Young age (AOR = 3.68, CI: 2.63, 5.14), alcohol consumption (AOR = 2.53, CI: 1.56, 4.11), and having no social protection (AOR = 3.21, CI: 2.22, 4.63) were factors significantly associated with gender-based violence., Conclusions and Recommendations: The present study showed that almost half of refugees and internally displaced women residing in Africa were survivors of gender-based violence. Younger women, alcohol users, and those without social protection were more likely to experience gender-based violence. Therefore, it is recommended that accessible information about the consequences of gender-based violence and early intervention for survivors be provided, taking these factors into consideration., (© 2024. The Author(s).)

Background: The global increase in forcibly displaced populations highlights the importance of understanding their health needs. Chronic pain is prevalent among refugees, poses significant personal and public health challenges, and complicates their integration into new home countries. Understanding refugees' pain post-migration and how it is being managed is crucial for ensuring adequate and timely interventions and fostering health equity. This paper explores the associations between pain levels and the use of painkillers, healthcare services, and long-term impairment among Syrian refugees with chronic pain, one year after their resettlement in Norway., Methods: This cross-sectional study is based on survey data collected from 353 quota refugees in 2018-19, one year after resettlement in Norway. The primary outcomes were the use of painkillers, the use of healthcare services, and long-term impairment, according to reported chronic pain levels. Associations between these outcomes and chronic pain levels were studied using Poisson regression, adjusted by sociodemographic variables and trauma experience., Results: Of the 353 adults included, 52% were women, and the median age was 36 years. A total of 5% reported very mild/mild, 10% moderate, and 12% strong/very strong chronic pain over the last four weeks. Significant associations were found between all chronic pain levels and use of non-prescription painkillers (adjusted relative risks (aRR) (95% CI)); mild (3.1 (2.0-4.7)), moderate (1.8 (1.1-2.8)), strong (1.7 (1.1-2.6)), and prescription painkillers; mild (4.6 (2.2-9.5)), moderate (5.6 (3.2-10.0)), strong (6.7 (3.9-11.3)), compared to those without chronic pain. Use of emergency rooms, specialist care, and hospitalization were significantly associated with strong chronic pain, with aRR (95% CI) of 2.0 (1.2-3.5), 3.9 (2.1-7.0) and 2.4 (1.3-4.4), respectively. Long-term impairment was strongly associated with chronic pain across all pain levels; mild (8.6 (5.6-13.49)), moderate (6.7 (4.3-10.5)) and strong (6.6 (4.3-10.4))., Conclusion: Despite their young age, more than a quarter of the Syrian refugees in our study reported chronic pain one year after resettlement in Norway. High levels of pain were related to the use of medication, healthcare services, and long-term impairment. Understanding the dynamics of pain among refugees is crucial to ensure adequate and timely management., (© 2024. The Author(s).)

Background: The Syrian civil war is considered as the greatest humanitarian crisis in modern history, which has resulted in a major refugee crisis. A significant concern is the high prevalence of mental disorders such as depression, anxiety, and post-traumatic stress disorder (PTSD) among Syrian refugees. While the focus of most refugee mental health research has been pre-migration trauma, post-migration challenges and stressors, which can also be significant determinants of mental health, are often ignored. The purpose of this study was to assess mental health of Syrian refugees as compared to local Jordanians, and to examine sociodemographic factors and perceived stressors that are associated with mental distress among participants., Methods: This was a cross sectional study conducted in northern region of Jordan among Syrian refugee and Jordanian adults. We used the validated Arabic version of Afghan Symptoms Checklist (ASC) to assess mental distress among participants., Results: A total of 929 subjects (43% Syrian refugees, 56% females) participated in this study. Disparities in education, monthly income, and health insurance were significant between Syrian refugees and Jordanians, p  < 0.001. The mean score in ASC was significantly higher among Syrian refugees, particularly among refugee females (mean ASC score ± standard deviation: Syrian refugee females: 58.22 ± 1.13; Syrian refugee males: 45.31 ± 1.28; Jordanian females: 51.06 ± 0.91; Jordanian males: 46.45 ± 1.08, p  = 0.002). Multivariable linear regression showed that the estimated difference in the mean of ASC score between males and females is 7.42 ( p < 0.001), and the estimated mean difference between Syrian refugees and Jordanians is 2.76 ( p = 0.019). Interestingly, the estimated mean of ASC scores for individuals with high education level is decreased by 4.18 as compared to individuals with lower education level (high school or less), p < 0.001., Conclusion: Education level was highly predictable of mental distress of Syrian refugees, particularly female refugees. Enhancing higher educational opportunities is proposed for improving socioeconomic status of refugees which might serve as a buffering strategy for mental distress among this vulnerable population., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Atrooz, Khabour, Almomani, Aljararwah, Alfurjani and Salim.)

