Search Results (30)

Background: Immigrants with disabilities (IWDs) are disproportionately affected by a lack of access to healthcare services and face unique challenges compared to the general population. This qualitative meta-synthesis examines the barriers, facilitators, and lived experiences of IWDs accessing healthcare in the U.S. and Canada. Methods: A theory-generating qualitative meta-synthesis approach was used to analyze and synthesize raw qualitative data. Using eight databases, 752 studies were retrieved, and 10 were selected and synthesized after a three-stage review. The final articles were assessed using the Critical Appraisal Skills Program (CASP) checklist, and a PRISMA flow chart was used to report on the selection process. Results: The analysis identified structural barriers, including the bureaucracy and complexity of the system, healthcare costs, transportation, communication, long wait times, and a lack of integrated services. Cultural barriers included denial and trust, stigma and discrimination, awareness and language gaps, and lack of social support. Facilitators of access included support from immediate family members, community health centers, and social workers. Conclusions: The findings highlight the need for policy reforms to reduce bureaucratic hurdles, improve communication within healthcare systems, and enhance cultural competence among healthcare providers. Addressing these issues through integrated service models and targeted support can significantly improve the quality of life as a result of improved healthcare access for IWDs. Full article

Background: Family caregivers provide most (75–90%) of the essential unpaid care and support for individuals living with chronic conditions, disabilities, and age-related needs in the community, with about half performing medical tasks traditionally performed by professionals. Caregivers also assist with 15 to 35% of the care in congregate care settings. Yet despite their critical contributions to patient care, caregivers face stress, declining well-being, and insufficient recognition in healthcare systems. Addressing these challenges requires innovative, person-centered approaches to training healthcare providers. Co-design or co-production are participatory research methods that involve individuals with lived experience to ensure relevance and impact. Objective: This study sought to understand how participatory co-design principles influenced learning, collaboration, and engagement among diverse participants in developing a caregiver-centered education program for healthcare providers. Actionable recommendations for optimizing co-design processes are provided. Methods: Eighty-five participants from a team of 155 collaborators, including caregivers, healthcare providers, educators, policymakers, and leaders, participated in ten focus group sessions conducted in Zoom breakout rooms. Interviews were transcribed verbatim and analyzed using Thorne’s interpretive description and Braun and Clarke’s reflexive thematic analysis. Results: Participants described the co-design process as fostering collaboration, inclusivity, and skill enhancement. Exposure to diverse perspectives expanded transformative understanding and prompted reflection on caregiver support within professional practices. Skilled facilitation ensured equitable engagement. Challenges included information overload and personal time constraints. Participants liked using breakout rooms to mitigate the dynamics of large group management. Still, they recommended pre-meeting materials, flexible scheduling, and expanding stakeholder diversity (e.g., rural, Indigenous, and immigrant caregivers). Conclusions: Co-design fosters meaningful, caregiver-centered education through collaboration and inclusivity. Addressing logistical challenges and representation gaps can further enhance the impact of co-design and empower multi-level, interdisciplinary partners to inform equitable healthcare education. Full article

The enhancement of mechanisms to protect the rights of migrants and refugees within the European Union represents a critical area for human-centered artificial intelligence (HCAI). Traditionally, the focus on algorithms alone has shifted toward a more comprehensive understanding of AI’s potential to shape technology in ways which better serve human needs, particularly for disadvantaged groups. Large language models (LLMs) and retrieval-augmented generation (RAG) offer significant potential to bridging gaps for vulnerable populations, including immigrants, refugees, and individuals with disabilities. Implementing solutions based on these technologies involves critical factors which influence the pursuit of approaches aligning with humanitarian interests. This study presents a proof of concept utilizing the open LLM model LLAMA 3 and a linguistic corpus comprising legislative, regulatory, and assistance information from various European Union agencies concerning migrants. We evaluate generative metrics, energy efficiency metrics, and metrics for assessing contextually appropriate and non-discriminatory responses. Our proposal involves the optimal tuning of key hyperparameters for LLMs and RAG through multi-criteria decision-making (MCDM) methods to ensure the solutions are fair, equitable, and non-discriminatory. The optimal configurations resulted in a 20.1% reduction in carbon emissions, along with an 11.3% decrease in the metrics associated with bias. The findings suggest that by employing the appropriate methodologies and techniques, it is feasible to implement HCAI systems based on LLMs and RAG without undermining the social integration of vulnerable populations. Full article

