Immigration Status and Breast Cancer Surgery Quality of Care Metrics: A Population-Level Analysis.

INTRODUCTION: As immigrant women face challenges accessing health care, we hypothesized that immigration status would be associated with fewer women with breast cancer receiving surgery for curable disease, fewer undergoing breast conserving surgery (BCS), and longer wait time to surgery. METHODS: A population-level retrospective cohort study, including women aged 18-70 years with Stage I-III breast cancer diagnosed between 2010 and 2016 in Ontario was conducted. Multivariable analysis was performed to assess odds of undergoing surgery, receiving BCS and wait time to surgery. RESULTS: A total of 31,755 patients were included [26,253 (82.7%) Canadian-born and 5502 (17.3%) immigrant women]. Immigrant women were younger (mean age 51.6 vs. 56.1 years) and less often presented with Stage I/II disease (87.4% vs. 89.8%) (both p < .001). On multivariable analysis, there was no difference between immigrant women and Canadian-born women in odds of undergoing surgery [Stage I OR 0.93 (95% CI 0.79-1.11), Stage II 1.04 (0.89-1.22), Stage III 1.22 (0.94-1.57)], receiving BCS [Stage I 0.93 (0.82-1.05), Stage II 0.96 (0.86-1.07), Stage III 1.00 (0.83-1.22)], or wait time [Stage I 0.45 (-0.61-1.50), Stage II 0.33 (-0.86-1.52), Stage III 3.03 (-0.05-6.12)]. In exploratory analysis, new immigrants did not have surgery more than established immigrants (12.9% vs. 10.1%), and refugee women had longer wait time compared with economic-class immigrants (39.5 vs. 35.3 days). CONCLUSIONS: We observed differences in measures of socioeconomic disadvantage and disease characteristics between immigrant and Canadian-born women with breast cancer. Upon adjusting for these factors, no differences emerged in rate of surgery, rate of BCS, and time to surgery. The lack of disparity suggests barriers to accessing basic components of breast cancer care may be mitigated by the universal healthcare system in Canada.

Migración en Venezuela, marco normativo e indicadores 2000- 2022 / Migration in Venezuela, regulatory framework and indicators 2000 - 2022

El objetivo fue describir el estado actual del marco normativo de migración, y la tendencia de indicadores de población y migración en Venezuela en el periodo 2000-2022.Métodos: Estudio descriptivo del marco normativo de migración y la tendencia de indicadores de población y migración en Venezuela. Indicadores: población total, tasa de dependencia demográfica (total, niñez, adulto mayor) y tasa de migración. Fuentes de datos: plataforma informativa salud y migración(marco normativo), Anuario estadístico de América Latina y el Caribe año 2000 al 2022 (indicadores de población).Resultados: El marco normativo de la migración en Venezuela está contenido en escasas leyes y Convenios Internacionales y regionales. La variación porcentual en la población venezolana fue descendente durante casi todo el periodo, donde se presentan incluso valores negativos para 2018-2021. La tasa anual decrecimiento poblacional, demostró un descenso constante y marcado desde el año 2000 hasta el año 2018, con altos valores negativos, luego asciende mostrando valores positivos a partir del año 2022, con un valor equivalente al año 2000. Conclusiones: El marco legal migratorio en Venezuela, es deficitario y no acorde a las necesidades de los migrantes. Los cambios ocurridos en la población venezolana de 2000 a 2022 fue debido a varios factores, siendo de gran impacto el fenómeno migratorio. La tasa de migración en Venezuela muestra tendencia negativa lo que indica que el país pierde población.

Objective Describe the current state of the regulatory framework for migration and the trend of populationand migration indicators in Venezuela for the period2000-2022. Methods: Descriptive study of the regulatory framework for migration and the trend of population andmigration indicators in Venezuela. Sample of national and international documents (regulatory framework). Indicators: total population, demographic dependency rate (total,childhood, elderly) and migration rate. Data sources: health andmigration information platform (regulatory framework) LatinAmerica and the Caribbean Statistical Yearbook 2000 to 2022(population indicators) Results: The regulatory framework formigration in Venezuela is contained in few international andregional laws and agreements. The percentage variation in the Venezuelan population was downward during almost the entireperiod, where even negative values are presented for 2018-2021.The annual rate of population growth showed a constant andmarked decrease from the year 2000 to the year 2018 with highnegative values, then it ascends showing positive values from theyear 2022 with a value equivalent to the year 2000. Conclusions:The migratory legal framework in Venezuela is deficient anddoes not meet the needs of migrants. The changes that haveoccurred in the Venezuelan population from 2000 to 2022 wasdue to several factors, the migratory phenomenon being of greatimpact. the migration rate in Venezuela shows a negative trend,which indicates that the country is losing population.

