Toward an emerging model of healthcare access: A theoretical framework

AIM

To conceptualize an emerging framework of healthcare access for foreign-born persons based on well-known access models in the United States.

BACKGROUND

The COVID-19 outbreak significantly impacted all global communities, disproportionately affecting people of color and highlighting preexisting health disparities. Health and immigration policies concerning healthcare access for foreign-born people were examined. Regarding access to social benefits in the United States, the Affordable Care Act underscored initial restrictions imposed by the Deficit Reduction Act of 2005 and the Personal Responsibility and Work Opportunity Reconciliation Act in 1996 on certain underserved groups.

METHODS

Guided by the study's aim, electronic databases, including Scopus, PubMed, Web of Science, and CINAHL, were queried for relevant nursing-related literature published on Penchansky's and Andersen's models from 1968 to 2022. Compared with Penchansky's model, Andersen's model outcome measures have evolved over the years in response to dynamic health policy issues.

RESULTS

Penchansky's model has five constructs in its original form, whereas Andersen's model has three. The current study shows that each existing access model provides a unique method for evaluating various policies. In some cases, the studies are limited to a simple application of the original model with few modifications in studies specific to foreign-born groups in the United States.

DISCUSSION

There is a dearth of systematic theorization of access that incorporates social justice and health equity. Health disparities were further explained using metrics from existing access models.

CONCLUSIONS

An emerging access model conceptualizing existing access models was proposed, using constructs framed within the basic tenets of health equity and social justice.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Applying the emerging model's constructs to future studies is anticipated to highlight opportunities for stakeholders such as policymakers, healthcare providers, nursing professionals, and community leaders to support programs that could further reduce health disparities.

Preventing Vertical Transmission of Chagas Disease: An Emerging Public Health Issue in Perinatal Care

Chagas [shah-guhs] disease, caused by the Trypanosoma cruzi parasite, presents a growing concern for health care providers overseeing perinatal care in the United States due to existing and expanding vector-borne transmission and population migration. This life-threatening disease can be transmitted vertically during pregnancy, although adequate testing and treatment can effectively reduce morbidity and mortality caused by Chagas disease. This article presents an overview of the disease burden in the United States and its implications for perinatal care providers including recommended testing and treatment practices and the information needed for patient education and shared decision-making regarding the management of care for individuals at risk of Chagas disease. Being informed about Chagas disease and its implications is needed for all individuals providing perinatal care and is especially critical for those overseeing the care of refugee and immigrant populations.

Changes in peer belonging, school climate, and the emotional health of immigrant, refugee, and non-immigrant early adolescents

INTRODUCTION

Early adolescents who are new to Canada experience dual challenges of navigating developmental changes and multiple cultures. This study examined how changes in early adolescents' emotional health from ages 9 to 12 differed by immigration background, and to what extent peer belonging and supportive school climate protected or promoted their emotional health.

METHODS

This study drew upon linked self-report and administrative data. Across 10 school districts in British Columbia, Canada, N = 4479 non-immigrant, immigrant, and refugee adolescents reported on their peer belonging, school climate, and emotional health (life satisfaction, optimism, self-esteem, sadness, worries) in Grades 4 and 7, using the Middle Years Development Instrument. Immigration background including immigration class (economic, family, refugee) and generation status (first, second) were obtained from linked Immigration, Refugees, and Citizenship Canada data. Multi-level modeling assessed the effect of time (grade level), immigration group, and changes in peer belonging and school climate on changes in self-reported emotional health. Analyses were adjusted for gender, English first language, and low family income.

RESULTS

Immigrant and refugee adolescents reported worse emotional health in Grade 4 compared to non-immigrants. Non-immigrant and immigrant adolescents reported declines in emotional health from Grades 4 to 7. In contrast, first-generation refugee adolescents reported significant improvements in life satisfaction, and first- and second-generation refugees reported improvements in worries over this period. Perceived improvements in peer belonging and school climate were associated with positive changes in emotional health for all adolescents.

CONCLUSIONS

Changes in adolescents' emotional health from Grades 4 to 7 differed between immigrants, refugees, and non-immigrants. Immigrants and refugees who enter adolescence with lower emotional health than their non-immigrant peers may particularly benefit from culturally responsive school and community-based interventions.

