Epidemiology of asylum seekers and refugees at the Mexico-US border: a cross-sectional analysis from the migrant settlement camp in Matamoros, Mexico.

BACKGROUND: The number of migrants and asylum seekers at the Mexico-US border has increased to historic levels. Our objective was to determine the medical diagnoses and treatments of migrating people seeking care in humanitarian clinics in Matamoros, Mexico. METHODS: We conducted a cross-sectional study of patient encounters by migrating people through a humanitarian clinic in Matamoros, Mexico, from November 22, 2019, to March 18, 2021. The clinics were operated by Global Response Medicine in concert with local non-governmental organizations. Clinical encounters were each coded to the appropriate ICD-10/CPT code and categorized according to organ system. We categorized medications using the WHO List of Essential Medicines and used multivariable logistic regression to determine associations between demographic variables and condition frequency. RESULTS: We found a total of 8,156 clinical encounters, which included 9,744 diagnoses encompassing 132 conditions (median age 26.8 years, female sex 58.2%). People originated from 24 countries, with the majority from Central America (n = 5598, 68.6%). The most common conditions were respiratory (n = 1466, 15.0%), musculoskeletal (n = 1081, 11.1%), and skin diseases (n = 473, 4.8%). Children were at higher risk for respiratory disease (aOR = 1.84, 95% CI: 1.61-2.10), while older adults had greater risk for joint disorders (aOR = 3.35, 95% CI: 1.73-6.02). Women had decreased risk for injury (aOR = 0.50, 95% CI: 0.40-0.63) and higher risk for genitourinary diseases (aOR = 4.99, 95% CI: 3.72-6.85) compared with men. Among 10,405 medications administered, analgesics were the most common (n = 3190, 30.7%) followed by anti-infectives (n = 2175, 21.1%). CONCLUSIONS: In this large study of a migrating population at the Mexico-US border, we found a variety of clinical conditions, with respiratory, musculoskeletal, and skin illnesses the most common in this study period which encompassed a period of restrictive immigration policy and the first year of the COVID-19 pandemic.

Migrantes venezuelanos e direito à saúde: percepções de técnicos de enfermagem de um hospital geral / Venezuelan migrants and the right to health: perceptions of nursing technicians at a general hospital

Resumo Objetivo: Conhecer as percepções de técnicos de enfermagem de um hospital geral relativas à imigração venezuelana e ao direito à saúde. Método: Pesquisa qualitativa com abordagem exploratória e descritiva que utilizou a observação participante e entrevistas semiestruturadas com 15 técnicos. Para análise dos dados, lançou-se mão do referencial de Bardin. Resultados: A maioria dos entrevistados associou o imigrante à piora da qualidade de vida local e à sobrecarga dos serviços de saúde. Apenas quatro consideraram a imigração e suas consequências como uma questão humanitária, demonstrando empatia com os imigrantes. Muitos manifestaram ciência do princípio da universalidade que caracteriza o sistema de saúde brasileiro, mas discordaram do direito do imigrante ao acesso gratuito aos serviços de saúde. Houve forte depreciação da saúde pública. Conclusão: A maioria dos entrevistados opôs-se à imigração dos venezuelanos e seus discursos continham traços de xenofobia, preconceito e discriminação. O estudo permitiu ampliar a compreensão sobre os processos de cuidar dos profissionais de saúde em um contexto de crises migratórias.

Abstract Objective: To understand the perceptions of nursing technicians at a general hospital regarding Venezuelan immigration and the right to health. Method: Qualitative research with an exploratory and descriptive approach using participant observation and semi-structured interviews with 15 technicians. Bardin's framework was used to analyze the data. Results: Most interviewees associated immigrants with a worsening quality of local life and an overload of health services. Only four considered immigration and its consequences to be a humanitarian issue, showing empathy with immigrants. Many were aware of the principle of universality that characterizes the Brazilian health system but disagreed with the immigrant's right to free access to health services. There was a strong depreciation of public health. Conclusion: Most of the interviewees opposed the immigration of Venezuelans and their speeches contained traces of xenophobia, prejudice, and discrimination. The study allowed us to broaden our understanding of the care processes of health professionals in the context of migratory crises.

Prevalence of tuberculosis, COVID-19, chronic conditions and vulnerabilities among migrants and refugees: an electronic survey / Prevalência de tuberculose, COVID-19, condições crônicas e vulnerabilidades entre migrantes e refugiados: inquérito eletrônico / Prevalencia de tuberculosis, COVID-19, condiciones crónicas y vulnerabilidades en inmigrantes y refugiados: encuesta electrónica

Abstract Objective: to analyze the prevalence of tuberculosis, coronavirus, chronic conditions and vulnerabilities among migrants and refugees in Brazil. Method: this is a cross-sectional study of the electronic survey type conducted with international migrants during the COVID-19 pandemic. Descriptive statistics was applied for the analysis, with calculation of position and dispersion measures. Regarding the categorical variables, relative and absolute frequencies were estimated. Results: the study participants were 553 migrants and refugees, verifying 3.07%, 7.2% and 27.3% prevalence of tuberculosis, COVID-19 and chronic conditions, respectively. Among the vulnerabilities, 32% reported unemployment, 37.6% moved to Brazil as a result of the social situation in their countries and 33.6% were living as refugees or sheltered people. Conclusion: tuberculosis, chronic diseases and COVID-19 presented higher prevalence values in migrants and refugees than in the general population. As this is a population group that still has significant difficulty accessing health services and social protection systems, based on diverse evidence, the study will subsidize public policies, Nursing care and the incorporation of new routines in the service.

Resumo Objetivo: analisar a prevalência de tuberculose, coronavírus, condições crônicas e vulnerabilidades entre migrantes e refugiados no Brasil. Método: trata-se de estudo transversal, do tipo inquérito eletrônico, realizado com migrantes internacionais durante a pandemia de COVID-19. Para a análise, aplicou-se estatística descritiva, com cálculo de medidas de posição e de dispersão. Quanto às variáveis categóricas, estimaram-se as frequências relativas e absolutas. Resultados: participaram do estudo 553 migrantes e refugiados, verificando-se prevalência de 3,07% de tuberculose, 7,2% de COVID-19 e 27,3% de condições crônicas. Entre as vulnerabilidades, 32% referiram desemprego, 37,6% mudaram para o Brasil em decorrência da situação social do seu país e 33,6% residiam em asilo e ou abrigo. Conclusão: a tuberculose, as doenças crônicas e a COVID-19 apresentaram maior prevalência em migrantes e refugiados que na população em geral. Por tratar-se de uma população ainda com grande dificuldade de acesso aos serviços de saúde e aos sistemas de proteção social, o estudo subsidiará, com base em evidências, as políticas públicas, o atendimento do enfermeiro e a incorporação de novas rotinas no serviço.

