#Effectiveness of pre-entry active #tuberculosis and post-entry latent tuberculosis #screening in new entrants to the #UK: a retrospective, population-based cohort study (Lancet Infect Dis., abstract)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

Effectiveness of pre-entry active tuberculosis and post-entry latent tuberculosis screening in new entrants to the UK: a retrospective, population-based cohort study

Luis C Berrocal-Almanza, PhD, Ross Harris, MSc, Maeve K Lalor, PhD, Morris C Muzyamba, PhD, John Were, MPH, Anne-Marie O’Connell, MSc, Adil Mirza, MSc, Prof Onn-Min Kon, MD, Prof Ajit Lalvani, DM  †, Dominik Zenner, MD †

Published: August 27, 2019 / DOI: https://doi.org/10.1016/S1473-3099(19)30260-9

 

Summary

Background

Evaluating interventions that might lead to a reduction in tuberculosis in high-income countries with a low incidence of the disease is key to accelerate progress towards its elimination. In such countries, migrants are known to contribute a large proportion of tuberculosis cases to the burden. We assessed the effectiveness of screening for active tuberculosis before entry to the UK and for latent tuberculosis infection (LTBI) post-entry for reduction of tuberculosis in new-entrant migrants to the UK. Additionally, we investigated the effect of access to primary care on tuberculosis incidence in this population.

Methods

We did a retrospective, population-based cohort study of migrants from 66 countries who were negative for active tuberculosis at pre-entry screening between Jan 1, 2011, and Dec 31, 2014, and eligible for LTBI screening. We used record linkage to track their first contact with primary care, uptake of LTBI screening, and development of active tuberculosis in England, Wales, and Northern Ireland. To assess the effectiveness of the pre-entry screening programme, we identified a control group of migrants who were not screened for active tuberculosis using the specific code for new entrants to the UK registering in primary care within the National Health Service patient registration data system. Our primary outcome was development of active tuberculosis notified to the National Enhanced Tuberculosis Surveillance System.

Findings

Our cohort comprised 224 234 migrants who were screened for active tuberculosis before entry to the UK and a control group of 118 738 migrants who were not. 103 990 (50%) migrants who were screened for active tuberculosis registered in primary care; all individuals in the control group were registered in primary care. 1828 tuberculosis cases were identified during the cohort time, of which 31 were prevalent. There were 26 incident active tuberculosis cases in migrants with no evidence of primary care registration, and 1771 cases in the entire cohort of migrants who registered in primary care (n=222 728), giving an incidence rate of 174 (95% CI 166–182) per 100 000 person-years. 672 (1%) of 103 990 migrants who were screened for active tuberculosis went on to develop tuberculosis compared with 1099 (1%) of 118 738 not screened for active tuberculosis (incidence rate ratio [IRR] 1·49, 95% CI 1·33–1·67; p<0·0001). 2451 (1%) of the 222 728 migrants registered in primary care were screened for LTBI, of whom 421 (17%) tested positive and 1961 (80%) tested negative; none developed active tuberculosis within the observed time period. Migrants settling in the least deprived areas had a decreased risk of developing tuberculosis (IRR 0·74, 95% CI 0·62–0·89; p=0·002), and time from UK arrival to primary care registration of 1 year or longer was associated with increased risk of active tuberculosis (2·96, 2·59–3·38; p<0·0001).

Interpretation

Pre-entry tuberculosis screening, early primary care registration, and LTBI screening are strongly and independently associated with a lower tuberculosis incidence in new-entrant migrants.

Funding

National Institute for Health Research (NIHR) Health Protection Research Unit in Respiratory Infections and NIHR Imperial Biomedical Research Centre.

Keywords: Tuberculosis; Migrants; UK.

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#Migrants in transit through #Mexico to the #US: Experiences with #violence and related factors, 2009-2015 (PLoS One, abstract)

[Source: PLoS One, full page: (LINK). Abstract, edited.]

