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1.
MMWR Morb Mortal Wkly Rep ; 69(11): 286-289, 2020 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-32191684

RESUMO

Since 1989, the United States has pursued a goal of eliminating tuberculosis (TB) through a strategy of rapidly identifying and treating cases and evaluating exposed contacts to limit secondary cases resulting from recent TB transmission (1). This strategy has been highly effective in reducing U.S. TB incidence (2), but the pace of decline has significantly slowed in recent years (2.2% average annual decline during 2012-2017 compared with 6.7% during 2007-2012) (3). For this report, provisional 2019 data reported to CDC's National Tuberculosis Surveillance System were analyzed to determine TB incidence overall and for selected subpopulations and these results were compared with those from previous years. During 2019, a total of 8,920 new cases were provisionally reported in the United States, representing a 1.1% decrease from 2018.* TB incidence decreased to 2.7 cases per 100,000 persons, a 1.6% decrease from 2018. Non-U.S.-born persons had a TB rate 15.5 times greater than the rate among U.S.-born persons. The U.S. TB case count and rate are the lowest ever reported, but the pace of decline remains slow. In recent years, approximately 80% of U.S. TB cases have been attributed to reactivation of latent TB infection (LTBI) acquired years in the past, often outside the United States (2). An expanded TB elimination strategy for this new decade should leverage existing health care resources, including primary care providers, to identify and treat persons with LTBI, without diverting public health resources from the continued need to limit TB transmission within the United States. Partnerships with health care providers, including private providers, are essential for this strategy's success.


Assuntos
Erradicação de Doenças , Vigilância da População , Tuberculose/epidemiologia , Tuberculose/prevenção & controle , Adulto , Emigrantes e Imigrantes/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Metas , Humanos , Incidência , Tuberculose/etnologia , Estados Unidos/epidemiologia
3.
Rev Saude Publica ; 54: 20, 2020.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32074219

RESUMO

OBJECTIVE: To compare the access to and effective use of health services available among international migrants and Chileans. METHODS: Secondary analysis of the National Socioeconomic Characterization Survey (CASEN - Caracterización Socioeconómica Nacional ), version 2017. Indicators of access to the health system (having health insurance) and effective use of health services (perceived need, appointment or coverage, barriers and need satisfaction) were described in immigrants and local population, self-reported. Gaps by immigrant status were estimated using logistic regressions, with complex samples. RESULTS: Immigrants were 7.5 times more likely to have no health insurance than local residents. Immigrants presented less perceived need than local residents, together with a greater lack of appointments (OR: 1.7 95%CI: 1.2-2.5), coverage (OR: 2.7 95%CI: 2.0-3.7) and unsatisfied need. The difference between immigrants and locals was not statistically significant in barriers to health care access (α = 0.005). CONCLUSIONS: Disadvantages persist regarding the access to and use of health services by immigrants as opposed to Chileans compared with information from previous years. It is necessary to reduce the gaps between immigrants and people born in Chile, especially in terms of health system access. This is the first barrier to effective use of services. The generation of concrete strategies and health policies that consider an approach of social participation of the immigrant community is suggested to bring the health system closer to this population.


Assuntos
Emigrantes e Imigrantes/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Determinação de Necessidades de Cuidados de Saúde/estatística & dados numéricos , Política Pública , Chile , Estudos Transversais , Feminino , Disparidades nos Níveis de Saúde , Inquéritos Epidemiológicos , Humanos , Masculino , Características de Residência , População Rural/estatística & dados numéricos , Autorrelato , Fatores Socioeconômicos , Migrantes/estatística & dados numéricos , População Urbana/estatística & dados numéricos
4.
BMC Public Health ; 20(1): 27, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31914960

RESUMO

BACKGROUND: Africans immigrants in the United States are the least-studied immigrant group, despite the research and policy efforts to address health disparities within immigrant communities. Although their healthcare experiences and needs are unique, they are often included in the "black" category, along with other phenotypically-similar groups. This process makes utilizing research data to make critical healthcare decisions specifically targeting African immigrants, difficult. The purpose of this Scoping Review was to examine extant information about African immigrant health in the U.S., in order to develop lines of inquiry using the identified knowledge-gaps. METHODS: Literature published in the English language between 1980 and 2016 were reviewed in five stages: (1) identification of the question and (b) relevant studies, (c) screening, (d) data extraction and synthesis, and (e) results. Databases used included EBSCO, ProQuest, PubMed, and Google Scholar (hand-search). The articles were reviewed according to title and abstract, and studies deemed relevant were reviewed as full-text articles. Data was extracted from the selected articles using the inductive approach, which was based on the comprehensive reading and interpretive analysis of the organically emerging themes. Finally, the results from the selected articles were presented in a narrative format. RESULTS: Culture, religion, and spirituality were identified as intertwined key contributors to the healthcare experiences of African immigrants. In addition, lack of culturally-competent healthcare, distrust, and complexity, of the U.S. health system, and the exorbitant cost of care, were identified as major healthcare access barriers. CONCLUSION: Knowledge about African immigrant health in the U.S. is scarce, with available literature mainly focusing on databases, which make it difficult to identify African immigrants. To our knowledge, this is the first Scoping Review pertaining to the healthcare experiences and needs of African immigrants in the U.S.