Resumen Objetivo: analizar la prevalencia de tuberculosis, coronavirus, condiciones crónicas y vulnerabilidades en inmigrantes y refugiados en Brasil. Método: se trata de un estudio transversal, del tipo encuesta electrónica, realizado con migrantes internacionales durante la pandemia de COVID-19. Para el análisis se aplicó estadística descriptiva, con cálculo de medidas de posición y dispersión. En cuanto a las variables categóricas, se estimaron las frecuencias relativas y absolutas. Resultados: participaron del estudio 553 inmigrantes y refugiados, la prevalencia de tuberculosis era del 3,07%, de COVID-19 del 7,2% y de condiciones crónicas del 27,3%. Entre las vulnerabilidades, el 32% reportó desempleo, el 37,6% emigró a Brasil por la situación social de su país y el 33,6% vivía en un asilo o albergue. Conclusión: la tuberculosis, las enfermedades crónicas y el COVID-19 fueron más prevalentes en inmigrantes y refugiados que en la población general. Por tratarse de una población que aún tiene grandes dificultades para acceder a los servicios de salud y sistemas de protección social, el estudio contribuirá, con base en la evidencia, a las políticas públicas, la atención de enfermería y la incorporación de nuevas rutinas en el servicio.

Cross-border utilization of cancer care by patients in the US and Mexico - a survey of Mexican oncologists.

BACKGROUND: The US-Mexico border is the busiest in the world, with millions of people crossing it daily. However, little is known about cross-border utilization of cancer care, or about the reasons driving it. We designed a cross sectional online survey to understand the type of care patients with cancer who live in the US and Mexico seek outside their home country, the reasons why patients traveled across the border to receive care, and the barriers faced when seeking cross-border care. RESULTS: The online survey was sent to the 248 cancer care providers working in the six Mexican border states who were registered members of the Mexican Society of Oncology. Responses were collected between September-November 2022. Sixty-six providers (response rate 26%) completed the survey. Fifty-nine (89%) reported interacting with US-based patients traveling to Mexico to receive various treatment modalities, with curative surgery (n = 38) and adjuvant chemotherapy (n = 31) being the most common. Forty-nine (74%) reported interacting with Mexico-based patients traveling to the US to receive various treatment modalities, with immunotherapy (n = 29) and curative surgery (n = 27) being the most common. The most frequently reported reason US-based patients sought care in Mexico was inadequate health insurance (n = 45). The most frequently reported reason Mexico-based patients sought care in the US was patients' perception of superior healthcare (n = 38). CONCLUSIONS: Most Mexican oncologists working along the Mexico-US border have interacted with patients seeking or receiving binational cancer care. The type of care sought, as well as the reasons for seeking it, differ between US and Mexico-based patients. These patterns of cross-border healthcare utilization highlight unmet needs for patients with cancer in both countries and call for policy changes to improve outcomes in border regions.

Suicide in a Colombian indigenous community: Beyond mental illness.

BACKGROUND: Among the causes associated with suicide there are social factors such as forced displacement has been described and health factors in general that have an impact on pediatric mental health. AIMS: To describe clinical and psychosocial factors, and their relationship with suicidal behavior in a Colombian indigenous community. PARTICIPANTS AND SETTING: The mean age were 9.23 years old, 53.7% male and 46.3% female. METHOD: Mixed approach study. A thematic analysis was carried out with the youth of the community to investigate emotional aspects. A descriptive cross-sectional study was carried out and correlations between variables were made. RESULTS: Correlations were found between suicidal behavior and medical findings. When comparing the mental health disorders and nutritional problems, statistically significant differences were found in the Suicide Risk domain (<.001). This was reaffirmed in the thematic analysis, where factors such as migration and difficulty understanding the language are highlighted as related to suicidal behavior in the pediatric population. CONCLUSIONS: Suicidal behavior should not be approached solely from psychopathology. Hunger, the weakening of one's own culture, armed conflict, migration, and other clinical conditions are found to be associated with suicidal behavior.

Enfermeiros imigrantes no Brasil: de 1973 a 2021 / Immigrant nurses in Brazil: from 1973 to 2021 / Enfermeros inmigrantes en Brasil: de 1973 a 2021

Objetivo: Atualizar o censo dos enfermeiros imigrantes no Brasil. Métodos: estudo descritivo e quantitativo sobre a dimensão e as características do censo dos enfermeiros imigrantes, segundo os estados e as regiões de destino, países de origem, idade e sexo. Os dados foram obtidos da base de dados do Conselho Federal de Enfermagem e analisados de forma descritiva. Resultados: Do total de 176 imigrantes, 145 são mulheres e 31 são homens, mostrando a prevalência feminina na profissão de enfermagem. Destes, 96 são peruanos, 126 sul americanos, 28 europeus, 9 cubanos, 5 norte americanos 8 imigrantes originários de diversos países. Conclusão: O censo de 1973 a 2021 mostra a predominância de imigrantes peruanos, com alta concentração na região norte e sudeste do Brasil, respectivamente no estado do Amazonas e de São Paulo. (AU)

Objective: To update the census of immigrant nurses in Brazil. Methods: descriptive and quantitative study on the dimension and characteristics of the census of immigrant nurses, according to the states and regions of destination, countries of origin, age, and sex. Data were obtained from the Federal Nursing Council database and analyzed descriptively. Results: Of the total of 176 immigrants, 145 are women and 31 are men, showing the female prevalence in the nursing profession. Of these, 96 are Peruvians, 126 South Americans, 28 Europeans, 9 Cubans, 5 North Americans, and 8 immigrants from different countries. Conclusion: the census from 1973 to 2021 shows the predominance of Peruvian immigrants, with a high concentration in the north and southeast of Brazil, respectively in the state of Amazonas and São Paulo. (AU)

