Adult Refugees Research Articles

Management and outcome of cutaneous diphtheria in adolescent refugees in Germany, June 2022 - October 2023.

From September 2022 an increase in Corynebacterium diphtheriae (C. diphtheriae)infections was reported in Europe. Our study focuses on 31 adolescent and young adult refugees with cutaneous C. diphtheriae infections detected in Germany. We examined treatment regimens and outcomes to provide targeted insights into the management of this infection. We distributed a standardized survey, focused on children and adolescents presenting to paediatric clinics through the German Paediatric Infectious Diseases Society (DGPI) and additional professional contacts in Germany. Data were extracted from routine medical documentation and reported anonymously. A total of 31 individuals with cutaneous C. diphtheriae infection were reported by 9 centres. Two of these showed diphtheria toxin (DT) related systemic symptoms and four exhibited systemic inflammation requiring complex management. The remaining 25 cases, with exclusively cutaneous manifestations, were afebrile. Treatment with topical antiseptics and systemic antibiotics, mainly aminopenicillin/beta-lactamase inhibitors (BLI) (35%) or clindamycin (25%), achieved eradication in all but two cases treated with aminopenicillin/BLI. Treatment duration varied between 5 and 17 days. In refugees presenting with chronic skin wounds, C. diphtheriae should be included into the differential diagnosis. Fever seems to be a valuable marker to differentiate severe cases with potentially DT-mediated sequelae from exclusively cutaneous diphtheria (CD). For afebrile CD, topical antiseptics and oral antibiotic therapy with clindamycin for 7 days, followed by clinical surveillance appears to be a safe treatment regimen. Patients with CD who present with fever or pharyngitis should be thoroughly investigated including blood and pharyngeal swab cultures.

The impact of age-related differences in emotion dysregulation on refugee mental health and social outcomes.

The refugee experience is typically characterized by exposure to numerous premigration traumatic events and postmigration stress in the resettlement environment. Refugees' experiences can lead to elevated rates of psychopathology, including posttraumatic stress disorder (PTSD) and depression. Emotion regulation is a key mechanism contributing to mental health outcomes among refugees. This study examined the impact of age on the association between emotion regulation and critical social outcomes relevant to refugee resettlement, such as social engagement and functional impairment. Participants were 1,081 Arabic-, Farsi-, Tamil- and English-speaking adult refugees. Premigration trauma exposure, postmigration stressors, PTSD symptoms, depressive symptoms, emotion regulation, social engagement, and functional impairment were measured. A series of hierarchical regression and Poisson regression analyses revealed emotion dysregulation as a significant predictor of functional impairment, β =.36, p <.001, and social engagement, Exp B = 0.99, p =.002. A significant interaction between age and emotion dysregulation was associated with both PTSD, β =.05, p =.048 and depressive symptoms, β =.06, p =.010, suggesting a stronger positive association between emotion dysregulation and both PTSD and depressive symptom severity for older individuals. Postmigration stressor exposure, emotion dysregulation, and older age are important factors that may negatively impact social engagement and functional impairment in the resettlement environment. Additionally, higher levels of trauma exposure may negatively impact social engagement. These findings have implications for public health and social services in the context of resettled refugee communities.

Refugee Housing Accessibility with a Strategic Digital City Project

Adequate housing is pivotal for the refugee’s well-being, demanding strategic urban management to facilitate their integration. The research objective is to analyze housing access for adult refugees within the context of a strategic digital city, focusing on adult refugees and city strategies as a subproject of the strategic digital city project. The research methodology adopted is a case study in Curitiba, the research employs both qualitative and quantitative techniques, guided by a research protocol. Results suggest that addressing housing access challenges entails more than mere provision; it involves safeguarding rights, stability, integration, and participation in public policies and municipal strategies within the strategic digital city framework and the right to the city. These findings underscore the necessity for support services and robust collaboration among diverse stakeholders and public policies to tackle the multifaceted refugee issue, thereby fostering their integration and well-being in the host society. The conclusion emphasizes prioritizing concepts such as privacy and dignity in housing, highlighting the urgent need for effective policies catering to refugees' diverse needs.

