Brain drain in pediatric anesthesiology: The geographic and demographic distribution of national origin among pediatric anesthesiologists in the United States.

BACKGROUND: American pediatric anesthesiologists have a long history of international volunteerism. However, the US healthcare system also benefits from the contributions of a large number of physicians who come from other nations to work within its borders. Despite this fact, little is known about the contribution of international medical graduates (IMG) to the pediatric anesthesiology subspecialty. AIMS: To characterize the contribution of IMG to the field of pediatric anesthesiology in the United States, and to elucidate the geographic and demographic distribution of their national origins so as to understand the movement of skilled personnel between countries. METHODS: Online physician directories of American children's hospitals were searched, and anesthesiologists were recorded for their national origin of medical education. International graduates were reported as a percentage of the pediatric anesthesiology workforce. Those attending medical colleges catering to American students ("offshore" medical schools) were analyzed separately from other IMGs. The cohort of non-offshore IMGs were analyzed for national and continental origins, and by national level of economic development. RESULTS: Of 1979 anesthesiologists analyzed, 397 attended medical school outside the United States, with 58 being from offshore schools. The remaining 338 represented 17.1% of the total pediatric anesthesiology workforce. They came from 58 countries on six continents. Of those, 65.1% attended medical school in low- and middle-income countries. CONCLUSIONS: International medical graduates, disproportionately from low- and middle-income countries, compose a large proportion of the US Pediatric Anesthesiology workforce. While these clinicians play a vital role in providing care for American children, the potential impacts of skilled physician loss on their nations of origin must also be considered.

Obstetric service demand is the main health need of the Vietnamese population in Guangxi, China: A cross-sectional study.

China has become an emerging destination for international migration, especially in some Association of South East Asian Nations countries, but the situation of migrants seeking medical care in China remains unclear. A retrospective cross-sectional study was conducted in a hospital in Chongzuo, which provides medical services for foreigners, to investigate the situation of Vietnamese people seeking health care in Guangxi, China. Vietnamese patients who visited the hospital between 2018 and 2020 were included in the study. Demographic characteristics, clinical characteristics, characteristics of payment for medical costs, and characteristics of hospitalization were compared between outpatients and inpatients. In total, 778 Vietnamese outpatients and 173 inpatients were included in this study. The percentages of female outpatients and inpatients were 93.44% and 88.44% (χ2 = 5.133, P = .023), respectively. Approximately 30% of outpatients and 47% of inpatients visited the hospital due to obstetric needs. The proportions of outpatients with basic medical insurance for urban residents, basic medical insurance for urban employees, and new cooperative medical schemes were 28.02%, 3.21%, and 2.31%, respectively. In comparison, the proportion of inpatients with the above 3 types of medical insurance was 16.76%, 1.73%, and 2.31%, respectively. The proportion of different payments for medical costs between outpatients and inpatients were significantly different (χ2 = 24.404, P < .01). Middle-aged Vietnamese females in Guangxi, China, may have much greater healthcare needs. Their main medical demand is for obstetric services. Measurements should be taken to improve the health services targeting Vietnamese female, but the legitimacy of Vietnamese in Guangxi is a major prerequisite for them to access more and better healthcare services.

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.

Beyond "Chilling Effects": Latinx and Asian Immigrants' Experiences With Enforcement and Barriers to Health Care.

