[Shortage of nurses in Spain: from the global case to particular situation. SESPAS Report 2024]. / Escasez de enfermeras en España: del caso global a la situación particular. Informe SESPAS 2024.

The nursing shortage is a multi-causal phenomenon that affects all countries and currently a global concern. The shortage of nurses jeopardizes the sustainability of health systems and the population health outcomes. Spain has historically had no difficulties in attracting new generations of nurses. The shortage of nurses is caused by the precarious working conditions and lack of professional development that have led to episodes of high international migration and abandonment of the profession. In this paper we focus on the evolution of different indicators of the working conditions of non-specialist nurses, who make up the bulk of the profession. These indicators allow us to analyse the abandonment of the profession, the duration of contracts, their full-time or part-time dedication and the excessive hiring. We have analysed the effect of COVID-19 and the labour reform on these indicators. COVID-19 reduced the abandonment of the profession and is currently at its lowest level, it has also accelerated the need to improve working conditions by increasing the percentage of permanent contracts and reducing the multiplicity of contracts in the same month. The labour reform has helped reduce the percentage of temporary contracts until reaching around 80% of the total contracts, and has reduced the number of nurses in Spain with more than one contract in the same month to below 3000 nurses on a sustained basis.

High immigration rates critical for establishing emigration-driven diversity in microbial communities.

Unraveling the mechanisms governing the diversity of ecological communities is a central goal in ecology. Although microbial dispersal constitutes an important ecological process, the effect of dispersal on microbial diversity is poorly understood. Here, we sought to fill this gap by combining a generalized Lotka-Volterra model with experimental investigations. Our model showed that emigration increases the diversity of the community when the immigration rate crosses a defined threshold, which we identified as Ineutral. We also found that at high immigration rates, emigration weakens the relative abundance of fast-growing species and thus enhances the mass effect and increases the diversity. We experimentally confirmed this finding using co-cultures of 20 bacterial strains isolated from the soil. Our model further showed that Ineutral decreases with the increase of species pool size, growth rate, and interspecies interaction. Our work deepens the understanding of the effects of dispersal on the diversity of natural communities.

Evaluation of the impact of "speak out" and "human libraries" educational methodologies on nursing students' attitudes toward immigration.

Introduction: Measuring and understanding attitudes toward migrants is crucial in Health Sciences professionals. Nursing students, as future professionals in the healthcare system, must be comprehensively trained and prepared from the undergraduate level to effectively face the challenges of caring for health and disease processes in an increasingly globalized world. Our study aims to determine the level of attitudinal change in nursing students for immigrants, based on a training intervention with sessions of coexistence with immigrants in Spain. Methods: Quasi-experimental controlled and non-randomized study, carried out in 2019 in Nursing School La Fe, Valencia (Spain), with 201 participants (74 intervention group, 127 control group). Instrument: Attitudes toward Immigration Instrument (IAHI) questionnaire. Educational techniques of the training intervention: Speak outs and Human Libraries. Descriptive statistical analysis and comparison of results between groups was performed. Results: The participants in the intervention group showed significant changes in attitude modification, both in the total score of the questionnaire and in 4 of the 5 dimensions (pre-post intervention medition). When comparing the differences between the intervention group and the control group, we observed significant differences in 3 of the 5 dimensions: equality principles and policies, positive favorability, and negative favorability. Conclussion: Sessions involving coexistence, discussion, and reflection with immigrants, as educational intervention methods for nursing students (Speak outs and Human Libraries), are useful and effective tools to promote positive attitudinal changes toward immigrants within the healthcar context in nursing students.

Epidemiology of asylum seekers and refugees at the Mexico-US border: a cross-sectional analysis from the migrant settlement camp in Matamoros, Mexico.

BACKGROUND: The number of migrants and asylum seekers at the Mexico-US border has increased to historic levels. Our objective was to determine the medical diagnoses and treatments of migrating people seeking care in humanitarian clinics in Matamoros, Mexico. METHODS: We conducted a cross-sectional study of patient encounters by migrating people through a humanitarian clinic in Matamoros, Mexico, from November 22, 2019, to March 18, 2021. The clinics were operated by Global Response Medicine in concert with local non-governmental organizations. Clinical encounters were each coded to the appropriate ICD-10/CPT code and categorized according to organ system. We categorized medications using the WHO List of Essential Medicines and used multivariable logistic regression to determine associations between demographic variables and condition frequency. RESULTS: We found a total of 8,156 clinical encounters, which included 9,744 diagnoses encompassing 132 conditions (median age 26.8 years, female sex 58.2%). People originated from 24 countries, with the majority from Central America (n = 5598, 68.6%). The most common conditions were respiratory (n = 1466, 15.0%), musculoskeletal (n = 1081, 11.1%), and skin diseases (n = 473, 4.8%). Children were at higher risk for respiratory disease (aOR = 1.84, 95% CI: 1.61-2.10), while older adults had greater risk for joint disorders (aOR = 3.35, 95% CI: 1.73-6.02). Women had decreased risk for injury (aOR = 0.50, 95% CI: 0.40-0.63) and higher risk for genitourinary diseases (aOR = 4.99, 95% CI: 3.72-6.85) compared with men. Among 10,405 medications administered, analgesics were the most common (n = 3190, 30.7%) followed by anti-infectives (n = 2175, 21.1%). CONCLUSIONS: In this large study of a migrating population at the Mexico-US border, we found a variety of clinical conditions, with respiratory, musculoskeletal, and skin illnesses the most common in this study period which encompassed a period of restrictive immigration policy and the first year of the COVID-19 pandemic.

Prevalence of abnormalities seen on orthopantomograms performed for forensic age estimation in unaccompanied minor asylum seekers.

