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Purpose of Review: Communicating effectively with patients having a traditional, alternative or complementary medicine-related health-belief model is challenging in today's cross-cultural society. This narrative review explores the integrative medicine setting of care, focusing on insights from the integrative oncology daily practice, while addressing the relevance to the mental health setting. The way in which healthcare providers can enhance cultural-sensitive communication with patients and informal caregivers; recognize and respect health-beliefs to bridge cultural gaps; and generate an open, non-judgmental and mindful dialogue are discussed. Recent Findings: Identifying cross-cultural barriers to healthcare provider-patient communication is important in order to address the potential for conflict between conventional and "alternative" health beliefs; difficulties in creating a shared-decision making process; disagreement on therapeutic goals and treatment plan; and finally, the potential for non-compliance or non-adherence to the conventional oncology treatment. Summary: Acquiring intercultural competencies is needed at all stages of medical education, and should be implemented in medical and nursing curricula, as well as during specialization and sub-specialization. As with patient-centered paradigms of care, integrative medicine entails a dual patient-centered and sensitive-cultural approach, based on a comprehensive bio-psycho-social-spiritual model of care. [ABSTRACT FROM AUTHOR]

Sinonasal teratocarcinosarcoma is a rare, highly aggressive tumor of the anterior skull base composed of malignant epithelial, mesenchymal, and neural tissue. Examination of cases in patients in minority populations is important in order to better understand the behavior of this neoplasm and outcomes of treatment in our nation's diverse population. [ABSTRACT FROM AUTHOR]

Abstract Sinonasal teratocarcinosarcoma is a rare, highly aggressive tumor of the anterior skull base composed of malignant epithelial, mesenchymal, and neural tissue. Examination of cases in patients in minority populations is important in order to better understand the behavior of this neoplasm and outcomes of treatment in our nation's diverse population.

We present the case of a 60‐year‐old man with non‐specific abdominal pain. We explore how communication between doctor and patient was challenged by a language barrier. We also consider how the ability to take an accurate clinical history differed between Google Translate and an accredited medical phone translation service. An accurate clinical history is crucial for providing high‐quality care to all patients. Unaccredited online translation services are insufficiently accurate for clinical history taking and should be avoided where possible. Enteropathy‐associated T‐cell lymphoma should be considered in the differential diagnosis for patients with coeliac disease presenting with non‐specific abdominal pain. [ABSTRACT FROM AUTHOR]

Abstract We present the case of a 60‐year‐old man with non‐specific abdominal pain. We explore how communication between doctor and patient was challenged by a language barrier. We also consider how the ability to take an accurate clinical history differed between Google Translate and an accredited medical phone translation service.

It is well-documented that patients’ religious characteristics may affect their health and health care experiences, correlating with better health and psychological well-being. Likewise, health care providers are impacted by religious characteristics that affect their attitudes and behaviors in a clinical setting. However, few of these studies examine non-theist, non-Western, or Indian-based traditions, and none have examined Jainism specifically, in spite of the high representation of Jains in medicine. Drawing upon a quantitative survey conducted in 2017–2018 of Jains in medical and healthcare fields, I argue that Jains physicians and medical professionals demonstrate a “reflexive ethical orientation”, characterized by: (1) adaptive absolutes emphasizing nonviolence, a many-sided viewpoint, and compassion; (2) balancing personally mediated sources of authority that evaluate and integrate Jain insights alongside cultural and legal sources, and clinical experience; and (3) privileging the well-being of five-sensed humans and animals.

