Tuberculosis Transmission among Immigrants and Autochthonous Populations of the Eastern Province of Saudi Arabia

Background

Eastern province of Saudi Arabia is an industrial zone with large immigrant population and high level of tuberculosis case notification among immigrants. The impact of immigration and current trends of tuberculosis transmission among immigrants and autochthonous population in the region had not been investigated so far using molecular tools.

Methodology

During 2009- 2011, a total of 524 Mycobacterium tuberculosis isolates were collected from the central tuberculosis reference laboratory, representing an estimated 79.2% of the culture-positive tuberculosis cases over the study period in the province. These isolates were genotyped by using 24 locus-based MIRU-VNTR typing and spoligotyping followed by first line drug susceptibility testing. The molecular clustering profiles and phylogenetic diversity of isolates were determined and compared to the geographical origins of the patients.

Principle Findings

Genotyping showed an overall predominance of Delhi/CAS (29.4%), EAI (23.8%) and Ghana (13.3%) lineages, with slightly higher proportions of Delhi/CAS among autochthonous population (33.3 %) and EAI (30.9%) among immigrants. Rate of any drug resistance was 20.2% with 2.5% of multi-drug resistance. Strain cluster analysis indicated 42 clusters comprising 210 isolates, resulting in a calculated recent transmission index of 32.1%. Overall shared cluster ratio was 78.6% while 75.8% were shared between autochthonous population and immigrant population with a predominance of immigrants from South east Asia (40.7%). In contrast, cross national transmission within the immigrant population was limited (24.2%). Younger age (15-30- p value-0.043, 16-45, p value 0.030), Saudi nationality (p value-0.004) and South East Asian origin (p value-0.011) were identified as significant predisposing factors for molecular strain clustering.

Conclusions

The high proportion of molecular clusters shared among the autochthonous and immigrant populations suggests a high permeability of tuberculosis transmission between both populations in the province. These results prompt for the need to strengthen the current tuberculosis control strategies and surveillance programs.     

Perspectives On Tuberculosis Among Traditional Chinese Medical Practitioners In New York City’s Chinatown

This article discusses the perspectives of Chinatown’s traditional Chinese medical practitioners on tuberculosis among New York City’s Chinese laborers. The practice of traditional Chinese medicine (TCM) in the United States is neither regulated nor well understood. Some public health providers have expressed their concern that the use of TCM could prevent Chinese tuberculosis patients from receiving proper, biomedical treatment. Contrary to the suspicion of public health providers, the traditional Chinese medical practitioners in the context of New York City’s Chinatown provide diverse methods of health care, many being familiar with the biomedical explanation for tuberculosis. All TCM informants in this study stated that biomedicine is more effective than Chinese medicine in treating tuberculosis. TCM in tuberculosis therapy is said to complement biomedicine and to restore bodily balance and the general health of patients. This study discusses the political–economic context shaping the explanation and treatment of tuberculosis among traditional Chinese medical practitioners and broadens our understanding of the various contexts in which TCM and biomedicine can be integrated. Furthermore, it is suggested that an opportunity exists for tuberculosis control programs to incorporate TCM practitioners in the effort to control the disease within New York City.     

Antituberculous drug resistance in Manitoba from 1980 to 1989.

OBJECTIVES: To estimate the magnitude of antituberculous drug resistance and identify the risk factors for its development in tuberculosis patients in Manitoba over a 10-year period. As well, to examine the clinical course of the patients whose initial or subsequent isolates of Mycobacterium tuberculosis were resistant to one or more drugs. DESIGN: Comparison of drug-resistant and non-drug-resistant cases of tuberculosis. SETTING: Manitoba. PATIENTS: All people with tuberculosis reported to the Central Tuberculosis Registry of Manitoba between Jan. 1, 1980, and Dec. 31, 1989. MAIN OUTCOME MEASURES: Of 1478 cases of active tuberculosis 1086 were culture positive, and drug susceptibility testing was performed in these cases. The clinical course, including outcome of treatment, of all drug-resistant cases was described. RESULTS: Of 1086 culture-positive cases of tuberculosis 77 (7.1%) were drug resistant. Odds ratios suggested that the risk of drug resistance was significantly higher among the immigrants than among the other Canadians. Compared with the other Canadians the risk of drug resistance was 9.9 times greater among the immigrants in whom tuberculosis developed within the first year after arrival in Canada and 5.4 times greater among the immigrants in whom it developed 2 to 5 years after arrival in Canada. Of the 71 patients with drug-resistant disease whose type of resistance was known 62% had never taken antituberculous drugs before and 38% had. Most (91%) of the 77 cases of drug-resistant disease were resistant to first-line drugs, especially isoniazid and streptomycin. Thirty-two (42%) of the 77 cases were resistant to two or more first-line drugs. Of patients with drug-resistant disease a subgroup of 10 had disease that became resistant to several drugs over the 10-year period. The outcome of treatment in these individuals was poor, and they presented a particular public health problem. CONCLUSION: Resistance to one or more first-line antituberculous drugs continues to complicate the treatment of tuberculosis and may facilitate the spread of the disease.     