OBJECTIVES: Evaluate the prevalence of radiological anomalies on orthopantomograms (OPT) performed as part of forensic age estimation in unaccompanied minors. METHODS: This is a retrospective study conducted on 208 OPT examinations requested by a magistrate. These OPTs were interpreted independently by two readers to establish the number of missing teeth (MT), presence of dental fillings (DF), and dental anomalies (DA). The presence of radiolucent (RL), radiopaque, and mixed lesions was also assessed. RESULTS: Most radiologic anomalies were RL, detected on 41% and 39% of the subjects evaluated for R1 and R2, respectively, with a mean of 1.3 ± 2.4 (1-16) and 1.1 ± 2 (1-13) RL lesions per subject. Among the RL identified, the majority were dental (70% for R1 and 65% for R2), all of which had a suspected infectious origin. Among readers, 43% and 41% of the subjects evaluated presented MT, 21% and 15% presented DF, and 22% and 20% presented DA for R1 and R2, respectively. The inter- and intra-observer reproducibility for OPT classification was considered excellent (Kappa = 0.84, 95% CI 0.78-0.90, and Kappa = 0, 95, 95% CI 0.86-0.99). DISCUSSION: There was a non-negligible prevalence of radiological anomalies in OPT studies performed for forensic age estimation. Most of these lesions were suspected to be infectious in origin, potentially requiring medical care. This constitutes an ethical dilemma inherent in the judicial expertise injunction requiring a limited specific response. CLINICAL RELEVANCE STATEMENT: This study highlights a non-negligible prevalence of supposedly infectious radiological abnormalities. The restricted possibility for the legal expert to declare these abnormalities raises ethical and medical questions. KEY POINTS: • Orthopantomograms can be performed as part of forensic age estimation. • Results indicate the majority of radiological anomalies detected on OPTs were of suspected infectious origin. • These findings give rise to ethical and medical questions about the way in which these forensic examinations are carried out.

Prevalence of tuberculosis, COVID-19, chronic conditions and vulnerabilities among migrants and refugees: an electronic survey / Prevalência de tuberculose, COVID-19, condições crônicas e vulnerabilidades entre migrantes e refugiados: inquérito eletrônico / Prevalencia de tuberculosis, COVID-19, condiciones crónicas y vulnerabilidades en inmigrantes y refugiados: encuesta electrónica

Abstract Objective: to analyze the prevalence of tuberculosis, coronavirus, chronic conditions and vulnerabilities among migrants and refugees in Brazil. Method: this is a cross-sectional study of the electronic survey type conducted with international migrants during the COVID-19 pandemic. Descriptive statistics was applied for the analysis, with calculation of position and dispersion measures. Regarding the categorical variables, relative and absolute frequencies were estimated. Results: the study participants were 553 migrants and refugees, verifying 3.07%, 7.2% and 27.3% prevalence of tuberculosis, COVID-19 and chronic conditions, respectively. Among the vulnerabilities, 32% reported unemployment, 37.6% moved to Brazil as a result of the social situation in their countries and 33.6% were living as refugees or sheltered people. Conclusion: tuberculosis, chronic diseases and COVID-19 presented higher prevalence values in migrants and refugees than in the general population. As this is a population group that still has significant difficulty accessing health services and social protection systems, based on diverse evidence, the study will subsidize public policies, Nursing care and the incorporation of new routines in the service.

Resumo Objetivo: analisar a prevalência de tuberculose, coronavírus, condições crônicas e vulnerabilidades entre migrantes e refugiados no Brasil. Método: trata-se de estudo transversal, do tipo inquérito eletrônico, realizado com migrantes internacionais durante a pandemia de COVID-19. Para a análise, aplicou-se estatística descritiva, com cálculo de medidas de posição e de dispersão. Quanto às variáveis categóricas, estimaram-se as frequências relativas e absolutas. Resultados: participaram do estudo 553 migrantes e refugiados, verificando-se prevalência de 3,07% de tuberculose, 7,2% de COVID-19 e 27,3% de condições crônicas. Entre as vulnerabilidades, 32% referiram desemprego, 37,6% mudaram para o Brasil em decorrência da situação social do seu país e 33,6% residiam em asilo e ou abrigo. Conclusão: a tuberculose, as doenças crônicas e a COVID-19 apresentaram maior prevalência em migrantes e refugiados que na população em geral. Por tratar-se de uma população ainda com grande dificuldade de acesso aos serviços de saúde e aos sistemas de proteção social, o estudo subsidiará, com base em evidências, as políticas públicas, o atendimento do enfermeiro e a incorporação de novas rotinas no serviço.

Resumen Objetivo: analizar la prevalencia de tuberculosis, coronavirus, condiciones crónicas y vulnerabilidades en inmigrantes y refugiados en Brasil. Método: se trata de un estudio transversal, del tipo encuesta electrónica, realizado con migrantes internacionales durante la pandemia de COVID-19. Para el análisis se aplicó estadística descriptiva, con cálculo de medidas de posición y dispersión. En cuanto a las variables categóricas, se estimaron las frecuencias relativas y absolutas. Resultados: participaron del estudio 553 inmigrantes y refugiados, la prevalencia de tuberculosis era del 3,07%, de COVID-19 del 7,2% y de condiciones crónicas del 27,3%. Entre las vulnerabilidades, el 32% reportó desempleo, el 37,6% emigró a Brasil por la situación social de su país y el 33,6% vivía en un asilo o albergue. Conclusión: la tuberculosis, las enfermedades crónicas y el COVID-19 fueron más prevalentes en inmigrantes y refugiados que en la población general. Por tratarse de una población que aún tiene grandes dificultades para acceder a los servicios de salud y sistemas de protección social, el estudio contribuirá, con base en la evidencia, a las políticas públicas, la atención de enfermería y la incorporación de nuevas rutinas en el servicio.

