Suicide attempts in the absence of depression: Differences between broad cultural groups

Suicide is one of the leading causes of death worldwide (WHO, 2021). Depression is a common precursor to suicide and suicidality; however, individuals' experience of depression and the meaning of suicide differs depending on one's cultural background (Colucci, 2013; Goodmann et al., 2021; Kleinman, 2004). The current study explores the relationship between suicide and depression among six broad cultural groups in a large sample (N = 17,015) of adults representing six broad cultural groups (Latin America, South Asia, former Soviet Bloc, Western English-speakers, Chinese, and Arab World). Participants were recruited to a multilingual depression and suicide screening study via Google Ads (Leykin et al., 2012; Gross et al., 2014). As expected, the presence of depression was associated with suicide attempts. However, cultural group moderated this association, with Chinese participants being most likely to report suicide attempts while screening negative for depression. Although depression remains an important predictor of suicidality, it appears that certain cultural groups may be at higher risk even when depression is not present. Clinicians should consider using culturally adapted assessments for depression and suicidality.

Imported infectious diseases in migrants from Latin America: A retrospective study from a referral centre for tropical diseases in Spain, 2017-2022

INTRODUCTION

Detecting imported diseases by migrants and individuals visiting friends and relatives (VFR) is key in the prevention and management of emergent infectious diseases acquired abroad.

METHODS

Retrospective descriptive study on migrants and VFR from Central and South America between 2017 and 2022 attended at a National Referral Centre for Tropical Diseases in Madrid, Spain. Demographic characteristics, syndromes and confirmed travel-related diagnoses were obtained from hospital patient medical records.

RESULTS

1654 cases were registered, median age of 42 years, 69.1% were female, and 55.2% were migrants. Most cases came from Bolivia (49.6%), followed by Ecuador (12.9%). Health screening while asymptomatic (31.6%) was the main reason for consultation, followed by Chagas disease follow-up (31%). Of those asymptomatic at screening, 47,2% were finally diagnosed of any disease, mainly Chagas disease (19,7%) and strongyloidiasis (10,2%) CONCLUSION: Our study emphasizes the importance of proactive health screening to detect asymptomatic conditions in migrants and VFR, enabling timely intervention and improved health outcomes. By understanding the unique health profiles of immigrant populations, targeted public health interventions can be devised to safeguard the well-being of these vulnerable groups.

Post-immigration factors affecting retention in HIV care and viral suppression in Latin American and Caribbean immigrant populations in the United States: a systematic review

OBJECTIVES

To reduce disparities in HIV care outcomes among Latin American and Caribbean (LAC) immigrants living with HIV in the U.S., it is necessary to identify factors influencing HIV care in this population. A systematic review that provides a comprehensive understanding of factors influencing retention in HIV care and viral suppression among LAC immigrants living with HIV in the U.S. is lacking. This systematic review used the Immigrant Health Services Utilization theoretical framework to provide an understanding of these factors.

DESIGN

We searched for peer-reviewed publications in MEDLINE, EMBASE, CINAHL, PsycINFO, and ASSIA, from January 1996 to June 2020.

RESULTS

A total of 17 qualitative (n = 10) and quantitative (n = 7) studies were included in the review. The most commonly reported general and immigrant-specific factors appearing in studies were undocumented immigration status, HIV stigma, homophobia, cultural norms, values and beliefs, family and social support, language barriers, structure, complexity and quality of the U.S. healthcare delivery system, and patient-provider relationship.

CONCLUSION

These findings highlight the importance of considering immigrant-specific factors along with general factors to improve the provision of HIV care services and HIV care outcomes among LAC immigrant populations.

Community-based screening of Chagas disease among Latin American migrants in a non-endemic country: an observational study

BACKGROUND

Chagas disease is a parasitic disease endemic to Latin America, but it has become a disease of global concern due to migration flows. Asymptomatic carriers may host the parasite for years, without knowing they are infected. The aim of this study is to assess prevalence of Chagas disease and evaluate the participants' level of knowledge between Latin American migrants attending a community-based screening campaign.

METHODS

Three community-based campaigns were performed in Alicante (Spain) in 2016, 2017 and 2018, including educational chats and blood tests for Trypanosoma cruzi serology. Participants completed a questionnaire assessing knowledge about the mechanisms of transmission, disease presentation, diagnosis, and treatment. People seropositive for T. cruzi underwent diagnostic confirmation by two different tests. Results were analyzed by multivariable logistic regression and expressed as adjusted odds ratios (aORs), adjusting for age, sex, and time in Spain.

RESULTS

A total of 596 participants were included in the study; 17% were aged under 18 years. Prevalence in adults was 11% [54/496; 95% confidence interval (CI): 8.3-14.5%] versus 0% among children. All but one case were in Bolivians. Diagnosis was independently associated with having been born in Bolivia (aOR: 102, 95% CI: 13-781) and a primary school-level education (aOR: 2.40, 95% CI: 1.14-5.06). Of 54 people diagnosed with Chagas disease (most of whom were asymptomatic), 42 (77.7%) returned to the clinic at least once, and 24 (44.4%) received treatment. Multivariable analysis showed that coming from Argentina (aOR: 13, 95% CI: 1.61-1188) or Bolivia (aOR: 1.90, 95% CI: 1.19-3.39) and having received information about Chagas disease in Spain (aOR: 4.63, 95% CI: 2.54-8.97) were associated with a good level of knowledge on the disease. Having primary level studies (aOR: 0.59, 95% CI: 0.34-0.98) and coming from Ecuador (aOR: 4.63, 95% CI: 2.52-847) were independently associated with a lower level of knowledge.

CONCLUSIONS

Community-based interventions are a good strategy for diagnosing neglected diseases such as Chagas disease in non-endemic countries and for identifying and treating infected, asymptomatic individuals.

Intersections Of Neighborhood Co-Ethnic Density and Nativity Status On Heavy Drinking In a General Population Sample Of US Latinos and Asians

AIMS

Greater neighborhood co-ethnic density (living in proximity with people sharing an ethnicity) and being foreign-born each can protect against risky drinking, but little is known about whether these two factors interact. Using a representative sample of Latinos and Asians from California, USA, we investigate main and interactive effects of neighborhood co-ethnic density and nativity status in relation to heavy episodic drinking (HED).

METHODS

This study uses the California Health Interview Survey (N = 30,203) linked with neighborhood data to investigate associations of co-ethnic density and nativity status with HED. Co-ethnic density was based on matching each respondent's ethnicity to the proportion of residents of the corresponding group in their Census tract. Using weighted logistic regression, we first examined main effects of neighborhood co-ethnic density and respondent nativity status on HED. Next, we assessed the interaction of co-ethnic density and nativity status. Finally, we estimated nativity-stratified models to investigate variation in effects of co-ethnic density.

RESULTS

Co-ethnic density was not associated with HED for the full sample, but US-born nativity status was associated with increased odds of past-year HED. The interaction model showed co-ethnic density and nativity had synergistic effects, whereby greater levels of neighborhood co-ethnic density buffered risk associated with being US-born. Further, greater neighborhood co-ethnic density was associated with reduced odds of HED for US-born respondents, but it was not associated with HED for foreign-born respondents.

CONCLUSIONS

Protective effects of high neighborhood co-ethnic density on HED are stronger for US-born than for foreign-born Latinos and Asians in California.