OBJECTIVES: Immigration enforcement policies are associated with immigrants' barriers to health care. Current evidence suggests that enforcement creates a "chilling effect" in which immigrants avoid care due to fear of encountering enforcement. Yet, there has been little examination of the impact of immigrants' direct encounters with enforcement on health care access. We examined some of the first population-level data on Asian and Latinx immigrants' encounters with law and immigration enforcement and assessed associations with health care access. METHODS: We analyzed the 2018 and 2019 Research on Immigrant Health and State Policy survey in which Asian and Latinx immigrants in California (n=1681) reported on 7 enforcement experiences (eg, racial profiling and deportation). We examined the associations between measures of individual and cumulative enforcement experiences and the usual sources of care and delay in care. RESULTS: Latinx, compared with Asian respondents, reported the highest levels of enforcement experiences. Almost all individual enforcement experiences were associated with delaying care for both groups. Each additional cumulative experience was associated with a delay in care for both groups (OR=1.30, 95% CI 1.10-1.50). There were no associations with the usual source of care. CONCLUSION: Findings confirm that Latinx immigrants experience high levels of encounters with the enforcement system and highlight new data on Asian immigrants' enforcement encounters. Direct experiences with enforcement have a negative relationship with health care access. Findings have implications for health systems to address the needs of immigrants affected by enforcement and for changes to health and immigration policy to ensure immigrants' access to care.

Age at Immigration and Depression: The Mediating Role of Contemporary Relationships With Adult Children Among Older Immigrants.

OBJECTIVES: For the growing population of older immigrants in the United States, both age at immigration and familial relationships are important factors affecting psychological well-being. This study explores how age at immigration and contemporary relationships with adult children combine to explain older immigrants' depressive symptoms. METHOD: This study uses 2014 Health and Retirement Study data from a sample of 759 immigrants aged 65 and older who have at least one adult child aged 21 or older. A series of ordinary least squares regressions and mediational analyses were conducted. RESULTS: Findings indicate that structural solidarity significantly mediates the association between age at immigration and depressive symptoms. Specifically, immigrating in later life was associated with a lower level of depressive symptoms through its relationship with structural solidarity. In addition, giving monetary support to children and providing care for grandchildren may alleviate depressive symptoms for older immigrants. DISCUSSION: This study suggests that relationships with adult children may differ with age at immigration. The types of support that older immigrants provide to their adult children may be crucial because such support may instill a sense of obligation and reciprocity that may be beneficial to the psychological well-being of older immigrants.

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.

Characteristics of Deaths Among Individuals in US Immigration and Customs Enforcement Detention Facilities, 2011-2018.

Importance: Concerns have been raised that substandard medical care has contributed to deaths in US Immigration and Customs Enforcement (ICE) detention facilities. After each in-custody death, ICE produces detainee death reviews, which describe the circumstances of the death and determine whether ICE Performance-Based National Detention Standards (PBNDS) were violated. Objective: To describe factors associated with deaths in ICE detention facilities. Design, Setting, and Participants: This case series used data extracted from detainee death reviews of deaths among individuals detained in ICE facilities for whom these reviews were available from January 2011 to December 2018. Exposures: All individuals were in the custody of ICE at the time of death. Main Outcomes and Measures: Data including demographic information, medical histories, recorded medical data, and reported violations of PBNDS were systematically extracted and summarized. Results: Among 71 individuals who died in an ICE detention facility during the study period, detainee death reviews were available for 55 (77.5%). Most were male (47 [85.5%]), and the mean (SD) age at death was 42.7 (11.5) years. Individuals resided in the US for a mean (SD) of 15.8 (13.2) years before detention and were in ICE custody for a median of 39 days (interquartile range, 9-76 days) before death. Most had low burdens of preexisting disease, with 18 (32.7%) having a Charlson Comorbidity Index score of 0 and 15 (27.3%) having a score of 1 or 2. A total of 47 deaths (85.5%) were attributed to medical causes and 8 (14.5%) to suicide. Markedly abnormal vital signs were documented in the death reviews before 29 of 47 deaths from medical causes (61.7%), and 21 of these 29 deaths (72.4%) were preceded by abnormal vital signs during 2 or more encounters with ICE personnel before death or terminal hospital transfer. Overall, 43 detainee death reviews (78.2%) identified PBNDS violations related to medical care, with a mean (SD) of 3.2 (3.0) deficiencies per detainee death review. Conclusions and Relevance: In this case series, deaths in ICE detention facilities from 2011 to 2018 occurred primarily among young men with low burdens of preexisting disease. Markedly abnormal vital signs preceded death or hospital transfer for most nonsuicide deaths. The PBNDS were violated in most detainee death reviews. These results suggest that additional oversight and external evaluation of practices related to medical and psychiatric care within ICE facilities are needed.

