The research combined a population-wide serosurvey with targeted testing among selected immigrant communities. Investigators screened the nationally representative sample for hepatitis B surface antibodies, or HBsAb, and analyzed results by age, sex, ethnicity, socioeconomic status and residential setting. In the separate immigrant sample, they assessed hepatitis B surface antigen, or HBsAg, and screened HBsAg-positive samples for hepatitis D virus, or HDV. The two components therefore measured different outcomes in different populations and were not equivalent to a uniform national survey of HBsAg and HDV prevalence.

HBsAb seropositivity was 49.2% among people born in or after 1992, when universal hepatitis B vaccination was introduced nationally, compared with 36.0% among those born before that year, a difference reported as p < 0.0001. The results also showed lower antibody positivity among people with lower socioeconomic status and among those living in peripheral areas. For the comparisons reported by the researchers, the odds ratio was 1.51 for high versus low socioeconomic status, with a 95% confidence interval of 1.29–1.78, and 1.61 for central versus peripheral residency, with a 95% confidence interval of 1.23–2.09. Ethnic patterns also varied with age: Jewish and other minority populations had higher rates in younger cohorts, whereas the Arab population had higher rates among older participants. These were cross-sectional associations, and the reported data do not establish that vaccination, ethnicity, socioeconomic conditions or residence caused the observed differences.

Among the selected immigrant samples, HBsAg prevalence was 9% among people from Ethiopia and 9% among people from Ukraine. Among HBsAg-positive carriers from Africa, 8.2% also tested positive for HDV. The reported estimate applies to the African carrier group represented in the study and should not be interpreted as a separate prevalence value for every African population. Moreover, because the immigrant component included selected populations rather than a nationally representative sample covering all origins, the study does not establish a comprehensive prevalence of HBsAg or HDV among all immigrants in Israel.

The findings show that the national vaccination program coincided with higher HBsAb seropositivity in the younger birth cohort, while important seropositivity gaps remained across demographic and social groups. The targeted immigrant results further document HBsAg prevalence in Ethiopian and Ukrainian samples and HDV coinfection among African HBsAg-positive carriers. The investigators concluded that screening strategies should be considered, particularly for high-risk immigrants and specified immigrant populations, while the study’s cross-sectional design and selected sampling limit conclusions about causes, changes over time and population-wide prevalence.

Subject of Research: Hepatitis B seroprevalence and hepatitis D coinfection across Israeli demographic and immigrant populations

Article Title: National HBsAb serosurvey and HBsAg/Hepatitis D coinfection prevalence across sociodemographic and immigrant populations in Israel

Article References: Yael, G., Keren, A., Lital, K.-B., Shoshana, A. S., Orit, P., Orna, M., & Ravit, B. (2026). National HBsAb serosurvey and HBsAg/Hepatitis D coinfection prevalence across sociodemographic and immigrant populations in Israel. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14403-2

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14403-2

Keywords: hepatitis B, hepatitis D, HBsAb, HBsAg, serosurvey, viral infections, immigrant health, Israel, socioeconomic disparities, national vaccination, National, Hepatitis

What struck him most, he recalls, was the distance between the intensity of the patient’s suffering and the quietness with which it was expressed. That gap raised two questions that would follow him through the rest of his training: how much of the patient’s inner experience remained unspoken, and how much of what he perceived belonged to the patient at all, rather than to his own expectations about how profound sadness should look. The distinction is more than philosophical. In clinical psychiatry, the interpretation of emotional expression shapes diagnosis, treatment planning, and the therapeutic alliance itself. When a clinician misreads restraint as absence of feeling, or stoicism as resilience, the resulting formulation can quietly steer care in directions the patient never intended.

