bluuebunny/crossref_metadata_2025 huggingface dataset:
Experts’ point of view on migrants’ health and Bulgarian health system performance
Authors: Kamburova M , Georgieva S , Tsanova D , Mineva E
Published: October 2020

Introduction

Migrants often face serious inequities concerning their state of health and their access to good quality health services. The aim of the study is to analyze the experts' point of view on migrants' health and Bulgarian health system performance in this field.

Methods

Within the TRAIN4M&H project, founded by European Commission, work seminar was organized in Bulgaria in March 2019th. Focus group and facilitated discussion with experts intended to elicit information about significant migrants' health problems was performed. Quantitative and qualitative data were collected through an unstructured interview. Data processing was performed by SPSS v.24.

Results

All participants in the seminar: 22 frontline health professionals (5), law enforcement officers (13), social workers (2) and other professionals (2) were covered. According 60% of participants the health of migrants threatens the health of the host population. The leading health issues among migrants are: infectious and parasitic disorders as a result of bad hygiene (9), psychiatric problems and drug abuse (5), children and pregnant women health problems (3) etc. Most of the experts (77.3%) determine that there is no difference between health care needs of the migrants and Bulgarian population. None of the respondents said that migrants need hospital care mainly. On the opposite, according to experts' point of view they need emergency care (31.8%), primary health care (36.4%) and specialized care (22.7%). The Bulgarian health system provides adequate health care only in some specific cases, according to two thirds of the respondents. As positive results of the health system performance experts point “asylum seekers are fully health insured”, “the treatment of migrants in the centers is free of charge” etc.

Conclusions

In order to establish migrant friendly health system in Bulgaria and to improve the quality of services provided develop and enhance skills of professionals working at local level is crucial.

Key messages

Professionals working at local level with migrants have to be well qualified to face problems in relation to migrants’ health and their access to health care. According to the experts working at local level with migrants Bulgarian health system is not well prepared and provides adequate health care for migrants only in some specific cases.
Examining emergency department inequities between Māori and non-Māori: do they exist?
Authors: Curtis E , Paine S , Jiang Y , Jones P , Raumati I , Tomash I , Healey O , Reid P
Published: October 2020

Despite Māori (Indigenous population of New Zealand, NZ) having high Emergency Department (ED) use, few studies have explored for ethnic inequities in ED within NZ. ED healthcare can be time-pressured, complex and demanding. Clinical decision-making in this context may facilitate provider prejudice, stereotyping and bias.

The Examining Emergency Department Inequities (EEDI) is a retrospective observational study, designed from a Kaupapa Māori Research position, examining ED admissions in NZ between 2006 and 2012 using the existing Shorter Stays in Emergency Department National Research Project dataset combined with clinical information extracted from NZ’s National Minimum Dataset. The key predictor variable is patient ethnicity with covariates: sex, age-group, area deprivation, mode of presentation, referral method, Australasian Triage Scale and the Multimorbidity Measure (M3 Index) for co-morbidities. Generalised linear regression models investigated the associations between pre-admission variables and the measures of ED care, and mortality.

There were a total of 5,972,102 ED events (1,168,944 Māori, 4,803,158 non-Māori). We found an increasing proportion of ED events/year, a higher proportion of Māori ED events from younger age groups and areas of high deprivation compared to non-Māori. Māori had a higher proportion of self-referral and were triaged to be seen within a longer timeframe compared to non-Māori. After controlling for year of ED event, gender, triage category, age at presentation, NZ Deprivation decile and M3 Comorbidity score: Māori had shorter ED arrival to assessment time; shorter ED Length of Stay and less Access Block (>8 hour ED LOS before ward admission). Despite this, Māori mortality within ED or within 10 days of discharge was higher than non-Māori.

These findings suggest different patterns in ED usage between Māori and non-Māori. Of concern, inequities in mortality exist despite positive indicators of ED care.

Key messages

There is evidence of different patterns in emergency department use between Māori and non-Māori in New Zealand. Māori:non-Māori inequities in mortality exist despite positive indicators of emergency department care.
Outcomes along the HIV continuum of care for Men who have Sex with Men in Haiti
Authors: Dunbar W , Sohler N , Coppieters Y
Published: October 2020

Background

The HIV epidemic in Haiti continues, with an estimated 160,000 people living with HIV at the end of 2018. Although HIV prevalence in the general population is estimated to be 2.0%, certain groups are at a higher risk of HIV infection. The prevalence of HIV among men who have sex with men (MSM) is estimated to be 12.9%. As previous data have found gaps in HIV care for this population, we explored the steps in the continuum of care to determine outcomes at each step.

