The lack of a comprehensive population-level study evaluating the association of marginalization markers with concussion presentation limits opportunities for health care system improvements. To describe the association of socioeconomic measures of disparity with location of concussion presentation and follow-up rates. This population-based cohort study used linked administrative databases to assess patients with International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Canada (ICD-10-CA) concussion diagnosis codes at emergency department (ED) or outpatient clinics in Ontario, Canada, from April 1, 2010, to March 31, 2023. Data analysis was performed from March 1, 2025, to February 8, 2026. Patient-level exposures were age, sex, immigrant status, presence of family physician, and rurality. Neighborhood-level exposures were income quintile, Ontario Marginalization (ON-Marg) Material Resource Index (access to basic material needs, such as percentage of unemployment), Household and Dwelling Index (accommodation type, such as percentage living alone), and Racialized and Newcomer Populations Index (such as percentage of recent immigrants or those who identify as a visible minority group) within 4 different age groups (<18, 18-39, 40-64, and ≥65 years). Location of initial visit (ED vs outpatient, including urgent care, walk-in, primary care, and specialty clinic) and presence of outpatient follow-up visit at 30 days or less. Overall, 674 629 patients were evaluated (356 842 [52.9%] female; mean [SD] age, 32.8 [22.0] years). Marginalization measures were higher for patients first presenting to EDs vs outpatient via the ON-Marg Material Resources Index (57 043 [20.4%] vs 56 856 [14.4%]; difference, 6.2 [95% CI, 6.0-6.3] percentage points), rurality (47 356 [16.9%] vs 35 521 [9.0%]; difference, 7.9 [95% CI, 7.8-8.1] percentage points), and presence of a family physician (264 179 [94.4%] vs 388 346 [98.3%]; difference, -3.9 [95% CI, -3.8 to -4.0] percentage points). In modeling, having a family physician was associated with first seeking care in EDs (18-39 years: odds ratio [OR], 4.71; 95% CI, 4.41-5.03), as was living in rural areas (18-39 years: OR, 1.56; 95% CI, 1.51-1.62). Follow-up rates at 30 days or earlier were lower for patients first seen in EDs (24 307 [8.7%]) vs outpatient (110 821 [28.1%]). In regression analysis assessing variables associated with follow-up, first being seen in EDs (aged 65 years: OR, 0.21; 95% CI, 0.19-0.22), not possessing a family physician (aged ≥65 years: OR, 0.29; 95% CI, 0.19-0.46), and being in the most marginalized quintile for ON-Marg Material Resources (aged ≥65 years: OR, 0.74; 95% CI, 0.65-0.84) were all significantly associated with not completing a follow-up visit. In this cohort study of patients with concussion treated in Ontario, Canada, those with higher marginalization markers were more likely to first seek care in EDs and have lower follow-up rates. These findings emphasize the importance of expanding health care system-wide resources, including primary care access and telemedicine, and enhancing resources for ED clinicians to optimize concussion care.

There is a strong achievement-gradient in attention-deficit hyperactivity disorder (ADHD), with a higher prevalence in children with low academic achievement. In Sweden, the prevalence of ADHD is also higher among native than immigrant children. The aim of this study was to investigate whether the change in diagnosed ADHD varies across different achievement levels, and whether this change in turn differs depending on students' immigration status. Register data on all students graduating from compulsory school in Sweden between 2001 and 2018 were used. ADHD was measured by diagnosis in specialised care recorded in the year of graduation, and academic achievement by students' grade point average. Logistic regression models with ADHD as the outcome were used. Changes in the association between achievement and ADHD over time were tested by including interactions terms for achievement and year. There was a positive interaction between achievement and year in the pooled sample, meaning that ADHD increased relatively more among higher-achieving students and that the achievement-gradient in ADHD diminished over time. In stratified analyses, the greatest relative increase in ADHD was observed among higher-achieving native and second-generation immigrant students, and the smallest among low-achieving first-generation immigrants. The achievement-gradient was flatter, and diminished more, among immigrant students. The reduced achievement-gradient in ADHD suggests that the absence of academic difficulties to a lesser degree disqualifies children from diagnosis. The limited increase among low-achieving first-generation immigrants may indicate persistent barriers to diagnosis and care in this group.

