BACKGROUND: Strategies to promote mental health care help-seeking among children are needed, especially in low-income and middle-income countries and in complex settings. The aim of this trial was to compare a vignette-based, community-level, proactive case detection tool (CCDT) against standard awareness raising for promoting mental health help-seeking among children and adolescents.
METHODS: This stepped wedge cluster randomised trial was conducted in the Bidi Bidi, Kyaka II, Kyangwali, Omugo, and Rhino refugee settlements in Uganda. Community gatekeepers received a 2-day training session on using the CCDT to proactively detect children with mental health concerns and encourage children (or their caregivers) to use the mental health-care service run by Transcultural Psychosocial Organization Uganda. At baseline, organisations implemented routine detection or mental health awareness-raising activities. At cross-over to CCDT implementation, gatekeepers used the tool in their daily activities. The primary outcome was mental health-care service use by children and adolescents. Child population size estimates at the zone level were not available. Therefore, service use was calculated using total population size. We report the effect of CCDT implementation as an incidence rate ratio (IRR), which we produced from a model that accounts for calendar time, exposure time, and person-time. IRRs were estimated for the analysis of effect over time in the per-protocol and intention-to-treat populations. The trial is registered with the ISRCTN registry, number ISRCTN19056780.
RESULTS: 28 administrative zones were selected for trial participation by October, 2021. Between Jan 1, and Nov 8, 2022, seven clusters of four zones sequentially crossed over from routine care to CCDT implementation in 1-month intervals. The CCDT was implemented by 177 trained community gatekeepers. In 9 months, 2385 children visited a mental health-care service; of these, 1118 (47%) were girls and 1267 (53%) were boys (mean age 12·18 years [SD 4.03]). 1998 children made a first or re-entry visit to a service; of these, 937 (47%) were girls and 1061 (53%) were boys (mean age 12·08 years [SD 4·06]). Compared to standard awareness-raising activities, CCDT implementation was associated with an increase in mental health-care service use in the first month after implementation (20·91-fold change [95% CI 12·87-33·99]). Despite a slight decline in service use over time in both the CCDT and pre-CCDT zones, CCDT zones maintained a time-average 16·89-fold increase (95% CI 8·15-34·99) in mental health service use.
CONCLUSIONS: The CCDT enabled community gatekeepers to increase mental health-care service use by children and adolescents. Vignette-based strategies rooted in the community could become a valuable contribution towards reducing the mental health-care gap among children, especially when accompanied by accessible mental health-care services.
BACKGROUND: Sint Antonius Stichting Projects.
UNASSIGNED: For the Arabic, French and Spanish translations of the abstract see Supplementary Materials section.

In the early months of the COVID-19 pandemic The National Resource Center for Refugees, Immigrants and Migrants (NRC-RIM) was established. NRC-RIM initially sought to rapidly identify promising case investigation and contact tracing (CICT) practices within refugee, immigrant, and migrant communities. Between September 2020 and April 2021, the team conducted 60 interviews with individuals from cross-sector organizations (i.e., public health, health systems, community experts/organizations) working with refugee, immigrant and migrant communities in health and public health capacities related to COVID-19. The overarching aim was to identify and amplify innovative promising and best practices for CICT with refugee, immigrant, and migrant communities, including an exploration of barriers and facilitators. We utilized layered methods to rapidly assess, summarize and disseminate promising practices while simultaneously completing four thematic analyses including: (1) public health organizations; (2) health system organizations; (3) community leaders and organizations; and (4) vaccine planning and access across the three sectors. The primary objective of this article is to describe the project design, applied methods, and team science approach we utilized. We found that rapid identification and dissemination of promising practices, and barriers and facilitators for CICT with refugee, immigrant and migrant communities was feasible during a public health emergency. This approach was essential for identifying and widely sharing culturally and linguistically concordant public health practices.