Neighborhood socioeconomic status and BMI differences by immigrant and legal status: Evidence from Utah

We build on recent work examining the BMI patterns of immigrants in the US by distinguishing between legal and undocumented immigrants. We find that undocumented women have relative odds of obesity that are about 10 percentage points higher than for legal immigrant women, and their relative odds of being overweight are about 40 percentage points higher. We also find that the odds of obesity and overweight status vary less across neighborhoods for undocumented women than for legal immigrant women. These patterns are not found among immigrant men: undocumented men have lower rates of obesity (by about 6 percentage points in terms of relative odds) and overweight (by about 12 percentage points) than do legal immigrant men, and there is little variation in the impact of neighborhood context across groups of men. We interpret these findings in terms of processes of acculturation among immigrant men and women.     

Immigration and the cost of ethnic subordination: the case of Israeli society

This study focuses on earnings disadvantages experienced by three ethnic groups of Jewish immigrants in Israel. Data were obtained from the 2011 Income Survey gathered by the Israel Central Bureau of Statistics. The findings reveal that when compared to Israeli-born, all ethnic groups are disadvantaged in earnings attainment in the first generation. The earnings disadvantages of immigrants as compared to Israeli-born decrease with the passage of time and become negligible in the second generation. To disentangle the impact on earnings penalty of ethnic origin from that of immigrant status, a procedure for decomposing mean differences between groups is introduced. The analysis reveals that earnings disadvantage among Ashkenazim and Soviet immigrants can be attributed to immigrant status but not to ethnicity. By contrast, earnings penalties among Sephardim immigrants can be attributed to both ethnicity and immigrant status. The implications of the long-lasting effect of ethnicity versus the short-term effect of immigrant status are discussed.     

National Cohort Study of Suicidality and Violent Criminality among Danish Immigrants

Background

Immigrant populations in western societies have grown in their size and diversity yet evidence is incomplete for their risks of suicidality and criminal violence. We examined these correlated harmful behaviours in a national cohort.

Aims

(i) Compare absolute risk between first and second generation immigrants, foreign-born adoptees and native Danes by plotting cumulative incidence curves to onset of early middle age; (ii) estimate sex-specific relative risks for these immigrant type subgroups vs. native Danes; (iii) examine effect modification by higher vs. lower socio-economic status.

Methods

In a cohort of over two million persons, attempted suicides and violent crimes were investigated using data from multiple interlinked registers. We plotted sex-specific cumulative incidence curves and estimated incidence rate ratios.

Results

In the whole study cohort, 1414 people died by suicide, 46,943 attempted suicide, and 51,344 were convicted of committing a violent crime. Among all immigrant subgroups combined, compared with native Danes, relative risk of attempted suicide was greater in female immigrants (incidence rate ratio, 1.59; 95% confidence interval: CI 1.54-1.64) than in male immigrants (1.26; CI 1.20-1.32), and vice versa for relative risk of violent offending in male immigrants (2.36; CI 2.31-2.42) than in female immigrants (1.74; CI 1.62-1.87). Risk for both adverse outcomes was significantly elevated in virtually every gender-specific immigrant type subgroup examined. Violent crime risk was markedly raised in first generation immigrant males and in the Danish born male children of two immigrant parents. However, male immigrants of lower social status had lower risk of attempted suicide than their native Danish peers.

Conclusion

Young immigrants of both first and second generation status face serious challenges and vulnerabilities that western societies need to urgently address. Relative risk patterns for these adverse outcomes vary greatly between the genders and also by socioeconomic status. This high degree of heterogeneity points to the existence of modifiable factors that are amenable to positive change and a potential for effective intervention.     

