Access to medicines among asylum seekers, refugees and undocumented migrants across the migratory cycle in Europe: a scoping review.

Access to essential medicines is a critical element of health systems and an important measure of their performance. Migrants may face barriers in accessing healthcare, including essential medicines, throughout the migration cycle, which includes the stages of departure from home or residence countries, transit through non-European or European countries, reception and settlement in a country in Europe and deportation. We aim to provide an overview of research and grey literature concerning access to essential medicines for asylum seekers, refugees and undocumented migrants in or heading to Europe (European Union, European Economic Area, Switzerland and the UK). To delineate and conceptualise access to medicines, we considered the definition of the Lancet Commission on Essential Medicines and the Pharmaceutical Management framework. These frameworks were combined to guide several critical steps in our review, including defining the search terms, data extraction, data analyses and reporting. Relevant studies and reports were identified through searches in bibliographic and grey literature databases. Out of 5760 studies and 66 grey literature reports, 108 met the inclusion criteria, with 72 focusing on medicine access. Overall, medicine use and medicine expenditure were found to be lower in migrant populations compared with the host population in many European countries. Although many studies focused on the use of infectious disease and psychotropic medicines, the most frequently used medicines by migrants were analgesics, hypertension and diabetes medicines. Determinants of medicine access were legal restrictions, language and transit times, which all contributed to interruption of and inequities in access to medicines among this population. This scoping review also indicated significant gaps in the literature regarding the evidence on access to medicine at different stages of the migration cycle, specifically in departure, transit and deportation stages. Overall, our findings highlighted significant unmet medicine needs among migrants in or on the way to Europe and access disparities attributable to various interconnected barriers. Urgent access is needed to address such inequities, particularly legal barriers, including registration of certain medicines required for treatment. Future research should prioritise investigating medicine access during departure, transit and deportation stages. Policy discussions around migrants' access to medicines should be centred on framing healthcare as a fundamental right.

Aljadeeah S ，Payedimarri AB ，Kielmann K ，Michielsen J ，Wirtz VJ ，Ravinetto R ... -  《BMJ Global Health》

Health and well-being of refugees, asylum seekers, undocumented migrants, and internally displaced persons under COVID-19: a scoping review.

The objective of this scoping review was to identify what is known about the impact of COVID-19 on the physical and mental well-being of refugees, asylum seekers, undocumented migrants, and internally displaced persons. The aim was also to identify barriers influencing access to treatment or prevention. The search was conducted using PubMed/Medline, CINAHL, Scopus, and ScienceDirect. A mixed methods appraisal tool was used to assess methodological rigor. The study findings were synthesized using a thematic analysis approach. This review comprised 24 studies and were conducted utilizing a mixed method approach incorporating both quantitative and qualitative methodologies. Two major themes were identified related to the impact of COVID-19 on the health and wellbeing of refugees, asylum seekers, undocumented migrants, and internally displaced persons and the key barriers influencing access to treatment or prevention of COVID-19. They often have barriers to accessing healthcare due to their legal status, language barriers, and limited resources. The pandemic has further strained already limited health resources, making it even more challenging for these populations to receive healthcare. This review reveals that refugees and asylum seekers in receiving facilities face a higher risk of COVID-19 infection than the general population due to their less favorable living conditions. The various health impacts stem from a lack of access to accurate information about the pandemic, misinformation, and the exacerbation of pre-existing mental health issues caused by heightened stress, anxiety, and uncertainty, fear of deportation among undocumented migrants, and overcrowding camps and detention facilities that increase exposure risk. Social distancing measures are difficult to implement in these settings, and inadequate sanitation, hygiene, and a lack of personal protective equipment further compound the problem. Moreover, the pandemic has had significant economic consequences for these populations. Many of them rely on informal or precarious employment, which has been disproportionately affected by the pandemic. Job losses and reduced working hours, and limited access to social protection can lead to increased poverty, and food insecurity. Children faced specific challenges, such as disruptions to education, additionally, interruptions in support services for pregnant women. Some pregnant women have avoided seeking maternity care due to fears of contracting COVID-19, resulting in increased home births and delays in accessing healthcare services. Factors that play a role in vaccination reluctance include uncertainty of undocumented migrants' inclusion in vaccination programs, furthermore, a growing vaccine hesitancy in the population; skepticism about the safety of vaccines, inadequate knowledge/education, a variety of access barriers such as language barriers, and logistical challenges including remote locations, and inaccurate information. This review highlights that the physical health of refugees, asylum seekers, undocumented migrants, and internally displaced persons has been significantly impacted by various barriers to healthcare access during the pandemic. These barriers include legal and administrative challenges, such as a lack of documentation. Additionally, the shift to digital tools has introduced new obstacles, not only due to language barriers or limited technical knowledge but also because of structural barriers, such as the requirement of a bank ID that is often inaccessible to these groups. Other factors contributing to limited healthcare access include financial constraints, language barriers, and discrimination. Additionally, limited access to accurate information about health services, prevention measures, and available resources may hinder them from seeking care or following public health guidelines. Misinformation and lack of trust in healthcare systems can also contribute to a reluctance to access care or vaccination programs. There is concerning evidence regarding vaccine hesitancy that needs to be addressed to reduce any future pandemic outbreak, in addition there is a need to explore the factors that play a role in vaccination reluctance among children in these populations.