To frame the experience, Pinto reaches for an unexpected literary companion: the young physician of Mikhail Bulgakov’s A Young Doctor’s Notebook, a semi-autobiographical collection following a newly graduated doctor in a remote rural hospital. Removed from the familiar world of his training, Bulgakov’s doctor approaches each patient with an unstable mixture of anticipation, responsibility, and fear. Medical knowledge that appears orderly on the page becomes far less certain when confronted with the complexity of an actual human life. Pinto recognized that anxiety when he moved from a city in South America to the United States to begin residency. He worried about remembering diagnostic criteria, choosing appropriate medications, presenting patients clearly, and staying composed during emergencies. Like Bulgakov’s young doctor, he feared encountering something he would fail to recognize.

What he was less prepared for, he writes, was a different possibility entirely: that he might recognize the diagnosis while still failing to understand the person experiencing it. This inversion sits at the heart of the essay and explains why it is resonating beyond the specialty. Diagnostic frameworks in psychiatry, codified in classification systems and measured through structured criteria, are designed to standardize recognition. They tell a clinician what a patient has, but they say remarkably little about what the condition means to the person who carries it. Pinto’s argument is that these are separate clinical tasks, and that training systems tend to reward the first while leaving the second to be absorbed, if at all, through experience.

Residency, he notes, gradually offered more than diagnostic certainty. Supervision, clinical encounters, literature, and his own experience of unfamiliar settings did not tell him what another person’s story meant, but they taught him how to approach it: to ask better questions, examine his assumptions, and remain curious. The city where he grew up was itself complex, shaped by racial, religious, and socioeconomic differences, yet many of its cultural references were familiar to him. He understood the rhythm of conversations, the role of family, and some of the meanings hidden in humor or silence. In residency, that familiarity could no longer be assumed. His patients came from different countries, neighborhoods, generations, religious traditions, and migration histories. Some lived only a few miles apart while inhabiting remarkably different social worlds.

The encounter with the depressed immigrant patient forced him to examine how he interpreted emotional expression. The patient’s reserve, he concluded, was not an absence of emotion but itself a form of communication, one that required him to listen differently. He wondered whether migration, masculinity, stigma, or cultural expectations surrounding emotional restraint had influenced what the patient felt able to reveal. At the same time, he recognized the danger of turning those possibilities into conclusions. Knowing where a patient comes from cannot substitute for understanding what the patient experiences. Culture, in his formulation, can help a clinician formulate questions, but it cannot answer them on the patient’s behalf.

This leads the essay to a pointed critique of the popular concept of cultural competence. Pinto had once imagined it as a body of knowledge he could acquire about beliefs and customs, a checklist of group-level facts that would prepare him for any patient. Psychiatry exposed the limits of that idea. Culture, he argues, is only one part of a patient’s context, alongside family, faith, social position, relationships, personality, and individual history. Each of these can shape suffering without determining its meaning. The implication for training is significant: teaching residents about cultural patterns is useful only if it is paired with the discipline of holding those patterns as hypotheses rather than conclusions, subject to revision by the individual in front of them.

The essay grounds this point in the history of psychiatry itself, citing the conceptual historian German Berrios’s work on melancholia and depression in the nineteenth century. Even psychiatry’s own language for depressive suffering has changed over time; melancholia and depression have been repeatedly redefined rather than representing one stable concept across medical history. The diagnosis written in the chart can be the same while its meaning differs profoundly between patients. Depression might be experienced as sadness, exhaustion, bodily pain, spiritual disconnection, loss of purpose, or failure toward family. Even silence, Pinto notes, could reflect fear, dignity, mistrust, restraint, uncertainty, or simply the absence of words adequate to describe suffering. A single diagnostic label, in other words, contains a plurality of illnesses of meaning that no classification system can collapse.

These realizations changed the questions he asks at the bedside. He became less satisfied with identifying symptoms and more interested in the world in which those symptoms developed. What does the patient call the problem? Why has help been sought now, and not earlier or later? Who agrees that something is wrong? What does the patient fear would happen if others learned about the diagnosis? What would recovery look like from the patient’s perspective? Such questions, familiar to medical anthropologists and to clinicians trained in narrative medicine, are deceptively simple. They require time, trust, and a tolerance for answers that may not fit the expected clinical script. But they address something the standard review of systems cannot: whether treatment will feel acceptable, whether family involvement will feel supportive, and what recovery itself is imagined to be.