A Retrospective Longitudinal Study of Refugees With Eosinophilia at an Academic Center in the United States From 2015 to 2020.

Refugees to the United States frequently have parasitic infections. If untreated, parasites can cause severe complications. The purpose of this study was to investigate the incidence, management, and outcomes of eosinophilia as a biomarker for parasites. We conducted a retrospective longitudinal chart review of consecutive refugees attending 3 refugee clinics in Rhode Island that manage the health care of all pediatric and adult refugees. Among 812 refugees who met inclusion criteria, 147 (18.1%) had eosinophilia upon arrival and almost half had ≥1 symptom. The rates and severity of eosinophilia in those with predeparture presumptive treatment records who did (112/115, 97.4%) or did not (488/498, 98.0%) receive predeparture antiparasitic treatment were similar. All refugees with eosinophilia had ≥1 parasitic test in the United States. The most common attributable parasites were Schistosoma and Strongyloides stercoralis. Overall, parasites were detected in 63 (42.9%) of 147 refugees with eosinophilia by either stool testing, serology, or blood smear, but testing was inconsistent and likely underestimated true incidence. Only some of the identified parasites typically cause eosinophilia. Forty-five (30.6%) refugees with eosinophilia received antiparasitics in the United States. Of 81 (55.1%) individuals who had repeat blood tests, eosinophilia had resolved in 52 (64.2%). Five individuals (3.4%) had alternative diagnoses, including eczema, myelofibrosis, and drug allergy. Our findings support Centers for Disease Control and Prevention recommendations to screen for eosinophilia in newly arrived refugees. Follow-up after 3-6 months is critical to confirm resolution of residual eosinophilia, which frequently occurs after effective predeparture treatment or if eosinophilia persists, to diagnose active parasitic infections.

Understanding Economic Integration in Immigrant and Refugee Populations: A Scoping Review of Concepts and Metrics in the United States

In an increasingly mobile world, the integration of immigrants and displaced individuals is an important factor in creating cohesive and inclusive societies. Integration has different dimensions; this scoping review examines the conceptualization and measurement of economic integration among immigrants and refugees in the United States. Quantitative peer-reviewed journal papers measuring or conceptualizing the economic integration of first-generation documented adult immigrants or refugees in the United States, as well as relevant conceptual or theory papers on this topic, were included in the review. The search strategy included an online search of the Web of Science Core Collection, PsycINFO, Applied Social Sciences Index and Abstracts (ASSIA), and EconLit. Additional search strategies included scanning the reference lists of studies identified as relevant in the initial database search. An analysis of 72 studies included in the review using a data extraction table reveals seven key domains of economic integration: income and economic security, employment and occupational categories, assets and use of financial services, neighborhood and housing, health, education, and use of public assistance. Income and economic security emerged as the most common indicators of integration in the reviewed studies. Notably, less than half of the reviewed publications had a multidimensional approach to defining or measuring economic integration, and the majority of studies were focused on immigrants, with a smaller proportion dedicated to refugees. This review emphasizes the need for comprehensive frameworks in assessing economic integration among immigrants and refugees, reflecting the multifaceted nature of their economic integration experiences.

Progressive worsening of posttraumatic stress symptoms in Syrian and Iraqi refugees associated with cumulative and victimization trauma: A longitudinal study.

