1
|
Lombardi M, Silva M, Giovanetti M, Cabibbe D, Luksch R, Terenziani M, Casanova M, Spreafico F, Meazza C, Podda M, Biassoni V, Schiavello E, Chiaravalli S, Puma N, Bergamaschi L, Gattuso G, Nigro O, Sironi G, Colombo V, Ferrari A, Massimino M, Clerici CA. Foreign patients and multicultural challenges in pediatric oncology: The experience of the Istituto Nazionale dei Tumori in Milan. Pediatr Blood Cancer 2024; 71:e31260. [PMID: 39138601 DOI: 10.1002/pbc.31260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 07/15/2024] [Accepted: 07/28/2024] [Indexed: 08/15/2024]
Abstract
This paper describes the complexity of the clinical management of foreign minors suffering from cancer, through the clinical experience of an Italian referral center. The study includes 50 patients less than 18 years (22% of the patients admitted to the unit in 2023), 32 foreigners who were Italian resident and 18 who had come to Italy specifically to receive cancer treatment. Patients who migrate for healthcare reasons often arrive at the referral center with advanced disease or relapse. Numerous socio-cultural issues were reported. To address them, specific strategies were implemented to ensure equal and high-quality care for all patients, respecting their needs.
Collapse
Affiliation(s)
- Martina Lombardi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Matteo Silva
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Giovanetti
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Daniele Cabibbe
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberto Luksch
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo Spreafico
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cristina Meazza
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marta Podda
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Veronica Biassoni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elisabetta Schiavello
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nadia Puma
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luca Bergamaschi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Gattuso
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Olga Nigro
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Sironi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Valeria Colombo
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlo Alfredo Clerici
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| |
Collapse
|
2
|
Chaudhry A, Hebert-Beirne J, Alessi EJ, Khuzam MZ, Mitchell U, Molina Y, Wasfie D, Fox S, Abboud S. Barriers and facilitators to healthcare utilisation by Arab sexual minority women migrants in the USA. CULTURE, HEALTH & SEXUALITY 2024:1-16. [PMID: 39092493 DOI: 10.1080/13691058.2024.2384055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 07/21/2024] [Indexed: 08/04/2024]
Abstract
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.
Collapse
Affiliation(s)
- Aeysha Chaudhry
- Division of Community Health Sciences, School of Public Health, University of IL Chicago, Chicago, IL, USA
| | - Jennifer Hebert-Beirne
- Division of Community Health Sciences, School of Public Health, University of IL Chicago, Chicago, IL, USA
| | - Edward J Alessi
- School of Social Work, Rutgers University, New Brunswick, NJ, USA
| | - Maya Z Khuzam
- Department of Political Science, University of MI, Ann Arbor, MI, USA
| | - Uchechi Mitchell
- Division of Community Health Sciences, School of Public Health, University of IL Chicago, Chicago, IL, USA
| | - Yamile Molina
- Division of Community Health Sciences, School of Public Health, University of IL Chicago, Chicago, IL, USA
| | - Dhuha Wasfie
- Department of Psychology, University of Illinois Urbana-Champaign, Champaign, IL, USA
| | - Samara Fox
- Baystate Medical Center, Springfield, MA, USA
| | - Sarah Abboud
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| |
Collapse
|
3
|
Hassell NE, Bustos VP, Elmer N, Comer CD, Manstein SM, Lin SJ. Costs Versus Complications: Public Perspectives on International Cosmetic Surgery Tourism. Plast Surg (Oakv) 2024; 32:468-475. [PMID: 39104936 PMCID: PMC11298143 DOI: 10.1177/22925503221134817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 09/03/2022] [Accepted: 09/10/2022] [Indexed: 08/07/2024] Open
Abstract
Introduction: The purpose of this study was to understand the perceptions of potential complications and motivations among patients willing to travel internationally for cosmetic surgery and to gain insight into public perceptions of cosmetic surgery tourism by surveying a large, cross-sectional sample of the general public. Methods: A cross-sectional survey was performed through Amazon Mechanical Turk regarding cosmetic surgery tourism in adults 18 years and older and currently residing in the United States (US). Results: A total of 484 responses were analyzed. Of those, 45.2% of participants would consider having plastic surgery. Among these participants, 67.1% would consider traveling outside of the US to receive cosmetic surgery. Participants who reported Hispanic or Latino ethnicity had increased odds of considering surgery abroad (OR 3.1, 95% CI 1.1-8.7, P = .030). Participants reported that the top advantages of traveling outside of the US for surgery were the price of surgery internationally, a shorter waiting list for surgery, and privacy during recovery. The top disadvantages were the risk of complications, lack of follow-up or continuity care after surgery, and distance from home. Although the risk of complications was acknowledged as the top disadvantage, the perceived safety of receiving plastic surgery abroad was not related to willingness to consider having surgery abroad (P = .268). Conclusion: These findings support the need for continued awareness of patients considering international travel for cosmetic surgery and increased education of the general public regarding the safety of cosmetic surgery tourism and the importance of selecting board-certified plastic surgeons and accredited facilities.