The risk of long-term opioid use among immigrants: a national registry-linkage study

AIMS

We aimed to investigate the association between being an immigrant and long-term prescription opioid use in Norway in 2010-2019.

METHODS

Nested case-control study. The cases were all persons 18 years of age or older with long-term opioid use - that is, the use of prescription opioids longer than 3 months (N=215,642). Cases were matched to four controls who filled at least one opioid prescription, but never developed long-term opioid use in the study period (N=862,568) on sex, age and year of starting long-term/short-term opioid use. Being an immigrant was defined as being born outside of Norway to two foreign-born parents and four foreign-born grandparents. Adjusting for socioeconomic variables and clinical confounders, analyses were stratified on three age groups (18-44 years, 45-67 years and ⩾68 years).

RESULTS

For the youngest age group, being an immigrant was inversely associated with long-term opioid use (adjusted odds ratio 0.75; 95% confidence interval [0.72-0.77]) compared with being native-born people. For this age group, the odds ratio differed between people born in Africa (0.56 [0.52-0.62]), Central or South America (0.70 [0.62-0.79]), Europe outside the European Union (EU) (0.71 [0.65-0.77]), Asia including Turkey (0.80 [0.77-0.84]) and EU/European Economic Area (EEA) (0.81 [0.77-0.85]). For the middle age group, increased odds were found for immigrants versus natives (1.05 [1.02-1.08]) in particular for those born in North America (1.26 [1.13-1.40]) and the EU/EEA (1.13 [1.09-1.18]). There was no association in the oldest group.

CONCLUSIONS

Compared with native-born people, immigrants had lower odds of long-term opioid use among younger adults, higher odds among middle-aged and similar odds among older adults.

Activated sludge microbial community assembly: the role of influent microbial community immigration

Wastewater treatment plants (WWTPs) are host to diverse microbial communities and receive a constant influx of microbes from influent wastewater. However, the impact of immigrants on the structure and activities of the activated sludge (AS) microbial community remains unclear. To gain insight on this phenomenon known as perpetual community coalescence, the current study utilized controlled manipulative experiments that decoupled the influent wastewater composition from the microbial populations to reveal the fundamental mechanisms involved in immigration between sewers and AS-WWTP. The immigration dynamics of heterotrophs were analyzed by harvesting wastewater biomass solids from three different sewer systems and adding to synthetic wastewater. Immigrating influent populations were observed to contribute up to 14% of the sequencing reads in the AS. By modeling the net growth rate of taxa, it was revealed that immigrants primarily exhibited low or negative net growth rates. By developing a protocol to reproducibly grow AS-WWTP communities in the lab, we have laid down the foundational principles for the testing of operational factors creating community variations with low noise and appropriate replication. Understanding the processes that drive microbial community diversity and assembly is a key question in microbial ecology. In the future, this knowledge can be used to manipulate the structure of microbial communities and improve system performance in WWTPs.IMPORTANCEIn biological wastewater treatment processes, the microbial community composition is essential in the performance and stability of the system. This study developed a reproducible protocol to investigate the impact of influent immigration (or perpetual coalescence of the sewer and activated sludge communities) with appropriate reproducibility and controls, allowing intrinsic definitions of core and immigrant populations to be established. The method developed herein will allow sequential manipulative experiments to be performed to test specific hypothesis and optimize wastewater treatment processes to meet new treatment goals.

Barriers and facilitators to healthcare utilisation by Arab sexual minority women migrants in the USA

Limited research on sexual minority women migrants demonstrate that they face elevated rates of mental health problems compared to their heterosexual and male counterparts, and less is known about their healthcare seeking behaviours. This study aimed to identify barriers and facilitators to mental and physical healthcare utilisation among first-generation (foreign-born) Arab sexual minority women migrants in the USA and to assess whether Penchansky and Thomas' theory of access can be used to understand their healthcare utilisation behaviours. We conducted 20 semi-structured interviews via Zoom. Employing community-engaged research methods, four advisors, Arab sexual minority women migrants and a mental health service provider, assisted in recruitment and thematic data analysis providing a rich and nuanced understanding of study findings. Five main themes demonstrated the pivotal role of cultural humility from providers and access to medical insurance in shaping healthcare-seeking decisions. Difficulties finding therapists and navigating the referral process and wait times encouraged participants to seek care outside of the USA in their Arab countries of origin. Stigma and social support further influenced participants' decisions to seek mental healthcare. The study findings inform policy and practice to foster the development of inclusive healthcare services grounded in cultural humility and to develop support groups specifically for Arab sexual minority women migrants to the USA.