Complementary and Alternative Medicine Use in Patients With Cancer and Immigration Background.

PURPOSE: Studies have shown that patients with cancer are more likely to use complementary and alternative medicine (CAM) than noncancer patients for symptom relief and hope. We aimed to evaluate factors of race, ethnic groups, and immigration status in attitude of patients with cancer in seeking out CAM. PATIENTS AND METHODS: This is a prospective questionnaire study where information on demographics, cancer information, race/ethnicity, immigration duration, and psychosocial factors was correlated with the CAM use in a community cancer center located in the borough of Brooklyn, at New York City. RESULTS: Among 658 patients, the prevalence of CAM use was 66.11%. CAM use was 71.98% in females and 54.34% in males (P = .113 × 10-4). Patients of African descent had higher CAM use (72.73%) than the White patients (63.53%; P = .0371). There was no difference of CAM use between the US born (68.77%) and the immigrants (63.98%, P = .199) as a whole; however, comparing with the US born (66.50%), Asian-born immigrants had lower CAM use (53.77%, P = .0161), whereas Latin-American born had a numerical trend toward higher CAM use (74.83%, P = .0608). The number of years of living in the United States was not associated with more CAM use. Prayer and spirituality was the most common CAM subtype used (25.91%). There was no difference in CAM use in the respective non-White ethnic groups whether they were US born or non-US born. CONCLUSION: In this cohort of patients with cancer enriched with immigration background, CAM use was the highest in African American patients. The use of CAM in the non-White patients was associated with their ethnic background, regardless whether they were US born or not. Cultural roots appeared to be a strong influencing factor for the usage of CAM.

Impacto epidemiológico fronterizo del flujo migratorio venezolano en el Perú 2017-2021 / Border epidemiological impact of the Venezuelan migratory flow in Peru 2017-2021

Las migraciones, aunque pueden ser beneficiosas para la sociedad, también pueden acarrear repercusiones, y desde una perspectiva humanitaria deben ser consideradas como un determinante transversal de la salud. Los informes de propagación de enfermedades importadas son cada vez más comunes, especialmente en los límites fronterizos donde es mayor la demanda sanitaria. Durante la última década Venezuela ha pasado a ser un país de emigrantes donde más del 15% de la población son inmigrantes, y siendo Perú el segundo país con más residentes venezolanos. Según las estadísticas para el 2021 la mayoría de los migrantes venezolanos establecidos en las regiones fronterizas de Perú se encuentran en Piura con 27.359 residentes (el 55% de las zonas fronterizas), seguido de Tumbes (16,5%) y Tacna (12,9%), demostrando la asidua preferencia del flujo de ingreso por la frontera norte del Perú y planteándose como un desafío máxime si se considera que la mayoría lo hace de forma irregular, dando como resultado diversas repercusiones epidemiológicas, sanitarias y humanitarias. Durante los dos últimos decenios, se han identificado problemas de salud priorizados (PSP) en las zonas de frontera peruanas, como la malaria, el dengue, la rabia humana, y más recientemente, la Covid-19; requiriendo el desarrollo de programas para la prevención y control de PSP. Investigar sobre la epidemiología migratoria actual nos ayuda a vislumbrar acerca de la relación entre la migración y la salud; lo cual resulta de utilidad para conocer su morbilidad, identificar áreas de mayor interés, y definir políticas preventivas según prioridades en las fronteras(AU)