OPEN ACCESS /  PEER-REVIEWED / RESEARCH ARTICLE

Migrants in transit through Mexico to the US: Experiences with violence and related factors, 2009-2015

René Leyva-Flores , Cesar Infante  , Juan Pablo Gutierrez , Frida Quintino-Perez , MariaJose Gómez-Saldivar , Cristian Torres-Robles

Published: August 21, 2019 / DOI: https://doi.org/10.1371/journal.pone.0220775

 

Abstract

Objectives

The objectives of the study are to 1) estimate the burden of physical, sexual, and psychological violence among migrants in transit through Mexico to the US; and 2) examine the associations between experiencing violence and sociodemographic characteristics, migratory background, and health status in this vulnerable population.

Method

A cross-sectional study combining qualitative and quantitative methods was carried out from 2009 to 2015 with a sample of 12,023 migrants in transit through Mexico to the US. Information on gender (male, female, and transsexual, transgender and transvestite -TTTs-); nationality; health status; migratory background; and experiences with violence was obtained. Fifty-eight migrants participated in in-depth interviews to explore any experiences of violence during their journey. A descriptive analysis was performed and a probit regression model was applied to analyze the factors associated with violence. Qualitative information was analyzed to understand experiences, meanings and responses to violence.

Results

The overall prevalence of suffering from any form of violence was 29.4%. Nearly 24% reported physical violence, 19.5% experienced psychological violence, and approximately 2% reported sexual violence. TTTs experienced a significantly greater burden of violence compared to men and women. Violence occurred more frequently among migrants from Central American (30.6%) and other countries (40.0%) than it did among Mexican migrants (20.5%). Experiences involving sexual, physical and psychological violence as well as theft and even kidnapping were described by interviewees. Migrants mistrust the police, migration authorities, and armed forces, and therefore commonly refrain from revealing their experiences.

Conclusion

Migrants are subjected to a high level of violence while in transit to the US. Those traveling under irregular migratory conditions are targets of even greater violence, a condition exacerbated by gender inequality. Migrants transiting through Mexico from Central American and other countries undergo violence more frequently than do Mexican migrants. Protective measures are urgently needed to ensure the human rights of these populations.

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Citation: Leyva-Flores R, Infante C, Gutierrez JP, Quintino-Perez F, Gómez-Saldivar M, Torres-Robles C (2019) Migrants in transit through Mexico to the US: Experiences with violence and related factors, 2009-2015. PLoS ONE 14(8): e0220775. https://doi.org/10.1371/journal.pone.0220775

Editor: Mary C. Smith Fawzi, Harvard Medical School, UNITED STATES

Received: May 25, 2018; Accepted: July 23, 2019; Published: August 21, 2019

Copyright: © 2019 Leyva-Flores et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: Data are from the Multicenter Project: International Migration and Sexual and Reproductive Rights of Migrants from Mexico and Central America, 2009-2015, whose authors may be contacted at: rene.leyva@insp.mx; cesar.infante@insp.mx. Data base are available at: Data base: https://osf.io/2sq8b; Do files: https://osf.io/4d5vw; Qualitative: https://osf.io/uwz2q; Zip file: https://osf.io/fs6x9. The data files uploaded to Open Science Framework represent the underlying data necessary to replicate the findings of this study in their entirety. For additional information regarding the project, interested researchers may also contact the President of Ethics Committee at INSP (PhD. Angelica Angeles) at: aangelica@insp.mx.

Funding: This study was funded by the Ford Foundation for Mexico and Central America, grant 1100-0482 to RL-F. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Keywords: Mexico; USA; Society; Poverty; Migrants.

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A Single-Center #Experience with a #Pregnant #Immigrant #Population and #Zika Virus Serologic #Screening in #NYC (Am J Perinatol., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Am J Perinatol. 2019 May 30. doi: 10.1055/s-0039-1688819. [Epub ahead of print]

A Single-Center Experience with a Pregnant Immigrant Population and Zika Virus Serologic Screening in New York City.

