Health Resilience in Arabic-speaking Adult Refugees With Type 2 Diabetes: A Grounded Theory Study During the COVID-19 Pandemic.

OBJECTIVES: This qualitative study aimed to describe the lived experiences of Arabic-speaking refugees in managing their type 2 diabetes mellitus (T2DM) while resettling during the COVID-19 pandemic, and to generate a grounded theory of how resilience is used to facilitate living well while facing multiple health stressors. METHODS: A grounded theory approach was used to conceptualize the dynamic process of resilience in living well with diabetes. Five recently resettled adult refugees with T2DM (2 women and 3 men) participated in unstructured individual interviews in Arabic in New Brunswick, Canada, during the pandemic's second wave (October 2020 to March 2021). Interview data were transcribed and analyzed thematically using open, axial, and core category coding followed by member checking. RESULTS: Participants identified self-reliance as the core driver for decision-making, actions, and interpretations in health management while experiencing unplanned instability. The process was found to be facilitated by 4 distinct constructs: knowledge seeking, positive outlook, self-care, and creativity. CONCLUSIONS: The substantive model derived from this study supports a strengths-based approach to clinical assessment and care of refugees with T2DM, notably during disrupted access to primary and preventive services due to forced resettlement and pandemic mitigation measures. More research is needed to increase understanding of how self-reliance can be optimized in resilience-promoting interventions to facilitate diabetes management among populations in posttraumatic circumstances.

Migratory phenomenon and expressive sandwork in vulnerable populations.

In these times the migratory phenomenon is a crisis with alarming dimensions worldwide. Wars, human rights violations and violence within borders have pushed many people to seek asylum or have forced internal displacement. We approach this phenomenon taking into account the cultural complexes, understanding it as a process with multiple psychological, social and existential effects for those who suffer it. We find these effects symbolized in many of the processes of the children participating in Expressive Sandwork projects. Expressive Sandwork is a transcultural, non-verbal method of therapeutic care that offers psychological support to children from vulnerable populations where psychotherapy is deficient or non-existent. The aim is to allow the emergence of images that favour reconnection with the child's creative potential, activating the process of self-regulation of the psyche. Its basis in symbolic processes and empathetic accompaniment makes it a Jungian psychosocial intervention for these times of transition. In Latin America, Expressive Sandwork projects have been implemented in Colombia and Argentina. Two examples of the participating children are presented.

A notre époque le phénomène migratoire est une crise qui a des dimensions alarmantes au niveau mondial. Les guerres, les violations des droits humains et la violence au sein même des frontières ont poussé de nombreuses personnes à chercher asile à l'étranger, ou les ont forcées à un déplacement à l'intérieur des frontières. Nous abordons ce phénomène en prenant en compte les complexes culturels. Nous le comprenons comme un processus ayant de multiples effets psychologiques, sociaux et existentiels pour les personnes qui en souffrent. Nous observons ces effets symbolisés dans de nombreux processus des enfants qui participent aux projets de travail expressif à l'aide du jeu de sable (Expressive Sandwork). L'Expressive Sandwork est une méthode de soin thérapeutique transculturelle et non-verbale qui offre du soutien psychologique à des enfants de populations vulnérables quand la psychothérapie est déficiente ou non-existante. Le but en est de permettre l'émergence d'images qui favorisent le rétablissement du potentiel créatif de l'enfant, activant ainsi le processus d'autorégulation de la psyché. Son enracinement dans les processus symboliques et l'accompagnement empathique en font une intervention Jungienne psychosociale pour notre époque de transition. En Amérique Latine, les projets de travail expressif à l'aide du jeu de sable ont été implantés en Colombie et en Argentine. Deux exemples d'enfants qui y ont participé sont présentés.

En estos tiempos el fenómeno migratorio es una crisis con dimensiones alarmantes a nivel mundial. Las guerras, la violación de los derechos humanos y la violencia al interior de las fronteras han empujado a muchas personas a buscar asilo o al desplazamiento forzado interno. Nos aproximamos a este fenómeno teniendo en cuenta los complejos culturales y comprendiéndolo como un proceso con múltiples efectos psicológicos, sociales y existenciales para quienes lo sufren. Estos efectos los encontramos simbolizados en muchos de los procesos de los niños/as participantes en los proyectos de Trabajo Expresivo con Arena. El Trabajo Expresivo con Arena es un método de cuidado terapéutico no verbal y transcultural que ofrece apoyo psicológico a niños/as de poblaciones vulnerables, donde la psicoterapia es deficiente o inexistente. El objetivo es permitir el surgimiento de imágenes que favorezcan la reconexión con el potencial creativo del niño/a, activando el proceso de autorregulación de su psique. Su base en procesos simbólicos y en el acompañamiento empático, lo constituyen en una intervención psicosocial de la psicología junguiana para estos tiempos de transición. En Latinoamérica se han implementado proyectos de Trabajo Expresivo con Arena en Colombia y Argentina. En este artículo se presentarán dos ejemplos de niños que formaron parte de estos proyectos.