Abstract Aims To evaluate the impact of immigration status and sociodemographic risk factors on postpartum depressive (PPD) symptoms among women with recent gestational diabetes mellitus (GDM). Methods We analysed data from 327 women with recent GDM who participated in a postpartum diabetes prevention trial in Toronto, Canada. Multivariable logistic regression evaluated the association between self‐reported immigration status (Canadian‐born vs. immigrant), overall and by time since immigration (&lt;10 years vs. ≥10 years) and PPD symptoms based on a score of ≥10 on the Edinburgh Postnatal Depression Scale. Results At a median 4 months postpartum, PPD symptoms were reported by 25.6% of immigrant women compared to 18.2% of Canadian‐born women (adjusted odds ratio [AOR] 1.01, 95% CI 0.50, 2.03). Time since immigration had no significant effect. Women with low household income (&lt;C$60,000) were significantly more likely to report PPD symptoms compared to those with income &gt;C$100,000 (AOR 3.71, 95% CI 1.61, 8.56). Among low‐income women, PPD symptom prevalence was 48%, with 52.8% in immigrant women and 35.7% in Canadian‐born women. Conclusions PPD symptoms are common in women with recent GDM, particularly those with low income. While the prevalence of PPD symptoms was not significantly higher in immigrant women, further studies are needed to explore subgroup‐specific risks. Clinical Trial Avoiding Diabetes After Pregnancy Trial in Moms (ADAPT‐M), NCT01918345.

New immigrants often face barriers when navigating the healthcare system, which can create unmet healthcare needs and contribute to health inequities. Primary care practices, as the gateway to the healthcare system, could use information about their patients' immigrant status to ensure accessible care and equitable resource allocation. However, this is not routinely collected or documented in primary care. The objective of this study was to explore two approaches (regular expression and machine learning) to determine patient-reported immigrant status from primary care electronic medical records (EMRs). De-identified EMR data from the St. Michael's Hospital Academic Family Health Team in Toronto, Ontario, Canada was used, including the reference set of patient-reported responses to a health equity questionnaire. Two approaches were tested and compared: 1) a regular expression classifier (using key text terms), and 2) supervised machine learning classifier (specifically XGBoost). Discrimination and calibration metrics were calculated using self-reported immigrant status from the patient surveys. Among eligible patients in the analytic cohort (N = 12,998), 44.5% reported being born outside of Canada. Although the XGBoost model outperformed the regular expression approach (XGBoost sensitivity = 53.1% and positive predictive value = 72.6%; regular expression sensitivity = 5.2% and positive predictive value = 96.8%), neither approach was accurate enough for use in practice. While understanding patients' immigrant status is important for the provision of high quality, comprehensive primary health care, our work demonstrates the challenges of using EMR data to derive immigrant status. For now, primary care practices should continue to rely on obtaining immigrant status through initial patient intakes or surveys.

Framing, Partisanship, and Race Shape American Public Opinion Regarding Immigration Status Reporting in U.S. Hospitals.

To evaluate the association between metformin use and incident osteoarthritis (OA) in people with diabetes and the impact of dosing. Nested case-control study within a cohort of >1.4 million individuals from Sweden. Participants were aged 35-80 years in 2005, without diabetes or OA. We identified persons with incident diabetes between 2006 and 2016 and excluded those with OA before the diabetes diagnosis and those with an incident OA diagnosis within 3 years of the diabetes diagnosis. Cases were defined as individuals with incident OA before 2020 and were matched with up to four controls without OA in the same period, by sex, diabetes duration, birth year (±1 year) and date of diabetes diagnosis (±180 days) using incidence density sampling. Metformin use before the index date (OA diagnosis) was the main exposure. Secondary exposures were quartiles of total metformin use (defined daily doses (DDD)) and duration-adjusted use (DDD/day), reflecting average daily use. We estimated risk ratios with 95% CIs using conditional logistic regressions, adjusted for age at diabetes diagnosis, education, immigration status and comorbidities. Incident OA diagnosis in primary or specialist care (International Classification of Diseases codes M15-M19). We identified 4007 cases and 14 111 controls. Any metformin use was not associated with OA risk (risk ratio (RR) 1.02, 95% CI 0.93 to 1.12). Results for higher total use (0.98 (95% CI 0.86 to 1.11)) and duration-adjusted use (0.92 (95% CI 0.79 to 1.07)) showed no or inconclusive associations. In individuals with incident diabetes and no prior OA, metformin was not linked to a lower risk of developing OA.

