De impact van het wijkgerichte werken voor de toeleiding naar zorg van oudere migranten

This article studies how older migrants gain access to care through neighbourhood-based forms of working. In the Netherlands, the neighbourhood is increasingly viewed as an ideal place to organize care and social services, close to citizens. To this end, municipalities are developing neighbourhood structures and facilities in which local providers cooperate. In our qualitative research we studied the developments in crafting practices relevant to access to care of older migrants in the city of Nijmegen, the Netherlands. In Nijmegen the new neighbourhood structures are only partly successful in helping older migrants gain access to care. Older migrants visit neighbourhood facilities not for the services these facilities provide, but because of the presence of care professionals who speak the same language, or share the same cultural background as do these older migrants. These caregivers are able to bridge the mental distance between the health care system and the lifeworld of older migrants. Relations also arise outside the neighbourhood structures, for instance at culture-specific day care facilities. To prevent too great a claim on professionals with a migration background, agreements between the city of Nijmegen and local providers to enhance cultural sensitivity should be better monitored.     

The impact of rural-urban migration on under-two mortality in India

This paper examines the impact of rural-urban migration on under-two mortality in India, using data from the 1992/93 Indian National Family Health Survey. Multilevel logistic models are fitted for mortality in three age groups: neonatal, early post-neonatal, and late post-neonatal and toddler. Migration status was not a significant determinant of mortality in any of the three age groups. Further analysis shows that a relationship between migration status and mortality exists when socioeconomic and health utilization variables are omitted from the models. The relationship between migration and mortality is thus explained by differences in socioeconomic status and use of health services between rural-urban migrant and nonmigrant groups. The selectivity of rural-urban migrants on socioeconomic characteristics creates mortality differentials between rural-urban migrants and rural non-migrants. Problems faced by migrants in assimilating into urban societies create mortality differentials between rural-urban migrants and urban non-migrants. These results highlight the need to target migrants in the provision of health services, and demonstrate that rural areas continue to have the highest levels of infant-child mortality. Further research is needed to understand the health care needs of rural-urban migrants in order to inform the provision of appropriate health care.     

The use of zootherapeutics in folk veterinary medicine in the district of Cubati, Paraíba State, Brazil

Background

Viewed through the micro focus of an interpretive lens, medical anthropology remains mystified because interpretivist explanations seriously downplay the given context in which individual health seeking-behaviours occur. This paper draws upon both the interpretivist and political economy perspectives to reflect on the ethno medical practices within the Korean-Australian community in Sydney.

Methods

We draw on research data collected between 1995 and 1997 for an earlier study of the use of biomedical and traditional medicine by Korean-Australians in Sydney. A total of 120 interviews were conducted with a range of participants, including biomedical doctors, traditional health professionals, Korean community leaders and Korean migrants representing a range of socio-economic backgrounds and migration patterns.

Results and Discussion

First, the paper highlights the extent to which the social location of migrants in a host society alters or restructures their initial cultural practices they bring with them. Second, taking hanbang medicine in the Korean-Australian community as an illustrative case, the paper explores the transformation of the dominant biomedicine in Australia as a result of the influx of ethnomedicine in the era of global capitalism and global movement.

Conclusion

In seeking to explain the popularity and supply of alternative health care, it is important to go beyond the culture of each kind of health care itself and to take into consideration the changes occurring at societal, national and global levels as well as consequential individual response to the changes. New social conditions influence the choice of health care methods, including herbal/alternative medicine, health foods and what are often called New Age therapies.     

Identifying Opportunities to Increase HIV Testing among Mexican Migrants: A Call to Step Up Efforts in Health Care and Detention Settings

HIV testing and counseling is a critical component of HIV prevention efforts and core element of current “treatment as prevention” strategies. Mobility, low education and income, and limited access to health care put Latino migrants at higher risk for HIV and represent barriers for adequate levels of HIV testing in this population. We examined correlates of, and missed opportunities to increase, HIV testing for circular Mexican migrants in the U.S. We used data from a probability-based survey of returning Mexican migrants (N=1161) conducted in the border city of Tijuana, Mexico. We estimated last 12-months rates of HIV testing and the percentage of migrants who received other health care services or were detained in an immigration center, jail, or prison for 30 or more days in the U.S., but were not tested for HIV. Twenty-two percent of migrants received HIV testing in the last 12 months. In general, utilization of other health care services or detention for 30 or more days in the U.S. was a significant predictor of last 12-months HIV testing. Despite this association, we found evidence of missed opportunities to promote testing in healthcare and/or correctional or immigration detention centers. About 27.6% of migrants received other health care and/or were detained at least 30 days but not tested for HIV. Health care systems, jails and detention centers play an important role in increasing access to HIV testing among circular migrants, but there is room for improvement. Policies to offer opt-out, confidential HIV testing and counseling to Mexican migrants in these settings on a routine and ethical manner need to be designed and pilot tested. These policies could increase knowledge of HIV status, facilitate engagement in HIV treatment among a highly mobile population, and contribute to decrease incidence of HIV in the host and receiving communities.     