Abstract: The recent wave of migration from Middle Eastern countries to Europe presents significant challenges to the European health profession. These include the inevitable communication gap created by differences in health care beliefs between European oncologists, health care practitioners, and refugee patients. This article presents the conclusions of a workshop attended by a group of clinicians and researchers affiliated with the Middle East Cancer Consortium, as well as four European‐based health‐related organizations. Workshop participants included leading clinicians and medical educators from the field of integrative medicine and supportive cancer care from Italy, Germany, Turkey, Israel, Palestine, Iran, Lebanon, Jordan, Egypt, and Sudan. The workshop illustrated the need for creating a dialogue between European health care professionals and the refugee population in order to overcome the communication barriers to create healing process. The affinity for complementary and traditional medicine (CTM) among many refugee populations was also addressed, directing participants to the mediating role that integrative medicine serves between CTM and conventional medicine health belief models. This is especially relevant to the use of herbal medicine among oncology patients, for whom an open and nonjudgmental (yet evidence‐based) dialogue is of utmost importance. The workshop concluded with a recommendation for the creation of a comprehensive health care model, to include bio‐psycho‐social and cultural‐spiritual elements, addressing both acute and chronic medical conditions. These models need to be codesigned by European and Middle Eastern clinicians and researchers, internalizing a culturally sensitive approach and ethical commitment to the refugee population, as well as indigenous groups originating from Middle Eastern and north African countries. Implications for Practice: European oncologists face a communication gap with refugee patients who have recently immigrated from Middle Eastern and northern African countries, with their different health belief models and affinity for traditional and herbal medicine. A culturally sensitive approach to care will foster doctor‐refugee communication, through the integration of evidence‐based medicine within a nonjudgmental, bio‐psycho‐social‐cultural‐spiritual agenda, addressing patients' expectation within a supportive and palliative care context. Integrative physicians, who are conventional doctors trained in traditional/complementary medicine, can mediate between conventional and traditional/herbal paradigms of care, facilitating doctor‐patient communication through education and by providing clinical consultations within conventional oncology centers. [ABSTRACT FROM AUTHOR]

Introduction: In this multinational Middle-Eastern study, we assessed health-care providers' (HCPs) perspectives on their patients' use of complementary and traditional medicine (CTM) and identified the leading barriers to CTM integration in supportive cancer care. Methods: A 17-item questionnaire was developed and administered to HCPs attending palliative medicine workshops conducted across the Middle East by the Middle East Cancer Consortium. Results: 339 HCPs from 16 countries across the Middle East completed the questionnaire (80.3 % response rate). Respondents perceived their patients' reasons for CTM use primarily in the context of cancer cure (63 %) and quality of life (QOL) improvement (57 %). Expectation regarding CTM's role in cancer cure/survival was more pronounced in Turkey, Jordan, the Palestinian Authority, and the Persian Gulf area. In contrast, the expectation that CTM would improve QOL was more emphasized in Israel. A mid-position between the cure/survival and QOL poles was observed in Cyprus, Lebanon, and the North African countries. Leading barriers to CTM integration in supportive cancer care included oncologists' skepticism and a gap between patients' expectations and HCP's objectives. Respondents' leading recommendation to HCPs was to communicate integrative care emphasizing well-being and improved functioning in accordance with their patients' health beliefs. Conclusion: CTM integration in supportive cancer care can be facilitated by implementing a platform for Middle Eastern clinical collaborations. HCPs' expectations and experiences with CTM have been positive in the oncology setting. These data need to be corroborated with information of patients' expectations on the provision of CTM over all phases of the oncology treatment. [ABSTRACT FROM AUTHOR]

Context There is a dearth of studies on how cultural background influences patients' attitudes and choices regarding complementary and traditional medicine (CTM) integration. Objectives To explore Arab and Jewish patients' perspectives regarding CTM use and its possible integration within conventional cancer care. Methods This was a cross-cultural study. We developed a 27-item questionnaire that evaluates patients' perceptions regarding CTM integration in supportive cancer care. The questionnaire was administered to a convenience sample of patients receiving cancer care in community and hospital oncology centers. Results Of the 770 respondents (response rate 88%), 324 defined their religion as Muslim, Christian, or Druze (henceforth, regarded as Arabs) and 446 were Jews. Respondents in the two groups differed significantly in terms of age, gender, marital status, number of children, education, religiosity, and prevalence of cancer types (excluding breast cancer). Although Arab respondents reported less use of CTM for cancer-related outcomes (39.6% vs. 52.1%; P = 0.001), they expressed greater support than Jewish respondents for optional CTM consultation if provided within conventional oncology care ( P < 0.0001). Respondents in both groups stated that their primary expectation from the oncologist concerning CTM was to participate in formulating a CTM treatment plan to be provided within the oncology department. Compared with Arab respondents, Jews expected CTM consultations to focus on improving daily functioning and coping, reducing chemotherapy side effects, and providing spiritual support. Conclusion Although quality of life-related expectations are more pronounced among Jewish respondents, both groups share the expectation from their health care providers to be actively involved in construction of a tailored integrative CTM treatment plan. [ABSTRACT FROM AUTHOR]

