Undocumented status as a social determinant of occupational safety and health: The workers' perspective.

BACKGROUND: Undocumented immigration to the United States has grown dramatically over the past 25 years. This study explores undocumented status as a social determinant of occupational health by examining its perceived consequences on workplace safety of Latino immigrants. METHODS: Guided by the Theory of Work Adjustment, qualitative analysis was conducted on transcripts from focus groups and individual interviews conducted with a convenience sample of Latino immigrant workers. RESULTS: Participants reported that unauthorized status negatively impacted their safety at work and resulted in a degree of alienation that exceeded the specific proscriptions of the law. Participants overwhelming used a strategy of disengagement to cope with the challenges they face as undocumented immigrants. CONCLUSION: This study describes the complex web of consequences resulting from undocumented status and its impact on occupational health. This study presents a framework connecting the daily work experiences of immigrants, the coping strategy of disengagement, and efforts to minimize the impact of structural violence.

Applying a typology of health worker migration to non-EU migrant doctors in Ireland.

BACKGROUND: Research on health worker migration in the Irish context has categorized migrant health workers by country or region of training (for example, non-EU nurses or doctors) or recruitment mechanism (for example, actively recruited nurses). This paper applies a new typology of health worker migrants - livelihood, career-oriented, backpacker, commuter, undocumented and returner migrants (European Observatory on Health Systems and Policies and WHO, vol. 2:129-152, 2014) - to the experiences of non-EU migrant doctors in Ireland and tests its utility for understanding health worker migration internationally. METHODS: The paper draws on quantitative survey (N = 366) and qualitative interview (N = 37) data collected from non-EU migrant doctors in Ireland between 2011 and 2013. RESULTS: Categorizing non-EU migrant doctors in Ireland according to the typology (European Observatory on Health Systems and Policies and WHO, vol. 2:129-152, 2014) offers insight into their differing motivations, particularly on arrival. Findings suggest that the career-oriented migrant is the most common type of doctor among non-EU migrant doctor respondents, accounting for 60 % (N = 220) of quantitative and 54 % (N = 20) of qualitative respondents. The authors propose a modification to the typology via the addition of two additional categories - the family migrant and the safety and security migrant. CONCLUSIONS: Employing a typology of health worker migration can facilitate a more comprehensive understanding of the migrant medical workforce, a necessary prerequisite for the development of useful policy tools (European Observatory on Health Systems and Policies and WHO, vol. 2:129-152, 2014). The findings indicate that there is some fluidity between categories, as health worker motivations change over time. This indicates the potential for policy levers to influence migrant health worker decision-making, if they are sufficiently "tuned in" to migrant health worker motivation.

International migration to Canada: the post-birth health of mothers and infants by immigration class.

There are over 214 million international migrants worldwide, half of whom are women, and all of them assigned by the receiving country to an immigration class. Immigration classes are associated with certain health risks and regulatory restrictions related to eligibility for health care. Prior to this study, reports of international migrant post-birth health had not been compared between immigration classes, with the exception of our earlier, smaller study in which we found asylum-seekers to be at greatest risk for health concerns. In order to determine whether refugee or asylum-seeking women or their infants experience a greater number or a different distribution of professionally-identified health concerns after birth than immigrant or Canadian-born women, we recruited 1127 migrant (and in Canada <5 years) women-infant pairs, defined by immigration class (refugee, asylum-seeker, immigrant, or Canadian-born). Between February 2006 and May 2009, we followed them from childbirth (in one of eleven birthing centres in Montreal or Toronto) to four months and found that at one week postpartum, asylum-seeking and immigrant women had greater rates of professionally-identified health concerns than Canadian-born women; and at four months, all three migrant groups had greater rates of professionally-identified concerns. Further, international migrants were at greater risk of not having these concerns addressed by the Canadian health care system. The current study supports our earlier findings and highlights the need for case-finding and services for international migrant women, particularly for psychosocial difficulties. Policy and program mechanisms to address migrants' needs would best be developed within the various immigration classes.