Background/Objectives: The World Federation of the Deafblind Global Report 2023 reports that many countries do not have a comprehensive identification, assessment, and referral system for persons with deafblindness, a combination of hearing and vision loss, across all age groups and geographic regions. The scan seeks to inform researchers, policymakers, and community-based organizations about the status of and gaps in sensory healthcare initiatives in Canada, with the intent to raise awareness to enhance the integration and coordination of eye and ear care services. Methods: We conducted an environmental scan of Canada’s healthcare system and current public health policies addressing vision and hearing care in Canada at the federal and provincial levels. The scan was conducted using published literature searches from five scientific databases—Embase, Medline, PsycINFO, PubMed, and CINAHL—in combination with the gray literature review of federal, provincial, and territorial governments and non-profit organizations’ websites from April 2011–October 2022. Out of 1257 articles screened, 86 studies were included that met the inclusion/exclusion criteria. In total, 13 reports were included in the gray literature search, with 99 total articles used in the analysis. Results: The thematic findings indicate stigma and discrimination toward individuals with disabilities and marginalized communities (Indigenous people, rural communities, recent immigrants, people of older age, and people with disabilities), including hearing, vision, or dual sensory loss, persist. Barriers to vision and hearing healthcare access include inadequate policies, underinvestment in vision and/or hearing services, limited collaboration and coordinated services between hearing and vision services, discrepancies in insurance coverages, and lack of health system support. Conclusions: This scan demonstrates the persisting barriers to vision and/or hearing services present in Canada, stemming from inadequate policy and limited service coordination. Future work to address gaps, evaluate public education, and develop integrated sensory healthcare initiatives to enhance coordinated eye and ear care services, as recommended in the WHO Report on Hearing and Vision, is imperative. Full article

In Panama, “Generation Y” was identified at the beginning of this millennium, which was two decades after the first reports of such a generation. However, the overall evolution caused by globalization and digital development generated changes at the collective level in society, as is to be expected. This article aims to provide a look at how Panamanians identified as Generation Y or Millennials express their national identity, values, and sense of belonging. This article presents a descriptive approach performed on the responses to a national survey of a sample of 384 people considered Millennials for the project “Panama’s millennials: sense of belonging and national identity in a globalized society”. The main findings show that this generation is very much in favor of equal rights between men, women, immigrants, and disabled persons; they advocate pro-social issues but show differences regarding the protection of the future. The majority of them disagree with civil society organizations, do not identify with the health system, nor do they recognize quality in the education system or state-sponsored employment-generating activities. They also highlighted imbalances in the implementation of justice and the distribution of the country’s wealth. Full article

Oral histories of Latina domestic workers in the United States feature hybrid narratives combining accounts of illness and “toxic discourse”. We approach domestic workers’ illnesses and disabilities in a capacious, extra-medical context that registers multiple axes of precarity (economic, racial, and migratory). We are naming this context “settler maintenance”. Riffing on the specific and general valences of “maintenance” (i.e., as a synonym for cleaning work, and as a term for the practices and ideologies involved in a structure’s upkeep), this term has multiple meanings. First, it describes U.S. domestic workers’ often-compulsory use of hazardous chemical agents that promise to remove dirt speedily, yet that imperil domestic workers’ health. The use of these chemicals perpetuates two other, more abstract kinds of settler maintenance: (1) the continuation of socioeconomic hierarchies between immigrant domestic workers and settler employers, and (2) the continuation of (white) settlers’ extractive relationship to the land qua private property. To challenge this logic of settler maintenance, which is predicated on a lack of care for care workers, Latina domestic workers have developed alternative forms of care via lateral networks and political activism. Full article

Educational poverty is widespread in compulsory education in terms of poor learning and socio-cultural disadvantages; it affects students with disabilities, students with learning difficulties, and those with an immigrant background. During the pandemic crisis, students with special educational needs (SENs) mostly suffered the risk of an additional deprivation. Within an advanced inclusive model during school closure, the Italian State guaranteed access to schools only to students with disabilities. What effects did this “equalizing” measure produce? What kinds of attitudes have teachers adopted and what roles have they played (active vs. passive) in order to make it sustainable? What was their acknowledgement of the educational poverty and deprivation? To what extent were their attitudes differentiated? This article explores the roles and attitudes of teachers during periods of lockdown as a result of the COVID-19 pandemic in Italy. We assume that the teachers’ attitudes were differentiated on the basis of five cultural dimensions (auto/hetero-referencing; vision of remote teaching; relationship with bureaucracy, relationships with students; teaching as performance or relation), and two functions (classroom teachers/ SENs teachers). The study is based on 42 semi-structured interviews conducted with teachers, principals, and parents in six lower secondary public schools with high rates of SENs students and multi-ethnicity (Northern Italy), and focused on the organisational, teaching, and relational aspects. Results seem to confirm that not all teachers agreed with the Ministry line and adopted a range of responses to the challenge of maintaining inclusivity, from the inert/impatient to the creative/active ones. Their attitudes changed during the post-pandemic period from atomistic to more collaborative, and their preoccupation with the fragile “uncertified students” increased. The article closes with recommendations on teacher training. Full article