Pinto is careful to note that his own experience as an immigrant did not automatically make him culturally perceptive. He knew what it felt like to communicate in a second language and to enter institutions whose unwritten rules others seemed to understand intuitively. But shared experiences of migration did not erase the differences between his patients and himself. His background could remind him to remain curious; it could not tell him what another person’s suffering meant. This honesty distinguishes the essay from simpler narratives in which personal similarity is treated as a shortcut to understanding. Empathy grounded in shared experience, the essay suggests, is a starting point for inquiry, never a substitute for it.

Perhaps, he concedes, we can never fully know what depression means in another human being. Clinical understanding is therefore not a final conclusion but an ongoing approximation, shaped through questions, attention, trust, and a willingness to revise what we think we understand. That uncertainty does not make understanding less important; it makes humility essential. The meanings patients attach to suffering can determine whether they accept treatment, whether they allow family into their care, and how they imagine getting better. Misread meanings can do the opposite, quietly undermining even technically correct treatment plans.

When he first read Bulgakov, Pinto understood the young doctor’s fear as the fear of insufficient knowledge: of encountering an illness he could not identify or a crisis he could not manage. Residency has changed the meaning of that fear. He still worries about what he may fail to diagnose. Increasingly, however, he also worries about recognizing a diagnosis too quickly and mistaking recognition for understanding. The diagnosis in his patient’s chart had been clear before he entered the room. Understanding the suffering contained within it required something the criteria alone could not provide: curiosity about the world from which the patient spoke, attention to what remained unspoken, and humility about the limits of interpretation.

Bulgakov’s young doctor entered each room uncertain of what the next patient would demand of him. Pinto is beginning to understand that this uncertainty is not something medical training eventually eliminates. In psychiatry, it can become a form of attentiveness: the willingness to listen long enough for each patient to reveal not only what they are suffering from, but what that suffering means in their world. For a specialty whose tools are conversation, observation, and relationship, that may be the most clinically consequential lesson of all, and the reason this short reflective essay is finding an audience far beyond its journal’s usual readership.

Subject of Research: Cultural understanding and the limits of diagnosis in psychiatric residency training

Article Title: The Diagnoses I Recognized, the Stories I Did Not

Article References: Albuquerque Barbosa Pinto, N. (2026). The Diagnoses I Recognized, the Stories I Did Not. Academic Psychiatry. https://doi.org/10.1007/s40596-026-02456-z

Image Credits: AI Generated

DOI: 10.1007/s40596-026-02456-z

Keywords: psychiatry, cultural competence, depression, countertransference, medical humanities, diagnosis, residency training, immigrant health, narrative medicine, mental health stigma, clinical communication, Bulgakov

The review, led by Ana Cardeña-Gutiérrez of Hospital Universitario Nuestra Señora de Candelaria in Tenerife, Spain, together with co-first authors Mary Tanay and Paula Rodríguez-Hernáez and an international team spanning the United Kingdom, the United States, Australia, and Mexico, set out to map what is actually known about the supportive care needs of immigrant adolescent and young adult cancer survivors, a population the field abbreviates as AYA. The team followed the established JBI methodology for scoping reviews and reported their process according to the PRISMA-ScR guidelines, searching major databases including PubMed and Embase for peer-reviewed studies focused on foreign-born or immigrant AYA survivors and their long-term survivorship experiences.

The headline finding is as stark as it is sobering: only six studies met the inclusion criteria. For a global population that includes large shares of the young adults diagnosed with cancer each year in high-income countries, six studies is not a body of evidence; it is a gap wearing the costume of one. The authors attribute this scarcity to a structural blind spot in oncology research itself. Survivorship frameworks, they conclude, fail to adequately account for the migratory process, and studies routinely conflate immigration status with broad racial and ethnic categories, collapsing a person’s country of birth, language, legal status, and length of residency into a single label that explains very little.