Merriam AA1, Nhan-Chang CL1, Huerta-Bogdan BI1, Wapner R1, Gyamfi-Bannerman C1.

Author information: 1 Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York.

 

Abstract

OBJECTIVE:

Our institution is in an area of New York City with a large population of immigrants from Zika virus endemic areas. With the recent Zika virus outbreak, we sought to examine our center’s experience with screening for Zika virus and outcomes among patients who tested positive for the disease during pregnancy.

STUDY DESIGN:

We performed a chart review of all pregnant patients who tested positive (positive serum or urine polymerase chain reaction [PCR]) or presumed positive (immunoglobulin M [IgM] enzyme-linked immunosorbent assay [ELISA] positive or IgM ELISA equivocal with positive plaque reduction neutralization test) for Zika virus. All tests were performed by the Department of Health (DOH) and followed Centers for Disease Control and Prevention guidelines in effect at the time of specimen collection. Testing of cord blood, placenta, and/or neonatal blood were/was performed by the DOH for New York County. Prenatal ultrasounds for fetal head size and surveillance for calcifications were performed by maternal-fetal medicine specialists. Infant head ultrasound results were included when available.

RESULTS:

Between March 2016 and April 2017, 70 pregnant patients were positive or presumed positive for Zika infection during pregnancy. Of those, 16 women had positive urine or serum PCR and the remaining 54 were presumed positive. Among positive cases, five women tested positive via urine PCR only, nine women tested positive via serum PCR only, and two women had both positive urine and serum PCR. Fifteen of 67 infants (22%) born during the study period were born to mothers with positive urine or serum PCR testing. Sixty-five newborns were clinically normal with normal head measurements. Of the intracranial ultrasound performed, one infant had a grade 1 intraventricular hemorrhage, four had incidental choroid plexus cysts, and one had severe ventriculomegaly that was also noted antenatally. There were 2 positive and 15 equivocal infant serum IgM samples and 1 positive placental PCR from these pregnancies. There were four pregnancy terminations and two cases with fetal anomalies in this population that were split evenly between patients who tested positive and those who tested presumed positive for Zika virus during pregnancy.

CONCLUSION:

We found no differences in pregnancy or neonatal outcomes between women who tested positive and presumed positive for Zika virus during pregnancy. Testing of infants and placenta tissue after delivery was largely inconclusive. Improvement in testing for Zika virus infection is needed to determine which pregnancies are at risk for congenital anomalies. Further research is still needed to determine which children are at risk for poor neurodevelopmental outcomes related to Zika virus and how to best coordinate care among the immigrant population during a new disease epidemic.

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

PMID: 31146294 DOI: 10.1055/s-0039-1688819

Keywords: Zika Virus; Zika Congenital Syndrome; Pregnancy; USA; NYC; Serology.

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#Refugee and #migrant #health in the #European Region (Lancet, summary)

[Source: The Lancet, full page: (LINK). Summary, edited.]

Refugee and migrant health in the European Region

Ryoko Takahashi, Krista Kruja, Soorej Jose Puthoopparambil, Santino Severoni

Published: May 20, 2019 / DOI: https://doi.org/10.1016/S0140-6736(19)30282-X

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WHO is the respected authority in leading the production and use of core evidence for public health decision making.1 The Health Evidence Network (HEN) is an information service for public health decision makers in the WHO European Region and supports them to use the best available evidence.

(…)

We declare no competing interests.

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Article Info

Published: May 20, 2019

Identification: DOI: https://doi.org/10.1016/S0140-6736(19)30282-X

Copyright © 2019 Elsevier Ltd. All rights reserved.

Keywords: Migrants; Society; Politics; European Region; Public Health.

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#Privatisation of #immigration #detention facilities (Lancet, summary)

[Source: The Lancet, full page: (LINK). Summary, edited.]