A nationwide survey on the preference of Indian undergraduate medical students to go abroad for higher studies and residency.

Context: Getting residency training abroad is a critical motivator in the emigration of Indian medical students. Brain drain is an emerging issue, especially for developing countries as it causes a shortage of trained staff in the donor country. Aim: We aimed to survey Indian medical students to know about their intentions to get trained abroad and to understand the factors influencing their decision. Materials and Methods: In this cross-sectional observational study, we surveyed Indian undergraduate medical students of all professional years, including internship. A validated questionnaire collected data on students' demographics and educational characteristics, intention to study overseas or stay back in India, and factors influencing their decision. Results: Out of a total of 1199 responses (51.1% males, 48.9% females), 45.0% partakers had planned to pursue their residency abroad, while 33.8% wanted to stay in India and 21.2% were undecided. Better lifestyle and higher pay grades overseas were viewed as the most significant barriers to staying back in India and a key influencer in decision-making among the maximum number of students (412; 76.3%). On the other hand, a whopping 58.2% of participants opined that they wanted to stay back in India for taking care of their parents. Conclusions: Source countries with better healthcare facilities and better incomes tend to attract medical students. Awareness among medical educators regarding constantly changing curricula, a shift to a competency-based education system, better pay grades, limited working hours, and interventions to mitigate workplace violence could help prevent brain drain among Indian medical students and graduates.

Cross-border utilization of cancer care by patients in the US and Mexico - a survey of Mexican oncologists.

BACKGROUND: The US-Mexico border is the busiest in the world, with millions of people crossing it daily. However, little is known about cross-border utilization of cancer care, or about the reasons driving it. We designed a cross sectional online survey to understand the type of care patients with cancer who live in the US and Mexico seek outside their home country, the reasons why patients traveled across the border to receive care, and the barriers faced when seeking cross-border care. RESULTS: The online survey was sent to the 248 cancer care providers working in the six Mexican border states who were registered members of the Mexican Society of Oncology. Responses were collected between September-November 2022. Sixty-six providers (response rate 26%) completed the survey. Fifty-nine (89%) reported interacting with US-based patients traveling to Mexico to receive various treatment modalities, with curative surgery (n = 38) and adjuvant chemotherapy (n = 31) being the most common. Forty-nine (74%) reported interacting with Mexico-based patients traveling to the US to receive various treatment modalities, with immunotherapy (n = 29) and curative surgery (n = 27) being the most common. The most frequently reported reason US-based patients sought care in Mexico was inadequate health insurance (n = 45). The most frequently reported reason Mexico-based patients sought care in the US was patients' perception of superior healthcare (n = 38). CONCLUSIONS: Most Mexican oncologists working along the Mexico-US border have interacted with patients seeking or receiving binational cancer care. The type of care sought, as well as the reasons for seeking it, differ between US and Mexico-based patients. These patterns of cross-border healthcare utilization highlight unmet needs for patients with cancer in both countries and call for policy changes to improve outcomes in border regions.

Suicide in a Colombian indigenous community: Beyond mental illness.

BACKGROUND: Among the causes associated with suicide there are social factors such as forced displacement has been described and health factors in general that have an impact on pediatric mental health. AIMS: To describe clinical and psychosocial factors, and their relationship with suicidal behavior in a Colombian indigenous community. PARTICIPANTS AND SETTING: The mean age were 9.23 years old, 53.7% male and 46.3% female. METHOD: Mixed approach study. A thematic analysis was carried out with the youth of the community to investigate emotional aspects. A descriptive cross-sectional study was carried out and correlations between variables were made. RESULTS: Correlations were found between suicidal behavior and medical findings. When comparing the mental health disorders and nutritional problems, statistically significant differences were found in the Suicide Risk domain (<.001). This was reaffirmed in the thematic analysis, where factors such as migration and difficulty understanding the language are highlighted as related to suicidal behavior in the pediatric population. CONCLUSIONS: Suicidal behavior should not be approached solely from psychopathology. Hunger, the weakening of one's own culture, armed conflict, migration, and other clinical conditions are found to be associated with suicidal behavior.

The role of acculturation in the process of advance care planning among Chinese immigrants: A narrative systematic review.

BACKGROUND: Acculturation is the process of two different cultures coming into contact. It is unclear how acculturation influences Chinese immigrants' engagement in advance care planning due to the complexity and multifaceted nature of both acculturation and advance care planning. AIMS: To synthesize evidence regarding the role of Chinese immigrants' acculturation in their engagement in advance care planning. DESIGN: Systematic mixed-method review, registered in PROSPERO (CRD42021231822). DATA SOURCES: EMBASE, MEDLINE, Web of Science, and Google Scholar were searched for publications until January 21, 2021. RESULTS: Twenty-one out of 1112 identified articles were included in the analysis. Of those 21 articles, 17 had a qualitative design and 13 originated from the United States. Three of four quantitative studies reported that higher acculturation levels were associated with better knowledge or higher rate of engagement in advance care planning. Analysis of qualitative studies showed that Chinese immigrants' engagement in advance care planning was associated with their: (1) self-perceived cultural identity (native or non-native); (2) interpretation of filial piety (traditional or modern); and (3) interpretation of autonomy (individual or familial). To facilitate their engagement, Chinese immigrants prefer an implicit approach, non-family-related initiators, contextualization advance care planning in Chinese culture and using Chinese language. CONCLUSION: Chinese immigrants' willingness to engage in advance care planning varied with their acculturation level. To engage them in advance care planning, we recommend adapting the introduction of advance care planning to address people's perceptions of their cultural identity, filial piety, and autonomy, as well as their preference for certain approach, initiator, context, and language.