War and forced migration expose refugees to trauma and ongoing stress, often contributing to long-term psychological consequences. Typically, trauma exposure is assessed cumulatively; yet, trauma type may better predict psychological outcomes. This study examined the differential impact of cumulative trauma and trauma subtypes (victimization, death threat, accidental/injury) on postmigration trajectories of posttraumatic stress and anxiety in refugees. Seventy-seven Syrian (88.3%) and Iraqi (9.1%) adult refugees self-reported prior trauma exposure and psychological symptoms at time of arrival in the United States and 2 years post. Linear mixed-effects modeling was performed to assess for associations between trauma variables and symptom trajectories. Models using cumulative trauma as a predictor were compared to models including the three trauma subtype variables as predictors, using pseudo-R² values to compare variance explained between the two methods of trauma measurement. Linear mixed-effects modeling indicated that prior exposure to victimization predicted progressively worsening posttraumatic stress disorder (PTSD) symptoms over time postmigration (b = .97, SE = .45, t = 2.14, p = .036). Cumulative trauma also predicted increasing PTSD symptoms (b = .124, SE = .06, t = 2.09, p = .041), but explained less variance than victimization (9% vs. 18.1%). Direct effects of cumulative trauma (p = .009) and victimization (p = .002) on anxiety severity emerged; however, anxiety symptoms did not change over time depending on prior trauma exposure. Accidents/injuries and death threats did not predict PTSD or anxiety. These findings can be leveraged toward focused identification of those at highest risk for progressive illness postmigration, thus providing empirical guidance for allocation of interventions and resources for refugees. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Survivors: Syrian Young Adult Refugee Experiences Navigating the Quebec Education System

Canada resettled over 74,000 Syrian refugees since 2015. However, education programs lack awareness needed to successfully promote refugee academic integration. Little research focuses on young adult refugees (YARs) aged out of traditional schools due to asylum displacement and disrupted education, left with adult education schools as their only alternative to complete high school. Drawing upon 29 semi-structured interviews with Syrian YARs in Montreal, findings suggest that this subgroup is unintentionally excluded by educational policy-makers. Although YARs are survivors, their drive was found to be insufficient when confronted with systemic barriers that prevent at-risk students from proceeding smoothly through school to reach their highest potential.

Resilience and Positive Wellbeing Experienced by 5-12-Year-Old Children with Refugee Backgrounds in Australia: The Childhood Resilience Study.

Refugee research tends to be deficit based and focused on the risks threatening positive adaptation and wellbeing. High rates of mental (and physical) health issues have been reported for refugee adults and children, including intergenerational trauma. This study uses the new Child Resilience Questionnaire (CRQ), co-designed with refugee background communities, to describe resilience and positive wellbeing experienced by children of refugee-background. The Childhood Resilience Study (CRS) recruited 1132 families with children aged 5-12 years in Victoria and South Australia, Australia. This included the recruitment of 109 families from 4 refugee background communities: Assyrian Chaldean (Iraq, Syria), Hazara (Afghanistan), Karen (Burma, Thailand) and Sierra Leonean families. CRQ-parent/caregiver report (CRQ-P/C) scores were categorised into 'low', 'moderate' and 'high'. The child's emotional and behavioural wellbeing was assessed with the Strengths and Difficulties Questionnaire, with positive wellbeing defined as <17 on the total difficulties score. Tobit regression models adjusted for a child's age. The CRQ-P/C scores were not different for boys and girls of refugee background. Children of refugee-background (n = 109) had higher average CRQ-P/C scores than other CRS children (n = 1023) in the personal, school and community domains, but were lower in the family domain. Most children with 'high' resilience scores had positive wellbeing for both children of refugee-background (94.6%) and other CRS children (96.5%). Contrary to common stereotypes, children of refugee-background show specific individual, family, school and cultural strengths that can help them navigate cumulative and complex risks to sustain or develop their positive wellbeing. A better understanding as to how to build strengths at personal, family, peer, school and community levels where children are vulnerable is an important next step. Working in close collaboration with refugee communities, schools, policy makers and key service providers will ensure the optimal translation of these findings into sustainable practice and impactful public policy.

Reviewing research methods on adult migrants’ digital literacy

This article presents a selective literature review covering the period from 2016 to 2023, focusing on research published in peer-reviewed journals, to examine the methodologies employed in investigating the digital literacy of adult migrants and refugees. Three distinct approaches emerged: digital use study, ethnography, and pedagogical experimentation and intervention. These methods offer unique perspectives and complement each other in exploring how digital literacy can empower migrants to actively engage in the evolving digital landscape and facilitate language learning. The findings from a subset of 14 studies included in this review were categorized into a digital literacy taxonomy, aiming to inform language teaching practices tailored to the needs of migrants. This research addresses the urgent need for adapting language teaching and curricula in host countries to accommodate the increasing global migration and digitalization of learning. Additionally, suggestions for future research directions are provided to gain a deeper understanding of the specific digital literacy needs of this population and enhance the linguistic skills and social inclusion of newcomers.