Mortality in first- and second-generation immigrants to Sweden diagnosed with type 2 diabetes: a 10 year nationwide cohort study

AIMS/HYPOTHESIS

Non-Western immigrants to Europe are at high risk for type 2 diabetes. In this nationwide study including incident cases of type 2 diabetes, the aim was to compare all-cause mortality (ACM) and cause-specific mortality (CSM) rates in first- and second-generation immigrants with native Swedes.

METHODS

People living in Sweden diagnosed with new-onset pharmacologically treated type 2 diabetes between 2006 and 2012 were identified through the Swedish Prescribed Drug Register. They were followed until 31 December 2016 for ACM and until 31 December 2012 for CSM. Analyses were adjusted for age at diagnosis, sex, socioeconomic status, education, treatment and region. Associations were assessed using Cox regression analysis.

RESULTS

In total, 138,085 individuals were diagnosed with type 2 diabetes between 2006 and 2012 and fulfilled inclusion criteria. Of these, 102,163 (74.0%) were native Swedes, 28,819 (20.9%) were first-generation immigrants and 7103 (5.1%) were second-generation immigrants with either one or both parents born outside Sweden. First-generation immigrants had lower ACM rate (HR 0.80 [95% CI 0.76, 0.84]) compared with native Swedes. The mortality rates were particularly low in people born in non-Western regions (0.46 [0.42, 0.50]; the Middle East, 0.41 [0.36, 0.47]; Asia, 0.53 [0.43, 0.66]; Africa, 0.47 [0.38, 0.59]; and Latin America, 0.53 [0.42, 0.68]). ACM rates decreased with older age at migration and shorter stay in Sweden. Compared with native Swedes, first-generation immigrants with ≤ 24 years in Sweden (0.55 [0.51, 0.60]) displayed lower ACM rates than those spending >24 years in Sweden (0.92 [0.87, 0.97]). Second-generation immigrants did not have better survival rates than native Swedes but rather displayed higher ACM rates for people with both parents born abroad (1.28 [1.05, 1.56]).

CONCLUSIONS/INTERPRETATION

In people with type 2 diabetes, the lower mortality rate in first-generation non-Western immigrants compared with native Swedes was reduced over time and was equalised in second-generation immigrants. These findings suggest that acculturation to Western culture may impact ACM and CSM in immigrants with type 2 diabetes but further investigation is needed. Graphical abstract.

Barriers to and facilitators of community participation among Latinx migrants with disabilities in the United States and Latinx migrant workers in Canada: An ecological analysis

Individuals migrate to improve their wellbeing and quality of life, and often experience adverse situations, both during the process of migration and once within the host country. The purpose of this paper is to unpack the barriers to and facilitators of community participation, among Latinx immigrants with disabilities in the United States and Latinx migrant workers in Canada, following the Social Ecological Model. The authors draw from an appraisal of existing literature and their own participatory research with Latinx immigrants. Based on this integrative literature review, Latinx experience individual issues such as language barriers and lack of knowledge of the services available to them. At the community level they experience discrimination, limited opportunities for community participation, and lack of opportunities for meaningful employment. At the systemic and policy level in the United States, the antimigrant political environment keeps Latinx immigrants with disabilities from participating in their communities due to fear of deportation. In Canada, Latinx workers experience the paradox of migration and discrimination. The discussion of barriers and facilitators is followed by recommendations for community research and action.

The moderating effect of gender as a protective factor against discrimination in migrants from Latin America and China

This study analysed the association between discrimination and satisfaction with life (SWL) in migrant groups by investigating whether different types of social support (SS; emotional, instrumental, and informational) and networks (family, immigrant and native friends, neighbours, and the community) buffer the negative effects of discrimination on SWL among migrant men and women from different backgrounds. Participants were 631 migrants from Latin America and China residing in Malaga (Spain). We identified behaviour patterns that suggest that SS has different effects on men and women from the same place of origin and similar effects on women and men from different places of origin. In conclusion, the main differences in the effects of SS as a buffer mechanism are not determined by cultural factors. It is more likely that they are determined by differential gender-role socialization, which would lead women to positively value social support.

Prevalence of strongyloidiasis and schistosomiasis among migrants: a systematic review and meta-analysis

BACKGROUND

Global migration from regions where strongyloidiasis and schistosomiasis are endemic to non-endemic countries has increased the potential individual and public health effect of these parasitic diseases. We aimed to estimate the prevalence of these infections among migrants to establish which groups are at highest risk and who could benefit from screening.

METHODS

We did a systematic review and meta-analysis of strongyloidiasis and schistosomiasis prevalence among migrants born in endemic countries. Original studies that included data for the prevalence of Strongyloides or Schistosoma antibodies in serum or the prevalence of larvae or eggs in stool or urine samples among migrants originating from countries endemic for these parasites and arriving or living in host countries with low endemicity-specifically the USA, Canada, Australia, New Zealand, Israel, and 23 western European countries-were eligible for inclusion. Pooled estimates of the prevalence of strongyloidiasis and schistosomiasis by stool or urine microscopy for larvae or eggs or serum antibodies were calculated with a random-effects model. Heterogeneity was explored by stratification by age, region of origin, migrant class, period of study, and type of serological antigen used.

FINDINGS

88 studies were included. Pooled strongyloidiasis seroprevalence was 12·2% (95% CI 9·0-15·9%; I² 96%) and stool-based prevalence was 1·8% (1·2-2·6%; 98%). Migrants from east Asia and the Pacific (17·3% [95% CI 4·1-37·0]), sub-Saharan Africa (14·6% [7·1-24·2]), and Latin America and the Caribbean (11·4% [7·8-15·7]) had the highest seroprevalence. Pooled schistosomiasis seroprevalence was 18·4% (95% CI 13·1-24·5; I² 97%) and stool-based prevalence was 0·9% (0·2-1·9; 99%). Sub-Saharan African migrants had the highest seroprevalence (24·1·% [95% CI 16·4-32·7]).

INTERPRETATION

Strongyloidiasis affects migrants from all global regions, whereas schistosomiasis is focused in specific regions and most common among sub-Saharan African migrants. Serological prevalence estimates were several times higher than stool estimates for both parasites. These data can be used to inform screening decisions for migrants and support the use of serological screening, which is more sensitive and easier than stool testing.

FUNDING

None.

Genetic Epidemiology in Latin America: Identifying Strong Genetic Proxies for Complex Disease Risk Factors

Epidemiology seeks to determine the causal effects of exposures on outcomes related to the health and wellbeing of populations. Observational studies, one of the most commonly used designs in epidemiology, can be biased due to confounding and reverse causation, which makes it difficult to establish causal relationships. In recent times, genetically informed methods, like Mendelian randomization (MR), have been developed in an attempt to overcome these disadvantages. MR relies on the association of genetic variants with outcomes of interest, where the genetic variants are proxies or instruments for modifiable exposures. Because genotypes are sorted independently and at random at the time of conception, they are less prone to confounding and reverse causation. Implementation of MR depends on, among other things, a strong association of the genetic variants with the exposure, which has usually been defined via genome-wide association studies (GWAS). Because GWAS have been most often carried out in European populations, the limited identification of strong instruments in other populations poses a major problem for the application of MR in Latin America. We suggest potential solutions that can be realized with the resources at hand and others that will have to wait for increased funding and access to technology.