Objetivo: Actualizar el censo de enfermeros inmigrantes en Brasil. Métodos: estudio descriptivo y cuantitativo sobre la dimensión y características del censo de enfermeras inmigrantes, según estados y regiones de destino, países de origen, edad y sexo. Los datos fueron obtenidos de la base de datos del Consejo Federal de Enfermería y analizados descriptivamente. Resultados: Del total de 176 inmigrantes, 145 son mujeres y 31 son hombres, mostrando el predominio femenino en la profesión de enfermería. De estos, 96 son peruanos, 126 sudamericanos, 28 europeos, 9 cubanos, 5 norteamericanos y 8 inmigrantes de diferentes países. Conclusion: el censo de 1973 a 2021 muestra el predominio de inmigrantes peruanos, con una alta concentración en el norte y sureste de Brasil, respectivamente en el estado de Amazonas y São Paulo. (AU)

Patient dissatisfaction associated with physician-patient linguistic discordance in California clinics: an analytical cross-sectional study.

BACKGROUND: Patient satisfaction is considered as a product of two psychological processes, a cognitive one, including expectations and perceptions, and an emotional one resulting from the congruence between expectation and subjective perception of the user. The objective was to identify the factors associated with the level of perceived satisfaction in patients treated in 36 nonprofit health clinics that offer comprehensive health care services in four counties in the state of California, United States. METHODS: Cross-sectional analytical study in 14 clinics in four California counties. It consisted of the application of a 30-item questionnaire to determine the degree of patient satisfaction with the clinic. The factorial composition of the quality of care and clinic quality components was analyzed and two factors with an Eigen value greater than 1 were obtained. RESULTS: A total of 846 responses were registered. Factor analysis identified two underlying dimensions: Physician Attitude and Empathy. It was found that the discordance in language between the physician and the patient generates a difference in the perception of satisfaction. Patients who prefer to speak English have better satisfaction than those who speak Spanish. Spanish speakers who do not have interpreter have lower satisfaction than those who do (p < 0,01). CONCLUSIONS: The most important sociodemographic cofactor was language. Satisfaction decreased in Spanish-speaking patients who were not proficient in the use of English since they expressed fewer comments and doubts.

Condiciones de trabajo percibidas por enfermeras migrantes mexicanas en Alemania / Occupational Conditions Perceived by Mexican Migrant Nurses in Germany

Introducción: Se espera que la migración de profesionales de enfermería mexicanos aumente en los próximos años debido a la escasez de enfermeras en todo el mundo. Es urgente estudiar las condiciones de trabajo de las enfermeras mexicanas en los países de acogida desde una perspectiva transcultural. Objetivo: Examinar las percepciones laborales de las enfermeras mexicanas que ejercen en un entorno clínico en Alemania desde una perspectiva transcultural. Métodos: Se realizó un estudio etnográfico focalizado entre noviembre de 2020 y mayo de 2021. La muestra (n = 11) involucró a profesionales de enfermería de México que trabajan en un entorno clínico en Alemania. Los datos se recogieron mediante entrevistas semiestructuradas a través de la plataforma digital Zoom. Las entrevistas fueron grabadas en audio previo consentimiento informado. Se utilizó un análisis temático para analizar los datos; QUIRKOS, un software de análisis de datos cualitativos ayudó en el proceso. Resultados: Se identificaron tres temas: las condiciones estructurales de trabajo, que describen las características del trabajo que influyen en la realización del cuidado transcultural de enfermería; la diversidad cultural de los cuidados, que describe la variabilidad del significado de los cuidados de enfermería; y la práctica transcultural, que describe las percepciones culturales de las enfermeras en relación con los cuidados que prestan en Alemania. Conclusiones: Las condiciones estructurales de trabajo y la diversidad cultural de los cuidados favorecen o impiden la calidad de los cuidados que prestan las enfermeras mexicanas en Alemania. Los hallazgos sugieren la necesidad de abogar por políticas que mejoren las condiciones de trabajo de las enfermeras en México y en Alemania(AU)

Introduction: Migration of Mexican nursing professionals is expected to increase in the coming years, due to the shortage of nurses worldwide. There is an urgent need to study the occupational conditions of Mexican nurses in host countries from a cross-cultural perspective. Objective: To examine the occupational perceptions of Mexican nurses practicing in a clinical setting in Germany, from a cross-cultural perspective. Methods: A focused ethnographic study was conducted between November 2020 and May 2021. The sample (n=11) involved nursing professionals from Mexico working in a clinical setting in Germany. The data were collected through semistructured interviews via the digital platform Zoom. The interviews were audio-recorded with prior informed consent. A thematic analysis was used to analyze the data; Quirkos, a qualitative data analysis software, was used in the process. Results: Three themes were identified: structural occupational conditions, describing the occupational characteristics that influence the performance of transcultural nursing care; cultural diversity of care, describing variability in the meaning of nursing care; and transcultural practice, describing nurses' cultural perceptions of the care that they provide in Germany. Conclusions: Structural occupational conditions and cultural diversity of care favor or impede the quality of care provided by Mexican nurses in Germany. The findings suggest the need to advocate for policies that improve the occupational conditions of nurses in Mexico and Germany(AU)

Getting knowledge to provide care: prevalence and factors associated with Sexually Transmitted Infections in immigrants from Goiás / Conocer para cuidar: prevalencia y factores asociados a las Enfermedades de Transmisión Sexual en inmigrantes de Goiás / Conhecer para cuidar: prevalência e fatores associados às Infecções Sexualmente Transmissíveis em imigrantes de Goiás

ABSTRACT Objective: To estimate the prevalence of Sexually Transmitted Infections (STIs) in immigrants and refugees living in the metropolitan region of Goiânia, Goiás. Method: This is a cross-sectional and analytical study. Data collection was carried out from July 2019 to January 2020 and 308 immigrants and refugees were included in the sample. All were underwent face-to-face interviews and were tested for HIV, Syphilis, and Hepatitis B, using rapid tests. Results: The general prevalence for any of the STIs investigated was 8.8% (95%CI 6.0% - 12.3%), being 5.8% (95%CI 3.6% - 8.9%) for Hepatitis B, 2.3% for Syphilis (95%CI 1.00% - 4.4%) and 0.7% for HIV (95%CI 0.1% - 2.1%). Multiple analysis, using logistic regression, showed that the variables male gender (OR = 2.7) and length of time living in Brazil (OR = 2.6) were significantly associated with STIs (p < 0.05). Conclusion: The results of this study suggest that STIs are a health problem in immigrants/refugees, which appear to be enhanced with the length of migration in the country. Public policies that guarantee health care for this population shall be considered.

