Prevalence of vitamin D deficiency and its association with cardiometabolic risk factors among healthcare workers in the Eastern Cape province, South Africa; cross-sectional study.

This study assesses the prevalence of Vitamin D deficiency and its potential association with cardiometabolic risk factors among South African adults residing in the Eastern Cape province. In this cross-sectional study, 1244 healthcare workers (HCWs) completed a self-administered questionnaire and venous blood samples were drawn at two academic hospitals in the Eastern Cape. History of hypertension and diabetes mellitus were self-reported. Participants were categorised as obese if their body mass index (BMI) ≥ 30 kg/m2. Participants were classified as having metabolic syndrome if they had hypertension, diabetes mellitus and obesity. Vitamin D [25(OH)D] deficiency was defined as venous blood concentrations < 50 nmol/L. Associations between vitamin D deficiency and participants' characteristics were assessed using multivariate logistic regression model analysis. The prevalence of vitamin D deficiency was 28.5% (n = 355), of whom 292 were female. Among the participants who were deficient in vitamin D, the prevalence of obesity, diabetes mellitus, hypertension, chronic kidney disease, and metabolic syndrome was 64.9% (n = 230), 9% (n = 32), 16.6% (n = 59), 2.3% (n = 8) and 18% (n = 64), respectively. In the adjusted multivariate logistic regression model, black Africans (AOR = 2.87; 95% CI 1.52-5.43) and individuals ≥ 42 years (AOR = 1.37; 95% CI 1.07-1.77) were more likely to exhibit vitamin D deficiency. However, there was no significant association by age, sex, and cardiometabolic markers. More than one in four healthcare workers was deficient in vitamin D among the study sample, especially the black Africans and older individuals. Further studies are needed at the population level to elucidate on the vitamin D status in the region.

Does Engagement in HIV Care Affect Screening, Diagnosis, and Control of Noncommunicable Diseases in Sub-Saharan Africa? A Systematic Review and Meta-analysis.

Low- and middle-income countries are facing a growing burden of noncommunicable diseases (NCDs). Providing HIV treatment may provide opportunities to increase access to NCD services in under-resourced environments. We conducted a systematic review and meta-analysis to evaluate whether use of antiretroviral therapy (ART) was associated with increased screening, diagnosis, treatment, and control of diabetes, hypertension, chronic kidney disease, or cardiovascular disease among people living with HIV in sub-Saharan Africa (SSA). A comprehensive search of electronic literature databases for studies published between 01 January 2011 and 31 December 2022 yielded 26 studies, describing 13,570 PLWH in SSA, 61% of whom were receiving ART. Random effects models were used to calculate summary odds ratios (ORs) of the risk of diagnosis by ART status and corresponding 95% confidence intervals (95% CIs), where appropriate. ART use was associated with a small but imprecise increase in the odds of diabetes diagnosis (OR 1.07; 95% CI 0.71, 1.60) and an increase in the odds of hypertension diagnosis (OR 2.10, 95% CI 1.42, 3.09). We found minimal data on the association between ART use and screening, treatment, or control of NCDs. Despite a potentially higher NCD risk among PLWH and regional efforts to integrate NCD and HIV care, evidence to support effective care integration models is lacking.

The association of menopause with cardiometabolic disease risk factors in low- and middle-income countries: a systematic review and meta-analyses.

IMPORTANCE: Menopause is an integral part of women's health, and studies in high-income countries have shown an increase in cardiometabolic disease (CMD) risk factors in postmenopausal compared with premenopausal women. However, to date, no study has combined and assessed such studies across low- and middle-income countries. This would better inform early monitoring and intervention strategies for reducing CMD risk factor levels in midlife women in these regions. OBJECTIVE: This study aimed to evaluate evidence from the literature on differences in CMD risk factors between premenopausal and postmenopausal midlife women living in low- and middle-income countries. EVIDENCE REVIEW: A systematic review with meta-analysis of original articles of all study designs from the databases PubMed, PubMed Central, Scopus, and ISI Web of Science was conducted from conception until April 24, 2023. Studies that met the inclusion criteria were included in the analysis. Quality assessment of the articles was done using the Newcastle-Ottawa Scale, adapted for each study design. The study protocol was registered with the International Prospective Register of Systematic Reviews and adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. For the meta-analysis, fixed-effects models were used to pool the odds ratios (OR), as measures of association. FINDINGS: Our search identified 4,849 relevant articles: 44 for the systematic review and 16 for the meta-analysis, in accordance with our inclusion criteria. Compared with premenopausal women, the postmenopausal stage was associated with metabolic syndrome (OR, 1.18 [95% CI, 1.11-1.27]), high waist-to-hip ratio (OR, 1.22 [95% CI, 1.12-1.32]), hypertension (OR, 1.10 [95% CI, 1.04-1.16]), elevated triglycerides (OR, 1.16 [95% CI, 1.11-1.21]), and elevated plasma glucose (OR, 1.21 [95% CI, 1.15-1.28]). CONCLUSIONS AND RELEVANCE: This study confirmed that CMD risk factors are present at higher levels in postmenopausal than premenopausal women. This demonstrates an urgent need for public health policies that focus on early monitoring and interventions targeted at reducing CMD risk and related adverse outcomes in midlife women in these nations.