Women from afar: an observational study of demographic characteristics and mortality among foreign-born women living with HIV in the Women's Interagency HIV Study (WIHS) in the United States 1994-2016

INTRODUCTION

Foreign-born persons comprise ~13% of the US population. Immigrants, especially women, often face a complex set of social and structural factors that negatively impact health outcomes including greater risk of HIV infection. We described socio-demographic, clinical and immunological characteristics and AIDs and non-AIDS death among foreign-born women living with HIV (FBWLWH) participating in the US Women's Interagency HIV Study (WIHS) in the US from 1994 to 2016. We hypothesized that FBW will experience higher AIDS-related mortality compared to US-born women (USBW).

METHODS

The WIHS is a multicenter prospective observational cohort study of mostly women living with HIV (WLWH). The primary exposure in this analysis, which focused on 3626 WLWH, was self-reported country of birth collapsed into foreign-born and US born. We assessed the association of birthplace with categorized demographic, clinical and immunological characteristics, and AIDS/non-AIDS mortality of WLWH, using chi-squared tests. Proportional hazard models examined the association of birthplace with time from enrolment to AIDS and non-AIDS death.

RESULTS

Of the 628 FBW, 13% were born in Africa, 29% in the Caribbean and 49% in Latin America. We observed significant differences by HIV status in socio-demographic, clinical and immunological characteristics and mortality. For both AIDS and non-AIDS caused deaths FBW WLWH had lower rates of death. Adjusting for year of study enrolment and other demographic/clinical characteristics mitigated FBW's statistical survival advantage in AIDS deaths Relative Hazard (RH = 0.91 p = 0.53), but did not substantively change the survival advantage in non-AIDS deaths RH = 0.33, p < 0.0001).

CONCLUSION

Foreign-born WLWH exhibited demographic, clinical and immunological characteristics that are significantly different compared with women born in the US or US territory. After adjusting for these characteristics, the FB WLWH had a significantly lower hazard of non-AIDS but not AIDS mortality compared to women born in the US or a US territory. These findings of non-increased mortality can help inform models of care to optimize treatment outcomes among FBWLWH in the United States.

Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer Is Associated with Indigenous American Ancestry in Latin American Women

Women of Latin American origin in the United States are more likely to be diagnosed with advanced breast cancer and have a higher risk of mortality than non-Hispanic White women. Studies in U.S. Latinas and Latin American women have reported a high incidence of HER2 positive (+) tumors; however, the factors contributing to this observation are unknown. Genome-wide genotype data for 1,312 patients from the Peruvian Genetics and Genomics of Breast Cancer Study (PEGEN-BC) were used to estimate genetic ancestry. We tested the association between HER2 status and genetic ancestry using logistic and multinomial logistic regression models. Findings were replicated in 616 samples from Mexico and Colombia. Average Indigenous American (IA) ancestry differed by subtype. In multivariate models, the odds of having an HER2+ tumor increased by a factor of 1.20 with every 10% increase in IA ancestry proportion (95% CI, 1.07-1.35; P = 0.001). The association between HER2 status and IA ancestry was independently replicated in samples from Mexico and Colombia. Results suggest that the high prevalence of HER2+ tumors in Latinas could be due in part to the presence of population-specific genetic variant(s) affecting HER2 expression in breast cancer. SIGNIFICANCE: The positive association between Indigenous American genetic ancestry and HER2+ breast cancer suggests that the high incidence of HER2+ subtypes in Latinas might be due to population and subtype-specific genetic risk variants.

The Experience of Learning EFT in Spanish-speaking Countries: A Multi-National Replication Study

This study is a multi-national follow-up to the original (Sandberg and Knestel (2011) Journal of Marital and Family Therapy, 37, 393-410) article on the process of learning Emotionally Focused Couples Therapy (EFT). A total of 102 clinicians from nine Spanish-speaking countries (Mexico, Costa Rica, Guatemala, Spain, Colombia, Argentina, Chile, Ecuador, and El Salvador) participated in the study. A comparison of results across the two studies revealed more similarities than differences. However, a few notable differences emerged from responses to qualitative questions, namely a heightened sense of appreciation for and resonance with the focus on core emotion in EFT and less frequent reports of difficulty learning and adapting to the model among Spanish-speaking therapists. These differences were consistent with common cultural values and forms of expression in Latin America and Spain. Results are discussed in terms of training, supervision, and future research as well.

Agreement in retinal nerve fiber layer values and comparison in children using two optical coherence tomography devices

OBJECTIVE

To assess absolute agreement and differences in peripapillary retinal nerve fiber layer (pRNFL) values according to sex, age, laterality, origin and optical coherence tomography (OCT) type in normal pediatric patients undergoing OCT scans using both Cirrus and Spectralis.

MATERIAL AND METHODS

Prospective, cross-sectional, and comparative study. We used Spectralis OCT and Cirrus OCT to measure optic disc values of both eyes in one hundred pediatric patients (age 5 to 15years), with no previous ocular pathology or systemic disease that could affect the eye. Due to the similarity between eyes, only right eyes were considered (n=100).

RESULTS

The average peripapillary retinal nerve fiber layer (pRNFL) values were 99.6μm with Cirrus and 106.7μm with the Spectralis system. The four quadrants followed the ISNT rule (inferior-superior-nasal-temporal). The average pRNFL measures correlated negatively with the AL (P<.01) in both OCTs, and the degree of agreement between OCTs for pRNFL and inferior RNFL was moderate (CCI: 0.67 and 0.61, respectively), and low in the rest of the sectors. The average pRNFL values of both OCTs were higher in women than in men (P>.05) and there were also no statistical differences in the pRNFL according to age or laterality (P>.05). All RNFL values were significantly different between both types of OCTs (P<.05) and average pRNFL values were significantly thicker (P<.05) in Latin American than in European children in both eyes.

CONCLUSIONS

We suggest that the respective peripapillary RNFL values obtained using these two OCTs should not be considered interchangeable in pediatric patients.

Trends in cannabis use among immigrants in the United States, 2002-2017: Evidence from two national surveys

BACKGROUND AND AIMS

Findings from recent studies suggest that, among the general population of adults, the prevalence of cannabis use has increased over the last decade in the United States (US). And yet, there is much we do not know regarding the trends in cannabis use among immigrants. We address this important shortcoming by examining data on immigrants vis-à-vis US-born individuals using two national surveys.

METHODS

We examine trend data from the National Epidemiologic Study on Alcohol and Related Conditions (NESARC, 2001-2013) and the National Survey on Drug Use and Health's Restricted Data Analysis System (NSDUH, 2002-2017). Main outcomes were past year cannabis use and cannabis use disorder with survey adjusted prevalence estimates generated for immigrants and US-born individuals.

RESULTS

In the NESARC, significant increases in the past year prevalence of cannabis use were observed both among US-born (2001-2002: 4.53%, 2012-2013: 10.74%) and immigrant participants (2001-2002: 1.67%, 2012-2013: 3.32%). We also found significant increases among immigrants arriving before age 12 and among immigrants from Latin America and Europe. In the NSDUH, we observed a significantly higher prevalence of cannabis use in 2016-2017 (6.3%) when compared to 2002-2003 (4.4%).

CONCLUSIONS

Findings make clear that cannabis use among US-born individuals has consistently been higher than that of immigrants since the early 2000s. However, while rates of cannabis use have declined among US-born adolescents in recent years, the prevalence of cannabis use has remained stable among immigrant adolescents. At the same time, cannabis use increased two-fold among both US-born and immigrant adults.