Risk factors for common mental disorders in young refugees from Iran, Somalia and Syria to Sweden.

BACKGROUND: Our primary aim was to determine sociodemographic and health-related risk factors for diagnosed common mental disorders (CMDs) among young refugees in Sweden. METHODS: All young adult refugees from Iran, Somalia and Syria (n = 7192), who were residents in Sweden in 2009, were followed from 2010 to 2013 regarding diagnosed CMDs. Cox regression models were used to compute hazard ratios (HRs) of CMDs with 95% confidence intervals (CIs). RESULTS: Those arriving as unaccompanied refugee minors had a lower risk of being diagnosed with CMDs (HR: 0.7; 95%CI: 0.6-0.9) than those arriving as accompanied refugee minors. A higher risk of being diagnosed with CMDs was also found in female refugees (HR: 1.3; 95%CI: 1.1-1.5) compared with male refugees. In addition, individuals with a low (HR: 1.7; 95%CI: 1.3-2.3) or a medium (HR: 1.4; 95%CI: 1.1-1.8) educational level were found to have a higher risk of being diagnosed with CMDs compared with individuals with a high educational level. Refugees from Iran (HR: 2.3; 95%CI: 1.8-2.9) had a higher risk of a diagnosis of a CMD than refugees from Somalia. Moreover, refugees with a diagnosis of a mental disorder other than a CMD (HR: 4.2; 95%CI: 2.8-6.1), digestive (HR: 1.5; 95%CI: 1.0-2.2) or musculoskeletal diseases (HR: 1.5; 95%CI: 1.0-2.2) had a higher risk of being diagnosed with subsequent CMDs, compared with those with no such disorders. CONCLUSIONS: Pre-existing diagnoses of mental disorders other than CMDs, and digestive and musculoskeletal disorders should be carefully considered in clinical assessments to initiate early interventions to prevent CMDs.

Mobility and ART retention among men in Malawi: a mixed-methods study.

INTRODUCTION: Mobility is associated with worse outcomes across the HIV treatment cascade, especially among men. However, little is known about the mechanisms that link mobility and poor HIV outcomes and what types of mobility most increase the risk of treatment interruption among men in southern Africa. METHODS: From August 2021 to January 2022, we conducted a mixed-methods study with men living with HIV (MLHIV) but not currently receiving antiretroviral therapy (ART) in Malawi. Data collection was embedded within two larger trials (ENGAGE and IDEaL trials). We analysed baseline survey data of 223 men enrolled in the trials who reported being mobile (defined as spending ≥14 nights away from home in the past 12 months) using descriptive statistics and negative binomial regressions. We then recruited 32 men for in-depth interviews regarding their travel experiences and ART utilization. We analysed qualitative data using constant comparative methods. RESULTS: Survey data showed that 34% of men with treatment interruptions were mobile, with a median of 60 nights away from home in the past 12 months; 69% of trips were for income generation. More nights away from home in the past 12 months and having fewer household assets were associated with longer periods out of care. In interviews, men reported that travel was often unplanned, and men were highly vulnerable to exploitive employer demands, which led to missed appointments and ART interruption. Men made major efforts to stay in care but were often unable to access care on short notice, were denied ART refills at non-home facilities and/or were treated poorly by providers, creating substantial barriers to remaining in and returning to care. Men desired additional multi-month dispensing (MMD), the ability to refill treatment at any facility in Malawi, and streamlined pre-travel refills at home facilities. CONCLUSIONS: Men prioritize ART and struggle with the trade-offs between their own health and providing for their families. Mobility is an essential livelihood strategy for MLHIV in Malawi, but it creates conflict with ART retention, largely due to inflexible health systems. Targeted counselling and peer support, access to ART services anywhere in the country, and MMD may improve outcomes for mobile men.

Enfermeiros imigrantes no Brasil: de 1973 a 2021 / Immigrant nurses in Brazil: from 1973 to 2021 / Enfermeros inmigrantes en Brasil: de 1973 a 2021

Objetivo: Atualizar o censo dos enfermeiros imigrantes no Brasil. Métodos: estudo descritivo e quantitativo sobre a dimensão e as características do censo dos enfermeiros imigrantes, segundo os estados e as regiões de destino, países de origem, idade e sexo. Os dados foram obtidos da base de dados do Conselho Federal de Enfermagem e analisados de forma descritiva. Resultados: Do total de 176 imigrantes, 145 são mulheres e 31 são homens, mostrando a prevalência feminina na profissão de enfermagem. Destes, 96 são peruanos, 126 sul americanos, 28 europeus, 9 cubanos, 5 norte americanos 8 imigrantes originários de diversos países. Conclusão: O censo de 1973 a 2021 mostra a predominância de imigrantes peruanos, com alta concentração na região norte e sudeste do Brasil, respectivamente no estado do Amazonas e de São Paulo. (AU)

Objective: To update the census of immigrant nurses in Brazil. Methods: descriptive and quantitative study on the dimension and characteristics of the census of immigrant nurses, according to the states and regions of destination, countries of origin, age, and sex. Data were obtained from the Federal Nursing Council database and analyzed descriptively. Results: Of the total of 176 immigrants, 145 are women and 31 are men, showing the female prevalence in the nursing profession. Of these, 96 are Peruvians, 126 South Americans, 28 Europeans, 9 Cubans, 5 North Americans, and 8 immigrants from different countries. Conclusion: the census from 1973 to 2021 shows the predominance of Peruvian immigrants, with a high concentration in the north and southeast of Brazil, respectively in the state of Amazonas and São Paulo. (AU)

