Strategies for expanding health insurance coverage in vulnerable populations

BACKGROUND

Health insurance has the potential to improve access to health care and protect people from the financial risks of diseases. However, health insurance coverage is often low, particularly for people most in need of protection, including children and other vulnerable populations.

OBJECTIVES

To assess the effectiveness of strategies for expanding health insurance coverage in vulnerable populations.

SEARCH METHODS

We searched Cochrane Central Register of Controlled Trials (CENTRAL), part of The Cochrane Library. www.thecochranelibrary.com (searched 2 November 2012), PubMed (searched 1 November 2012), EMBASE (searched 6 July 2012), Global Health (searched 6 July 2012), IBSS (searched 6 July 2012), WHO Library Database (WHOLIS) (searched 1 November 2012), IDEAS (searched 1 November 2012), ISI-Proceedings (searched 1 November 2012),OpenGrey (changed from OpenSIGLE) (searched 1 November 2012), African Index Medicus (searched 1 November 2012), BLDS (searched 1 November 2012), Econlit (searched 1 November 2012), ELDIS (searched 1 November 2012), ERIC (searched 1 November 2012), HERDIN NeON Database (searched 1 November 2012), IndMED (searched 1 November 2012), JSTOR (searched 1 November 2012), LILACS(searched 1 November 2012), NTIS (searched 1 November 2012), PAIS (searched 6 July 2012), Popline (searched 1 November 2012), ProQuest Dissertation &Theses Database (searched 1 November 2012), PsycINFO (searched 6 July 2012), SSRN (searched 1 November 2012), Thai Index Medicus (searched 1 November 2012), World Bank (searched 2 November 2012), WanFang (searched 3 November 2012), China National Knowledge Infrastructure (CHKD-CNKI) (searched 2 November 2012).In addition, we searched the reference lists of included studies and carried out a citation search for the included studies via Web of Science to find other potentially relevant studies.

SELECTION CRITERIA

Randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-after (CBA) studies and Interrupted time series (ITS) studies that evaluated the effects of strategies on increasing health insurance coverage for vulnerable populations. We defined strategies as measures to improve the enrolment of vulnerable populations into health insurance schemes. Two categories and six specified strategies were identified as the interventions.

DATA COLLECTION AND ANALYSIS

At least two review authors independently extracted data and assessed the risk of bias. We undertook a structured synthesis.

MAIN RESULTS

We included two studies, both from the United States. People offered health insurance information and application support by community-based case managers were probably more likely to enrol their children into health insurance programmes (risk ratio (RR) 1.68, 95% confidence interval (CI) 1.44 to 1.96, moderate quality evidence) and were probably more likely to continue insuring their children (RR 2.59, 95% CI 1.95 to 3.44, moderate quality evidence). Of all the children that were insured, those in the intervention group may have been insured quicker (47.3 fewer days, 95% CI 20.6 to 74.0 fewer days, low quality evidence) and parents may have been more satisfied on average (satisfaction score average difference 1.07, 95% CI 0.72 to 1.42, low quality evidence).In the second study applications were handed out in emergency departments at hospitals, compared to not handing out applications, and may have had an effect on enrolment (RR 1.5, 95% CI 1.03 to 2.18, low quality evidence).

AUTHORS' CONCLUSIONS

Community-based case managers who provide health insurance information, application support, and negotiate with the insurer probably increase enrolment of children in health insurance schemes. However, the transferability of this intervention to other populations or other settings is uncertain. Handing out insurance application materials in hospital emergency departments may help increase the enrolment of children in health insurance schemes. Further studies evaluating the effectiveness of different strategies for expanding health insurance coverage in vulnerable population are needed in different settings, with careful attention given to study design.

Immigration experience of Latin American working women in Alicante, Spain: an ethnographic study

OBJECTIVE

To describe the experience of Latin American working women regarding immigration, taking into account the expectations and conditions in which this process takes place.

METHOD

Ethnographic qualitative study. Data collection was performed by means of semi-structured interviews with 24 Latin American immigrant women in Spain. The information collected was triangulated through two focal groups.

RESULTS

The expectations of migrant women focus on improving family living conditions. Social support is essential for their settling and to perform daily life activities. They declare they have adapted to the settlement country, although they live with stress. They perceive they have greater sexual freedom and power with their partners but keep greater responsibility in childcare, combining that with the role of working woman.

CONCLUSIONS

Migrant women play a key role in the survival of households, they build and create new meanings about being a woman, their understanding of life, their social and couple relationships. Such importance is shaped by their expectations and the conditions in which the migration process takes place, as well as their work integration.

Factors associated with not using folic acid supplements preconceptionally

OBJECTIVE

Neural tube defects are among the most common birth defects worldwide. Folic acid intake from one month before to three months after conception reduces the likelihood of neural tube defects by at least 50%. Since 1995, several campaigns have been organised in the Netherlands which resulted in 51% of pregnant women using folic acid supplements during the entire recommended period in the northern part of the Netherlands in 2005. Our research question was to gain insight into the current prevalence and factors associated with inadequate pregnancy-related use of folic acid supplements.

DESIGN

Data from the DELIVER study were used, which is a population-based cohort study.

SETTING

Twenty midwifery practices across the Netherlands in 2009 and 2010.

SUBJECTS

In total 5975 pregnant women completed a questionnaire covering items on sociodemographic and lifestyle factors, including folic acid intake.

RESULTS

Of our study population, 55·5% (3318/5975) used folic acid supplements before conception. Several sociodemographic and lifestyle factors were associated with no preconception use of folic acid, of which non-Western ethnicity and not having a partner had the largest effect size.

CONCLUSIONS

In the Netherlands, the folic acid intake before conception is suboptimal and has not improved over recent years. Fortification of staple foods with folic acid should be reconsidered as it would provide a more effective means of ensuring an adequate intake, especially for those groups of women who are unlikely to plan their pregnancies or to receive or respond to health promotion messages.