Gaps in the type 2 diabetes care cascade: a national perspective using South Africa's National Health Laboratory Service (NHLS) database.

BACKGROUND: Research out of South Africa estimates the total unmet need for care for those with type 2 diabetes mellitus (diabetes) at 80%. We evaluated the care cascade using South Africa's National Health Laboratory Service (NHLS) database and assessed if HIV infection impacts progression through its stages. METHODS: The cohort includes patients from government facilities with their first glycated hemoglobin A1c (HbA1c) or plasma glucose (fasting (FPG); random (RPG)) measured between January 2012 to March 2015 in the NHLS. Lab-diagnosed diabetes was defined as HbA1c ≥ 6.5%, FPG ≥ 7.0mmol/l, or RPG ≥ 11.1mmol/l. Cascade stages post diagnosis were retention-in-care and glycaemic control (defined as an HbA1c < 7.0% or FPG < 8.0mmol/l or RPG < 10.0mmol/l) over 24-months. We estimated gaps at each stage nationally and by people living with HIV (PLWH) and without (PLWOH). RESULTS: Of the 373,889 patients tested for diabetes, 43.2% had an HbA1c or blood glucose measure indicating a diabetes diagnosis. Amongst those with lab-diagnosed diabetes, 30.9% were retained-in-care (based on diabetes labs) and 8.7% reached glycaemic control by 24-months. Prevalence of lab-diagnosed diabetes in PLWH was 28.6% versus 47.3% in PLWOH. Among those with lab-diagnosed diabetes, 34.3% of PLWH were retained-in-care versus 30.3% PLWOH. Among people retained-in-care, 33.8% of PLWH reached glycaemic control over 24-months versus 28.6% of PLWOH. CONCLUSIONS: In our analysis of South Africa's NHLS database, we observed that 70% of patients diagnosed with diabetes did not maintain in consistent diabetes care, with fewer than 10% reaching glycemic control within 24 months. We noted a disparity in diabetes prevalence between PLWH and PLWOH, potentially linked to different screening methods. These differences underscore the intricacies in care but also emphasize how HIV care practices could guide better management of chronic diseases like diabetes. Our results underscore the imperative for specialized strategies to bolster diabetes care in South Africa.

The stability of C-peptide and insulin in plasma and serum samples under different storage conditions.

OBJECTIVES: C-peptide and insulin are peptide hormones and their stability is affected by a number of pre-analytical factors. The study aimed to investigate the impact of sample type, storage temperature and time delays before centrifugation and analysis on the stability of C-peptide and insulin. METHODS: Ten healthy non-diabetic adults in fasting and non-fasting state were enrolled. 40 mL of blood was collected from each participant into SST and dipotassium EDTA tubes. Samples were centrifuged immediately or at timed intervals (8, 12, 48 and 72 h). After baseline measurements on the Roche Cobas e602 analyzer using electrochemiluminescence immunoassays, aliquots were stored at room temperature (RT), 2-8 and -20 °C for 4 h to 30 days. The percentage deviation (PD) from baseline was calculated and a change greater than desirable biological variation total error was considered clinically significant. RESULTS: C-peptide was more stable in separated serum than plasma (PD of -5 vs. -13 %) samples stored at 2-8 °C for 7 days and was most unstable at RT when centrifugation was delayed (PD -46 % in plasma and -74 % in serum after 48 h). Insulin was more stable in plasma than in serum under the different storage conditions with a minimum PD of -1% when stored at -20 °C for 30 days. When samples were kept unspun at RT for 72 h, PD was -23 and -80 % in plasma and serum, respectively. CONCLUSIONS: C-peptide was more stable in serum provided the sample was centrifuged immediately and stored in the fridge or freezer while insulin was found to be more stable in EDTA plasma.

