Liver Transplantation in Unauthorized Immigrants in the United States.

BACKGROUND AND AIMS: Eleven million unauthorized immigrants reside in the United States and may account for 3% of deceased organ donors. Recently introduced federal and state legislation propose to address access to organ transplantation among unauthorized immigrants. The national landscape of liver transplantation (LT) for unauthorized immigrants is unknown. APPROACH AND RESULTS: We included all US LT recipients between March 2012 and December 2018 who were linked to Pew Center of Research data to estimate the population of unauthorized immigrants in each US state and by country of origin, based on US Census data. We categorized patients as unauthorized immigrants versus US citizens/residents. The main outcome measures were (1) the proportion of LTs performed for unauthorized immigrants compared with the proportion of unauthorized immigrants among total population in each US state and (2) graft failure and death post-LT. Of 43,192 LT recipients, 43,026 (99.6%) were US citizens/residents and 166 (0.4%) were unauthorized immigrants. Among unauthorized immigrants, most LTs were performed in California (47%) and New York (18%). The absolute difference in proportion of LTs performed for unauthorized immigrants compared with the proportion of unauthorized immigrants among the total population differed among states, ranging from +20% in California to -12% in Texas. The most common countries of birth among LT recipients who were unauthorized immigrants were Mexico (52%), Guatemala (7%), China (6%), El Salvador (5%), and India (5%). In competing risk analysis, unauthorized immigration status (vs. US citizens/residents) was associated with a similar risk of graft failure (subdistribution hazard ratio [sHR] 0.74; 95% confidence interval [CI], 0.40-1.34; P = 0.38) and death (sHR 0.68; 95% CI, 0.36-1.29; P = 0.23). CONCLUSIONS: LT for unauthorized immigrants is rare, and disparities in access to LT by state are present. Patient and graft survival among unauthorized immigrants is comparable with citizens/residents.

Genitourinary Systems Entangled with Shifting Environments in a Salvadoran Subsistence Farming Community.

Diseases of the genitourinary system are the leading cause of hospital deaths in El Salvador, and chronic kidney disease of unknown origin has been gaining attention as a public health problem among farmers in particular. Epidemiological studies point, in part, to environmental risk factors, which have shifted over time with the deployment of modern agricultural science and ongoing climate change. We examined how diseases of the genitourinary system were situated at several margins of an epidemic in one rural Salvadoran municipality where these environmental and epidemiological changes are occurring, albeit relatively slow. By using this approach to study diseases of the genitourinary system, we illustrate one way in which shifting human/environment entanglements can be experimentally "known" in the context of human diseases associated with them. Our approach offers a unique perspective in thinking with ethnographic data to compliment ongoing epidemiological investigations of kidney disease in El Salvador.

Global Ambitions: Evidence, Scale, and Child Well-being in El Salvador.

Experimental design and metrics have become increasingly common in international assistance, as donor agencies have demanded rigorous forms of evaluation and monitoring. This article contributes to debates about the effects of an "evidence-based turn" on interventions and recipients by exploring two questions: What constitutes evidence when it comes to everyday practices of aid at global scales? How are the goals of assistance affected? The article draws on collaborative research with an NGO and a group of social scientists who seek to improve child well-being in El Salvador. It shows how evidence-making was polysemic and costly, ultimately impacting the NGO's planned intervention. This outcome, I argue, was not a matter of poor planning, but reflects structural, evidence-making demands placed on global assistance at this historical conjuncture. Discussions among stakeholders about the trade-offs between evidence-making and assistance is a possible future route through the challenges described in this article.

How religiosity shapes health perceptions and behaviors of Latina immigrants: is it an enabling or prohibitive factor?