That conflation matters because the barriers the review identifies are not the same as the disparities captured by race and ethnicity variables. Immigrant AYAs, the synthesis found, face a compounding matrix of linguistic, financial, and legal barriers that limit healthcare access. Language discordance between patient and provider degrades the quality of information about late effects and follow-up care. Financial toxicity, already a documented burden for young adult survivors generally, is amplified for those navigating employment, insurance eligibility, or documentation status in a new country. Legal uncertainty, in turn, can make survivors reluctant to engage with institutions at all, producing quiet attrition from the very surveillance programs designed to catch recurrences and treatment complications early.

One of the most conceptually interesting findings concerns the transition from pediatric to adult oncology, a handoff that is notoriously fragile even for patients who share a language and culture with their care teams. For immigrant families, the review highlights a profound disconnect between individualistic Western healthcare models, which center the autonomy of the young patient, and collectivist, family-centered decision-making norms, in which parents and extended kin are expected to share in medical choices. A survivorship system that assumes the 20-year-old should speak alone with the oncologist may inadvertently sideline the family structures that immigrant patients rely on for support, while a system that excludes the family may leave the patient without an advocate in the room. Neither model, the authors suggest, currently flexes to accommodate both.

The review also draws on the broader acculturation literature to describe a paradoxical health trajectory. Post-migration acculturation processes, the authors report, can sometimes erode baseline healthy behaviors, meaning that the dietary patterns, physical activity habits, and social supports that immigrants bring with them may deteriorate as they adopt the risk profiles of their host societies. Layered on top of a cancer diagnosis and its treatment, this erosion can worsen financial toxicity and long-term psychosocial outcomes. The implication is uncomfortable for simplistic narratives: migration itself, independent of race or ethnicity, reshapes cancer risk and survivorship in ways that standard demographic variables never capture.

The methodological critique embedded in the review is likely to resonate far beyond AYA oncology. The authors call for systemic changes in cancer research to capture granular data on nativity, meaning whether a person was born inside or outside the country of care, and on length of residency, which shapes everything from language proficiency to insurance eligibility to familiarity with preventive care. Without those data points, they argue, the disparities affecting immigrant survivors remain statistically hidden, folded into categories where they cannot be detected, measured, or addressed. It is a data problem as much as a clinical one: what is not recorded cannot be acted upon.

The practical implications the authors outline are correspondingly concrete. Culturally responsive survivorship programs, dedicated language services, and family-inclusive patient navigation models are described as essential to prevent care attrition, reduce post-treatment social stigma, and optimize long-term quality of life for immigrant AYA survivors. Patient navigation, in particular, has emerged in recent years as one of the more promising equity interventions in oncology, pairing patients with trained guides who help them traverse scheduling, interpretation, insurance, and follow-up. Extending such models to explicitly include family members, and to account for the legal and financial precarity that migration can entail, would represent a meaningful adaptation of survivorship care to the populations it actually serves.

The stakes are considerable. Adolescents and young adults occupy an awkward position in cancer care, falling between pediatric and adult services and historically underrepresented in clinical trials, a problem documented in reports from cooperative groups showing elevated loss to follow-up among minority and young adult participants. Survivors in this age group face decades of life during which late effects, secondary cancers, and cardiovascular and psychosocial complications can emerge. When an immigrant survivor drops out of follow-up care at 25 because of a language barrier or a documentation fear, the consequences may not surface for another decade, by which point the opportunity for early intervention has passed. The review’s finding that current frameworks fail this population is therefore not an abstract concern about research taxonomy; it is a warning about preventable harm unfolding silently across health systems.

What makes the study notable is its candor about how little is known. A scoping review that ends with six eligible studies is, in effect, a map of an empty continent, and the authors are explicit that the field needs far more research before it can design evidence-based interventions with confidence. Yet the direction of travel is clear from the evidence assembled: the categories oncology has long relied upon to describe inequity are too blunt to see one of its fastest-growing dimensions. As global migration continues to reshape the demographics of every wealthy nation’s cancer population, the question the review poses, beyond race and ethnicity, who is being left out of survivorship care, is one that researchers, clinicians, and policymakers can no longer afford to leave unanswered.