Cultural assimilation of adult Syrian refugees in Lebanon: Effect modification by religiosity and sex on the relation between cultural adversities and common mental health disorders.

In this study, we aimed to explore the prevalence and determinants of common mental health disorders (CMHDs, posttraumatic stress disorder [PTSD], depression, and anxiety) in Syrian refugees in Lebanon. Specifically, we examined how the associations between cultural adversities (discrimination, unemployment, and separation from family) and CMHDs are modified by levels of religiosity and sex. Between March and June 2017, a cross-sectional study was conducted targeting adult Arab Syrian refugees residing in Beirut and Southern Lebanon. Eligibility criteria comprised being a United Nations High Commissioner for Refugees-registered Syrian refugee residing in Lebanon, 18 years and older, and having no history of mental disorder or physical disability. A total of 191 refugees agreed to participate and complete a battery of six questionnaires. Exposures were measured using a sociodemographic questionnaire, the Postmigration Living Difficulties Checklist, the Harvard Trauma Questionnaire, and the Belief into Action Scale, while outcomes were measured using the Posttraumatic Stress Disorder Checklist for DSM-5 and the Depression and Anxiety Scale-21 Items. Half (50.3%) of our sample had high PTSD risk, 73.8% had high depression risk, and 73.8% had high anxiety risk. Stratified analysis revealed religiosity and sex to be effect modifiers of the associations between cultural adversities and CMHDs. Specifically, cultural adversities were only significantly associated with CMHDs in the low religiosity stratum and males. Only unemployment was a significant risk factor for PTSD in both males (OR = 4.53, 95% CI [1.44, 14.27]) and females (OR = 2.77, 95% CI [1.14, 6.74]). Religiosity and sex are effect modifiers of the associations between cultural adversities and CMHDs. Religious and spiritual interventions in mental health care should be adopted in refugee settings. Moreover, there is an urgent need for capacity-building initiatives addressing social determinants of mental health among Syrian refugees in Lebanon. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Unpacking gender-specific risk and protective factors for mental health status among Congolese refugees in Uganda

ABSTRACT Background: Research indicates refugees from the Democratic Republic of Congo (DRC), particularly females, have a higher incidence of mental health problems compared to the global norm for conflict-affected populations. Objective: This study aimed to unpack gender differences in the mental health of Congolese refugees by examining specific risk (trauma exposure, adaptation challenges, and discrimination) and protective factors (marital status, literacy, and social resources) in relation to posttraumatic stress symptoms (PTSS) and depression. Method: Utilizing systematic random sampling, we surveyed 667 adult refugees (370 females, 297 males) in the Kyaka II refugee settlement in Western Uganda. A multi-group path analysis was conducted, initially allowing for variance between genders and subsequently comparing a constrained model, where paths were set equal across groups. Results: The unconstrained model presented an excellent fit to the data. When paths were set to be equal across groups, the decline in model fit, confirmed by a chi-square difference test, indicated differences in the model for males and females. A series of Z-tests were used to compare individual paths. Experiencing discrimination was a stronger risk factor for depression among men, whereas a history of rape was more strongly associated with depression for females. Being literate and a member of a social group in the settlement were stronger protective factors for depression among men, whereas living with a partner and a felt sense of connection to their community was more important for women. Associations between risk and protective factors and PTSS were more similar across groups, only membership in a group was significantly moderated by gender; with group membership being more impactful for males. Conclusion: The results highlight similarities and differences in predictors of distress for male and female Congolese refugees and point to potential avenues for tailoring programming to be gender sensitive.