RESUMEN Objetivo: Estimar la prevalencia de Enfermedades de Transmisión Sexual (ETS) en inmigrantes y refugiados residentes en la región metropolitana de Goiânia, Goiás. Método: Se trata de un estudio transversal y analítico. La recolección de datos se llevó a cabo desde julio de 2019 hasta enero de 2020 y se incluyeron en la muestra 308 inmigrantes y refugiados. Todos fueron entrevistados cara a cara y sometidos a pruebas de VIH, Sífilis y Hepatitis B, mediante pruebas rápidas.. Resultados: La prevalencia general para cualquiera de las ETS investigadas fue de 8,8% (IC95% 6,0% - 12,3%), siendo 5,8% (IC95% 3,6% - 8,9%) para Hepatitis B, 2,3% para Sífilis (IC95% 1,00% - 4,4%) y 0,7% para VIH (IC95% 0,1% - 2,1%). El análisis múltiple, mediante regresión logística, mostró que las variables género masculino (OR = 2,7) y tiempo de residencia en Brasil (OR = 2,6) se asociaron significativamente con las ETS (p < 0,05). Conclusión: Los resultados de este estudio sugieren que las ETS son un problema de salud en inmigrantes/refugiados, que parecen exacerbarse con la duración de la migración en el país. Se deben considerar políticas públicas que garanticen la atención de la salud de esta población.

RESUMO Objetivo: Estimar a prevalência de Infecções Sexualmente Transmissíveis (IST) em imigrantes e refugiados residentes na região metropolitana de Goiânia, Goiás. Método: Trata-se de um estudo transversal e analítico. A coleta de dados foi realizada no período de julho de 2019 a janeiro de 2020 e integraram a amostra 308 imigrantes e refugiados. Todos foram entrevistados face-a-face e testados para HIV, Sífilis e Hepatite B, por meio de testes rápidos. Resultados: A prevalência geral para alguma das IST investigadas foi de 8,8% (IC95% 6,0% - 12,3%), sendo 5,8% (IC95% 3,6% - 8,9%) para Hepatite B, 2,3% para Sífilis (IC95% 1,00% - 4,4%) e 0,7% para HIV (IC95% 0,1% - 2,1%). A análise múltipla, por regressão logística, mostrou que as variáveis sexo masculino (OR = 2,7) e tempo de moradia no Brasil (OR = 2,6) foram associadas significativamente às IST (p < 0,05). Conclusão: Os resultados deste estudo sugerem que as IST são um problema de saúde em imigrantes/refugiados, que parecem ser exacerbadas com o tempo de migração no país. Políticas públicas que garantam a assistência à saúde dessa população devem ser consideradas.

Ways of living and working of Haitian immigrants in Western Paraná/Brazil / Modo de vida y trabajo de inmigrantes haitianos en el oeste de Paraná/Brasil / Modos de vida e trabalho de imigrantes haitianos no Oeste do Paraná/Brasil

ABSTRACT Objective: To analyze the migratory process, ways of living, and working conditions of Haitians residing in the municipality of Cascavel, Paraná, as well as their impact on health conditions, consumption patterns, and political and ideological life. Method: cross-sectional observational design. Data was collected through semi-structured interviews conducted from December 2019 to December 2020 with 128 participants who were Haitian immigrants residing in the municipality. Simple descriptive statistics were used for the data analysis, and the findings were discussed in conjunction with relevant literature, with the social determination theory serving as a reference. Results: The majority of participants were male 75.0% (n = 96), young adults 71.0% (n = 91), speakers of two or more languages 87.5% (n = 112), catholic 61.7% (n = 79), high school education or higher 57.0% (n = 73). They consider their life and health conditions good but are unsatisfied with the working conditions and salary. Conclusion: Haitian immigrants' arrival facilitation to work in cold stores may indicate labor exploitation of economically and socially vulnerable groups. Immigration policies and the recognition of the educational level of their country of origin may contribute to improving the living condition of this population.

RESUMEN Objetivo: Analizar el proceso migratorio, el modo de vida y el trabajo de haitianos que residen en la ciudad de Cascabel, Paraná y sus expresiones en las condiciones de salud, en las costumbres de consumo y en la vida política e ideológica. Método: Se trata de una investigación observacional transversal, con datos recopilados y sopesados con la literatura pertinente y la teoría de la determinación social. La entrevista semiestructurada se llevó a cabo con 128 participantes, inmigrantes haitianos residentes en el municipio, de diciembre de 2019 a diciembre de 2020. Para el análisis, se utilizó la estadística descriptiva simple. Resultados: La mayoría de los participantes eran hombres (75,0%) (n = 96), adultos jóvenes (71,0%) (n = 91), hablaban dos idiomas o más (87,5%) (n = 112), eran católicos (61,7%) (n = 79) y tenían estudios secundarios o terciarios (57,0%) (n = 73). Consideran que sus condiciones de vida y de salud son buenas, pero están insatisfechos con su situación laboral y su salario. Conclusión: La facilitación de la venida de inmigrantes haitianos para trabajar en frigoríficos de la región puede indicar explotación laboral de grupos económica y socialmente vulnerables. Las políticas de integración y el reconocimiento de la escolaridad del país de origen pueden contribuir a mejorar las condiciones de vida de este grupo de inmigrantes.