Background: On October 7th, 2023, Hamas launched a surprise attack on Israel, triggering a conflict with Israel in the Gaza Strip. This ongoing war, now six months old, has also seen threats from Hezbollah in Lebanon, as well as from Yemen and Iran. The precarious security situation along Israel's southern and northern borders led to extensive evacuations, with residents relocating within Israel under uncertain conditions concerning their return and property safety. This study compares resilience (societal, SR; community, CR; and individual, IR), hope, morale, distress symptoms (anxiety and depression symptoms), and perceived danger between general Hebrew-speaking adults and evacuee adults a few months post-conflict initiation., Methods: Data was collected using structured self-reported questionnaires focusing on resilience and coping strategies, administered through two online panel companies. The general population data was collected from January 14-21, 2024 (N = 1,360), and the evacuees' data from March 1-9, 2024 (N = 372; 133 from the north, 239 from the south)., Results: Evacuees reported lower SR and CR, hope, and morale, and higher distress symptoms and perceived danger compared to the general population. No differences in IR were found. Regression analyses identified different primary predictors of SR for each group: hope for the general population and governmental support for evacuees. Additionally, IR significantly predicted outcomes only among evacuees, whereas age, religiosity, and education were significant predictors solely in the general population. One notable similarity emerged: CR served as the second most influential predictor in both samples., Conclusions: The entire population of Israel is affected by the ongoing war, yet evacuees endure a disproportionately severe impact, with potential for increased harm as the conflict persists. The adjustment to a new wartime emergency routine is more complex for evacuees than for the general population. It is crucial for policy and decision-makers to address the distinct differences between evacuees and the general populace to effectively meet their specific needs. Yet, it should be acknowledged that the evacuees represent a heterogenic group, necessitating a detailed subdivision into subgroups to accurately assess and address their unique challenges., (© 2024. The Author(s).)

Purpose: Syrian refugees (SRs) have had difficulties in the diagnosis, treatment, and follow-up of chronic diseases, such as cancer, because of the conflict in the region. The cancer diagnosis and treatment process of SR are also a matter of curiosity. We aimed to compare the demographic characteristics and survival outcome data of SRs and Turkish citizens (TCs), and colorectal cancer (CRC) is one of the most common cancer types seen with similar frequency globally., Materials and Methods: A total of 421 patients with CRC were included. Overall survival (OS) was estimated using the Kaplan-Meier method, and the log-rank test was used for comparison. Patient demographic data were compared using the Pearson Chi-square test and independent t test., Results: In total, 421 patients (282 TCs and 139 SRs) were included in this study. The mean age was 52.9 ± 14.3 years for the entire population: 55.3 ± 14.1 years for TCs and 47.9 ± 13.4 years for SRs. Forty (29%) SRs and 60 (21.4%) TCs had de novo metastatic disease ( P = .08). The median OS in the general population was 57.9 months (95% CI, 40.1 to 75.7), whereas it was 80.9 months (95% CI, 56.5 to 97.2) in TCs and 42.2 months in SRs (95% CI, 27.0 to 57.4; P = .006). In the nonmetastatic group, the median OS did not reach (NR) in TCs, and it was 52.6 months (95% CI, 43.7 to 61.5) in SRs ( P = .02). In the metastatic group, the median OS was 21 months (95% CI, 8.5 to 29.2) in TCs, and it was 18.9 months in SRs (95% CI, 16.3 to 25.7; P = .93)., Conclusion: The survival rate was lower in the SR group. Since CRC is also common among refugees, developing and implementing methods to improve the welfare of vulnerable populations is necessary.

The experiences of war and refugee status can alter intrafamily dynamics, with implications for family formation, including marriage. We use the nationally representative Syrian Migrant Sample of the 2018 Turkey Demographic Health Survey (TDHS-S) to conduct a duration analysis of marriage outcomes among Syrian refugees in Turkey, tracking women throughout their residence in prewar Syria (before the conflict began in 2011), postwar Syria (after the conflict began but before arrival in Turkey), and Turkey. We find that early marriage was more prominent among refugees who were unmarried at the time of migration than among those married before migration; the mean marriage age dropped from 19.6 in prewar Syria to 19.1 in postwar Syria and 18.1 in Turkey. Using the TDHS-S and prewar Syrian surveys, we show that this finding aligns with the observed declines in household income and young women's opportunity cost of marriage. Our duration analysis also reveals a notable shift from traditional arranged marriages to more modern marriage forms among refugees in Turkey. An intergenerational power shift might drive the shift toward nonarranged marriages. After arrival in Turkey, wealth and employment of parents decline among refugees. In contrast, Syrian youth in Turkey have higher age-adjusted employment rates than in prewar Syria. Moreover, nonarranged marriages increase more among demographic groups with stronger intergenerational power shifts than among groups with weaker shifts., (Copyright © 2024 The Authors.)

Introduction: The Syrian refugee crisis has led to significant population displacement, with many seeking refuge and asylum in Nordic countries. While these countries offer safety and stability, the resettlement process combined with the refugees' own traumatic experiences can exacerbate existing or precipitate new mental health issues., Aim: This systematic review aims to comprehensively analyse the literature on mental health problems among Syrian refugees resettled in Nordic countries, exploring their prevalence and associated factors., Methods: A comprehensive literature search was conducted following PRISMA guidelines, utilizing databases including Web of Science, PubMed, MEDLINE, and Cochrane. The included studies focused on adult Syrian refugees or asylum seekers aged 18 and above, residing within Nordic countries, and investigated various mental health problems between March 2011 and January 2024, conducted in various Nordic countries., Results: Studies revealed high prevalence rates of PTSD (26%-45%), depression (40%-45%), and anxiety (30%-32%). Factors contributing to mental health problems included pre- and post-migration trauma, perceived discrimination, and socio-demographic variables. Pre-migration trauma exposure, such as witnessing violent events, was linked to trauma centrality and emotional suppression. Post-migration stressors like discrimination and financial strain, along with socio-demographic factors like gender and age, were associated with mental health issues. Specifically, female and older refugees reported higher levels of anxiety, depression, and low future expectations., Conclusion: The findings underscore the urgent need for comprehensive mental health assessment and services for Syrian refugees in Nordic countries. Addressing trauma, discrimination, and socio-economic challenges is crucial for improving their well-being and facilitating successful integration into host countries.