Migrations, although they can be beneficial for society, can also have repercussions, and from a humanitarian perspective they must be considered as a cross-cutting determinant of health. Reports of the spread of imported diseases are becoming more common, especially at the border limits where the health demand is greatest. During the last decade Venezuela has become a country of emigrants where more than 15% of the population are immigrants, and Peru being the country with the second most Venezuelan residents. According to statistics for 2021, the majority of Venezuelan migrants established in the border regions of Peru are in Piura with 27,359 residents (55% of the border areas), followed by Tumbes (16.5%) and Tacna (12, 9%), demonstrating the assiduous preference of the flow of entry through the northern border of Peru and posing as a challenge especially if it is considered that the majority do so irregularly, resulting in various epidemiological, health and humanitarian repercussions. During the last two decades, prioritized health problems (PHP) have been identified in the Peruvian border areas, such as malaria, dengue, human rabies, and more recently, Covid-19; requiring the development of programs for the prevention and control of PHP. Investigating about the current migratory epidemiology helps us to get a glimpse of the relationship between migration and health, which is useful to know their morbidity, identify areas of greatest interest, and define preventive policies according to priorities at the borders(AU)

Epidemiology of adult T-cell leukemia-lymphoma in Japan: An updated analysis, 2012-2013.

Adult T-cell leukemia-lymphoma (ATL) is a T-cell malignancy that is endemic to Japan. In this latest nationwide study of ATL, we collected the data from 4 nationwide registries of patients diagnosed in 2012-2013; the Hematology Blood Disease, the Skin Cancer Society, the Hospital-Based Cancer Registries, and information from the hospitals that participated in the Japanese nationwide survey of ATL in 2010-2011. In the present study, 2614 patients with ATL were diagnosed based on the registries, and 117 departments registered 1042 patients. Among these patients, 984 were eligible for analysis. The median age at diagnosis was 69 y. A larger proportion of patients with ATL older than 70 y was diagnosed with the lymphoma subtype, and more than half of the patients with ATL in the metropolitan areas were born in the human T-cell leukemia virus type I (HTLV-1)-endemic areas of Kyushu/Okinawa, which are almost identical to the findings in our 2010-2011 study. Additionally, we identified that patients with ATL migrated from the endemic areas for HTLV-1 to the non-endemic metropolitan areas. The present study was able to reduce the burden of searching each hospital and to update the clinico-epidemiological characteristics of a large number of patients with ATL in Japan, suggesting the usefulness and feasibility of the novel data collection method. The establishment of a more sophisticated database management system for ATL is necessary for future continuous surveys.

Assessment of COVID-19-Related Immigration Concerns Among Latinx Immigrants in the US.

Importance: Despite the contentious immigration environment and disproportionate rates of COVID-19 infection among Latinx individuals in the US, immigrants' concerns about engaging in COVID-19-related testing, treatment, and contact tracing have been largely unexplored. Objective: To examine the proportions of Latinx immigrants who endorse statements about the potential negative immigration ramifications of seeking and using COVID-19-related testing and treatment services and engaging in contact tracing. Design, Setting, and Participants: In this cross-sectional survey study, 25 COVID-19-related items were incorporated into the online Spanish-language survey of an ongoing study. Data were collected between July 15 and October 9, 2020, in Chicago, Illinois; Los Angeles, California; and Phoenix, Arizona. A nonrandom sample of 379 adult, Spanish-speaking, noncitizen Latinx immigrants (with either documented or undocumented immigration status) were sent surveys. Of those, 336 individuals (88.7% participation rate) returned surveys, and 43 individuals did not. An additional 213 individuals were screened but ineligible. Descriptive statistics were computed, and mean comparisons and bivariate correlations between sociodemographic variables, indices of immigration risk, and COVID-19-related survey items were conducted. Main Outcomes and Measures: Items elicited agreement or disagreement with statements about immigrants' access to COVID-19-related testing and treatment services and the potential immigration ramifications of using these services. Willingness to identify an undocumented person during contact tracing was also assessed. Results: A total of 336 Latinx immigrants completed surveys. The mean (SD) age of participants was 39.7 (8.9) years; 210 participants (62.5%) identified as female, and 216 participants (64.3%) had undocumented immigration status. In total, 89 participants (26.5%) agreed that hospital emergency departments were the only source of COVID-19 testing or treatment for uninsured immigrants, and 106 participants (31.6%) agreed that using public testing and health care services for COVID-19 could jeopardize one's immigration prospects. A total of 96 participants (28.6%) and 114 participants (33.9%), respectively, would not identify an undocumented household member or coworker during contact tracing. Reluctance to identify an undocumented household member or coworker was associated with having had deportation experiences (r = -0.17; 95% CI, -0.06 to 0.27; P = .003) but not with the number of years lived in the US (r = 0.07; 95% CI, -0.16 to 0.17; P = .15) or immigration status (r = 0.03; 95% CI, -0.07 to 0.13; P = .56). Conclusions and Relevance: In this cross-sectional survey study, a substantial number of immigrants endorsed statements about immigrants' restricted access to COVID-19-related testing and treatment services and the potential negative immigration ramifications of using these services. These results suggest that programs for COVID-19-related testing, contact tracing, and vaccine administration that are designed to allay immigration concerns are needed.