Objetivo: Actualizar el censo de enfermeros inmigrantes en Brasil. Métodos: estudio descriptivo y cuantitativo sobre la dimensión y características del censo de enfermeras inmigrantes, según estados y regiones de destino, países de origen, edad y sexo. Los datos fueron obtenidos de la base de datos del Consejo Federal de Enfermería y analizados descriptivamente. Resultados: Del total de 176 inmigrantes, 145 son mujeres y 31 son hombres, mostrando el predominio femenino en la profesión de enfermería. De estos, 96 son peruanos, 126 sudamericanos, 28 europeos, 9 cubanos, 5 norteamericanos y 8 inmigrantes de diferentes países. Conclusion: el censo de 1973 a 2021 muestra el predominio de inmigrantes peruanos, con una alta concentración en el norte y sureste de Brasil, respectivamente en el estado de Amazonas y São Paulo. (AU)

Patient dissatisfaction associated with physician-patient linguistic discordance in California clinics: an analytical cross-sectional study.

BACKGROUND: Patient satisfaction is considered as a product of two psychological processes, a cognitive one, including expectations and perceptions, and an emotional one resulting from the congruence between expectation and subjective perception of the user. The objective was to identify the factors associated with the level of perceived satisfaction in patients treated in 36 nonprofit health clinics that offer comprehensive health care services in four counties in the state of California, United States. METHODS: Cross-sectional analytical study in 14 clinics in four California counties. It consisted of the application of a 30-item questionnaire to determine the degree of patient satisfaction with the clinic. The factorial composition of the quality of care and clinic quality components was analyzed and two factors with an Eigen value greater than 1 were obtained. RESULTS: A total of 846 responses were registered. Factor analysis identified two underlying dimensions: Physician Attitude and Empathy. It was found that the discordance in language between the physician and the patient generates a difference in the perception of satisfaction. Patients who prefer to speak English have better satisfaction than those who speak Spanish. Spanish speakers who do not have interpreter have lower satisfaction than those who do (p < 0,01). CONCLUSIONS: The most important sociodemographic cofactor was language. Satisfaction decreased in Spanish-speaking patients who were not proficient in the use of English since they expressed fewer comments and doubts.

Prostate Specific Antigen Testing Behaviors for Prostate Cancer Screening Among U.S. Immigrants: A Cross-sectional Analysis Using the National Health Interview Survey.

PURPOSE: Immigrants constitute 14% of the U.S. population, and this group is especially vulnerable to poor health care access. Prior research demonstrates U.S. immigrants have low rates of guideline-concordant breast and colorectal screening, but prostate cancer screening has not previously been evaluated. We sought to characterize screening behaviors among U.S. immigrants and to consider possible mechanisms to enhance PSA-based screening for this population. MATERIALS AND METHODS: Data were obtained from the 2010, 2013, 2015, and 2018 National Health Interview Survey reports, which were the recent survey years that included questions about PSA testing. Complex samples logistic regression was performed to assess the relationship between immigrant-specific characteristics including region of birth, citizenship status, length of residence within the U.S., English language proficiency, and history of PSA testing. RESULTS: There were 22,997 survey respondents; 3,257 were foreign-born and 19,740 were U.S.-born. Rates of PSA testing were much lower among the foreign-born population compared to the U.S.-born population (43% vs 60%). Citizenship status, length of residence in the U.S. for more than 15 years, and English proficiency were directly linked to increased rates of PSA testing. There was significant variability in PSA testing among immigrant subgroups and Asian immigrants had the lowest rate of PSA testing. Annual physician visits and English language proficiency were associated with increased PSA testing among the U.S. immigrant population. CONCLUSIONS: Immigrants have relatively low rates of PSA testing. Improving health care utilization and language services may help to narrow the gap in guideline-concordant prostate cancer screening between immigrants and nonimmigrants.

Getting knowledge to provide care: prevalence and factors associated with Sexually Transmitted Infections in immigrants from Goiás / Conocer para cuidar: prevalencia y factores asociados a las Enfermedades de Transmisión Sexual en inmigrantes de Goiás / Conhecer para cuidar: prevalência e fatores associados às Infecções Sexualmente Transmissíveis em imigrantes de Goiás

ABSTRACT Objective: To estimate the prevalence of Sexually Transmitted Infections (STIs) in immigrants and refugees living in the metropolitan region of Goiânia, Goiás. Method: This is a cross-sectional and analytical study. Data collection was carried out from July 2019 to January 2020 and 308 immigrants and refugees were included in the sample. All were underwent face-to-face interviews and were tested for HIV, Syphilis, and Hepatitis B, using rapid tests. Results: The general prevalence for any of the STIs investigated was 8.8% (95%CI 6.0% - 12.3%), being 5.8% (95%CI 3.6% - 8.9%) for Hepatitis B, 2.3% for Syphilis (95%CI 1.00% - 4.4%) and 0.7% for HIV (95%CI 0.1% - 2.1%). Multiple analysis, using logistic regression, showed that the variables male gender (OR = 2.7) and length of time living in Brazil (OR = 2.6) were significantly associated with STIs (p < 0.05). Conclusion: The results of this study suggest that STIs are a health problem in immigrants/refugees, which appear to be enhanced with the length of migration in the country. Public policies that guarantee health care for this population shall be considered.