Shocks effects are under-theorised in the growing literature on health system resilience. Existing work has focused on the effects of single shocks on discrete elements within the health system, typically at national level. Using qualitative system dynamics, we explored how effects of multiple shocks interacted across system levels and combined with existing vulnerabilities to produce effects on essential health services delivery, through the prism of a case study on childhood vaccination in Lebanon. Lebanon has experienced a series of shocks in recent years, including large-scale refugee arrivals from neighbouring Syria, the COVID-19 pandemic and a political-economic crisis. We developed a causal loop diagram (CLD) to explore the effects of each shock individually, and in combination. The CLD was developed and validated using qualitative data from interviews with 38 stakeholders working in Lebanon's vaccination delivery system, in roles ranging from national level policy to facility-level service delivery, conducted between February 2020 and January 2022. We found that each of the shocks had different effects on service demand- and supply-side dynamics. These effects cascaded from national through to local levels. Both Syrian refugee movement and the COVID-19 pandemic primarily exposed vulnerabilities in service demand, mainly through slowly emerging knock-on effects on vaccination uptake behaviour among host communities, and fear of contracting infection in crowded health facilities respectively. The economic crisis exposed wider system vulnerabilities, including demand for vaccination as household income collapsed, and supply-side effects such as reduced clinic time for vaccination, declining workforce retention, and reduced availability of viable vaccine doses, among others. Finally, important pathways of interaction between shocks were identified, particularly affecting the balance between demand for vaccination through publicly supported facilities and private clinics. Future research should incorporate dynamic approaches to identifying within-system vulnerabilities and their potential impacts under different scenarios, as a precursor to improved resilience measurement, system preparedness, and intervention targeting., Competing Interests: Declaration of competing interest None reported., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The study aimed to assess household and child dietary diversity in Southern Somalia by identifying determinants of adequate dietary diversity in three internally displaced person (IDP) camps in Baidoa, Dayniile and Dharkanley. A total of 1655 female main caregivers with 2370 children (6-59 months old) were included. Data on household dietary diversity score and child dietary diversity score indicators were collected from all households. The questionnaire was read face-to-face to the female main caregivers. Multivariate logistic regression analysis was performed to identify factors associated with adequate dietary diversity, which was defined as the consumption of at least four food groups within 24 h before the survey. The proportion of households achieving adequate HDDS was high in all locations 95.8%, 96.9% and 89.0% in Baidoa, Dharkanley and Dayniile, respectively, and the total adequate household dietary diversity score (AHDDS) was 95.6%. The proportion of adequate child dietary diversity score (ACDDS) was achieved in 63.5%, 8.5% and 38.3%. The main factors associated with AHDDS were larger household size, greater wealth, attendance of antenatal care (ANC) and joint decision-making between husband and wife, while factors associated with ACDDS included ANC attendance, age, the consumption of ready-to-use therapeutic food and deworming tablets. These findings can guide future programmes and policies aimed at improving maternal and child nutrition in IDP camps in Somalia. By tackling these diverse factors, a promising pathway emerges to enhance the nutritional welfare of both households and children in IDP camps., (© 2024 The Author(s). Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