Trauma in the American asylum process: Experiences of immigrant families under the migrant protection protocols

OBJECTIVE

Latinx asylum-seeking families report posttraumatic distress that is 161-204% higher than in nonimmigrants, with adverse consequences for health and well-being. Recent U.S. policies have further embedded trauma in the asylum-seeking process by forcing families to remain in Mexico, enduring dire living conditions in tent encampments near the border while awaiting processing. These families are now entering the United States in large numbers. This article sheds light on their recent experiences and mental health needs, using a mixed methods-grounded theory design, presenting quantitative and qualitative data to describe the experiences of six asylum-seeking families who waited for 1-2 years in the refugee camp in Mexico.

METHOD

Quantitative data was obtained from the Brief Symptom Inventory-18 and the Harvard Trauma Questionnaire while qualitative interviews provided insight into reasons for migration and trauma at different stages of the migration process.

RESULTS

All participants experienced multiple traumas and endorsed trauma related symptoms. Important themes of psychological distress and trauma emerged, including unending suffering, hunger, and worry for the safety of their children while living in the refugee camp. Asylum-seeking families experienced substantial distress and trauma secondary to their stay in Mexico and COVID-19.

CONCLUSION

Families arriving to the United States have experienced significant trauma, separation, and loss before and during their journey. Interactions with an unprepared and overwhelmed immigration system further compromises their psychological well-being. It is imperative that first-person narratives inform policy that addresses their complex needs and protects their human rights. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Patterns of recovery in extant and extirpated seabirds after the world's largest multipredator eradication

Eradicating invasive predators from islands can result in substantial recovery of seabirds, but the mechanisms that drive population changes remain poorly understood. Meta-analyses have recently revealed that immigration is surprisingly important to the recovery of philopatric seabirds, but it is not known whether dispersal and philopatry interact predictably to determine rates of population growth and changes of distribution. We used whole-island surveys and long-term monitoring plots to study the abundance, distribution, and trends of 4 burrowing seabird species on Macquarie Island, Australia, to examine the legacy impacts of invasive species and ongoing responses to the world's largest eradication of multiple species of vertebrates. Wekas (Gallirallus australis) were eradicated in 1988; cats (Felis catus) in 2001; and rabbits (Oryctolagus cuniculus), black rats (Rattus rattus), and mice (Mus mus) in 2011-2014. We compared surveys from 1976-1979 and 2017-2018 and monitoring from the 1990s and 2000s onward. Antarctic prions (Pachyptila desolata) and white-headed petrels (Pterodroma lessonii) increased ∼1% per year. Blue petrels (Halobaena caerulea) and gray petrels (Procellaria cinerea) recolonized following extirpation from the main island in the 1900s but remained spatially and numerically rare in 2018. However, they increased rapidly at 14% and 10% per year, respectively, since cat eradication in 2001. Blue and gray petrel recolonization occurred on steep, dry, west-facing slopes close to ridgelines at low elevation (i.e., high-quality petrel habitat). They overlapped <5% with the distribution of Antarctic prion and white-headed petrels which occurred in suboptimal shallow, wet, east-facing slopes at high elevation. We inferred that the speed of population growth of recolonizing species was related to their numerically smaller starting size compared with the established species and was driven by immigration and selection of ideal habitat.

Wage Disparities across Immigrant Generations: Education, Segregation, or Unequal Pay?

Immigrants and their native-born children often face considerable wage penalties relative to natives, but less is known about whether this inequality arises through differences in educational qualifications, segregation across occupations and establishments, or unequal pay for the same work. Using linked employer-employee data from Norway, the authors ask whether immigrant-native wage disparities 1) reflect differences in detailed educational qualifications, labor market segregation, or within-job pay differences; 2) differ by immigrant generation; and 3) vary across different segments of the labor market. They find that immigrant-native wage disparities primarily reflect sorting into lower-paying jobs, and that wage disadvantages are considerably reduced across immigrant generations. When doing the same work for the same employer, immigrant-background workers, especially children of immigrants, earn similar wages to natives. Sorting into jobs seems more meritocratic for university graduates, for professionals, and in the public sector, but within-job pay differences are strikingly similar across market segments.