The trends and focal points of studies on lactation in migrant women contribute to a deeper understanding of this field. This study, conducted from a macro-level perspective, aims to comprehensively examine the primary focal points, trends, and depth of global research on the lactation experiences of migrant women. Synonyms for the keywords "migrant, woman, and lactation" were standardized using Boolean search operators. A literature search was then conducted in the Web of Science database on January 6, 2025. Articles were then downloaded and analyzed using RStudio (Version 1.4.1717) and the "biblioshiny for bibliometrix" application, an R-based bibliometric analysis tool. The PRISMA 2020 checklist was used solely to guide the transparent reporting of the search and screening process. 275 articles were selected, with English-language articles appearing in 166 different journals between 1980 and 2024. The highest number of publications occurred in 2018. The International Breastfeeding Journal was the most prolific in terms of publications, while Pediatrics received the highest number of citations. The most cited article was titled "Couples' immigration status and ethnicity as determinants of breastfeeding." The most frequently used keywords were "migrant, duration, and infant," while trending topics included "women, duration, and health." Thematic mapping revealed that core themes of the field were women, duration, health, risk, children, infants, migration, mortality, and malnutrition. This study maps global research trends on lactation among migrant women, identifying key thematic emphases and gaps within the literature. The findings highlight an outcome-focused and predominantly descriptive evidence landscape, while pointing to the need for more intervention- and implementation-oriented research to advance culturally responsive breastfeeding support.

HIV disproportionately affects Latino men who have sex with men (LMSM) in the United States (U.S.). Pre-exposure prophylaxis (PrEP) reduces HIV transmission, but prescription and use rates remain low among this population. This systematic literature review aimed to (1) identify and categorize barriers and facilitators of LMSM's PrEP use, and (2) leverage findings for future interventions. The PICOS structure was used to establish inclusion criteria to search studies published between 2018 and 2023 on December 24 2023. Covidence was used to screen studies and PRISMA 2020 to report the findings. Barriers/facilitators were categorized across the PrEP continuum of care and domains of the WHO 2024 Operational framework. Most barriers and facilitators were related to PrEP information/knowledge, provider influences, PrEP/insurance costs, immigration status, and government/medical mistrust. Findings highlight the need for culturally adapted/tailored PrEP interventions that leverage LMSM social networks, incorporate accessible PrEP service delivery, address language barriers, and involve community-based PrEP navigators.

Objective: Accurate cognitive screening tests for culturally, linguistically, and educationally diverse populations remain scarce, contributing to diagnostic inequities. To address this, we examined the cross-cultural properties and diagnostic accuracy of the Multicultural Cognitive Examination (MCE) in classifying mild cognitive impairment (MCI), dementia, Alzheimer’s disease (AD) dementia, and non-AD dementia in participants with diverse backgrounds. Method: In this retrospective cross-sectional study, we aggregated data from 1,449 participants across 11 countries. Multiple linear regression models were used to determine the influence of demographic variables on MCE scores, which informed the creation of regression-based normative data. Diagnostic accuracies were examined using Receiver Operating Characteristics (ROC) curves. Results: The cohort consisted of 1001 cognitively intact participants, 140 patients with MCI, and 308 patients with dementia. 54.2% had immigrant backgrounds and originated from 63 different countries. MCE scores were significantly influenced by education and age, but not by sex or immigrant status. The MCE demonstrated high accuracy in differentiating cognitively intact participants from patients with dementia (AUC: .95) and MCI (AUC: .84). The MCE was both accurate for classifying AD dementia (AUC: .97) and non-AD dementia (AUC: .94). Conclusions: This study supports the clinical utility of the MCE as a culturally robust and highly accurate cognitive screening test. Future studies should examine the ability of the MCE to monitor cognitive decline.

