Primary care
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This article describes the current state of migration of immigrant children into the United Sates and the various categories of immigrant children, including refugees, asylum seekers, unaccompanied minors, adoptees, and Special Immigrant Visa holders, hereafter called immigrant children. It focuses on guidelines for medical screening and management of newcomer immigrant children and adolescents and their ongoing preventive care. This article also addresses challenges unique to immigrant children and adolescents and the importance of culturally sensitive anticipatory guidance.
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This article describes the different ways culture affects health care, in terms of patient-related factors, health care provider-related factors, and health care system-related factors. This article also reviews interventions and best practices that draw on the incorporation of culture into health care and that thus may be effective for building cross-cultural understanding between providers and their immigrant and refugee patients.
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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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Immigrant and refugee patients may have limited English proficiency. Effective use of professional interpreter services reduces clinically significant errors and increases the quality of care. ⋯ Children less than 18 years of age should only be used as interpreters in emergency situations. Professional telephonic, video, or in-person interpreters each have distinct advantages in specific clinical situations.
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Circumstances forcing individuals and families to flee set the stage for disruptions in mental health and forge resilience. Individual characteristics and conditions premigration, perimigration, and postmigration influence health, mental health, care-seeking behavior, and stages of well-being and successful resettlement. ⋯ Integrated or collaborative care models are ideal for delivering optimum care for refugee and immigrant communities. Connecting primary and behavioral care promotes a team approach; provides comprehensive, whole-person care; and relies on participation of patients and families.