The COVID-19 pandemic and subsequent school lockdowns in many countries forced teachers to deliver lessons online to ensure that students continued their studies. This shift, which caused major challenges for school systems worldwide, significantly affected the Cypriot education system, which is highly centralised and in which teacher-centred practices are widely used. In many countries, teachers and students were unfamiliar with the new teaching and evaluation methods, and learners in the most marginalised groups were deemed to be at risk of falling behind. For these reasons, an online survey was undertaken in Cyprus from March to September 2020 as part of an international online survey initiated by a university in the Northern Mexican state of Nuevo Leon. The survey examined teachers’ perspectives on the new online pedagogical practices; the challenges they faced; and the impact of these practices on the learning progress of all students, including two vulnerable groups, i.e., individuals with learning disabilities and immigrant students aged 6–18 years. Key findings suggest that the teachers were unprepared to design inclusive student-centred digital activities and deliver online lessons and that distance teaching may have negatively affected students’ learning experiences, especially in the vulnerable groups. Full article

The establishment of the Global Programme to Eliminate Lymphatic Filariasis (GPELF) to stop the transmission of infection has significantly reduced the incidence of lymphatic filariasis, a debilitating mosquito-borne neglected tropical disease. The primary strategies that have been employed include mass drug administration (MDA) of anthelminthics and morbidity management and disability prevention (MMDP). While some countries have been able to reach elimination status in Africa, there is still active transmission of LF in Zambia. The nematode responsible for the disease is Wuchereria bancrofti, which is transmitted by Anopheles mosquitoes. To alleviate the suffering of those infected by the disease, the Zambian Ministry of Health launched a program to eliminate LF as a public health problem in 2003. This project reviewed the efforts to achieve the elimination of LF in Zambia, past and present government policies, and the anticipated challenges. MDAs have been conducted since 2014 and coverage has been between 87% and 92%. Zambia has now moved towards pre-transmission assessment surveys (PRETAS) and transmission assessment surveys (TAS). MMDP is a major priority and planned to be conducted between 2022 and 2026. COVID-19 presented a new challenge in the control of LF, while climate change, immigration, co-infections, and funding limitations will complicate further progress. Full article

It is estimated that 40% of the cancer cases in Europe could be prevented if people had better information and tools to make healthier choices and thereby reduce some of the most important cancer risk factors. The aim of this study is to gain knowledge and understanding about cancer prevention literacy among people with intellectual disabilities, immigrants, young people and young cancer survivors. In this qualitative study, we conducted six online focus-group interviews, including forty participants, to explore the cancer prevention literacy of four population subgroups and determine how cancer prevention recommendations according to the European Code Against Cancer (ECAC) were perceived. The analysis resulted in the following main categories: current health beliefs and their impacts on how the ECAC recommendations were perceived, communication strategies and sources benefiting or hindering cancer prevention information from reaching out, and how vulnerabilities in these subgroups impact cancer prevention literacy. To improve cancer prevention literacy in Europe, more attention is needed this topic to overcome barriers among different population subgroups. Recommendations include improved and adapted cancer prevention information, support to individuals, as well as societal support, such as easy-access screening and vaccination programmes and regulations related to tobacco, alcohol, and diet. Full article

In Peru, Venezuelan migrants and refugees have been exposed to food shortages before their emigration. This problem could have worse outcomes in vulnerable populations (such as people with disabilities); however, the literature on the basic needs of this population is still scarce. The objective was to determine the association between the presence of disability and the unmet need for access to food in the household of the Venezuelan migrant and refugee population residing in Peru. A cross-sectional study was conducted using data from the Second Survey of the Venezuelan Population Residing in Peru (ENPOVE 2022). The outcome variable was unmet need for food, while the independent variable was the presence of disability. Poisson log generalized linear regression models (crude and adjusted for potential confounding variables) were fitted to evaluate the association between the variables of interest, reporting prevalence ratios (PR) and 95% confidence intervals (CIs). A total of 7739 migrants and refugees from Venezuela were included. The proportion of unmet need for access to food in the household was 45.2%, while the proportion of disability was 2.1%. People with disabilities were found to be more likely to have an unmet need for access to food at home (adjusted PR [aPR]: 1.25; 95% CI: 1.08–1.46; p = 0.003). According to our findings, almost half of Venezuelan households were found to have an unmet need for access to food. In addition, Venezuelan migrants and refugees with disabilities were more likely to have an unmet need for this basic need. Full article