Culturally Targeted Video Improves Psychosocial Outcomes in Latina Women at Risk of Hereditary Breast and Ovarian Cancer

Latina women at risk of hereditary breast and ovarian cancer (HBOC) have lower awareness, knowledge, and use of genetic counseling and testing services (GCT) than non-Latina Whites. Few interventions have been developed to reduce these disparities among at-risk Latinas. This pilot study assessed the impact of a culturally targeted narrative video developed by our team. The study included 40 Latina immigrants living in the United States who were at risk of HBOC, including affected and unaffected women. We assessed pre-post differences in psychosocial outcomes. Participants were 47.35 years old on average (SD = 9.48). Most (70%) were unaffected with cancer, had an annual income of $40,000 or less (65%), an education of High School or less (62.5%), and were uninsured (77.5%). The video significantly enhanced knowledge (p < 0.001), positive attitudes (p < 0.05), anticipatory positive emotions (p < 0.05), and intentions to participate in counseling (p < 0.001). Importantly, the video also significantly reduced negative attitudes (p < 0.05), and attitudinal ambivalence (p < 0.001). The culturally targeted video shows preliminary evidence in improving psychosocial outcomes related to GCT uptake in Latinas at risk for HBOC. This intervention is a promising easily-disseminable strategy to address disparities in GCT utilization.

Association of acculturation with cardiac structure and function among Hispanics/Latinos: a cross-sectional analysis of the echocardiographic study of Latinos

OBJECTIVE

Hispanics/Latinos, the largest immigrant population in the USA, undergo the process of acculturation and have a large burden of heart failure risk. Few studies have examined the association of acculturation on cardiac structure and function.

DESIGN

Cross-sectional.

SETTING

The Echocardiographic Study of Latinos.

PARTICIPANTS

1818 Hispanic adult participants with baseline echocardiographic assessment and acculturation measured by the Short Acculturation Scale, nativity, age at immigration, length of US residence, generational status and language.

PRIMARY AND SECONDARY OUTCOME MEASURES

Echocardiographic assessment of left atrial volume index (LAVI), left ventricular mass index (LVMI), early diastolic transmitral inflow and mitral annular velocities.

RESULTS

The study population was predominantly Spanish-speaking and foreign-born with mean residence in the US of 22.7 years, mean age of 56.4 years; 50% had hypertension, 28% had diabetes and 44% had a body mass index >30 kg/m². Multivariable analyses demonstrated higher LAVI with increasing years of US residence. Foreign-born and first-generation participants had higher E/e' but lower LAVI and e' velocities compared with the second generation. Higher acculturation and income >$20K were associated with higher LVMI, LAVI and E/e' but lower e' velocities. Preferential Spanish-speakers with an income <$20K had a higher E/e'.

CONCLUSIONS

Acculturation was associated with abnormal cardiac structure and function, with some effect modification by socioeconomic status.

Gut microbiome composition in the Hispanic Community Health Study/Study of Latinos is shaped by geographic relocation, environmental factors, and obesity

BACKGROUND

Hispanics living in the USA may have unrecognized potential birthplace and lifestyle influences on the gut microbiome. We report a cross-sectional analysis of 1674 participants from four centers of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), aged 18 to 74 years old at recruitment.

RESULTS

Amplicon sequencing of 16S rRNA gene V4 and fungal ITS1 fragments from self-collected stool samples indicate that the host microbiome is determined by sociodemographic and migration-related variables. Those who relocate from Latin America to the USA at an early age have reductions in Prevotella to Bacteroides ratios that persist across the life course. Shannon index of alpha diversity in fungi and bacteria is low in those who relocate to the USA in early life. In contrast, those who relocate to the USA during adulthood, over 45 years old, have high bacterial and fungal diversity and high Prevotella to Bacteroides ratios, compared to USA-born and childhood arrivals. Low bacterial diversity is associated in turn with obesity. Contrasting with prior studies, our study of the Latino population shows increasing Prevotella to Bacteroides ratio with greater obesity. Taxa within Acidaminococcus, Megasphaera, Ruminococcaceae, Coriobacteriaceae, Clostridiales, Christensenellaceae, YS2 (Cyanobacteria), and Victivallaceae are significantly associated with both obesity and earlier exposure to the USA, while Oscillospira and Anaerotruncus show paradoxical associations with both obesity and late-life introduction to the USA.

CONCLUSIONS

Our analysis of the gut microbiome of Latinos demonstrates unique features that might be responsible for health disparities affecting Hispanics living in the USA.

Enhanced immigration enforcement in the USA and the transnational continuity of HIV care for Latin American immigrants in deportation proceedings

In our work as clinicians, researchers, and immigrant rights advocates, we have noted increased anxiety about the possibility of deportation and disruptions in care among immigrants with HIV. Before the 2016 US elections, patients rarely asked about HIV treatment in their home countries. However, since the increase in anti-immigrant rhetoric and arrests by US Immigration and Customs Enforcement, patients have voiced concerns about the availability of HIV treatment in their home countries much more frequently. Although antiretroviral therapy is available throughout Latin America, access depends on economic, social, and political circumstances. Maintaining uninterrupted continuity of care among immigrants held in detention or deported to their home countries is challenging. In this Viewpoint, we identify periods of particular vulnerability for immigrants during deportation proceedings, from initial detention to deposition in their country of origin. We discuss the effect of enhanced immigration enforcement on the health and wellbeing of HIV-infected immigrants, and on public health. Finally, we also discuss recommendations for clinicians, immigration authorities, and public health institutions in the USA and in receiving countries.

Ethnic disparities in community antibacterial dispensing in New Zealand, 2015

AIMS

There are significant ethnic disparities in the incidence of various infectious diseases in New Zealand. Antimicrobial stewardship interventions which ignore these disparities may have negative effects on the health of some ethnic groups. We aimed to determine the relationship between ethnicity and community antimicrobial dispensing in New Zealand, to inform the development of antimicrobial stewardship interventions in New Zealand.

METHODS

Demographic data on all patients registered with a general practice in New Zealand and on all community pharmacy antibacterial dispensings during 2015 were obtained from national healthcare databases. The rates of dispensing were measured as the number of dispensings per 1,000 population per day and as defined daily doses per 1,000 population per day.

RESULTS

The rate of community antibacterial dispensing for the total population surveyed was 3.01 dispensings per 1,000 population per day, and was 3.49 for Pacific, 3.23 for Māori, 3.02 for European, 2.70 for Middle Eastern, Latin American and African, and 2.35 for Asian people. In all ethnic groups the rate of community antibacterial dispensing increased with increasing socioeconomic deprivation. Seasonal variation in antibacterial dispensing ranged between 34% in Asian people and 24% in European people.

CONCLUSIONS

The ethnic disparities in the rates of antibacterial dispensing in New Zealand are consistent with, but less marked than, the ethnic disparities in the incidence of infectious diseases in New Zealand. Improved community-wide understanding of both the benefits and the harms of antibacterial medicines is necessary to support improved antibacterial use in New Zealand in the future.

Physical-psychiatric comorbidity: patterns and explanations for ethnic group differences

OBJECTIVE

This paper examines ethnic differences in the co-occurrence of physical and psychiatric health problems (physical-psychiatric comorbidity) for women and men. The following ethnic groups are included: Non-Latino Whites, African Americans, Caribbean Blacks, Spanish Caribbean Blacks, Mexicans, Cubans, Puerto Ricans, Other Latinos, Chinese, Filipinos, Vietnamese, and Other Asian Americans. In addition, the study assesses the extent to which social factors (socioeconomic status, stress exposure, social support) account for ethnic differences in physical-psychiatric comorbidity (PPC).