UNASSIGNED: A total of 7,307 Ukrainian refugees moved to Antwerp, Belgium, during the study period (01 April 2022 to 31 December 2022). The city\'s administration set up three care centers where these people were introduced to the Belgian primary care system, a medical file was created, and acute/preventive/chronic care was delivered. This community case study analyzes the organization and contents of care and reflects upon its meaning for the mainstream healthcare system.
UNASSIGNED: This is an observational study using routine electronic medical record data to measure the uptake of care. For a sample of 200 subjects, a retrospective chart review was conducted.
UNASSIGNED: All refugees with a medical file at one of the three participating care centers were included.
UNASSIGNED: For the observational study, 2,261 patients were reached (30% of the potential users), and 6,450 contacts were studied. The nurses (including midwives) conducted 4,929 out of 6,450 (76%) of all consultations, while the general practitioners (GPs) conducted 1,521 out of 6,450 (24%). Of the nurse consultations, 955 (19%) were followed by another nurse consultation and 866 (18%) by a GP consultation. In the structured case reviews, most contacts were concerned with acute problems (609 out of 1,074, 57%). The most prevalent reasons for encounters and diagnoses were typical primary care issues. The nurses were able to manage half of the cases independently (327, 55%), referred 37% (217) of cases to the GP, and consulted a GP (live, by telephone, or a dedicated app) for 8% (48) of cases. GPs mostly prescribed drugs, referred to a medical specialist, and advised over-the-counter drugs, while nurses more often advised over-the-counter drugs (mostly paracetamol, nose sprays, and anti-inflammatory drugs), provided non-medical advice, or ordered laboratory tests.
UNASSIGNED: The medical care points delivered mostly typical acute primary care in this first phase, with a key role for nurses. The care points did not sufficiently take up chronic diseases and mental health problems. These results will inform policymakers on the use of primary care centers for newly arriving patients in times of a large influx. A nurse-first model seems feasible and efficient, but evaluation of safety and quality of care is needed. Once the acute phase of this crisis fades away, questions about the comprehensiveness, continuity, and integration of care for migrants remain relevant.

Despite the existence of significant research on the mental health care challenges of migrants, particularly refugees and asylum seekers, less attention has been paid to treatment approaches. We used a case study from the UK to look at the topic from a cultural models approach (which comes from cognitive anthropology) to analyse migrants\' experiences with mental health care. Twenty-five refugees and asylum seekers living in North East England and Northern Ireland were interviewed who had used at least six sessions of talking therapy during the last three years. Our results suggested that adopting a \'cultural models\' approach, which offers a new conceptual and methodological framework of migrants\' experiences and their underlying schemas and expectations, would significantly contribute to building therapeutic alliances and provide relevant and appropriate treatments for migrant clients, particularly for unrecognised pre- and post-migration traumatic experiences.

Researchers have documented multiple stressors and mental health problems along the journey of refugees as they are displaced to seek refuge in nearby and remote host countries. This article examines published research on Syrian refugees to propose a framework to conceptualize Syrian refugees\' pre- and post-stressors and their collective impact on their mental health. The proposed framework provides a comprehensive understanding of the interconnected pathways between pre-displacement stressors, post-displacement stressors, and mental health outcomes for Syrian refugees. Pre-displacement stressors are best captured by the concept of trauma centrality and emotional suppression. Post-displacement stressors, categorized under financial, political, and social themes, have a direct impact on the mental health of the refugees, but could also play a partial mediating role on the impact of pre-displacement stressors on mental health. The framework suggests a direct pathway between the experience of war-related traumatic events and mental health and introduces the country of residence as a potential moderator of the severity of mental health. The latter is primarily influenced by local policies and the host communities\' acceptance of refugees. We believe that the proposed framework can guide the work of researchers, policymakers, and practitioners concerned with the mental health and well-being of Syrian refugees. Additionally, although based on the experience of Syrian refugees, it presents a holistic perspective that could be adapted in other refugee settings.

Despite an increased prevalence of psychiatric morbidity, minor refugees resettled in Western host societies are less likely to access mental health care services than their native peers. This study aims to explore how a collaborative approach can be implemented to promote access to specialized mental health care. Collaborative mental health care embeds specialized intervention in primary care settings and emphasizes the inclusion of minority cultural perspectives through an interdisciplinary, intersectoral network. In this study, we analyze how such a collaborative approach can support access to specialized mental health care for refugee youth. The study presents findings from a qualitative multiple-case study (n = 10 refugee patients), conducted in the setting of a psychiatric day program for young refugees that develops an intersectional, collaborative practice in supporting minor refugees\' trajectory from referral to admission. Building on in-depth interviews, participant observation and case documents, within-case analysis and cross-case inductive thematic analysis identify the specific working mechanisms of a collaborative approach. The results indicate how this intersectoral approach addresses the interplay between traumatic suffering and both cultural and structural determinants of mental health. To conclude, a discussion identifies future research directions that may further strengthen the role of collaborative practice in promoting mental health care access for refugee youth.