COVID Diagnostics: From Molecules to Omics.

The identification and genetic sequencing of a novel coronavirus was key to the diagnosis and management of the global pandemic. An understanding of the SARS-CoV-2 structure and mechanism of injury is vital to explaining the disease course and the pathophysiology of the signs and symptoms observed. This particularly as the presentation, disease course, and severity are noted to be highly variable. The role of the spike protein and angiotensin-converting enzyme 2 (ACE-2) receptor in immune response and viral entry provides great insight into current and future diagnostics and therapeutics. This article reviews the traditional diagnostic methods, which include molecular testing methods, antigen testing, and antibody testing. The gold standard for diagnosis of COVID-19 is reverse transcriptase polymerase chain reaction (RT-PCR). There have been multiple improvements to these principles to help optimize the sensitivity, specificity, and user friendliness of the method. In addition, advancements in gene sequencing and identification have been integral to identifying variants and managing outbreaks. Serological and immunological testing have made significant contributions to the management of the COVID-19 pandemic, each with its unique benefits and limitations. A growing role of the laboratory is in triaging patients to determine which patients will most benefit from hospitalization and specialized care. This is imperative for rationalizing resources during outbreaks. As we learn to live with the pandemic, novel testing methods include the use of multiomic technologies and the greater utility of point of care.

Assessing Biomarkers in Viral Infection.

Current biomarkers to assess the risk of complications of both acute and chronic viral infection are suboptimal. Prevalent viral infections like human immunodeficiency virus (HIV), hepatitis B and C virus, herpes viruses, and, more recently, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) may be associated with significant sequelae including the risk of cardiovascular disease, other end-organ diseases, and malignancies. This review considers some biomarkers which have been investigated in diagnosis and prognosis of key viral infections including inflammatory cytokines, markers of endothelial dysfunction and activation and coagulation, and the role that more conventional diagnostic markers, such as C-reactive protein and procalcitonin, can play in predicting these secondary complications, as markers of severity and to distinguish viral and bacterial infection. Although many of these are still only available in the research setting, these markers show promise for incorporation in diagnostic algorithms which may assist to predict adverse outcomes and to guide therapy.

Food Insecurity, Food Assistance, and Psychological Distress among University Students: Cross-Sectional Survey Western Australia, 2020.

University students have been identified as a population sub-group vulnerable to food insecurity. This vulnerability increased in 2020 due to the COVID-19 pandemic. This study aimed to assess factors associated with food insecurity among university students and the differences between students with and without children. A cross-sectional survey of (n = 213) students attending one university in Western Australia measured food insecurity, psychological distress, and socio-demographic characteristics. Logistic regression analyses were conducted to identify factors associated with food insecurity. Forty-eight percent of students who responded to the survey had experienced food insecurity in 2020. International students who were studying in Australia were nine times more likely to experience food insecurity than domestic students (AOR = 9.13; 95% CI = 2.32-35.97). International students with children were more likely to experience food insecurity than international students without children (p < 0.001) and domestic students with (p < 0.001) or without children (p < 0.001). For each unit increase in depression level, the likelihood of experiencing food insecurity increased (AOR = 1.62; 95% CI = 1.12-2.33). Findings show a higher prevalence of food insecurity among international university students and students with children during the COVID-19 pandemic and that food insecurity was associated with higher levels of psychological distress. These findings highlight the need for targeted interventions to mitigate the risk of food insecurity among Australian university students, particularly among international students, students with children, and those experiencing psychological distress.

Corrigendum: The application of sigma metrics in the laboratory to assess quality control processes in South Africa.

[This corrects the article DOI: 10.4102/ajlm.v11i1.1344.].

Cardiometabolic disease risk factors in pre- and postmenopausal women from four sub-Saharan African countries: A cross-sectional study.