Análisis socioeconómico y demográfico de la prevalencia en niños infectados por el virus de la inmunodeficiencia humana por transmisión vertical en la Comunidad de Madrid / A socio-economic and demographic analysis of the prevalence of paediatric HIV due to vertical transmission in the Community of Madrid

España sigue siendo uno de los países con tasas más altas deincidencia del virus de la inmunodeficiencia humana (VIH)/sidaen Europa occidental. La Comunidad de Madrid es la zona másafectada por la infección, con un total de 17.667 casos de sidahasta diciembre de 2008, lo que representa el 23,9% de loscasos registrados en toda España. En dicha comunidad se identificaroncomo áreas básicas de transmisión los distritos delsur y del norte-este, especialmente Usera, Puente de Vallecas,San Blas y Hortaleza, con una mayor prevalencia en el númerode casos de transmisión vertical. También se observó un cambiorespecto al flujo migratorio en los diferentes distritos de laciudad, coincidiendo los distritos con mayor censo de inmigrantescon un registro superior de las tasas de prevalencia de lainfección por el VIH por transmisión vertical. La prevalencia decasos de VIH por transmisión vertical se correlacionó significativamentecon el porcentaje de los inmigrantes (p= –0,544; p=0,011), personas sin estudios (p= 0,487; p= 0,025), mujeres desempleadas(p= 0,477; p= 0,029) y población con una renta percápita baja (p= –0,508; p= 0,019). Por otra parte, cabe pensarque estas zonas sur y norte-este, a su vez, pueden ser franjasimportantes para la propagación de otras enfermedades infecciosas,por lo que la presente memoria podría contribuir aldesarrollo de estrategias efectivas para la educación sobre elVIH, en cuanto a la prevención de situaciones de riesgo(AU)

Spain continues to be one of the countries with the highest HIV/AIDS incidence rates in Western Europe. The Community of Madrid is the area most affected by the infection, with a total of 17,667 cases of AIDS until December 2008, accounting for 23.9% of the cases recorded on a nation level. The south and north-eastern districts of the aforementioned Community, and especially Usera, Puente de Vallecas, San Blas and Hortaleza, were identified as basic transmission areas with a higher prevalence of cases of vertical transmission. A change was also observed with regard to the migration flow in the different districts of the city, with the districts with the highest numbers of immigrants coinciding with those with the highest recorded prevalence rates of cases of vertically transmitted HIV. The prevalence of cases of vertically transmitted HIV was significantly correlated with the percentage of migrants (p= –0.544; p=0.011), people without degrees (p= 0.487; p= 0.025), un employed women (p= 0.477; p= 0.029) and populations with a low per capitain come (p= –0.508; p= 0.019). Moreover, this leads to the thought that these south and north-eastern districts may also be important areas for the spread of other infectious diseases and, therefore, this report may contribute to the development of effective strategies for HIV education as regards the prevention of risk situations (AU)

Características del fenómeno migratorio internacional en estudiantes de la Universidad Libre de Pereira / International migration characteristics in students at the Universidad Libre of Pereira

Objetivo: Definir las características del fenómeno migratorio internacional en los estudiantes de la Universidad Libre de Pereira Metodología: Se realizó un estudio descriptivo mediante la aplicación de una encuesta a 1734 estudiantes de todas las facultades y semestres de la universidad. Se aplico una prueba piloto a un grupo de 20 estudiantes seleccionados de cada una de las facultades. Se caracterizó el fenómeno por variables de persona y se indago sobre la frecuencia del fenómeno migratorio en el núcleo familiar de los estudiantes, el tipo de pariente y país de destino de los migrantes. Se investigó además sobre el grado de beneficio de las remesas y el tipo de apoyo solicitado a la universidad. Resultados: El porcentaje de estudiantes con familia migrante fue de 58.8 con una mayor proporción en la facultad de ciencias económicas y contables (66,9) seguida de la facultad de ciencias de la salud con 62,1. La prevalencia de parientes migrantes fue mayor en las estudiantes mujeres (62,3) que en los hombres (53,5) (p<0.05). El 40,1 de los estudiantes con familiares migrantes se beneficiaban de los dineros enviados desde el exterior y el apoyo más solicitado fue el certificado (44,8), seguido por la línea gratuita (18,1) y el Link (19,2); Conclusiones: Los resultados de la investigación generan debates y demandan acciones futuras, siendo necesario profundizar en el análisis del impacto de la migración internacional y de las remesas en la calidad de vida y bienestar de sus protagonistas (individuos, hogares y comunidades).