Undocumented immigrants face chronic contextual stressors that undermine their mental health and limit their access to culturally adapted mental health interventions. This pilot implementation study evaluated the online Acceptance and Commitment Therapy (ACT) Guide for Immigrant Resilience, a seven-session self-guided program culturally adapted for young adults with liminal immigration status. Forty members of a national immigrant youth-led organization (62.5% undocumented) were given access to the ACT Guide for Immigrant Resilience and completed pre, mid, and post treatment outcome measures and a four-week follow-up. The study aimed to determine the level of engagement, acceptability/appropriateness/feasibility of the intervention, and gather preliminary effectiveness data. Participants engaged on average with 5.22 (SD = 2.59) of seven sessions and spent a median of 102.11 minutes with the program (Interquartile range [IQR] 25% = 54.96, 75% = 260.86). Implementation ratings were high, suggesting intervention acceptability, appropriateness, and feasibility. While low assessment engagement and the single-arm design limited causal inference, participant that completed post-assessment (n = 15) reported significant decreases in depression, anxiety, and stress, and values obstruction improvement. Reductions in depression and stress were also present at follow-up relative to baseline (n = 19). Qualitative feedback underscored self-compassion, values clarification, and mindfulness as being culturally relevant. Suggested improvements included clearer instructions, briefer modules, and audio options. Our findings provide preliminary support for the use of this self-guided intervention with young adults with liminal immigration status. However, randomized trials with adaptations to improve engagement are needed to further establish the efficacy of the ACT Guide for Immigrant Resilience.

Palliative Care for Immigrants with Cancer in the United States: A Roadmap to Equitable Care.

Age of first exposure and duration of child physical and sexual abuse - Links to adolescent psychological and somatic health.

This study investigates the relationships among students’ use of ICT for learning and leisure, self-efficacy in digital competencies, and achievement in math, reading, and science, and compares differences based on gender and immigrant background. Previous studies show inconsistent relationships among these variables. Student background affects the use of ICT, and while self-efficacy may vary depending on the subject, it has had positive effects on academic achievement. In this study, self-efficacy in digital competencies is viewed as two different competence beliefs: computer and information literacy (CIL) and computational thinking (CT). Although self-efficacy in CIL and CT has had varying effects on digital skills, the effects on math, reading, and science are not well studied. We analyzed Finnish data ( N = 10,239) from PISA 2022 using general and multigroup structural equation modelling. We found that ICT use for learning had little to no practical significance across groups. ICT use for leisure and self-efficacy in CT were associated with being approximately a year or more behind in math, reading, and science across groups. Self-efficacy in CIL was associated with being two or more years ahead and played a protective short-term role as a mediator, especially in immigrants. These findings imply that closer integration of ICT use for learning with subject-specific goals in authentic learning contexts may promote their contribution to achievement. Further research should examine how different uses of ICT and CT skill development interact with subject learning in practice and how schools can be supported in adopting more pedagogically purposeful digital activities. • ICT use for leisure is detrimental to math, reading, and science. • Girls benefit slightly from ICT use for learning, but boys do not. • Immigrant students' achievement does not benefit from ICT use for learning. • Computer and information literacy is beneficial for math, reading, and science. • Computational thinking is detrimental to math, reading, and science.

An International Multicenter Study of Native and Immigrant South Asian Crohn's Disease.

Narcissism is viewed as both a heritable trait and an activated state, but little research has explored how narcissism manifests in populations from an evolutionary perspective. Relying on two nationally representative US samples, we explore how narcissism may be mobilized or manifest in populations that undergo major environmental changes such as migration. More specifically, we treat immigrant generational status as a naturally occurring experiment and explore the differing levels of narcissism of new migrants, first, second and successive generations. We find new immigrants and first-generation Americans have the highest levels of narcissism, but those rates steadily decrease with later generations. Overall, narcissism appears to either be activated in populations under conditions of need, scarcity, stress, and survival, or be a key motivator for people who choose to migrate. Critically important, and from a generational perspective, narcissism declines to the new population level as migrants settle into their new environments.

Mental Health Treatment Utilization Among Hispanic and Latino Adults in the United States: The Role of Immigration Status, Acculturation, and Socioeconomic Disadvantage.