Nestes tempos, o fenômeno migratório é uma crise com dimensões alarmantes em todo o mundo. Guerras, violações dos direitos humanos e violência dentro das fronteiras levaram muitas pessoas a buscar asilo ou deslocamento interno forçado. Abordamos esse fenômeno levando em consideração os complexos culturais, entendendo-o como um processo com múltiplos efeitos psicológicos, sociais e existenciais para aqueles que o sofrem. Encontramos esses efeitos simbolizados em muitos dos processos das crianças que participam de projetos Expressive Sandwork. O Expressive Sandwork é um método transcultural e não verbal de cuidados terapêuticos que oferece apoio psicológico a crianças de populações vulneráveis onde a psicoterapia é deficiente ou inexistente. O objetivo é permitir o surgimento de imagens que favoreçam a reconexão com o potencial criativo da criança, ativando o processo de autorregulação do psiquismo. Sua base em processos simbólicos e acompanhamento empático o torna uma intervenção psicossocial junguiana para esses tempos de transição. Na América Latina, projetos Expressive Sandwork foram implementados na Colômbia e na Argentina. Dois exemplos das crianças participantes são.

Exploring the Role of Occupational Therapy and Forced Migration in Canada.

Background. In response to increasing forced migration across the globe, Canadian occupational therapists are returning to the profession's social justice roots by exploring this emergent area of practice. Purpose. This research explores occupational therapy practices with forced migrants in a Canadian context. Method. Grounded in critical epistemologies, the researchers conducted 12 semi-structured interviews with occupational therapists, students, and researchers connected to displacement. Data were analyzed using thematic analysis. Findings. Four themes describe current occupational therapy practices related to forced migration: 1) engaging clients in new environments, 2) translating the everyday, 3) connecting and networking, and 4) advocating for occupational justice. Implications. This research contributes to the advancement of occupational therapy and forced migration by documenting the diverse and fluid nature of occupational therapy roles. Further, the paper outlines promising reflexive practices while forwarding advocacy priorities for (occupational) justice.

[Vaccination Uptake in Newly-Arrived Migrants in France]. / Le rattrapage vaccinal des personnes migrantes arrivant sur le territoire français.

The issue of catching up vaccines among children and adult migrants is of concern in France. Migrants do not represent a homogeneous population, but a majority of them are insufficiently vaccinated on the basis of the French vaccination schedule that includes more vaccine than those of their countries of origin. Among migrants, people in precarious situations or belonging to certain social groups have poorer immunization coverage, are exposed to a delay in the implementation of their catch-up and are at higher risk of vaccine-preventable infectious diseases. Epidemic situations of vaccine-preventable diseases have been observed in France, accelerating the awareness of the need to implement catch-up vaccination programs and highlighting the difficulties to implement this catch-up in people who have, for the most, already received vaccinations in their countries of origin but have no vaccine proof. Different catch-up strategies are possible with or without pre- or post-vaccination serologies and were the subject of recommendations co-developed by the French High Authority in Health (HAS) and the French Infectious Disease Society (SPILF).

La problématique du rattrapage vaccinal chez les enfants et adultes migrants s'installant en France est un enjeu de santé publique. Les migrants ne représentent pas une population homogène, mais une majorité d'entre eux sont insuffisamment vaccinés au regard du calendrier vaccinal français qui est plus exigeant que ceux des pays d'origine. Au sein des populations migrantes, les personnes en situation de précarité ou appartenant à certains groupes sociaux sont plus souvent insuffisamment vaccinées, sont exposées à un retard de la mise en œuvre de son rattrapage, alors qu'elles sont surexposées au risque de maladies infectieuses à prévention vaccinale comme la rougeole ou la varicelle. Des situations épidémiques de maladies à prévention vaccinale ont été observées en France, accélérant la prise de conscience de la nécessité de mettre en place des programmes de rattrapage vaccinal. Leur mise en œuvre est confrontée à la problématique des modalités pratiques de ce rattrapage chez des personnes ayant pour la grande majorité déjà reçu des vaccinations dans leur pays d'origine, mais n'ayant pas de trace de ces dernières. Différentes stratégies de rattrapage sont possibles avec ou sans recours à des sérologies préou postvaccinales notamment et ont fait l'objet de discussions et de l'élaboration de recommandations sous l'égide de la Haute Autorité de santé (HAS) et de la Société de pathologie infectieuse de langue française (SPILF).