A 3D basicranial shape-based assessment of local and continental northwest European ancestry among 5th to 9th century CE Anglo-Saxons.

The settlement of Great Britain by Germanic-speaking people from continental northwest Europe in the Early Medieval period (early 5th to mid 11th centuries CE) has long been recognised as an important event, but uncertainty remains about the number of settlers and the nature of their relationship with the preexisting inhabitants of the island. In the study reported here, we sought to shed light on these issues by using 3D shape analysis techniques to compare the cranial bases of Anglo-Saxon skeletons to those of skeletons from Great Britain that pre-date the Early Medieval period and skeletons from Denmark that date to the Iron Age. Analyses that focused on Early Anglo-Saxon skeletons indicated that between two-thirds and three-quarters of Anglo-Saxon individuals were of continental northwest Europe ancestry, while between a quarter and one-third were of local ancestry. In contrast, analyses that focused on Middle Anglo-Saxon skeletons suggested that 50-70% were of local ancestry, while 30-50% were of continental northwest Europe ancestry. Our study suggests, therefore, that ancestry in Early Medieval Britain was similar to what it is today-mixed and mutable.

Measuring transnational social fields through binational link-tracing sampling.

We advance bi-national link-tracing sampling design, an innovative data collection methodology for sampling from so-called "transnational social fields", i.e. transnational networks embedding migrants, returned migrants and non-migrants. This paper describes our contributions to this methodology and its empirical implementation, and evaluates the features of the resulting networks (sample), with the aim to guide future research. We performed 303 face-to-face structured interviews on sociodemographic variables, migration trajectories and personal networks of people living in a Romanian migration sending community (Dâmbovița) and in a migration receiving Spanish town (Castellón). Inter-connecting the personal networks, we built a multi-layered complex network structure embedding 4,855 nominated people, 5,477 directed ties (nominations) and 2,540 edges. Results indicate that the link-tracing nomination patterns are affected by sex and residence homophily. Our research contributes to the emerging efforts of applying social network analysis to the study of international migration.

[Homelessness and mental health diagnose during the Great Recession (2008-2017): the effect of immigration.] / Sinhogarismo y salud mental durante la Gran Recesión (2008-2017): el efecto de la inmigración.

OBJECTIVE: Homelessness, which is a severe social problem across Europe and on the rise over the past decade, is closely linked to organic and mental health problems. In front of the lack of diagnostic analysis studies in the Spanish territory, this research aimed to determine the sociodemographic characteristics of a sample of individuals experiencing homelessness (IEH), to determine the prevalence of diagnoses of substance use disorders, dual pathology and other mental disorders and to analyze the existence of diagnostic differences between IEH born in the country and immigrant IEH. METHODS: A transversal and observational study was carried out, based on the analysis of mental health diagnostics of the medical histories of a sample of 1,072 IEH (453 locals and 619 immigrants) assisted between 2008 and 2017 in mental health services in Girona, northeastern Spain. For the statistical analysis, Student's t test was used to compare means and the chi-squared test was used for the analysis of qualitative variables. A binary logistic regression analysis was carried out to establish the predictor variables for the diagnosis of drug addiction and dual pathology. RESULTS: IEH showed high rates of mental disorders, especially psychoactive substances (82.6% of diagnosed people). 43.9% of IEH showed alcohol dependence as the reason for their diagnosis, followed by cocaine addiction and opiates. Foreign born IEH had more diagnoses for alcohol dependence and less for opiates or dual pathology than spanish born IEH. IEH born in Spain showed a higher vulnerability and received more mental health diagnoses than immigrant IEH. CONCLUSIONS: Even though immigrant PESS show more diagnoses for alcohol dependence, PESS born in Spain show a higher vulnerability and receive more mental health diagnoses than immigrant PESS. The process of migrating seems to establish a difference in the kind of mental disorders and addictions the PESS collective is prone to.