Disparate outcomes in nonsmall cell lung cancer by immigration status.

OBJECTIVE: The purpose of this study was to evaluate overall survival (OS) outcomes by race, stratified by country of origin in patients diagnosed with NSCLC in California. METHODS: We performed a retrospective analysis of nonsmall cell lung cancer (NSCLC) patients diagnosed between 2000 and 2012. Race/ethnicity was defined as White (W), Black (B), Hispanic (H), and Asian (A) and stratified by country of origin (US vs. non-US [NUS]) creating the following patient cohorts: W-US, W-NUS, B-US, B-NUS, H-US, H-NUS, A-US, and A-NUS. Three multivariate models were created: model 1 adjusted for age, gender, stage, year of diagnosis and histology; model 2 included model 1 plus treatment modalities; and model 3 included model 2 with the addition of socioeconomic status, marital status, and insurance. RESULTS: A total of 68,232 patients were included. Median OS from highest to lowest were: A-NUS (15 months), W-NUS (14 months), A-US (13 months), B-NUS (13 months), H-US (11 months), W-US (11 months), H-NUS (10 months), and B-US (10 months) (p < 0.001). In model 1, B-US had worse OS, whereas A-US, W-NUS, B-NUS, H-NUS, and A-NUS had better OS when compared to W-US. In model 2 after adjusting for receipt of treatment, there was no difference in OS for B-US when compared to W-US. After adjusting for all variables (model 3), all race/ethnicity profiles had better OS when compared to W-US; B-NUS patients had similar OS to W-US. CONCLUSION: Foreign-born patients with NSCLC have decreased risk of mortality when compared to native-born patients in California after accounting for treatments received and socioeconomic differences.

La inmigración internacional reciente en la Ciudad de Buenos Aires / Recent international immigration in the City of Buenos Aires

En un nuevo contexto de la migración en la Ciudad de Buenos Aires, el presente informe tiene como objetivo analizar las características sociodemográficas de los principales orígenes que integran el conjunto de inmigrantes externos y que, como se mencionó, presentan particularidades en su composición y antigüedad de residencia en la Ciudad, considerando asimismo desde una perspectiva comparativa a los residentes nacidos en el país. Para este informe se explotaron los datos de la última Encuesta Anual de Hogares disponible correspondiente a 2019 que releva la Dirección General de Estadística y Censos sobre la base de una muestra probabilística de viviendas y hogares residentes en CABA y que contiene preguntas específicas sobre el lugar de nacimiento y el año desde que la persona reside en forma continua, que permiten identificar la antigüedad y cohortes de inmigrantes. (AU)

Completing the Great Unfinished Symphony of Cancer Together: The Importance of Immigrants in Cancer Research.

Recent changes in U.S. immigration policy are adversely affecting biomedical science, at a time when biomedical research is most sorely needed on multiple fronts. Here we discuss the immense contributions of immigrants to cancer research and the adverse impact that current administration policies will have on successful cancer research.

Worldwide prevalence of smoking in immigration: A global systematic review and meta-analysis.

OBJECTIVES: Considering that smoking is an important aspect of health in the immigrant population, the purpose of this study is therefore to pool studies that have examined smoking in the immigrant population to obtain a pooled prevalence. METHOD: This study used the PRISMA protocol. Online available articles until March 2020 in PubMed and Scopus databases were targeted. After collecting the articles, data were extracted from them. The extracted data were analyzed in Stata software and the pooled prevalence of smoking was investigated. For a detailed analysis, several subgroups were analyzed. Heterogeneity was also studied in the studies. RESULT: Of the 3585 articles that were found in the two databases, eventually, 52 articles were eligible. The prevalence of smoking is 24% with a confidence interval (CI) between 18% and 30%. For current smoking, the prevalence of smoking is 16% and for former smoking, the prevalence of smoking is 17%. In men, the prevalence of smoking is 38% and for women, the prevalence is 17%. The difference was noticeable in the prevalence of smoking on the continents. Europe has the highest prevalence of immigrant smokers (36%), followed by Asia (18%), American (18%), and Australia (12%). I2 and χ2 showed a high degree of heterogeneity. CONCLUSION: Given the known effects of smoking on different health dimensions, more attention is needed to the increasing health of the immigrant population.