Objective: To define the characteristics of international migration in students at the Universidad Libre of Pereira Methodology: A descriptive study was conducted by applying a survey to 1734 university students from all faculties and semesters. A pilot study was applied to a group of 20 students selected from each of the faculties. The phenomenon was characterized by variables of person and inquired about the frequency of the student´s family migration, type of relative and destination country for migrants. The level of profit remittances and the type of support requested from the university, was also investigated. Results: The percentage of students with migrant family was 58.8 with a higher proportion in the faculty of economics and accounting (66.9), followed by the faculty of health sciences with 62.1. The prevalence of migrant relatives was higher in female students (62.3) than men (53.5) (p<0.05). 40.1 of the students with migrant families benefited from the money sent from abroad and the encouragement of the certificate was requested (44.8), followed by the toll-free (18.1) and Link (19.2). Conclusions: The research results generated debates and demand further action. Further analysis of the impact of international migration and remittances in the quality of life and welfare of their players (individuals, households and communities,) must be taken into account.

Tracking human travel using stable oxygen and hydrogen isotope analyses of hair and urine.

The stable oxygen and hydrogen isotope compositions of organic samples are increasingly being used to investigate patterns of animal migration. Relatively few studies have applied these techniques to modern humans, despite a variety of potential forensic applications. We analyzed drinking water and food at two geographic locations, East Greenbush, New York (USA) and Fairbanks, Alaska (USA), with different delta(18)O and deltaD values for precipitation and tap water. Foods varied widely in measured delta(18)O and deltaD values, but not systematically by purchase location. We measured delta(18)O and deltaD values of scalp hair from five residents at each location. We used a mixing model to establish the proportion of oxygen and hydrogen in head hair derived from drinking water ( approximately 27% and approximately 36%, respectively). Finally, we analyzed the delta(18)O and deltaD values of facial hair and urine from a subject who traveled from Fairbanks to East Greenbush, on to the UK and back to Fairbanks. Urine delta(18)O and deltaD values responded immediately and strongly to travel-related change in drinking water, and were well described by a single-pool turnover model. Beard hair delta(18)O values tracked changes in urine delta(18)O closely, and oscillated between the values for the resident populations in both locations. In contrast, beard hair deltaD values did not track changes in urine deltaD as well, and retained a signature of the traveler's permanent residence. Our findings show that the delta(18)O and deltaD values of urine and facial hair (specifically delta(18)O) can provide a record of the geographical movements of humans.

Impact on and use of an inner-city London Infectious Diseases Department by international migrants: a questionnaire survey.

BACKGROUND: The UK has witnessed a considerable increase in immigration in the past decade. Migrant may face barriers to accessing appropriate health care on arrival and the current focus on screening certain migrants for tuberculosis on arrival is considered inadequate. We assessed the implications for an inner-city London Infectious Diseases Department in a high migrant area. METHODS: We administered an anonymous 20-point questionnaire survey to all admitted patients during a 6 week period. Questions related to sociodemographic characteristics and clinical presentation. Analysis was by migration status (UK born vs overseas born). RESULTS: 111 of 133 patients completed the survey (response rate 83.4%). 58 (52.2%) were born in the UK; 53 (47.7%) of the cohort were overseas born. Overseas-born were over-represented in comparison to Census data for this survey site (47.7% vs 33.6%; proportional difference 0.142 [95% CI 0.049-0.235]; p = 0.002): overseas born reported 33 different countries of birth, most (73.6%) of whom arrived in the UK pre-1975 and self-reported their nationality as British. A smaller number (26.4%) were new migrants to the UK (< or =10 years), mostly refugees/asylum seekers. Overseas-born patients presented with a broad range and more severe spectrum of infections, differing from the UK-born population, resulting in two deaths in this group only. Presentation with a primary infection was associated with refugee/asylum status (n = 8; OR 6.35 [95% CI 1.28-31.50]; p = 0.023), being a new migrant (12; 10.62 [2.24-50.23]; p = 0.003), and being overseas born (31; 3.69 [1.67-8.18]; p = 0.001). Not having registered with a primary-care physician was associated with being overseas born, being a refugee/asylum seeker, being a new migrant, not having English as a first language, and being in the UK for < or =5 years. No significant differences were found between groups in terms of duration of illness prior to presentation or duration of hospitalisation (mean 11.74 days [SD 12.69]). CONCLUSION: Migrants presented with a range of more severe infections, which suggests they face barriers to accessing appropriate health care and screening both on arrival and once settled through primary care services. A more organised and holistic approach to migrant health care is required.