Relevance of eosinophilia and hyper-IgE in immigrant children

Immigrants from undeveloped countries are a growing problem in Europe. Spain has become a frequent destination for immigrants (20% of whom are children) because of its geographic location and its historic and cultural links with Africa and Latin America. Eosinophilia is frequent in adult immigrants, travelers and expatriates coming from tropical areas. However, there are few studies that focus on the incidence and causes of tropical eosinophilia and hyper-IgE in immigrant children.We evaluated, prospectively, the prevalence and causes of eosinophilia and hyper-immunoglobulin E (IgE) in 362 immigrant children coming from Sub-Saharan Africa, Northern Africa and Latin America to Salamanca, Spain, between January 2007 and December 2011.Absolute eosinophilia and hyper-IgE were present in 22.9% and 56.8% of the analyzed children, respectively. The most frequent causes of absolute eosinophilia were filariasis (52.6%), strongyloidiasis (46.8%) and schistosomiasis (28.9%). Filariasis (41.9%), strongyloidiasis (29.6%) and schistosomiasis (22.2%) were the most frequent causes of increased levels of IgE. The area under the ROC curve showed similar values between eosinophil count and IgE levels in the diagnosis of helminthiasis (69% [95% confidence interval (CI) 63%-74%] vs 67% [95% CI 60%-72%], P = 0.24). Eosinophilia and hyper-IgE have a high value as biomarkers of helminthiasis in children coming from tropical and subtropical areas.

Should we look for Strongyloides stercoralis in foreign-born HIV-infected persons?

The objective was to evaluate the implementation of a systematic Strongyloides stercoralis screening programme in HIV infected immigrants attending an HIV Unit in Spain. An enzyme-linked immunosorbent assay (ELISA) was performed to assess the presence of Strongyloides IgG. Patients with a positive serology were treated with ivermectin; serologic follow-up testing was performed. 237 patients were screened (65.4 % men). Origin: 64.1 % came from Latin America, 16.5 % from Sub-Saharan Africa, 9.7 % from the Caribbean, 9.7 % from other areas. Strongyloides stercolaris IgG was positive in 13 cases (5.5 %). In the multivariate analysis, factors associated with a positive Strongyloides serology were illiteracy (OR: 23.31; p = 0.009) and eosinophilia (OR: 15.44; p < 0.0001). Nine of the 13 patients positive for S. stercoralis IgG and treated with ivermectin had a follow up serologic test: 77.8 % achieved a serologic response (55.5 % seroreversion). Screening of HIV-positive immigrants may be desirable, at least in those with higher risk of hyperinfection syndrome. Serologic testing seems a useful tool in both diagnosis and follow-up of these patients.

Testing the Latino paradox in Latin America: a population-based study of Intra-regional immigrants in Chile

BACKGROUND

Several studies in high-income countries report better health status of immigrants compared to the local population ("healthy migrant" effect), regardless of their socioeconomic deprivation. This is known as the Latino paradox.

AIM

To test the Latino paradox within Latin America by assessing the health of international immigrants to Chile, most of them from Latin American countries, and comparing them to the Chilean-born.

MATERIAL AND METHODS

Secondary data analysis of the population-based CASEN survey-2006. Three health outcomes were included: disability, illness/accident, and cancer/chronic condition (dichotomous). Demographics (age, sex, marital status, urban/rural, ethnicity), socioeconomic-status (SES: educational level, employment status and household income per-capita), and material standards (overcrowding, sanitation, housing quality). Crude and adjusted weighted regression models were performed.

RESULTS

One percent of Chile's population were immigrants, mainly from other Latin American countries. A "healthy migrant" effect appeared within the total immigrant population: this group had a significantly lower crude prevalence of almost all health indicators than the Chilean-born, which remained after adjusting for various demographic characteristics. However, this effect lost significance when adjusting by SES for most outcomes. The Latino paradox was not observed for international immigrants compared to the local population in Chile. Also, health of immigrants with the longest time of residency showed similar health rates to the Chilean-born.

CONCLUSIONS

The Latino paradox was not observed in Chile. Protecting low SES immigrants in Chile could have large positive effects in their health at arrival and over time.

A pilot of an intervention delivered to Chinese- and Spanish-speaking carers of people with dementia in Australia

There are limited language- and culture-specific support programs for carers of people with dementia living in Australia. A group intervention for use with Chinese and Spanish speakers in the United States was adapted to the Australian context, and a pilot study was undertaken with these 2 communities. The intervention is based on a cognitive behavioral therapy approach and was delivered by bilingual health professionals. The adapted material comprised 7 sessions, spanning 2 hours in duration. All 22 participants completed the Depression Anxiety and Stress Scale-Short form (DASS-21) pre- and postintervention. A significant decrease in depression, anxiety, and stress was observed among Spanish speakers; a significant decrease in depression and anxiety was present among the Chinese speakers. The implications are considered in the context of Australia's changing aged care service system.

Use of health services by adult Latin American immigrants residing in Seville

OBJECTIVE

This work sought to describe the use of health services by adult Latin American immigrants from Seville.

METHODOLOGY

This was a descriptive cohort study with the participation of 190 adult Latin American immigrants from 25 to 44 years of age, residing in the city of Seville (Spain) in 2011. A self-report survey was applied.

RESULTS

Within the past year, 67% of the individuals have visited a physician and 23% have attended nursing consultation. A total of 14% of the immigrants who called on a healthcare center reported that their experience was worse than that of others. La annual prevalence by accidents was: 10% domestic, 4% traffic-related and 9% occupational; nearly half these accidents justified emergency care or hospitalization due to their severity. The logistic regression model revealed that health services were used mostly by: women, those in poor self-perceived health status, those with secondary level of education, the elderly, and those who were single.

CONCLUSION

The population studied presents adequate use of health services, although it would be recommendable to implement prevention activities by nurses in the immigrant's work and family environment to reduce the accident incidence described by this group.

Prospective predictors of unprotected anal intercourse among HIV-seropositive men who have sex with men initiating antiretroviral therapy

Contemporary HIV prevention efforts are increasingly focused on those already living with HIV/AIDS (i.e., "prevention with positives"). Key to these initiatives is research identifying the most risky behavioral targets. Using a longitudinal design, we examined socio-demographic and psychosocial factors that prospectively predicted unprotected anal intercourse (UAI) in a sample of 134 HIV-seropositive men who have sex with men (MSM) initiating, changing, or re-starting an antiretroviral therapy regimen as part of a behavioral intervention study. Computer-based questionnaires were given at baseline and 6 months. In a sequential logistic regression, baseline measures of UAI (step 1), socio-demographic factors such as Latino ethnicity (step 2), and psychosocial factors such as crystal methamphetamine use, greater life stress, and lower trait anxiety (step 3) were predictors of UAI at 6 months. Problem drinking was not a significant predictor. Prevention efforts among MSM living with HIV/AIDS might focus on multiple psychosocial targets, like decreasing their crystal methamphetamine use and teaching coping skills to deal with life stress.

Cross-cultural analysis of determinants of hot flashes and night sweats: Latin-American immigrants to Madrid and their Spanish neighbors

OBJECTIVE

This study applies a biocultural perspective to better understand the determinants of hot flashes and night sweats within immigrant and local populations in Madrid, Spain.