OBJETIVO: El sinhogarismo, grave problema social en toda Europa y en aumento durante la última década, está estrechamente vinculado a problemas orgánicos y de salud mental. Frente a la ausencia de estudios de análisis diagnóstico en territorio español, esta investigación pretendió conocer las características sociodemográficas de una muestra de personas en situación de sinhogarismo (PESS), determinar la prevalencia de diagnósticos de trastorno por uso de sustancias psicoactivas, patología dual y otros trastornos mentales y analizar la existencia de diferencias diagnósticas entre PESS nacidas en el país y PESS inmigrantes. METODOS: Se realizó un estudio transversal, observacional y analítico a partir del análisis de los diagnósticos de salud mental de las historias clínicas de una muestra de 1.072 PESS (453 autóctonas y 619 inmigrantes), atendidas durante 2008 y 2017 en los Servicios de Salud Mental de Girona (noreste de España). Para el análisis estadístico se utilizó t de Student para la comparación de medias y el ji-cuadrado para el análisis de variables categóricas. Se efectuó un análisis de regresión logística binaria para establecer las variables predictoras del diagnóstico de drogodependencias y patología dual. RESULTADOS: El 44% de la muestra estaba historiado en la Red de Salud Mental y Adicciones. Las PESS mostraron elevados índices de trastornos mentales, especialmente trastornos por uso de sustancias psicoactivas (82,6% de las personas diagnosticadas). El 43,9% de las PESS diagnosticadas lo fueron por dependencia al alcohol, seguidos de la dependencia a cocaína y a opiáceos. Las PESS inmigrantes tuvieron más diagnósticos por dependencia al alcohol y menos por dependencia a los opiáceos o patología dual que las PESS autóctonas. CONCLUSIONES: Aunque las PESS inmigrantes presentan más diagnósticos en dependencia al alcohol, las PESS nacidas en España muestran una mayor vulnerabilidad y reciben más diagnósticos de salud mental que las PESS inmigrantes. El proceso migratorio establece pues diferencias en el tipo de trastornos mentales y por uso de sustancias en la población de PESS.

The persistence of ancient settlements and urban sustainability.

We propose a dedicated research effort on the determinants of settlement persistence in the ancient world, with the potential to significantly advance the scientific understanding of urban sustainability today. Settlements (cities, towns, villages) are locations with two key attributes: They frame human interactions and activities in space, and they are where people dwell or live. Sustainability, in this case, focuses on the capacity of structures and functions of a settlement system (geography, demography, institutions) to provide for continuity of safe habitation. The 7,000-y-old experience of urbanism, as revealed by archaeology and history, includes many instances of settlements and settlement systems enduring, adapting to, or generating environmental, institutional, and technological changes. The field of urban sustainability lacks a firm scientific foundation for understanding the long durée, relying instead on narratives of collapse informed by limited case studies. We argue for the development of a new interdisciplinary research effort to establish scientific understanding of settlement and settlement system persistence. Such an effort would build upon the many fields that study human settlements to develop new theories and databases from the extensive documentation of ancient and premodern urban systems. A scientific foundation will generate novel insights to advance the field of urban sustainability.

Immigration Detention in the United States: Identifying Alternatives That Comply With Human Rights and Advance Public Health.

Under international law, the United States is obligated to uphold noncitizens' fundamental rights, including their rights to health. However, current US immigration laws-and their enforcement-not only fail to fulfill migrants' health rights but actively undermine their realization and worsen the pandemic's spread. Specifically, the US immigration system's reliance on detention, which precludes effective social distancing, increases risks of exposure and infection for detainees, staff, and their broader communities. International agreements clearly state that the prolonged, mandatory, or automatic detention of people solely because of their migration status is a human rights violation on its own. But in the context of COVID-19, the consequences for migrants' right to health are particularly acute. Effective alternatives exist: other countries demonstrate the feasibility of adopting and implementing immigration laws that establish far less restrictive, social services-based approaches to enforcement that respect human rights. To protect public health and realize its global commitments, the United States must shift away from detaining migrants as standard practice and adopt effective, humane alternatives-both amid COVID-19 and permanently.