The study examines how religiosity shapes the health perceptions and health-related behaviors of 50 Latina immigrants from El Salvador, Guatemala, Mexico and Bolivia. Between May and August 2011, focus groups were conducted with participants representing each country of origin. Qualitative content analysis was the analytic strategy adopted in the study. The meta-theme, Religiosity Contributes to Positive Perceptions of Health and Health-Promoting Behaviors, is associated with six emerging themes: (1) Religiosity promotes a sense of personal responsibility for one's health; (2) Religiosity promotes a holistic view of health; (3) Religiosity promotes the view that health is a priority; (4) Religiosity promotes the view that health enables one to perform necessary tasks; (5) Religiosity promotes health-seeking behavior; and (6) Religiosity provides intrinsic health benefits. Findings do not follow the clear-cut dichotomy of the health locus of control model and challenge simplified notions that Latinas hold a purely external health locus of control toward their health and health care. Latinas rely on both God and themselves in managing their health and engaging in health-promoting actions, which are prompted in large part by their religiosity. Implications for culturally appropriate health communication and interventions are discussed.

Notes from the field: identification of a Taenia tapeworm carrier - Los Angeles County, 2014.

Carriers of the pork tapeworm, Taenia solium, are the sole source of cysticercosis, a parasitic tissue infection. When tapeworm eggs excreted by the carrier are ingested, tapeworm larvae can form cysts. When cysts form in the brain, the condition is called neurocysticercosis and can be especially severe. In Los Angeles County an average of 136 county residents are hospitalized with neurocysticercosis each year. The prevalence of Taenia solium carriage is largely unknown because carriage is asymptomatic, making detection difficult. The identification and treatment of tapeworm carriers is an important public health measure that can prevent additional neurocysticercosis cases.

Qualitative Exploration of an Effective Depression Literacy Fotonovela with at Risk Latina Immigrants.

While depression is prevalent among immigrant Latinas, mental health literacy is low. Culturally tailored health narratives can improve mental health literacy and are now increasingly featured in Spanish language fotonovelas (i.e., booklets in a comic book format with posed photographs and dialogue bubbles). The purpose of this qualitative study is to explore why a depression literacy fotonovela proved effective with Latina immigrants at risk for depression in a quantitative randomized control study. This study is the qualitative companion of the previously published quantitative piece of a mixed methods study, the latter revealing posttest improvements in depression knowledge, self-efficacy to identify the need for treatment, and decreased stigma towards mental health care (Hernandez and Organista in Am J Community Psychol 2013. doi: 10.1007/s10464-013-9587-1 ). Twenty-five immigrant Latinas participated in structured interviews, in the current qualitative study, 3 weeks after participating in the quantitative study. Results suggest depression literacy improved because participants evidenced high recall of the storyline and characters, which they also found appealing (e.g., liked peer and professional support offered to depressed main character). Further, identification with the main character was reflected in participants recalling similar circumstances impacting their mental health. Despite some improvement, stigma related to depression and its treatment remained for some women. Future research for the improvement of health literacy tools is discussed.

Characterizing the low wage immigrant workforce: a comparative analysis of the health disparities among selected occupations in Somerville, Massachusetts.

BACKGROUND: This study estimates job-related risks among common low wage occupations (cleaning, construction, food service, cashier/baggers, and factory workers) held by predominantly Haitian, El Salvadorian, and Brazilian immigrants living or working in Somerville, Massachusetts. METHODS: A community-based cross-sectional survey on immigrant occupational health was conducted between 2006 and 2009 and logistic regression was used to assess the job-related risks among the most common low wage occupations. RESULTS: Construction workers reported significantly higher health risks, and lower access to occupational health services than the other occupations. Compared to cashier/baggers, the reference population in this study, cleaners reported significantly lower access to health and safety and work training and no knowledge of workers' compensation. Factory workers reported significantly lower work training compared to cashier/baggers. Food service workers reported the least access to doctors compared to the other occupations. CONCLUSION: We found significant variability in risks among different low wage immigrant occupations. The type of occupation independently contributed to varying levels of risks among these jobs. We believe our findings to be conservative and recommend additional inquiry aimed at assuring the representativeness of our findings.

Growing up as "man of the house": adultification and transition into adulthood for young men in economically disadvantaged families.

Many children in economically disadvantaged communities assume adult roles in their families. Negotiating the responsibilities and expectations associated with becoming what some young men describe as "man of the house" has important implications for how adolescent boys move into adulthood. In this study, we share insights from field work and life-history interviews with low-income, young African American men and Salvadoran men in the Washington, DC/Baltimore region to illustrate how adultification may deliver contradictory expectations for adolescents. The findings also show how the accelerated responsibilities that accompany the experience of adultification create difficulties in the young men's transition into adulthood. These findings indicate that the age period of emerging adulthood may begin earlier for economically disadvantaged young men.