Methods

We used an observational retrospective cohort study design to follow up MSM diagnosed with HIV in the largest HIV care clinic in Port-au-Prince, Haiti. Estimates were calculated of proportions of participants reached, tested, linked to care, commencing treatment, adherent to treatment, and who achieved virologic suppression. We identified factors associated with loss to follow-up at each step using multivariable analysis.

Results

Data were collected between January 1, 2015, and December 31, 2018. 5009 MSM were reached for prevention services. Of those reached, 2499 (49.8%, 95% CI 48.5-51.3) were tested for HIV, 222 (8.8%, 95% CI 7.8-10.0) had a positive test result for HIV, and 172 (77,47%, 95% CI 71.4-82.8) were linked to HIV care. Among participants who started care, 54 (44.6 95% CI 24.5-38.9) were retained and 98 (78.4%, 95% CI 49.2-64.5) achieve a suppressed viral load. Fifty-nine (44.8%, 95% CI 27.2-41.9) were lost to follow-up. Participants who had been younger, with lower educational and economic level were significantly less likely to achieve retention and viral suppression (p = 0.001).

Conclusions

HIV cascade data among MSM in Haiti show very poor rates of retention in treatment although those retained had good virologic outcome. Characteristics associated with LTFU suggest an urgent need to develop and implement effective interventions to support patients in achieving retention and viral suppression among MSM living with HIV.

Key messages

Poor HIV outcomes for men who have sex with men in Haiti. Effective interventions to improve HIV outcomes for men who have sex with men in Haiti are urgently needed.
The care ethics of child health nurses in Danish asylum centers: An ethnographic study
Authors: Barghadouch A , Norredam M , Skovdal M
Published: October 2020

Background

Asylum-seeking children have often been on a harrowing journey with potentially grave consequences for their health and well-being. As little is known about how child health nurses enter into engaging and caring partnerships with asylum-seeking families to meet their children's healthcare needs - despite challenges pertaining to culture and language - our objective is to examine how child health nurses navigate, negotiate and respond to the range of challenges, needs and circumstances that affect their nursing care practices.

Methods

We report on ethnographic fieldwork from four Danish Red Cross asylum centers, where child health nurses have their first encounters with asylum-seeking families. The fieldwork included participant observations of child health consultations and interviews with 6 child health nurses and 11 asylum-seeking families. We coded and analyzed the empirical material thematically to identify emerging and crosscutting themes.

Results

The care performed by the child health nurses was characterized by five ethical care practices. One, their care was driven by compassion, exhibiting intrinsic beliefs, values and personal motivations to care for asylum-seeking children. Two, they provided responsible care, building on their humanitarian and professional roles as child health nurses within Red Cross. Three, they showed flexibility, drawing on past experience and recognition of the families' complex needs. Four, they were collaborative, working in partnership with parents. Five, the child health nurses' care was empowering asylum-seeking families by encouraging parents to be autonomous and acknowledging their own efforts in caring for their children.

Conclusions

The confluence of the five ethical care practices enables child health nurses to promote and safeguard the health and well-being of asylum-seeking children. We argue that these practices are constituent parts of person-centered care for asylum-seeking and refugee children.

Key messages

We identified five ethical care practices, which enable child health nurses’ care of asylum-seeking children and their families. Our study provides an empirical understanding of how person-centered care is critical to asylum-seeking families.
Better mental health through identifying with locals and country of origin among foreign-born people
Authors: Seppänen A , Lilja E , Kuusio H , Castaneda A
Published: October 2020

Background

Sense of belonging (SoB) is an important determinant of health among foreign-born population and it has previously been found to be associated with perceived health. In this study we examined: 1) which types of SoB are associated with psychological strain (PS), and 2) whether this varies between different country groups.

Methods

The data were gathered from the cross-sectional Survey on Well-Being among Foreign-Born Population (FinMonik, n = 6 836), conducted in Finland in 2018-19. SoB was assessed by the question “Which of the following areas or groups you feel you belong to?”, classified into 1) both Finns/local municipality and citizens of country of origin CCO (acculturation identity), 2) only Finns/local municipality (local identity), 3) only CCO (origin identity), 4) only Europeans, world citizens, religious, work-related or political group (other identity), and 5) none of the previous. PS was measured by using the MHI-5 (psychological strain: yes; no). Logistic regression was used to test the association between SoB and PS, with age, sex and country of origin as confounding variables. In the analyses, weights were used to reduce non-response bias.