Determinants of nursing students' intention to migrate overseas to work and implications for sustainability: The case of Indonesian students.

High graduation of nurses and limited job opportunities in Indonesia may lead to the emigration of nurses particularly through facilitated migration. This study aimed at identifying the prevalence of Indonesian nursing students with intention to work in Japan and predictors of their intention to migrate as well as having a definite plan to work in Japan. The study adopted cross-sectional design with a sample of 1,407 Indonesian nursing students. Factors associated with having migration intention, as well as a definite plan to work in Japan, were age, residence, and overseas experience. Other factors related to a definite plan to work abroad were family income, mastering a foreign language, knowledge about the nurse migration related to Indonesia-Japan cooperation, and their motivations to migrate to Japan. Sustainability of this international recruitment of nurses is possible by understanding the context of both source and destination countries. Maximizing benefits of migration of nurses for Indonesia and Japan requires structured policies targeting the educational sector and addressing the sustainability issues.

Inequalities in referral pathways for young people accessing secondary mental health services in south east London.

Differences in health service use between ethnic groups have been well documented, but little research has been conducted on inequalities in access to mental health services among young people. This study examines inequalities in pathways into care by ethnicity and migration status in 12-29 years old accessing health services in south east London. This study analyses anonymized electronic patient record data for patients aged 12-29 referred to a south east London mental health trust between 2008 and 2016 for an anxiety or non-psychotic depressive disorder (n = 18,931). Multinomial regression was used to examine associations between ethnicity, migration status, and both referral source and destination, stratified by age group. Young people in the Black African ethnic group were more likely to be referred from secondary health or social/criminal justice services compared to those in the White British ethnic group; the effect was most pronounced for those aged 16-17 years. Young people in the Black African ethnic group were also significantly more likely to be referred to inpatient and emergency services compared to those in the White British ethnic group. Black individuals living in south east London, particularly those who identify as Black African, are referred to mental health services via more adverse pathways than White individuals. Our findings suggest that inequalities in referral destination may be perpetuated by inequalities generated at the point of access.

[Utilization of Medical Rehabilitation and Access Barriers for Persons with a Migrant Background - Results of the lidA Cohort Study]. / Inanspruchnahme medizinischer Rehabilitation und Zugangsbarrieren bei Personen mit Migrationshintergrund ­ Ergebnisse der lidA-Kohortenstudie.

INTRODUCTION: Rehabilitation services are considerably less used by persons with a migration background of working age in Germany than by persons without migration background. One reason could be access barriers. They can arise both from the structures of the health/rehabilitation system as well as from influences of the personal environment, e. g. financial burdens incurred through the use of rehabilitation or cultural expectations. In addition to the migration status, other factors such as country of origin, reasons for immigration, length of stay as well as the religious affiliation and social status could influence the utilization of medical rehabilitation. It was examined to what extent differences in utilisation are due to the migration background and to migration-independent personal barriers to access. METHODS: The lidA-study is a nationwide, representative prospective cohort study among employees with insurable employment born in 1959 and 1965 with a focus on work, age, health and employment. Data from the first (2011) and the second wave (2014) were combined for the analyses. In addition to bivariate analyses to describe the sample according to migration status, logistic regression analyses were carried out to estimate the odds ratios for the influence of migration background or nationality and other factors on the use of a medical rehabilitation measure. RESULTS: The chance of receiving medical rehabilitation is increased for migrants of the 1st generation (odds ratio (OR) 1.56, 95% confidence interval (CI): 1.09-2.25). If predominantly or exclusively no German is spoken at home, this could be associated with a comparatively much lower chance of utilisation (OR: 0.56, 95% CI: 0.28-1.15). Because only nationality is often available in routine data to determine the status of migration, another model only considers migrants and 2nd generation nationals and examines the influence of nationality on utilisation. A foreign nationality was not associated with a higher utilisation (OR: 1.07, 95% CI: 0.55-2.08). DISCUSSION: Results of previous studies on the use of medical rehabilitation for people with a migration background are inconsistent. This could be due to different examined population groups, different indications for rehabilitation, a temporal change in utilisation and the various study designs as well as data sources. We found a higher use of medical rehabilitation services by persons with a migrant background (1st generation) compared to non-migrant persons. One reason could be our more precise definition of the migration background compared to analyses of routine data. If predominantly or exclusively another language than German is spoken at home, the utilisation tends to be lower. The finding coincides with a lack of German language skills described as an access barrier in the literature.