WPA guidance on mental health and mental health care in migrants

The purpose of this guidance is to review currently available evidence on mental health problems in migrants and to present advice to clinicians and policy makers on how to provide migrants with appropriate and accessible mental health services. The three phases of the process of migration and the relevant implications for mental health are outlined, as well as the specific problems of groups such as women, children and adolescents, the elderly, refugees and asylum seekers, and lesbian, gay, bisexual and transgender individuals. The concepts of cultural bereavement, cultural identity and cultural congruity are discussed. The epidemiology of mental disorders in migrants is described. A series of recommendations to policy makers, service providers and clinicians aimed to improve mental health care in migrants are provided, covering the special needs of migrants concerning pharmacotherapies and psychotherapies.     

Rural to Urban Migration Is an Unforeseen Impact of Development Intervention in Ethiopia

Rural development initiatives across the developing world are designed to improve community well-being and livelihoods. However they may also have unforeseen consequences, in some cases placing further demands on stretched public services. In this paper we use data from a longitudinal study of five Ethiopian villages to investigate the impact of a recent rural development initiative, installing village-level water taps, on rural to urban migration of young adults. Our previous research has identified that tap stands dramatically reduced child mortality, but were also associated with increased fertility. We demonstrate that the installation of taps is associated with increased rural-urban migration of young adults (15–30 years) over a 15 year period (15.5% migrate out, n = 1912 from 1280 rural households). Young adults with access to this rural development intervention had three times the relative risk of migrating to urban centres compared to those without the development. We also identify that family dynamics, specifically sibling competition for limited household resources (e.g. food, heritable land and marriage opportunities), are key to understanding the timing of out-migration. Birth of a younger sibling doubled the odds of out-migration and starting married life reduced it. Rural out-migration appears to be a response to increasing rural resource scarcity, principally competition for agricultural land. Strategies for livelihood diversification include education and off-farm casual wage-labour. However, jobs and services are limited in urban centres, few migrants send large cash remittances back to their families, and most return to their villages within one year without advanced qualifications. One benefit for returning migrants may be through enhanced social prestige and mate-acquisition on return to rural areas. These findings have wide implications for current understanding of the processes which initiate rural-to-urban migration and transitions to low fertility, as well as for the design and implementation of development intervention across the rural and urban developing world.     

Examining the effect of household wealth and migration status on safe delivery care in urban India, 1992-2006

Background

Although the urban health issue has been of long-standing interest to public health researchers, majority of the studies have looked upon the urban poor and migrants as distinct subgroups. Another concern is, whether being poor and at the same time migrant leads to a double disadvantage in the utilization of maternal health services? This study aims to examine the trends and factors that affect safe delivery care utilization among the migrants and the poor in urban India.

Methodology/Principal Findings

Using data from the National Family Health Survey, 1992–93 and 2005–06, this study grouped the household wealth and migration status into four distinct categories poor-migrant, poor-non migrant, non poor-migrant, non poor-non migrant. Both chi-square test and binary logistic regression were performed to examine the influence of household wealth and migration status on safe delivery care utilization among women who had experienced a birth in the four years preceding the survey. Results suggest a decline in safe delivery care among poor-migrant women during 1992–2006. The present study identifies two distinct groups in terms of safe delivery care utilization in urban India – one for poor-migrant and one for non poor-non migrants. While poor-migrant women were most vulnerable, non poor-non migrant women were the highest users of safe delivery care.

Conclusion

This study reiterates the inequality that underlies the utilization of maternal healthcare services not only by the urban poor but also by poor-migrant women, who deserve special attention. The ongoing programmatic efforts under the National Urban Health Mission should start focusing on the poorest of the poor groups such as poor-migrant women. Importantly, there should be continuous evaluation to examine the progress among target groups within urban areas.     