Chile has implemented the PACAM program to support older people with nutrition and for the prevention of malnutrition and frailty. This work aims to identify the social determinants of older persons not withdrawing PACAM food in order to obtain helpful knowledge for improving the program. First, the CASEN Survey 2017 was used (960,498 observations); the inclusion criterion was PACAM recipients (Yes/No). Next, a probit model was performed with a dichotomous response to determine the marginal effects of each independent variable (e.g., demographic, health, and social). The model shows a good fit (64.4%) with an explained variance between 10.5% to 14.1%. Those variables with more significant marginal effects are people aged 70–75, having tertiary and secondary education, urban living, not participating in social organizations, immigrants, and living in the austral zone. On the other hand, a higher likelihood of consumption was found among people of greater vulnerability (lowest income, lowest education, low health insurance, and aged over 80) and, therefore, in greater fragility. To conclude, the program achieves effective targeting, although improvement actions are required to expand coverage in some groups (indigenous people, immigrants, and people with disabilities). Moreover, authorities should evaluate and reinforce the program with tailored strategies for the older adults who actually withdraw food. Full article

Background: Few studies in Canada have focused on the relationship between immigrant status and successful aging. The concept of successful aging used in this study includes the ability to accomplish both activities of daily living (ADLs) and instrumental activities of daily living (IADLs), freedom from mental illness, memory problems and disabling chronic pain, adequate social support and older adults’ self-reported happiness and subjective perception of their physical health, mental health and aging process as good. Methods: The present study analyzed the first two waves of data from the comprehensive cohort of the Canadian Longitudinal Study on Aging (CLSA). The sample includes 7651 respondents aged 60+ at time 2, of whom 1446 respondents were immigrants. Bivariate and multivariable binary logistic regression analyses were conducted. Results: Canadian-born older adults had a slightly higher prevalence and age-sex adjusted odds of achieving successful aging than their immigrant counterparts (aOR = 1.18, 95% CI: 1.04, 1.34, p < 0.001). After adjusting for 18 additional factors, immigrant status remained statistically significant (aOR = 1.24, 95% CI: 1.09, 1.41, p < 0.001). Significant baseline factors associated with successful aging among immigrants included being younger, having higher income, being married, not being obese, never smoking, engaging in moderate or strenuous physical activities, not having sleeping problems and being free of heart disease or arthritis. Conclusions: Immigrant older adults had a lower prevalence of successful aging than their Canadian-born peers. Further research could investigate whether policies and interventions supporting older immigrants and promoting a healthy lifestyle enhance older adults achieve successful aging in later life. Full article

Urban areas are increasingly experiencing extreme weather events, especially related to water (e.g., droughts, heatwaves, floods), which are devastatingly impacting infrastructure and human lives. Compact cities, conceived to create more robust, effective, and sustainable environments, are under pressure to increase their resilience by co-producing adaptive strategies mainly focused on the urban public space. However, public space design tends to face environmental challenges without sufficiently exploring their intersection with social issues (citizens living conditions and vulnerability) and political structures (governance). This contribution delves into how urban public space interventions are (not) moving towards achieving urban resilience in an integrated way instead of sectoral. A triple-loop approach has been developed and tested in ten urban public spaces in European compact cities in the last 25 years. The results report how most projects reinforce the social dimension by promoting citizen well-being through new quality standards in public spaces, excluding some citizenry’s vulnerable segments (immigrants, women, and disabled). The political dimension reinforces hard adaptation measures to manage water resources, although increasing attention is put on nature-based solutions, and most projects ensure participation processes. Finally, the environmental dimension is the most transversal by increasing land conversion, ensuring flooding mitigation, and enhancing adaptive capacity. Full article

This paper employs a qualitative case study to investigate the parenting experiences of multicultural families with disabled children in Korea. The topic at hand focuses specifically on mothers’ experiences of raising a child with disability in a multicultural family. Participants chosen through purposive sampling method were recommended by the Korean multicultural support center. This study’s five participants are married female immigrants who are raising elementary school-age children with disabilities and who have Korean communication skills. The qualitative case study approach seeks to elicit the participants’ experiences of child nurturing. Their experiences were analyzed and categorized into two main categories: (1) hardships for mothers raising children with disabilities and (2) expectations of mothers raising children with disabilities. Such analyses lead us to understand the intricacies of motherhood for children with special needs in foreign countries. Lastly, the implications of this study aim to provide direction for effective and practical policies—including social welfare and educational support—that will meet the needs of multicultural families with disabled children. Full article