Assuntos
Atitude Frente a Saúde , Emigrantes e Imigrantes/psicologia , Necessidades e Demandas de Serviços de Saúde , África/etnologia , Emigrantes e Imigrantes/estatística & dados numéricos , Humanos , Estados Unidos
5.
BMC Public Health ; 20(1): 26, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31914967

RESUMO

BACKGROUND: From 2000 to 2008, in urban areas in Spain, adolescent fertility and abortion rates underwent unprecedented increases, consecutive to intensive immigration from developing countries. To address unmet needs for contraception information and services, a community-based, gender-sensitive and culturally adapted brief counselling intervention (SIRIAN program) was launched in some deprived neighbourhoods with a high proportion of immigrants in Barcelona. Once a randomized controlled trial demonstrated its effectiveness in increasing the use of contraceptives, we aim to examine its population impact on adolescent fertility rates. METHODS: Quasi-experimental study with comparison group, using population data from 2005 to 2016. Five neighbourhoods in the lowest tercile of Disposable Household Income were intervened in 2011-13. The comparison group included the three neighbourhoods which were in the same municipal district and in the lowest Disposable Household Income tercile, and displayed the highest adolescent fertility rates. Generalized linear models were fitted to assess absolute adolescent fertility rates and adjusted by immigrant population between pre-intervention (2005-10) and post-intervention periods (2011-16); Difference in Differences and relative pre-post changes analysis were performed. RESULTS: In 2005-10 the intervention group adolescent fertility rate was 27.90 (per 1000 women 15-19) and 21.84 in the comparison group. In 2011-16 intervention areas experienced great declines (adolescent fertility rate change: - 12.30 (- 12.45 to - 12.21); p < 0.001), while comparison neighbourhoods remained unchanged (adolescent fertility rate change: 1.91 (- 2.25 to 6.07); p = 0.368). A reduction of - 10.97 points (- 13.91 to - 8.03); p < 0.001) is associated to the intervention. CONCLUSION: Adolescent fertility rate significantly declined in the intervention group but remained stable in the comparison group. This quasi-experimental study provide evidence that, in a country with universal health coverage, a community counselling intervention that increases access to contraception, knowledge and sexual health care in hard-to-reach segments of the population can contribute to substantially reduce adolescent fertility rates. Reducing adolescent fertility rates could become a feasible goal in cities with similar conditions.


Assuntos
Coeficiente de Natalidade/tendências , Serviços de Saúde Comunitária , Anticoncepção/psicologia , Aconselhamento , Adolescente , Cidades , Anticoncepção/estatística & dados numéricos , Anticoncepcionais/administração & dosagem , Emigrantes e Imigrantes/psicologia , Emigrantes e Imigrantes/estatística & dados numéricos , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Áreas de Pobreza , Gravidez , Avaliação de Programas e Projetos de Saúde , Características de Residência/estatística & dados numéricos , Espanha , Adulto Jovem
6.
BMC Public Health ; 20(1): 31, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31918699

RESUMO

BACKGROUND: People in socially disadvantaged groups face a myriad of challenges to their health. Discrimination, based on group status such as gender, immigration generation, race/ethnicity, or religion, are a well-documented health challenge. However, less is known about experiences of discrimination specifically within healthcare settings, and how it may act as a barrier to healthcare. METHODS: Using data from a nationally representative survey of France (N = 21,761) with an oversample of immigrants, we examine rates of reported discrimination in healthcare settings, rates of foregoing healthcare, and whether discrimination could explain disparities in foregoing care across social groups. RESULTS: Rates of both reporting discrimination within healthcare and reporting foregone care in the past 12 months were generally highest among women, immigrants from Africa or Overseas France, and Muslims. For all of these groups, experiences of discrimination potentially explained significant proportions of their disparity in foregone care (Percent disparity in foregone care explained for: women = 17%, second-generation immigrants = 8%, Overseas France = 13%, North Africa = 22%, Sub-Saharan Africa = 32%, Muslims = 26%). Rates of foregone care were also higher for those of mixed origin and people who reported "Other Religion", but foregone healthcare was not associated with discrimination for those groups. CONCLUSIONS: Experiences of discrimination within the healthcare setting may present a barrier to healthcare for people that are socially disadvantaged due to gender, immigration, race/ethnicity, or religion. Researchers and policymakers should consider barriers to healthcare that lie within the healthcare experience itself as potential intervention targets.