Rural-to-Urban Migrants' Experiences with Primary Care under Different Types of Medical Institutions in Guangzhou,China

Objectives

China is facing the unprecedented challenge of rapidly increasing rural-to-urban migration. Migrants are in a vulnerable state when they attempt to access to primary care services. This study was designed to explore rural-to-urban migrants’ experiences in primary care, comparing their quality of primary care experiences under different types of medical institutions in Guangzhou, China.

Methods

The study employed a cross-sectional survey of 736 rural-to-urban migrants in Guangzhou, China in 2014. A validated Chinese version of Primary Care Assessment Tool—Adult Short Version (PCAT-AS), representing 10 primary care domains was used to collect information on migrants’ quality of primary care experiences. These domains include first contact (utilization), first contact (accessibility), ongoing care, coordination (referrals), coordination (information systems), comprehensiveness (services available), comprehensiveness (services provided), family-centeredness, community orientation and culturally competent. These measures were used to assess the quality of primary care performance as reported from patients’ perspective. Analysis of covariance was conducted for comparison on PCAT scores among migrants accessing primary care in tertiary hospitals, municipal hospitals, community health centers/community health stations, and township health centers/rural health stations. Multiple linear regression models were used to explore factors associated with PCAT total scores.

Results

After adjustments were made, migrants accessing primary care in tertiary hospitals (25.49) reported the highest PCAT total scores, followed by municipal hospitals (25.02), community health centers/community health stations (24.24), and township health centers/rural health stations (24.18). Tertiary hospital users reported significantly better performance in first contact (utilization), first contact (accessibility), coordination (information system), comprehensiveness (service available), and cultural competence. Community health center/community health station users reported significantly better experience in the community orientation domain. Township health center/rural health station users expressed significantly better experience in the ongoing care domain. There were no statistically significant differences across settings in the ongoing care, comprehensiveness (services provided), and family-centeredness domains. Multiple linear regression models showed that factors positively associated with higher PCAT total scores also included insurance covering parts of healthcare payment (P<0.001).

Conclusions

This study highlights the need for improvement in primary care provided by primary care institutions for rural-to-urban migrants. Relevant policies related to medical insurance should be implemented for providing affordable healthcare services for migrants accessing primary care.     

Reproductive health status, knowledge, and access to health care among female migrants in Shanghai, China

As the largest labour flow in human history, the recent rise in migration in China has opened up unprecedented opportunities for millions of Chinese to rearrange their lives. At the same time, this process has also posed great challenges to Chinese migrants, especially female migrants, who not only face a bias against 'outsiders' but also have a greater need for reproductive health-related services in their migratory destinations. Based on data collected via multiple sources in Shanghai, China's largest metropolis, this study profiles the changing characteristics of female migrants, presents data on self-reported symptoms of reproductive health-related problems and knowledge on reproductive health issues, compares maternal and child health measures between migrants and local residents, and examines factors related to reproductive health knowledge and migrants' access to health care in urban China. Results of this study show a relatively low level of self-reported reproductive health problems among female migrants, coupled with a relatively high level of ignorance in knowledge related to STD. Both self-reported health status and knowledge of reproductive health are related to migrants' educational attainment and length of stay in the urban destination. This study also finds ample evidence that female migrants' access to urban health care is limited by a number of institutional barriers.     

Radar observations of the autumn migration of the beet armyworm Spodoptera exigua (Lepidoptera: Noctuidae) and other moths in northern China

The autumn return migration of the beet armyworm Spodoptera exigua Hübner and other insects in northern China was observed with radar and with a simultaneously-operated searchlight trap and ground light-trap at a site in Langfang, near Beijing. The searchlight trap was found to be an efficient tool for trapping migrants and, operated alongside a ground light-trap, could distinguish migrant from locally-flying species. It was confirmed that S. exigua and some other species were high-altitude nocturnal windborne migrants during September and October in northern China. Maximum density of moths typically occurred below 500 m, and strong layering was often observed at about 200 m above ground level in airflows that would carry the moths towards the south. Descent of S. exigua in the vicinity of the radar site in late September was often associated with rain.     