Transition, Adjustment, and Healthcare Avoidance: African Immigrant Women's Experiences and Perceptions of Navigating Primary Healthcare in the USA

This study explores the transition and adjustment of African immigrant women, particularly Ethiopian immigrant women (EIW), as they navigate the U.S. healthcare system and their ability to access and utilize healthcare services. A qualitative cross-sectional design with a mix of purposive and snowball sampling techniques was utilized to recruit EIW (N = 21, ≥18 years) who arrived in the U.S. within the last five years. One-on-one in-depth interviews were conducted to collect data. The interviews were audio-recorded, transcribed verbatim, and analyzed thematically using Nvivo12 software. The thematic analysis revealed three major themes: (1) settling into new life in the U.S. delays EIWs' ability to access primary healthcare; (2) adjusting to the U.S. healthcare system: confusions and mixed perceptions; and (3) avoidance of care: EIW's reasons for PHC visits changed in the U.S. Participants avoided healthcare, except for life-threatening conditions, general check-ups, and maternal healthcare services. Transitional support for legal, residential, employment, and health information could help tackle the challenges of accessing primary healthcare for EIW. Future research should analyze access to healthcare in relation to the everyday struggles of immigrant women, as well as legal and complex structural issues beyond acculturative issues.

Decoding the Dynamics of Cultural Change: A Cultural Evolution Approach to the Psychology of Acculturation

PUBLIC ABSTRACT

Acculturation describes the cultural and psychological changes resulting from intercultural contact. Here, we use concepts from "cultural evolution" to better understand the processes of acculturation. Cultural evolution researchers view cultural change as an evolutionary process, allowing them to borrow tools and methods from biology. Cultural evolutionary mechanisms such as conformity (copying the numerical majority), anti-conformity (copying the numerical minority), prestige bias (copying famous individuals), payoff bias (copying successful people), and vertical cultural transmission (copying your parents) can cause people to adopt elements from other cultures and/or conserve their cultural heritage. We explore how these transmission mechanisms might create distinct acculturation strategies, shaping cultural change and diversity over the long-term. This theoretical integration can pave the way for a more sophisticated understanding of the pervasive cultural shifts occurring in many ethnically diverse societies, notably by identifying conditions that empower minority-group members, often marginalized, to significantly influence the majority group and society.

Are ethnic inequalities in adult oral health-related quality of life modified by immigration status?

OBJECTIVE

To explore ethnic inequalities in oral health-related quality of life (OHRQoL) and the role of nativity status on them.

METHODS

Data from 1868 adults (16-65 years) of 9 ethnic groups participating in a community-based health survey in East London. Participants completed a supervised questionnaire including the Oral Health Impact Profile (OHIP-14) to calculate prevalence, extent and severity of oral impacts. Associations between ethnicity and nativity status (individually and combined) with OHRQoL were assessed in regression models, crude and adjusted for socio-demographic factors and clinical oral health indicators.

RESULTS

Black others showed higher prevalence (OR: 1.91; 95%CI 1.05-3.46), severity (IRR: 2.87, 95%CI 1.63-5.06) and extent of oral impacts (IRR: 1.86, 95%CI 1. 35-2.59). Oral impacts were more severe among Black Caribbeans (IRR: 2.85, 95%CI 1.31-6.18) and Bangladeshis (IRR: 3.08, 95%CI .07-8.91); whereas impacts were more extensive among Pakistanis (IRR: 1.54, 95%CI 1.05-2.25) and Bangladeshis (IRR: 1.87, 95%CI 1.16-3.00). Nativity status individually showed no association with OHRQoL, although when combined with ethnicity resulted in many minority groups showing worse OHRQoL than White British participants.

CONCLUSION

Ethnicity and nativity status have a combined and important role in OHRQoL: ethnic minority groups showed worse OHRQoL even when controlling for clinical oral status.

Why are Turkish nurses migrating? A mixed-methods study

AIM

This study aimed to identify the factors influencing nurses' migration patterns in Turkey.

BACKGROUND

The flow of nurse migration from developing countries to developed countries is steadily increasing. As a result, countries that are sources of migration tend to develop domestic inequities with respect to the population's ability to access health services. In particular, fragile economic conditions and the pandemic triggered the migration of nurses from Turkey, a developing country.