Impact of an Oral Health Education Program on the Oral Health Literacy of Refugees

Inadequate comprehension of healthcare information contributes to poor health outcomes. Ethnic minorities are one of the populations most affected by low health and oral health literacy (OHL). The hypothesis of the current study was that an oral health education program (OHEP) can improve the OHL, oral health awareness and behaviors of refugees. We also hypothesized that there will be a difference between OHL in English and native language in the Pre-intervention phase. Fifty-two adult refugees participated in an educational program that included a comprehensive and culturally sensitive PowerPoint presentation and hands-on learning activities on oral health topics. The study used a cross-sectional pre-post study design. Before the program (Pre-intervention group), participants completed 2 surveys: Sociodemographic Survey and Oral Health Perceptions of Refugees in a bilingual format, and the Estimate of Oral Health Literacy-Bilingual40 (EOHL-BL40) in English, and in the participants’ native language. Immediately after an OHEP (Post-intervention group), participants completed the EOHL-BL40 survey in English only. Two weeks after OHEP (Follow-up intervention), participants completed again the Sociodemographic Survey and Oral Health Perceptions of Refugees and the Estimate of Oral Health Literacy-Bilingual40 (EOHL-BL40) in English only. The mean percentage of words understood on Pre-intervention EOHL-BL40 survey were significantly higher in native languages (47.3% ±3.7%) compared with survey in English (15.3% ±1.2%, P < 0.001). Post-intervention scores, immediately after educational program, were higher (28.6% ±2.4%), P < 0.001) for survey in English compared with the Pre-intervention (15.3% ±1.2%). The follow-up (2 weeks later) scores (25.5% ±2.4) were slightly lower than Post-intervention but still significantly higher (P < 0.001) than Pre-intervention. Results for both Sociodemographic Survey and Oral Health Perceptions of Refugees surveys were similar: the OHEP positively affected oral health awareness and oral health behaviors. Results of the study suggested that OHEP may improve oral health literacy, oral health awareness, and personal oral hygiene practices of refugees.

“My brain doesn’t run”: language learning for refugee adults

“My brain doesn’t run”: language learning for refugee adults

But life goes on: drama classes, Ukrainian refugees, and Icelandic language learning

AbstractThis paper explores the relationship between additional language (L2) literacy development and drama plays based on the experiences of adult refugees from Ukraine in Iceland. This inquiry is guided by the following questions: What are the learners' experiences and perceptions of drama classes in relation to their literacy development in Icelandic as an L2? What role might engaging in drama classes have when it comes to learners' sense of well‐being? We employ a multiliteracies perspective, which has pluralised the traditional view of literacy and offered new insight into literacy teaching and learning by integrating multimodal, multi‐sensorial, and critical practices into literacy education. The findings originate from a qualitative, interview‐based study with five Ukrainian learners of a refugee background in Iceland. Findings suggest that learning Icelandic through drama afforded the learners an opportunity to learn Icelandic in creative, engaging, and meaningful ways. Furthermore, learning Icelandic through drama supported the enactment and development of essential capacities for personal and professional growth, such as open‐mindedness, tolerance, respect, and collaboration. Many of the learners felt positively challenged to try out something new. This paper concludes with a discussion on the importance of critical, experiential L2 education that acknowledges learners' diverse lived experiences.

Adult refugees and asylum seekers’ basic need satisfaction and educational success in pre-study programmes in Germany

Host country education can be crucial for the social integration as well as labour market outcomes of refugees and asylum seekers. To meet the same admission criteria for studying at German higher education institutions (HEI) as other international student applicants, refugees and asylum seekers can attend pre-study programmes at preparatory colleges or language centres of HEI. According to the self-determination theory, the satisfaction of basic psychological needs is relevant to learning motivation and success in educational contexts. This paper examines the differences in the satisfaction of basic needs (autonomy, competence, and relatedness) and learning motivation between refugees and other international student applicants, and the extent to which these differences explain inequalities in the probability of success in pre-study programmes. Data from participants in pre-study programmes at 18 HEI show no significant differences in basic need satisfaction and learning motivation between the respective groups of learners. While basic need satisfaction and motivation make only a small contribution to the explanation of success in pre-study programmes, the biographical and social situation manifested in previous study experiences, age, and social resources seem to be of significance. Implications for further research and practice are discussed.