OBJECTIVE: To compare the risk factors for cardiometabolic disease between pre- and postmenopausal women from four sub-Saharan African countries. STUDY DESIGN: This cross-sectional study included 3609 women (1740 premenopausal and 1869 postmenopausal) from sites in Ghana (Navrongo), Burkina Faso (Nanoro), Kenya (Nairobi), and South Africa (Soweto and Dikgale). Demographic, anthropometric and cardiometabolic variables were compared between pre- and postmenopausal women, within and across sites using multivariable regression analyses. The sites represent populations at different stages of the health transition, with those in Ghana and Burkina Faso being rural, whilst those in Kenya and South Africa are more urbanised. MAIN OUTCOME MEASURES: Anthropometric and cardiometabolic variables. RESULTS: The prevalence rates of risk factors for cardiometabolic disease were higher in South (Soweto and Dikgale) and East (Nairobi) Africa than in West Africa (Nanoro and Navrongo), irrespective of menopausal status. Regression models in combined West African populations demonstrated that postmenopausal women had a larger waist circumference (ß = 1.28 (95 % CI: 0.58; 1.98) cm), log subcutaneous fat (ß =0.15 (0.10; 0.19)), diastolic (ß = 3.04 (1.47; 4.62) mm Hg) and log systolic (ß = 0.04 (0.02; 0.06)) blood pressure, log carotid intima media thickness (ß = 0.03 (0.01; 0.06)), low-density lipoprotein cholesterol (ß = 0.14 (0.04; 0.23) mmol/L) and log triglyceride (ß= 0.10 (0.04; 0.16)) levels than premenopausal women. No such differences were observed in the South and East African women. CONCLUSIONS: Menopause-related differences in risk factors for cardiometabolic disease were prominent in West but not East or South African study sites. These novel findings should inform cardiometabolic disease prevention strategies in midlife women specific to rural and urban and peri-urban locations in sub-Saharan Africa.

Preparing Students for Post-COVID Nursing Careers: The Value of International Clinical Placements.

BACKGROUND: Prior to the coronavirus disease 2019 (COVID-19) pandemic, international clinical placements (ICPs) for nursing students were used to build cultural humility and global awareness. This study explored the influence of ICPs on nursing students' career planning and views of the nursing role; the findings were considered against the evolving pandemic context. METHOD: A qualitative, descriptive longitudinal study was conducted with 25 preregistration nursing students who participated in an international placement. Semistructured individual interview data were examined using thematic analysis. RESULTS: Participants were interested in patient equity and empowerment, high acuity and variety, health policy, and primary care. Participants developed resilience and nursing confidence. They saw the effects of poor health equity and health policy decisions on population health. CONCLUSION: ICPs expanded participants' understanding of global interconnectedness and also identified new career possibilities. Postpandemic, nursing education should continue to maintain a global focus on health. [J Nurs Educ. 2023;62(4):207-214.].

Professional Interpreter Services and the Impact on Hospital Care Outcomes: An Integrative Review of Literature.

Migration patterns have rapidly changed in Australia and elsewhere, which have contributed to increasingly culturally and linguistically diverse societies. This requires healthcare sectors to provide professional interpreter services for patients with a language barrier to eliminate healthcare disparities. This integrative review aimed to investigate the impact of professional interpreter services on hospital care outcomes and the associated cost of service provision. A systematic search of five databases was conducted for peer-reviewed articles from January 1996 to December 2020. Data were extracted for the hospital setting, intervention, population, study design, outcomes and key findings. Following the PRISMA guidelines, full-text screening identified 37 articles that were analysed and included. Communication quality, hospital care outcomes and hospital costs were the three main themes identified. Closing the language gap should be a primary consideration to prevent adverse events that affect patient safety and the standard of care in hospitals. The findings of this review indicate the provision of professional interpreter services can enhance hospital care for linguistically diverse patients by improving patient-provider communication. To gain insight into the changing patterns on the outcomes of medical care, further research requires efforts by the hospital administrative system to document complete records of service usage.

Does engagement in HIV care affect screening, diagnosis, and control of noncommunicable diseases in sub-Saharan Africa? A systematic review and meta-analysis.

Objective: Low- and middle-income countries are facing a growing burden of noncommunicable diseases (NCDs). Providing HIV treatment may also provide opportunities to increase access to NCD services in under-resourced environments. We sought to investigate whether reported use of antiretroviral therapy (ART) was associated with increased screening, diagnosis, treatment, and/or control of diabetes, hypertension, chronic kidney disease, or cardiovascular disease among people living with HIV (PLWH) in sub-Saharan Africa (SSA). Design: Systematic review and meta-analysis. Methods: We searched 10 electronic literature databases for studies published between 01 January 2011 and 31 December 2022 using a comprehensive search strategy. We sought studies reporting on screening, diagnosis, treatment, and/or control of NCDs of interest by ART use among non-pregnant adults with HIV ≥16 years of age in SSA. Random effects models were used to calculate summary odds ratios (ORs) of the risk of diagnosis by ART status and corresponding 95% confidence intervals (95% CIs), where appropriate. Results: Twenty-six studies, describing 13,570 PLWH in SSA, 61% of whom were receiving ART, were included. ART use was associated with a small but imprecise increase in the odds of diabetes diagnosis (OR: 1.07; 95% CI: 0.71, 1.60) and an increase in the odds of hypertension diagnosis (OR: 2.10, 95% CI: 1.42, 3.09). We found minimal data on the association between ART use and screening, treatment, or control of NCDs. Conclusion: Despite a potentially higher NCD risk among PLWH and regional efforts to integrate NCD and HIV care, evidence to support effective care integration models is lacking.