METHODS

A combined sample of 575 women from Madrid, aged 45 to 55 years, was drawn from two studies. The Spanish sample (n = 274) participated in The Decisions At Menopause Study in 2000-2002. The Latin-American sample (n = 301) was drawn from immigrants to Madrid in 2010-2011. χ(2) analyses and logistic regression models were carried out on the combined sample, controlling for origin of provenance.

RESULTS

Forty-four percent of women reported hot flashes, 36% reported night sweats, and 26% reported both symptoms. Compared with Spanish women, Latin-American women were less likely to report hot flashes (odds ratio, 0.7; 95% CI, 0.4-0.9), after demographic variables and menopause status were controlled for. The same was not found for night sweats and for both symptoms combined. Determinants of hot flashes differed from determinants of night sweats.

CONCLUSIONS

Because their determinants differ, hot flashes and night sweats should be queried and analyzed separately. Latin-American women are less likely to report hot flashes, but not night sweats or both symptoms combined. More research is needed to clarify the differences in reported hot flashes, as the lesser reporting among immigrants could have been a cultural phenomenon rather than a biological phenomenon.

Decisional control preferences of Hispanic patients with advanced cancer from the United States and Latin America

CONTEXT

Understanding cancer patients' preferences in decisional roles is important in providing quality care and ensuring patient satisfaction. There is a lack of evidence on decisional control preferences (DCPs) of Hispanic Americans, the fastest growing population in the U.S.

OBJECTIVES

The primary aims of this study were to describe DCPs of Hispanics with advanced cancer in the U.S. (HUSs) and compare the frequency of passive DCPs in this population with that of Hispanics with advanced cancer in Latin America (HLAs).

METHODS

We conducted a prospective survey of patients with advanced cancer referred to outpatient palliative care clinics in the U.S., Chile, Argentina, and Guatemala. Information was collected on sociodemographic variables, Karnofsky Performance Scale scores, acculturation (Marin Acculturation Assessment Tool), and DCP (Control Preference Scale). Chi-square tests were used to determine the differences in DCPs between HUSs and HLAs.

RESULTS

A total of 387 patients were surveyed: 91 in the U.S., 100 in Chile, 94 in Guatemala, and 99 in Argentina. The median age of HUSs was 56 years, 59% were female, and the median Karnofsky Performance Scale score was 60; the corresponding values for HLAs were 60 years, 60%, and 80. HLAs used passive DCP strategies significantly more frequently than HUSs did with regard to the involvement of the family (24% vs. 10%; P=0.009) or the physician (35% vs. 16%; P<0.001), even after age and education were controlled for. Eighty-three percent of HUSs and 82% of HLAs preferred family involvement in decision making (P=non-significant). No significant differences were found in DCPs between poorly and highly acculturated HUSs (P=0.91).

CONCLUSION

HUSs had more active DCPs than HLAs did. Among HUSs, acculturation did not seem to play a role in DCP determination. Our findings confirm the importance of family participation for both HUSs and HLAs. However, HUSs were less likely to want family members to make decisions on their behalf.

Behavioral inhibition and risk for posttraumatic stress symptoms in Latino children exposed to violence

Latino children in urban contexts marked by poverty are at high risk of being exposed to violence and developing posttraumatic stress disorder (PTSD). Nonetheless, there is great variability in individual responses to violence exposure. This study examines risk for developing re-experiencing, avoidance, and arousal symptoms of PTSD as a function of individual differences in behavioral inhibition and exposure to community violence. Participants were 148 Latino students (M age =11.43 years, SD = 0.69; 55 % girls) living in an area marked by poverty and crime. Children completed self-report measures of behavioral inhibition and posttraumatic stress symptoms during a baseline assessment. During a follow-up interview 6 months later, children completed self-report measures of exposure to community violence since the baseline assessment and posttraumatic stress symptoms. Structural equation models revealed that behavioral inhibition at baseline was positively associated with PTSD avoidance and arousal symptoms at follow-up, after controlling for symptoms at baseline. Furthermore, behavioral inhibition moderated the association between violence exposure and symptoms such that violence was more strongly associated with the development of PTSD avoidance symptoms as behavioral inhibition increased. Results suggest that individual differences in behavioral inhibition contribute to risk for specific PTSD symptoms and are important for understanding variation in responses to trauma exposure. By examining diathesis--stress models within a disorder, we may be better able to elucidate the etiology of a disorder and translate this improved understanding into personalized intervention approaches that maximize effectiveness.

[Assessing the profile and nutritional intake of an Ibero-American group of nutrition postgraduate students]

INTRODUCTION

Dietary habits have a great influence on people health of, and its study is extremely important to proof adaptation to current recommendations in order to develop nutritional education and/or supplementation policies adjusted to reality.

MATERIAL AND METHODS

A descriptive cross study with the participation of postgraduate students. Participants were selected using non-probability accidental sampling accidental. Information was sent by e-mail, including a questionnaire on socio-demographic characteristics and a 3-day dietary record. We obtained a sample of n = 50 participants. The 3-day dietary records were evaluated with NutrIber software and the data obtained were treated using the statistical software SPSS 15.

RESULTS AND DISCUSSION

The profile of the students was 80% females and 20% males, mean age 33.7 ± 9.32 years, and body mass index of 22.91 ± 4.07. All groups have an excessive consumption of proteins and lipids and carbohydrates deficit. At the macro-story is remarkable that no group covers iodine recommended nutrient intake, and that no group of women covers the recommendations for fiber, folic acid and iron intake.

CONCLUSIONS

Further studies are needed to confirm the results found. However, it can be concluded that urban populations in Latin America are increasingly closer to the model of Western diet, rich in protein and fat and low in carbohydrates, fiber and micronutrients, which is indicative of poor diets in whole grains, fruits and vegetables.

Correlates of health literacy among latinos in Arkansas

Although research on acculturation and its effects on Latino health continue to grow, there is a dearth of knowledge on how acculturation levels shape health literacy. Health literacy is an important aspect of health to consider with the Latino population because a number of studies have found that this group has the lowest levels of health literacy in the United States. The purpose of this study was to examine how acculturation and sociodemographic characteristics contribute to the health literacy of Latinos adults. Cross-sectional data was collected from a nonprobability sample of 123 Latinos living in various Arkansas communities. Multiple regression results suggest that Latinos who were more acculturated and were educated beyond high school were significantly more likely to have increased levels of health literacy. Findings also show that age, gender, income, and citizenship status were not significant predictors of health literacy. Implications and future research are discussed.