Assuntos
Assistência à Saúde , Acesso aos Serviços de Saúde , Preconceito , Populações Vulneráveis/psicologia , Adolescente , Adulto , África ao Sul do Saara/etnologia , África do Norte/etnologia , Emigrantes e Imigrantes/psicologia , Emigrantes e Imigrantes/estatística & dados numéricos , Feminino , França , Pesquisas sobre Serviços de Saúde , Humanos , Islamismo/psicologia , Masculino , Pessoa de Meia-Idade , Racismo , Sexismo , Fatores Sociológicos , Populações Vulneráveis/estatística & dados numéricos , Adulto Jovem
7.
BMC Public Health ; 20(1): 38, 2020 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-31924196

RESUMO

BACKGROUND: Families resettling to the U.S. from conflict-affected countries in the Middle East and North Africa (MENA) face countless challenges. These families must cope with experiences of armed conflict and forced migration while also assimilating to a new society. According to the 'immigrant paradox,' time spent in a new country can compound the effects of migration and assimilation challenges and lead to deteriorated mental health. This study aims to assess the psychosocial wellbeing of MENA-born or first-generation adolescents attending school in the Detroit metropolitan area (DMA) to understand how schools, families, and communities play a role in supporting these adolescents' wellbeing. METHODS: The quantitative component of this mixed methods study will involve a self-administered survey with a sample of students whose responses will be linked to academic records and behavioral assessments. The survey will utilize validated instruments to measure depressive and anxiety symptoms (Hopkins Symptom Checklist-37A), hope (Children's Hope Scale), resilience (Child and Youth Resilience Measure-12), externalizing and prosocial behavior (Hopkins Symptom Checklist-37A, Strengths and Difficulties Questionnaire), school belonging (Psychological Sense of School Membership), and peer relationships (Multidimensional Scale of Perceived Social Support). Differences in outcomes will be analyzed across two strata: students born in the MENA region and first-generation students whose parents immigrated to the US from the MENA region. The qualitative component will involve semi-structured key informant interviews with parents, school administrators, educators, and mental health providers, and focus group discussions (FGDs) with a purposive sample of adolescents born - or whose parents were born - in the MENA region. The FGDs will include a participatory ranking activity where participants will be asked to free-list and rank ideas about how schools can better support students like them. Thematic content analysis will be conducted to identify common themes. DISCUSSION: This study will contribute evidence about the wellbeing of adolescents who come from - or whose parents come from - conflict-affected countries currently living in the U.S. Findings can be used to inform program and policy development to enable schools and their community partners to serve this population more effectively.


Assuntos
Conflitos Armados/psicologia , Emigrantes e Imigrantes/psicologia , Transtornos Mentais/epidemiologia , Refugiados/psicologia , Apoio Social , Aculturação , Adaptação Psicológica , Adolescente , África do Norte/etnologia , Cidades , Estudos Transversais , Emigrantes e Imigrantes/estatística & dados numéricos , Família/psicologia , Feminino , Humanos , Masculino , Michigan/epidemiologia , Oriente Médio/etnologia , Pesquisa Qualitativa , Refugiados/estatística & dados numéricos , Instituições Acadêmicas , Estudantes/psicologia , Estudantes/estatística & dados numéricos , Inquéritos e Questionários
8.
BMC Public Health ; 20(1): 42, 2020 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-31924212

RESUMO

BACKGROUND: Overweight and obesity are important risk factors for chronic non-communicable diseases, and their prevalence is on the rise worldwide. This study seeks to describe the prevalence and predictors of overweight and obesity in Brazilian immigrants living in Massachusetts, United States of America (USA). METHODS: Modeled after a survey on behavioral risk factors for chronic disease conducted annually in Brazil (Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico: Vigitel), Brazilian immigrants aged 18+ (n = 361) were surveyed between December 2013 and March 2014. Information was obtained from consenting participants regarding their demographic characteristics, physical activity, dietary and lifestyle habits, and other behavioral risk factors. Weight status was estimated from body mass index (BMI), calculated from self-reported height and weight data. Participants were categorized as overweight/obese if their BMI was ≥25; overweight and obese categories were combined to ensure appropriate sample size. Prevalence of overweight/obesity was estimated using STATA, and significant predictors were identified via multi-variable logistic regression. Odds ratio (OR), 95% confidence intervals (95% CI) and p-values were determined. RESULTS: The overall prevalence of overweight/obesity in the sample was 47.6%. Significant predictors of overweight and obesity were gender (men OR 2.30, 95% CI: 1.10, 3.78; women are comparison group), working in the 3 months prior to the survey (OR 2.90, 95% CI: 1.01, 8.30), and longer duration living in the USA (OR per additional year 1.06, 95% CI: 1.02, 1.11). Significant dietary predictors of overweight/obesity included 5 or more days per week of consumption of red meat (OR red meat 3.70, 95% CI: 1.47, 9.26) or of sweetened beverages, like soft drinks also known as soda (OR soda 2.40, 95% CI: 1.00, 5.78) compared with less frequent consumption of these foods. CONCLUSIONS: This study suggests that long duration of time lived in the USA increases odds of overweight and obesity for Brazilian immigrants living in Massachusetts. Efforts to curb increases in overweight and obesity in this population should focus not only on the men and those who work but also the women. Possible intervention measures should target soda (soft drink) and red meat consumption in Brazilian immigrants.