An estimated 7.7 million Venezuelans have fled a severe humanitarian crisis in their country, most (70%) to other middle-income host countries in the same Andean region. Migration-related exposures during periconception and other critical gestational periods can adversely impact maternal-perinatal outcomes. Emerging evidence suggests that Venezuelan refugee and migrant women (VRMW) who migrate to Andean host countries are at-risk for delivering preterm and low birthweight infants and for Cesarean-sections. However, relatively few studies have examined obstetrical complications that could contribute to these or other short- and longer-term health outcomes of VRMW and/or their offspring. Our exploratory study analyzed four recent years of national hospital discharge data (2018-2021) from Ecuador to compare the primary discharge diagnoses of VRMW (n = 29,005) and Ecuadorian nationals (n = 1,136,796) for ICD-10 O code obstetrical complications related to or aggravated by pregnancy, childbirth, or the puerperium. Our findings indicated that VRMW were hospitalized for 0.5 days longer than Ecuadorian reference group women and they had higher adjusted odds (aOR) for a primary discharge diagnosis for obstetrical complications including preeclampsia (aOR:1.62, 95% CI:1.55,1.69), preterm labor (aOR:1.20, 95% CI:1.11,1.31), premature rupture of membranes (aOR: 1.72, 95% CI:1.63,1.83), oligohydraminos (aOR:1.24, 95% CI:1.12,1.36), obstructed labor (aOR: 1.39, 95% CI:1.31,1.47), perineal lacerations/other obstetric trauma (aOR:1.76, 95% CI:1.63, 1.91), STIs (aOR:2.59, 95% CI:1.29,2.92), anemia (aOR:1.33, 95% CI:1.24,1.42), and ectopic pregnancy (aOR:1.16 95% CI:1.04,1.28). They had similar aOR for diagnosed gestational diabetes and spontaneous abortion (SAB) compared to the reference group but a reduced aOR for genitourinary infections (aOR:0.79, 95% CI:0.74,0.84) and early pregnancy hemorrhage not ending in SAB (aOR:0.43, 95% CI:0.36,0.51). Our findings underscore the vulnerability of VRMW for a number of potentially serious obstetrical complications with the potential to adversely impact the short- and longer-term health of mothers and their offspring. Future studies should collect more detailed information on the migration status, experiences, and exposures of MRMW that influence their risk for obstetrical complications. These are needed to expand our findings to better understand why they have excess risk for these and to inform social and public health policies, programs and targeted interventions aimed at reducing the risk of this vulnerable refugee and migrant group., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Given the frequent exposure of humanitarian migrants to traumatic or stressful circumstances, there exists a potential predisposition to mental illness. Our objective was to pinpoint the trends and determinants of mental illness among humanitarian migrants resettled in Australia. This study considered five waves of longitudinal data involving humanitarian migrants resettled in Australia. Post-traumatic stress disorder (PTSD) and psychological distress were assessed using PTSD-8 and Kessler-6 screening tools. Through a Generalised Linear Mixed model (GLMM), variables displaying a 95% CI that excluded the value of 1.0 for the odds ratio were identified as associated factors for both PTSD and elevated psychological distress. The selection of multivariable covariates was guided by causal loop diagrams and least absolute shrinkage and selection operators methods. At baseline, there were 2399 humanitarian migrants with 1881 retained and at the fifth yearly wave; the response rate was 78.4%. PTSD prevalence decreased from 33.3% (95% CI: 31.4-35.3) at baseline to 28.3% (95% CI: 26.2-30.5) at year 5. Elevated psychological distress persisted across all waves: 17.1% (95% CI: 15.5-18.6) at baseline and 17.1% (95% CI: 15.3-18.9) at year 5. Across the five waves, 34.0% of humanitarian migrants met screening criteria for mental illness, either PTSD or elevated psychological distress. In the multivariate model, factors associated with PTSD were loneliness (AOR 1.5, 95% CI: 1.3-1.8), discrimination (AOR 1.6: 1.2-2.1), temporary housing contract (AOR 3.7: 2.1-6.7), financial hardship (AOR 2.2:1.4-3.6) and chronic health conditions (AOR 1.3: 1.1-1.5), whereas the associated factors for elevated psychological distress were loneliness (AOR 1.8: 1.5-2.2), discrimination (AOR 1.7: 1.3-2.2) and short-term lease housing (AOR 1.6: 1.0-1.7). The prevalence, persistence and consequential burden of mental illness within this demographic underscore the urgent need for targeted social and healthcare policies. These policies should aim to mitigate modifiable risk factors, thereby alleviating the significant impact of mental health challenges on this population., (© 2024 The Authors. International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd.)

Background and Objectives: Language-appropriate outcome measurements help to improve health equity. The purpose of this study was to translate and validate the Cohen-Hoberman Inventory of Physical Symptoms (CHIPS) in Nepali for Bhutanese refugee utilization., Methods: English-Nepali forward and back translations of CHIPS were completed by an official translator and evaluated by three content experts. A scaled rubric measured the following constructs: neurogenic stress response (NSR), somatic stress response (SSR), and visceral stress response (VSR). Data were analyzed using SPSS 26.0., Results: The Nepali version of CHIPS reported good content validity, strong internal consistency (Cronbach's α  = .94), and inter-rater reliability (ICC = 0.91). Kappa statistic reported 88% to 96% agreement. Constructs of NSR (0.91), SSR (0.94), and VSR (0.94) reported strong internal consistency., Conclusions: The Nepali translated version of CHIPS showed strong validity and reliability for utilization in the Bhutanese refugee population and improves health access to outcome measurements for a vulnerable population., Competing Interests: The authors declare no conflicts of interests., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: With increasing globalization and diversity, the intersection of immigration and language barriers can impact patient outcomes. This scope review aims to summarize current evidence on immigration and language barriers on pediatric surgical outcomes., Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Four databases were searched with Medical Subject Heading terms describing pediatric surgery, immigration, limited English proficiency (LEP), and refugees between 2000-2023. Four independent reviewers screened and analyzed texts for final inclusion., Results: Thirty-three studies were included. Ten studies described disease incidence and severity, finding that LEP, immigrant, and refugee patients were more likely to present with severe disease in appendicitis and traumatic injuries. five studies described pain management, finding patients with LEP received fewer pain assessments, waited longer for analgesia, and had more discrepancies in pain scores. Seventeen studies investigated treatment receipt and delay, finding that immigrants and patients with LEP had longer time to and reduced rates of treatment. Seventeen studies described surgical outcomes, finding that patients with LEP have longer length of stay and more postoperative emergency department visits but fewer follow-up appointments. In kidney transplants, patients with LEP and immigrants had worse outcomes, but these trends are not seen in immigrants from Europe. Overall, immigrants and refugees have higher rates of complications and mortality., Conclusions: Immigrants and patients with LEP and are more likely to present with advanced disease and severe injuries, receive inadequate pain management, experience delays in surgery, and suffer more complications. There is continued need to assess the impact of LEP and immigration on pediatric surgery outcomes., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: This paper examines the frequency of suicidal behaviors (suicidal ideation or attempt) among a sample of Syrian refugee women living in non-camp settings in Jordan. We asked several questions surrounding suicide and examined the associations between post-traumatic stress disorder (PTSD), social connectedness, post-displacement stressors and suicidal behaviors., Methods: Participants (n = 507) were recruited using a clinic-based systematic sampling from four health clinics throughout Jordan in 2018. We used a multivariable logistic regression to examine the hypothesis of whether positive screening for PTSD (PCL-5), social isolation (have no friends or family members available to help), and greater number of post-displacement stressors (PMLD Checklist) is associated with suicidal behaviors., Results: Approximately one-tenth (9.86%) of participants surveyed reported suicidal behaviors (suicidal ideation or attempt) in the past six months. Our hypothesis was partially supported. In the adjusted multivariable analyses, screening positive for PTSD [OR:4.02 (95% CI:1.33, 12.15)] increased odds of suicidal behaviors, while having one friend or family member available to help when in need [OR:0.31 (95% CI:0.13, 0.78)] decreased odds of suicidal behaviors. We did not find any associations between the number of post-displacement stressors and suicidal behaviors in the multivariable model., Conclusion: Agencies and practitioners addressing suicidal behaviors among Syrian refugee women should provide interventions that aim to reduce PTSD symptoms and social isolation. Potential intervention includes screening for mental health symptoms and suicidal behaviors during routine visits with service providers, as well as providing proper mental health and psychosocial support services according to the mapping of available services., (© 2024. The Author(s).)