Actions to alleviate the mental health impact of the economic crisis

The current global economic crisis is expected to produce adverse mental health effects that may increase suicide and alcohol-related death rates in affected countries. In nations with greater social safety nets, the health impacts of the economic downturn may be less pronounced. Research indicates that the mental health impact of the economic crisis can be offset by various policy measures. This paper aims to outline how countries can safeguard and support mental health in times of economic downturn. It indicates that good mental health cannot be achieved by the health sector alone. The determinants of mental health often lie outside of the remits of the health system, and all sectors of society have to be involved in the promotion of mental health. Accessible and responsive primary care services support people at risk and can prevent mental health consequences. Any austerity measures imposed on mental health services need to be geared to support the modernization of mental health care provision. Social welfare supports and active labour market programmes aiming at helping people retain or re-gain jobs can counteract the mental health effects of the economic crisis. Family support programmes can also make a difference. Alcohol pricing and restrictions of alcohol availability reduce alcohol harms and save lives. Support to tackle unmanageable debt will also help to reduce the mental health impact of the crisis. While the current economic crisis may have a major impact on mental health and increase mortality due to suicides and alcohol-related disorders, it is also a window of opportunity to reform mental health care and promote a mentally healthy lifestyle.     

Childhood conditions, migration, and mortality: migrants and natives in 19th-century cities

Migrants often have lower mortality than natives in spite of relatively unfavorable social and economic characteristics. Although migrants have a short-run advantage due to the selective migration of healthy workers, persistent health and mortality differences between migrants and natives may be long-run effects of different experiences in childhood. We made use of a natural experiment resulting from rural-to-urban migration in the mid-19th century. Mortality was much higher in urban areas, especially in rapidly growing industrial cities. Migrants usually came from healthier rural origins as young adults. Data used in this study is available from 19th-century Belgian population registers describing two sites: a rapidly growing industrial city and a small town that became an industrial suburb. We found evidence of three processes that lead to differences between the mortality of migrants and natives. First, recent migrants had lower mortality than natives, because they were self-selected for good health when they arrived. This advantage decreased with time spent in the destination. Second, migrants from rural backgrounds had a disadvantage in epidemic years, because they had less experience with these diseases. Third, migrants from rural areas had lower mortality at older (but not younger) ages, even if they had migrated more than 10 years earlier. We interpret this as a long-run consequence of less exposure to disease in childhood.     

Rural Medicine—Making It Now,and the Problems Ahead

King City, California, a small remote town among thousands in the nation, has demonstrated that private physicians and federal funds can jointly develop effective health care delivery mechanisms to serve residents of all incomes with a full complement of hospital and outpatient services as well as community health programs. Young health care professionals can be drawn to the traditionally difficult-to-serve rural areas. Unanswered is the problem of developing and maintaining an adequate funding base for health services in rural communities in the face of a disproportionately large number of poor people with a sub-optimal job future. The dollar resources in the rural community are often simply inadequate to buy needed health and social services.     

Childhood conditions,migration, and mortality: Migrants and natives in 19th‐century cities

Abstract

Migrants often have lower mortality than natives in spite of relatively unfavorable social and economic characteristics. Although migrants have a short‐run advantage due to the selective migration of healthy workers, persistent health and mortality differences between migrants and natives may be long‐run effects of different experiences in childhood. We made use of a natural experiment resulting from rural‐to‐urban migration in the mid‐19th century. Mortality was much higher in urban areas, especially in rapidly growing industrial cities. Migrants usually came from healthier rural origins as young adults. Data used in this study is available from 19th‐century Belgian population registers describing two sites: a rapidly growing industrial city and a small town that became an industrial suburb. We found evidence of three processes that lead to differences between the mortality of migrants and natives. First, recent migrants had lower mortality than natives, because they were self‐selected for good health when they arrived. This advantage decreased with time spent in the destination. Second, migrants from rural backgrounds had a disadvantage in epidemic years, because they had less experience with these diseases. Third, migrants from rural areas had lower mortality at older (but not younger) ages, even if they had migrated more than 10 years earlier. We interpret this as a long‐run consequence of less exposure to disease in childhood.     

The emergence of an ‘ethnic economy’? The spatial relationships of migrant workers in London's health and hospitality sectors

This paper examines how the globalized nature of London's service sector redefines spatial relationships for recent migrants working in the health and hospitality industries. Findings from the qualitative data demonstrate that recent temporary migrants to the UK employ broader strategies to secure employment than accounted for by current theories. The migrants in our case studies overwhelmingly utilized global and local recruitment and employment agencies, as well as sought employment in industries already established as ‘ethnic economies’. We suggest that this might be attributed to a lack of interaction with established co-ethnic immigrant communities; temporary migration trajectories; and living arrangements with co-migrants. We conclude by emphasizing the need to broaden our understanding of ethnic economies and social networks in light of these changing spatial relationships that have emerged through the globalization of the service sector in the UK.     