Assuntos
Emigrantes e Imigrantes/estatística & dados numéricos , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Aculturação , Adolescente , Adulto , Idoso , Brasil/etnologia , Dieta/efeitos adversos , Dieta/estatística & dados numéricos , Feminino , Humanos , Masculino , Massachusetts/epidemiologia , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Adulto Jovem
9.
BMC Infect Dis ; 20(1): 76, 2020 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-31992216

RESUMO

BACKGROUND: Following migration from Schistosoma and Strongyloides endemic to non-endemic regions, people remain at high risk for adverse sequelae from these chronic infections. HIV co-infected persons are particularly vulnerable to the serious and potentially fatal consequences of untreated helminth infection. While general screening guidelines exist for parasitic infection screening in immigrant populations, they remain silent on HIV positive populations. This study assessed the seroprevalence, epidemiology and laboratory characteristics of these two parasitic infections in a non-endemic setting in an immigrant/refugee HIV positive community. METHODS: Between February 2015 and 2018 individuals born outside of Canada receiving care at the centralized HIV clinic serving southern Alberta, Canada were screened by serology and direct stool analysis for schistosomiasis and strongyloidiasis. Canadian born persons with travel-based exposure risk factors were also screened. Epidemiologic and laboratory values were analyzed using bivariate logistic regression. We assessed the screening utility of serology, direct stool analysis, eosinophilia and hematuria. RESULTS: 253 HIV positive participants were screened. The prevalence of positive serology for Schistosoma and Strongyloides was 19.9 and 4.4%, respectively. Age between 40 and 50 years (OR 2.50, 95% CI 1.13-5.50), refugee status (3.55, 1.72-7.33), country of origin within Africa (6.15, 2.44-18.60), eosinophilia (3.56, 1.25-10.16) and CD4 count < 200 cells/mm3 (2.46, 1.02-5.92) were associated with positive Schistosoma serology. Eosinophilia (11.31, 2.03-58.94) was associated with positive Strongyloides serology. No Schistosoma or Strongyloides parasites were identified by direct stool microscopy. Eosinophilia had poor sensitivity for identification of positive serology. Hematuria was not associated with positive Schistosoma serology. CONCLUSION: Positive Schistosoma and Strongyloides serology was common in this migrant HIV positive population receiving HIV care in Southern Alberta. This supports the value of routine parasitic screening as part of standard HIV care in non-endemic areas. Given the high morbidity and mortality in this relatively immunosuppressed population, especially for Strongyloides infection, screening should include both serologic and direct parasitological tests. Eosinophilia and hematuria should not be used for Schistosoma and Strongyloides serologic screening in HIV positive migrants in non-endemic settings.


Assuntos
Esquistossomose/epidemiologia , Estrongiloidíase/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Adulto , Alberta/epidemiologia , Contagem de Linfócito CD4 , Estudos Transversais , Emigrantes e Imigrantes/estatística & dados numéricos , Eosinofilia/parasitologia , Fezes/parasitologia , Feminino , Infecções por HIV/parasitologia , Humanos , Hospedeiro Imunocomprometido , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Prevalência , Refugiados/estatística & dados numéricos , Estudos Soroepidemiológicos , Viagem
10.
J Forensic Sci ; 65(1): 103-111, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31404476

RESUMO

This study analyzes postmortem records from 260 homicide cases autopsied by the Department of Forensic Medicine in Rome from 2000 to 2014. The victims were mainly males (74%) and young (61% aged from 21 to 50 years). Although the victims were mostly Italians, the number of foreign victims (33%) has increased since 1990, primarily due to immigration. The offenders frequently used firearms (39%), particularly in multiple murders. An increase in blunt (20%) and sharp force (32%) weapons was also seen. The primary crime scene was residential (42%), and the head was the most frequently injured body region. Male victims occurred frequently in the context of organized crime (7.6%). In family or intimate-sexual relationships, women were the majority of victims (8%). Forensic pathologists play an important role during investigation. They should consider all the information available to them, including autopsy information, crime scene information, and crime investigation data.