DESIGN

This study uses data from the Collaborative Psychiatric Epidemiology Surveys (CPES) (N = 12,787). Weighted prevalence rates of physical-psychiatric comorbidity (PPC) - the co-occurrence of physical and psychiatric health problems - are included to examine ethnic group differences among women and men. Multinomial logistic regression analysis was used to determine group differences in PPC before and after adjusting for social factors.

RESULTS

Puerto Rican men have significantly higher risk of PPC in comparison to Non-Latino White men. Among women, Blacks and Cubans were more likely than Non-Latino Whites to experience PPC as opposed to 'Psychiatric Only' health problems. Social factors account for the Puerto Rican/Non-Latino White difference in comorbid health among men, but have little explanatory power for understanding ethnic differences in comorbidity among women.

CONCLUSION

These findings have implications for medical care and can guide intervention programs in targeting a specific constellation of co-occurring physical and psychiatric health problems for diverse ethnic groups in the United States. As comorbidity rates increase, it is crucial to identify the myriad factors that give rise to ethnic group differences therein.

ESRD among Immigrants to Ontario, Canada: A Population-Based Study

Background The epidemiology of ESRD requiring maintenance dialysis (ESRD-D) in large, diverse immigrant populations is unclear.Methods We estimated ESRD-D prevalence and incidence among immigrants in Ontario, Canada. Adults residing in Ontario in 2014 were categorized as long-term Canadian residents or immigrants according to administrative health and immigration datasets. We determined ESRD-D prevalence among these adults and calculated age-adjusted prevalence ratios (PRs) comparing immigrants to long-term residents. Among those who immigrated to Ontario between 1991 and 2012, age-adjusted ESRD-D incidence was calculated by world region and country of birth, with immigrants from Western nations as the referent group.Results Among 1,902,394 immigrants and 8,860,283 long-term residents, 1700 (0.09%) and 8909 (0.10%), respectively, presented with ESRD-D. Age-adjusted ESRD-D prevalence was higher among immigrants from sub-Saharan Africa (PR, 2.17; 95% confidence interval [95% CI], 1.84 to 2.57), Latin America and the Caribbean (PR, 2.11; 95% CI, 1.90 to 2.34), South Asia (PR, 1.45; 95% CI, 1.32 to 1.59), and East Asia and the Pacific (PR, 1.34; 95% CI, 1.22 to 1.46). Immigrants from Somalia (PR, 4.18; 95% CI, 3.11 to 5.61), Trinidad and Tobago (PR, 2.88; 95% CI, 2.23 to 3.73), Jamaica (PR, 2.88; 95% CI, 2.40 to 3.44), Sudan (PR, 2.84; 95% CI, 1.53 to 5.27), and Guyana (PR, 2.69; 95% CI, 2.19 to 3.29) had the highest age-adjusted ESRD-D PRs relative to long-term residents. Immigrants from these countries also exhibited higher age-adjusted ESKD-D incidence relative to Western Nations immigrants.Conclusions Among immigrants in Canada, those from sub-Saharan Africa and the Caribbean have the highest ESRD-D risk. Tailored kidney-protective interventions should be developed for these susceptible populations.

Demographic and Travel Characteristics of Travel-Associated Zika Virus Infection Case-Patients in San Diego County, California (January 1, 2016-March 31, 2017)

Most Zika disease cases diagnosed in the continental US have been associated with travel to areas with risk of Zika transmission, mainly the Caribbean and Latin America. Limited information has been published about the demographic and travel characteristics of Zika case-patients in the United States, besides their age and gender. During 2016-2017 the County of San Diego Health and Human Services Agency, California, expanded the scope and completeness of demographic and travel information collected from Zika case-patients for public health surveillance purposes. The majority (53.8%) of travel-related Zika virus infection case-patients (n = 78) in the county were Hispanic, significantly higher (p ≤ 0.05) than the 33.0% of Hispanics in the county. Foreign-born residents, mainly from Mexico, were also overrepresented among cases compared to their share in the county population (33.3 vs. 23.0%; p ≤ 0.05). Seventeen (21.8%) patients reported a primary language other than English (14 Spanish). Most case-patients traveled for tourism (54%) or to visit friends and relatives (36%). This surveillance information helps identify higher-risk populations and implement culturally targeted interventions for Zika prevention and control.

High incidence of thrombosis in African-American and Latin-American patients with Paroxysmal Nocturnal Haemoglobinuria

Paroxysmal Nocturnal Haemoglobinuria (PNH) results in a marked thrombophilic state by unknown mechanisms. Geographic differences in thrombosis incidence in PNH have been observed. We have reviewed 64 patients with “Classic PNH” from a single institution in order to determine the rate of thrombosis in different ethnic groups.When we compared African- Americans (n=11) and Latin-Americans (n=8) with other patients (n= 45), we found that African-American and Latin-American patients are at increased risk [Hazard ratio 3.66 (p=0.005) and 3.52, (p= 0.035) respectively by Cox regression]. Our data also suggest that this difference in the rate of thrombosis has an impact on length of survival.These findings demonstrate that ethnicity is a risk factor for thrombosis in PNH and have implications for decision-making regarding the management of these patients,including the prevention of thrombosis.

Food Hardship and Obesity in a Sample of Low-Income Immigrants

Very little work has examined the relationship between food hardship (having inconsistent financial resources to buy food) and obesity among immigrant groups. A cross-sectional study was conducted in a low-income, multi-racial/ethnic adult sample in greater Boston, MA (n = 828). Modified Poisson regression models estimated the association between food hardship obesity (BMI ≥ 30) among adults reporting food hardship; interactions were tested by place of birth. Body mass index (BMI) was based on anthropometric height and weight. In adjusted models, those experiencing food hardship were more likely to be obese (RR 1.17, CI 1.07, 1.29) than those not experiencing food hardship. Participants from Haiti reporting food hardship were more likely to be obese than those not reporting hardship (RR 1.58, CI 1.23, 2.04); this was not the case among other groups (US born, Puerto Rican, Latin American, Other). The relationship between food hardship and weight may vary among immigrant subgroups.

Seroprevalence of Strongyloides stercoralis infection among HTLV-I infected blood donors in Barcelona, Spain: A cross-sectional study

Strongyloides stercoralis infection in patients with HTLV-I infection may lead to severe clinical manifestations. The aim of the present study is to determine the seroprevalence of S. stercoralis infection among blood donors who tested positive for HTLV-I infection. A cross-sectional study was performed at the Vall d'Hebron University Hospital (Barcelona, Spain) in 2016. Serum samples from HTLV-I positive patients diagnosed from 2008 to 2015 were retrieved from the Blood Bank, and S. stercoralis serology was performed. Thirty six serum samples from HTLV-I positive patients were retrieved from the Blood Bank. The blood samples came from 36 blood donors, and most of them were born in Latin America (75%), being Peru the most frequent country (11 participants). S. stercoralis serology was positive in one patient, corresponding to a prevalence of 2.8% (3.4% if we exclude donors coming from European countries, where the risk of S. stercoralis infection is highly unlikely).