Violence reported by the immigrant population is high as compared with the native population in southeast Spain

Immigrants constitute a population vulnerable to the problem of violence. This study sought to ascertain the prevalence of violence reported by the immigrant population in the Murcian Region of Spain and characterize the related factors, taking the country population as reference. A cross-sectional study was carried out based on a representative population sample of Latin American (n = 672; 48% women), Moroccan (n = 361; 25% women), and Spanish origin (n = 1,303; 66% women), aged 16 to 64 years. Using a specific questionnaire, the prevalence of violence in the preceding year was assessed. The results were compared with the Spaniards using the 2006 National Health Survey (NHS). Multivariate logistic regression models were used to study the factors associated with violence having been reported in each group, both separately and in immigrants versus Spaniards. Finally, the cause and place of last aggression were studied. The prevalence of violence was 6.5% in Latin Americans, 12.0% in Moroccans, and 2.7% in Spaniards. Discrimination was the principal violence-related factor in all three groups. Among Latin Americans, low educational level was also associated with violence. Among Moroccans, those who had perceived discrimination showed the greatest differences in prevalence of violence compared with natives. Intimate partner violence (IPV) registered a prevalence of below 2%. As a conclusion, in this study, violence was little reported and higher among immigrants. The principal violence-related factor was discrimination. More studies of this type are called for to characterize the problem in other population-representative samples.

Ethnic Differences in Correlates of Obesity between Latin-American and Black Women

OBJECTIVE

To date, no studies have examined dietary intake, physical activity, and body image in a large sample of Latin-American and black women recruited using the same methodology. The aim of this study was to examine three potential correlates of obesity (dietary intake, body image, and physical activity) in a large sample of Latin-American and black women across the weight spectrum.

RESEARCH METHODS AND PROCEDURES

Participants were black (n = 271) and Latin-American (n = 234) adult women who completed a 24-hour dietary recall and physical activity and body image questionnaires.

RESULTS

After controlling for BMI, education, marital status, and number of children, black women consumed more kilocalories, dietary fat (grams), and percent calories from fat than Latin-American women, who consumed more carbohydrates (grams) and dietary fiber (total and soluble). Black women engaged in more sedentary behavior than Latin-American women. Although Latin-American women weighed less than black women, they perceived their current body image as heavier and reported greater body image dissatisfaction than black women. Black women also reported a higher ideal body image than Latin-American women.

DISCUSSION

The combined effect of a diet higher in calories and fat, increased sedentary behavior, and more accepting body image could account for higher rates of obesity among black women. Future studies should further explore cultural attitudes and beliefs related to weight that could provide information for the development of culturally competent obesity interventions.

Cancer statistics for Hispanics/Latinos, 2012

Hispanics/Latinos are the largest and fastest growing major demographic group in the United States, accounting for 16.3% (50.5 million/310 million) of the US population in 2010. In this article, the American Cancer Society updates a previous report on cancer statistics for Hispanics using incidence data from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries and mortality data from the National Center for Health Statistics. In 2012, an estimated 112,800 new cases of cancer will be diagnosed and 33,200 cancer deaths will occur among Hispanics. In 2009, the most recent year for which actual data are available, cancer surpassed heart disease as the leading cause of death among Hispanics. Among US Hispanics during the past 10 years of available data (2000-2009), cancer incidence rates declined by 1.7% per year among men and 0.3% per year among women, while cancer death rates declined by 2.3% per year in men and 1.4% per year in women. Hispanics have lower incidence and death rates than non-Hispanic whites for all cancers combined and for the 4 most common cancers (breast, prostate, lung and bronchus, and colorectum). However, Hispanics have higher incidence and mortality rates for cancers of the stomach, liver, uterine cervix, and gallbladder, reflecting greater exposure to cancer-causing infectious agents, lower rates of screening for cervical cancer, differences in lifestyle and dietary patterns, and possibly genetic factors. Strategies for reducing cancer risk among Hispanics include increasing utilization of screening and available vaccines, as well as implementing effective interventions to reduce obesity, alcohol consumption, and tobacco use.

Academic achievement of legal immigrants' children: the roles of parents' pre- and postmigration characteristics in origin-group differences

Using data from the New Immigrant Survey, a study based on a nationally representative sample of legal immigrants, the present study extends prior research on the academic outcomes of immigrants' children by examining the roles of pre- and postmigration parental characteristics and the home environment. An analysis of 2,147 children aged 6-12 shows that parents' premigration education is more strongly associated with children's academic achievement than any other pre- or postmigration attribute. Premigration parental attributes account for the test score disadvantage of Mexican-origin children of legal immigrants, relative to their non-Latino counterparts. The findings reveal continuities and discontinuities in parental socioeconomic status and demonstrate that what parents bring to the United States and their experiences after arrival influence children's academic achievement.

'Boots for my Sancho': structural vulnerability among Latin American day labourers in Berkeley, California

This paper addresses the structural vulnerability of Latin American undocumented day labourers in Northern California, as it is expressed in conversations on street corners where they wait for work. The intimate aspects of migrant experience become exemplified in jokes about the Sancho - a hypothetical character who has moved in on a day labourer's family and who enjoys the money he sends home. Joking turns to more serious topics of nostalgia and tensions with family far away, elements that come together with the fears and threats of labour on the corner and affect the way day labourers see themselves. Sexuality is rearticulated in the absence of women and masculinity becomes enmeshed in the contingencies of unregulated work and long-term separation from the people the men support. Together, these elements result in the articulation of threat to the immigrant body itself, which is exemplified by anxieties over homosexual propositions on the corner.

The Latino Migrant Worker HIV Prevention Program: building a community partnership through a community health worker training program

There is limited information on the impact of the HIV/AIDS epidemic on Latino migrant workers (LMWs), although available data indicate that this community is being disproportionally affected. The need for prevention programs that address the specific needs of LMWs is becoming well recognized. HIV prevention interventions that train and employ community health workers are a culturally appropriate way to address the issues of community trust and capacity building in this community. This article describes the Latino Migrant Worker HIV Prevention Program and its efforts to train and engage community health workers in the prevention of HIV among LMWs in South Florida.

Salud Para Su Carozón--a Latino promotora-led cardiovascular health education program

Salud Para Su Carozón is a culturally sensitive, community-based program to increase heart healthy knowledge and behaviors among Latinos. Promotoras were trained using a 10-session manual to teach participants from 7 communities about heart disease risk factors and skills to achieve heart healthy behaviors. In 435 participants with pre-to-post self-reported data, there were increases in physical activity outside of work (57%-78%), heart health knowledge (49%-76%), and confidence in preparing heart healthy meals (66%-81%) (all Ps < .001). Results suggest that promotoras can provide effective health education to improve heart health risk behaviors in select Latino communities.