RESUMO Objetivo: Analisar o processo migratório, os modos de vida e trabalho de haitianos que residem no município de Cascavel-Paraná e suas expressões nas condições de saúde, no padrão de consumo e na vida política e ideológica. Método: Pesquisa observacional transversal. A coleta de dados se deu por meio de entrevista semiestruturada, de dezembro de 2019 a dezembro de 2020 com 128 participantes, imigrantes haitianos residentes no município. Para análise, utilizou-se estatística descritiva simples, discutidos com a literatura pertinente, tendo como referencial a teoria da determinação social. Resultados: A maioria dos participantes foi da população masculina 75,0% (n = 96), adultos jovens 71,0% (n = 91), falam duas línguas ou mais 87,5% (n = 112), de religião católica 61,7% (n = 79), com escolaridade de nível médio ou acima 57,0% (n = 73). Consideram boas suas condições de vida e saúde, mas estão insatisfeitos com as condições de trabalho e salário. Conclusão: O favorecimento da vinda de imigrantes haitianos para atuarem em frigoríficos da região, pode indicar exploração do trabalho de grupos vulneráveis econômica e socialmente. Políticas de integração e o reconhecimento da formação escolar do país de origem, podem contribuir para melhorar a condição de vida desta população.

Recursos y vulnerabilidades de comunidades migrantes en Chile para enfrentar la pandemia SARS-CoV-2

Objetivo Conocer, en contexto de la pandemia por SARS-CoV-2, las vulnerabilidades psicosociales y socioeconómicas de la población migrante internacional en Chile y los recursos y capitales sociales reportados desde la propia comunidad. Métodos Estudio cualitativo descriptivo. Se realizaron 40 entrevistas semiestructuradas a migrantes (N=30) e informantes claves (N=10), ejecutadas virtualmente durante el 2020. El material fue analizado mediante análisis temático. El proyecto fue aprobado por el Comité de Ética Científico de la Facultad de Medicina de la Universidad del Desarrollo. Resultados Como principales vulnerabilidades enfrentadas por parte de personas migrantes en pandemia se identifican: hacinamiento, precariedad laboral y necesidades económicas, uso del transporte público, desinformación y creencias en torno al COVID-19, discriminación, falta de redes de apoyo, y estatus migratorio. Como recursos se reconocen: contar con redes de apoyo, posibilidad de teletrabajo o salir a trabajar, acceso a información y a la red asistencial y municipal, apoyo gubernamental y de la sociedad civil. Adicionalmente, se reportan experiencias de diagnóstico de COVID-19, identificando dificultades en acceso a PCR y adaptaciones familiares y laborales como cambios en los hábitos de vida dentro y fuera del hogar. Discusión El estudio entrega información relevante e inédita para la construcción de políticas en salud para migrantes internacionales con foco en crisis sanitarias. Se destaca la necesidad de fortalecer adecuaciones interculturales en las estrategias de prevención del contagio y de promoción de la salud y aumentar la disponibilidad de respuesta en el acceso a salud en el marco de la pandemia, mitigando así la vulnerabilidad social en migrantes y potenciando sus recursos de afrontamiento.

Objective To know, in the context of the SARS-CoV-2 pandemic, the psychosocial and socioeconomic vulnerabilities experienced by the international migrant population in Chile, as well as the resources and social capital reported from the community itself and its support networks, and to analyze the reception and implementation of the measures recommended by the health authorities in the different stages of the pandemic in the country. Methods Descriptive qualitative study. The information was collected through 40 semi-structured individual interviews with migrants (N=30) and key informants (N=10), carried out through online communication platforms during 2020. A thematic analysis of the material was carried out. The project was approved by the Scientific Ethics Committee of the Faculty of Medicine of the Universidad del Desarrollo. Results The main vulnerabilities experienced by migrants in the context of the pandemic include overcrowding, job insecurity and economic needs, use of public transport, misinformation and beliefs about COVID-19, experiences of discrimination and xenophobia, lack of support networks, and migratory status. The main resources are support networks, the possibility of working remotely or going out to work, access to information, access to the assistance and municipal network, and government support and civil society. In addition, experiences of diagnosis of COVID-19 are reported, identifying difficulties in accessing PCR testing, and family and work adaptations such as changes in lifestyle habits inside and outside the home. Discussion The study provides relevant and unpublished information for the construction of health policies for international migrants with a focus on sanitary crises. It highlights the need to strengthen cross-cultural strategies for the prevention of infection and health promotion, and to improve access to health in the context of the pandemic and beyond, thereby mitigating the social vulnerability experienced by migrants and enhancing their coping resources.

Hepatitis B and C in Immigrants and Refugees in Central Brazil: Prevalence, Associated Factors, and Immunization.

Introduction: Eliminating hepatitis B and C in immigrant and refugee populations is a significant challenge worldwide. Given the lack of information in Brazil, this study aimed to estimate the prevalence of infections caused by hepatitis B and C viruses and factors associated with hepatitis B in immigrants and refugees residing in central Brazil. Methods: An observational, cross-sectional, and analytical study was conducted from July 2019 to January 2020 with 365 immigrants and refugees. Hepatitis B was detected by a rapid immunochromatographic test, enzyme immunoassay, and chemiluminescence, and hepatitis C by rapid immunochromatographic test. Multiple analysis was used to assess factors associated with hepatitis B infection. Results: Of the participants, 57.8% were from Haiti and 35.6% were from Venezuela. Most had been in Brazil for less than 2 years (71.2%). The prevalence of HBV infection and exposure was 6.6% (95% CI: 4.5-9.6%) and 27.9% (95% CI: 23.6-2.8%), respectively, and 34% had isolated anti-HBs positivity. Reporting a sexually transmitted infection was statistically associated with HBV infection (OR: 7.8; 95% CI: 2.3-26.4). No participant with positive anti-HCV serology was found. Conclusions: The study showed that participants were outside the reach of prevention and control actions for hepatitis B. Therefore, public health strategies must be designed to reach, inform, and vaccinate this group.

Social exclusion at the intersections of immigration, employment, and healthcare policy: A qualitative study of Mexican and Chinese immigrants in California.

While immigrants in the US suffer poor access to healthcare in general, access within immigrant populations varies notably by legal status and employment. Intersections between immigration, employment, and healthcare policy have shaped immigrants' access or exclusion from healthcare; however, little research has examined how immigrants experience and navigate these intersections. Drawing on social exclusion theory and the theory of bounded agency, we aimed to investigate Mexican and Chinese immigrants' experiences of exclusion from healthcare as one key dimension of social exclusion-and how this was shaped by interactions with the institutions of immigration and employment. The examination of two ethnic immigrant groups who live under the same set of policies allows for a focus on the common impacts of policy. We selected Mexican and Chinese immigrants as the two largest subgroups in California's Latinx and Asian immigrant population. We use a policy lens to analyze qualitative data from the mixed-methods Research on Immigrant Health and State Policy (RIGHTS) Study, involving 60 in-depth interviews with Mexican and Chinese immigrants in California between August 2018-August 2019. We identified two primary themes: pathways of social exclusion and access, and strategies used to address social exclusion. Findings show that immigrants' exclusion from healthcare is fundamentally linked to legal status and employment, and that immigrants navigate difficult choices between opportunities for improved employment and changes in legal status. We argue that multiple categories of legal status affect immigrants' employment opportunities and social position, which, in turn, translates to stratified healthcare access. Our findings support the literature establishing legal status as a mechanism of social stratification but challenge legal-illegal binary paradigms.