Introduction: The high prevalence of the use of traditional herbs among patients with cancer is a cause for concern with regard to potentially adverse interactions with conventional oncology treatments. In this study, we explore herbal use among patients with cancer in northern Israel who are referred by their health care providers to complementary and traditional medicine (CTM) consultations provided to them within the conventional oncology department. The study's objectives were to identify which herbs patients use and to examine the scope of current research on the efficacy and safety regarding the identified herbs. Patients and methods: Herbal use by patients receiving oncology care was assessed prospectively from July 2009 to July 2012 by integrative physicians (IPs) trained in herbal medicine. Historical, ethnobotanical, basic research, and clinical data regarding the identified herbs were explored by using a keyword search in PubMed and Middle Eastern ethnohistorical literature. Results: Disclosure of herbal use was reported by 154 of the 305 patients (50.5 %) interviewed by IPs. The use of 85 single herbs and 30 different herbal formulas was documented during the initial or follow-up IP assessments. Patients reported 14 quality of life-associated indications for herbal use. The ten most prevalent herbs displaying in vitro/in vivo anticancer activity and nine other herbs were preliminarily assessed concerning potential risks, safety, and interaction with chemotherapy. Conclusions: Herbal use by patients with cancer in northern Israel is widespread and calls for further study in order to address issues of safety and effectiveness. We recommend constructing a multinational and multidisciplinary team of researchers with ethnopharmacological and clinical expertise that will explore the use of herbs among patients with cancer in a cross-cultural perspective attuned with patients' affinity to traditional herbal medicine. [ABSTRACT FROM AUTHOR]

This is the first study that explored Arab patient's perspectives on complementary medicine (CM) integration in a conventional oncology setting. Integrative physicians can facilitate a nonjudgmental and culturally sensitive discussion on CM use, and empower patients in their quest for informed decision tuned with their health belief model and evidence-based medicine.Background Limited research is available on the perspectives of patients with cancer regarding integration of complementary medicine (CM) in conventional supportive cancer care. The purpose of this study was to explore patients' perspectives concerning CM integration within conventional oncology settings. Patients and methods A 27-item questionnaire was constructed and administered to a convenient sample of Arab patients receiving cancer care in three oncology centers in northern Israel. Results Of the 324 respondents (94.7% response rate), 124 of 313 (39.6%) reported the use of CM for cancer-related outcomes. A logistic regression model indicated that CM was used with active chemo- or radiotherapy treatment [EXP [B], 2.926, 95% confidence interval (CI) 1.276–6.708; P = 0.011] and a higher degree of spiritual quest (EXP [B], 3.425, 95% CI 1.042–11.253; P = 0.043). Herbal medicine was the leading CM modality (87.9% of CM users), which included the use of 28 plants and traditional remedies, of which 17 were used to improve QOL, with 5 of the herbs having potential interactions with chemotherapy. 83.1% of respondents stated that they would consult with a CM provider if CM were to be integrated into the oncology department. Patients’ expectation of CM consultation was clearly associated with expectations of QOL improvement, coping with cancer, and alleviating chemotherapy's side-effects when compared with expectations of cancer cure (P < 0.0001). The three leading concerns which patients expected to be improved by integrative CM treatment were gastrointestinal symptoms (63.2%), fatigue (51.9%), and pain (40.5%). Conclusions Integrative CM consultations should focus on the improvement of QOL concomitant with safety concerns regarding potential drug–herb interactions. The need to integrate a nonjudgmental yet evidence-based CM consultation service may also be applicable to oncology institutions challenged with culturally diverse populations with a high prevalence of traditional medicine use. [ABSTRACT FROM AUTHOR]

Purpose. Complementary and traditional medicine (CTM) plays an important role in culture-centered care for cancer patients in the Middle East. In this article, we have studied the attitudes of Arab CTM therapists concerning integration of complementary medicine within the conventional supportive cancer care of Arab patients in northern Israel. Methods. Semistructured interviews were held with 27 Arab therapists who use medicinal herbs, the Quran, and various CTM modalities, with the aim of characterizing their treatment practices and learning about their perspectives regarding conventional cancer care. Results. We first summarized the different characteristics of the various CTM therapists, including training, typical practice, and so on. Thematic analysis revealed that folk healers and complementary medicine therapists describe their role as supportive and secondary to that of physicians. Their goal was not to cure patients with cancer but rather to enhance their quality of life by reducing the severity of both the disease symptoms and the side effects of cancer treatment. Religious healers, by contrast, purport to cure the disease. While folk healers opt for parallel alternative care and complementary therapists support integrative care, religious healers claimed that they offer an alternative to conventional medicine in terms of both etiology and practice. Conclusions. The majority of Arab CTM therapists support integration of their treatments with the conventional system, but in practice, they are not sure how to bring about this change or create a parallel model in which 2 different systems are active, but not integrated. Our findings emphasized the need to promote doctor–CTM practitioner communication based on structured referral and bidirectional consultation. Moreover, we recommend intensifying research on the efficacy and safety of CTM in the Middle East and the potential role in promoting culture-based supportive care. [ABSTRACT FROM PUBLISHER]