El Arab RA ，Somerville J ，Abuadas FH ，Rubinat-Arnaldo E ，Sagbakken M ... -  《Frontiers in Public Health》

Gender differences in the context of interventions for improving health literacy in migrants: a qualitative evidence synthesis.

Health literacy can be defined as a person's knowledge, motivation and competence in four steps of health-related information processing - accessing, understanding, appraising and applying health-related information. Individuals with experience of migration may encounter difficulties with or barriers to these steps that may, in turn, lead to poorer health outcomes than those of the general population. Moreover, women and men have different health challenges and needs and may respond differently to interventions aimed at improving health literacy. In this review, we use 'gender' rather than 'sex' to discuss differences between men and women because gender is a broad term referring to roles, identities, behaviours and relationships associated with being male or female. The overall objective of this qualitative evidence synthesis (QES) was to explore and explain probable gender differences in the health literacy of migrants. The findings of this QES can provide a comprehensive understanding of the role that any gender differences can play in the development, delivery and effectiveness of interventions for improving the health literacy of female and male migrants. This qualitative evidence synthesis had the following specific objectives: - to explore whether there are any gender differences in the health literacy of migrants; - to identify factors that may underlie any gender differences in the four steps of health information processing (access, understand, appraise, and apply); - to explore and explain gender differences found - or not found - in the effectiveness of health literacy interventions assessed in the effectiveness review that is linked to this QES (Baumeister 2023); - to explain - through synthesising findings from Baumeister 2023 and this QES - to what extent gender- and migration-specific factors may play a role in the development and delivery of health literacy interventions. We conducted electronic searches in MEDLINE, CINAHL, PsycINFO and Embase until May 2021. We searched trial registries and conference proceedings. We conducted extensive handsearching and contacted study authors to identify all relevant studies. There were no restrictions in our search in terms of gender, ethnicity or geography. We included qualitative trial-sibling studies directly associated with the interventions identified in the effectiveness review that we undertook in parallel with this QES. The studies involved adults who were first-generation migrants (i.e. had a direct migration experience) and used qualitative methods for both data collection and analysis. We extracted data into a form that we developed specifically for this review. We assessed methodological limitations in the studies using the CASP (Critical Appraisal Skills Programme) Qualitative Studies) checklist. The data synthesis approach that we adopted was based on "best fit" framework synthesis. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our level of confidence in each finding. We followed PRISMA-E guidelines to report our findings regarding equity. We included 27 qualitative trial-sibling studies directly associated with 24 interventions assessed in a linked effectiveness review (Baumeister 2023), which we undertook in parallel with this QES. Eleven studies included only women, one included only men and 15 included both. Most studies were conducted in the USA or Canada and primarily included people of Latino/Latina and Hispanic origin. The second most common origin was Asian (e.g. Chinese, Korean, Punjabi). Some studies lacked information about participant recruitment and consideration of ethical aspects. Reflexivity was lacking: only one study contained a reflection on the relationship between the researcher and participants and its impact on the research. None of the studies addressed our primary objective. Only three studies provided findings on gender aspects; these studies were conducted with women only. Below, we present findings from these studies, with our level of confidence in the evidence added in brackets. Accessing health information We found that 'migrant women of Korean and Afghan origin preferred access to a female doctor' (moderate confidence) for personal reasons or due to cultural norms. Our second finding was that 'Afghan migrant women considered their husbands to be gatekeepers', as women of an Afghan background stressed that, in their culture, the men were the heads of the household and the decision-makers, including in personal health matters that affected their wives (low confidence). Our third finding was 'Afghan migrant women reported limited English proficiency' (moderate confidence), which impeded their access to health information and services. Understanding health information Female migrants of Afghan background reported limited writing and reading abilities, which we termed 'Afghan migrant women reported low literacy levels' (moderate confidence). Applying health information Women of Afghan and Mexican backgrounds stated that the 'women's role in the community' (moderate confidence) prevented them from maintaining their own health and making themselves a priority; this impeded applying health information. Appraising health information We did not find any evidence related to this step in health information processing. Other findings In the full text of this QES, we report on migration-specific factors in health literacy and additional aspects related to health literacy in general, as well as how participants assessed the effectiveness of health literacy interventions in our linked effectiveness review. Moreover, we synthesised qualitative data with findings of the linked effectiveness review to report on gender- and migration-specific aspects that need to be taken into account in the development, design and delivery of health literacy interventions. The question of whether gender differences exist in the health literacy of migrants cannot be fully answered in this qualitative evidence synthesis. Gender-specific findings were presented in only three of the 27 included studies. These findings represented only Afghan, Mexican and Korean women's views and were probably culturally-specific. We were unable to explore male migrants' perceived health literacy due to the notable lack of research involving migrant men. Research on male migrants' perceived health literacy and their health-related challenges is needed, as well as more research on potential gender roles and differences in the context of migration. Moreover, there is a need for more research in different countries and healthcare systems to create a more comprehensive picture of health literacy in the context of migration.