Cardiovascular diseases and their risk factors among Syrian refugees in Turkey.

BACKGROUND: Information on the world distribution of cardiovascular disease and its risk factors in refugees/migrants is not available at the same rate for all countries or for different ethnic and socioeconomic groups. Today, Syria's humanitarian catastrophe has become a public health concern, which cannot be ignored. METHODS: A search was conducted across PubMed and Google Scholar for papers on cardiovascular diseases among refugees/migrants worldwide with a focus on Syrian in Turkey. RESULTS: The total number of papers identified through the database searches and from reference lists was 486. Of these, 62 were found to be relevant after further screening. A further 42 papers were considered not eligible after full-text, language and data assessments, resulting in a final 20 papers included in the qualitative analysis. These studies discussed several major themes: cardiovascular diseases and their risk factors among refugees/migrants, the effects of changing living conditions on refugees/migrants, the effects of psychological and socioeconomic factors, and the prevention and treatment of cardiovascular diseases in refugees/migrants. The risk of cardiovascular disease varied by country of origin, country of destination, and duration of residence. The findings suggest that cardiovascular diseases and their risk factors are increased for Syrian refugees in Turkey. CONCLUSION: Raising awareness, prevention, early detection, and good management as well as monitoring and reporting of risk factors are the key components to controlling cardiovascular diseases in refugees. Further studies and greater acquisition of survey data are urgently needed.

Crianças em situação de imigração na escola pública: percepções de docentes / Immigrant children in public school: perceptions of teachers / Scolarisation à lécole publique denfants en situation dimmigration: perception des enseignants / Niños inmigrantes en la escuela pública: percepciones del profesorado

Resumo Este artigo apresenta uma pesquisa qualitativa sobre as percepções de docentes a respeito de crianças em situação de imigração ou de refúgio na escola pública, baseada na perspectiva crítica de educação intercultural e na concepção histórico-cultural. Foram realizadas entrevistas entre 2018 e 2019 com dez professores do Ensino Fundamental I de uma escola municipal de Duque de Caxias, Rio de Janeiro, com mais de doze anos de experiência na educação básica e que tiveram, em suas turmas, crianças congolesas ou angolanas. Identificamos que a presença de crianças em situação de imigração, que inicialmente se poderia constituir em um elemento dificultador para o processo de ensino-aprendizagem, tem sido um motor para novas reflexões sobre diferenças, desigualdades, preconceitos e discriminação no espaço escolar.

Abstract This article presents a qualitative study on the perceptions of teachers about immigrant or refugee children in public schools. It is based on the critical perspective of intercultural education and in the historical-cultural concept. Interviews were conducted between 2018 and 2019 with ten teachers of the first five years in a municipal elementary school in Duque de Caxias, Rio de Janeiro. All the teachers have over twelve years of experience in basic education, and had Congolese or Angolan children in their classes. We identified that the presence of immigrant children, which could initially be a difficult element for the teaching-learning process, has motivated new reflections on differences, inequalities, prejudices and discrimination in schools.

Résumé Cet article présente une recherche qualitative sur les perceptions des enseignants concernant des enfants en situation d'immigration ou de réfuge, ancrée sur la perspective critique de l'éducation interculturelle et la conception historico-culturelle. Des entretiens ont été menés entre 2018 et 2019 auprès de dix enseignants de l'Enseignement élementaire d'une école comunale de Duque de Caxias, Rio de Janeiro, ces enseignants avec douze ans et plus d'expérience avaient dans leurs classes des enfants congolais ou angolais. Nous avons constaté que la présence d'enfants en situation d'immigration qui, au départ, aurait pu rendre difficile le processus d'enseignement-apprentissage est plutôt un moteur de nouvelles réflexions sur les différences, les inégalités, les préjugés et la discrimination dans l'espace scolaire.