While student-run clinics are often important healthcare safety nets for underserved populations, their efficacy for improving patient health knowledge has not been thoroughly explored. From September 2011 to April 2012, we assessed patients' retention of hepatitis B virus (HBV) knowledge after receiving student-led education at two student-run HBV screening and vaccination clinics. Patient education was provided by trained first and second-year medical, nursing, and pharmacy students, aided by a script and interpreters. Patient knowledge of HBV was evaluated at three points: before education, after the initial visit, and at one-month follow-up. Student-led education produced improved knowledge of HBV transmission, prevention, and management, which was retained 1 month after education for 52 patients tracked through time. Mean scores on an HBV knowledge survey improved from 56.4 % (SD = 15.2 %) at baseline to 66.6 % (SD = 15.1 %) after education, and 68.3 % (SD = 15.2 %) after one month. There was a statistically significant difference between the first and second (paired T test, p < 0.001) and the first and third tests (paired T test, p < 0.001), but no difference between the second and third tests (paired T test, p = 0.45). Multivariate analysis demonstrated that retention was correlated with patient educational background but independent of patient age, gender, income, primary language and number of years lived in the United States. Our study suggests that trained health professional students can effectively impart health knowledge that is retained by patients for at least 1 month. These results warrant consideration of student-led educational sessions at SRCs as a promising community health education model. [ABSTRACT FROM AUTHOR]

Background. Spirituality, as distinct from religiosity, has become a most common term in complementary and alternative medicine (CAM) discourse. The association between religiosity and spirituality in the context of CAM use is a complex one and is worthy of being researched in specific local cultural contexts. Objective. Exploring the association between CAM use and religiosity, in patients with and without diabetes Type 2 attending primary care clinics in Northern Israel. Research design and methods. Research assistants administered a questionnaire developed to assess CAM use in primary care to a convenience sample of patients attending seven primary care clinics. Results. Of the 3742 respondents, 485 (12.9%) reported having Type 2 diabetes. Respondents with diabetes reported more overall CAM use during the previous year (46.9% vs. 42%, P=0.049). A logistic regression model of patients with diabetes Type 2 indicated that CAM use was associated with higher self-assessed religiosity [Exp(B)=1.898, 95% CI for Exp(B) 1.02-3.529, P=0.043]. CAM use among patients with diabetes was also associated more with female gender, higher education, and age under 60. The positive association between CAM use and degree of self-assessed religiosity was further studied in sub-populations of Jewish and Arab patients with diabetes Type 2. A logistic regression model of the Jewish population indicated significant association between CAM use and higher religiosity [Exp(B)=3.668, 95% CI for Exp(B) 1.232-10.922, P=0.02]. Conclusion. Primary care physicians need to be aware of a possible association between religiosity and CAM use in patients with diabetes. Physicians may consider adding questions on CAM and religiosity to routine clinical interviews in order to enrich their dialog with diabetes patients. [ABSTRACT FROM AUTHOR]

Background: In 2000 a diverse group of clinicians/educators at an inner-city safety-net hospital identified relational skills to reduce disparities at the point of care.Description: The resulting interviewing and precepting model helps build trust with patients as well as with learners. RESPECT adds attention to the relational dimension, addressing documented disparities in respect, empathy, power-sharing, and trust while incorporating prior cross-cultural models. Specific behavioral descriptions for each component make RESPECT a concrete, practical, integrated model for teaching patient care.Conclusions: Precepting with RESPECT fosters a safe climate for residents to partner with faculty, address challenges with patients at risk, and improve outcomes. [ABSTRACT FROM AUTHOR]