METHODS

This study employed a mixed-method explanatory sequential design and was conducted in Turkey between April and November 2022. The decision to migrate was the focus of both the quantitative aspect, involving 237 participants, and the qualitative aspect, with 20 participants. Quantitative data were gathered through a questionnaire, and qualitative data were obtained using open-ended questions during in-depth individual interviews. We followed the Strengthening the Reporting of Observational Studies in Epidemiology checklist in the quantitative phase and the Consolidated Criteria for Reporting Qualitative Research checklist in the qualitative phase. Descriptive statistics and thematic analyses were used to analyze the data.

RESULTS

In the quantitative stage of the study, nurses' reasons for deciding to migrate were identified as economic conditions, working conditions, society's outlook on the profession, political factors, and professional growth opportunities. In the qualitative stage, four major themes influencing nurse migration patterns emerged: devaluation and poor collegiality in nursing; inadequate management support; negative work environment; and health, social, and economic policies.

CONCLUSION

The results of the study showed that the three factors most influential in the decision to migrate were economic issues, a negative work environment, and political climate.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

In developing countries, there is an urgent need for nurse administrators and health workforce decision-makers to create healthy working conditions and manage resources efficiently, focusing on improving nurses' economic situations while developing appropriate nationwide and international strategies.

Immigration allows population persistence and maintains genetic diversity despite an attempted experimental extinction

Widespread fragmentation and degradation of habitats make organisms increasingly vulnerable to declines in population size. Immigration is a key process potentially affecting the rescue and persistence of populations in the face of such pressures. Field research addressing severe demographic declines in the context of immigration among interconnected local populations is limited owing to difficulties in detecting such demographic events and the need for long-term monitoring of populations. In a 17-subpopulation metapopulation of the butterfly, Parnassius smintheus, all adults observed in two adjacent patches were removed over eight consecutive generations. Despite this severe and long-term reduction in survival and reproduction, the targeted populations did not go extinct. Here, we use genetic data to assess the role of immigration versus in situ reproduction in allowing the persistence of these populations. We genotyped 471 samples collected from the targeted populations throughout the removal experiment at 152 single nucleotide polymorphisms. We found no reduction in the genetic diversity of the targeted populations over time, but a decrease in the number of loci in Hardy-Weinberg equilibrium, consistent with a high level of immigration from multiple surrounding populations. Our results highlight the role of connectivity and movement in making metapopulations resilient to even severe and protracted localized population reductions.

Religiosity, Aging in the Homeland, and Growing Old in the Diaspora: A Longitudinal Study of Two Cohorts of Indian Older Adults

This article reports a longitudinal study comparing religiosity among two cohorts of Indian older adults-those who age in the homeland of India (AIH cohort) and immigrants (to the USA) or diaspora older adults (DOA). Results indicated that AIH and DOA cohorts' religiosity outcomes were comparable at baseline but there was a statistically significant increase in all outcomes of the DOA cohort at subsequent time points. Women and single older adults in both the cohorts had higher religiosity scores at baseline. Religiosity scores were higher among those in the DOA cohort who migrated following marital disruption (widowhood, divorce) or grandchild birth and lived with adult immigrant children and their families. The immigration process can have an impact on religious orientation of older adults and place is a significant variable impacting religiosity possibly for augmenting the sense of self, acquire social capital and preserve cultural identity in the foreign land.

Congenital rubella syndrome, a case series

Rubella, or German measles, is a vaccine-preventable disease. Rubella infection is usually mild; however, infection in pregnancy is associated with severe outcomes for the baby, including pregnancy loss or a combination of developmental defects called congenital rubella syndrome. Within the last ten-year period, two cases of congenital rubella syndrome in Saskatchewan were reported to the provincial ministry and the Public Health Agency of Canada of the newborns of mothers who had recently arrived from Sub-Saharan Africa. Both infants had multiple health complications at birth consistent with congenital rubella and tested positive for the rubella virus. The article discusses the challenges encountered by the healthcare system in diagnosing, investigating, monitoring and managing cases of congenital rubella syndrome to prevent further sporadic transmission. The article emphasizes the need to provide additional support for cases and their households, especially new Canadians with less support to comply with public health advice and the importance of routine immunization to eliminate rubella globally.