Resumen Este artículo presenta una investigación cualitativa sobre las percepciones de docentes sobre los niños inmigrantes o refugiados en las escuelas públicas, basada en la perspectiva crítica de la educación intercultural y la concepción histórico-cultural. Las entrevistas se realizaron entre 2018 y 2019 con diez profesores del primer ciclo de enseñanza primaria, de una escuela municipal en Duque de Caxias, Río de Janeiro, con más de doce años de experiencia en educación básica y que tenían niños congoleños o angoleños en sus clases. Identificamos que la presencia de niños inmigrantes, que inicialmente podría ser un elemento obstaculizador para el proceso de enseñanza-aprendizaje, ha sido un motor para nuevas reflexiones sobre diferencias, desigualdades, prejuicios y discriminación en el espacio escolar.

Políticas de atendimento a migrantes e refugiados no Brasil e aproximações da psicologia / Policies of assistance to migrants and refugees in Brazil and psychology approaches / Políticas de atención a migrantes y refugiados en Brasil y aproximaciones de la psicología / Politiques d'accueil des migrants et des réfugiés au Brésil et approches de la psychologie

Temos assistido em todo o mundo a intensificação dos deslocamentos de pessoas que deixam seus locais de origem em virtude de ameaças à vida em busca de acolhida em outros países, enfrentando situações extremas tanto antes do processo migratório, como durante e após a chegada em novo território. O Brasil conta com políticas públicas de acolhimento e integração previstas em leis e acordos internacionais, que são aqui explanadas. Propõe-se discutir as aproximações da Psicologia enquanto área que atua nesse campo, a partir de bibliografias disponíveis sobre o tema, tecendo reflexões acerca das formas de compreensão das condições de saúde de imigrantes e refugiados e as modalidades de intervenção que têm sido desenhadas, evidenciando as dimensões sociopolíticas que envolvem o trabalho humanitário. Entende-se que as intervenções devem mobilizar suporte socioassistencial, acionar os recursos materiais e simbólicos dos sujeitos e grupos para enfrentamento da situação e construção de um novo cotidiano, considerando a complexidade das experiências de deslocamentos.

We have witnessed the intensification of displacements of people who have left their hometown because of threats to life, searching for refuge in other countries, facing extreme situations before the migratory process, during and after arrival in new territory. Brazil has public policies of reception and integration provided for laws and international agreements, which are explained here. This article discusses the approaches of Psychology as an area that acts directly in this field, based on bibliographical references, reflecting on ways of understanding the health conditions of immigrants and refugees and how interventions have been designed, highlighting the sociopolitical dimensions of humanitarian work. Interventions should mobilize socio-assistance support, trigger the material and symbolic resources of the individuals and groups to face the situation and build a new daily life, considering the complexity of the displacement experiences.

Hemos visto en todo el mundo una intensificación de desplazamientos de personas que dejan sus lugares de origen en virtud de amenazas a su vida en busca de acogida en otros países, enfrentando situaciones extremas tanto antes delproceso migratorio, como durante y después de la llegada al nuevo territorio. El Brasil cuenta con políticas públicas de acogida e integración previstas en leyes y acuerdos internacionales, que serán explicadas en el presente texto. Proponemos discutir las aproximaciones de la Psicología como área que actúa en ese campo, a partir de bibliografias disponibles sobre el tema, elaborando reflexiones acerca de las formas de comprensión de las condiciones de salud de inmigrantes y refugiados y las modalidades de intervención que han sido disenadas, evidenciando las dimensiones sociopolíticas implicadas en el trabajo humanitario. Las intervenciones deben movilizar apoyo socio-asistencial, accionar los recursos materiales y simbólicos de los sujetos y grupos para enfrentar la situación y construir un nuevo cotidiano, considerando la complejidad de las experiencias de desplazamientos.

Nous avons assisté à l'intensification des déplacements de personnes qui ont quitté leur ville d'origine en raison de menaces de mort, qui cherchaient refuge dans d'autres pays et faisaient face à des situations extrêmes avant le processus de migration, pendant etaprès leur arrivée sur un nouveau territoire. Le Brésil a des politiquespubliques d'accueil et d'intégration prévoyant des lois et des accords internationaux, qui sont expliqués ici. Cet article traite des approches de la psychologie en tant que domaine agissant directement dans ce champ, en se basant sur des bibliographies disponibles sur le sujet, sur des moyens de comprendre les conditions de santé des immigrants et des réfugiés et sur la manière dont les interventions ont été conçues, en soulignant les dimensions sociopolitiques du travail humanitaire. Les interventions doivent mobiliser un mouvement socio-assistance, mobiliser les ressources matérielles et symboliques des individus et des groupes pour faire face à la situation et construire un nouveau quoti-dien, en tenant compte de la complexité des expériences de déplacement.