RESUMEN Objetivo: Estimar la prevalencia de Enfermedades de Transmisión Sexual (ETS) en inmigrantes y refugiados residentes en la región metropolitana de Goiânia, Goiás. Método: Se trata de un estudio transversal y analítico. La recolección de datos se llevó a cabo desde julio de 2019 hasta enero de 2020 y se incluyeron en la muestra 308 inmigrantes y refugiados. Todos fueron entrevistados cara a cara y sometidos a pruebas de VIH, Sífilis y Hepatitis B, mediante pruebas rápidas.. Resultados: La prevalencia general para cualquiera de las ETS investigadas fue de 8,8% (IC95% 6,0% - 12,3%), siendo 5,8% (IC95% 3,6% - 8,9%) para Hepatitis B, 2,3% para Sífilis (IC95% 1,00% - 4,4%) y 0,7% para VIH (IC95% 0,1% - 2,1%). El análisis múltiple, mediante regresión logística, mostró que las variables género masculino (OR = 2,7) y tiempo de residencia en Brasil (OR = 2,6) se asociaron significativamente con las ETS (p < 0,05). Conclusión: Los resultados de este estudio sugieren que las ETS son un problema de salud en inmigrantes/refugiados, que parecen exacerbarse con la duración de la migración en el país. Se deben considerar políticas públicas que garanticen la atención de la salud de esta población.

RESUMO Objetivo: Estimar a prevalência de Infecções Sexualmente Transmissíveis (IST) em imigrantes e refugiados residentes na região metropolitana de Goiânia, Goiás. Método: Trata-se de um estudo transversal e analítico. A coleta de dados foi realizada no período de julho de 2019 a janeiro de 2020 e integraram a amostra 308 imigrantes e refugiados. Todos foram entrevistados face-a-face e testados para HIV, Sífilis e Hepatite B, por meio de testes rápidos. Resultados: A prevalência geral para alguma das IST investigadas foi de 8,8% (IC95% 6,0% - 12,3%), sendo 5,8% (IC95% 3,6% - 8,9%) para Hepatite B, 2,3% para Sífilis (IC95% 1,00% - 4,4%) e 0,7% para HIV (IC95% 0,1% - 2,1%). A análise múltipla, por regressão logística, mostrou que as variáveis sexo masculino (OR = 2,7) e tempo de moradia no Brasil (OR = 2,6) foram associadas significativamente às IST (p < 0,05). Conclusão: Os resultados deste estudo sugerem que as IST são um problema de saúde em imigrantes/refugiados, que parecem ser exacerbadas com o tempo de migração no país. Políticas públicas que garantam a assistência à saúde dessa população devem ser consideradas.

Condiciones de trabajo percibidas por enfermeras migrantes mexicanas en Alemania / Occupational Conditions Perceived by Mexican Migrant Nurses in Germany

Introducción: Se espera que la migración de profesionales de enfermería mexicanos aumente en los próximos años debido a la escasez de enfermeras en todo el mundo. Es urgente estudiar las condiciones de trabajo de las enfermeras mexicanas en los países de acogida desde una perspectiva transcultural. Objetivo: Examinar las percepciones laborales de las enfermeras mexicanas que ejercen en un entorno clínico en Alemania desde una perspectiva transcultural. Métodos: Se realizó un estudio etnográfico focalizado entre noviembre de 2020 y mayo de 2021. La muestra (n = 11) involucró a profesionales de enfermería de México que trabajan en un entorno clínico en Alemania. Los datos se recogieron mediante entrevistas semiestructuradas a través de la plataforma digital Zoom. Las entrevistas fueron grabadas en audio previo consentimiento informado. Se utilizó un análisis temático para analizar los datos; QUIRKOS, un software de análisis de datos cualitativos ayudó en el proceso. Resultados: Se identificaron tres temas: las condiciones estructurales de trabajo, que describen las características del trabajo que influyen en la realización del cuidado transcultural de enfermería; la diversidad cultural de los cuidados, que describe la variabilidad del significado de los cuidados de enfermería; y la práctica transcultural, que describe las percepciones culturales de las enfermeras en relación con los cuidados que prestan en Alemania. Conclusiones: Las condiciones estructurales de trabajo y la diversidad cultural de los cuidados favorecen o impiden la calidad de los cuidados que prestan las enfermeras mexicanas en Alemania. Los hallazgos sugieren la necesidad de abogar por políticas que mejoren las condiciones de trabajo de las enfermeras en México y en Alemania(AU)

Introduction: Migration of Mexican nursing professionals is expected to increase in the coming years, due to the shortage of nurses worldwide. There is an urgent need to study the occupational conditions of Mexican nurses in host countries from a cross-cultural perspective. Objective: To examine the occupational perceptions of Mexican nurses practicing in a clinical setting in Germany, from a cross-cultural perspective. Methods: A focused ethnographic study was conducted between November 2020 and May 2021. The sample (n=11) involved nursing professionals from Mexico working in a clinical setting in Germany. The data were collected through semistructured interviews via the digital platform Zoom. The interviews were audio-recorded with prior informed consent. A thematic analysis was used to analyze the data; Quirkos, a qualitative data analysis software, was used in the process. Results: Three themes were identified: structural occupational conditions, describing the occupational characteristics that influence the performance of transcultural nursing care; cultural diversity of care, describing variability in the meaning of nursing care; and transcultural practice, describing nurses' cultural perceptions of the care that they provide in Germany. Conclusions: Structural occupational conditions and cultural diversity of care favor or impede the quality of care provided by Mexican nurses in Germany. The findings suggest the need to advocate for policies that improve the occupational conditions of nurses in Mexico and Germany(AU)

Ways of living and working of Haitian immigrants in Western Paraná/Brazil / Modo de vida y trabajo de inmigrantes haitianos en el oeste de Paraná/Brasil / Modos de vida e trabalho de imigrantes haitianos no Oeste do Paraná/Brasil