Assuntos
Vítimas de Crime/estatística & dados numéricos , Homicídio/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Emigrantes e Imigrantes/estatística & dados numéricos , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Motivação , Distribuição por Sexo , Suicídio/estatística & dados numéricos , Armas/estatística & dados numéricos , Ferimentos e Lesões/mortalidade , Adulto Jovem
11.
Medicine (Baltimore) ; 98(52): e18481, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876734

RESUMO

To study the clinical presentation of Chronic Schistosomiasis (CS) in immigrants from East Africa to Israel and the tests that were useful in confirming the diagnosis.A retrospective study of all medical notes pertaining to hospitalized patients who were immigrants from East Africa with a pathological or microscopic confirmation of CS. Literature review was also conducted focusing on diagnosis of schistosomiasis among immigrants from endemic countries.We identified 32 suspected and 11 confirmed cases of CS. Most of the patients (82%) presented with gastrointestinal symptoms. Sensitivity of stool smear, serology and tissue diagnosis (by histopathology or microscopy) were 14%, 100%, 89%, respectively. Patients have undergone extensive diagnostic evaluation with long hospitalization stays (median 10 days, range 4 to 33 days).CS has multiple presentations and is seen in Israel among refugees from Eritrea and Sudan. Most of the manifestations are gastrointestinal, suggestive of infection with Schistosoma mansoni (S. mansoni). Standard diagnostic techniques used in endemic countries, such as microscopy for ova and parasites were unhelpful, necessitating more advanced procedures like colonoscopic or liver biopsy. We propose a diagnostic algorithm for CS in this patient population in order to make an accurate diagnosis and avoid unnecessary invasive procedures.


Assuntos
Emigrantes e Imigrantes , Esquistossomose/epidemiologia , Adulto , África Oriental/etnologia , Animais , Doença Crônica , Emigrantes e Imigrantes/estatística & dados numéricos , Feminino , Humanos , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Schistosoma , Schistosoma mansoni , Esquistossomose/parasitologia , Esquistossomose/patologia , Esquistossomose mansoni/epidemiologia , Adulto Jovem
12.
BMC Public Health ; 19(1): 1697, 2019 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-31852465

RESUMO

BACKGROUND: In Germany, the term 'migration background' has been established to differentiate between immigrants and natives. In the present study post-traumatic stress disorder (PTSD), anxiety, and depression were analysed in immigrant populations in Germany by considering self-attribution as well as attribution by others on one's own 'migration background'. METHODS: In a population-based survey (N = 2317), socio-demographic characteristics, migration background (official statistics definition vs. self-attribution as well as the anticipated attribution by others), PTSD (PCL-5), and symptoms of anxiety and depression (PHQ-4) were assessed. Logistic regression models were applied to predict mental health outcomes by considering socio-demographic and immigration-related factors. RESULTS: A total of 10.7% of respondents (N = 248) had a 'migration background'. Immigrants of the 2nd generation compared to 1st generation immigrants are less likely to see themselves as immigrants. Attribution as an immigrant (self and/or by others) was found as significant predictor for PTSD and depression, but not anxiety. CONCLUSIONS: It seems useful to focus on immigration-related factors considering subjective perspectives and not only comparing immigrants and natives using a federal statistics definition. Our findings suggest that research on the association between immigration-related factors such as attribution as an immigrant and mental health outcomes might be a promising approach to better identify subgroups at higher risk of mental distress.


Assuntos
Transtorno Depressivo/epidemiologia , Emigrantes e Imigrantes/psicologia , Emigrantes e Imigrantes/estatística & dados numéricos , Saúde Mental/estatística & dados numéricos , Percepção Social , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Alemanha/epidemiologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Adulto Jovem
13.
Rev Med Chil ; 147(8): 1042-1052, 2019 Aug.
Artigo em Espanhol | MEDLINE | ID: mdl-31859970

RESUMO

BACKGROUND: Recent data suggest an increase in tuberculosis (TB) incidence in Chile. AIM: To evaluate recent epidemiological trends, geographic extension and potential factors associated with TB reemergence in Chile. MATERIAL AND METHODS: Data analysis from official sources and trend analysis. RESULTS: TB incidence rate increased from 12.3 (2014) to 14.7 (2017) per 100,000 inhabitants. Morbidity rates also increased in nine out of 15 regions. The proportion of TB cases in specific groups has also increased in the last six years: HIV/AIDS (68%), immigrants (118%), drug users/alcoholics (267%) and homeless people (370%). Several indicators of the national TB program performance have deteriorated including TB case detection, HIV co-infection study and contact tracing activities. Overall results indicate a higher than expected case-fatality ratio (> 3%), high rates of loss from follow-up (> 5%), and low percentage of cohort healing rate (< 90%). This decline is associated with a Control Program with scarce human resources whose central budget decreased by 90% from 2008 to 2014. New molecular diagnostic tools and liquid media culture were only recently implemented. CONCLUSIONS: TB trends and overall program performance indicators have deteriorated in recent years in Chile and several factors appear to be involved. Multiple strategies will be required to rectify this situation.