Results

Compared to the acculturation identity group, PS was more common among those with local identity (OR = 1.60, p < 0.01), origin identity (OR = 1.99, p < 0.001) or other identity (OR = 3.33, p < 0.001) and those with no belonging to any of the groups presented (OR = 5.40, p < 0.001). The last group was more likely to experience PS than the acculturation identity group in all five country groups included in the analysis. Acculturation identity was associated with less PS especially for those born in EU-, EFTA- and North American countries.

Conclusions

Acculturation identity was strongly associated with less psychological strain, especially when compared with the group reporting no belonging to any of the groups presented.

Key messages

Sense of belonging is associated with mental health and should be studied more extensively among different foreign-born population groups. Identification with both the local people and one’s own country of origin should be supported.
“Migration and Health” in public health perspective course experience in a medical faculty, Turkey
Authors: Aslan D
Published: October 2020

Introduction

Public health practices of medical training should be modifiable according to the needs of the population. Turkey has been facing with the refugee problem since 2011. In this regard, new requirements are arising for medical professionals starting from the medical faculties. In this paper, a new elective course introduced for medical students on migration and health will be defined.

Materials and Methods

”Migration and Health” in Public Health Perspective Course was proposed for the first phase medical students at Hacettepe University, Faculty of Medicine. The proposal was approved by the official mechanisms of the medical faculty after a detailed assessment. The aim of the approved Course was to gain information and increase awareness on health aspect of migration based on good medical practices.

Results

The Couse was held between October 2019 and January 2020 once a week for two hours. Fifteen Turkish and other international students completed the Course. Interactive training techniques were used during the Course. Feedbacks of the students were regularly taken after each class once a week. Reflections of the students were also recorded both at the beginning and at the end of the Course. The students were successful in achieving the aims of the Course. Additionally, another achievement was gained which was not proposed at the beginning of the Course. The “positive” attitude of the medical students refusing discrimination against refugees was the secondary and may be a more worthy outcome of the Course. All students were able to look at the refugee problem with good medical values and based on the basic rights of the humanity.

Conclusions

The students reported their satisfaction about the Course. As the Course was applied for the first time, it is open for revision according to the feedbacks received during of the Program. The Content, the methods will be overviewed before the next year.

Key messages

Medical students’ curricula could have been updated due to the new and the dynamic developments in the population. Refugee issue needs a global perspective which the medical students need to learn.
Health issues in female Moldovan migrants in a north-eastern Italian region
Authors: Buja A , Vianello F A , Zaccagnini F , Pinato C , Maculan P
Published: October 2020

Background

Migration from Eastern Europe to Italy is still massively expanding, with a subsequent increase of migrants in the job market who are traditionally employed in low specialized and high strain jobs. In this context Health Literacy is a known factor contributing to immigrant health disparities. The purpose of this study was to evaluate the health status of a population of migrant Moldovan women and their access to health care services in northern Italy by age class and health literacy level.

Methods

We administered an ad-hoc questionnaire to adult Moldovan women to assess their lifestyles, employment status, reported health status, access to Health Services and Health Literacy. Moreover, the study compared our data with a sample of Italian women of the same age range living in North-Eastern region interviewed in 2015. Analysis employs descriptive statistics.

Results

The sample included 170 Moldovan women (age 46.5 ±12.3). Prevalence of active smokers was found double in women with a low Health Literacy. Health Literacy status also determined the different access to Public Health Services, with women with higher literacy using more programmed health services and screening programs, and women with lower literacy conversely using more emergency health services. Overall reported health status was found worse in our sample than in Italian women and reported disease prevalence among age ranges was different than Italian ones with an increased probability for allergies, lumbar diseases and depression.

Conclusions

Some diseases have a higher prevalence in Moldovan than in Italian women. Health literacy is associated with lifestyles and use of health care services also in migrants, as previously demonstrated for native population.

Key messages

Tailored prevention programs and intervention should be designed in Moldovan women to address high prevalence diseases in this population. Strategy to improve health literacy should involve immigrants. Some diseases resulted well-spread over the whole sample and not influenced by age or employment; the difficulties migrants have to overcome might influence their health status.
Are Norwegian Municipality policies enabling intersectoral collaboration in migration health?
Authors: Nordström C , Kumar B
Published: October 2020

Issue

Sporadic accounts of initiatives, interventions and good practices in Migrant Health at the Municipality level account for Norways' lower score on “Measures to achieve change” in the Migrant Integration Policy Index (MIPEX). While the structure and organization at the municipality level should enable intersectoral action (as all under one umbrella), the municipal counties say lack of intersectoral collaboration is one of the main barriers for long-term public health work.