[Immigration from countries with a strong migratory pressure and participation in cervical cancer screening program in the Local Health Unit 2, Umbria Region. Impact on the probability of high-grade lesions and cervical cancer]

OBJECTIVE

to measure the risk of having serious lesions and cervical cancer for immigrant women, by evaluating the impact of their lack of participation in the previous rounds.

DESIGN

retrospective study.

SOURCE OF DATA

archive of the screening programme of Local Health Unit 2, Umbria. People subjected to the study: those adhering to the last round (2008- 2010) and belonging to an age group potentially capable of participating in all the previous rounds (1999-2007).

MAIN OUTCOME MEASURES

positivity to Pap test; lesions that require colposcopy (AGCH,AGCUS,ASCH, HSIL); tumours (squamous cell carcinomas and adenocarcinomas).

RESULTS

1.7% of the women were positive to the Pap test, 0.7% presented lesions with the immediate need for colposcopy, and 0.039% were diagnosed with cancer. The percentage of women who resulted either positive to the Pap test, or presenting lesions requiring colposcopy or with cancer, is significantly higher among those who come from poor countries. Furthermore, participation in previous rounds has proven to be protective with reference to the above-mentioned markers.

CONCLUSION

the independent weight of several risk factors has emerged and consequently the need to promote with particular commitment the participation in screening of women coming from poor countries.

[Chagas screening in pregnant Latin-American women. Experience in Poniente Almeriense (Almeria, Spain)]

INTRODUCTION

The transmission of Chagas disease is a public health problem in non-endemic countries.

METHODS

Chagas screening was performed by two serological tests in pregnant women from endemic areas for 4 years.

RESULTS

We studied 261 pregnant women from 13 Latin American countries, making a confirmatory diagnosis (two positive tests) in 4 cases. There was no case of vertical transmission.

CONCLUSION

Although Chagas disease has a low prevalence in the province of Almeria, the screening is necessary for the detection and treatment of infants with the disease.

Drinking and working in a cantina: misrecognition and the threat of stigma

Poor women are often compelled to accept jobs that jeopardise their health and their social reputations. Cantineras are recently immigrated Latinas employed in working-class Latino bars (cantinas) where they are hired as waitresses to earn sales commissions from beer purchased for them by male clients seeking female companionship. Narratives solicited from 31 cantineras revealed the work subculture of local cantinas, where drinking is a primary work obligation and where men expect sexual favours as a quid pro quo for beers they buy. This paper describes strategies that cantineras adopt to downplay their drinking and to disguise sex-trading practices. This distortion or 'misrecognition' of work-related practices functions to manage cantineras' fear of being stigmatised as workers and devalued as individuals. We argue that misrecognition in this context represents more than simple attempts at denial or to uphold a public image. Rather, it is a strategy employed by cantineras in order to function adaptively under oppressive work circumstances. Confronting stigma leads cantineras to adopt social and cognitive strategies that, while minimising social damage in the near term, can lead to devastating health and social consequences over time.

National and local vulnerability to climate-related disasters in Latin America: the role of social asset-based adaptation

The Latin American region is particularly prone to climate-related natural hazards. However, this article argues that natural hazards are only partly to blame for the region's vulnerability to natural disasters with quantitative evidence suggesting instead that income per capita and inequality are main determinants of natural disaster mortality in Latin America. Locally, the region's poor are particularly susceptible to climate-related natural hazards. As a result of their limited access to capital, adaptation based on social assets constitutes an effective coping strategy. Evidence from Bolivia and Belize illustrates the importance of social assets in protecting the most vulnerable against natural disasters.

The future of urban water services in Latin America

In recent decades, problems with the provision of drinking water and sanitation services around the world have increasingly been addressed by attempts at privatisation, recasting clean water as an essentially economic, rather than public, good. This approach gained particular acceptance in Latin America, but with limited success. In order to address the full range of social, economic and environmental values necessary to sustain water resources over time, public and governmental involvement in establishing integrated water management, pursuing ‘soft path’ approaches, assuring stakeholder input and setting policy will be essential to the process.

Being born in Sweden increases the risk for type 1 diabetes - a study of migration of children to Sweden as a natural experiment

AIM

To investigate whether the age of first exposure to a high-incidence country like Sweden determines the risk of T1DM in children with an origin in a low incidence region of the world.

METHODS

Register study in a Swedish study population in the age 6-25 years in three categories of residents with an origin in low incidence regions of T1DM (Eastern Europe, East Asia, South Asia and Latin America); 24,252 international adoptees; 47,986 immigrants and 40,971 Swedish-born with two foreign-born parents and a comparison group of 1,770,092 children with Swedish-born parents. Retrieval of a prescription of insulin during 2006 was used as an indicator of T1DM and analysed with logistic regression.

RESULTS

The odds ratios (OR) for T1DM were lower than the Swedish majority population for residents with an origin in the four low incidence regions. Being Swedish-born implied a higher risk for T1DM in the four low incidence study groups compared with the internationally adopted with an OR of 1.68 (CI 1.03-2.73).

CONCLUSIONS

Being born in Sweden increases the risk for T1DM in children with an origin in low incidence countries. This may imply that exposures in utero or very early infancy are important risk factors for T1DM.

The Latin American cohabitation boom, 1970–2007

The article describes the rise of unmarried cohabitation in Latin American countries during the last 30 years of the twentieth century, both at the national and regional levels. It documents that this major increase occurred in regions with and without traditional forms of cohabitation alike. In addition, the striking degree of catching up of cohabitation among the better-educated population segments is illustrated. The connections between these trends and economic (periods of high inflation) and cultural (reduction of stigmas in ethical domains) factors are discussed. The conclusion is that the periods of inflation and hyperinflation may have been general catalysts, but no clear indications of correlation were found between such economic factors and the rise in cohabitation. The shift toward more tolerance for hitherto stigmatized forms of conduct (e.g., homosexuality, euthanasia, abortion, singleparent household) is in line with the rise of cohabitation in regions of Argentina, Chile, and Brazil where cohabitation used to be uncommon. Further rises in cohabitation during the first decade of the twenty-first century are expected in a number of countries (e.g., mexico) despite conditions of much lower inflation.