Chinese and white Canadian satisfaction and compliance with physicians.

BACKGROUND: Patient satisfaction has become an important indicator of primary care and healthcare system performance. Ethnic disparities in patient satisfaction and compliance with physician care have been studied in several countries. However, this issue has not received significant attention in Canada. The unique characteristics of the Canadian healthcare system and ethnic population make it worthwhile to examine this issue in this population. Therefore, we conducted a survey among Chinese and Whites in a Canadian city to determine their reported satisfaction, and perceptions of physicians. METHODS: The survey was conducted in English, Mandarin and Cantonese in 2005 among Chinese and White Canadians, 18 years of age or older, who had visited at least one physician in Canada. RESULTS: We analyzed 746 Chinese and 711 Whites in the general practitioner (GP) visit group and 485 Chinese and 637 Whites in the specialist visit group. A lower proportion of Chinese compared to Whites reported that they were very satisfied or satisfied with GP (73.7% vs. 92.8%) and specialist care (75.5% vs. 85.6%) and the differences between the two groups remained after adjustment for demographic variables and chronic conditions (risk adjusted OR: 0.70, 95%CI: 0.42-1.18 for the GP visit group and OR: 0.77, 95%CI: 0.48-1.23 for the specialist visit group). A similar proportion of Chinese and Whites reported that they always followed a physician's advice (59.4% vs. 59.6% for the GP visit group and 67.2% vs. 62.8% for the specialist visit group). Non-English speaking Chinese and recent arrivals in Canada were less likely to be satisfied with GPs than Chinese born in Canada [risk adjusted OR: 0.5, 95%CI: 0.3-0.9, 0.2 and 0.1-0.7, respectively]. CONCLUSION: Chinese Canadians reported lower satisfaction with physicians and perceived physicians slightly more negatively than White Canadians. Particularly, Chinese with limited English and short length of stay in Canada were less satisfied than Canadian born Chinese.

Impact of immigration on the cost of emergency visits in Barcelona (Spain).

BACKGROUND: The impact of immigration on health services utilisation has been analysed by several studies performed in countries with lower levels of immigration than Spain. These studies indicate that health services utilisation is lower among the immigrant population than among the host population and that immigrants tend to use hospital emergency services at the expense of primary care. We aimed to quantify the relative over-utilisation of emergency services in the immigrant population. METHODS: Emergency visits to Hospital del Mar in Barcelona in 2002 and 2003 were analysed. The country of origin, gender, age, discharge-related circumstances (hospital admission, discharge to home, or death), medical specialty, and variable cost related to medical care were registered. Immigrants were grouped into those from high-income countries (IHIC) and those from low-income countries (ILIC) and the average direct cost was compared by country of origin. A multivariate linear mixed model of direct costs was adjusted by country of origin (classified in five groups) and by the individual variables of age, gender, hospital admission, and death as a cause of discharge. Medical specialty was considered as a random effect. RESULTS: With the exception of gynaecological emergency visits, costs resulting from emergency visits by both groups of immigrants were lower than those due to visits by the Spanish-born population. This effect was especially marked for emergency visits by adults. CONCLUSION: Immigrants tend to use the emergency department in preference to other health services. No differences were found between IHIC and ILIC, suggesting that this result was due to the ease of access to emergency services and to lack of knowledge about the country's health system rather than to poor health status resulting from immigrants' socioeconomic position. The use of costs as a variable of complexity represents an opportunistic use of a highly exhaustive registry, which is becoming ever more frequent in hospitals and which overcomes the lack of clinical information related to outpatient activity.