Introduction. In this study, we have compared attitudes of two social groups within the Israeli-Muslim population in order to examine the influence of modernization on the use of traditional and Complementary/Alternative Medicine (CAM). Research design and methods. We developed a 13-item questionnaire that addresses issues of CAM use, expectations from the primary-care physicians concerning CAM and attitudes toward CAM integration within the patient's primary-care clinic. Data for statistical analysis were obtained from 472 respondents who defined themselves as Bedouins and 869 non-Bedouins attending five primary-care clinics. Results. Respondents in the two groups were equally distributed by demographic characteristics. Bedouin respondents reported less CAM use during the previous year (26.3% vs. 50.2%, P<0.0001), and less use of traditional medicine and herbs. Compared to non-Bedouins, Bedouin respondents who were considering CAM use expressed more drug reluctance. Respondents in both groups greatly supported a theoretical scenario of CAM integration in primary-medical care, and expected their family practitioner to initiate the referral to CAM. Bedouin respondents held higher expectations for their physician to refer them to CAM and to offer CAM treatment in the clinic. Moreover, Bedouins expected to receive CAM in a primary-care setting, and supported the option that their family physician would provide CAM in such a setting more than the non-Bedouin Muslims did. Conclusions. We hypothesize that the two communities differ due to later modernization in the Bedouin society that may highly regard and pursue medical science while forsaking traditional and herbal medicine. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The purpose of this study was to examine the use of complementary and alternative medicine (CAM) in a primary care practice in Israel to determine prevalence and patterns of use. Methods: Trained research assistants invited all patients attending the administrative, medical, pharmaceutical, or nursing services of 7 clinics in urban and rural areas of northern Israel over a 16-month period, from April 1, 2005, through August 1, 2006, to complete a 13-item written questionnaire about CAM use and beliefs about CAM safety and efficacy. CAM was defined as therapies often referred to as alternative, complementary, natural, or folk/traditional medicine, and which are not usually offered as part of the medical treatment in the clinic, including herbal medicine, Chinese medicine (including acupuncture), homeopathy, folk and traditional remedies, dietary/nutritional therapy (including nutritional supplements), chiropractic, movement/manual healing therapies (including massage, reflexology, yoga, and Alexander and Feldenkrais techniques), mind-body techniques (including meditation, guided imagery, and relaxation), energy and healing therapies, and other naturopathic therapies. The Pearson χ2 test and multivariate logistic regression were used to assess univariate associations with the odds ratios of CAM use among Arab and Jewish women. A t test was performed to determine whether there were any differences in the continuous variables between the 2 groups. Results: Of 3972 consecutive patients who received the questionnaire, 3447 responded; 2139 respondents (62%) were women. Of the female respondents, 2121 reported their religion (1238 respondents [58%] self-identified as being Arab, and 883 [41.6%] as being Jewish). Compared with men, more women used CAM during the previous year (46.4% vs 39.4%; P < 0.001). Women were more likely to use CAM and to be interested in receiving CAM at primary care clinics. Arab women reported less CAM use than Jewish women but were more interested in experiencing CAM, had a higher degree of confidence in CAM efficacy and safety, and more frequently supported the integration of CAM practitioners in primary care clinics. Conclusions: In this study, women visiting primary care clinics in northern Israel used CAM more often than men did. Arab women reported less use of CAM than did Jewish women but also reported greater confidence in CAM efficacy and safety. [Copyright &y& Elsevier]

The purpose of this cross-cultural study was to evaluate patient perspectives on complementary and alternative medicine (CAM) integration within primary care clinics. It is one of the first multiethnic studies to explore patients' perspectives on the best model for integrating CAM into the conventional care setting. We developed a 13-item questionnaire that addresses issues of CAM use, expectations from the primary care physicians concerning CAM, and attitudes toward CAM integration within a patient's primary care clinic. We constructed the questionnaire with cross-cultural sensitivity concerning the core concepts of CAM and traditional medicine in both the Arab and Jewish communities in northern Israel. Data for statistical analysis were obtained from 3840 patients attending seven primary care clinics. Of the 3713 respondents who were willing to identify their religion, 2184 defined themselves as Muslims, Christians, or Druze and 1529 as Jews. Respondents in the two groups were equally distributed by sex but differed significantly by age, education, self-rated religiosity, and self-reported chronic diseases in their medical background. Respondents in the two groups reported comparable overall CAM use during the previous year, but the Arab respondents reported more use of herbs and traditional medicine. Respondents in both groups stated that their primary expectation from a family physician concerning CAM was to refer them appropriately and safely to a CAM practitioner. Respondents in both groups greatly supported a theoretical scenario of CAM integration into primary medical care. However, Arab respondents were more supportive of the option that non-physician CAM practitioners would provide CAM rather than physicians. [Copyright &y& Elsevier]