Measuring the migration of surgical specialists.

BACKGROUND: The lack of access to essential surgical care in low-income countries is aggravated by emigration of locally-trained surgical specialists to more affluent regions. Yet, the global diaspora of surgeons, obstetricians, and anesthesiologists from low-income and middle-income countries has never been fully described and compared with those who have remained in their country of origin. It is also unclear whether the surgical workforce is more affected by international migration than other medical specialists. In this study, we aimed to quantify the proportion of surgical specialists originating from low-income and middle-income countries that currently work in high-income countries. METHODS: We retrieved surgical workforce data from 48 high-income countries and 102 low-income and middle-income countries using the database of the World Health Organization Global Surgical Workforce. We then compared this domestic workforce with more granular data on the country of initial medical qualification of all surgeons, anesthesiologists, and obstetricians made available for 14 selected high-income countries to calculate the proportion of surgical specialists working abroad. RESULTS: We identified 1,118,804 specialist surgeons, anesthesiologists, or obstetricians from 102 low-income and middle-income countries, of whom 33,021 (3.0%) worked in the 14 included high-income countries. The proportion of surgical specialists abroad was greatest for the African and South East Asian regions (12.8% and 12.1%). The proportion of specialists abroad was not greater for surgeons, anesthesiologists, or obstetricians than for physicians and other medical specialists (P = .465). Overall, the countries with the lowest remaining density of surgical specialists were also the countries from which the largest proportion of graduates were now working in high-income countries (P = .011). CONCLUSION: A substantial proportion of all surgeons, anesthesiologists, and obstetricians from low-income and middle-income countries currently work in high-income countries. In addition to decreasing migration from areas of surgical need, innovative strategies to retain and strengthen the surgical workforce could involve engaging this large international pool of surgical specialists and instructors.

Hepatocellular Carcinoma (HCC) in Egypt: A comprehensive overview.

BACKGROUND: Worldwide, hepatocellular carcinoma (HCC) is a universal problem and its epidemiological data showed variation from place to place. Hepatocellular carcinoma (HCC) is the sixth and fourth common cancer in worldwide and Egypt, respectively. Egypt ranks the third and 15th most populous country in Africa and worldwide, respectively. The aim of this review is to compare the status of HCC in Egypt to that in the worldwide from different issues; risk factors, screening and surveillance, diagnosis and treatment, prevention, as well as research strategy. MAIN BODY: The risk factors for HCC in Egypt are of great importance to be reported. The risk factor for HCC are either environmental- or host/genetic-related risk factors. In the last years, there is a tangible improvement of both screening and surveillance strategies of HCC in Egypt. The unprecedented national screening campaign launched by the end of 2018 is a mirror image of this improvement. While the improvement of the HCC prevention requires the governmental health administration to implement health policies. Although the diagnosis of Egyptian HCC patients follows the international guidelines but HCC treatment options are limited in terms of cost. In addition, there are limited Egyptian reports about HCC survival and relapse. Both basic and clinical HCC research in Egypt are still limited compared to worldwide. SHORT CONCLUSION: Deep analysis and understanding of factors affecting HCC burden variation worldwide help in customization of efforts exerted to face HCC in different countries especially large country like Egypt. Overall, the presence of a research strategy to fight HCC in Egyptian patients will help in the optimum allocation of available resources to reduce the numbers of HCC cases and deaths and to improve the quality of life.

Cardiovascular disease behavioral risk factors among Latinos by citizenship and documentation status.