'Just black sometimes', part 2: reflections on an adolescent's journey.

In this second article about work at a refugee centre for unaccompanied minors in Berlin, the author discusses his encounter with Syrian and Afghani adolescents who were enrolled in the program. Issues around adaptation to a new culture are explored with attention to the dynamics of conformity and marginalization. The questions of what happens to adolescent refugees separated from their families, and how their identity formation is shaped by this burden is explored in relation to the author's meeting with a Syrian adolescent living in Berlin. To illustrate the long reach of a missing father who has been left behind, characters from Virgil's Aeneid are discussed to amplify heroic and spiritual aspects within father-son relationships. The interplay between needing help and allowing for resilience is explored as an important aspect of refugees' transitions, while also considering variables such as dependence and independence, foreign and familiar, being with or without family, and adjusting to the present and/whilst relating to the past; tensions between these alternatives can create various psychosocial challenges for adolescent refugees.

Dans ce deuxième article sur le travail dans un centre pour réfugiés mineurs et non-accompagnés à Berlin, l'auteur évoque sa rencontre avec les adolescents Syriens et Afghans qui suivent le programme de ce centre. Les problèmes dus à l'adaptation à une nouvelle culture sont examinés, en prêtant une attention particulière aux dynamiques liées à la conformité et la marginalisation. La question de ce qui arrive aux réfugiés adolescents séparés de leurs familles, et de comment la formation de leur identité est façonnée par ce fardeau, sont examinées en s'appuyant sur la rencontre de l'auteur avec un adolescent Syrien vivant à Berlin. Pour illustrer la portée d'un père absent et qui a été laissé en arrière, des personnages de l'Enéide de Virgile sont discutés afin d'amplifier les aspects héroïques et spirituels des relations père-fils. L'interaction entre avoir besoin d'aide et donner de la place à la résilience est étudiée comme un aspect important des transitions des réfugiés. En même temps d'autres variables sont également prises en compte: la dépendance et l'indépendance, l'étranger et le familier, être avec sa famille ou sans famille, ainsi que l'ajustement au présent tout en restant en contact avec le passé. Les tensions entre ces alternatives peuvent créer divers défis sociologiques et psychologiques pour les réfugiés adolescents.

En este segundo artículo sobre el trabajo en un centro de refugiados para menores no acompañados en Berlín, el autor discute su encuentro con adolescentes Sirios y Afganos enrolados en el programa. Se exploran temas vinculados a la adaptación a una nueva cultura con especial atención a las dinámicas de conformidad y marginalización. Las preguntas acerca de lo que sucede a los adolescentes refugiados separados de sus familias, y cómo la formación de su identidad es determinada por este peso, son exploradas a partir del encuentro del autor con un adolescente Sirio viviendo en Berlín. Para ilustrar el largo alcance del padre perdido quien ha sido dejado atrás, se presentan caracteres de La Eneida de Virgilio, para amplificar aspectos espirituales y heroicos, dentro de la relación padre-hijo. Se explora el inter juego entre la necesidad de ayuda y el permitir la resiliencia, como un aspecto importante en las transiciones del refugiado, considerando al mismo tiempo variables como dependencia e independencia, extranjero y familiar, estar con o sin familia, y ajustarse al presente y/mientras relacionarse con el pasado; tensiones entre estas alternativas pueden crear varios desafíos psicosociales a los adolescentes refugiados.

'Just black sometimes': analytic tools applied at the frontlines of social upheaval, part 1.

Analysts are increasingly grappling with making space for the discussion of turbulent and disturbing current events in their practices. This social disorder raises questions about the role of social activism and advocacy for groups suffering discrimination, persecution, violence, and displacement. Jung too commented on the immediacy of political happenings that show up in our practices with 'violence'. The author discusses an organizational consultation he did in Berlin in 2017 to consult for an NGO that handles placements for unaccompanied minors who are refugees. Such consultation can employ analytic ideas and concepts to the benefit of the organization and its staff. This process, though, requires some translation of these ideas so as not to burden consultees with theoretical terminology with which they may have little or no familiarity. The role of vicarious trauma is discussed, including how it is passed along, and its implications for frontline helpers are considered. Developmental aspects of adolescence figured prominently in the consultation. This is the first of two papers addressing this topic; the second will focus on interactions that the author had with young refugees.