Access and utilisation of social and health services as a social determinant of health: the case of undocumented Latin American immigrant women working in Lleida (Catalonia, Spain)

Although Spain has social and healthcare systems based on universal coverage, little is known about how undocumented immigrant women access and utilise them. This is particularly true in the case of Latin Americans who are overrepresented in the informal labour market, taking on traditionally female roles of caregivers and cleaners in private homes. This study describes access and utilisation of social and healthcare services by undocumented Latin American women working and living in rural and urban areas, and the barriers these women may face. An exploratory qualitative study was designed with 12 in-depth interviews with Latin American women living and working in three different settings: an urban city, a rural city and rural villages in the Pyrenees. Interviews were recorded, transcribed and analysed, yielding four key themes: health is a tool for work which worsens due to precarious working conditions; lack of legal status traps Latin American women in precarious jobs; lack of access to and use of social services; and limited access to and use of healthcare services. While residing and working in different areas of the province impacted the utilisation of services, working conditions was the main barrier experienced by the participants. In conclusion, decent working conditions are the key to ensuring undocumented immigrant women's right to social and healthcare. To create a pathway to immigrant women's health promotion, the 'trap of illegality' should be challenged and the impact of being considered 'illegal' should be considered as a social determinant of health, even where the right to access services is legal.

Cost-effectiveness of Chagas disease screening in Latin American migrants at primary health-care centres in Europe: a Markov model analysis

BACKGROUND

Chagas disease is currently prevalent in European countries hosting large communities from Latin America. Whether asymptomatic individuals at risk of Chagas disease living in Europe should be screened and treated accordingly is unclear. We performed an economic evaluation of systematic Chagas disease screening of the Latin American population attending primary care centres in Europe.

METHODS

We constructed a decision tree model that compared the test option (screening of asymptomatic individuals, treatment, and follow-up of positive cases) with the no-test option (screening, treating, and follow-up of symptomatic individuals). The decision tree included a Markov model with five states, related to the chronic stage of the disease: indeterminate, cardiomyopathy, gastrointestinal, response to treatment, and death. The model started with a target population of 100 000 individuals, of which 4·2% (95% CI 2·2-6·8) were estimated to be infected by Trypanosoma cruzi. The primary outcome was the incremental cost-effectiveness ratio (ICER) between test and no-test options. Deterministic and probabilistic analyses (Monte Carlo simulations) were performed.

FINDINGS

In the deterministic analysis, total costs referred to 100 000 individuals in the test and no-test option were €30 903 406 and €6 597 403 respectively, with a difference of €24 306 003. The respective number of quality-adjusted life-years (QALYs) gained in the test and no-test option were 61 820·82 and 57 354·42. The ICER was €5442. In the probabilistic analysis, total costs for the test and no-test option were €32 163 649 (95% CI 31 263 705-33 063 593) and €6 904 764 (6 703 258-7 106 270), respectively. The respective number of QALYs gained was 64 634·35 (95% CI 62 809·6-66 459·1) and 59 875·73 (58 191·18-61 560·28). The difference in QALYs gained between the test and no test options was 4758·62 (95% CI 4618·42-4898·82). The incremental cost-effectiveness ratio (ICER) was €6840·75 (95% CI 2545-2759) per QALY gained for a treatment efficacy of 20% and €4243 per QALY gained for treatment efficacy of 50%. Even with a reduction in Chagas disease prevalence to 0·05% and with large variations in all the parameters, the test option would still be more cost-effective than the no-test option (less than €30000 per QALY).

INTERPRETATION

Screening for Chagas disease in asymptomatic Latin American adults living in Europe is a cost-effective strategy. Findings of our model provide an important element to support the implementation of T cruzi screening programmes at primary health centres in European countries hosting Latin American migrants.

FUNDING

European Commission 7th Framework Program.

HIV risk behaviours among immigrant and ethnic minority gay and bisexual men in North America and Europe: A systematic review

HIV surveillance systems show that gay, bisexual, and other men who have sex with men (MSM) bear a disproportionate burden of HIV in North American and European countries. Within the MSM category, HIV prevalence is often elevated among ethnic minority (i.e., Latino, Asian, and Black) MSM, many of whom are also foreign-born immigrants. Little research has focused specifically on foreign-born populations, though studies that provide data on the nativity of their samples offer an opportunity to investigate the potential role of transnational migration in informing HIV risk among ethnic minority MSM. This systematic review of ethnic minority MSM studies where the nativity of the sample is known provides a robust alternative to single studies measuring individual-level predictors of HIV risk behaviour. In this review, HIV prevalence, unprotected sex, drug use, and HIV testing are analysed in relation to the ethnicity, nativity, and location of the samples included. The results, which include high rates of HIV, unprotected sex, and stimulant use in foreign-born Latino samples and high rates of alcohol and club drug use in majority foreign-born Asian Pacific Islander (API) samples, provide baseline evidence for the theory of migration and HIV risk as syndemics within ethnic minority populations in North American and European countries. The findings also suggest that further research on the contextual factors influencing HIV risk among ethnic minority MSM groups and especially immigrants within these groups is needed. These factors include ethnic networks, individual post-migration transitions, and the gay communities and substance use cultures in specific destination cities. Further comparative work may also reveal how risk pathways differ across ethnic groups.

Clinical Practice and Knowledge in Caring: Breastfeeding Ties and the Impact on the Health of Latin-American Minor Migrants

In the context of the project "Clinical and social evaluation of medical practices in the treatment of infectious diseases in pediatrics for children of vulnerable population" carried out in 2013 by a multidisciplinary team at the National Institute for Health, Migration and Poverty (NIHMP) in Rome, a study in medical anthropology on the incorporation of illnesses that mothers feel they transmit to their children through breastfeeding was conducted. The results of the anthropological study, that targeted 34 children and adolescents from the age of 3 to the age of 17, all immigrants from Latin America residing in Italy, show that some forms of suffering in minors are described by women as being connected to factors such as susto ("fright"), coraje, muina, enojo ("anger") and mal de ojo ("evil eye"), and are in relation to a specific cultural frame. It is clear that barriers that prevent the access to the healthcare system must be removed, barriers that are accentuated by linguistic and cultural incomprehension, through adequate multidisciplinary healthcare settings such as the one we are presenting, composed of a medical doctor, an anthropologist and a cultural mediator.

"In our own words": Defining medical professionalism from a Latin American perspective

BACKGROUND

Latin America has experienced a tremendous growth in a number of medical schools, and there are concerns about their quality of training in critical areas such as professionalism. Medical professionalism is a cultural construct. The aim of the study was to compare published definitions of medical professionalism from Latin American and non-Latin American regions and to design an original and culturally sound definition.

METHODS

A mixed methods approach was used with three phases. First, a systematic search and thematic analysis of the literature were conducted. Second, a Delphi methodology was used to design a local definition of medical professionalism. Third, we used a qualitative approach that combined focus groups and personal interviews with students and deans from four medical schools in Chile to understand various aspects of professionalism education. The data were analyzed using NVivo software.

RESULTS

A total of 115 nonrepeated articles were identified in the three databases searched. No original definitions of medical professionalism from Latin America were found. Twenty-six articles met at least one of the three decisional criteria defined and were fully reviewed. Three theoretical perspectives were identified: contractualism, personalism, and deontology. Attributes of medical professionalism were classified in five dimensions: personal, interpersonal, societal, formative, and practical. Participants of the Delphi panel, focus groups, and personal interviews included 36 medical students, 12 faculties, and four deans. They took a personalistic approach to design an original definition of medical professionalism and highlighted the relevance of respecting life, human dignity, and the virtue of prudence in medical practice. Students and scholars differed on the value given to empathy and compassion.