Gynaecological Cancers in India: The Less Heard Perspectives of Healthcare Providers.

There has been mounting evidence on the role of healthcare providers in chronic illnesses such as cancer. The specific complexities in their roles to enable health are less heard. Gynaecological cancers have several undercurrents beyond the obvious. Semi-structured interviews were conducted with healthcare providers in Southern India (n = 35) and the data presented in this article were collected as a part of a larger study on the role of communication in the management of gynaecological cancers in India. Thematic analysis of the qualitative data provided information on the providers' perspectives of gynaecological cancers. Patient numbers, cost, time, cultural norms, context, and institutional constraints in cancer care provision are just some of the factors impacting care provision. Healthcare providers are typically acknowledged for the criticality of their roles in the continuum of care. However, our research suggests that the psychological harm and challenges they themselves may face in providing that care are severely neglected. Through listening to healthcare provider voices, clear solutions emerge to better support the practice of those who are responsible for cancer care.

Males' Lived Experience with Self-Perceived Pornography Addiction: A Qualitative Study of Problematic Porn Use.

The positive impact of pornography use has been demonstrated; however, most research points towards problematic, compulsive, or excessive engagement with pornography and associated adverse effects on well-being. However, results remain inconclusive and qualitative research capturing perspectives of affected people is scarce. This phenomenological study aimed to explore the perspective and lived experience of males with a self-reported addiction to pornography. Semi-structured in-depth interviews with 13 males aged between 21 and 66 years from Australia and the USA were conducted. A thematic analysis of the transcripts was undertaken, resulting in the identification of four themes. The interviews explored the participants' reasoning for determining themselves as porn addicts, investigated patterns of use, examined the perceived multifaceted impacts of pornography use, illustrated applied individual strategies to overcome the addiction, and proposed interventions helping to inform future recommendations. Experiences and perceptions of pornography addiction were consistently depicted as problematic and harmful. Most participants described an inability to stop their consumption despite experiencing adverse effects. Commonly reported was a gradual increase in the use of and consumption of new or more shocking content. Consumption of content was outlined as an escape or coping mechanism for negative emotions or boredom. Participants reported a variety of applied strategies to manage their addiction and suggested recommendations. Investigation into strategies for the identification of problematic pornography use, its conceptualization, associated health outcomes, and effective preventative and interventional strategies are required to provide academic consistency, support those negatively affected by pornography, and achieve increased public awareness of the issue.

"I don't think marijuana counts as a drug": Drug & alcohol use amongst South Sudanese youth in Australia.

AIMS: To understand alcohol and other drug (AOD) use and its impact among South Sudanese youth in Melbourne, Australia. METHODS: This qualitative exploratory study was underpinned by the psychosocial conceptual framework. We undertook semi-structured interviews with 23 South Sudanese youth aged 14-21 years to explore attitudes and potential harms of AOD use. We also undertook focus groups with these participants and a focus group of 11 South Sudanese community elders and parents. Feedback on results was obtained through two forums with community members. The data collected were analyzed using thematic analysis. RESULTS: The participants revealed that AOD use was common, specifically the use of cannabis. The participants believed that there was a lack of basic understanding of the potential harm of cannabis use. The results also highlighted that the community was unaware how the use of drugs and alcohol can contribute and exacerbate poor mental health. Cannabis was a regular drug of choice used by young South Sudanese in this study. It was used daily as a coping mechanism both for stress and for undiagnosed mental health. CONCLUSION: The results of this study indicate increased potential harm for South Sudanese youth from AOD use. Of concern was a lack of diagnosis and treatment for mental health wellbeing due to the beliefs around AOD use. Without targeted interventions this has significant implications for the South Sudanese community and the young people affected. The significance of these findings may assist in the delivery of AOD treatment and improve health education for refugee youth.

Intergenerational conflict among resettled South Sudanese in Australia.