Aid relations in protracted displacement comprise a diversity of actors with different influence and involvement over time. Building on the case of Sri Lanka\'s northern Muslim\'s expulsion from the north of the country in 1990, this paper investigates the dynamic space of aid relations in their drawn-out internal displacement. The study draws on 38 key informant interviews and 10 focus-group discussions, conducted in Sri Lanka (Jaffna, Mannar, Puttalam, and Colombo) in 2022. The paper contributes new knowledge of the local dynamics of assistance in protracted displacement, by analysing the roles of a wide set of actors within this dynamic space of aid relations over time. The analysis incorporates angles and voices often overlooked in mainstream humanitarian studies, including internally displaced persons, hosts, and Middle Eastern aid funders. The study argues that a long-term perspective and a variety of voices provide foundations for more productive engagement with localisation in humanitarian action in protracted displacement crises.
تتشكل علاقات تقديم المعونة في حالات النزوح الممتد بمجموعة متنوعة من الجهات الفاعلة التي يختلف تأثيرها ومشاركتها بمرور الوقت، واستنادًا إلى حالة طرد مسلمي شمال سري لانكا من شمال البلاد في عام 1990، نبحث في الحيز الديناميكي لعلاقات تقديم المعونة في نزوحهم الداخلي الممتد، ونعتمد في ذلك على 38 مقابلة مع المخبرين الرئيسيين وعشر مناقشات جماعية مركزة أُجريت في سري لانكا (جافنا، ومانار، وبوتالام، وكولومبو) عام 2022، وتساهم المقالة بمعرفة جديدة حول الديناميكيات المحلية لتقديم المعونة في حالات النزوح الممتد من خلال تحليل أدوار مجموعة واسعة من الجهات الفاعلة في هذا الحيز الديناميكي لعلاقات تقديم المعونة على مر الوقت، ويتضمن التحليل زوايا وأصوات غالبًا ما يتم تجاهلها في الدراسات الإنسانية السائدة، بما في ذلك النازحين الداخلين، والمضيفين، وممولي المعونة من الشرق الأوسط، ونحن نحتج بأن المنظور طويل الأمد وتنوع الأصوات يوفران أسسًا لمشاركة أكثر إنتاجية في التوطين في العمل الإنساني في أزمات النزوح الممتدة.
长期流离失所的援助关系是由长期具有不同影响和参与的多种行为者构成的。在1990年斯里兰卡北部穆斯林被从北部驱逐的案例的基础上，我们研究援助关系在旷日持久的境内流离失所中的动态空间。我们借鉴了2022年在斯里兰卡（贾夫纳、马纳尔、普塔勒姆和科伦坡）进行的38次关键知情者访谈和10次焦点小组讨论。本文通过分析长期援助关系的这个动态空间中广泛的一组行为者的作用，为长期流离失所的当地援助动态提供了新的认知。该分析包括主流人道主义学中经常被忽视的角度和声音，包括IDP(国内流离失所者)、东道国和中东援助资助者。我们认为，长期的视角和声音的多样性为在旷日持久的流离失所危机中更富有成效地参与人道行动的本地化奠定了基础。.

Refugees are more vulnerable to COVID-19 due to factors such as low standard of living, accommodation in crowded households, difficulty in receiving health care due to high treatment costs in some countries, and inability to access public health and social services. The increasing income inequalities, anxiety about providing minimum living conditions, and fear of being unemployed compel refugees to continue their jobs, and this affects the number of cases and case-related deaths. The aim of the study is to analyze the impact of refugees and income inequality on COVID-19 cases and deaths in 95 countries for the year 2021 using Poisson regression, Negative Binomial Regression, and Machine Learning methods. According to the estimation results, refugees and income inequalities increase both COVID-19 cases and deaths. On the other hand, the impact of income inequality on COVID-19 cases and deaths is stronger than on refugees.

暂无摘要。

This research was conducted as a descriptive study to determine the mental adjustment status of refugee children aged 6 to 14 in Duzce.
The sample of the study consisted of 163 refugee children. Data were collected through face-to-face interviews with primary caregivers of children using the Hacettepe Mental Adjustment Scale. The collected data were analyzed in the SPSS 22.0 database using percentages, Mann Whitney U, Kruskal-Wallis H, and chi-square tests.
Adjustment problems were detected in 25.8% of the children participating and behavioral problems were detected in over half (52.4%).
In line with the findings obtained from the research, it has been suggested to form a team of mental health experts, including psychiatric nurses, who have adopted the principles of transcultural care to make early diagnosis and effective treatment of psychiatric diseases of refugee children.