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Background The growing number of vulnerable migrants and refugees (VMRs) in the European Union presents challenges to healthcare systems, emphasizing the need for enhanced intercultural competence training for healthcare professionals. Educational escape rooms, using gamification-based principles, may offer an innovative solution to improve these competencies. Objective This pilot study evaluates the acceptability and preliminary effectiveness of an educational escape room aimed at improving intercultural competence, self-efficacy, and knowledge among healthcare students and professionals caring for VMRs. Methods A pre-post, single-group pilot study was conducted with 101 healthcare students and professionals, recruited through convenience sampling. Participants engaged in an educational escape room simulating a migratory crisis, designed to foster collaborative problem-solving under pressure. A newly validated questionnaire was administered before and after the intervention to measure changes in intercultural competence, self-efficacy, and knowledge. Paired t-tests were used to analyze pre-post differences, and thematic analysis explored participant feedback on the learning experience and the acceptability of the intervention. Results Significant improvements were observed in intercultural competence (d = 1.13, p  < 0.001), self-efficacy (d = 0.38, p  = 0.001), and knowledge (d = 1.19, p  < 0.001). Participants reported high engagement, satisfaction, and an enhanced understanding of healthcare challenges related to VMRs. The escape room was deemed acceptable. Conclusions This pilot study provides evidence of the acceptability and effectiveness of an educational escape room in enhancing intercultural competence, self-efficacy, and knowledge. Further research with larger, more rigorous studies is recommended to confirm these findings and explore scalability.

Background Tunisia, situated at the crossroads of North Africa and Europe, has increasingly become an important origin, destination, and transit point for sub-Saharan migrants and refugees in recent decades. Despite growing migration flows, there remains a paucity of research on how these populations navigate healthcare access in Tunisia. This study addresses this gap by exploring migrants’ experiences with and perceptions of Tunisia’s healthcare system, with a focus on barriers to and facilitators of healthcare. Methods A qualitative study was conducted in four urban areas (Tunis, Medenine, Sousse, and Sfax) with concentrated migrant populations between May and December 2023. A purposive sample of migrants, migrant community leaders, and nongovernmental organization (NGO) staff were engaged through semi-structured interviews and focus-group discussions. Data were analysed via thematic analysis, combining inductive and deductive coding via NVivo 14 software, guided by an adaptation of Levesque’s conceptual framework. Results In total, 120 migrants and 43 NGO staff members participated in the study. The participants identified structural barriers such as legal status limitations, language barriers, and financial constraints, as well as social and cultural issues such as stigma and distrust of health system. While informal networks provide critical health information, they often lead to fragmented care. The private sector was perceived as better quality but unaffordable for the majority of migrants. Key facilitators included NGO support for referrals and coordination, particularly for undocumented migrants. Access was further hindered by communication gaps and limited awareness of the healthcare process. Conclusions Our study underscores the complex interplay of structural and individual barriers to accessing healthcare for migrants in Tunisia. Addressing these challenges requires culturally sensitive policies, multilingual resources, simplified administrative processes, and expanded health insurance coverage. Strengthening collaboration between NGOs, healthcare providers, and policymakers is essential to ensure equitable healthcare access for migrants.

Migrants in the Middle East and North Africa (MENA) region face an increased tuberculosis (TB) risk due to socioeconomic and structural barriers. This systematic review synthesises evidence on TB burden, clinical outcomes, and epidemiological characteristics among migrants in MENA. We searched six electronic databases and grey literature sources for studies published between 2000 and September 2024 in any language. Eligible studies reported primary data on TB prevalence, incidence, treatment outcomes, and clinical or epidemiological features in migrants. Pooled estimates were calculated using DerSimonian & Laird's random-effects model where applicable or narratively synthesised. Of the 779 records identified, we included 57 studies, comprising 95,190 TB cases and 3,532,359 migrants across 12 MENA countries. TB incidence was consistently higher in migrants than non-migrants (26.7–69.8/100,000 vs. 11.5–16.8/100,000). Migrants had lower TB-related mortality (pooled OR 0.8, 95 % CI 0.7–0.9; I2 = 2.9 %), however, treatment success rates were consistently below the WHO-recommended 90 % threshold. Migrant TB patients were younger (mean age difference: 12.8 years; 95 % CI 8.8–16.0; I2 = 86.5 %) and predominantly male (sex ratio: 1:5). Drug-resistant TB was more common among migrants, though this was not always statistically significant (multi-drug-resistant TB: pooled OR 1.2; 95 % CI 0.9–1.6; I2 = 40.2 %), while extrapulmonary TB was more prevalent among non-migrants (33.4–83.4 % vs. 16.6–72.9 %). Migrants in MENA region experience disproportionate TB burden and poorer treatment outcomes, underscoring the need for targeted interventions. Enhanced data, especially from North Africa, is essential to support regional TB elimination aligned with World Health Organization and Sustainable Development Goals. •TB incidence and drug resistance are higher among migrants in MENA than non-migrants.•Migrant TB patients are younger, have lower mortality rates, but poorer treatment success.•Data on TB among North African migrants is critically scarce.•Migrant-focused strategies and better data are urgently needed to meet WHO's End TB targets.