Ischemic Heart Disease in German Immigrants and Their Descendants in a Region of Southern Brazil: A Comparison of Initial Symptoms Reported between two Generations

Abstract Background Nothing is known about ischemic heart disease (IHD) in the Germans who emigrated to Brazil during the last century. Objective We sought to compare age at diagnosis and IHD manifestations between German immigrants and their first-generation descendants in the region of Blumenau, Brazil. Methods We reviewed medical records of hospitals in Blumenau. Comparison of the groups in the evaluation times was made by analysis of variance (ANOVA) with repeated measures, and comparison of two factors was made by two-way ANOVA. The level of significance was set at p <0.05. Results Study population comprised 68 patients who were born in Germany (group G) and 99 descendants (group D). Twenty-nine patients of group D had two German parents and 70 had one. Mean age at diagnosis was 66.8 ± 10.6 years, with a significant difference between the groups, four years higher in Group G than group D (69.0 ± 8.8 vs 65.4 ± 11.5 years old) (p = 0.025). There was no significant difference in risk factors or coronary angiography data between the groups. HDL cholesterol levels were significantly higher in group G than in group D (48.4 ± 11.1 mg/dL vs 43.3 ± 11.2 mg/dL, p = 0.005). Conclusion At the time of first IHD diagnosis, mean age of the group G was significantly higher than group D, with no differences between groups in sex, risk factors, LDL levels, or clinical and angiographic manifestations. An earlier manifestation of the disease could be part of lifestyle changes in descendants, in this population that mantained eating habits characterized by high saturated fat consumption.

Migrações, trabalho de cuidado e saúde de cuidadoras: revisão integrativa / Migrations, care work and caregivers' occupational health: an integrative review

Resumo Introdução: o trabalho remunerado de cuidado em domicílio é exercido predominantemente por mulheres e caracterizado por baixos salários e pouca valoração social. Objetivo: analisar a migração no trabalho de cuidado e as suas relações com as condições de trabalho e saúde de cuidadoras latino-americanas. Método: foi realizada uma revisão integrativa da literatura com busca nas bases de dados BVS, SciELO, PubMed, Sociological Abstract, Scopus e Web of Science. Foram incluídos estudos sobre a América Latina, publicados no período de 2010 a agosto de 2019. Resultados: foram incluídos 21 artigos, dos quais 20 relatam estudos qualitativos. A migração influencia as trajetórias de cuidadoras ao se deslocarem pela América Latina, Estados Unidos e Europa; foram identificadas contradições entre cuidar de outras pessoas enquanto os filhos/família ficam no país de origem; dificuldades com a língua; ausência de permissões para o exercício do trabalho; condições de trabalho precárias; situações de exploração e maus-tratos, discriminações, racismo, problemas de saúde físicos e emocionais. Conclusão: as trajetórias de migração das cuidadoras latino-americanas revelam dificuldades que estão relacionadas a condições de trabalho precárias e situações de violência no trabalho.

Abstract Introduction: paid home care is largely performed by women and characterized by low wages and little social status. Objective: to analyse migration in care work and its relationship with Latin American caregivers' working conditions and health status. Methods: We collected data by searching the BVS, SciELO, PubMed, Sociological Abstract, Scopus and Web of Science databases. Studies carried out about Latin America, published between 2010 and August 2019, were included in the review. Results: of the 21 papers included, 20 had a qualitative approach. Migration influences caregivers' trajectories as they move through Latin America, the United States, and Europe. The analysis found contradictions between caring for others while their own children/family stay in their home country; difficulties with the language; lack of work permits; precarious working conditions; exploitation, mistreatment, discrimination, racism, emotional and physical health problems. Conclusion: the Latin American caregivers' migrations trajectories reveal difficulties related to precarious working conditions and workplace violence.

A Qualitative Study of the Health Perceptions in the Venezuelan Immigrant Population in Medellín (Colombia) and Its Conditioning Factors.

This study explored the general and oral health perceptions in the Venezuelan immigrant population in Medellín (Colombia) and its conditioning factors. A qualitative study involving Venezuelan immigrants ≥18 years with a minimum stay of six months in Colombia was conducted. Dentists, dental students, and other health professionals also participated. Semi-structured interviews (n = 17), focus groups (n = 2), and key informants' interviews (n = 4) were utilized. The interviews and focus groups were recorded and transcribed for later narrative content analysis. A high degree of vulnerability of participants was found due to the precarious living conditions from the premigratory moment and the lack of job placement possibilities at the time of settling in Colombia, where the migratory status played a fundamental role. Among the perceived needs, the mitigation of noncommunicable diseases stood out. Poor mental health symptoms (depression and anxiety) were perceived, and oral health was not a priority. Barriers to accessing health and dental care were found. The migrant condition was found to be a determinant that affected physical, mental, and oral health and the provision of health care. This situation is of interest to the construction of public health policies that guarantee access to fundamental rights.