Quality of race, Hispanic ethnicity, and immigrant status in population-based cancer registry data: implications for health disparity studies.

Population-based cancer registry data from the Surveillance, Epidemiology, and End Results (SEER) Program at the National Cancer Institute are based on medical records and administrative information. Although SEER data have been used extensively in health disparities research, the quality of information concerning race, Hispanic ethnicity, and immigrant status has not been systematically evaluated. The quality of this information was determined by comparing SEER data with self-reported data among 13,538 cancer patients diagnosed between 1973-2001 in the SEER--National Longitudinal Mortality Study linked database. The overall agreement was excellent on race (kappa = 0.90, 95% CI = 0.88-0.91), moderate to substantial on Hispanic ethnicity (kappa = 0.61, 95% CI = 0.58-0.64), and low on immigrant status (kappa = 0.21. 95% CI = 0.10, 0.23). The effect of these disagreements was that SEER data tended to under-classify patient numbers when compared to self-identifications, except for the non-Hispanic group which was slightly over-classified. These disagreements translated into varying racial-, ethnic-, and immigrant status-specific cancer statistics, depending on whether self-reported or SEER data were used. In particular, the 5-year Kaplan-Meier survival and the median survival time from all causes for American Indians/Alaska Natives were substantially higher when based on self-classification (59% and 140 months, respectively) than when based on SEER classification (44% and 53 months, respectively), although the number of patients is small. These results can serve as a useful guide to researchers contemplating the use of population-based registry data to ascertain disparities in cancer burden. In particular, the study results caution against evaluating health disparities by using birthplace as a measure of immigrant status and race information for American Indians/Alaska Natives.

XLII Reunión de la Asociación Española de Psiquiatría Infanto-juvenil: Bilbao, 31 de mayo - 2 de junio, 2007 / No disponible

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Estrés crónico y salud mental en los menores inmigrantes / No disponible

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[Name-based identification of cases of Turkish origin in the childhood cancer registry in Mainz]. / Namensbasierte Identifizierung von Fällen mit türkischer Herkunft im Kinderkrebsregister Mainz.

Until now few analyses of routine data relating to the health of migrants have been conducted in Germany. A major obstacle is that most data sources do not provide reliable information on the origin of migrants. While some sources contain the nationality of persons registered, this information does not allow one to identify migrants who have taken up German citizenship, i.e., a substantial part of second-generation migrants. In this paper we demonstrate how a computer-aided, name-based algorithm can be used to identify persons of Turkish origin in the German Childhood Cancer Registry in Mainz, Germany. The performance of the algorithm, as assessed against the gold standard of assessing names manually, was very good (sensitivity and specificity > or = 0.975). In total, we identified 1774 of the 37,259 cases in the registry as being of Turkish origin. The name algorithm proved to be a useful tool to identify Turkish migrants in routine data sources, thus avoiding potential bias due to changes in citizenship. This approach aims at improving migrant-sensitive health reporting and research in Germany. In future, additional information on migrant status should be obtained already during primary data collection so that health data for all migrant groups can be provided.

Immigrants and the cost of medical care.

Foreign-born adults in Los Angeles County, California, constituted 45 percent of the county's population ages 18-64 but accounted for 33 percent of health spending in 2000. Similarly, the undocumented constituted 12 percent of the nonelderly adult population but accounted for only 6 percent of spending. Extrapolating to the nation, total spending by the undocumented is 6.4 billion dollars , of which only 17 percent (1.1 billion dollars) is paid for by public sources. The foreign-born (especially the undocumented) use disproportionately fewer medical services and contribute less to health care costs in relation to their population share, likely because of their better relative health and lack of health insurance.

Pregnancy in immigrant women.

OBJECTIVE: We wanted to study how foreign women face pregnancy and childbirth in a society quite different from their own. METHODS: In 2004 we studied 328 pregnant women at the Department of Gynaecology at the "General Hospital Umberto I" in Rome. Information on patients' personal lives and experiences was collected. RESULTS: Women were classified into six (6) groups based on nationality, race, religion and culture. CONCLUSIONS: Arabian women had the most natural childbirths. African women had a longer duration of gestation. Women from Eastern Europe underwent frequent tests and examinations, but had the highest chance of having preterm births. Chinese women did not usually undergo many examinations and were able to tolerate pain during childbirth quite well.