Do Varroa destructor (Acari: Varroidae) mite flows between Apis mellifera (Hymenoptera: Apidae) colonies bias colony infestation evaluation for resistance selection?

Since the global invasion of the ectoparasitic mite Varroa destructor (Anderson and Trueman), selection of mite-resistant honey bee (Apis mellifera L.) colonies appears challenging and has to date not broadly reduced colony mortality. The low published estimated heritability values for mite infestation levels could explain the limited genetic progresses obtained so far. We hypothesize that intercolonial horizontal mite transmission could differentially affect the single colonies located in a given apiary and therefore invisibly bias colony infestation phenotypes. This bias may be lower in regions with lower colony density, providing suitable conditions to set up evaluation apiaries. To verify these hypotheses, we monitored mite infestation and reinvasion in experimental colonies, as well as infestation in neighboring colonies belonging to beekeepers in three areas with variable colony densities in the canton of Bern, Switzerland during three consecutive beekeeping seasons. Mite immigration fluctuated between apiaries and years and significantly contributed to colony infestation level. Depending on apiary and year, 17-48% of the mites present in the experimental colonies at the time of the summer oxalic acid final treatment potentially derived from mite immigration that had occurred since mid-spring. Mite immigration was not linked to local colony density or the infestation levels of beekeepers' colonies located within 2 km. Our results do not prove that apiaries for colony evaluation should necessarily be established in areas with low colony density. However, they highlight the high impact of beekeeping management practices on mite colony infestation levels.

Welcoming new neighbors: Minnesota's rapid response model to address the urgent health needs of Afghan newcomers, 2021-2022

As a result of the United States withdrawal from Afghanistan in fall 2021, 1,260 Afghan evacuees arrived in Minnesota between October 2021 and February 2022. Several contextual factors including an overtaxed health system under duress from COVID-19 and uncertain benefit eligibility prompted a coordinated public health response to appropriately address the acute and pressing medical concerns of our new neighbors. This community case study describes the State of Minnesota's cross-sectoral response that created a welcoming environment, identified public health concerns, and addressed acute medical needs. Medical volunteers provided an initial health and safety check for Afghan families upon arrival. Volunteers also offered onsite culturally and linguistically appropriate mental health assessments, group therapy, women's clinics, vaccine clinics, medication refills, and ongoing walk-in primary care. Care coordinators facilitated primary care and specialty care referrals. The majority (96%) of eligible arrivals were screened as part of this response and the median time between arrival to Minnesota and initial health screening was 2 days. Half of all arrivals screened reported at least one health concern and 56% were referred to a specialty for further evaluation. Almost one in four adults (24%) reported mental health concerns. Existing partnerships across local sectors can be leveraged to provide comprehensive physical and mental health services to newcomers in an emergency response.

Intergenerational Relations and Well-being Among Older Middle Eastern/Arab American Immigrants During the COVID-19 Pandemic

This study aimed to examine the consequences of COVID-19 socialization restrictions on familial and social support systems of older Middle Eastern/Arab immigrants in Michigan, home to the largest, most visible concentration of Middle Eastern/Arab Americans in the United States. Six focus group (N = 45) interviews were conducted with Middle Eastern/Arab American immigrants aged 60 and older to assess difficulties faced during the pandemic as it related to familial, social, and medical care. Inductive analysis identified two major themes to advance meanings of intergenerational relations among older immigrants (a) the breakdown of family relations, which describes a shift in both the experience and expectations of intergenerational relations in Middle Eastern/Arab families; and (b) cultural sources of increased stress, illustrating how the pandemic interfered with valued family interactions to affect well-being. These findings indicated social and cultural sources of heightened stress linked to shifts in intergenerational relations among Middle Eastern/Arab American older immigrants.

Delayed colonization of Bifidobacterium spp. and low prevalence of B. infantis among infants of Asian ancestry born in Singapore: insights from the GUSTO cohort study

Background

The loss of ancestral microbes, or the "disappearing microbiota hypothesis" has been proposed to play a critical role in the rise of inflammatory and immune diseases in developed nations. The effect of this loss is most consequential during early-life, as initial colonizers of the newborn gut contribute significantly to the development of the immune system.