BACKGROUND: Studies have observed that recent Latino immigrants tend to have a physical health advantage compared to immigrants who have been in the US for many years or Latinos who are born in the United States. An explanation of this phenomenon is that recent immigrants have positive health behaviors that protect them from chronic disease risk. This study aims to determine if trends in positive cardiovascular disease (CVD) risk behaviors extend to Latino immigrants in California according to citizenship and documentation status. METHODS: We examined CVD behavioral risk factors by citizenship/documentation statuses among Latinos and non-Latino US-born whites in the 2011-2015 waves of the California Health Interview Survey. Adjusted multivariable logistic regressions estimated the odds for CVD behavioral risk factors, and analyses were stratified by sex. RESULTS: In adjusted analyses, using US-born Latinos as the reference group, undocumented Latino immigrants had the lowest odds of current smoking, binge drinking, and frequency of fast food consumption. There were no differences across the groups for fruit/vegetable intake and walking for leisure. Among those with high blood pressure, undocumented immigrants were least likely to be on medication. Undocumented immigrant women had better patterns of CVD behavioral risk factors on some measures compared with other Latino citizenship and documentation groups. CONCLUSIONS: This study observes that the healthy Latino immigrant advantage seems to apply to undocumented female immigrants, but it does not necessarily extend to undocumented male immigrants who had similar behavioral risk profiles to US-born Latinos.

Tuberculosis screening during the 2015 European refugee crisis.

BACKGROUND: The purpose of our study was to describe and evaluate management, performance and results of Tuberculosis (TB)-screening among refugees and asylum seekers in a rural area in Germany in 2015. METHODS: Refugees or asylum seekers, staying in shared-accommodation are obligated to participate on screening chest X-ray (CXR) in order to screen for signs of potentially infectious pulmonary TB (German Protection against Infection Act and German Asylum Procedure Act). n = 705 individuals underwent screening chest X-ray (CXR) to detect pulmonary TB in September and October 2015 on site. One experienced radiologist interpreted and reported each CXR within 24 h after the enrollment in the screening program and results were sent to the local Public Health Department for potential further medical care. Image abnormalities suggestive for TB were defined according to established radiographic criteria such as pleural effusion, cavitation, consolidation, fibrous scarring or calcification. Only in case of TB-suggestive findings on CXR, further diagnostics were arranged (pulmonological examination, follow-up CXR, sputum culture, interferon-gamma release assay, bronchoscopy). Follow-up data was collected in collaboration with the local Public Health Department. Descriptive statistics were calculated using GraphPad Prism software. RESULTS: n = 637 CXR examinations (90%) did not show abnormal findings, n = 54 CXR (8%) showed incidental findings, and n = 14 CXR (2%) were suspicious for acute TB. Of these, n = 14 individuals, eight underwent further TB diagnostics. Active TB was confirmed in one individual (0.001% of the screening cohort). CONCLUSIONS: Our cohort reflects current immigrations statistics in Europe and illustrates an overall low TB prevalence amongst individuals entering Germany in 2015. However, our findings support the improvement of diagnostic algorithms.

The association between family members' migration and Epstein-Barr virus antibody titers among people left behind in rural Fujian, China.

OBJECTIVES: In contrast to the health of migrants, which has been extensively studied, little attention has been paid to the health of adults left behind by family members who out-migrated to other locations. This study was performed to investigate the association between being left behind and the Epstein-Barr virus (EBV) antibody titer, which is an indicator of cellular immune functioning previously shown to be associated with psychological stress. METHODS: A cross-sectional survey was conducted in rural communities in Fujian, China, in 2015. Questionnaire data and dried blood spot samples were collected from 748 adults. A mixed effect regression analysis was conducted to investigate the association. RESULTS: Results indicated that the EBV antibody titers were higher among people who had been left behind compared with those who had not. CONCLUSIONS: Our findings suggest that, in rural Fujian, China, family separation following the out-migration of family members is an important determinant of psychological stress.

Awareness of European practitioners toward uncommon tropical diseases: are we prepared to deal with mass migration? Results of an international survey.