迁徙鸟类中途停歇期的生理生态学研究

大多数候鸟的迁徙活动由迁徙飞行和中途停歇两个部分组成。在迁徙过程中,鸟类要多次交替经历消耗能量的飞行阶段和积累能量的中途停歇阶段。从鸟类在中途停歇时期的能量积累速度、体重变化模式以及迁徙飞行中的禁食或食物限制、食物种类的改变、中途停歇的能量快速积累过程对消化器官的影响等方面,对目前迁徙鸟类的生理生态学研究成果进行回顾,并提出有待解决的问题及今后的研究方向。     

Bound between care and control: Institutional contradictions and daily practices of healthcare for migrants in an irregular situation in Italy

On the books, the inclusiveness of the Italian framework regulating healthcare access for migrants is indisputable. However, we might wonder how access takes shape on the front-line of the healthcare system, particularly in times of increasingly hostile institutional and discursive environments. By focusing on Italian migration and healthcare policies and the practices of health workers during their encounters with migrants in an irregular situation, this contribution analyses how health workers deal with institutional tensions in the field and how these, in turn, shape their narratives and actions. It suggests that individual positioning plays a major role in favouring the adoption of discretional practices of care or control. Nonetheless, practices are also mediated by the wider institutional and discursive landscape, which has been exponentially characterized by a tension between a medical-humanitarian logic that legitimates providing healthcare to vulnerable migrants, and a control-oriented logic targeting immigration and health expenditure.     

Struggling with Imaginaries of Trauma and Trust: The Refugee Experience in Switzerland

This article discusses some effects of migration politics on asylum seekers and refugees and on the Swiss health services. It is based on multisited ethnographic research that tracked interpretative concepts of the refugee experience. Following a grounded theory approach, it identifies imaginaries of trauma and trust as key categories in the field of transnational migration and health. The psychiatric concept of trauma and a more popularized discourse of traumatic memory are strongly emphasized in all of the investigated field sites: the providers of primary health care and psychosocial services and representatives of social welfare agencies and law-making bodies use this "diagnosis" extensively. This leads refugees to develop tactics of a) identifying with the trauma discourse in order to become "good refugees" and achieve legal status in Switzerland; b) struggling with the ascribed pathologies and suffering from retraumatizing effects of these predominant trauma policies; and c) trying to refuse or subvert them by emphasizing the existence of structural violence in the receiving countries. An analysis of the interactions of health providers and refugees shows that it takes place in an environment of social and economic insecurity and in a shared imaginary of (mis)trust, putting at stake the moral economy of recent migration politics and the refugee experience.     

Understanding users' perspectives of barriers to maternal health care use in Maharashtra, India.

This paper uses data collected using in-depth, semi-structured interviews to examine utilization of maternal health care services among two rural and urban populations of Pune and Mumbai in Maharashtra, India. The study aims to identify key social, economic and cultural factors influencing women's decisions to use maternal health care and the places used for child delivery, whilst considering the accessibility of facilities available in the local area. Socioeconomic status was not found to be a barrier to service use when women perceived the benefits of the service to outweigh the cost, and when the service was within reasonable distance of the respondent's place of residence. A large number of women perceived private services to be superior to those provided by the government, although cost often meant they were unable to use them. The provision of services did not ensure that women used them; they had to first perceive them to be beneficial to their health and that of their unborn child. Respondents identified the poor quality of services offered at government institutions to be a motivating factor for delivering at home. Thus further investigation is needed into the quality of services provided by government facilities in the area. A number of respondents who had received antenatal care went on to deliver in the home environment without a trained birth attendant. Further research is needed to establish the types of care provided during an antenatal consultation to establish the feasibility of using these visits to encourage women, particularly those with high-risk pregnancies, to be linked to a trained attendant for delivery.     

From Exceptional to Liminal Subjects: Reconciling Tensions in the Politics of Tuberculosis and Migration

Controlling the movement of potentially infectious bodies has been central to Australian immigration law. Nowhere is this more evident than in relation to tuberculosis (TB), which is named as a ground for refusal of a visa in the Australian context. In this paper, I critically examine the “will to knowledge” that this gives rise to. Drawing on a critical analysis of texts, including interviews with migrants diagnosed with TB and healthcare professionals engaged in their care (n=19), I argue that this focus on border policing, rather than resettlement and the broader social determinants of health that drive current rates of TB, paradoxically renders migrants diagnosed with TB as liminal subjects in the post-arrival phase. This raises ethical issues about who “matters,” as well as dilemmas about what constitutes adequate care for the “Other,” both of which go to the heart of the political economy of migration.