This is the first systematic review and meta-analysis to estimate the prevalence of human T-lymphotropic virus 1 and 2 (HTLV-1 and 2) infections among immigrants and refugees worldwide. PubMed/MEDLINE, Scopus, EMBASE, Web of Science, and Virtual Health Library (VHL) databases were searched for studies published from their inception to 6 January 2023. A meta-analysis using a generalized linear mixed model with a random effect was performed for HTLV-1 and HTLV-2. Subgroup analyses were performed based on the decade of study, sample size, confirmatory methods, region of study, risk group, and region of origin. Of the 381 studies initially identified, 21 were included. The pooled prevalence of HTLV-1 and HTLV-2 was 1.28% (95% CI: 0.58, 2.81) and 0.11% (95% CI: 0.04, 0.33), respectively. HTLV-1 prevalence differed significantly by region of origin, with the highest prevalence among those from the Western Pacific Region (7.27%; 95% CI: 2.94, 16.83). The subgroup analysis also showed significant differences between the estimates of HTLV-1 considering the decade of study, sample size, and region of study. For HTLV-2, significant differences were shown in relation to sample size, confirmatory methods, and risk group. The higher HTLV-1 prevalence found deserves public health attention in immigrant and refugee-receiving non-endemic countries.

Background: This study focused on Ukrainian refugees and migrants, a population that, with an ongoing war, is expected to grow in Germany. Over 1 million Ukrainians with exceptional legal status and access to public insurance in Germany significantly burden governmental services, especially German healthcare. It is thus essential to facilitate their integration into the healthcare system and ensure its proper usage. Identifying the obstacles Ukrainian refugees and migrants encounter while accessing healthcare services is crucial to ease their integration., Methods: A qualitative study was conducted from February 2023 to April 2023. Thirty semi-structured interviews were performed with Ukrainian migrants and refugees. The interviews were transcribed verbatim, organized, and categorized. Thematic analysis was performed to identify barriers related to the use of German healthcare services. To assess possible differences in the experiences of Ukrainian refugees and migrants, the responses of these two groups for each topic were analysed separately., Results: Ukrainian migrants and refugees experience similar barriers while accessing German healthcare services. Predominantly, language barriers and a lack of understanding of the German healthcare system posed the main barriers in both groups. Additionally, structural challenges, such as differences in referral processes, appointment scheduling, and consultation duration, presented further challenges., Conclusion: This research study emphasizes the importance of addressing cultural and structural barriers to improve healthcare accessibility and utilization for Ukrainian refugees and migrants in Germany to better facilitate their integration into the healthcare system., (© 2024. The Author(s).)

Background: Refugees resettled in Australia may experience significant physical, mental and emotional health issues on arrival and difficulty accessing mainstream healthcare that often demands specialised services. It is not known if and how refugee health needs and service use change over time and generations, how this compares with the broader Australian population and what level of resourcing is required to maintain specialised services. There is also a significant knowledge gap concerning the resources and skills of refugees that can be harnessed to sustain the health and well-being of individuals and communities. Such knowledge gaps impede the ability of the health system to deliver responsive, efficient, acceptable and cost-effective care and services and limit the engagement of refugees in the coproduction of these services., Methods: This study will be the first to provide comprehensive, longitudinal, population-based evidence of refugee health, service use and the accumulated resources or assets related to positive health and well-being (compared with data on deficits, illness and death) across the lifespan and generations. This will enable a comprehensive understanding of the relationships among assets, health status, service gaps and behaviours. We will identify the assets contributing to increased capacities to protect and promote health. This evidence is essential for planning health prevention programmes.This project has three phases: (1) employ national linked datasets to examine the health and social outcomes of refugees in Australia; (2) engage with refugees in a participatory manner to map the social, economic, organisational, physical and cultural assets in their communities and deliver an integrated model of health; and (3) codesign a roadmap of agreed actions required to attain health and well-being in communities and indicators to assess outcomes., Ethics and Dissemination: Ethics and procedures-phase I:Ethical approval for phase I was gained from the Australian Bureau of Statistics (ABS) for Person Level Integrated Data Asset microdata (unit record data) via the ABS DataLab and the NSW Population and Health Services Research Ethics Committee (2023ETH01728), which can provide a single review of multijurisdictional data linkage research projects under the National Mutual Acceptance Scheme. This will facilitate approval for the Victorian and ACT datasets. The ABS will be the integrating/linkage authority. The Centre for Health Record Linkage (CHeReL) and the Victorian Data Linkage Unit will prepare a data extract representing all data records from the dataset to provide to the ABS for linkage.Ethics and procedures-phases 2 and 3:Written consent will be obtained from all participants, as well as consent to publish. We have obtained ethical approval from the University of Technology Sydney Medical Research Ethics Committee; however, as we deepen our consultation with community members and receive input from expert stakeholders, we will likely seek amendments to hone the survey and World Café questions. We will also need to provide flexible offerings that may extend to individual interviews and online interactions., Discussion: This innovative approach will empower refugees and put them at the centre of their health and decision-making., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Background: Refugees frequently face the challenges of adapting to unfamiliar environments and new cultural contexts. Such adaptations emphasize the importance of coping strategies during resettlement and for individuals to successfully integrate in the new communities. Particularly for Syrian refugees in Norway, many of whom have escaped war and conflict, understanding their ways of coping with mental health problems, such as depression, is pivotal., Method: This study used a cross-sectional study design to explore the relationship between integration aspects and coping strategies for depression from the Syrian population living in Norway. Syrian participants (N = 96) answered questions from the Brief COPE, the Hopkins symptom checklist (HSCL-13), and the Immigration Policy Lab index (IPL-12/24)., Results: Hierarchical multiple regression analysis indicated that employing a problem-focused coping strategy was significantly associated with better psychological and social integration outcomes among Syrian refugees in Norwegian society., Conclusion: The study suggests that certain aspects of integration, such as feeling a sense of belonging and actively seeking help, significantly improve mental health outcomes for Syrian refugees. Emphasizing problem-focused coping strategies could be vital in facilitating the successful integration of refugees into Norwegian society., (© 2024. The Author(s).)