Chronic health disparities among refugee and immigrant children in Canada.

There are knowledge gaps in our understanding of the development of chronic disease risks in children, especially with regard to the risk differentials experienced by immigrants and refugees. The Healthy Immigrant Children study employed a mixed-methods cross-sectional study design to characterize the health and nutritional status of 300 immigrant and refugee children aged 3-13 years who had been in Canada for less than 5 years. Quantitative data regarding socioeconomic status, food security, physical activity, diet, and bone and body composition and anthropometric measurements were collected. Qualitative data regarding their experiences with accessing health care and their family lifestyle habits were gathered through in-depth interviews with the parents of newcomer children. Many newcomers spoke about their struggles to attain their desired standard of living. Regarding health outcomes, significantly more refugees (23%) had stunted growth when compared with immigrants (5%). Older children, those with better-educated parents, and those who consumed a poorer-quality diet were at a higher risk of being overweight or obese. Sixty percent of refugees and 42% of immigrants had high blood cholesterol. Significant health concerns for refugee children include stunting and high blood cholesterol levels, and emerging trends indicate that older immigrant children from privileged backgrounds in low-income countries may be more at risk of overweight and obesity. A variety of pathways related to their families' conceptualization of life in Canada and the social structures that limit progress to meeting their goals likely influence the development of health inequity among refugee and immigrant children. Public health initiatives should address these health inequities among newcomer families.

Disintegration of the self and the regeneration of 'psychic skin' in the treatment of traumatized refugees.

This paper presents a tentative understanding of the characteristics of the extreme traumas, elsewhere called 'complex PTSD', that some refugees and asylum-seekers bring into therapy. It suggests that these kinds of traumas suffered during adulthood may involve a disintegration of the self and a loss of 'psychic skin'. This conceptualization is derived from the treatment of a refugee who survived multiple extreme traumas and with whom efforts were made in therapy to identify a complex methodology making use of supplementary therapeutic tools in addition to individual psychotherapy. The case demonstrates how the disintegration of self implies not only a deep somato-psychic dissociation, but also a loss of intrapsychic and interpersonal space. In the treatment this was worked through via repetition of the victim-aggressor dynamics at multiple levels. In the end, the therapeutic context was structured like a set of concentric layers, creating a 'bandage' over the patient's wounds whilst his 'psychic skin' was able to regenerate. The conditions triggered by extreme traumas in refugees challenge some of the cornerstones of individual psychoanalytic technique, as well as the idea that individual therapy may be thought of as existing in an environmental vacuum.

Health status and disease burden of unaccompanied asylum-seeking adolescents in Bielefeld, Germany: cross-sectional pilot study.

OBJECTIVE: This exploratory pilot study aimed to investigate the physical and mental disease burden of unaccompanied asylum-seeking adolescents arriving in Bielefeld, a medium-size city in Germany. METHODS: A cross-sectional survey with purposive sampling of 102 unaccompanied asylum-seeking adolescents aged 12-18 years was performed. Information on general health status, selected infectious and non-communicable diseases, iron deficiency anaemia and mental illness was collected during routine check-up medical examinations upon arrival in Bielefeld, Germany. The data were analysed using descriptive statistics. RESULTS: The analysis revealed a complex disease burden with a high prevalence of infections (58.8%), mental illness (13.7%) and iron deficiency anaemia (17.6%) and a very low prevalence of non-communicable diseases (<2.0%). One in five of the refugees were infected with parasites. Whilst sub-Saharan Africans showed the highest prevalence of infections (86.7%), including highest prevalences of parasites (46.7%), West Asians had the highest prevalence of mental disorders (20.0%). Overall, the disease burden in females was higher. CONCLUSION: A thorough medical and psychological screening after arrival is highly recommended to reduce the individual disease burden and the risk of infection for others. This promotes good physical and mental health, which is needed for successful integration into the receiving society. Barriers to health service access for unaccompanied asylum-seeking adolescents need to be lowered to allow need-specific health care and prevention.

Impacts of a Support Intervention for Zimbabwean and Sudanese Refugee Parents: "I Am Not Alone".