Fixed drug eruption associated with sulfonamides sold in Latino grocery stores - Greater Washington, DC, area, 2012-2013.

In March 2012, a Salvadoran-American boy aged 7 years living in Maryland developed three slightly painful, well-demarcated, flat, gray-brown patches on his torso. A dermatologist in Washington, DC, suspected a fixed drug eruption (an erythema multiforme-like adverse drug reaction that occurs in the same location each time the person uses a particular medication). The child had recently taken a cough and cold remedy, Baczol Antigripal, which was made in El Salvador and purchased in a Maryland suburb of Washington, DC, without a prescription. The Baczol Antigripal ingredients included the sulfonamide-containing antibiotic trimethoprim-sulfamethoxazole (TMP/SMX), which is a common cause of fixed drug eruption. In June 2013, another Salvadoran-American child, a girl aged 14 years living in northern Virginia, was evaluated for a similar fixed drug eruption likely caused by a Baczol product purchased near her home. In August 2013, staff members from the Children's National Medical Center investigated the availability of Baczol products in grocery stores in Salvadoran neighborhoods of Washington, DC, and neighboring suburbs. TMP/SMX-containing products were found in seven of 19 stores.

Agricultural work and chronic musculoskeletal pain among Latino farm workers: the MICASA study.

BACKGROUND: Agriculture poses varied dangers to hired farm workers in the U.S., but little information exists on occupational risks for chronic musculoskeletal pain. We examined common work positions, such as kneeling, carrying heavy loads, and repetitive motion that may increase the risk for chronic musculoskeletal pain. METHODS: MICASA is a population-based study of occupational exposures and health in hired farm workers in California. This analysis includes 759 participants, 18-55 years old, engaged in farm work and residing in Mendota, CA. Chronic pain was defined as pain lasting 6 weeks or longer at specific body sites (back, knee, hip, etc.) over the entire farm work career. RESULTS: Mean age was 37.9 years. Sixty-five percent participants were born in Mexico, 27.7% were born in El Salvador, and 4.2% were U.S-born. Chronic pain was associated with older age and female sex. After adjustment for age, years working in agriculture, and smoking, stooping/bending >30 hr/week among both men (OR = 2.49, 95% CI: 1.03-5.99) and women (OR = 2.15, 95% CI: 1.04-4.46) was associated with chronic hip pain. Driving tractors or other heavy farm equipment >60 hr/week was associated with increased odds of chronic hip pain (OR = 2.16, 95% CI: 1.02-4.54) among men. We also observed significant associations with kneeling or crawling >35 hr/week among women for both chronic back pain (OR = 2.96, 95% CI: 1.27-6.93) and knee pain (OR = 3.02, 95% CI: 1.07-8.50), respectively. CONCLUSIONS: Chronic musculoskeletal pain is prevalent among farm workers and is associated with common work positions. Further research should focus on developing preventive interventions for tasks associated with increased pain risk. These interventions should be targeted to specific types of agricultural tasks.

Dermatographic fixed-drug eruption: another cause of pseudo-Darier's sign.

A 7-year-old boy from El Salvador presented with several well-demarcated 3- to 4-cm round to oval, grey-brown patches on his shoulder and trunk (Figure a) that appeared simultaneously about 1 year previously. The lesions were red initially and thought by the patient's mother and primary care physicians to be bruises, but a hematologist's evaluation was unremarkable. The erythema soon subsided, leaving persistent light-brown spots on the torso. The patient was otherwise asymptomatic.

Gastronomic nostalgia: Salvadoran immigrants' cravings for their ideal meal.

Immigrants typically express cravings for the food of their homeland, but for undocumented and temporarily documented Salvadoran immigrants living in the United States, the hunger for their traditional cuisine is particularly poignant. To cope with a history of food scarcity in El Salvador and their documentation liminality in the United States, Salvadoran immigrants in this study crave symbolically rich foods. Salvadoran women provide these foods by recreating for their families an ideal Salvadoran meal into which they "groom" meanings of an imagined past and a hoped for present and future. Salvadoran immigrants' cravings, more cultural than physiological, are not readily satisfied, thus contributing to the overconsumption of food and the high rate of overweight among first-generation Salvadoran-American children.