Man and other introduced organisms

Man's tremendously increased migratory potention, coupled with his ability to transport any material, causes ecological revolutions on most islands of this world–Fernandina and most smaller islands of the Galapagos being fortunate exceptions to that rule. It is proposed to make distinctions between species colonizing the Galapagos We can distinguish between those immigrant species which do not profit from man as a transport medium (independent immigrants) and those who do depend on him (man-dependent immigrants). These immigrants, in turn, may or may not be able to settle and these settlers may either gain a footing with or without depending on man's direct or indirect influence on the habitat (non-settlers, primary resource-using settlers, and secondary resource-using settlers). Introduced species represent a terrible attack on the biotic uniqueness of the Galapagos ecosystems. However, it is proposed to make better use of the scientific value of these introductions. For example, a case of selective impact of an introduced on an indigenous species was investigated: lava lizards of the genus Tropidurus seem to be more wary of moving objects on islands where cats have been introduced by man than on islands free of cats.
Under the peculiar Galapagos conditions it may turn out that science's most difficult and important task is to investigate and interpret man's role in such places.     

Participation of non‐English‐speaking‐background immigrants in work‐related training

This article uses representative data on a sample of Australian workers to examine whether non‐English‐speaking‐background [NESB] immigrants are disadvantaged in terms of access to, and participation in, employment‐related training. Results from the estimation of logit models explaining participation in various types of training indicate that NESB immigrant workers have much lower probabilities of receiving training, even after holding other individual and employment characteristics constant. Further, this differential was generally found to be most pronounced for those immigrants with English‐language difficulties. Decomposition of the training differential, however, suggests that part of the explanation for the lesser incidence of training among NESB immigrants may well lie in employer‐based discrimination.     

Are Immigrants and Nationals Born to Immigrants at Higher Risk for Delayed or No Lifetime Breast and Cervical Cancer Screening? The Results from a Population-Based Survey in Paris Metropolitan Area in 2010

Objectives

This study aims to compare breast cancer screening (BCS) and cervical cancer screening (CCS) practices of French women born to French parents with those of immigrants and nationals born to immigrants, taking their socioeconomic status into account.

Methods

The study is based on data collected in 2010 in the Paris metropolitan area among a representative sample of 3000 French-speaking adults. For women with no history of breast or cervical cancer, multivariate logistic regressions and structural equation models were used to investigate the factors associated with never having undergone BCS or CCS.

Results

We confirmed the existence of a strong gradient, with respect to migration origin, for delaying or never having undergone BCS or CCS. Thus, being a foreign immigrant or being French of immigrant parentage were risk factors for delayed and no lifetime screening. Interestingly, we found that this gradient persisted (at least partially) after adjusting for the women’s socioeconomic characteristics. Only the level of income seemed to play a mediating role, but only partially. We observed differences between BCS and CCS which suggest that organized CCS could be effective in reducing socioeconomic and/or ethnic inequities.

Conclusion

Socioeconomic status partially explained the screening nonparticipation on the part of French women of immigrant origin and foreign immigrants. This was more so the case with CCS than with BCS, which suggests that organized prevention programs might reduce social inequalities.     

Tuberculosis surveillance in immigrants to Manitoba.

Despite a decrease in the incidence of tuberculosis in Canada over the last decade, the proportion of cases in people not born in Canada has increased. To determine the prevalence of active tuberculosis at the first surveillance clinic visit and the incidence of the disease over a 2-year to 6-year follow-up period, we reviewed the records of all 523 immigrants admitted to Manitoba between 1981 and 1985 who were placed under surveillance. Of the 523, 429 (82%) were seen at least once in the clinic. Among the 429, active tuberculosis was diagnosed at the first visit in 12 (3%) and during the follow-up period in 7 (2%). The relative risk of tuberculosis was 4.5 times higher for immigrants under surveillance than for those not under surveillance. Of the 483 immigrants who were to be seen in Winnipeg 232 (48%) were noncompliant: 94 were not seen at any time, and 138 did not attend for the full follow-up period. Active disease was not reported to have developed in any of the noncompliant subjects. Noncompliers were significantly older than compliers (p less than 0.005), and variations in compliance were noted according to region of origin. Further attempts to improve compliance with surveillance without resorting to punitive measures are indicated.     