While cultural competency is widely promoted, the lack of a measure of cultural competency limits our ability to evaluate interventions and to understand the effects of cultural competency on health care quality. Based on a conceptual framework of cultural competency derived from expert focus groups, we developed a patient-reported measure of physician culturally competent communication behaviors that we validated in a group of 429 adult primary-care patients with diabetes and/or hypertension and their 53 physicians. Construct validity was supported by a moderate association with both patient satisfaction (r = .32, p < .001) and patient trust (r = .53, p < .001). Predictive validity was supported by an association with a decrease in blood pressure among hypertensive patients (r = -.18; p < .05). This new measure may be useful in assessing levels of culturally competent provider behavior and investigating associations between provider cultural competency and health care processes and outcomes. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To describe the development and introduction of patient education materials in a primary care setting in Jordan. Methods: During the 2003–2004 academic year, the authors collaborated to produce more than 25 Arabic language written patient education materials designed to conform to cultural and social norms and expectations. Results: Patient education materials were frequently shared with friends and family members. Readability of materials was judged to be excellent when materials were presented at approximately a sixth grade reading level. Conclusions: Patient education materials are greatly needed in Jordan. A thorough understanding of the culture facilitates alignment of the health message with social norms and establishment of credibility with the target audience. The materials developed were well received by patients and physicians. Practice implications: The routine integration of patient education into all medical consultations in Jordan is an important goal. Practice based research will be vital in identifying and eliminating barriers to the introduction of patient education in the clinical setting. [Copyright &y& Elsevier]

Objectives: To understand the impact of physicians’ and patients’ religious/spiritual orientation on discussions of spiritual issues.Methods:We performed semi-structured interviews of 10 Missouri family physicians and 10 patients of these physicians, selecting subjects nonrandomly to represent a range of demographic factors, practice types, and chronic or terminal illness. We coded and evaluated transcribed interviews for themes.Results: Respondents expressed that similar belief systems facilitate patient-physician spiritual interactions and bring confidence to their relationships. Those holding dissimilar faiths noted limited ability to address spiritual questions directly. They cited significant barriers to spiritual interaction but considered that ecumenism, use of patient-centered care, and negotiation skills lessen these barriers.Conclusions:Our respondents view spirituality similarly to other aspects of the physician-patient relationship involving differing viewpoints. Where discordance exists, cross-cultural, patient-centered, diplomatic approaches facilitate spiritual discussions. [ABSTRACT FROM AUTHOR]

The objective of the study was to develop a culturally relevant video and a pamphlet for use as a cervical cancer screening educational intervention among North-American Chinese women. The project conducted 87 qualitative interviews and nine focus groups to develop a culturally tailored intervention to improve Pap testing rates. The intervention consisted of an educational/motivational video, a pamphlet, and home visits. Less acculturated Chinese women draw on a rich tradition of herbal knowledge and folk practices historically based on Chinese medical theory, now mixed with new information from the media and popular culture. The video, the pamphlet, and the outreach workers knowledge base were designed using these results and combined with biomedical information to address potential obstacles to Pap testing. Culturally relevant information for reproductive health promotion was easily retrieved through qualitative interviews and used to create educational materials modeling the integration of Pap testing into Chinese women's health practices. [ABSTRACT FROM AUTHOR]

While grappling with the implications of the current COVID-19 pandemic, we have perhaps overlooked recent history dealing with previous outbreaks. In the spring of 1993, America was presented with an outbreak of Hantavirus Pulmonary Syndrome caused by the Sin Nombre virus. This article recounts the investigation into this disease and discusses the spectrum of issues that medical communities must face as it deals with a mysterious outbreak.

Refugees share a common experience of displacement from their country of origin, migration, and resettlement in an unfamiliar country. More than 17 million people have fled their home countries due to war, generalized violence, and persecution. US primary care physicians must care for their immediate and long-term medical needs. Challenges include (1) language and cultural barriers, (2) high rates of mental health disorders, (3) higher prevalence of latent infections, and (4) different explanatory models for chronic diseases. This article discusses management strategies for common challenges that arise in the primary care of refugees., (Copyright © 2015 Elsevier Inc. All rights reserved.)