Background: This study aimed to determine the prevalence of chronic pelvic pain(CPP) in refugee and non-refugee women, determine the factors associated with CPP, and evaluate the effect of CPP on life quality., Methods: This was a cross-sectional study conducted among 283 non-refugee and 278 refugee women in Turkey. A questionnaire including questions assessing chronic pelvic pain and related factors, World Health Organization Quality of Life Scale Short Form(WHOQOL-BREF), Depression Anxiety Stress Scale-21, were administered to the participants. Chi-square test, Mann-Whitney U test and multiple logistic regression analysis were used for statistical analysis., Results: The prevalence of chronic pelvic pain was 41.0% in refugee women and 19.1% in non-refugee women (p< 0.001). The prevalence of CPP was 1.68 times higher in refugee women than in non-refugee women (OR;95%CI:1.68;1.01-2.81). In the multivariate analysis performed in the study group, refugee status, low family income status(OR;95%CI:2.09;1.26-3.46), low back pain(OR;95%CI:2.02;1.21-3.35), dyspareunia (OR; 95%CI:2.96;1.75-4.99), number of three or more miscarriages (OR;95%CI:3.07;1.18-8.01), history of gynaecological surgery (OR;95%CI:2.44;1.33-4.50), diarrhea (OR;95%CI:2.01;1.07-3.76), urinary tract infections(OR; 95%CI:1.66;1.02-2.71) and anxiety(OR; 95%CI:1.17;1.10-1.24) were found to be risk factors for CPP. In the refugee and non-refugee groups, those with CPP had lower scores in all subdomains of the WHOQOL-BREF scale than those without CPP (p < 0.05)., Conclusions: Refugee status independently contributes to the risk of developing CPP. Targeted interventions to address CPP and its associated risk factors are needed, particularly in vulnerable refugee populations, to improve their quality of life., (© 2024. The Author(s).)

Background: The COVID-19 pandemic presented unprecedented challenges, particularly for vulnerable populations residing in confined settings such as refugee shelters: Physical distancing measures were challenging to implement in shelters due to shared rooms or communal use of kitchens and sanitary facilities, which increased the risk of infections. Meanwhile, individuals' capabilities for individual protection strategies were severely impaired by the structure of the shelters. Consequently, shelters had the duty to develop and implement strategies for the prevention and handling of SARS-CoV-2 infections. The aim of this study was to explore the perspectives of refugees, NGO employees, and shelter directors regarding COVID-19-related measures in German refugee shelters. The study aimed to identify challenges and conflicts arising from implemented measures, as well as expectations for improved support during the pandemic., Methods: Semi-structured and narrative interviews were conducted with 6 refugees, 6 facility managers, 12 NGO staff, and 2 social service agency staff from February to August 2022. Qualitative content analysis was employed to analyze the data, identifying overarching themes and codes., Results: The study uncovered challenges and conflicts resulting from pandemic measures, particularly mass quarantine orders, within refugee shelters. Lack of transparency and ineffective communication worsened tensions, with refugees feeling distressed and anxious. The quarantine experience had a negative impact on refugees' mental health, which was exacerbated by limited social interaction and leisure-time activities. Shelter managers encountered administrative challenges when implementing measures due to facility constraints and limited resources, while NGO employees encountered obstacles in providing immediate assistance due to legal regulations and a lack of cooperation from shelter managers., Conclusions: The study highlights that shelters are problematic institutions from a public health perspective. It shows the importance of implementing customized pandemic interventions in refugee shelters that take account of the diverse needs and experiences of both refugee and staff. To achieve this, we recommend to establish an ethics committee and involve various stakeholders in decision-making processes. Additionally, enhancing information dissemination to promote transparency and public understanding of measures is crucial. These insights can help develop comprehensive and effective pandemic plans for refugee shelters, ensuring better preparedness for future public health crises., (© 2024. The Author(s).)