Subject of Research: Supportive care needs and access barriers among immigrant adolescent and young adult cancer survivors

Article Title: Beyond race and ethnicity: a scoping review of supportive care needs and barriers for immigrant AYA cancer survivors

Article References: Cardeña-Gutiérrez, A., Tanay, M., Rodríguez-Hernáez, P., Jiang, C., Hart, N. H., Soto-Perez-de-Celis, E., & Chan, A. (2026). Beyond race and ethnicity: a scoping review of supportive care needs and barriers for immigrant AYA cancer survivors. Journal of Cancer Survivorship. https://doi.org/10.1007/s11764-026-02094-2

Image Credits: AI Generated

DOI: 10.1007/s11764-026-02094-2

Keywords: AYA cancer survivors, cancer survivorship, immigrant health, supportive care, healthcare disparities, scoping review, healthcare transition, financial toxicity, acculturation, patient navigation, health equity, oncology

The research team, led by Lina Harvold Ellingsen-Dalskau of the Norwegian Institute of Public Health, set out to address a persistent blind spot in health services research. Immigrants are known to carry an elevated risk of mental health problems, yet they use specialist psychiatric services less than expected, and there are reasons to suspect that when they do reach hospital care, the quality of their experience may differ from that of the majority population. Previous evidence on psychiatric inpatient experiences among immigrant groups has been scarce, partly because measuring patient experience in a way that is fair and comparable across cultural and linguistic groups is itself a formidable methodological challenge. The new study confronts that challenge head-on, using a national survey infrastructure and openly acknowledging the limits of cross-group comparison.

The quantitative backbone of the study is the Psychiatric Inpatient Patient Experience Questionnaire with Continuous Electronic Measurement, known as PIPEQ-CEM. This instrument was deployed continuously in psychiatric inpatient institutions across Norway from January 2020 to June 2022, producing an unusually rich dataset of 8,184 patients, of whom 89.5 percent were Norwegian-born. Respondents completed the questionnaire alongside items covering demographic background, experiences of coercion, and indicators of their mental health. The researchers then used linear regression to test whether a patient’s region of birth was associated with the key outcomes: the overall experience score, ratings of specific dimensions of care, reported coercion, and the perceived change in mental health over the course of the admission.

The headline quantitative result is one of broad similarity. On overall patient experience scores, the study found few statistically meaningful differences between immigrant groups and the majority population. That null finding matters, because it pushes back against any assumption that immigrant patients necessarily rate psychiatric hospitals more harshly across the board. Yet beneath the aggregate similarity, the analysis uncovered patterns that cannot be ignored. Some immigrant groups rated specific aspects of care, including the initial welcome they received on admission, the privacy they were afforded, and the perceived benefit of their treatment, lower than the Norwegian-born majority did. These are not peripheral details; the first hours of an admission shape trust, and privacy is a core dignity concern in any locked ward environment.

More striking still were the differences in coercion and clinical trajectory. Some immigrant groups reported higher levels of coercive measures during their inpatient stay, and also reported less improvement in their mental health between admission and discharge. Coercion, which in psychiatric settings can include involuntary medication, restraint, seclusion, or being admitted against one’s will, is one of the most ethically charged dimensions of mental health care, and international policy has long aimed to minimize it. Its uneven distribution across population groups raises questions that the survey data alone cannot answer, about how risk is assessed, how communication difficulties influence clinical decisions, and whether patients from some backgrounds are more likely to experience care as something done to them rather than with them.