Description of the Problem

51 municipalities have an immigrant population larger than the national average 17,8% (2019). In a recent Country Assessment (part of Joint Action on Health Equity Europe), limited inter-sectoral action on the social determinants of health including migration was observed. Although multiple agencies are engaged in attempts to address these issues. While there is a drive to promote public health and primary health care in municipalities, these initiatives do not pay special attention to migrants. In the first stage of this project, we have reviewed municipal policy documents to map policy and measures on public health, migrant health and intersectoral collaboration. In the second stage, municipalities will be contacted to engage them in the implementation of intersectoral actions.

Results

The desk review and mapping show that only 8 of the “top” 32 municipalities mention “intersectoral” in the municipal master plan (5 were not available online), its mentioned in 9 action program/budgets, but not necessarily by the same municipalities. 15 of the municipalities mention migrants, but rarely in relation to health. We observe that, the size of the municipality, financial resources and support from the County are factors that may play a significant role in prioritising migrant health and intersectoral collaboration.

Lessons

Advocating for and supporting the local/municipal level for intersectoral action is highly relevant, timely and essential.

Key messages

Intersectoral action on the social determinants of migrants’ health needs to be implemented through municipal policies to reduce inequities in migrants’ health. Implementation on the local level is the main arena for good public health work and is crucial to ensure good health for migrants.
They just took him: Impacts of immigration enforcement on U.S. citizen Latino adolsecents’ well-being
Authors: Tellez Lieberman J , Bakely L , Correa C , Valdez C , Asadi Gonzalez A , Gonzalez-Fagoaga J E , Rangel M G , McGhee Hassrick E , Martinez-Donate A P
Published: October 2020

Background

Escalating interior immigration enforcement by the Trump administration threatens U.S. Latino immigrant families, yet systematic evidence is limited regarding the impacts of immigration enforcement in this community. Our study explored lived experiences of U.S.-citizen adolescents affected by various levels of immigration enforcement, including parental deportation.

Methods

In-depth interviews were conducted with adolescents (13-17 years old, N = 7) who experienced-or were at risk of-parental deportation as part of a larger, on-going longitudinal study. Interviews queried after their health, family life, perceived discrimination, conceptualization of today's anti-immigrant climate and, if applicable, the circumstances and impact of their parent's deportation. A preliminary qualitative analysis of the interviews was conducted. Interview summaries were created and reviewed systematically. Major themes and qualitative assertions were derived and discussed by the analytical team.

Results

Parental detainment/deportation was inherently violent and traumatic and had profound mental/emotional, physical, socio-cultural and economic consequences for separated adolescents as they assumed adult roles and responsibilities. The threat of deportation negatively affected the well-being of adolescents with deportable parents, resulting in increased vigilance and stress. Participants were ambivalent regarding their desire to talk about the risk of deportation or their experiences with it, as well as their own identities as Latinx citizens. They also reported feelings of isolation, discrimination and victimization related to immigration enforcement.

Conclusions

Anticipated and experienced parental deportation negatively affects health and well-being among U.S.-citizen adolescents. Family-friendly immigration policies, community-based interventions, and family counseling are critical to protect this vulnerable population.

Key messages

Following deportation, the deportee’s family—especially their U.S.-citizen adolescents—are profoundly and negatively affected. Even the threat of deportation stresses adolescents and their families and results in negative psychosocial outcomes.
Decolonising the commissioning of Indigenous health and wellbeing program evaluations in Australia
Authors: Finlay S , Judd J , Roe Y , Fredericks B , Smith J , Foley D , Boulton A , Cargo M
Published: October 2020

Background

Significant financial investments have been made to improve the life expectancy gap between Indigenous people and other Australians over the last 10 years. Despite the investment, few evaluations have been commissioned to assess program effectiveness. Indigenous leaders have been calling for a more active role in the commissioning of Indigenous program evaluations. This project aims to identify how government and non-government commissioning practices can better support Indigenous engagement and leadership in the evaluation of health and wellbeing programs in Australia. This presentation reports on the different commissioning models that support Indigenous program evaluations, from the perspectives of commissioners, evaluators and program providers.

Methods

Semi-structured interviews were conducted with 20 Indigenous and non-Indigenous commissioners, evaluators and program providers. A mixed coding procedure was used. Interviews were coded using deductively derived codes reflecting best practice principles in Indigenous evaluation and inductively derived codes from participant stories. Interviews were analysed using NVivo qualitative software. A collaborative group-based approach to data analysis was used guided by Indigenous Standpoint Theory.

Results

The commissioning of Indigenous-specific program evaluations in Australia reflects top-down, participatory, co-design and Indigenous-led approaches. Top-down approaches were considered 'extractive' and had limited or token Indigenous input. Indigenous models were more strongly aligned with best practice and reflected authentic Indigenous engagement. There was agreement across the stakeholder groups on the value of Indigenous engagement in the commissioning process. The presentation will elaborate on the different approaches, their characteristics, strengths/ limitations.