Estresores de aculturación de los inmigrantes hispanos en Estados Unidos de América. Revisión sistemática exploratoria / Stressors during the process of culture adaptation of hispanic migrants in the United States of America: An exploratory systematic review / Estressores de aculturação de imigrantes hispânicos nos Estados Unidos da América. Revisão sistemática exploratoria

RESUMEN Introducción: Los inmigrantes hispanos que se desplazan hacia Estados Unidos experimentan una transición migratoria altamente estresante, padeciendo alteraciones en la salud que continúan después de su llegada, lo que puede dificultar su adaptación a la nueva cultura. Identificar los factores más estresantes en el inmigrante hispano en su proceso de aculturación es primordial para el diseño de intervenciones puntuales y oportunas, donde el personal de enfermería es un elemento central para ello. Objetivo: Identificar los estresores de aculturación que presentan los inmigrantes hispanos en Estados Unidos. Desarrollo: Mediante un análisis numérico de los datos cuantitativos y el análisis temático de los hallazgos cualitativos, sugerido por metodología para revisiones sistemáticas exploratorias, se identificaron estresores personales, del entorno, sociales y globales, que enfrentan los inmigrantes hispanos. De igual manera, se describen las principales repercusiones a la salud tales como: angustia, ansiedad, depresión, ideación suicida, riesgo de consumo de alcohol, conductas sexuales de riesgo, entre otras, que se derivan de dicho proceso de transición. Conclusiones: Los encuentros más comunes entre el profesional de enfermería se dan durante momentos de transición de las personas, por ello es importante resaltar que la transición cultural de los inmigrantes hispanos es acompañada de estresores que afectan directamente su salud. El presente estudio muestra y clasifica los estresores más comunes, evidencia la necesidad de la creación de estrategias encaminadas a la adaptación social del inmigrante hispano y el involucramiento de la enfermería tanto en el diseño como liderazgo de estas.

ABSTRACT Introduction: Hispanic migrants who settle in the United States experience a highly stressful transition period, which not only has an impact on their process of adaptation to the new culture but also on their health. Therefore, identifying stressing factors which influence the hispanic migrants during their process of culture adaptation is a key goal in the design and implementation of timely interventions led by nursing professionals. Objective: To identify stressing factors which have an influence on the process of culture adaptation of hispanic migrants in the United States. Development: Based on the numeric analysis of quantitative data, and the thematic analysis of the qualitative data which was informed by an exploratory systematic review methodology, personal, social, global stressors were identified influencing hispanic migrants in the United States. Among the identified health issues were: anguish, anxiety, depresion, suicide thoughts, alcohol consumption, and risky sexual behaviors. Conclusions: The present study showed some important stressors influencing the hispanic migrants in the United States in their process of culture adaptation. These factors can be considered by the nursing professionals who are addressing the process of social adaptation of these populations.

RESUMO Introdução: Os imigrantes hispânicos que se mudam para os Estados Unidos passam por uma transição migratória altamente estressante, sofrendo alterações de saúde que continuam após sua chegada, o que pode dificultar sua adaptação à nova cultura. Identificar os fatores mais estressantes para os imigrantes hispânicos em seu processo de aculturação é essencial para a concepção de intervenções oportunas, nas quais o pessoal de enfermagem é um elemento central para isso. Objetivo: Identificar os estressores de aculturação entre os imigrantes hispânicos nos Estados Unidos. Desenvolvimento: Através de uma análise numérica dos dados quantitativos e análise temática dos resultados qualitativos, sugeridos pela metodologia de revisões sistemáticas exploratórias, foram identificados os estresses pessoais, ambientais, sociais e globais enfrentados pelos imigrantes hispânicos. Da mesma forma, são descritas as principais repercussões na saúde, tais como: angústia, ansiedade, depressão, ideação suicida, risco de consumo de álcool, comportamentos sexuais de risco, entre outros, que são derivados deste processo de transição Conclusões: Os encontros mais comuns entre os profissionais de enfermagem ocorrem durante os momentos de transição das pessoas, portanto é importante salientar que a transição cultural dos imigrantes hispânicos é acompanhada por fatores de estresse que afetam diretamente sua saúde. Este estudo mostra e classifica os fatores de estresse mais comuns, demonstra a necessidade da criação de estratégias voltadas para a adaptação social do imigrante hispânico e o envolvimento da enfermagem tanto no desenho quanto na liderança dessas estratégias.

Atenção à saúde de imigrantes haitianos em diferentes países na atualidade: revisão integrativa de literatura / Health care for Haitian immigrants in different countries nowadays: an integrative literature review / Atención de salud para inmigrantes haitianos en diferentes países hoy: una revisión integradora de literatura

Com a globalização, os fluxos migratórios intensificaram-se e as razões financeiras são umas das principais impulsionadoras de tais eventos. As populações migrantes têm diferentes necessidades, sendo o acesso à saúde algo primordial para garantir a qualidade de vida. Assim, este estudo objetivou analisar a produção científica sobre atenção à saúde de imigrantes internacionais haitianos em diferentes contextos e países, buscando compreender quais são os desafios e as perspectivas para a atenção à saúde dessa população nos contextos investigados. Trata-se de uma Revisão Integrativa de Literatura, realizada a partir de pesquisas nas bases Sistema Online de Busca e Análise de Literatura Médica (Medline/PubMed) e Scientific Electronic Library Online (SciELO), com os descritores padronizados 'Health Care' ('Public Health'), 'Haiti' e 'Emigrants and Immigrants', combinados por meio do operador booleano AND. Selecionaram-se artigos publicados no período de 2015 a 2019 que fossem em português, inglês ou espanhol e que tratassem desse tema. A partir da análise dos artigos, identificaram-se três categorias de análise temática: Impactos das regulamentações imigratórias na integração dos imigrantes haitianos; Competência intercultural para a atenção à saúde de imigrantes haitianos; e Condições de saúde e acesso a serviços por imigrantes haitianos. Destaca-se a importância da inclusão de aspectos políticos interculturais nas políticas de saúde voltadas à atenção à saúde do imigrante.

With globalization, migration flows have intensified and financial reasons are one of the main drivers of these events. Migrant populations have different needs, and access to health is essential to ensure their quality of life. Accordingly, this study aimed to analyze the scientific production on health care of international Haitian immigrants in different contexts and countries, seeking to understand what are the challenges and perspectives for the health care of this population in the investigated contexts. This is an Integrative Literature Review, performed from searches in the Medical Literature Analysis and Retrieval System Online (Medline/PubMed) and Scientific Electronic Library Online (SciELO), with the standardized descriptors 'Health Care' ('Public Health'), 'Haiti' and 'Emigrants and Immigrants', combined through the Boolean operator AND. We selected articles published in the period 2015-2019, in Portuguese, English or Spanish, that dealt with this theme. From the analysis of the articles, we identified three categories of thematic analysis: Impacts of immigration regulations on the integration of Haitian immigrants; Intercultural competency for the health care for Haitian immigrants; and Health conditions and access to services by Haitian immigrants. We should highlight the importance of including intercultural political aspects in health policies focused on the health care for immigrants.