Assuntos
Tuberculose/epidemiologia , Chile/epidemiologia , Emigrantes e Imigrantes/estatística & dados numéricos , Geografia , Infecções por HIV/epidemiologia , Gastos em Saúde/tendências , Pessoas em Situação de Rua/estatística & dados numéricos , Humanos , Incidência , Fatores de Risco , Fatores Socioeconômicos , Estatísticas não Paramétricas , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Fatores de Tempo , Tuberculose/economia , Tuberculose/etiologia
14.
BMC Public Health ; 19(1): 1741, 2019 Dec 27.
Artigo em Inglês | MEDLINE | ID: mdl-31881953

RESUMO

BACKGROUND: While discrimination takes multiple forms, racial or ethnic discrimination is a root cause of this health-damaging social phenomenon. We drew on intersectionality theory, which offers an account of discrimination's multiple effects, to consider associations between women's experiences of discrimination and postpartum depression (PPD) using four measures: single forms of discrimination (SFD); multiple forms of discrimination (MFD); ethnic discrimination combined with MFD (E-MFD); and a composite MFD that interacted with women's identity (C-MFD). METHODS: We interviewed a stratified sample of 1128 mothers face to face in 2014-2015 during mothers' visits to maternal and child health clinics. The mothers belonged to three groups in Israel: Palestinian-Arab minority, Jewish immigrant, and non-immigrant Jewish. We conducted unadjusted and adjusted logistic regressions for PPD, measured on the Edinburgh Postnatal Depression Scale, in associations with SFD (experiencing discrimination based on any of the following: age, sex, class, ethno-national identity, religiosity level and skin color); MFD (experiencing 0,1, 2 or ≥ 3 of SFD); E-MFD (ethnic discrimination combined with other MFD); and finally, C-MFD (interaction between MFD and women's identity). RESULTS: Palestinian-Arab mothers had higher PPD and reported higher SFD (based on ethnicity, religiosity level, and socioeconomic status), as well as higher MFD and E-MFD. This was followed by Jewish immigrant mothers, and lastly by non-immigrant Jewish mothers. However, both MFD and E-MFD had a strong association with PPD among non-immigrant Jewish mothers reporting 2MFD and ≥ 3MFD, and Palestinian-Arab mothers reporting ≥3MFD, but no significant association among immigrant Jewish mothers. When we used C-MFD, we found a dose-response association in which Palestinian-Arab mothers experiencing more MFD (2MFD and ≥ 3MFD) were more likely to experience PPD. This was followed by immigrant Jewish mothers (reporting 2MFD and ≥ 3MFD), and lastly by non-immigrant Jewish mothers. CONCLUSIONS: MFD should be considered in relation to women's identity (being part of a minority, immigrant, or non-immigrant majority group) in maternal mental health research and practice. Otherwise, we risk underestimating the effects of MFD on PPD, especially in minority and immigrant mothers, who are more likely to face interlocking forms of discrimination.


Assuntos
Árabes/psicologia , Depressão Pós-Parto/etnologia , Emigrantes e Imigrantes/psicologia , Judeus/psicologia , Grupos Minoritários/psicologia , Mães/psicologia , Preconceito/etnologia , Adolescente , Adulto , Árabes/estatística & dados numéricos , Estudos Transversais , Emigrantes e Imigrantes/estatística & dados numéricos , Feminino , Humanos , Israel , Judeus/estatística & dados numéricos , Pessoa de Meia-Idade , Grupos Minoritários/estatística & dados numéricos , Mães/estatística & dados numéricos , Adulto Jovem
15.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 46(4): 154-158, oct.-dic. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-184303

RESUMO

Introducción: La mujer inmigrante presenta unas características específicas desde el punto de vista sanitario, debido a su procedencia, diferencias culturales y estrato social, que pueden afectar a sus consultas de salud. El ámbito ginecológico y la salud reproductiva son áreas de frecuente consulta en este grupo poblacional. Objetivo: Describir la enfermedad ginecológica por la que consultan las mujeres inmigrantes y definir posibles factores de riesgo. Material y métodos: Estudio descriptivo y transversal sobre las consultas de salud en la esfera ginecológica de las mujeres de origen inmigrante atendidas en la consulta de atención primaria. Estudio comparativo con una muestra de mujeres de origen nacional. Resultados: La mayoría de las pacientes inmigrantes del estudio eran de origen magrebí. La consulta de salud más habitual fueron las vaginitis de origen infeccioso. Hasta un 19% presentaban multiparidad (3 o más embarazos). Estos 2 procesos fueron significativamente mayores que en el colectivo de mujeres de origen nacional con quienes se comparó la muestra. Conclusiones: Las mujeres inmigrantes presentan, en general, una paridad elevada y más infecciones de la esfera ginecológica. Estos factores pueden causar una mayor vulnerabilidad en este colectivo