DISCUSSION

This study provides an original and culturally sound definition of medical professionalism that could be useful in Latin American medical schools. The methodology used in the study could be applied in other regions as a basis to develop culturally appropriate definitions of medical professionalism.

World region of origin and common mental disorders among migrant women in Spain

Migration can affect the mental health of migrants. This cross-sectional study has two objectives: (1) to compare the prevalence of common mental disorder (CMD) between migrants (n = 458) living in Granada (Spain) and Spanish-born women (n = 448); (2) within migrants, to analyse the associations of world region of origin, other sociodemographic factors and post-migration features with the presence of CMD. Participants answered a questionnaire, including sociodemographic characteristics, post-migration features and CMD that was measured by Kessler K6-scale. Logistic regression analyses showed that CMD (K6 ≥ 13) was significantly higher among migrants than Spaniards. Compared with Spaniards, the odds of CMD were 3.6 [95 % confidence intervals (CI) 2.1–6.0] and 2.9 (CI 1.6–5.3), respectively, for Latin Americans and for Moroccan and other African women. Among migrants, Latin Americans as opposed to the reference group (migrants from other countries), had higher probability of CMD (OR 2.3, CI 1.1–4.9). This study supports the hypothesis that migration leads to mental distress. Consideration of world region of origin may clarify the differences observed in mental health across different migrant groups.

Hispanic Adolescent Farmworkers’ Perceptions Associated with Pesticide Exposure1

The migrant farmworker population in the United States is a vulnerable and understudied population whose characteristics are constantly shifting. The number of youth involved in agriculture work is increasing, and they, in particular, may be at increased risk for occupational hazards, such as pesticide exposure. The present study utilized an ecological framework for focus group discussions with 33 adolescent migrant farmworkers in Oregon. Adolescents’ risk perception and health beliefs associated with pesticide exposure are examined on four levels of environmental influence: microenvironment, organizational environment, social/community environment, and macroenvironment. Adolescents provided insight on such topics as perceived vulnerability of illness due to pesticide exposure, attitudes toward farmwork, influence of their boss, knowledge of occupational hazards, safety training, and barriers to occupational choice. Cultural influences on occupational safety and health are discussed and increased attention to safety training is recommended.

[Chronic infections in Latin American immigrants in Switzerland]

Recently arrived immigrants from Latin American countries represent a growing population in Switzerland. This article reviews the evidences on the most frequent chronic infections affecting this population group in Switzerland and presents screening recommendations adapted to primary care practice. Efforts should particularly focus on screening for Trypanosoma cruzi and Strongyloides stercoralis, especially in groups at higher risk of complication or transmission.

Provider-Initiated HIV Testing for Migrants in Spain: A Qualitative Study with Health Care Workers and Foreign-Born Sexual Minorities

Introduction

Provider-initiated HIV testing (PITC) is increasingly adopted in Europe. The success of the approach at identifying new HIV cases relies on its effectiveness at testing individuals most at risk. However, its suitability to reach populations facing overlapping vulnerabilities is under researched. This qualitative study examined HIV testing experiences and perceptions amongst Latin-American migrant men who have sex with men and transgender females in Spain, as well as health professionals’ experiences offering HIV tests to migrants in Barcelona and Madrid.

Methods

We conducted 32 in-depth interviews and 8 discussion groups with 38 Latin-American migrants and 21 health professionals. We imported verbatim transcripts and detailed field work notes into the qualitative software package Nvivo-10 and applied to all data a coding framework to examine systematically different HIV testing dimensions and modalities. The dimensions analysed were based on the World Health Organization “5 Cs” principles: Consent, Counselling, Connection to treatment, Correctness of results and Confidentiality.

Results

Health professionals reported that PITC was conceptually acceptable for them, although their perceived inability to adequately communicate HIV+ results and resulting bottle necks in the flow of care were recurrent concerns. Endorsement and adherence to the principles underpinning the rights-based response to HIV varied widely across health settings. The offer of an HIV test during routine consultations was generally appreciated by users as a way of avoiding the embarrassment of asking for it. Several participants deemed compulsory testing as acceptable on public health grounds. In spite of—and sometimes because of—partial endorsement of rights-based approaches, PITC was acceptable in a population with high levels of internalised stigma.

Conclusion

PITC is a promising approach to reach sexual minority migrants who hold high levels of internalised stigma but explicit extra efforts are needed to safeguard the rights of the most vulnerable.

Insulin Therapy, Glycemic Control, and Cardiovascular Risk Factors in Young Latin Americans with Type 2 Diabetes Mellitus

BACKGROUND

Type 2 diabetes has been linked to an increased risk of cardiovascular (CV) disease, but this risk has not been well documented in young patients, especially of Latin American descent. Also, the potential CV benefits of insulin therapy have not been evaluated in young patients with type 2 diabetes. The objectives of this study were to determine any gender-related difference in the presence of CV risk factors in young Latin Americans with poorly controlled type 2 diabetes and the effect of intensive insulin therapy on these CV risk factors.

METHODS AND RESULTS

Fifty-seven Latin American patients with type 2 diabetes between the ages 18 and 45 years were evaluated at baseline. All women were premenopausal and had regular menstrual periods. The mean body mass index (BMI) was > 30 kg/m2 in both genders. Percent body fat, percent hemoglobin A1c, and lipoprotein profiles were similar between genders. Highly sensitive C-reactive protein (CRP) levels were elevated and similar between genders (p = .4). Leukocyte adhesion molecules (intercellular adhesion molecule 1, vascular adhesion molecule 1, E-selectin) and monocyte chemoattractant protein 1 were elevated, whereas adiponectin levels were below normal in both gender groups. Urinary albumin excretion was similar between genders and did not show any relationship with any of the variables. In women, there was a direct relationship between waist circumference and high-sensitivity CRP levels (rho = .53, p = .01). No other significant relationships were observed. Eighteen Latin American patients with type 2 diabetes completed up to 104 weeks of post-intervention with insulin monotherapy. In these patients, glycemic, lipoprotein, and anthropometric measurements were obtained every 12 weeks. Highly sensitive CRP, leukocyte adhesion molecules, and urinary albumin excretion, among other tests, were obtained every 52 weeks. At 52 and 104 weeks, body weight, BMI, waist circumference, and percent body fat increased in a parallel and significant manner. Despite a significant decrease in percent hemoglobin A1c (22.2%; p = < .0001), lipid and lipoprotein profiles, highly sensitive CRP, leukocyte adhesion molecules, and other nontraditional CV risk factors did not change significantly.

CONCLUSIONS

In young, obese, Latino type 2 diabetic patients, improvement in glycemic control with insulin monotherapy was not associated with a parallel improvement in markers of vascular inflammation. Premenopausal Latino women with uncontrolled type 2 diabetes have CV risks comparable to Latino diabetic men of the same age. Obesity and underlying insulin resistance may counteract the potential CV benefits associated with insulin therapy in lean diabetic patients. Weight loss could be a potential therapeutic modality to improve CV risk in Latino type 2 diabetic patients, especially women.

[Clinical and epidemiological characteristics of HIV infection in Latin-American immigrants: comparative analysis from clinical records in a clinical care centre in Santiago in the last decade]

BACKGROUND

There has been an increasing number of immigrants to Chile in the last years, especially from South American countries. The phenomenon of immigration and its consequences has been studied by international literature, and different health care needs have been reported for this group as compared with local population. In Chile this phenomenon is poorly studied and HIV prevention campaigns are focused on national population needs.