Aldin A ，Baumeister PhD A ，Chakraverty D ，Monsef I ，Noyes J ，Kalbe E ，Woopen C ，Skoetz N ... -  《Cochrane Database of Systematic Reviews》

Erratum: Eyestalk Ablation to Increase Ovarian Maturation in Mud Crabs.

《Jove-Journal of Visualized Experiments》

Ethics of Procuring and Using Organs or Tissue from Infants and Newborns for Transplantation, Research, or Commercial Purposes: Protocol for a Bioethics Scoping Review.

Since the inception of transplantation, it has been crucial to ensure that organ or tissue donations are made with valid informed consent to avoid concerns about coercion or exploitation. This issue is particularly challenging when it comes to infants and younger children, insofar as they are unable to provide consent. Despite their vulnerability, infants' organs and tissues are considered valuable for biomedical purposes due to their size and unique properties. This raises questions about the conditions under which it is permissible to remove and use these body parts for transplantation, research, or commercial purposes. The aim of this protocol is to establish a foundation for a scoping review that will identify, clarify, and categorise the main ethical arguments regarding the permissibility of removing and using organs or tissues from infants. The scoping review will follow the methodology outlined by the Joanna Briggs Institute (JBI), consisting of five stages: (1) identifying the research question, (2) developing the search strategy, (3) setting inclusion criteria, (4) extracting data, and (5) presenting and analysing the results. We will include both published and unpublished materials that explicitly discuss the ethical arguments related to the procurement and use of infant organs or tissues in the biomedical context. The search will cover various databases, including the National Library of Medicine, Web of Science, EBSCO, and others, as well as grey literature sources. Two raters will independently assess the eligibility of articles, and data from eligible studies will be extracted using a standardised form. The extracted data will then be analysed descriptively through qualitative content analysis. There has been debate about how to respect the rights and interests of organ and tissue donors since the beginning of transplantation practice, given the moral risks involved in procuring parts of their bodies and using them for transplantation or research. A major concern has been to ensure that, at a minimum, donation of organs or other bodily tissues for transplantation or research is done under conditions of valid informed consent, so as to avoid coercion or exploitation among other moral harms. In the case of infants and younger children, however, this concern poses special difficulties insofar as infants and younger children are deemed incapable of providing valid consent. Due to their diminutive size and other distinctive properties, infants' organs and tissues are seen as valuable for biomedical purposes. Yet, the heightened vulnerability of infants raises questions about when and whether it is ever permissible to remove these body parts or use them in research or for other purposes. The aim of this protocol is to form the basis of a systematic scoping review to identify, clarify, and systematise the main ethical arguments for and against the permissibility of removing and using infant or newborn (hereafter, "infant") organs or tissues in the biomedical context (i.e. for transplantation, research, or commercial purposes). Our scoping review will broadly follow the well-established methodology outlined by the Joanna Briggs Institute ( Peters et al., 2020). We will follow a five-stage review process: (1) identification of the research question, (2) development of the search strategy, (3) inclusion criteria, (4) data extraction, and (5) presentation and analysis of the results. Published and unpublished bibliographic material (including reports, dissertations, book chapters, etc.) will be considered based on the following inclusion criteria: the presence of explicit (bio)ethical arguments or reasons (concept) for or against the procurement and use of organs or tissues from infants, defined as a child from birth until 1 year old (population), in the biomedical domain, including transplantation, research, and commercial development (context). We will search for relevant studies in the National Library of Medicine (including PubMed and MEDLINE), Virtual Health Library, Web of Science, Google Scholar, EBSCO, Google Scholar, PhilPapers, The Bioethics Literature Database (BELIT), EthxWeb as well as grey literature sources (e.g., Google, BASE, OpenGrey, and WorldCat) and the reference lists of key studies to identify studies suitable for inclusion. A three-stage search strategy will be used to determine the eligibility of articles, as recommended by the JBI methodological guidelines. We will exclude sources if (a) the full text is not accessible, (b) the main text is in a language other than English, or (c) the focus is exclusively on scientific, legal, or religious/theological arguments. All articles will be independently assessed for eligibility between two raters (MB & XL); data from eligible articles will be extracted and charted using a standardised data extraction form. The extracted data will be analysed descriptively using basic qualitative content analysis. Ethical review is not required as scoping reviews are a form of secondary data analysis that synthesise data from publicly available sources. Our dissemination strategy includes peer review publication, presentation at conferences, and outreach to relevant stakeholders. The results will be reported according to the PRISMA-ScR guidelines. An overview of the general data from the included studies will be presented in the form of graphs or tables showing the distribution of studies by year or period of publication, country of origin, and key ethical arguments. These results will be accompanied by a narrative summary describing how each included study or article relates to the aims of this review. Research gaps will be identified and limitations of the review will also be highlighted. A paper summarising the findings from this review will be published in a peer-reviewed journal. In addition, a synthesis of the key findings will be disseminated to biomedical settings (e.g., conferences or workshops, potentially including ones linked to university hospitals) in the UK, USA, Türkiye, and Singapore. They will also be shared with the academic community and policy makers involved in the organ procurement organisations (OPO), which will potentially consider our recommendations in their decision-making processes regarding infant tissue/organ donation practice in these countries. The use of a rigorous, well-established methodological framework will ensure the production of a high-quality scoping review that will contribute to the bioethics literature.A comprehensive search of disciplinary and cross-disciplinary databases will be undertaken to ensure coverage of all possible sources that meet the inclusion criteria for the review.This review will focus exclusively on infant tissue/organ procurement/use in biomedical contexts, providing a comprehensive and reliable source of ethical arguments for future debates on this sensitive topic.The review will be limited to articles published in English, which increases the risk of missing relevant sources published in other languages.The review will be limited to articles for which the full text is available, which increases the risk of missing relevant sources that otherwise may have been included in the scoping review had the full text been accessible.

Barış M ，Lim X ，T Almonte M ，Shaw D ，Brierley J ，Porsdam Mann S ，Nguyen T ，Menikoff J ，Wilkinson D ，Savulescu J ，Earp BD ... -  《-》