Introduction: Immigrant women have specific characteristics from the health point of view, due to their origin, cultural differences and social status, which can affect their health consultations. The gynaecological field and reproductive health are areas of frequent consultation by this population group. Objectives: To describe the gynaecological disorders for which immigrant women consult, and to define possible risk factors. Material and methods: A descriptive and cross-sectional study was conducted on gynaecological health consultations by women of immigrant origin seen in the primary care clinic. A comparative study was performed with a sample of women of Spanish origin. Results: The majority of the immigrant patients in the study were of Maghrebi origin. The most common health consultation was vaginitis of infectious origin. Up to 19% were multiparous (3 or more pregnancies) and these 2 processes were significantly greater than in the group of women of national origin in whom the sample was compared. Conclusions: Immigrant women have a high parity, in general, and have more gynaecological infections. These factors can cause greater vulnerability in this group


Assuntos
Humanos , Feminino , Emigrantes e Imigrantes/estatística & dados numéricos , Fatores de Risco , Saúde Reprodutiva , Atenção Primária à Saúde , Doenças Urogenitais Femininas/epidemiologia , Estudos Transversais , Vaginite/epidemiologia , Vaginose Bacteriana/epidemiologia , Infertilidade Feminina , Doenças Transmissíveis/epidemiologia
16.
J Rehabil Med ; 51(11): 861-868, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31690950

RESUMO

OBJECTIVE: To explore the health situation and identify specific health challenges in non-Western immigrants with polio in Norway, by comparing their status with Western immigrants with polio and native Norwegians with polio. DESIGN: A questionnaire covering demographics, polio history, life satisfaction, medical, psychological and social conditions was answered by 1,408 persons with polio, among them 34 immigrants from non-Western countries and 32 immigrants from Western countries. RESULTS: The non-Western immigrant polio group had a mean age of 46 years, were highly educated, reported high frequency of mental health problems and only one-third was working. Mean age for contracting polio was 2.8 years. Only 30% was hospitalized in the acute phase and 80% reported severe leg weakness. Use of a powered wheelchair was reported by 72%. Post-polio symptoms had started at a mean age of 31 years. The non-Western immigrant group reported more fatigue, pain and loneliness, and a high proportion reported insufficient assistance from the public health system. CONCLUSION: The group of non-Western immigrants with polio in Norway reported more health and social problems than the group of Western immigrants with polio or the native Norwegian group with polio, even though they were younger and more highly educated. Their complex psychological and social situation requires active intervention from the health system, and health professionals need extra skills to deal most effectively with their situation.


Assuntos
Assistência à Saúde/normas , Emigrantes e Imigrantes/estatística & dados numéricos , Poliomielite/epidemiologia , Síndrome Pós-Poliomielite/epidemiologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Poliomielite/psicologia
17.
Artigo em Inglês | MEDLINE | ID: mdl-31581450

RESUMO

In Taiwan, immigrant workers play an important role in fisheries but they are easily ignored by society. The health problems and associated characteristics of immigrant workers in fisheries remain unclear. Descriptive and retrospective analyses were performed. Outpatient data were collected from a primary care clinic for six fishing villages in North Eastern Taiwan between 1 August 2016 and 31 July 2017. The data of immigrant workers was recorded and compared with that of natives. A total of 241 immigrant workers and 1342 natives were enrolled. Compared with the natives, the immigrant workers had a significantly younger age, male predominance, and fewer mean visits per year. The immigrant worker's visits tended to be more highly focused during the third quarter of the year. Immigrant workers paid more registration fees and self-payment, but they paid less on diagnosis fees, oral medication, laboratory exams and had reduced total costs. The top five diagnoses for immigrant workers were respiratory diseases (38.3%), trauma (15.2%), musculoskeletal diseases (11.2%), skin-related diseases (9.5%), and digestive diseases (9.1%). Immigrant workers were positively correlated with infectious/parasitic diseases, and negatively correlated with medical consults and endocrine/metabolic diseases. Immigrant workers were also positively associated with registration fees and self-payment, but negatively correlated with diagnosis fees and total costs (all p < 0.05). The distribution of skin diseases and trauma were affected by age and sex as opposed to ethnic group. Immigrant status' health issues should be given more attention.


Assuntos
Emigrantes e Imigrantes/estatística & dados numéricos , Pesqueiros/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Feminino , Financiamento Pessoal , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/economia , Estudos Retrospectivos , Fatores Sexuais , Taiwan
18.
Int J Occup Med Environ Health ; 32(6): 797-804, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31584040

RESUMO

OBJECTIVES: This article investigates sickness presence among secondary school students in 5 European countries. The research questions asked are: What characterizes students with high sickness presence in secondary schools? Does high sickness presence influence future sickness absence? MATERIAL AND METHODS: A group of 7008 students aged 16-19 years participated in the first study (2016), and 5002 of them also participated in the follow-up study (2017). The participants came from 25 schools in Belgium, Estonia, Finland, Italy and Latvia. The response rate was high. A multivariate binomial logistic regression analysis was used. RESULTS: In 2016 high sickness presence (≥ 5 incidents) was reported by 16% of the students, and in 2017 by 15% of them. In 2016 there were significant differences between countries, and students from Latvia were most likely to report high sickness presence (adjusted odds ratio [aOR] = 3.45). Students with high absence (aOR = 1.86) and high school motivation (aOR = 1.16, for 1 pt increase on a 5-point scale) were overrepresented among those reporting high sickness presence. Country, absence and motivation were also significant factors for sickness presence in 2017. Furthermore, there was a significant positive association between high sickness presence and high sickness absence the following year. CONCLUSIONS: Country, absence, and motivation were important factors for high sickness presence in secondary schools. Engaging in high sickness presence seemed to influence future sickness absence. Int J Occup Med Environ Health. 2019;32(6):797-804.