OBJECTIVE

To determine baseline clinical and epidemiological characteristics of the HIV infection in Latin-American immigrants presenting to a referral HIV clinical care centre between the years 2003-2013.

METHODS

Retrospective analysis. Baseline characteristics of Latin-American immigrants at admission to the infectious disease unit were compared to a peered group of Chileans in the same unit.

RESULTS

There was an increase in the number of immigrants trough out the observation period. Foreigners presented larger proportion of women (26% vs. 9%) and heterosexual conduct as compared to nationals (37% vs 22%). The majority of immigrants came from Peru (55%) and Colombia (12%).

CONCLUSIONS

There were significant differences in regards to gender and sexual behavior. This brings up the need to address different prevention strategies with more emphasis in women and heterosexual population in this vulnerable group.

The inter-relationship among economic activities, environmental degradation, material consumption and population health in low-income countries: a longitudinal ecological study

OBJECTIVES

The theory of ecological unequal exchange explains how trade and various forms of economic activity create the problem of environmental degradation, and lead to the deterioration of population health. Based on this theory, our study examined the inter-relationship among economic characteristics, ecological footprints, CO2 emissions, infant mortality rates and under-5 mortality rates in low-income countries.

DESIGN

A longitudinal ecological study design.

SETTING

Sixty-six low-income countries from 1980 to 2010 were included in the analyses. Data for each country represented an average of 23 years (N=1497).

DATA SOURCES

Data were from the World Development Indicators, UN Commodity Trade Statistics Database, Global Footprint Network and Polity IV Project.

ANALYSES

Linear mixed models with a spatial power covariance structure and a correlation that decreased over time were constructed to accommodate the repeated measures. Statistical analyses were conducted separately by sub-Saharan Africa, Latin America and other regions.

RESULTS

After controlling for country-level sociodemographic characteristics, debt and manufacturing, economic activities were positively associated with infant mortality rates and under-5 mortality rates in sub-Saharan Africa. By contrast, export intensity and foreign investment were beneficial for reducing infant and under-5 mortality rates in Latin America and other regions. Although the ecological footprints and CO2 emissions did not mediate the relationship between economic characteristics and health outcomes, export intensity increased CO2 emissions, but reduced the ecological footprints in sub-Saharan Africa. By contrast, in Asia, the Middle East and North Africa, although export intensity was positively associated with the ecological footprints and also CO2 emissions, the percentage of exports to high-income countries was negatively associated with the ecological footprints.

CONCLUSIONS

This study suggested that environmental protection and economic development are important for reducing infant and under-5 mortality rates in low-income countries.

Prevention and intervention research with Latino families: a translational approach

The present paper takes a translational approach in applying the themes of the current special section to prevention and intervention science in Latino families. The paper reviews the current literature on cultural processes in prevention and intervention research with Latino families. Overall, many prevention and intervention programs have either been developed specifically for Latino families or have been modified for Latino families with great attention paid to the socio-cultural needs of these families. Nevertheless, few studies have tested the role of cultural values or acculturation processes on outcomes. We make recommendations based on findings within basic science and in particular this special section on the incorporation of these values and processes into prevention and intervention science with Latino families.

Using hospital discharge database to characterize Chagas disease evolution in Spain: there is a need for a systematic approach towards disease detection and control

After the United States, Spain comes second in the list of countries receiving migrants from Latin America, and, therefore, it is the European country with the highest expected number of infected patients of Chagas disease. We have studied the National Health System’s Hospital Discharge Records Database (CMBD) in order to describe the disease evolution from 1997 to 2011 in Spain. We performed a retrospective descriptive study using CMBD information on hospitalizations including Chagas disease. Data was divided in two periods with similar length in time: 1997-2004 and 2005-2011. Hospitalization rates were calculated and clinical characteristics were described. We used multivariable logistic regression to calculate adjusted odds-ratio (aOR) for the association between various conditions and being hospitalized with organ affectation. A total of 1729 hospitalization records were identified. Hospitalization rates for the two periods were 18 and 242.8/100000 population, respectively. The median age was 35 years (range 0-87), 74% were female and the 16-45 age-group was mostly represented (69.8%). Overall, 23.4% hospitalizations included the diagnosis of Chagas disease with organ complications. Being male [aOR: 1.3 (1.00-1.77)], aged 45 and 64 years [aOR: 2.59 (1.42-4.71)], and a median hospitalization cost above 3,065 euro [aOR: 2.03 (3.73-7.86)] were associated with hospitalizations with organ affectation. Since 2005, the number of detected infections increased in Spain. The predominant patients’ profile (asymptomatic women at fertile age) and the conditions associated with organ affectation underlines the need for increased efforts towards the early detection of T cruzi.

Chagas disease, caused by the protozoa Trypanosoma cruzi, is endemic in most Latin American countries and it is considered a neglected tropical disease (NTD). T. cruzi transmission is feasible in vector-free world regions. The main non-vectorial routes are congenital transmission, blood transfusion, and solid organ transplant. According to WHO, in Spain, which is the second country in the world receiving migrant population from endemic countries, there are up to 40.000 persons at risk of developing symptomatic Chagas disease. Since 2005, serological screening for at-risk blood and solid organ donors is mandatory. Lately, some regulations regarding screening of pregnant women from Latin American endemic countries have also been implemented, but only in some autonomous regions. Up to date, there is no surveillance system in place. Thus, the Chagas disease burden remains unknown. In this paper we use hospitalized Chagas disease discharge data, in order to describe Chagas disease’s geographical and temporal trends before and after the implementation of control measures in Spain from 1997 to 2011. We also assess patients’ main clinical characteristics by organ affectation.

Common mental disorders in primary health care: differences between Latin American-born and Spanish-born residents in Madrid, Spain

PURPOSE

Our main objective was to estimate and compare the prevalence of the most common mental disorders between Latin American-born and Spanish-born patients in Madrid, Spain. We also analyzed sociodemographic factors associated with these disorders and the role of the length of residency for Latin American-born patients.

METHODS

We performed a cross-sectional study to compare Latin American-born (n = 691) and Spanish-born outpatients (n = 903) from 15 primary health care centers in Madrid, Spain. The Primary Care Evaluation of Mental Disorders was used to diagnose common mental disorders. Sociodemographic, psychosocial, and migration data were collected.

RESULTS

We detected common mental disorders in 49.9 % (95 % CI = 47.4-52.3 %) of the total sample. Values were higher in Latin American-born patients than in Spanish-born patients for any disorder (57.8 % vs. 43.9 %, p < 0.001), mood disorders (40.1 % vs. 34.8 %, p = 0.030), anxiety disorders (20.5 % vs. 15.3 %, p = 0.006), and somatoform disorders (18.1 % vs. 6.6 %, p < 0.001). There were no statistically significant differences in prevalence between Latin American-born patients with less than 5 years of residency and Latin American-born residents with 5 or more years of residency. Finally, multivariate analysis shows that gender, having/not having children, monthly income, geographic origin, and social support were significantly associated with several disorders.

LIMITATIONS

The sample was neither population-based nor representative of the general immigrant or autochthonous populations.

CONCLUSIONS

The study provides further evidence of the high prevalence of common mental disorders in Latin American-born patients in Spain compared with Spanish-born patients.

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.