Mental health service utilization and help seeking behaviours of adult Cambodians living in Western countries: A systematic scoping review.

Health disparity and under-utilization of health services is prevalent among Asian refugees and migrants in Western countries and can profoundly impact health outcomes. Cambodians who survived extreme physical and emotional trauma during the genocides enacted by the Khmer Rouge regime in the 1970's are particularly vulnerable to poor mental health outcomes decades later. Understanding the experiences of help-seeking and service use by displaced Cambodians in Western countries may help to design more effective and culturally safe healthcare services. To identify characteristics or factors associated with help seeking behaviours and service utilization of displaced Cambodians with mental health issues living in Western countries. This review followed the Arksey & O'Malley methodological framework for scoping reviews. Articles for review were identified through searches of nine electronic databases and manual searches. Relevant articles were selected, and data was extracted and synthesized into key themes. This review included 15 articles. Most of the studies were conducted in the USA (n = 13) with one each conducted in Canada and New Zealand. Seven studies used qualitative interviews, five used a cross-sectional survey approach, two used a mixed-methods approach and one was a narrative review and case series. Key findings highlighted the impact of Cambodian cultural beliefs about mental health (guilt, shame and help-seeking stigma) on service utilization and the disconnect between Western models of service provision and preferred Cambodian ways of receiving support. Mental health services in Western countries are likely to be under-utilized by Cambodians due to a mismatch between health beliefs and Western models of care. Further investigation of the association between health beliefs and barriers to service utilization among adult Cambodian refugees is warranted.

Art therapy with adult refugees: A systematic review of qualitative research

There are currently no systematic reviews that evaluate art therapy as a treatment for trauma in adult refugees. With over 32.5 million refugees worldwide as of mid-2022, many of them facing trauma, it’s crucial that access to proper therapeutic support be available. Art therapy de-emphasizes verbal communication, which may help refugees facing language barriers and difficulties talking about their experiences. Most of the research on this topic is qualitative, so a qualitative meta-analysis as outlined by Timulak (2009) was attempted. Inclusion and exclusion criteria were made based on date, publication type, sample size, data collection method, participant information, type of therapeutic intervention, and data analysis method. Out of 594 articles located, selection resulted in only N = 4 studies. Timulak recommends 8–16 articles for meta-analysis. Therefore, studies were instead summarized in a box score table. Results revealed that art therapy shows potential, but no reliable conclusions can be drawn because, despite a large body of literature, there are very few empirical studies in this field. Considering this, further primary empirical research must be done. Results suggest that building culturally significant art forms into therapy may be a particularly helpful avenue of exploration.

Effectiveness and cost-effectiveness of a transdiagnostic intervention for alcohol misuse and psychological distress in humanitarian settings: study protocol for a randomised controlled trial in Uganda