ABSTRACT Objective: To analyze the migratory process, ways of living, and working conditions of Haitians residing in the municipality of Cascavel, Paraná, as well as their impact on health conditions, consumption patterns, and political and ideological life. Method: cross-sectional observational design. Data was collected through semi-structured interviews conducted from December 2019 to December 2020 with 128 participants who were Haitian immigrants residing in the municipality. Simple descriptive statistics were used for the data analysis, and the findings were discussed in conjunction with relevant literature, with the social determination theory serving as a reference. Results: The majority of participants were male 75.0% (n = 96), young adults 71.0% (n = 91), speakers of two or more languages 87.5% (n = 112), catholic 61.7% (n = 79), high school education or higher 57.0% (n = 73). They consider their life and health conditions good but are unsatisfied with the working conditions and salary. Conclusion: Haitian immigrants' arrival facilitation to work in cold stores may indicate labor exploitation of economically and socially vulnerable groups. Immigration policies and the recognition of the educational level of their country of origin may contribute to improving the living condition of this population.

RESUMEN Objetivo: Analizar el proceso migratorio, el modo de vida y el trabajo de haitianos que residen en la ciudad de Cascabel, Paraná y sus expresiones en las condiciones de salud, en las costumbres de consumo y en la vida política e ideológica. Método: Se trata de una investigación observacional transversal, con datos recopilados y sopesados con la literatura pertinente y la teoría de la determinación social. La entrevista semiestructurada se llevó a cabo con 128 participantes, inmigrantes haitianos residentes en el municipio, de diciembre de 2019 a diciembre de 2020. Para el análisis, se utilizó la estadística descriptiva simple. Resultados: La mayoría de los participantes eran hombres (75,0%) (n = 96), adultos jóvenes (71,0%) (n = 91), hablaban dos idiomas o más (87,5%) (n = 112), eran católicos (61,7%) (n = 79) y tenían estudios secundarios o terciarios (57,0%) (n = 73). Consideran que sus condiciones de vida y de salud son buenas, pero están insatisfechos con su situación laboral y su salario. Conclusión: La facilitación de la venida de inmigrantes haitianos para trabajar en frigoríficos de la región puede indicar explotación laboral de grupos económica y socialmente vulnerables. Las políticas de integración y el reconocimiento de la escolaridad del país de origen pueden contribuir a mejorar las condiciones de vida de este grupo de inmigrantes.

RESUMO Objetivo: Analisar o processo migratório, os modos de vida e trabalho de haitianos que residem no município de Cascavel-Paraná e suas expressões nas condições de saúde, no padrão de consumo e na vida política e ideológica. Método: Pesquisa observacional transversal. A coleta de dados se deu por meio de entrevista semiestruturada, de dezembro de 2019 a dezembro de 2020 com 128 participantes, imigrantes haitianos residentes no município. Para análise, utilizou-se estatística descritiva simples, discutidos com a literatura pertinente, tendo como referencial a teoria da determinação social. Resultados: A maioria dos participantes foi da população masculina 75,0% (n = 96), adultos jovens 71,0% (n = 91), falam duas línguas ou mais 87,5% (n = 112), de religião católica 61,7% (n = 79), com escolaridade de nível médio ou acima 57,0% (n = 73). Consideram boas suas condições de vida e saúde, mas estão insatisfeitos com as condições de trabalho e salário. Conclusão: O favorecimento da vinda de imigrantes haitianos para atuarem em frigoríficos da região, pode indicar exploração do trabalho de grupos vulneráveis econômica e socialmente. Políticas de integração e o reconhecimento da formação escolar do país de origem, podem contribuir para melhorar a condição de vida desta população.

[COVID-19 exposure setting, social and gender determinants in a mediterranean region.] / Características sociales y de género en el ámbito de contagio de COVID-19 en una región mediterránea.

OBJECTIVE: Knowledge of social and gender determinants, which influence the places where people are exposed to COVID-19, may be relevant in the development of preventive and control strategies. The aim of this paper was to determine the context in which COVID-19 cases were infected (household, work/labor, health, social-health, and social-leisure settings) according to country of origin, occupational social class and gender, which is essential in order to designing public health strategies. METHODS: A cross-sectional study of an epidemiological registry of 56,628 COVID-19 incident cases was made, whose exposure/contagion setting was studied according to the previous variables from June 15 to December 23, 2020, in the Region of Murcia (Spain). An exact Fisher test was used to study the distribution of COVID-19 cases based on the above variables. RESULTS: The cumulative incidence was higher in people from Africa (5,133.5 cases/100,000 inhabitants) and Latin America (11,351.1) than in non-immigrants (3,145.7). It was also higher in women (3,885.6) than in men (3,572.6). It is noteworthy, that 53.3% of the cases with employment were workers in industry or construction, artisans, agricultural workers, or elementary occupations. In contrast, during the second semester of 2020, 41.3% of the employed population in the Region of Murcia performed such jobs. The household was the main exposure setting (56.5% of cases with a known setting), followed by social-leisure (20.7%) and work/labor (18.2%). The labor settings were more important in immigrants from Africa (28.4%) and Latin America (35.7%) than in non-immigrants (12%), inversely to social-leisure settings. Labor context was more important in women (19.6%) than in men (16.5%) and in manual workers (44.1%) than in non-manual workers (26.6%). CONCLUSIONS: The context in which COVID-19 cases were infected is different according to social inequalities related to country of origin, gender and occupational social class.

