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      Use of health services among international migrant children – a systematic review

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          Abstract

          Background

          Migrant children have specific health needs, and may face difficulties in accessing health care, but not enough is known about their health service use. This study aims to describe patterns of use of health services of international migrant children and differences to respective native populations.

          Methods

          Electronic databases PubMed and Web of Science, references of identified publications, and websites of relevant international agencies were searched. We included observational studies published between 2006 and 2016 that reported use of formal health services by migrant children (0–18 years), including first and second generation migrants. Data on study characteristics, study theme, main outcome and study quality were extracted.

          Results

          One hundred seven full texts were included in the review. Of the studies that reported comparable outcomes, half (50%) indicated less use of healthcare by migrants compared with non-migrants; 25% reported no difference, 18% reported greater use, and 7% did not report this outcome. There was variation by theme, so that the proportion of conclusions “less use” was most common in the categories “general access to care”, “primary care” and “oral health”, whereas in the use of emergency rooms or hospitalisations, the most common conclusion was “greater use”.

          Conclusions

          Migrant children appear to use different types of healthcare services less than native populations, with the exception of emergency and hospital services.

          Systematic review registration

          PROSPERO systematic review registration number: CRD42016039876.

          Electronic supplementary material

          The online version of this article (10.1186/s12992-018-0370-9) contains supplementary material, which is available to authorized users.

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          Most cited references74

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          Implicit bias in healthcare professionals: a systematic review

          Background Implicit biases involve associations outside conscious awareness that lead to a negative evaluation of a person on the basis of irrelevant characteristics such as race or gender. This review examines the evidence that healthcare professionals display implicit biases towards patients. Methods PubMed, PsychINFO, PsychARTICLE and CINAHL were searched for peer-reviewed articles published between 1st March 2003 and 31st March 2013. Two reviewers assessed the eligibility of the identified papers based on precise content and quality criteria. The references of eligible papers were examined to identify further eligible studies. Results Forty two articles were identified as eligible. Seventeen used an implicit measure (Implicit Association Test in fifteen and subliminal priming in two), to test the biases of healthcare professionals. Twenty five articles employed a between-subjects design, using vignettes to examine the influence of patient characteristics on healthcare professionals’ attitudes, diagnoses, and treatment decisions. The second method was included although it does not isolate implicit attitudes because it is recognised by psychologists who specialise in implicit cognition as a way of detecting the possible presence of implicit bias. Twenty seven studies examined racial/ethnic biases; ten other biases were investigated, including gender, age and weight. Thirty five articles found evidence of implicit bias in healthcare professionals; all the studies that investigated correlations found a significant positive relationship between level of implicit bias and lower quality of care. Discussion The evidence indicates that healthcare professionals exhibit the same levels of implicit bias as the wider population. The interactions between multiple patient characteristics and between healthcare professional and patient characteristics reveal the complexity of the phenomenon of implicit bias and its influence on clinician-patient interaction. The most convincing studies from our review are those that combine the IAT and a method measuring the quality of treatment in the actual world. Correlational evidence indicates that biases are likely to influence diagnosis and treatment decisions and levels of care in some circumstances and need to be further investigated. Our review also indicates that there may sometimes be a gap between the norm of impartiality and the extent to which it is embraced by healthcare professionals for some of the tested characteristics. Conclusions Our findings highlight the need for the healthcare profession to address the role of implicit biases in disparities in healthcare. More research in actual care settings and a greater homogeneity in methods employed to test implicit biases in healthcare is needed.
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            Immigration as a social determinant of health.

            Although immigration and immigrant populations have become increasingly important foci in public health research and practice, a social determinants of health approach has seldom been applied in this area. Global patterns of morbidity and mortality follow inequities rooted in societal, political, and economic conditions produced and reproduced by social structures, policies, and institutions. The lack of dialogue between these two profoundly related phenomena-social determinants of health and immigration-has resulted in missed opportunities for public health research, practice, and policy work. In this article, we discuss primary frameworks used in recent public health literature on the health of immigrant populations, note gaps in this literature, and argue for a broader examination of immigration as both socially determined and a social determinant of health. We discuss priorities for future research and policy to understand more fully and respond appropriately to the health of the populations affected by this global phenomenon.
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              Mental health of displaced and refugee children resettled in high-income countries: risk and protective factors.

              We undertook a systematic search and review of individual, family, community, and societal risk and protective factors for mental health in children and adolescents who are forcibly displaced to high-income countries. Exposure to violence has been shown to be a key risk factor, whereas stable settlement and social support in the host country have a positive effect on the child's psychological functioning. Further research is needed to identify the relevant processes, contexts, and interplay between the many predictor variables hitherto identified as affecting mental health vulnerability and resilience. Research designs are needed that enable longitudinal investigation of individual, community, and societal contexts, rather than designs restricted to investigation of the associations between adverse exposures and psychological symptoms. We emphasise the need to develop comprehensive policies to ensure a rapid resolution of asylum claims and the effective integration of internally displaced and refugee children. Copyright © 2012 Elsevier Ltd. All rights reserved.
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                Author and article information

                Contributors
                +358503013020 , niina.markkula@helsinki.fi
                bcabieses@udd.cl
                veinle@utu.fi
                noortjeuphoff@gmail.com
                smastorga@uc.cl
                francisca.stutzin.15@ucl.ac.uk
                Journal
                Global Health
                Global Health
                Globalization and Health
                BioMed Central (London )
                1744-8603
                16 May 2018
                16 May 2018
                2018
                : 14
                : 52
                Affiliations
                [1 ]ISNI 0000 0000 9631 4901, GRID grid.412187.9, Social Studies in Health Research Programme, Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina, , Clínica Alemana Universidad del Desarrollo, ; Av. Las Condes 12461, Las Condes, Santiago Chile
                [2 ]ISNI 0000 0004 1936 9668, GRID grid.5685.e, Department of Health Sciences, , University of York, ; York, England
                [3 ]ISNI 0000 0000 9950 5666, GRID grid.15485.3d, Department of Psychiatry, , Helsinki University Hospital and University of Helsinki, ; Helsinki, Finland
                [4 ]ISNI 0000000121901201, GRID grid.83440.3b, Centre for Interdisciplinary and Intercultural Inquiry, Health Humanities, , University College London, ; London, UK
                Author information
                http://orcid.org/0000-0002-5312-8564
                Article
                370
                10.1186/s12992-018-0370-9
                5956827
                29769091
                fd83881b-b406-4185-96e2-1a5fb0bee338
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 18 October 2017
                : 6 May 2018
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100010125, Jalmari ja Rauha Ahokkaan Säätiö;
                Funded by: Fondecyt
                Award ID: 11130042
                Award Recipient :
                Funded by: Universidad del Desarrollo Interfaculty Funds
                Categories
                Review
                Custom metadata
                © The Author(s) 2018

                Health & Social care
                transients and migrants,immigrants,children,health service use,access
                Health & Social care
                transients and migrants, immigrants, children, health service use, access

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