BackgroundThe war in South Sudan has displaced more than four million people, with Uganda hosting the largest number of South Sudanese refugees. Research in Uganda has shown elevated levels of alcohol misuse and psychological distress among these refugees. The World Health Organization (WHO) has developed a trans-diagnostic scalable psychological intervention called Problem Management Plus (PM +) to reduce psychological distress among populations exposed to adversities. Our study aims to evaluate the effectiveness and cost-effectiveness of the CHANGE intervention, which builds on PM + , to also address alcohol misuse through problem-solving therapy and selected behavioural strategies for dealing with alcohol use disorders. We hypothesise that the CHANGE intervention together with enhanced usual care (EUC) will be superior to EUC alone in increasing the percentage of days abstinent.MethodsA parallel-arm individually randomised controlled trial will be conducted in the Rhino Camp and Imvepi settlements in Uganda. Five hundred adult male South Sudanese refugees with (i) elevated levels of alcohol use (between 8 and 20 on the Alcohol Use Disorder Identification Test [AUDIT]); and (ii) psychological distress (> 16 on the Kessler Psychological Distress Scale) will be randomly assigned 1:1 to EUC or CHANGE and EUC. CHANGE will be delivered by lay healthcare providers over 6 weeks. Outcomes will be assessed at 3 and 12 months post-randomisation. The primary outcome is the percentage of days abstinent, measured by the timeline follow-back measure at 3 months. Secondary outcomes include percentage of days abstinent at 12 months and alcohol misuse (measured by the AUDIT), psychological distress (i.e. depression, anxiety, posttraumatic stress disorder), functional disability, perpetration of intimate partner violence, and health economic indicators at 3 and 12 months. A mixed-methods process evaluation will investigate competency, dose, fidelity, feasibility, and acceptability. Primary analyses will be intention-to-treat.DiscussionCHANGE aims to address alcohol misuse and psychological distress with male refugees in a humanitarian setting. If it is proven to be effective, it can help fill an important under-researched gap in humanitarian service delivery.Trial registrationISRCTN ISRCTN10360385. Registered on 30 January 2023.

Reflective Case Study of a Literacy Instructor Teaching English to Refugee Adult Learners

The United States has been the global leader resettling refugees since the 1970s; its resettlement program is the largest in the world. The state of Texas has a high number of admissions and longstanding refugee programs which makes it a strategic site for research. This article reports findings of a reflective case study within an open enrollment literacy program in Central Texas. It describes the experiences of a literacy instructor teaching English to refugee adult learners for six years. The research questions guiding the study are: (1) what are the experiences of a literacy instructor teaching English to refugee adult learners? and (2) what can other English language instructors transfer from this reflective case study to their classroom settings when teaching refugee learners? To document the case study, it was important to keep a systematic account of facts and reflection. Thus, the instructor kept a reflective journal for a semester and participated in a series of conversational storytelling interviews to generate data for the study. Thematic analysis procedures guided the data analysis process and allowed for identifying five major themes to report study findings. These are: (1) traumatic stress, (2) classroom dynamics, (3) active listening, (4) flexibility for teaching and learning, and (5) curriculum challenges. Study findings provide examples and narratives that can be useful to practitioners interested in this topic. This article is an invitation to instructors of adult refugee language learners to engage in reflection and become more aware of their teaching practices.

Prevalence of infectious diseases, immunity to vaccine-preventable diseases and chronic medical conditions among Ukrainian refugees in Germany – A cross sectional study from the German Network University Medicine (NUM)

BackgroundVulnerability to infectious diseases in refugees is dependent on country of origin, flight routes, and conditions. Information on specific medical needs of different groups of refugees is lacking. We assessed the prevalence of infectious diseases, immunity to vaccine-preventable diseases, and chronic medical conditions in children, adolescents, and adult refugees from Ukraine who arrived in Germany in 2022. MethodsUsing different media, we recruited Ukrainian refugees at 13 sites between 9–12/2022. An antigen test for acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection, serologies for a range of vaccine-preventable diseases, as well as interferon gamma release assays (IGRAs) for tuberculosis (TB), and SARS-CoV-2 were performed. We assessed personal and family history of chronic medical conditions, infectious diseases, vaccination status, and conditions during migration. ResultsOverall, 1793 refugees (1401 adults and 392 children/adolescents) were included. Most participants were females (n = 1307; 72·3%) and from Eastern or Southern Ukraine. TB IGRA was positive in 13% (n = 184) of the adults and in 2% (n = 7) of the children.Serology-based immunological response was insufficient in approximately 21% (360/1793) of the participants for measles, 32% (572/1793) for diphtheria, and 74% (1289/1793) for hepatitis B. ConclusionsWe show evidence of low serological response to vaccine-preventable infections and increased LTBI prevalence in Ukrainian refugees. These findings should be integrated into guidelines for screening and treatment of infectious diseases in migrants and refugees in Germany and Europe. Furthermore, low immunity for vaccine-preventable diseases in Ukrainians independent of their refugee status, calls for tailor-made communication efforts.