IntroductionThis systematic review investigates the burden, clinical outcomes and risk factors of neglected tropical diseases (NTDs) and malaria in the Middle East and North African region, highlighting the urgency and scope of these health challenges.MethodsWe searched six databases for peer-reviewed literature and additional sources to capture grey literature in any language from 2000 to 28 August 2024. Studies were included if they provided primary data on outcomes in migrants. Primary outcomes were prevalence, incidence and mortality. Peer-reviewed articles were critically appraised using Joanna Briggs Institute tools, while the AACODS (Authority, Accuracy, Coverage, Objectivity, Date and Significance) checklist was used for grey literature. Estimates were pooled using random-effects meta-analysis where possible or synthesised narratively.ResultsWe included 39 studies with 81 678 migrants across 11 countries for NTDs and 16 studies encompassing 12 823 migrants across five countries for malaria. The pooled prevalence of specific NTDs among migrants was 4.7% for hookworm (95% CI 0.9% to 11.3%, I²=99%), 1.8% for Trichuris trichiura (95% CI 0.3% to 4.3%, I²=98%), 1.75% for Ascaris lumbricoides (95% CI 0.6% to 3.5%, I²=96%) and 1.8% for taeniasis (95% CI 0.3% to 4.4%, I²=98%). Compared with non-migrants, migrants exhibited higher prevalence rates for hookworm (1.8% vs 0.03%), Ascaris lumbricoides (0.3% vs 0%), Trichuris trichiura (0.5% vs 0%), dengue (26% vs 3.5%) and chikungunya (4.2% vs 0.5%). Migrants had a higher proportion of confirmed cases of schistosomiasis (0.21–20.3% vs 0–0.013%), cystic echinococcosis (7.4% vs 3.5%) and dengue (57.2% vs 56.4%) among suspected cases compared with non-migrants. Case fatality rates were 3.1% for dengue and 0.2–1.5% for malaria. Malaria incidence was only reported in Sudan (internally displaced persons: 6.8/1000; refugees: 2.72/1000; refugees <5 years old: 7.3/1000). While hospitalisation and intensive care unit rates for malaria were 25.8% and 1.3%, respectively, severe malaria was higher in non-migrants compared with migrants in Qatar (50% vs 5.2%, respectively).ConclusionsDespite a wide range of diseases reported in 55 studies, there were gaps in the evidence, primarily related to risk factors, clinical outcomes and the subregion of North Africa. We generally found that migrants were disproportionately affected by both NTDs and malaria, especially in the Middle East. PROSPERO registration number CRD42023407748