Background: The Jordanian healthcare system has evolved over the past decades expanding its services, technological, and educational resources. A comprehensive view of this system is lacking. The objective of this report is to describe the structure of the Jordanian healthcare system, the challenges facing it, and the current and recommended health policies., Materials and Methods: This study reviewed the current status of the Jordanian healthcare system. The following parameters were analyzed: health indicators, infrastructure, human resources, insurance system, pharmaceutical expense, health education system, and medical tourism. Data were collected from various relevant official institutions and related published literature., Results: Jordan has a young population with a median age of 23.8 years. Life expectancy is 78.8 years for females and 77.0 years for males. The Jordanian healthcare system is divided into three major categories: (1) Governmental Insurance (i.e., the Ministry of Health (MOH), the Royal Medical Services (RMS) and semi-governmental insurance); (2) Private Insurance; and (3) Refugee Insurance, including the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) and the United Nations High Commissioner for Refugees (NHUR). The Governmental Insurance covers 64.30% of the total population. Health expenditure is 6.37% of the gross domestic product (GDP). Pharmaceutical expenses make up 26.6% of the total national healthcare budget. Human resource assessment shows a high ratio of medical staff per 10.000 inhabitants, especially concerning physicians (31.7), dentists (7.9), and pharmacists (15.1). However, the ratio of nursing staff per 10.000 inhabitants is considered low (37.5). The Hospital bed/1000 population ratio is also relatively low (1.4). Healthcare accreditation is implemented through the Joint Commission International (JCI) accreditation which was achieved by 7 hospitals and by the National Health Care Accreditation Certificate (HCAC) achieved by 17 hospitals and 42 primary healthcare centers. Postgraduate medical education covers almost all medical and surgical fields. Medical tourism is currently well-established., Conclusions: Assessment of the Jordanian healthcare system shows high ratios of physicians, dentists, and pharmacists but a low ratio of nursing staff per 10.000 inhabitants. The hospital bed/1000 population ratio is also relatively low. Pharmaceutical expenses are significantly high and medical tourism is well-developed., (© 2024. The Author(s).)

Background: The oral health of refugees and asylum seekers is understudied. However, oral health has important implications for overall health and wellbeing. This study addresses this gap by characterizing oral health care utilization in Médecins du Monde (MdM) clinics across mainland Greece from 2016 - 2017., Methods: A retrospective cross-sectional study design was used to estimate proportional morbidities for caries, extraction, developmental, periodontal disease, preventive, and other oral health outcomes. The association between physical health conditions and consultations of interest - upper respiratory tract infections (URTIs) and reproductive health consultations - and oral health were compared using odds ratios (OR) and 95% confidence intervals (CIs). Oral health outcomes between Afghans and Syrians were compared using odds ratios and 95% CIs., Results: Caries (39.44%) and extractions (28.99%) were highly prevalent in our study population. The utilization of preventive dental consultations (37.10%) was high, particularly among males. Individuals with at least one upper respiratory tract infection (OR = 1.52; 95% CI: 1.30 - 1.77; Or = 1.90; 95% CI: 1.53 - 2.36) and women and girls with reproductive health consultations (OR = 1.30; 95% CI: 1.03 - 1.66; OR = 2.03; 95% CI: 1.49 - 2.76) were more likely to have any dental or caries specific consultations. The observed patterns in oral health needs differed between Afghans and Syrians, with Afghans more likely to have preventive screenings and less likely to have caries, extractions, or other conditions., Conclusions: Displaced populations utilizing MdM dental clinics had high levels of oral health needs, particularly for caries and extractions. The connection between oral and overall health was seen in the study population, and these findings reinforce the public health importance of oral health for improving health and wellbeing of displaced populations. Evidence-informed policy, practice, and programming inclusive of oral health are needed to address both oral and overall health of refugees and asylum seekers in Greece. Future research should investigate not only oral health care needs but also knowledge and beliefs that inform utilization patterns among displaced populations., (© 2024. The Author(s).)

Importance: Rohingya refugees, forcibly displaced from Myanmar, face challenges adapting to Bangladesh. Examining their quality of life (QOL) is vital to identifying nuanced factors associated with their well-being, informing targeted interventions for an improved QOL., Objectives: To identify the QOL among Rohingya refugees 5 years after migration to Bangladesh, with a particular emphasis on understanding the complex interplay between sociodemographic factors and chronic illnesses., Design, Setting, and Participants: A cross-sectional study involving resettled Rohingya adults was conducted between May 18 and July 7, 2021, approximately 5 years after their resettlement in Bangladesh. Of the participants, 500 individuals were healthy, whereas 558 individuals were undergoing treatment for at least 1 chronic disease. Data were analyzed from January to February 2024., Main Outcomes and Measures: The study assessed QOL using the short version of the World Health Organization's QOL Questionnaire, covering 4 domains: physical, psychological, social, and environmental. Scores were transformed to a maximum of 100. Tobit linear regression, adjusted for potential confounders, was employed for analysis., Results: The study included a total of 1058 respondents, who were predominantly female (630 participants [59.5%]) and had a mean (SD) age of 42.5 (16.1) years. Despite being healthy, individuals without chronic illnesses had median QOL scores ranging from 44 to 56 out of 100, indicating a relatively poor QOL. A total of 260 participants (46.6%) with chronic diseases reported very poor or poor QOL, in contrast to 58 healthy individuals (11.6%) in the fifth year after displacement. Specifically, patients with cancer and those who had multimorbidity exhibited the lowest QOL scores across all domains, with significant reductions in the physical health (10.57 decrease; 95% CI, -12.97 to -8.17) and psychological domain scores (7.20 decrease; 95% CI, -9.71 to -5.93) according to Tobit regression analysis., Conclusions and Relevance: This study found that chronic illnesses were associated with all domains of QOL among Rohingya refugees, particularly those with musculoskeletal disorders, cancer, and multimorbid conditions. This heightened vulnerability may contribute to poor QOL in this population. By uncovering these disparities, the study lays the groundwork for targeted interventions and policies aligned with the United Nations' goal of leaving no one behind in sustainable development efforts.