Methods

In this longitudinal study (day 3, week 3, and month 3 post-birth) of infants of Asian ancestry born in Singapore, we studied how generational immigration status and common perinatal factors affect bifidobacteria and Bifidobacterium longum subsp. infantis (B. infantis) colonization. Cohort registry identifier: NCT01174875.

Results

Our findings show that first-generation migratory status, perinatal antibiotics usage, and cesarean section birth, significantly influenced the abundance and acquisition of bifidobacteria in the infant gut. Most importantly, 95.6% of the infants surveyed in this study had undetectable B. infantis, an early and beneficial colonizer of infant gut due to its ability to metabolize the wide variety of human milk oligosaccharides present in breastmilk and its ability to shape the development of a healthy immune system. A comparative analysis of B. infantis in 12 countries by their GDP per capita showed a remarkably low prevalence of this microbe in advanced economies, especially Singapore.

Conclusion

This study provides new insights into infant gut microbiota colonization, showing the impact of generational immigration on early-life gut microbiota acquisition. It also warrants the need to closely monitor the declining prevalence of beneficial microbes such as B. infantis in developed nations and its potential link to increasing autoimmune and allergic diseases.

Assessment of health perceptions, use of health services and traditional health practices of Afghan immigrants in Türkiye

Immigration, as a social determinant of health, encompasses several social and economic transformations. Neglecting to adequately address this issue could potentially worsen pre-existing challenges within health systems and in the management of migration. In the present study, we aim to evaluate the health perceptions, traditional health practices and use of health services of Afghan immigrants. We enrolled 1597 Afghan immigrants over 18 years old in the descriptive cross-sectional research. The mean age of the immigrants was 49.19 ± 1.6 years. The smallest number of points that can be achieved on the health perception scale is 15, while the greatest number is 75. We found that the health perception scale average score is 37.61 ± 7.32. Some factors, such as age 65 and over, female gender, postgraduate education level, good social insurance and economic status, being a public officer, not having any infectious diseases, and having a good Turkish level, have positively affected the health perception levels (p < 0.05). Moreover, we observed that cultural differences, expensive health care, a lack of social insurance, fear and anxiety, lack of language skills, waiting times and traditional health practices were the most common barriers to accessing healthcare services. Considering these issues in the health system, identifying the factors that negatively affect the perception of health and related to the use of health services can help immigrants increase their use of health services and improve their health.

Asylum seekers and the role of the acute care physician

There has been a recent influx of migrants and asylum seekers to the United States. They often arrive with poor social support and an inability to access reliable health care. This can lead to overutilization of emergency departments (ED) while awaiting legal proceedings. With asylum seekers in all 50 states, it is important for emergency physicians (EP) to understand the barriers to care and difficulties asylum seekers face, and to gain tools to improve both migrants' and community health. Migration and experiences within the United States can worsen pre-existing health conditions. EPs are uniquely positioned to screen for acute pathology and link people to care. Psychiatric illnesses may present differently in asylum seekers. EPs must understand the sequalae of trauma to address it. EPs must also be aware of legal protections for asylum seekers to care for these patients, and recognize challenges faced by the population to mitigate health disparities.

Mind the Gap: Sexual Orientation Wage Gaps for Non-White and Immigrant Minorities in the United States

A growing body of literature has found that sexual orientation and gender impact labor market outcomes, including earnings. This literature generally finds that gay and bisexual men earn less than heterosexual men. Despite being the highest earners among women, lesbians earn less than heterosexual men, and bisexual women earn the least. Far less research has explored intersectional disadvantages/advantages of being a lesbian, gay, or bisexual (LGB) individual and belonging to other minority groups. Using data from the 2013 to 2018 US National Health Interview Survey, this paper explores whether being an LGB racial minority or LGB immigrant results in cumulative earning disadvantages/advantages. This study finds that regardless of race or immigrant status, gay men's earnings did not statistically differ from white/US-born heterosexual men's earnings. For white and US-born women, their earnings followed the same pattern, with lesbians earning the most, followed by heterosexual women, then bisexuals; however, for nonwhite women, bisexuals earned the most and lesbians earned the least. The results for immigrant sexual minorities were not statistically significant. These findings suggest that disadvantage/advantage is multilayered-sexual minorities who occupy multiple minority positions may experience different levels of disadvantage/advantage.