PURPOSE: The recent rise in migration from Africa through the Mediterranean basin into Europe has resulted in an increased incidence of uncommon diseases such as schistosomiasis and genito-urinary tuberculosis, which were previously largely unknown in this region. This study aimed to evaluate the insight of European urologists into diagnosing and managing these disease conditions and to determine whether they were adequately prepared to deal with the changing disease spectrum in their countries. METHODS: A survey including specific questions about the diagnosis and management of 'tropical' urological diseases was distributed among urologists working in Europe and Africa. Multivariate logistic regression models were performed to detect the continent (African or European) effect on knowledge of and insight into tropical urological diseases. RESULTS: A total of 312 surveys were administered. African and European respondents accounted for 109 (36.09%) and 193 (63.91%) respondents, respectively. The multivariate logistic regression analysis demonstrated a significant deficiency in the knowledge of tropical urological diseases in the European cohort compared with the African cohort (p < 0.05). Moreover, in the European cohort, markedly superior knowledge of tropical urological diseases was observed for respondents who had previously worked in a developing country. CONCLUSIONS: Though European urologists are not required to have the same insight as African urologists, they showed a very unsatisfactory knowledge of tropical urological diseases. The experience of working in a developing country could improve the knowledge of European urologists regarding tropical urological diseases.

Smoking Among Immigrant Groups in the United States: Prevalence, Education Gradients, and Male-to-Female Ratios.

INTRODUCTION: Immigrants in the United States are less likely to smoke than those born in the United States, but studies have not fully described the diversity of their smoking patterns. We investigate smoking by world region of birth and duration of residence in the United States, with a comprehensive approach covering current prevalence levels, education gradients, and male-to-female ratios. METHODS: The data originate from the National Health Interview Surveys, 2000-2015, and the sample of 365 404 includes both US-born and foreign-born respondents aged 25-70 years. World region of birth and duration of residence in the United States measure immigrant characteristics. Current cigarette smoking was analyzed using logistic regression. RESULTS: Immigrant groups were protected from smoking and had weaker education gradients in smoking and larger male-to-female smoking ratios than the US-born population. However, large differences emerged among the immigrant groups for region of birth but less so for duration of residence in the United States. For example, immigrants from sub-Saharan Africa and the Indian subcontinent have low prevalence, weak education gradients, and high male-to-female ratios. Immigrants from Europe have the opposite pattern, and immigrants from Latin America fall between those two extremes. CONCLUSION: The stage of the cigarette epidemic in the region of birth helps explain the diverse group profiles. Duration of residence in the United States does less to account for the differences in smoking than region of birth. The findings illustrate the heterogeneity of immigrant populations originating from diverse regions across the world and limited convergence with the host population after immigration. IMPLICATIONS: The study identifies immigrant groups that, because of high smoking prevalence related to levels in the host country, should be targeted for cessation efforts. It also identifies immigrant groups with low prevalence for which anti-smoking programs should encourage maintenance of healthy habits. Many immigrant groups show strong education disparities in smoking, further suggesting that smokers with lower levels of education be targeted by public health programs.

Schistosomiasis, strongyloidiasis and Chagas disease: the leading imported neglected tropical diseases in Italy.

BACKGROUND: In recent years, an increasing number of individuals affected by neglected tropical diseases (NTDs) have been observed in Italy, due to migration, international travels and climate changes. Reliable data on the current NTD epidemiology in Italy and the health system preparedness on this issue are not available. METHODS: We report the results of a survey on selected NTDs (schistosomiasis, strongyloidiasis, echinococcosis, Chagas disease, leishmaniasis, cysticercosis, filariasis and scabies) in nine Italian sentinel centres, in order to investigate their occurrence throughout the country and identify which ones are a priority for public health interventions, development of protocols for case management, and training activities. To explore the preparedness of the centres, we investigate the availability of specific diagnostic tools and drugs, needed for the management of the most common NTDs. We also reviewed and summarized the available national policies, recommendations and guidelines on NTDs in Italy. RESULTS: Overall, 4123 NTDs cases were diagnosed in nine Italian centres within a 7-year period (2011-2017). Schistosomiasis and strongyloidiasis were the most common NTDs, accounting for about one-third each of all the diagnosed cases, followed by Chagas disease. The number of cases showed a significant trend to increase over time, mainly due to foreign-born subjects. Serology for Schistosoma spp. and Strongyloides stercoralis was available in seven and five centres, respectively. Agar plate stool culture for S. stercoralis was available in three sites. Ivermectin and praziquantel were always available in six centres. Six national policies, recommendations and guidelines documents were available, but for the most part, they are not fully implemented yet. CONCLUSIONS: This survey showed how some NTDs, such as schistosomiasis and strongyloidiasis, are becoming more common in Italy, due to multiple components. A list of seven key actions was proposed, in order to improve diagnosis, management and control of NTDs in Italy.