Primary care
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Refugees are among the world's most vulnerable people, and COVID-19 presents novel threats to their well-being. Suspension of resettlement prolongs persecution for those accepted but not yet relocated to a host country and delays family reunification. ⋯ Communication barriers make telehealth access uniquely difficult, and children lose the school environment that is essential for their adaptation in a new country. Providers can mitigate pandemic-related harms by assessing barriers, disseminating information, and advocating for inclusive policies.
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Immigrants enrich the United States through economic contributions and unique perspectives. Immigrants find themselves navigating a new culture, a complicated health care system, unfamiliar social programs, and an ever-changing policy environment. ⋯ Screening for the social determinants of health is crucial, as not all patients will proactively seek the advice of their health care provider for these issues. Health care providers can assist and empower immigrants to navigate these challenges, as well as serve as advocates on a broader scale.
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The initial assessment of immigrant and refugee patients, including which health concerns to address and which infectious diseases may benefit from early screening, may present challenges to clinicians. Evidence-based research suggests certain infectious diseases should be screened for and treated in refugees. Overseas refugee preemptive treatment programs have reduced the burden of some diseases but have not removed the value of in-country screening programs. This article provides discussion of a series of common tropical and infectious diseases providing refugee and geographic contexts and links to international resources that have been developed to improve the care of newly arriving immigrants and refugees.
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Women's health is largely influenced by cultural beliefs, local traditions, and access to care across the world. Immigrant and refugee women experience health in varied ways; prior experiences with health care and beliefs about health should be explored with women on their arrival to the United States. Topics that should be discussed include menstrual practices, contraception and beliefs about family planning, prior screening for preventable diseases, pregnancies and experiences with childbirth, sexual assault and trauma, and history of traditional practices, including female genital mutilation (dependent on area of origin).
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Immigrants may have variable access to chronic disease screening and treatment in their countries of origin and host country, often limited by their immigration status. Immigrants face barriers to chronic disease management and preventive care, including health insurance access, linguistic challenges, lack of culturally sensitive care, limited records, and acculturation. Health care providers should prioritize chronic disease screening and follow up regularly to encourage preventive care and self-management of chronic disease.