Dropout from mental health treatment is a substantial hindrance to relevant and effective treatment. Despite the high prevalence of PTSD among refugees, research into their treatment dropout has received limited attention. This study aimed to identify patterns and predictors of treatment dropout versus completion through different treatment stages. The sample included 940 patients with a refugee background undergoing outpatient treatment for PTSD in Denmark. All patients were offered 10 medical doctor sessions and 16-20 psychotherapy sessions. Dropout was analysed in three stages: (1) during the first six MD sessions, (2) during the first eight psychotherapy sessions upon completion of Stage 1, and (3) during psychotherapy sessions 9 to 16. A stepwise multiple regression analysis was conducted for each stage to identify predictors of stage-specific dropout. Counter to expectations, both early dropout and full completion were associated with better symptom outcomes, relative to late-treatment dropout. Key predictors varied by stage, with younger age predicting early dropout, whereas chronic pain and poor Danish proficiency predicted late dropout. Female gender and a clearly articulated motivation for active participation were predictors for full treatment completion. Practical advice is suggested to accommodate at-risk patients and to re-evaluate patient engagement after familiarisation with treatment., (© 2024 John Wiley & Sons Ltd.)

Background Many refugee women and women seeking asylum arrive in high-income countries with unmet preventive sexual and reproductive health (SRH) care needs. Primary healthcare providers (HCPs) are usually refugee and asylum seekers' first point of care. This study aimed to identify HCP characteristics associated with initiating conversations and discussing SRH opportunistically during other health interactions. Methods An anonymous online survey was distributed nationally to representatives of health professional organisations and Primary Health Networks. Hierarchical logistic regression analysed factors including HCP demographics, knowledge and awareness, perceived need for training and professional experience with refugee women were included in the models. Results Among 163 HCPs, those initiating conversations ranged from 27.3% (contraceptive care) to 35.2% (cervical screening). Opportunistic discussions ranged from 26.9% (breast screening) to 40.3% (contraceptive care). Positively associated factors included offering care to refugee women or women seeking asylum at least once every 2months 7.64 (95% CI 2.41;24.22, P P P P P P Conclusions Direct professional experience, frequency of service provision, years of practice, and part time work positively influence HCPs' SRH care practices. Enhancing bilingual health worker programs, outreach, education, and support for SRH and cultural competency training are essential to improving the preventive SRH care of refugee women and women seeking asylum.

The Minnesota Immunization Networking Initiative (MINI) led by Fairview Health Services has addressed barriers to accessing immunizations through partnerships with community organizations to provide free influenza vaccinations to historically underserved communities, especially refugee, immigrant, and migrant communities. Once the COVID-19 vaccine was available, MINI quickly pivoted operations to distribute the vaccine and provide technical assistance to community partners amidst rapidly evolving guidance. With infrastructure and a vaccination team in place, MINI responded to new and emerging needs, eg, implementing a more accessible and low-tech scheduling system, increasing staffing to meet growing needs, and expanding partnerships with community organizations and leaders. From February 2021 to September 2023, MINI organized 1120 community-based vaccine clinics and administered 43,123 COVID-19 vaccinations. Of those vaccine recipients, 88% identified as Black, Indigenous, and other people of color, and for preferred language, over half stated that they preferred a language other than English. These demographics are similar to those of the earlier influenza clinics, even as average annual clinics have tripled and average total vaccinations have quadrupled since the pivot to COVID-19 vaccination clinics. Some keys to success were: (1) consistent, bidirectional communication and shared decision-making with community partners; (2) prioritizing sustainable staffing models with the support of administrative leadership and resources; and (3) having a community-informed approach supported by the practice of hiring staff from communities served. Because of the effectiveness of this model, MINI is primed to respond to planned and unplanned emergent public health crises., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc.)

Background: Despite the exposure to a wide combination of risk factors, evidence concerning risk of suicide among refugees is mixed., Aims: We aimed to establish more precise estimates of suicide and suicidal behavior in refugees and asylum seekers, investigate the role of somatic and psychiatric comorbidities, and the effectiveness of preventative interventions., Methods: We searched PubMed/Medline, EMBASE, CINAHL, and PsycInfo without time limitations from inception until June 5, 2024. Studies were included if systematic reviews or meta-analyses reporting data on suicide or suicidal behavior in refugees or asylum seekers, or detailing the results of preventive interventions. Quality was assessed using the National Institutes of Health Quality Assessment Tool for Systematic Reviews and Meta-Analyses., Results: Out of 49 papers, 10 systematic reviews and meta-analyses were included. Refugees showed significantly higher suicide death rates and suicidal ideation, suicide plan and suicide attempt prevalence compared to people living in the host countries. Refugees who arrived in low-income and lower-middle-income countries displayed lower suicidal ideation, but higher suicide death rates and suicide attempt prevalence compared to refugees who arrived in high-income and upper-middle-income countries. However, no review provided data regarding somatic comorbidity, psychiatric comorbidity, or the effectiveness of treatments, and evidence on specific categories of refugees is scarce., Conclusion: Refugees have been proven to be at risk for suicide and suicidal behavior. More research is required to identify the targets and procedures of intervention., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)