Conclusions

Diverse approaches to commissioning are used and reflect different levels of Indigenous engagement and leadership.

Key messages

In the commissioning of Indigenous evaluations there needs to be governance structures to support Indigenous engagement. In the commissioning of Indigenous evaluations there needs to be greater input by Indigenous people.
Communication barriers in maternity care - a questionnaire study among migrants to Norway
Authors: Bains S , Sundby J , Lindskog B V , Vangen S , Diep L M , Owe K , Sørbye I K
Published: October 2020

Background

Sub-optimal maternity care among migrants has been reported in a number of European countries. Explanations are multifactorial; however, communication barriers have been suggested as a major factor. Our aim was to explore recent migrant women's reported need for interpreter, actual interpreter use and the understanding of information provided during maternity care in Norway.

Methods

As part of the multidisciplinary, mixed method MiPreg-project, we applied a quantitative questionnaire, using a modified version of Migrant Friendly Maternity Care Questionnaire. We included recently (≤ 5 years) migrated women born in low or middle-income countries giving birth in urban Oslo, Norway, during 2019. Face-to-face interviews in women's own language of choice were conducted postpartum.

Results

We included 401 women from 65 countries. The five most frequent languages spoken at home were English, Polish, Arabic, Urdu and Tigrinya. The Norwegian proficiency was low; 23% not at all, 39% with difficulty, 39% good. Two thirds of women would have understood the information during maternity care better in another language. Two out of five felt a need for interpreting services and of these 44% and 81% were not offered interpreter during pregnancy and birth, respectively. The woman's partner or other adult family member interpreted most frequently, followed by professional interpreter and healthcare professionals. The women themselves often felt they understood the information provided; 78% always, 20% sometimes and 2% rarely/never. Increased length of residency and higher education was associated with better understanding, also after adjusting for maternal age and immigrant status.

Discussions

Several communication barriers exist for recent migrant women, with possible consequences for quality of maternity care. Recommended standards for interpretation services were not followed. To address barriers, increased use of interpreter and multilingual antenatal courses could be effective.

Key messages

Low language proficiency and use of interpreter may contribute to disparities in maternity care for migrants. The unmet needs for interpretation services must be addressed with appropriate actions.
Sexual health knowledge and behaviours in International MSM Students in Australia
Authors: Demant D , Kang M , Saliba B
Published: October 2020

Background

International sexual minority students, particularly men who have sex with men (MSM), experience disparities in health, including a significantly higher prevalence of HIV and other STIs and lower levels of sexual health services use. Limited research has been conducted in this population around sexual health knowledge, behaviour and services use.

Methods

A multi-language cross-sectional online survey was completed by 168 international MSM tertiary students (median age: 25 years) in New South Wales (Australia). Variables included demographics, sexual identity and behaviour, sexual health knowledge and behaviour including PrEP use as well as sexual health services use. Descriptive and correlational analyses, and binary logistic regressions were conducted.

Results

Sexual health knowledge including routes of HIV transmission was overall high in the sample, while 20% had limited knowledge regarding pre-exposure prophylaxis (PrEP) and 28% regarding post-exposure prophylaxis (PEP). Less than half (44%) reported inconsistent condom use. PrEP use was low in the sample (14%) and not correlated with condom use. Sexual health behaviours and dimensions LGBT Community connectedness were significantly correlated with the use of different sexual health services.

Conclusions

This first comprehensive study among international MSM tertiary students in Australia demonstrates a high level of inconsistent condom use and low levels of PrEP use as well as strong correlations between sexual health behaviour and HIV/STI testing, and connectedness with other sexual minority men. International MSM students do not feel included in the local LGBT Community but demonstrate a strong desire to be involved. Those included were more likely to use vital sexual health services.

Key messages

International MSM students are an emerging priority population for sexual health research and practice. Future health promotion campaigns should consider incorporating strong community building and connectedness elements.
Barriers and enablers for Indigenous public health practitioners
Authors: Rawson E
Published: October 2020

Indigenous Maori Public Health Practitioners who work in mainstream public health systems experience significant barriers to workplace success and the barriers to positive public health impact in our communities. This is a Kaupapa Maori qualitative study that highlights the barriers and enablers to Maori Senior Public Health practitioners within Mainstream New Zealand Public Health Units. Given there are nearly 400 million Indigenous people worldwide, this is an opportunity to share recommendations from this research study with the global public health community about how to re-orient public health organisations and approaches to effectively address workforce development as well as improve engagement and impact in Indigenous communities.