Privatisation of immigration detention facilities

Altaf Saadi, Lello Tesema

Published: May 20, 2019 / DOI: https://doi.org/10.1016/S0140-6736(19)30351-4

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In December, 2018, two Guatemalan children, a 7-year-old girl and an 8-year-old boy, died while detained in immigration custody in the USA. Their tragic deaths should raise alarm about the dangerously substandard medical and mental health care at US immigration detention facilities.

(…)

We declare no competing interests.

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Article Info

Published: May 20, 2019

Identification: DOI: https://doi.org/10.1016/S0140-6736(19)30351-4

Copyright © 2019 Elsevier Ltd. All rights reserved.

Keywords: USA; Society; Politics; Migrants; Racism; Public Health.

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#Immigration in #Italy: the #medical #community’s role in #human #rights (Lancet, summary)

[Source: The Lancet, full page: (LINK). Summary, edited.]

Immigration in Italy: the medical community’s role in human rights

Raffaella Casolino

Published: May 20, 2019 / DOI: https://doi.org/10.1016/S0140-6736(19)30216-8

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Italy has been witnessing a rapid escalation towards racism and xenophobia since the new government came into power in June, 2018. On Nov 27, 2018, the lower house of the Italian Parliament approved the Decree-Law on Immigration and Security, which includes measures that would abolish humanitarian protection status for migrants, block asylum seekers from accessing reception centres focusing on social inclusion, and extend the duration of detention in return centres and hotspots. These measures fundamentally undermine international human rights principles. The day after approval, the Deputy Prime Minister and Minister of the Interior declared that Italy would not sign the UN Global Compact for Safe, Orderly and Regular Migration or take part in an intergovernmental conference in Marrakech, Morocco, on Dec 10, 2018.

(…)

I declare no competing interests.

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Reference

UN Human Rights, Office of the high commissioner. Legal changes and climate of hatred threaten migrants’ rights in Italy, say UN experts. URL: https://www.ohchr.org/en/NewsEvents/Pages/DisplayNews.aspx?NewsID=23908&LangID=E | Date: Nov 21, 2018 | Date accessed: November 28, 2018

 

Article Info

Published: May 20, 2019

Identification: DOI: https://doi.org/10.1016/S0140-6736(19)30216-8

Copyright © 2019 Elsevier Ltd. All rights reserved.

Keywords: Public Health; Society; Politics; Italy; Migrants; Racism.

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“Heal Thyself.”—An Argument for Granting #Asylum to #HCWs Persecuted During the 2014 West #African #Ebola #Crisis (SMU Law Rev., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

SMU Law Rev. 2018;71(4):1153-79.

“Heal Thyself.”—An Argument for Granting Asylum to Healthcare Workers Persecuted During the 2014 West African Ebola Crisis.

Echols B1.

Author information: 1 Southern Methodist University, Dedman School of Law. bechols@smu.edu

 

Abstract

This article argues for a change in United States asylum policy at a time when change is needed most. Those seeking asylum must prove that they fear persecution in their home country based on one of five protected categories and that their government is the persecutor or is unable to control the actions of the persecutors. Multiple articles have recognized that the “particular social group” is the most difficult category of asylum seeker to analyze. Not only do the standards for particular social groups (PSGs) vary among circuit courts, but judicial consistency is lacking. This article focuses on a particular PSG, healthcare workers from recently Ebola-stricken West Africa. During the 2014 Ebola crisis, these healthcare workers faced discrimination and violence due to their association with western medicine. Hospitals were frequently threatened and ransacked. Multiple accounts of violence against local and international healthcare workers were recorded by Doctors Against Borders, the Centers for Disease Control, and the international media. However, because of the inconsistencies in asylum law and the ever-present political influence in what originates as a humanitarian process, it is unlikely for these PSGs to be found asylum-eligible. This highlights the need for a more consistent and humanitarian-based asylum policy with less political influence.

PMID: 30648831

Keywords: Ebola; Migrants; Society; USA; African Region.

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