Collapse
Affiliation(s)
- Natalie E. Hassell
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Valeria P. Bustos
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Nicholas Elmer
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Carly D. Comer
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Samuel M. Manstein
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Samuel J. Lin
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
4
|
Stepanova V, Poppleton A, Ponsford R. Central and Eastern European Migrants in the United Kingdom: A Scoping Review of the Reasons for Utilisation of Transnational Healthcare. Health Expect 2024; 27:e14155. [PMID: 39044675 PMCID: PMC11266902 DOI: 10.1111/hex.14155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 07/08/2024] [Accepted: 07/10/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND An estimated 2.2 million people from Central and Eastern Europe (CEE) live in the United Kingdom. It has been documented that CEE migrants underutilise health services in the United Kingdom and, as an alternative, seek healthcare in their home country. However, reasons for seeking healthcare abroad are not always clear. This review aims to identify the reasons for the uptake of transnational healthcare among CEE migrants resident in the United Kingdom. METHODS Informed by discussions with community members, medical stakeholders and academics, a systematic scoping review was undertaken following the nine-stage Joanna Briggs Institute framework for scoping reviews. A search strategy with MeSH terms, where relevant, was used and adapted in five academic databases, two grey literature databases and Google Scholar. Included records encompassed four concepts: migration, CEE nationalities, UK nations and healthcare utilisation, which were written in English and published between May 2004 and 2022. Data from the literature were coded, grouped and organised into themes. RESULTS A total of 16 publications fulfilled the inclusion criteria. There is evidence that some CEE migrants exclusively use healthcare services in the United Kingdom. However, many CEE migrants utilise healthcare both in the United Kingdom and their country of origin. Four themes were identified from the literature as to why migrants travelled to their country of origin for healthcare: cultural expectations of medical services, distrust in the UK NHS, barriers and transnational ties. CONCLUSION Push factors led CEE migrants to seek healthcare in their country of origin, facilitated by ongoing transnational ties. CEE migrants frequently combine visits to their country of origin with medical appointments. Utilising healthcare in their country of origin as opposed to the United Kingdom can result in fragmented and incomplete records of medications, medical tests and surgeries and risk of unnecessary treatments and complications. This review highlights the need for more targeted health outreach with CEE groups within the United Kingdom, as well as the need for further research on the impact of national events, for example, COVID-19 and Brexit, on transnational healthcare-seeking behaviours. PATIENT OR PUBLIC CONTRIBUTION The concept for this scoping review was informed by discussions with community members, medical professionals and academics, who identified it as a current issue. The results of this scoping review were discussed with healthcare stakeholders.