Asian health in New Zealand--progress and challenges.

The recent increase in the population classed as 'Asian' in New Zealand (now 9.5%) has seen the establishment of an 'Asian health' platform with activities by academic institutions, service providers, and community organisations. However, Asian health remains outside the frames of reference for most health professionals. Three recent reports provide the first large-scale systematic data about the health of Asian peoples in New Zealand. These reports identify the problem of 'averaging' if the whole Asian category is used. Key health concerns include access to health services; cardiovascular disease, and diabetes for Indian peoples; levels of physical activity; and mental health, particularly in young people. Asian peoples born in New Zealand are less healthy than recent migrants classified as Asian. This 'healthy immigrant effect' abates with length of settlement in New Zealand. Despite these identified issues, there is a policy void for the health of Asian peoples in New Zealand, with no clear mandate to consider or monitor Asian peoples when undertaking research or formulating policy. Explicit engagement, policy, and service development for this significant and diverse part of the population should build on the agenda laid out by the recent advances in knowledge about Asian health in New Zealand.

A comparison of the mental health of refugees with temporary versus permanent protection visas.

OBJECTIVES: To determine the impact of the Australian provisions for temporary rather than permanent protection for asylum seekers found to be genuine refugees. DESIGN AND SETTING: A comparison of the mental health of Persian-speaking refugees with temporary (n = 49) versus permanent (n = 67) protection visas attending an early intervention program in Sydney, New South Wales, 2002-03. MEASURES: Standard measures were used to assess past trauma, detention experiences, postmigration stresses, symptoms of post-traumatic stress disorder (PTSD), anxiety, depression and functional impairment. RESULTS: The two groups had experienced similar levels of past trauma and persecution. Nevertheless, holders of temporary protection visas (TPVs) returned higher scores on three psychiatric symptom measures (P < 0.001). Multivariate analyses showed that TPV status was the strongest predictor of anxiety, depression and particularly PTSD. Further analyses suggested that, for TPV holders, experience of past stresses in detention in Australia and ongoing living difficulties after release contributed to adverse psychiatric outcomes. CONCLUSIONS: The sequence of postmigration stresses experienced by TPV holders appears to impact adversely on their mental health.

Demographic, migration status, and work-related changes in Asian female sex workers surveyed in Sydney, 1993 and 2003.

OBJECTIVE: To compare demography, sexual health awareness, migration and workplace conditions of Asian female sex workers in Sydney in 1993 and 2003. METHOD: A Chinese interpreter and a Thai-speaking health education officer (HEO) were used to administer a questionnaire survey to Thai- and Chinese-speaking sex workers attending sexual health clinics in 1993. A follow-up survey, which included some women contacted at work as well as clinic attenders, was administered by Thai- and Chinese-speaking HEOs in 2003. RESULTS: Ninety-one female sex workers were surveyed in 1993 and 165 in 2003. Median age increased (26 years vs. 33 years, p=0.000), as did numbers of Chinese- versus Thai-speakers (1993, 25.3% Chinese vs. 2003, 58.2% Chinese, p=0.000). In 2003, the women reported more years of schooling and better English skills. Fewer reported previous sex work (48.4% vs. 17.6%, p=0.000). Numbers currently or ever on a contract decreased sharply (27.5% vs. 9.1%, p=0.000) and the majority were apparently working legally. Condom use at work for vaginal (51.6% vs. 84.8%) and oral sex (39.6% vs. 66.1%) increased significantly (p=0.001). Chinese-speaking sex workers were less informed about HIV transmission and safer sex practices than were Thai sex workers. Drug and alcohol use was low. CONCLUSIONS AND IMPLICATIONS: Positive changes have occurred in the conditions of Asian female sex workers surveyed over 10 years in Sydney. Maintaining current levels of health service delivery will ensure continued improvements in health and workplace conditions and address inequalities between language groups.