Migration of physicians and keys to success.

There are currently nearly 1 billion migrants, of whom 259 million are international migrants, according to the World Health Organization. In the Americas, Venezuela has the highest migratory flow in the region in recent history. By September 2019, more than 4,300,000 people of all social classes had left the country. They included more than 24,000 doctors, who were fleeing the serious political, economic, and social crises affecting that nation. Others in the exodus are a large number of university faculty. The author's personal experience as a migrant doctor is presented, and job alternatives beyond medical practice/clinical medicine are described. The exodus of highly qualified personnel is not a new phenomenon but one that negatively affects the region or country of origin, whereas the receiving place benefits from the professionals who manage to join the workforce in their field of training. This, of course, is dependent on their complying with requirements to obtain legal residency and respective licensures, in addition to finding existing alternatives according to their expertise. To achieve this objective, they require a network of relatives, colleagues, and friends who can provide guidance on the steps to be followed; being fluent in the language of the new residence; and obtaining the necessary certifications to practice the profession either by taking the legally required examinations or by obtaining another degree from a university in the country.

Cross-border COVID-19 spread amidst malaria re-emergence in Venezuela: a human rights analysis.

BACKGROUND: Since 2016 Venezuela has seen a collapse in its economy and public health infrastructure resulting in a humanitarian crisis and massive outward migration. With the emergence of the novel coronavirus SARS-CoV-2 at the end of 2019, the public health emergency within its borders and in neighboring countries has become more severe and as increasing numbers of Venezuelans migrants return home or get stuck along migratory routes, new risks are emerging in the region. RESULTS: Despite clear state obligations to respect, protect and fulfil the rights to health and related economic, social, civil and political rights of its population, in Venezuela, co-occurring malaria and COVID-19 epidemics are propelled by a lack of public investment in health, weak governance, and violations of human rights, especially for certain underserved populations like indigenous groups. COVID-19 has put increased pressure on Venezuelan and regional actors and healthcare systems, as well as international public health agencies, to deal with a domestic and regional public health emergency. CONCLUSIONS: International aid and cooperation for Venezuela to deal with the re-emergence of malaria and the COVID-19 spread, including lifting US-enforced economic sanctions that limit Venezuela's capacity to deal with this crisis, is critical to protecting rights and health in the country and region.

Publicly provided healthcare and migration.

Publicly provided healthcare has received growing attention. Debates have been fuelled by evidence on improved health and reduced poverty, and concerns over adverse labour market effects; concerns that are, to date, only supported by mixed empirical findings. This article examines whether publicly provided healthcare influences the decision to migrate. The spatial and temporal variation in the expansion of a non-contributory health insurance programme in Mexico, combined with the panel dimension and the timing of household survey data allows causal identification of the effect of increased coverage on migration. Difference-in-differences estimates reveal that accessing healthcare for free raises internal migration. The effect on international migration, costlier by nature, is statistically insignificant. Potential mechanisms include better health, the alleviation of financial constraints and a greater propensity to work. Results point to the relevance of including household members who have migrated in assessing the impacts of social health policies. They suggest that publicly provided healthcare could have multiplier effects on economic development and welfare by enabling labour force detachment of working-age members in affiliated households.