To get closer to those questions, the team turned to the free-text comments that patients attached to their questionnaires. In total, 390 comments from immigrant patients and 125 from Norwegian-born patients were subjected to thematic analysis, a qualitative method that identifies recurring patterns of meaning across large bodies of unstructured text. The analysis revealed four interlocking themes that were specific to immigrant patients’ experiences: their expectations of and prior knowledge about psychiatric care before admission; their sense of belonging and trust within the ward environment; communication with staff; and access to information about their treatment and rights.

Each of these themes points to a concrete mechanism through which care can go wrong for patients unfamiliar with the system. A patient who has never encountered a psychiatric hospital before, or whose expectations are shaped by stigma or frightening stories from their country of origin, may arrive with fear that staff do not recognize or address. A patient who cannot follow rapid conversations in Norwegian, or who receives written information only in a language they do not read, may miss crucial explanations about medication, legal safeguards, or discharge planning. A patient who feels culturally invisible on the ward may withhold trust precisely at the moment when trust is the foundation of therapeutic benefit. The qualitative findings thus give psychological texture to the numbers, suggesting how small differences in welcome, privacy, and information flow could accumulate into lower perceived treatment benefit and a slower recovery trajectory.

The study’s authors are careful about what their measurement can and cannot claim, and that caution is itself an important finding. Patient-reported experience measures, or PREMs, assume that patients share a common framework for judging care: what counts as a good welcome, what counts as acceptable privacy, what a helpful treatment feels like. When those frameworks differ across cultural groups, identical scores may not mean identical experiences, and different scores may reflect different expectations rather than different treatment. The thematic analysis helps here, because it shows that contextual factors, such as prior knowledge of psychiatric care and the experience of belonging, actively shape how patients interpret and report their care. Any fair comparison of patient experience across diverse populations must therefore be accompanied by culturally appropriate measurement instruments, not simply translated versions of majority-population questionnaires.

The practical implications extend well beyond Norway’s borders. Health systems across Europe and North America serve increasingly diverse populations, and mental health services sit at the intersection of several well-documented inequities: barriers to access, communication gaps, stigma that varies across communities, and clinical decision-making that may be more coercive for some groups than others. This study suggests a template for detecting such inequities early, through continuous electronic measurement rather than one-off surveys, combined with systematic analysis of patient comments that can reveal why the numbers look the way they do. For ward managers, the actionable levers are tangible: invest in the admission experience, protect privacy deliberately, ensure interpreters and translated materials are genuinely available, and build staff competence in cross-cultural communication so that trust can form quickly even in crisis admissions.

For researchers, the message is that methodology and equity are inseparable. A PREM that works for the majority population is not automatically a valid instrument for everyone, and treating aggregate similarity as evidence of equity risks obscuring the disparities, in coercion and in recovery, that surface when the data are disaggregated by region of birth. The Norwegian study demonstrates that it is possible to run such disaggregated analysis at national scale while still listening carefully to patients in their own words. What emerges is a dual mandate for psychiatric services: deliver care that is culturally sensitive in practice, and measure patient experience in ways that are culturally appropriate in method. Only when both halves of that mandate are met can health systems honestly claim to know how well they are serving all of the patients in their care, and only then can the higher coercion and flatter recovery curves reported by some immigrant groups be understood, and ultimately eliminated.

Subject of Research: Comparison of patient-reported experiences, coercion, and mental health outcomes between immigrant and majority populations in Norwegian psychiatric inpatient care

Article Title: Patient-reported experience measures (PREMs), coercion, and mental health outcomes in psychiatric inpatient care: a national mixed-methods study comparing immigrant and majority populations

Article References: Ellingsen-Dalskau, L. H., Bjertnæs, Ø., Kjøllesdal, M. K. R., & Iversen, H. H. (2026). Patient-reported experience measures (PREMs), coercion, and mental health outcomes in psychiatric inpatient care: a national mixed-methods study comparing immigrant and majority populations. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15511-0

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15511-0

Keywords: patient-reported experience measures, PREMs, psychiatric inpatient care, coercion, mental health outcomes, immigrant health, health services research, Norway, cross-cultural psychiatry, mixed-methods study, PIPEQ-CEM, health equity