Assuntos
Motivação , Presenteísmo/estatística & dados numéricos , Estudantes/estatística & dados numéricos , Absenteísmo , Adolescente , Emigrantes e Imigrantes/estatística & dados numéricos , Europa (Continente)/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Estudantes/psicologia , Inquéritos e Questionários , Adulto Jovem
19.
J Prev Med Public Health ; 52(5): 299-307, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31588699

RESUMO

OBJECTIVES: While occupational stress has long been a central focus of psychological research, few studies have investigated how immigrant microbusiness owners (MBOs) respond to their unusually demanding occupation, or how their unresolved occupational stress manifests in psychological distress. Based on the job demands-resources model, this study compared MBOs to employees with regard to the relationships among emotional demands, job resources, and depressive symptoms. METHODS: Data were derived from a cross-sectional survey of 1288 Korean immigrant workers (MBOs, professionals, office workers, and manual workers) aged 30 to 70, living in Toronto and surrounding areas. Face-to-face interviews were conducted between March 2013 and November 2013. RESULTS: Among the four occupational groups, MBOs appeared to endure the greatest level of emotional demands, while reporting relatively lower levels of job satisfaction and job security; but MBOs reported the greatest job autonomy. The effect of emotional demands on depressive symptoms was greater for MBOs than for professionals. However, an inspection of stress-resource interactions indicated that though MBOs enjoyed the greatest autonomy, the protective effects of job satisfaction and security on the psychological risk of emotional demands appeared to be more pronounced for MBOs than for any of the employee groups. CONCLUSIONS: One in two Korean immigrants choose self-employment, most typically in family-owned microbusinesses that involve emotionally taxing dealings with clients and suppliers. However, the benefits of job satisfaction and security may protect MBOs from the adverse mental health effects of job stress.


Assuntos
Comércio/economia , Depressão/psicologia , Emigrantes e Imigrantes/estatística & dados numéricos , Emoções , Estresse Ocupacional/psicologia , Ocupações/estatística & dados numéricos , Adulto , Idoso , Canadá , Estudos Transversais , Feminino , Humanos , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , República da Coreia/etnologia , Inquéritos e Questionários
20.
Public Health Rep ; 134(6): 695-702, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31647883

RESUMO

OBJECTIVES: Chronic hepatitis B virus (HBV) infection is a lifelong infection that can cause serious liver damage and liver cancer. The last surveillance-based prevalence estimate of chronic HBV infection in New York City was 1.2% in 2008; however, it did not account for persons with undiagnosed infection. The objective of this study was to calculate the prevalence of chronic HBV infection, including undiagnosed infection, for 2016 by using surveillance data and literature-based information. METHODS: We calculated the number of persons with diagnosed chronic HBV infection (2000-2016) who were alive and living in New York City in 2016 by using routine surveillance data. We estimated the percentage of persons with undiagnosed chronic HBV infection by using birth region-specific percentages from the literature, weighted by the proportion of the New York City population with diagnosed chronic HBV infection from the same birth region. We identified minimum, maximum, and most likely values for the percentage with undiagnosed chronic HBV infection to generate 95% certainty limits (CLs) of the prevalence estimate. RESULTS: The prevalence of chronic HBV infection in 2016, including undiagnosed infection, in New York City was 2.7% (95% CL, 2.2%-3.6%), representing approximately 230 000 persons. The prevalence of diagnosed chronic HBV infection was 1.5%. The estimated prevalence among non-US-born residents was 6.9% (95% CL, 5.4%-8.9%). CONCLUSIONS: The current burden of chronic HBV infection in New York City, especially for non-US-born residents, is substantial. A renewed focus and dedication of resources is required to increase the number of new diagnoses and improve provider capacity to care for the large number of persons with chronic HBV infection.


Assuntos
Emigrantes e Imigrantes/estatística & dados numéricos , Hepatite B Crônica/epidemiologia , Vigilância da População , Adulto , África/etnologia , Ásia/etnologia , Feminino , Vírus da Hepatite B/isolamento & purificação , Hepatite B Crônica/diagnóstico , Humanos , Masculino , Modelos Estatísticos , Cidade de Nova Iorque/epidemiologia , Prevalência , Fatores de Risco
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