In recent decades, growing environmental concerns in architecture have coincided with the increasing focus on the preservation of architectural heritage, particularly, that of the Modern Movement. Sustainability in architecture is viewed as a certain attitude and approach to design, construction and building operation, assessed by rating systems that apply the same criteria to both new and existing structures. For this reason, the discussion on the sustainability of the Modern architectural heritage is still considered by many to form an ambition and a paradox. This paper explores contemporary discourse on the sustainability and preservation of modern architectural heritage. It first examines architectural preservation through the key components of reuse, renovation, and restoration. The strategic design decisions toward such a task require a deep understanding of the Modern Movement’s ideology, extending beyond stylistic concerns to material choices, social and aesthetic values, and the movement’s innovative and technological agenda. Additionally, this study contextualizes sustainability within modernist-era perspectives on climate and economy. A particular focus is given to the modern architecture of the Mediterranean, analyzing how design elements such as brise-soleils, long cantilevers, materials, cross-ventilation, orientation, and landscaping contribute to sustainable principles. This analysis highlights the intersection between sustainability and cultural preservation, emphasizing the need to expand sustainability concepts when assessing modernist buildings. Finally, the paper presents contemporary case studies from various countries, showcasing projects that have successfully adapted modernist buildings through reuse, renovation, and restoration. These examples illustrate structural, energy, and regulatory challenges encountered in such interventions, offering insights into best practices for balancing sustainability with heritage conservation. By reframing sustainability in modernist preservation, this study argues for a broader, more nuanced approach that integrates new assessment methods and design strategies to ensure the longevity of modern architectural heritage.

ObjectivesSome migrant groups are disproportionately affected by key infectious diseases in European countries. These pose a challenge for healthcare systems providing care to these groups. We aimed to explore the views of general practitioners (GPs) on the acceptability, adaptability and feasibility of a multidisease screening programme based on an innovative clinical decision-support system for migrants (the ISMiHealth tool), by examining the current gaps in healthcare provision and areas of good practice and the usefulness and limitations of training in the health needs of migrants.MethodsWe undertook a qualitative descriptive study and carried out a series of focus groups (FGs) taking a pragmatic utilitarian approach. Participants were GPs from the four primary healthcare (PHC) centres in Catalonia, Spain, that piloted an intervention of the ISMiHealth tool. GPs were recruited using purposive and convenience sampling. FG discussions were transcribed and analysed using thematic content analysis.ResultsA total of 29 GPs participated in four FGs. Key themes identified were: (1) GPs found the ISMiHealth tool to be very useful for helping to identify specific health problems in migrants, although there are several additional barriers to screening as part of PHC, (2) the importance of considering cultural perspectives when caring for migrants, and of the impact of migration on mental health, (3) the important role of PHC in healthcare provision for migrants and (4) key proposals to improve screening of migrant populations. GPs also highlighted the urgent need, to shift to a more holistic and adequately resourced approach to healthcare in PHC.ConclusionsGPs supported a multidisease screening programme for migrant populations using the ISMiHealth tool, which aided clinical decision-making. However, intercultural participatory approaches will need to be adopted to address linguistic and cultural barriers to healthcare access that exist in migrant communities.

IntroductionThe Middle East and North Africa (MENA) region is characterised by major health disparities and complex migration flows. Yet, because of a lack of epidemiological data, there is an urgent need to strengthen routine data collection around migrant health and to define key indicators towards migrant health monitoring. To address this problem, we aim to design and pilot test the Migrant Health Country Profile tool (MHCP-t) which can collate country-level data collection around migration health data, policies and healthcare provision.Methods and analysisThe MHCP-t development is a stepwise process that will integrate a process evaluation model with active involvement and engagement of multilevel stakeholders. First, towards the generation of indicators, qualitative field activities will be conducted in different regions in Morocco, Tunisia and Egypt with migrants (n=50 per region), migrant community leaders (n=20 per region) and professionals working with them (n=20 per region). Deductive–inductive thematic analysis will be applied to the data collected. Results from the national qualitative studies and a series of systematic reviews in the MENA region will conclude with a first draft of tool indicators which will be reviewed by national and international experts using the Nominal Group Technique. The revised indicators will be entered into an electronic data capture system and the tool will be pilot-tested by applying a mixed-methods process evaluation to examine its relevance, comprehensiveness, comprehensibility and other practical issues, such as completion time and ease of responding. Mechanisms of change will be assessed on how the participative interactions towards the tool development can trigger change at national and regional levels.Ethics and disseminationThe study protocol has been approved by the institutional review boards at the Hospital Clinic in Barcelona, Spain, the University of Sousse in Sousse, Tunisia, the University Hospital of Tanger, Morocco and Badr University of Cairo in Egypt. Findings will be disseminated in peer-reviewed journals and communications to national and regional congresses.