Declining suburbs in Europe and Latin America

Suburban shrinkage, understood as a degenerative urban process stemming from the demise of the Fordist mode of urbanism, is generally manifested in a decline in population, industry and employment. It is also intimately linked to the global restructuring of industrial organization associated with the rise of the post-Fordist mode of urbanism and, more recently, the thrust of Asian industrialization. Framed in the discourse of industrial urbanism, this article examines the first ring of industrial suburbs that developed around large cities in their most rapid Fordist urbanization phase. These industrial suburbs, although they were formed at different times, are today experiencing specific mutations and undergoing profound restructuring on account of their particular spatial position between the central area and the expanding peripheries of the post-Fordist metropolis. This article describes and compares suburban decline in two European cities (Glasgow and Paris) and two Latin American Cities (São Paulo, Brazil and Guadalajara, Mexico), as different instances of places asymmetrically and fragmentarily integrated into the geography of globalization.

Chagas disease in Italy: breaking an epidemiological silence

Chagas disease, a neglected tropical disease that due to population movements is no longer limited to Latin America, threatens a wide spectrum of people(travellers, migrants, blood or organ recipients,newborns, adoptees) also in non-endemic countries where it is generally underdiagnosed. In Italy, the available epidemiological data about Chagas disease have been very limited up to now, although the country is second in Europe only to Spain in the number of residents from Latin American. Among 867 at-risk subjectsscreened between 1998 and 2010, the Centre for Tropical Diseases in Negrar (Verona) and the Infectious and Tropical Diseases Unit, University of Florence found 4.2% patients with positive serology for Chagas disease (83.4% of them migrants, 13.8% adoptees).No cases of Chagas disease were identified in blood donors or HIV-positive patients of Latin American origin. Among 214 Latin American pregnant women,three were infected (resulting in abortion in one case).In 2005 a case of acute Chagas disease was recorded in an Italian traveller. Based on our observations, we believe that a wider assessment of the epidemiological situation is urgently required in our country and public health measures preventing transmission and improving access to diagnosis and treatment should be implemented.

Chagas disease in Switzerland: history and challenges

Chagas disease, endemic in Latin America, is an emerging health problem in Europe affecting an estimated 80,000 persons. Around 60,000 Latin American migrants live in Switzerland, and cases of Chagas disease have been reported since 1979. As of June 2011, 258 cases have been diagnosed, mostly adults in the indeterminate phase of the chronic stage of the disease. Vertical transmission has been identified and there is a high potential for blood- and organ-borne transmission in the absence of systematic screening. Major challenges include (i) raising awareness among migrants and healthcare professionals, (ii) developing national protocols for screening and treatment targeting high-risk groups such as pregnant woman, newborns, migrants from highly endemic areas (e.g. Bolivia), and immunocompromised migrants, (iii) preventing blood- and organ-borne transmission by appropriate screening strategies, (iv) taking into account the social vulnerability of individuals at risk in the design and implementation of public health programmes, and (v) facilitating contacts with the communities at risk through outreach programmes, for example in churches and cultural groups.

Chagas disease at the crossroad of international migration and public health policies: why a national screening might not be enough

Since the year 2000, Chagas disease, traditionally known as a rural Latin American affliction, has been rising in the ranking of international health priorities due to the growing migration flows from endemic areas to non-endemic ones. Using the example of Italy and reporting preliminary results of a study carried out in the district of Bologna, the paper will argue that a disease-centred public health approach might be inadequate when dealing with complex and uncertain situations, in which complete statistical data are not available or not reliable, and in which the involved actors, health professionals on the one side, migrants on the other, appear to be unaware of the issue, or might even be denying it. In such a context, an effective public health approach should be capable of crossing disciplinary boundaries and bridging the gap between health services and communities, as well as between health and social issues.

Chagas disease in European countries: the challenge of a surveillance system

A study of aggregate data collected from the literature and official sources was undertaken to estimate expected and observed prevalence of Trypanosoma cruzi infection, annual incidence of congenital transmission and rate of underdiagnosis of Chagas disease among Latin American migrants in the nine European countries with the highest prevalence of Chagas disease. Formal and informal data sources were used to estimate the population from endemic countries resident in Europe in 2009, diagnosed cases of Chagas disease and births from mothers originating from endemic countries. By 2009, 4,290 cases had been diagnosed in Europe, compared with an estimated 68,000 to 122,000 expected cases. The expected prevalence was very high in undocumented migrants (on average 45% of total expected cases) while the observed prevalence rate was 1.3 cases per 1,000 resident migrants from endemic countries. An estimated 20 to 183 babies with congenital Chagas disease are born annually in the study countries. The annual incidence rate of congenital transmission per 1,000 pregnancies in women from endemic countries was between none and three cases. The index of under diagnosis of T. cruzi infection was between 94% and 96%. Chagas disease is a public health challenge in the studied European countries. Urgent measures need to be taken to detect new cases of congenital transmission and take care of the existing cases with a focus on migrants without legal residency permit and potential difficulty accessing care.

'Before you teach me, I cannot know': immigrant women's barriers and enablers with regard to cervical cancer screening among different ethnolinguistic groups in Canada

OBJECTIVE

To describe the similarities and differences among multiple groups of immigrant women and Canadian-born women of low socio-economic status regarding barriers and enablers associated with cervical cancer screening, in order to inform core elements of a strategy that would be acceptable across multiple underscreened groups.

METHOD

Within a health behaviour framework, we used a qualitative explanatory multiple-case study approach consisting of focus group interviews (n = 11) in Hamilton, Canada. Participants were newly immigrated (1-5 years) women and a group of Canadian-born women of low socio-economic status; all participants were in the age range 35-69 years and married. Language groups were Arabic, Cantonese, Somali, Dari (Afghanistan) and Spanish (Latin America). Two separate focus groups for each ethnolinguistic group were conducted; one in English and one in the native language. A template approach to analysis was used.

RESULTS

All groups indicated a strong need for information on necessity of screening and on how the procedure is done. Use of a video and a group discussion format were desired strategies. Women had positive feelings about being proactive for their health even if prevention had not been the norm in their home countries. There were differences between groups with respect to preferring a female clinician, which was a higher priority than language congruence with the provider. Only Chinese and Arabic groups discussed embarrassment and modesty as barriers.

CONCLUSION

Addressing key knowledge gaps around cervical cancer screening through personal approaches, educational videos and invitations may be useful core strategies to remove stigma and fear around screening and improve uptake across multiple ethnic groups and in women of lower socioeconomic status.

Latin America: native populations affected by early onset periodontal disease

Millions of individuals are affected by early onset periodontal disease in Latin America, a continent that includes more than 20 countries. The decision-makers claim that the disease is not commonly encountered. In 2009, 280,919 authorized immigrants were registered in the United States versus 5,460,000 unauthorized (2,600,000 in California). The objective of the present article is to raise awareness about the high prevalence of the disease among Latin Americans and the good prognosis of preventive measures associated with minimal financial cost.