Key messages

Indigenous knowledge is undervalued in Mainstream Public Health Systems. Indigenous inequities cannot be truly addressed unless providers re-orient themselves by authentically understanding Indigenous ways of working.
Attendences on health to riverine population living in the banks of Amazon river, Amapa, Brazil
Authors: Bortoloti Faria Junior F F J , Vedovelli de Araujo J P A , Sabbag F Q , Rocha M P , Araujo H A , Vedovelli S , Duarte I S , D'Alexandri F L , Nava D , de Melo Cabral E R
Published: October 2020

Introduction

The riverine population resident at banks of Amazon river (Amapá, Brazil) has particularities related to health-disease process and socioepidemiologic demands, that represents a challenge for appointment of professionals in the unique health system. The project Mandic Borderless has a purpose to attend, in a complete and humanized way, populations without assistance in places of difficult access.

Objectives

Describe the experience and results obtained from the health care to riverine population in the region along Amazon River, Amapá, Brazil, attended during an expedition in 2020. Descriptive cross-sectional survey. The health-care staff that performed the consultations was composed of doctor, dentists, nurses and medical students, who work in a college located in the interior of the state of São Paulo.

Results

About 4,500 riverine populations were attended indirectly and other 1,775 directly by many medical specialties, such as: clinical medicine, gynecology, pediatrics, ophthalmology, dermatology, ultrasonography, nursery and odontology work for free. And also collective health education actions were carried out, addressing topics such as: oral health, scabies, pediculosis (lice), first aid, hypertension, diabetes, sexually transmitted diseases prevention and contraceptive methods. More than 300 patients received toothpaste kits and were instructed about oral health.

Conclusions

The expedition collected data about isolate population showing their necessary and provide an innovated experience in the medical teachings, considering the knowledge about the disease health process and the integrated and humanity care.

Key messages

Provide for medical students a vision about communities who lives in a geographic isolation. There are necessary of an upgrade in access a basic e essential services for the riverine population.
Do refugee women have increased risk of perinatal psychiatric dirsorders: a registered-based study?
Authors: Marti Castaner M , Norredam M , Holm Petersen J
Published: October 2020

Perinatal mental health (PMD) disorders affect up to 15% of women and have negative, long-lasting impact on mothers and children. This is recognized by the WHO as major public health issue. Studies show that migrant women are at increased risk of experiencing perinatal depression and anxiety compared to non-migrants. Knowledge about risk of other mental health disorders is limited and studies in Europe have not examined differences among women with different migrant status. This registered based study examines whether refugee (R) women and different groups of family-reunified (FR) migrants in Denmark have higher risk of PMD compared to native Danes (D) and, how migration related factors are associated with differences in risk of PMD among migrants.

We use data from the Danish Adult Refugee Cohort, which includes all refugee and family-reunified individuals who received residence permission in Denmark from 1998-2014 matched 1:6 to Danish born (D) individuals. We identified 274,920 women that gave birth to a live child, without prior psychiatric history and compared risk for PMD from pregnancy to 1 years postpartum between R, FR to R, FR to migrants, FR to Danes, and D women. Differences in types of diagnose (affective, psychotic, neurotic, or any other psychiatric disorder) were examined in sub-analyses. Within migrant women, we examined differences in psychiatric contact by region of origin, time since migration, refugee status, sociodemographic, and birth characteristics.

Compared to Danish born women, refugee women were more likely to have a PMD (aOR 1.23, 95% CI 1.01-1.49) and a higher burden of psychotic and neurotic-stress related disorders, while FR to migrants were less likely to have a PMD (aOR=0.37, 95% CI; 0.22-0.64) adjusting covariates. No differences in PMD emerged between FR to refugees, FR to Danes and Danes. Findings will have implications for perinatal mental health service delivery targeting certain immigrant groups and particularly refugees.

Key messages

Refugee women are at increased risk of experiencing psychiatric disorders during the perinatal period and efforts should be made to offer psychosocial support during pregnancy and after birth. Certain groups of non-refugee migrants may benefit from a ‘healthy migrant effect’ in regards to their risk of experiencing psychiatric disorders during the perinatal period.
Digital media and risks involved for the LGBT community
Authors: Sousa M A , Lima M D O , Oliveira P A
Published: October 2020

Background

With the increase in the use of the internet and digital media, the number of people looking to network digitally, or just to find someone to have romantic or sexual encounters, has also increased. For this, there are networks and applications that are used for the purpose of romantic and sexual encounters, such as Tinder, Happn, Badoo, Scruff, Grindr, among others. These types of networks currently allow and facilitate sexual contact, making it possible to arrange meetings only for the so-called casual sex, which can be defined as a kind of sexual experience that occurs without the need for a fixed relationship. With the possibility of the ease and practicality of being able to have a sexual relationship, attention should be paid to the vulnerability and risks that the social networks used for this purpose can place its users.