Knowledge about the beneficial effects of social support has not been used to systematically develop and evaluate interventions to help refugee new parents cope. The purpose of this study was to design and evaluate a social support intervention for refugee new parents. A multi-method research design was used and participatory research strategies were employed. Qualitative and quantitative measures were used to understand experiences of participants and to assess the perceived psychosocial and health-related outcomes of the intervention. Mentored support groups, matched by gender and ethnicity, met biweekly over 7 months. The participants were 48 Sudanese and 37 Zimbabwean refugee parents in 2 Canadian provinces. Increases were found in informational support, spousal support, community engagement, coping, and support-seeking. Decreases were found in parenting stress, loneliness, and isolation. The authors conclude that there is a need for culturally appropriate nursing practices and programs for refugee new parents from diverse cultures.

Les connaissances concernant les effets bénéfiques du soutien social n'ont pas été utilisées de manière systématique pour élaborer et évaluer les interventions visant à aider les réfugiés nouveaux parents à s'adapter à leur situation. L'objectif de cette étude est de concevoir et d'évaluer une intervention pour venir en aide aux réfugiés nouveaux parents. Diverses méthodes de recherche et différentes stratégies de recherche participative ont été utilisées pour la réalisation de l'étude. Des mesures quantitatives et qualitatives ont été effectuées pour comprendre l'expérience vécue par les participants et pour évaluer les résultats perçus de l'intervention sur les plans psychologique et de la santé. Des groupes de soutien encadrés et formés en fonction du sexe et de l'ethnie se sont réunis toutes les deux semaines pendant sept mois. L'ensemble des nouveaux parents participants comprenait 48 réfugiés soudanais et 37 réfugiés zimbabwéens établis dans deux provinces canadiennes. Ces groupes ont donné lieu à un accroissement du soutien informationnel, du soutien conjugal, de la participation communautaire, de l'adaptation et des demandes d'aide, ainsi qu'à une diminution du stress, de la solitude et de l'isolement des parents. En conclusion de leur étude, les auteurs signalent la nécessité d'adopter des programmes et des pratiques de soins infirmiers adaptés sur le plan culturel aux besoins des réfugiés nouveaux parents appartenant à diverses cultures.

Hypertension and treatment outcomes in Palestine refugees in United Nations Relief and Works Agency primary health care clinics in Jordan.

OBJECTIVE: In six United Nations Relief and Works Agency (UNRWA) primary health care clinics in Jordan serving Palestine refugees diagnosed with hypertension, to determine the number, characteristics, programme outcomes and measures of disease control for those registered up to 30 June, 2013, and in those who attended clinic in the second quarter of 2013, the prevalence of disease-related complications between those with hypertension only and hypertension combined with diabetes mellitus. METHOD: Retrospective cohort study with programme and outcome data collected and analysed using E-Health. RESULTS: There were 18 881 patients registered with hypertension with females (64%) and persons aged ≥ 40 years (87%) predominating. At baseline, cigarette smoking was recorded in 17%, physical inactivity in 48% and obesity in 71% of patients. 77% of all registered patients attended clinic in the second quarter of 2013; of these, 50% had hypertension and diabetes and 50% had hypertension alone; 9% did not attend the clinics and 10% were lost to follow-up. Amongst those attending clinic, 92% had their blood pressure measured, of whom 83% had blood pressure <140/90 mm Hg. There were significantly more patients with hypertension and diabetes (N = 966, 13%) who had disease-related complications than patients who had hypertension alone (N = 472, 6%) [OR 2.2, 95% CI 2.0-2.5], and these differences were found for both males [18% vs. 10%, OR 1.9, 95% CI 1.6-2.2] and females [11% vs. 5%, OR 2.4, 95% CI 2.1-2.9]. CONCLUSION: Large numbers of Palestine refugees are being registered and treated for hypertension in UNRWA primary health care clinics in Jordan. Cohort analysis and E-Health can be used to regularly assess caseload, programme outcomes, clinic performance, blood pressure control and cumulative prevalence of disease-related complications. Current challenges include the need to increase clinic attendance and attain better control of blood pressure.

Duration of residence and disease occurrence among refugees and family reunited immigrants: test of the 'healthy migrant effect' hypothesis.