OBJETIVO: El conocimiento de los determinantes sociales y de género que influyen en el ámbito de exposición al SARS-CoV-2 puede ser relevante en el planteamiento de estrategias preventivas y de control de la transmisión. No se han encontrado estudios previos que evalúen cómo influyen la clase social ocupacional y el país de origen en el ámbito de exposición del SARS-CoV-2. El objetivo de este trabajo fue conocer el contexto en que se contagiaron los casos de COVID-19 (ámbito: hogar, trabajo, sanitario, sociosanitario y social-ocio) según país de origen, clase social ocupacional y género, lo cual es esencial para orientar estrategias de Salud Pública. METODOS: Se realizó un estudio descriptivo de un registro epidemiológico de 56.628 casos incidentes de COVID-19 en los que se estudió el ámbito de exposición/contagio en función de las variables anteriormente indicadas entre el 15 de junio y el 23 de diciembre de 2020 en la Región de Murcia. Se utilizó una prueba exacta de Fisher para el estudio de la distribución de los casos de COVID-19 en función de las variables anteriores. RESULTADOS: La incidencia acumulada fue mayor en personas procedentes de África (5.133,5 casos por cada 100.000 habitantes) y Latinoamérica (11.351,1) que en no inmigrantes (3.145,7) y superior en mujeres (3.885,6) que en hombres (3.572,6). Es destacable que el 53,3% de los casos COVID-19 con empleo registrado eran operarios en industria o construcción, artesanos, trabajadores agrarios o con ocupaciones elementales (15 de junio y el 23 de diciembre de 2020). En contraste, el 41,3% de la población ocupada en la Región de Murcia realizaba dichos empleos (promedio 3º y 4º trimestre de 2020). El hogar fue el principal ámbito de contagio (56,5% de los casos con ámbito conocido), seguido del social-ocio (20,7%) y el laboral (18,2%). Este último tuvo mayor peso en personas procedentes de África (28,4%) y Latinoamérica (35,7%) que en no inmigrantes (12%), a la inversa que el social-ocio. Fue más importante en mujeres (19,6%) que en hombres (16,5%) y en trabajadores manuales (44,1%) que en no manuales (26,6%). CONCLUSIONES: El contexto en el que los casos de COVID-19 se contagiaron es diferente en función de las desigualdades sociales relativas a país de origen, género y clase social ocupacional.

Características sociales y de género en el ámbito de contagio de COVID-19 en una región mediterránea / COVID-19 exposure setting, social and gender determinants in a mediterranean region

FUNDAMENTOS: El conocimiento de los determinantes sociales y de género que influyen en el ámbito de exposición al SARS-CoV-2 puede ser relevante en el planteamiento de estrategias preventivas y de control de la transmisión. No se han encontrado estudios previos que evalúen cómo influyen la clase social ocupacional y el país de origen en el ámbito de exposición del SARS-CoV-2. El objetivo de estetrabajo fue conocer el contexto en que se contagiaron los casos de COVID-19 (ámbito: hogar, trabajo, sanitario, sociosanitario y social-ocio) según país de origen, clase social ocupacional y género, lo cual es esencial para orientar estrategias de Salud Pública. MÉTODOS: Se realizó un estudio descriptivo de un registro epidemiológico de 56.628 casos incidentes de COVID-19 en los que seestudió el ámbito de exposición/contagio en función de las variables anteriormente indicadas entre el 15 de junio y el 23 de diciembre de 2020 en la Región de Murcia. Se utilizó una prueba exacta de Fisher para el estudio de la distribución de los casos de COVID-19 en función de las variables anteriores. RESULTADOS: La incidencia acumulada fue mayor en personas procedentes de África (5.133,5 casos por cada 100.000 habitantes) y Latinoamérica (11.351,1) que en no inmigrantes (3.145,7) y superior en mujeres (3.885,6) que en hombres (3.572,6). Es destacable que el 53,3% de los casos COVID-19 con empleo registrado eran operarios en industria o construcción, artesanos, trabajadores agrarios ocon ocupaciones elementales (15 de junio y el 23 de diciembre de 2020). En contraste, el 41,3% de la población ocupada en la Región de Murcia realizaba dichos empleos (promedio 3º y 4º trimestre de 2020). El hogar fue el principal ámbito de contagio (56,5% de los casos con ámbito conocido), seguido del social-ocio (20,7%) y el laboral (18,2%). Este último tuvo mayor peso en personas procedentes de África (28,4%) y Latinoamérica (35,7%) que en no inmigrantes (12%), a la inversa que el socialcio...(AU)

BACKGROUND: Knowledge of social and gender determinants, which influence the places where people are exposed to COVID-19, may be relevant in the development of preventive and control strategies. The aim of this paper was to determine the context in which COVID-19 cases were infected (household, work/labor, health, social-health, and social-leisure settings) according to country of origin, occupational social class and gender, which is essential in order to designing public health strategies.METHODS: A cross-sectional study of an epidemiological registry of 56,628 COVID-19 incident cases was made, whose exposure/contagion setting was studied according to the previous variables from June 15 to December 23, 2020, in the Region of Murcia (Spain). An exact Fisher test was used to study the distribution of COVID-19 cases based on the above variables.RESULTS: The cumulative incidence was higher in people from Africa (5,133.5 cases/100,000 inhabitants) and Latin America (11,351.1) than in non-immigrants (3,145.7). It was also higher in women (3,885.6) than in men (3,572.6). It is noteworthy, that 53.3% of the cases with employment were workers in industry or construction, artisans, agricultural workers, or elementary occupations. In contrast, during the second semester of 2020, 41.3% of the employed population in the Region of Murcia performed such jobs. The household was the main exposure setting (56.5% of cases with a known setting), followed by social-leisure (20.7%) and work/labor (18.2%). The labor settings were more important in immigrants from Africa (28.4%) and Latin America (35.7%) than in non-immigrants (12%), inversely to social-leisure settings. Labor context was more important in women (19.6%) than in men (16.5%) and in manual workers (44.1%) than in non-manual workers (26.6%)...(AU)