Background The prevalence of mental health disorders in children, teens, and young adults is rising at an alarming rate. This study aims to explore time trends in the incidence of mental disorders among young people in Catalonia, Spain from 2008 to 2022, focusing on the effects of the COVID-19 pandemic and from the perspective of social inequities. Methods A cohort study using primary care records from the SIDIAP database was conducted. It included 2,088,641 individuals aged 10 to 24 years. We examined the incidence of depressive, anxiety, eating, and attention deficit/hyperactivity disorders, stratified by sex, age, deprivation, and nationality. Results All disorders reflected an increasing trend throughout the study period: depressive disorders (IRR: 2.44, 95% CI: 2.31–2.59), anxiety disorders (IRR: 2.33, 95% CI: 2.27–2.39), ADHD (IRR: 2.33, 95%CI: 2.17–2.50), and eating disorders (IRR: 3.29, 95% CI: 3.01–3.59). A significant increase in incidence was observed after the outbreak of the COVID-19 pandemic. In 2022, anxiety disorders were most frequent, with an incidence rate (IR) of 2,537 per 100,000 persons-year (95% CI: 2,503–2,571). Depressive disorders followed with an IR of 471 (95% CI: 458–486), ADHD with an IR of 306 (95% CI: 295–317) and eating disorders with an IR of 249 (95% CI: 239–259). Significant associations were reported with sex, age, deprivation, and nationality. Conclusion The incidence of all studied disorders has steadily increased, reaching unprecedented levels during the pandemic. Understanding these trends is essential for an appropriate healthcare response, while addressing the non-medical determinants, requires action across all sectors of society.

The need for the public to take an active role in scientific research is becoming increasingly important, particularly in health-related research. However, the coexistence and alignment of scientific and citizen interests, needs, knowledge and timing is not straightforward, especially when involving migrant populations. To conduct impactful research, it becomes also essential to consider the perspectives of policymakers, thereby adding a layer of complexity to the processes.In this article we address the experience of a living lab created in a research institution and supported by the city council and a local foundation, in which we developed three experiences of patient and public involvement (PPI): (1) accessing to comprehensive care for people at risk of Chagas disease; (2) strategies towards improving access and quality of mental healthcare services in migrants; (3) promoting healthy and safe school environments in vulnerable urban settings.These three challenges provided an opportunity to delve into diverse strategies for involving key stakeholders, including migrant populations, expert researchers and political actors in health research. This article offers insights into the successes, challenges, and valuable lessons learnt from these endeavours, providing a vision that can be beneficial for future initiatives. Each living lab experience crafted its unique governance system and agenda tailored to specific challenge scenarios, giving rise to diverse methods and study designs.We have found that the management of the cocreation of the research question and the institutional support are key to building robust PPI processes with migrant groups.

WKS 36: Migration, Motherhood, and Maternal Health: Addressing Gaps in Care for Forcibly Displaced Women, B307 (FCSH), September 5, 2025, 09:00 - 10:00 Rationales and Purpose Migration is increasingly feminized, with women comprising 48% of global migrants. Forcibly displaced pregnant women and new mothers face heightened risks of poor physical and mental health due to migration-related adversities and disruptions in care, leading to under-documented intergenerational impacts. Multisectoral strategies to improve maternal and infant care for forcibly displaced migrant (FDM) women remain scarce, especially in low- and middle-income countries and transit regions. This workshop highlights the need to rethink maternal and child health services, drawing from a scoping review and three qualitative pilot studies engaging FDM women and stakeholders across transitory destinations in Colombia, Tunisia, and Spain. Methods/Process of Workshop This 60-minute workshop will present qualitative data from three pilot studies in northern Colombia, Tunisia, and the Canary Islands, alongside findings from a scoping review of maternal health guidelines. Each case will focus on migrant mothers, offering different perspectives on their experiences, which will be integrated into the discussion. The session will invite participants to discuss research gaps, intervention strategies, and how adopting a Feminist Ethics of Care approach that emphasizes communities of care and mutual responsibility among care actors can help us reimagine maternal healthcare for migrants in transitory destinations. Projected Learning Outcomes Participants will: Gain insight into the complexities of providing maternal care for migrant women in transitory destinations. Understand how violence and the gendered realities of migration intersect with maternal health and well-being. Reflect on the influence of socio-political shifts and deterrence policies on migrant mothers on the move. Discuss how women’s migration journeys, aspirations, and resources shape the ways in which they (dis)engage with services and how they (de)prioritize care for themselves and their children.