To determine the impact of social determinants of health (SDOH) on outcomes in pediatric short bowel syndrome (SBS) patients. A retrospective cohort of SBS children managed by an Intestinal Rehabilitation Program was analyzed. Socio-economic variables including income, race, distance to hospital, parental education and immigrant status were chosen to assess whether they independently predicted the following outcomes: enteral autonomy (EA), central line associated blood stream infection (CLABSI), intestinal failure associated liver disease (IFALD), and mortality. Bowel anatomy, prematurity, and disease type were controlled for. Univariate analysis and Cox proportional hazards model (CPH) were performed, where an alpha-value of <0.05 was significant. A total of 161 patients were analyzed between 2006 and 2019. The median gestational age was 34 (29.0-37.0) weeks and 61.9% were male. EA was achieved in 63.5%, 22.5% developed IFALD, and 10% died. The median CLABSI rate was 4.0 (0.4-11.1) per 1000 catheter days. CPH modeling revealed that the only social factor positively associated with attaining EA was non-white race (p = 0.03). Parental post-secondary education was associated with a lower risk of CLABSI (p = 0.04) while those living larger distances from hospital had an increased risk (p = 0.02). The development of IFALD was also positively associated with greater distance from hospital (p < 0.01). Mortality was positively associated with both having an immigrant background (p = 0.04), non-white race (p = 0.03) and having a parent with post-secondary education (p < 0.01). Although clinical factors such as anatomy and diagnosis predict prognosis in SBS, social determinants also influence outcomes and should be considered in the support of families.

This study aimed to make a head-to-head comparison of the diagnostic accuracy and cross-cultural applicability of abbreviated 20-item versions of the Copenhagen Cross-Linguistic Naming Test (C-CLNT20) and Naming Assessment in Multicultural Europe (NAME20). The present study was conducted in a multicultural and multilingual patient sample from memory clinics across five European countries. Receiver operating characteristic curve analysis was used to assess the diagnostic accuracy of C-CLNT20 and NAME20 in classifying dementia and mild cognitive impairment (MCI). Binary logistic regression analysis was performed to evaluate the influence of demographic and cultural factors on diagnostic accuracy. C-CLNT20 and NAME20 showed acceptable diagnostic accuracy for dementia with areas under the curve (AUC) of .75 and .82, respectively, but had low accuracy for MCI (AUC of .64 and .62, respectively). Compared to C-CLNT20, NAME20 had slightly higher, but statistically non-significant, AUCs for dementia in both in the full sample and in participants with immigrant background. The diagnostic accuracy of the C-CLNT20 and NAME20 was not significantly influenced by education and immigrant status in the full sample, or by acculturation and use of an interpreter in participants with immigrant background. Both C-CLNT20 and NAME20 are promising brief alternatives to the full versions of the naming tests when time is limited. They also present a promising alternative to other established naming tests by maintaining diagnostic accuracy while showing minimal cross-cultural and cross-linguistic bias.

British immigration policies are intended to create a "hostile environment" for "undesirable" migrants within the UK and a deterrence to anyone beyond its borders. The seeping of these policies into everyday life, including healthcare provision, for all migrants has been well documented. This article draws on ethnographic research with migrant women who have precarious immigration statuses in Glasgow, which explored interwoven experiences of maternal health, migration and motherhood. Building on this research, the authors co-developed "Nurture Together", a participatory project with migrant women and Amma Birth Companions, which created trauma-informed and culturally safe peer support resources for infant feeding. Drawing on both projects, this paper highlights how the hostile environment and the subsequent isolation, discrimination, and fear of unfamiliar social and medical environments can compound the trauma experienced by many women during and after migration to the UK. We emphasise the importance of communities of care for mothers who are not surrounded by their usual perinatal support networks.

To investigate the relationship between immigrant status, disability status, and sense of community belonging in Canada, and to identify sociodemographic factors associated with weaker community belonging among immigrants with disabilities. Given established links between community belonging and health outcomes, this analysis contributes to understanding social determinants of health equity. We analyzed data from the 2020 General Social Survey (Cycle 35): Social Identity (n = 30,136), using binary logistic regression to assess the associations between immigrant status, disability status, and sense of community belonging. By including an interaction term in the analysis, we examined whether the effect of one social status (e.g., disability) varied across levels of the other (e.g., immigrant status). Subgroup analysis examined predictors of weak community belonging among immigrants with disabilities. Disability was associated with increased odds of reporting weak community belonging, while immigrant status was associated with decreased odds. A significant interaction indicated that the effect of disability was greater among Canadian-born individuals, and the protective effect of immigrant status was greater among those with disabilities (interaction OR = 0.81, CI [.71-.87] p < .001). Findings suggest that young, male, and single immigrants with disabilities may be particularly vulnerable to experiencing a weak sense of community belonging. Sense of community belonging is a key social determinant of health. These findings highlight the need for public health strategies that address how immigrant and disability status jointly shape social inclusion and health equity in Canada.