Lrrk2 p.Q1111H substitution and Parkinson's disease in Latin America

Mutations in the LRRK2 gene are the most common genetic cause of Parkinson's disease, with frequencies displaying a high degree of population-specificity. Although more than 100 coding substitutions have been identified, only seven have been proven to be highly penetrant pathogenic mutations. Studies however are lacking in non-white populations. Recently, Lrrk2 p.Q1111H (rs78365431) was identified in two affected Hispanic brothers and absent in 386 non-Hispanic white healthy controls. We therefore screened this variant in 1460 individuals (1150 PD patients and 310 healthy controls) from 4 Latin American countries (Peru, Chile, Uruguay and Argentina). In our case-control series from Peru and Chile we observed an increased frequency of Lrrk2 p.Q1111H in patients (7.9%) compared to controls (5.4%) although the difference did not reach significance (OR 1.38; p = 0.10). In addition, the frequency of Lrrk2 p.Q1111H varied greatly between populations and further screening in a set of pure Amerindian and pure Spanish controls suggested that this variant likely originated in an Amerindian population. Further studies in other Latin American populations are warranted to assess its role as a risk factor for Parkinson's disease. Screening in Parkinson's disease patients from under-represented populations will increase our understanding of the role of LRRK2 variants in disease risk worldwide.

[Imported and non-imported diseases in the immigrant population. A decade of experience from an infectious diseases unit]

INTRODUCTION

Immigration is an inexorable process. Immigrants may suffer infectious diseases commonly seen in our environment, or those more exotic or more prevalent in their own environment.

MATERIAL AND METHODS

A study was performed including all immigrants see in an Infectious Diseases Unit of a general hospital from June 2001 to May 2010.

RESULTS

We studied 1,071 patients from Latin America (n=405, 37.8%), Northern Africa (n=281, 26.2%), Eastern Europe (n=186, 17.4%), sub-Saharan Africa (n=178, 16.6%), and Asia (21, 2.0%). Transmissible infectious diseases were the leading cause of consultation (53.8%), and they were more common among people coming from Northern Africa (61.6%) and Eastern Europe (69.4%) (P=.001). The second reason for consultation was for common infectious diseases (29%). Tropical infectious diseases were diagnosed in 16.4% of the patients, particularly from sub-Saharan Africa (36%), and Latin America (25.9%) (P<.001). The most common diagnoses were latent tuberculous infection (20.8%) [most common in those from Eastern Europe (27.4%) (P=.004)], respiratory tract infection (12.5%), sexually transmitted infections (10.6%) [most common in patients from Northern Africa (17.1%) (P=.004)], chronic hepatitis (10.4%) [most common in patients from Eastern Europe (26.3%) (P<.001) and sub-Saharan Africa (16.9%) (P=.004)], and active tuberculosis (8.7%) [most common in sub-Saharan Africa patients (15.7%) (P=.001)].

CONCLUSIONS

The spectrum of infectious diseases in the immigrant population in our area is broad, and includes a wide variety of tropical and communicable diseases, but also of common infections. While communicable diseases are the leading cause of consultation, common infections constitute an important part of health care activity.

Getting REDD-y: conservation and climate change in Latin America

Deforestation in Latin America, especially in the Amazon basin, is a major source of greenhouse gases such as carbon dioxide that contribute to global warming. Protected areas play a vital role in minimizing forest loss and in supplying key environmental services, including carbon sequestration and rainfall regulation, which mitigate the adverse impacts of climate change amid a rising tide of economic development in the region. The area of protected forest has expanded rapidly since 1980 to cover one-fifth of Latin America and more than two-fifths of Amazonia, a region whose rain forest captures some 40 percent of Latin America's carbon emissions. The reserve sector has traditionally suffered from severe underfunding, but the possibility of new resources being generated through financial compensation for "reduced emissions from deforestation and forest degradation" (REDD) or "avoided deforestation" under a new Kyoto protocol after 2012 could help strengthen the environmental and social roles of protected areas. However, a number of major implementation and governance challenges will need to be addressed.

Comparison of clinical features and drug therapies among European and Latin American patients with juvenile dermatomyositis

OBJECTIVES

To compare the demographic features, presenting manifestations, diagnostic investigations, disease course, and drug therapies of children with juvenile dermatomyositis (JDM) followed in Europe and Latin America.

METHODS

Patients were inception cohorts seen between 1980 and 2004 in 27 paediatric rheumatology centres. The following information was collected through the review of patient charts: sex; age at disease onset; date of disease onset and diagnosis; onset type; presenting clinical features; diagnostic investigations; course type; and medications received during disease course.

RESULTS

Four hundred and ninety patients (65.5% females, mean onset age 7.0 years, mean disease duration 7.7 years) were included. Disease presentation was acute or insidious in 57.1% and 42.9% of the patients, respectively. The course type was monophasic in 41.3% of patients and chronic polycyclic or continuous in 58.6% of patients. The more common presenting manifestations were muscle weakness (84.9%), Gottron's papules (72.9%), heliotrope rash (62%), and malar rash (56.7%). Overall, the demographic and clinical features of the 2 continental cohorts were comparable. European patients received more frequently high-dose intravenous methylprednisolone, cyclosporine, cyclophosphamide, and azathioprine, while methotrexate and antimalarials medications were used more commonly by Latin American physicians.

CONCLUSIONS

The demographic and clinical characteristics of JDM are similar in European and Latin American patients. We found, however, several differences in the use of medications between European and Latin American paediatric rheumatologists.

Latino parents' perceptions of their ability to prevent obesity in their children

The obesity epidemic in Latino children has reached staggering proportions. This study explored Latino parents' perceptions of their ability to prevent obesity in children. Three focus groups were conducted with 26 Latino parents of preschoolers at a New York City Head Start program. Parents perceived high levels of ability to prevent obesity primarily via dietary influence. Four factors negatively impacted parents' ability: family history, intergenerational and interparental issues, adolescence, and societal pressures. Culturally effective, family-based obesity interventions among Latinos should build upon parental perceptions of ability to prevent obesity, while simultaneously helping parents address the factors they perceive challenge this ability.

Abortion law reforms in Colombia and Nicaragua: issue networks and opportunity contexts

This article analyses two instances of abortion law reform in Latin America. In 2006, after a decades-long impasse, the highly controversial issue of abortion came to dominate the political agenda when Colombia liberalized its abortion law and Nicaragua adopted a total ban on abortion. The article analyses the central actors in the reform processes, their strategies and the opportunity contexts. Drawing on Htun's (2003) framework, it examines why these processes concluded with opposing legislative outcomes. The authors argue for the need to understand the state as a non-unitary site of politics and policy, and for judicial processes to be seen as a key variable in facilitating gender policy reforms in Latin America. In addition, they argue that ‘windows of opportunity’ such as the timing of elections can be critically important in legislative change processes.