South Sudanese families have faced many hardships in the process of acculturation to Australian society. This has led to rapid family breakdown amongst refugees from South Sudan who live in Melbourne, Australia, and has created tension between families, the wider South Sudanese community, and authorities. This qualitative study explores how shifting dynamics of religious faith, the concept of family and cultural values impacts South Sudanese families and young people. The study consisted of 23 semi-structured interviews, three focus groups and two feedback forums, gathering data from South Sudanese youth aged 14 to 21 years, social workers, elders and parents from the South Sudanese community. Several themes were identified including the impact of intergenerational conflict, coping with new freedoms in Australia, the associated tensions these freedoms create within the South Sudanese community, and young people's conflict with religion. The patriarchal system that underpins the family structure of the South Sudanese culture is under significant strain as women and children are becoming aware of their rights, resulting in friction between men and women, parents and children. Male elders believed the embracing of freedom by women and children was at the core of family breakdown, leading to cultural erosion, and was the root of the problems experienced by the youth. The church as a traditional meeting place and a centre point for social inclusion within the South Sudanese community remains relevant as an important factor in social networking for parents and elders but lacks relevance for many South Sudanese youth.

Chronic kidney disease (CKD) and associated risk in rural South Africa: a population-based cohort study.

Background: In Africa, true prevalence of chronic kidney disease (CKD) is unknown, and associated clinical and genetic risk factors remain understudied. This population-based cohort study aimed to investigate CKD prevalence and associated risk factors in rural South Africa. Methods: A total 2021 adults aged 20-79 years were recruited between 2017-2018 from the Agincourt Health and Socio-Demographic Surveillance System in Bushbuckridge, Mpumalanga, South Africa. The following were collected: sociodemographic, anthropometric, and clinical data; venous blood samples for creatinine, hepatitis B serology; DNA extraction; spot urine samples for dipstick testing and urine albumin: creatinine ratio (UACR) measurement. Point-of-care screening determined prevalent HIV infection, diabetes, and hypercholesterolemia. DNA was used to test for apolipoprotein L1 ( APOL1) kidney risk variants. Kidney Disease Improving Global Outcomes (KDIGO) criteria were used to diagnose CKD as low eGFR (<60mL/min/1.73m 2) and /or albuminuria (UACR ≥ 3.0mg/mmol) confirmed with follow up screening after at least three months. eGFR was calculated using the CKD-EPI (creatinine) equation 2009 with no ethnicity adjustment. Multivariable logistic regression was used to model CKD risk. Results: The WHO age-adjusted population prevalence of CKD was 6.7% (95% CI 5.4 - 7.9), mostly from persistent albuminuria. In the fully adjusted model, APOL1 high-risk genotypes (OR 2.1; 95% CI 1.3 - 3.4); HIV infection (OR 1.8; 1.1 - 2.8); hypertension (OR 2.8; 95% CI 1.8 - 4.3), and diabetes (OR 4.1; 95% CI 2.0 - 8.4) were risk factors. There was no association with age, sex, level of education, obesity, hypercholesterolemia, or hepatitis B infection. Sensitivity analyses showed that CKD risk factor associations were driven by persistent albuminuria, and not low eGFR. One third of those with CKD did not have any of these risk factors. Conclusions:  In rural South Africa, CKD is prevalent, dominated by persistent albuminuria, and associated with APOL1 high-risk genotypes, hypertension, diabetes, and HIV infection.

Peer Mentoring Programs for Culturally and Linguistically Diverse Refugee and Migrant Women: An Integrative Review.

Refugee and migrant women experience personal, cultural and structural challenges as they adapt to new lives in host countries. Peer mentoring programs are used to facilitate resettlement, build empowerment and improve job-readiness for refugee and migrant women; however, the effectiveness of these programs is not well understood. A systematic search of five databases, plus grey literature from January 2005 to December 2020, was undertaken, resulting in 12 articles. A narrative synthesis using thematic analysis identified the key components and outcomes of effective programs. Most mentoring programs were co-designed with community-based service providers, using participatory approaches to ensure cultural acceptability. Communication and sharing were facilitated using workshops and individual in-person or telephone mentoring. The training and support of mentors was critical. However, differences in expectations between mentors and mentees at times resulted in attrition. Qualitative evaluation revealed enhanced social support, greater empowerment and confidence for the women. There was improved access to the social determinants of health such as education, but limited success in obtaining employment. Mentoring programs can enhance refugee and migrant women's wellbeing and social connectedness in resettlement contexts. However, it is unclear whether these benefits can be sustained over the longer term. Future programs should be rigorously evaluated through qualitative and quantitative analyses to generate conclusive evidence for best practice.