Objective

To understand how LGBT students deal with the use and risks involved in digital media.

Methods

This is a research with a qualitative approach, based on the Theory of Social Representations. University students who declared themselves as LGBT in the city of Belo Horizonte participated in the study. Data collection took place through open and in-depth interviews, with a semi-structured script. The data were interpreted based on the Structural Analysis of the Narration, proposed by Demazière; Dubar.

Results

Two theoretical categories were listed: Ease of contact with the use of social media - this category shows the ease that research participants have to show themselves, give opinions and demonstrate their interest in a person through digital media. Risks of using social media - Risks range from personal exposure, making an appointment with an unknown person, in addition to the risks related to sexually transmitted infections.

Conclusions

Users of digital media need to interpret the risks that are involved when accessing a social network and outline ways of taking care of themselves and others.

Key messages

Knowing ways that the LGBT community exposes itself in digital media can contribute to preventive actions and to promote the health of these people in a more effective way. With the ease of exchanging images and dating for casual sex, it is necessary to discuss new approaches to health, including by digital means.
Barriers and facilitators to surveying asylum seekers: reflections of the fieldwork personnel
Authors: Ahmed A , Omar H a j i , Castaneda A E , Klemettilä K-L , Garoff F , Skogberg N
Published: October 2020

Background

There is scarcity of representative data on the health and service needs of asylum seekers in Europe due to numerous practical and methodological challenges in planning and implementation of studies among this population group. Yet such data is acutely needed for development of health system response to meet the needs of asylum seekers. The aim of this study was to examine barriers and facilitators for conducting a population-based study among asylum seekers in Finland.

Methods

Semi-structured face-to-face individual interviews (n = 7) were carried out with the fieldwork personnel of the Asylum Seekers Health and Well-being Survey (TERTTU). Interviews contained four themes of which two will be presented in this abstract: the recruitment of the survey participants and carrying out the interviews and health examinations of the survey. Interviews of the fieldwork personnel were recorded and transcribed in verbatim. Data were analysed qualitatively using thematic analysis.

Results

Recruitment was substantially easier in reception centers than in private accommodations. Face-to-face and written information in participant's own language reduced misunderstandings and confidentiality concerns. Certain characteristics of the fieldwork personnel (mature age, female sex, and common cultural background) were facilitators for both recruitment and carrying out the survey appointments. Family and community members' perceptions influenced participation. Reception center personnel's attitudes influenced logistics of the recruitment process and the conduct of the survey. Incentives for participation were perceived both as facilitators and barriers.

Conclusions

It is feasible to obtain a high response rate among asylum seekers through investing in planning and dissemination of information about the study. Findings of this study can be benefited by other countries planning a survey among asylum seekers.

Key messages

Challenges in data collection among asylum seekers can be solved with careful planning and flexible fieldwork protocols. Sharing good practices about data collection among asylum seekers on a European level will inform researchers intending to conduct health surveys among asylum seekers and other forced migrants.
Characteristics of migrants to Japan with TB and implications for pre-migration TB screening
Authors: Uchimura K , Hamaguchi Y , Ohkado A , Yoshiyama T
Published: October 2020

Background

Japan plans to introduce pre-entry tuberculosis (TB) screening for those traveling from the Philippines, China, Vietnam, Nepal, Indonesia, and Myanmar, who are intending to stay in Japan for more than 90 days, in 2020. According to its screening algorithm, migrants will be screened by chest X-ray and those with abnormal findings will be asked to undergo sputum testing. We analyzed the characteristics of foreign-born TB patients coming from the above six countries, to identify some potential issues.

Methods

Data on foreign-born patients who had been newly notified with active pulmonary TB (PTB) in 2018 and 2017, and who had entered Japan in the same year they were notified, was extracted from the Japan TB Surveillance system. We assumed that these patients approximated to those hypothetical migrants who would be detected by pre-entry TB screening, and analyzed them by basic socio-demographic characteristics, radiological findings, and bacteriological test results.

Results

In 2017 and 2018, a total of 1,915 foreign-born PTB patients were notified from the above six countries. Of them, 19.9% (n = 381) had entered Japan in the same year they were notified. Among the 381, 23.9% (n = 50) had cavitary lesion, 27.3% (n = 57) were smear positive, and 48.9% (n = 73) were culture positive. 34.4% (n = 72) were both smear and culture negative, and the diagnosis would have depended on radiographical presentation. However, among the 72, the majority i.e. 87.5%, presented with non-cavitary pulmonary involvement.