OBJECTIVES: The 'healthy migrant effect' (HME) hypothesis postulates that health selection has a positive effect on migrants' health outcomes, especially in the first years after migration. We examined the potential role of the HME by assessing the association between residence duration and disease occurrence. METHODS: We performed a historical prospective cohort study. We included migrants who obtained residence permits in Denmark between 1 January 1993 and 31 December 2010 (n = 114,331). Occurrence of severe conditions was identified through linkage to the Danish National Patient Register. Hazard Ratios (HRs) were modelled for disease incidence by residence duration since arrival (0-5 years; 0-10 years; 0-18 years) adjusting for age and sex. RESULTS: Compared with Danish-born individuals, refugees and family reunited immigrants had lower HRs of stroke and breast cancer within 5 years after arrival; however, HRs increased at longer follow-up. For example, HRs of stroke among refugees increased from 0.77 (95% CI: 0.66; 0.91) to 0.96 (95% CI: 0.88; 1.05). For ischaemic heart disease (IHD) and diabetes, refugees and family reunited migrants had higher HRs within 5 years after arrival, and most HRs had increased by end of follow-up. For example, HRs of IHD among family reunited migrants increased from 1.29 (95% CI: 1.17; 1.42) to 1.43 (95% CI: 1.39; 1.52). In contrast, HRs for TB and HIV/AIDS showed a consistent decrease over time. CONCLUSION: Our analyses of the effect of duration of residence on disease occurrence among migrants imply that, when explaining migrants' advantageous health outcomes, the ruling theory of the HME should be used with caution, and other explanatory models should be included.

Cohort monitoring of persons with diabetes mellitus in a primary healthcare clinic for Palestine refugees in Jordan.

OBJECTIVE: To illustrate the method of cohort reporting of persons with diabetes mellitus (DM) in a primary healthcare clinic in Amman, Jordan, serving Palestine refugees with the aim of improving quality of DM care services. METHOD: A descriptive study using quarterly and cumulative case findings, as well as cumulative and 12-month analyses of cohort outcomes collected through E-Health in UNRWA Nuzha Primary Health Care Clinic. RESULTS: There were 55 newly registered patients with DM in quarter 1, 2012, and a total of 2851 patients with DM ever registered on E-Health because this was established in 2009. By 31 March 2012, 70% of 2851 patients were alive in care, 18% had failed to present to a healthcare worker in the last 3 months and the remainder had died, transferred out or were lost to follow-up. Cumulative and 12-month cohort outcome analysis indicated deficiencies in several components of clinical care: measurement of blood pressure, annual assessments for foot care and blood tests for glucose, cholesterol and renal function. 10-20% of patients with DM in the different cohorts had serious late complications such as blindness, stroke, cardiovascular disease and amputations. CONCLUSION: Cohort analysis provides data about incidence and prevalence of DM at the clinic level, clinical management performance and prevalence of serious morbidity. It needs to be more widely applied for the monitoring and management of non-communicable chronic diseases.

Diferença entre as espécies de Timbó ( Derris Spp., Fabaceae) de diferentes regiões da Amazônia no controle da Musca domestica L

O pó das raízes das espécies de timbó coletadas em diferentes regiões da Amazônia, testado em agrupamentos de larvas, não produziu efeito diferencial significativo entre duas linhagens de Musca domestica. As duas espécies com maior número de plantas empregadas foram Derris nicou e Denis urucu; seus representantes são provenientes de regiões que foram consideradas como "refúgios florestais", durante o plcistoceno na Amazônia. Dentro de cada espécie, as plantas variaram, desde aquelas ineficientes, até as que foram altamente letais no controle das moscas. Esta capacidade diferencial no controle das larvas entre plantas da mesma espécie, originadas de regiões diferentes, sugere que ambas as espécies devem ter apresentado isolamento de suas populações, durante esta época do quaternário. Nas regiões ou "refúgios florestais", onde essas espécies estiveram representadas, D. urucu foi superior a D. nicou na capacidade de controlar as larvas. Enquanto, entre as plantas da região F (refúgio do Leste-peruano), do Estado do Acre, as duas espécies apresentaram convergência de valores, dos danos produzidos nos agrupamentos de larvas. Entre as outras espécies, Derris sp. (timbó amarelo ou melancia) não apresentou entre as amostras provenientes de duas regiões, diferenças nos efeitos às larvas; enquanto, a espécie introduzida na Amazônia, Derris elliptica, mostrou danos nos agrupamentos de larvas, semelhantes a algumas das melhores plantas de D. nicou e D. urucu.