Who cares in Nicaragua? A care regime in an exclusionary social policy context

In Latin American countries with historically strong social policy regimes (such as those in the Southern Cone), neoliberal policies are usually blamed for the increased burden of female unpaid work. However, studying the Nicaraguan care regime in two clearly defined periods — the Sandinista and the neoliberal eras — suggests that this argument may not hold in the case of countries with highly familialist social policy regimes. Despite major economic, political and policy shifts, the role of female unpaid work, both within the family and in the community, remains persistent and pivotal, and was significant long before the onset of neoliberal policies. Nicaragua's care regime has been highly dependent on the ‘community’ or ‘voluntary’ work of mostly women. This has also been, and continues to be, vital for the viability of many public social programmes.

How much do they know about sexual health?: Knowledge and information-seeking behaviors of Spanish-speaking immigrant adolescents in Curacao, Netherlands Antilles

Scant HIV/AIDS prevalence data from Curacao suggest that 65.9% of the HIV/AIDS cases in the Netherlands Antilles are currently being documented in this country. The present cross-sectional qualitative study evaluated levels of knowledge of sexual health and information-seeking behavior of Spanish-speaking immigrant adolescents in Curacao. Findings point to a greater need for channels of sexual health information targeting adolescents that focus on the interpersonal aspects of sexuality, to encourage greater parental involvement in their adolescents' lives, and to improve communications between adolescents and their parents. Study findings also suggest the need for a more thoughtful and systematic exploration of the indications by participants that force/coercion specifically by older men including stepfathers was a reason for sexual initiation of many young Latina girls in Curacao.

[Chagas disease in a non endemic country: a study in the district of Bologna (Italy). Multidisciplinary analysis of the disease in the Latin American migrant population]

Chagas disease is a parasitic illness endemic in 21 countries of Central and South America, affecting over 10 million people. Due to the increase of migration flows to Europe, Chagas disease is an emerging public health issue in non endemic countries. In Italy, where no specific policy has yet been developed, the Centre for International Health of the University of Bologna is carrying out the project "Chagas disease in a non endemic country: a study in the district of Bologna". A multidisciplinary and multi-method approach was adopted to estimate the problem and its impact in our territory. A retrospective analysis was performed searching several databases in order to collect information concerning the demographic and epidemiological profile of Latin American migrants coming from endemic countries. At the same time, a preliminary ethnographic research was conducted to start unveiling the main socio-anthropological characteristics of this population, thanks to the involvement of key informants and community associations. According to preliminary findings, Chagas disease is a present and possibly increasing reality in our territory. Due to the particular features of the affected population, socio-cultural variables have to be considered for their impact on the visibility of the condition and on health seeking behaviors.

Outreach strategies for expanding health insurance coverage in children

BACKGROUND

Health insurance has the potential to improve access to health care and protect people from healthcare costs when they are ill. However, coverage is often low, particularly in people most in need of protection.

OBJECTIVES

To assess the effectiveness of outreach strategies for expanding insurance coverage of children who are eligible for health insurance schemes.

SEARCH STRATEGY

We searched the Cochrane Effective Practice and Organisation of Care Group (EPOC) Specialised Register (The Cochrane Library 2009, Issue 2), PubMed (January 1951 to January 2010), EMBASE (January 1966 to April 2009), PsycINFO (January 1967 to April 2009) and other relevant databases and websites. In addition, we searched the reference lists of included studies and relevant reviews, and carried out a citation search for included studies to find more potentially relevant studies.

SELECTION CRITERIA

Randomised controlled trials, controlled clinical trials, controlled before-after studies and interrupted time series which evaluated the effects of outreach strategies on increasing health insurance coverage for children. We defined outreach strategies as measures to improve the implementation of existing health insurance to enrol more eligible populations. This included increasing awareness of schemes, modifying enrolment, improving management and organis ation of insurance schemes, and mixed strategies.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data and assessed the risk of bias . We narratively summari sed the data.

MAIN RESULTS

We included two studies, both from the United States. One randomised controlled trial study with a low risk of bias showed that community- based case managers who provided health insurance information, application support, and negotiated with the insurer were effective in enrolling and maintaining enrolment of Latino American children into health insurance schemes (n = 257). The second quasi-randomised controlled trial, with an unclear risk of bias (n = 223), indicated that handing out insurance application materials in hospital emergenc y departments can increase enrolment of children into health insurance.

AUTHORS' CONCLUSIONS

The two studies included in this review provide evidence that in the US providing health insurance information and application assistance, and handing out application materials in hospital emergency departments can probably both improve insurance coverage of children. Further studies evaluating the effectiveness of different outreach strategies for expanding health insurance coverage of children in different countries are needed, with careful attention given to study design.

Discrimination, psychosocial stress, and health among Latin American immigrants in Oregon

Chronic psychosocial stress related to discrimination has been shown to be associated with biological measures such as elevated systolic blood pressure (SBP), increased body fat, and higher fasting glucose levels. Few studies have examined these relationships in immigrant populations. The present study recruited a sample of 132 Oregon Latino immigrant adults to investigate the relationships between perceived discrimination and several health measures (blood pressure, body mass index [BMI], and fasting glucose). Results indicate that perceived discrimination stress predicted elevated SBP among men but not among women. Perceived discrimination was significantly higher among obese women than among women of normal BMI. The same pattern was not observed for men. Further, a strong trend relationship was detected: the higher women's reported discrimination stress, the higher their fasting glucose levels. Again, this pattern was not observed for men. These results suggest that chronic psychosocial stress plays an important role in disease risk among Latin American immigrants, and that male and female immigrants may have distinctive physiological responses. If confirmed, these findings may have important clinical and public health implications for chronic disease prevention among Latinos.

[Chagas disease. American trypanosomiasis. Recommendation for non-endemic zones]

The following recommendations were made at the end of the consensus workshop organized by the Société de Pathologie Exotique (Exotic Pathology Society) (Paris, 26 June 2009). They apply to people of Latin American origin (immigrants, children born in France to a Latin-American mother, French people originating in Guyana) and expatriates and travellers who have stayed in areas where Chagas disease is endemic. These recommendations concern screening for people who are infected but asymptomatic, diagnosis of acute forms, diagnosis of chronic forms with clinical manifestations and therapeutic procedure.