Conclusions

Considering that approximately a third of TB patients who would may detected by the pre-entry screening are likely to be bacteriologically negative, Japan must ensure that the clinics conducting the pre-entry TB screening have access to high-quality radiography with expert interpretations, such as teleradiology and computer-assisted reading.

Key messages

A third of TB patients who would may detected by the pre-entry screening are likely to be bacteriologically negative. It is critical that clinics conducting screening have access to high-quality radiography with expert interpretations, such as teleradiology and computer-assisted reading.
Vaccination knowledge, attitudes and practices in patients with HIV: a cross-sectional survey
Authors: Rousset S , Voglino G , Boietti E , Corradi A , Gualano M R , Orofino G , Bert F , Farenga M , Siliquini R
Published: October 2020

Background

Infectious diseases are more common and severe in patients with HIV, which show different response to vaccines and a diminished protection. It is therefore very important to assess knowledge and attitudes towards vaccination in people with HIV, since precise vaccination coverage and vaccine hesitancy are not well established in this subgroup of patients.

Methods

A sample of 119 patients with HIV completed a cross-sectional survey. Patients were recruited during their routine medical examination at the infectious diseases clinic in Turin. The survey explored these main areas: demographics and history of HIV infection, vaccination history, attitudes towards vaccination, confidence in the public health system, contagion risk and disease seriousness perception. In this preliminary phase descriptive analysis were conducted.

Results

Preliminary data show that mean age of the participants was 49.51 years, 80% were males. The median of HIV infection duration was 10 years, while the median of the lymphocyte count was 762.50 cells/mm3. The disease with the highest vaccination coverage was tetanus (88.7%), considered a serious or very serious disease by 85.6% of the participants, despite low or very low contagion risk perception (84.1%). The disease with the lowest vaccination coverage was Herpes Zoster (7.3%), despite high or very high seriousness perception (70%). Furthermore, 99.1% of the participants showed high or very high confidence toward public health system professionals, and the majority of them (59.5%) stated that vaccines are more useful for the community than for the single person.

Conclusions

Vaccination coverage is still not fully satisfactory regarding diseases considered infrequent or mild. Considering the high level of confidence toward the public health system that has emerged, it is necessary to implement informative and operative strategies about vaccination for European HIV patients, which are particularly at risk regarding infectious diseases.

Key messages

Vaccination coverage and risk perception in HIV patients is not satisfactory for many diseases and an effort to implement informative strategies in Europe is needed. The role of vaccination in preventing infectious diseases in HIV patients should be recognized and strengthened by relying on the high level of confidence toward European public health systems.
Tuberculosis among immigrants: risk factors associated with a delayed diagnosis in Portugal
Authors: Moniz M , Soares P , Nunes C
Published: October 2020

Background

A timely diagnosis is a key factor to TB control, since delayed diagnosis increases transmission, severity and mortality rates. However, immigrants have a higher risk of delay due to difficulties in the access to the healthcare services. Hence, the aim of this study is to identify risk factors associated with delays in immigrants and compare the results with the national population.

Methods

We carried out a retrospective study to analyse all pulmonary TB cases notified in Portugal having a passive case finding, between 2008 and 2017. Global delay was defined as the number of days between symptoms onset and diagnosis date and divided into patient delay (time between symptoms onset and first appointment date) and healthcare services delay (time between first appointment date and diagnosis date). A descriptive analysis was performed, and factors associated with each delay were identified using a Cox regression. Analyses were stratified by country of origin: immigrants (born outside of Portugal) and nationals (Portuguese population).

Results

Our results were consistent with previous studies and showed that the immigrant population was younger, had a higher proportion of HIV infection and had a smaller proportion of alcoholics, drug addicts, inmates, homeless and individuals living in community residencies compared to nationals. Immigrants had higher patient delay (44 vs. 36 days) compared to nationals. Different risk factors were associated with the delay in immigrants and nationals. Alcohol addiction was the only significant variable in both populations and was associated with lower delay in health services.

Conclusions

Immigrants have higher global delay, attributable to a higher patient delay. The risk factors related to TB diagnosis delay have an heterogeneous association in immigrant and nationals. Hence, tailored interventions should be implemented to decrease the delay among immigrants.

Key messages

Different risk factors were identified for the patient and healthcare services delay among immigrants and nationals, which highlight the importance to analyse each component of TB diagnosis delay. Immigrants have higher patient delay compared to nationals, hence tailored interventions should be implemented to facilitate access to healthcare services in this population.