Collapse
Affiliation(s)
- Victoria Stepanova
- Faculty of Public Health & PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | | | - Ruth Ponsford
- Faculty of Public Health & PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| |
Collapse
|
5
|
Peng B, Ling L. Health service behaviors of migrants: A conceptual framework. Front Public Health 2023; 11:1043135. [PMID: 37124818 PMCID: PMC10140430 DOI: 10.3389/fpubh.2023.1043135] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 03/14/2023] [Indexed: 05/02/2023] Open
Abstract
Universal health coverage is vital to the World Health Organization's (WHO's) efforts to ensure access to health as a human right. However, it has been reported that migrants, including both international immigrants and internal migrants, underuse health services. Establishing a conceptual framework to facilitate research on the health service behaviors (HSB) of migrants is particularly important. Many theoretical frameworks explaining the general population's HSB have been published; however, most theoretical frameworks on migrants' HSB only focus on international immigrants without the inclusion of internal migrants. Of note, internal migrants are much more abundant than immigrants, and this group faces similar barriers to HSB as immigrants do. Based on theoretical frameworks of immigrants' HSB and Anderson's behavior model, the author proposes a new conceptual framework of migrants' HSB that includes both immigrants and internal migrants. The new conceptual framework divides the determinants into macro-structural or contextual factors, health delivery system characteristics, and characteristics of the population at risk and describes subgroup-specific factors. The author added some variables and reclassified variables in some dimensions, including characteristics of health delivery systems and access to healthcare. The characteristics of health delivery systems comprise the volume, organization, quality, and cost of the health delivery system, while the characteristics of access to healthcare include time accessibility, geographic accessibility, and information accessibility. The outcomes of HSB have been expanded, and relationships between them have been reported. The mediating effects of some variables have also been described. This conceptual framework can facilitate a deep and comprehensive understanding of the HSB determination process for migrants, including internal migrants.
Collapse
Affiliation(s)
- Boli Peng
- Department of Actuarial Science, School of Insurance, Guangdong University of Finance, Guangzhou, China
| | - Li Ling
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Li Ling,
| |
Collapse
|
6
|
Amuedo‐Dorantes C, Rivera‐Garrido N, Vall Castelló J. Reforming the provision of cross-border medical care: Evidence from Spain. HEALTH ECONOMICS 2022; 31:859-876. [PMID: 35212071 PMCID: PMC9303968 DOI: 10.1002/hec.4481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 01/13/2022] [Accepted: 01/26/2022] [Indexed: 06/14/2023]
Abstract
Cross-border medical care, defined as care facilitated by a local health provider under pre-established regional agreements, as in the case of European Union (EU) citizens accessing care within EU countries, has been on the rise. Unlike medical tourism, typically sought by patients through their own volition and paid for out-of-pocket, cross-border medical care is often reimbursable or paid for directly by the responsible government. Yet, because nations vary in the extent of health coverage offered to their residents, these expenditures are often only partially reimbursed. The resulting financial burden for some countries can be large and not reciprocal, straining regional and country-level finances. We analyze the effectiveness of a legislative measure adopted by a Spanish region in January 2012 with the purpose of curbing cross-border medical care. Using a comprehensive administrative dataset of all medical procedures performed in the country between 2008 and 2015, we find that the measure led to a drastic drop in the number of foreigners' hospitalizations and a reduction of 4.8 million euros/trimester in costs. Finally, the decrease in hospitalizations did not disproportionally affect patients based on their gender, age, or origin, although it fostered a reduction in readmissions.
Collapse
|
7
|
Digital Information Technology Use and Transnational Healthcare: A Population-Based Study on Older Russian-Speaking Migrants in Finland. J Immigr Minor Health 2021; 24:125-135. [PMID: 34738165 PMCID: PMC8766379 DOI: 10.1007/s10903-021-01301-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 10/31/2022]
Abstract
This study examines the association between digital information technology (DIT) use and the utilization of transnational healthcare (THC) in older migrants, and investigates how this relationship depends on social integration or perceived discrimination in health services in the destination country. The data from a population-based study conducted in Finland in 2019, which targeted Russian-speaking residents aged 50 and above (n = 1082) nationwide, are analyzed. The analysis demonstrates that those who had a high level of DIT use were significantly more likely to use THC than those who had a low level of use. However, the findings do not show that the relationship depends on social integration or perceived discrimination. Older migrants can actively use transnational networks to address their health and well-being issues by using DIT and seeking healthcare abroad. Their health service use can be illustrated as an active process involving various geographical domains.
Collapse
|
8
|
O’Sullivan D, McCabe JP, Flaherty GT. Orthopedic Tourism and Volunteerism: Joint Effort or Disjointed Mobility? Arthroplast Today 2021; 10:114-116. [PMID: 34345641 PMCID: PMC8319507 DOI: 10.1016/j.artd.2021.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/12/2021] [Accepted: 06/16/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- David O’Sullivan
- Department of Orthopaedic Surgery, Galway University Hospitals, Galway, Ireland
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - John P. McCabe
- Department of Orthopaedic Surgery, Galway University Hospitals, Galway, Ireland
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Gerard T. Flaherty
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| |
Collapse
|