A qualitative inquiry of Latino immigrants' work experiences in the Midwest.

Latino immigrants are the largest source of immigrant workers in the United States. In this study, 11 first-generation Latino immigrants (8 men, 3 women) living in the Midwest were interviewed about their work experiences. Interview data were analyzed using consensual qualitative research methods (Hill, Thompson, & Williams, 1997). Five domains associated with the data included work for survival and power, work for social connections, work as self-determination, work barriers in the Midwest, and access to work in the Midwest. We identify ways in which vocational psychologists can intervene to work effectively with Latino newcomers seeking employment in the United States and to support their transition into new settlement communities. Suggestions for future research with immigrant workers are discussed.

Colon cancer information preferences of English-as-a-second-language immigrant women: does language of interview matter?

Language of interview, an acculturation proxy measure, may differentiate between cancer information preferences of English-as-a-second-language (ESL) immigrant women in Canada. Using directed content analysis, we compared 28 interviews conducted in Spanish or English. Demographic comparisons were completed using paired t tests and McNemar related samples. Themes identified were: (1) using English language information and (2) improving information for ESL speakers. No differences were found in women's conversations about colon cancer by age, income, education, or employment. However, English interviewees resided in Canada longer and watched less television. Language skill and contextual factors influence women's confidence using English cancer information.

Community health workers speak out about the Kin KeeperSM model.

Community health workers (CHWs) informed students and researcher alike on the Kin Keeper(SM) Cancer Prevention Intervention. Students interested in medicine, guided by faculty, conducted a focus group session with 13 CHWs to find out if the intervention was effective for delivering breast and cervical cancer education. Strengths reported were (1) cultural appropriateness, (2) home visits, (3) CHW resource kits, and (4) increased awareness. The barriers were privacy perceptions and scheduling home visits. Overall, the CHWs indicated that the intervention was effective and flexible enough to accommodate the African American, Latina, and Arab groups of women.

Rural Latino farmworker fathers' understanding of children's oral health.

PURPOSE: This study's purpose was to examine rural Latino fathers' understanding of their children's oral health. METHODS: A convenience sample (n=20) of fathers from a small agricultural community in California was recruited door-to-door and interviewed in their homes. Individual qualitative interviews in Spanish were conducted. Interviews were audiotaped, translated, and transcribed. Codes were developed, and the text was analyzed for recurrent themes. RESULTS: Fathers came from Mexico (n=15) and El Salvador (n=5). Fathers had very little understanding of the etiology and clinical signs of dental caries. Overall, 18 of 19 fathers reported that their wife was primarily responsible for taking care of the children's hygiene. Fathers agreed that children's teeth should be taken care of from a young age, considered to be after 2 years. The fathers described very minimal hygiene assistance given to children by either parent and often considered a verbal reminder to be sufficient assistance. Fathers generally thought a child did not need supervision after approximately age 4 (range=1-11 years). CONCLUSIONS: While rural Latino fathers might not actively participate in their children's oral hygiene, they do place value on it. Men are supportive of dental treatments, albeit later than recommended. Educational messages aimed at these families will disseminate to the fathers, indirectly.

Cross-border Communication and the Enregisterment of Collective Frameworks for Care.

Communication plays an important role in the non-copresent care that is increasingly prevalent today. Drawing on long-term research with transnational Salvadoran families, I explore how one multigenerational kin network managed a health crisis: a family member had been diagnosed with a new form of chronic kidney disease that is epidemic in rural Central American communities. The family used cross-border communication to simultaneously enact care and consolidate a particular register of care. I suggest that everyday communication is a powerful force that works both within and beyond immediate care work encounters in ways that have far-reaching consequences for ethical and moral life.

Maternal Place of Birth, Socioeconomic Characteristics, and Child Health in US-Born Latinx Children in Boston.