Con la globalización, los flujos migratorios se han intensificado y las razones financieras son uno de los principales impulsores de tales eventos. Las poblaciones migrantes tienen diferentes necesidades, siendo el acceso a la salud fundamental para garantizar la calidad de vida. Así, este estudio tuvo como objetivo analizar la producción científica en salud de inmigrantes haitianos internacionales en diferentes contextos y países, buscando comprender cuáles son los desafíos y perspectivas para la atención de la salud de esta población en los contextos investigados. Se trata de una Revisión Integrativa de Literatura, realizada a partir de la investigación del Sistema de Análisis y Búsqueda de Literatura Médica en Línea (Medline / PubMed) y Biblioteca Electrónica Científica en Línea (SciELO), con los descriptores estandarizados 'Health Care' ('Salud Pública'), 'Haití' y 'Emigrantes e inmigrantes', combinados a través del operador booleano AND. Se seleccionaron artículos publicados en el período de 2015 a 2019 que estuvieran en portugués, inglés o español y abordaran este tema. Del análisis de los artículos se identificaron tres categorías de análisis temático: Impactos de las regulaciones migratorias en la integración de inmigrantes haitianos; Competencia intercultural para la atención de la salud de los inmigrantes haitianos; y Condiciones de salud y acceso a servicios de inmigrantes haitianos. Se destaca la importancia de incluir aspectos políticos interculturales en las políticas de salud dirigidas a la atención de la salud de los inmigrantes.

Healthcare-related expenditures among immigrants and non-immigrants living with HIV in colombia.

The perception that immigrants represent a burden to national health systems can hinder the development of policies for their inclusion in health coverage. In order to inform the development of such policies, data on the healthcare needs and healthcare spending for immigrants is required. The objective of this article is to compare the clinical characteristics and healthcare-related expenditures of Venezuelan immigrants and non-migrants living with HIV in Colombia. We analysed data from the Colombian High-cost Diseases Fund from February 1, 2018 to January 31, 2019, identifying the hospital and non-hospital expenditures per patient for Venezuelan immigrants and non-migrant patients, in both the state-subsidised and the contributory coverage schemes. We employed binomial negative regression models to compare expenditures between the two groups. In the contributory scheme, the average annual per-capita expenditure for immigrants was USD $ 859.07 (SD: ± $793.37) for non-hospital care. For non-migrants, the average costs were 1,796.53. In the state-subsidised scheme expenditures were higher on average, but still lower for immigrants than for non-migrants. After adjusting by clinical and sociodemographic characteristics, non-hospital per capita expenditures were lower for immigrants as compared with non-migrants (25,37% lower in the state-subsidised scheme, and 33,75% lower in the contributory scheme). Hospital expenditures were also lower, but the small sample size limited analysis. To conclude, Venezuelan immigrants living with HIV do not represent a major economic burden to the health system in Colombia. Further studies are required in order to understand if the lower healthcare expenditures of this population are the result of limitations in healthcare access, of clinical characteristics that were not assessed in this study, or of other unmeasured aspects.

Possibilidades para promover a saúde de imigrantes haitianos: percepções de estudantes de enfermagem / Posibilidades para promover la salud de los inmigrantes haitianos: percepciones de estudiantes de enfermería / Possibilities to promote the health of haitian immigrants: perceptions of nursing students

Objetivos: Conhecer as percepções dos estudantes de enfermagem sobre as possibilidades de promover a saúde de imigrantes haitianos no Brasil. Método: Pesquisa qualitativa, tipo ação participante, fundamentada no Itinerário de Pesquisa de Paulo Freire, que possui três fases interligadas: Investigação Temática; Codificação e Descodificação; Desvelamento Crítico. Realizou-se um Círculo de Cultura, em 2019, com a participação de 12 estudantes de enfermagem, de uma universidade pública do Sul do Brasil. Resultados: No Círculo de Cultura, discutiram-se as temáticas: saúde física e mental; ser universitário e trabalhador; adaptação no Brasil. Conclusão: Há invisibilidade de discussões sobre a saúde dos imigrantes na formação do enfermeiro, tendo diversas possibilidades de promover a saúde desse público: criação de espaços de lazer e interação na universidade; políticas de permanência; valorização do trabalho dos haitianos; organização de casa de apoio; cartilha informativa na língua nativa, com vista a ampliar a qualidade de vida dos imigrantes no Brasil(AU)

Purposes: To understand how nursing students perceive the possibilities to promote the health of Haitian immigrants in Brazil. Method: This is a qualitative, participatory action research, based on Paulo Freire's Research Itinerary, which has three interconnected phases: Thematic Research; Encoding and Decoding; Critical Unveiling. A Culture Circle was held in 2019, with the participation of 12 nursing students, from a public university in southern Brazil. Results: The Culture Circle discussed the topics: physical and mental health; being a university student and worker; adaptation in Brazil. Conclusion: The health of immigrants is not usually discussed in the training of nurses, even though there are several possibilities to promote the health of this public: creation of leisure and interaction spaces at the university; permanence policies; valuing the work of Haitians; support home organization; information booklet in their native language, with a view to increasing the quality of life of immigrants in Brazil.(AU)

Objetivos: Comprender percepciones de estudiantes de enfermería sobre las posibilidades de promover salud de inmigrantes haitianos en Brasil. Método: Investigación cualitativa, tipo acción participante, basada en Itinerario de Investigación de Paulo Freire, que tiene tres fases interconectadas: Investigación Temática; Codificación y decodificación; Revelación crítica. En 2019 se realizo un Círculo de Cultura, con participación de 12 estudiantes de enfermería, de una universidad pública del sur de Brasil. Resultados: En Círculo Cultural se discutió los temas: salud física y mental; ser estudiante y trabajador universitario; adaptación en Brasil. Conclusión: Existe invisibilidad de discusiones sobre salud de inmigrantes en la formación de enfermeros, con varias posibilidades para promover salud de este público: creación de espacios de ocio e interacción en universidad; políticas de permanencia; valorar el trabajo de los haitianos; apoyar la organización del hogar; folleto informativo en lengua nativa, con miras a mejorar la calidad de vida de inmigrantes en Brasil(AU)