OBJECTIVE: Among US-born children of Latina US (USB) and Latina foreign-born mothers (FBM), to determine whether 1) household and child characteristics differ; 2) child health outcomes differ; 3) these differences diminish for children of FBM with longer duration of residence in the United States; and 4) these differences can be explained by food insecurity (FI) or by Supplemental Nutrition Assistance Program (SNAP) participation. METHODS: Cross-sectional survey of 2145 Latina mothers of publicly insured US-born children 0 to 48 months old in a Boston emergency department (ED) 2004 to 2013. Predictors were FBM versus USBM and duration of residence in the United States. Outcomes were mothers' report of child health, history of hospitalization, developmental risk, and hospital admission on the day of ED visit. Multivariable logistic regression adjusted for potential confounders and effect modification. RESULTS: FBM versus USBM households had more household (31% vs 26%) and child (19% vs 11%) FI and lower SNAP participation (44% vs 67%). Children of FBM versus USBM were more likely to be reported in fair/poor versus good/excellent health (adjusted odds ratios 1.9, 95% confidence interval [1.4, 2.6]), with highest odds for children of FBM with shortest duration of residence, and to be admitted to the hospital on the day of the ED visit (adjusted odds ratios 1.7, 95% confidence interval [1.3, 2.2]). SNAP and FI did not fully explain these outcomes. CONCLUSION: When providing care and creating public policies, clinicians and policymakers should consider higher rates of food insecurity, lower SNAP participation, and risk for poor health outcomes in Latinx children of FBM.

Characterization of the mental health of immigrant children separated from their mothers at the U.S.-Mexico border.

Immigrant children who faced forced separation from their parents may be at heightened risk of developing mental health disorders, including depression, post-traumatic stress disorder (PTSD), and anxiety disorders. This cross-sectional study assessed the mental health of children being held in U.S. immigration detention who had been previously separated from their mothers. We interviewed 73 mothers about their eldest child age 5-17 using the Parent-Report version of the Strengths and Difficulties Questionnaire (SDQ). Among these children, many had elevated scores for emotional problems (49%), peer problems (21%), and total difficulties (15%). Male children demonstrated significantly higher rates of abnormal peer problems compared to females. Younger children (age 5-11 years) also demonstrated significantly higher rates of abnormal conduct problems, hyperactivity, and total difficulties. Scores did not differ significantly based on length of separation. Results reveal that children who had been separated from their parents experience high levels of mental health distress, which are especially high in younger children. Regardless of length of separation, these children would benefit from comprehensive mental health treatment with a culturally-responsive and trauma-informed lens.

Head injury and neuropsychiatric sequelae in asylum seekers.

OBJECTIVE: Asylum seekers experience a high burden of physical and psychological trauma, yet there is a scarcity of literature regarding the epidemiology and sequelae of head injury (HI) in asylum seekers. We examined HI prevalence and association with neuropsychiatric comorbidities in asylum seekers. METHODS: A retrospective cross-sectional study was performed through review of 139 medical affidavits from an affidavit database. Affidavits written from 2010 to 2018 were included. Demographic and case-related data were collected and classified based on the presence of HI. For neuropsychiatric sequelae, the primary study outcome was headache and the secondary outcomes were depression, posttraumatic stress disorder, and anxiety. Multivariable logistic regression was performed to examine the association between HI and neuropsychiatric sequelae, adjusted for demographic and clinical characteristics. RESULTS: A total of 139 medical affidavits of asylum seekers were included. The mean age was 27.4 ± 12.1 years, 56.8% were female, and 38.8% were <19 years. Almost half (42.5%) explicitly self-reported history of HI. Compared to clients who did not report HI, clients with HI were older and more likely to report a history of headache, physical abuse, physical trauma, concussion, and loss of consciousness. After adjustment for demographic and clinical characteristics, clients with HI had greater odds for neuropsychological sequelae such as headache (odds ratio [OR] 4.2, 95% confidence interval [CI] 2.0-8.7) and depression (OR 2.5, 95% CI 1.1-5.7). CONCLUSIONS: We observed a high prevalence of HI in asylum seekers. Comprehensive screening for HI and neuropsychiatric comorbidities is encouraged when evaluating asylum seekers.