Understanding the diversity of immigrant incorporation: a forms-of-capital model

This article develops the concept of forms of capital as the basis of a model of immigrant incorporation. The model sets out the manner in which the social, financial, and human-cultural capital of immigrant families predict the sorting of immigrants into various labour market trajectories. For example, immigrants arriving with low stocks of financial and human-cultural capital are most likely to find employment in the ethnic economy, whereas immigrants with human-cultural capital that is fungible in the host society tend to gain employment in the broader mainstream economy. Event history analysis is employed to demonstrate the model on four patterns of job mobility common among immigrants: entrepreneurship, professional-managerial-technical jobs, employment in the public sector, and semi- or low-skilled factory work and low-paid service jobs. The findings show that the mix of capital immigrants arrive with, and subsequently accumulate, shapes the trajectory of their incorporation into the host society. The research is based on a field study of Asian immigrants in the greater Los Angeles area.     

Organizational life and political incorporation of two Asian immigrant groups: A case study

Civil society is the foundation of a healthy democracy but its immigrant element has received little attention. This paper is a case study of immigrant organizations of highly skilled Asian Indians and Chinese immigrants in a suburban town of Edison, New Jersey. I find that civic participation of Asian Indian immigrants spills over into political incorporation while Chinese immigrant organizations remain marginalized. I argue that local processes of racialization are central in explaining differences in political incorporation of immigrants. In the local context, the Chinese are seen as successful but conformist model minorities and Asian Indians as invaders and troublemakers. The racialization of Asian Indians has resulted in more political activity and higher levels of political visibility of their organizations. The results highlight shortcomings of current assimilation theories, which give little space to civic and political incorporation and view human capital in an unqualifiedly positive light.     

Cancer mortality among immigrant populations in Ontario, 1969 through 1973.

Ontario is home to a sizeable, recently established immigrant population whose cancer mortality has until now remained unexamined. The province''s six largest immigrant groups (British, Italian, German, Dutch, Polish and Soviet) were investigated to compare their cancer mortality experience with that prevailing in Ontario and in their countries of birth for the period 1969 through 1973. Standardized mortality ratios (SMRs) were computed from data from Statistics Canada and the World Health Organization (for 1971) for five sites of cancer. The rates of death from stomach cancer were significantly higher for the immigrant groups (except the Germans) than for the Canadian-born (SMRs 158.6 to 256.1) and were significantly lower for the immigrants (except the Dutch) than for the populations of their countries of birth (SMRs 26.5 to 72.9). The rates of death from colorectal cancer and cancer of the breast tended to be lower among the immigrants. Most male immigrants had high rates of death from lung cancer relative to the Canadian-born, whereas their female counterparts had relatively low rates. For most of the immigrant groups the rates of death from prostate cancer closely resembled those prevailing in the country of birth. Displacement of cancer mortality experience towards that in Ontario was most evident for Polish immigrants. It may have been too soon to see trends among the more recent immigrants (Italian, German and Dutch), who, for the most part, had not yet reached the age of highest cancer risk. Ontario should provide a valuable resource for further studies of lifestyle and environmental determinants of cancer.     

Heterosis and outbreeding depression in descendants of natural immigrants to an inbred population of song sparrows (Melospiza melodia)

We studied heterosis and outbreeding depression among immigrants and their descendants in a population of song sparrows on Mandarte Island, Canada. Using data spanning 19 generations, we compared survival, seasonal reproductive success, and lifetime reproductive success of immigrants, natives (birds with resident-hatched parents and grandparents), and their offspring (F1s, birds with an immigrant and a native parent, and F2s, birds with an immigrant grandparent and resident-hatched grandparent in each of their maternal and paternal lines). Lifetime reproductive success of immigrants was no worse than that of natives, but other measures of performance differed in several ways. Immigrant females laid later and showed a tendency to lay fewer clutches, but had relatively high success raising offspring per egg produced. The few immigrant males survived well but were less likely to breed than native males of the same age that were alive in the same year. Female F1s laid earlier than expected based on the average for immigrant and native females, and adult male F1s were more likely to breed than expected based on the average for immigrant and native males. The performance differences between immigrant and native females and between F1s and the average of immigrants and natives are consistent with the hypothesis that immigrants were disadvantaged by a lack of site experience and that immigrant offspring benefited from heterosis. However, we could not exclude the possibility that immigrants had a different strategy for optimizing reproductive success or that they experienced ecological compensation for life-history parameters. For example, the offspring of immigrants may have survived well because immigrants laid later and produced fewer clutches, thereby raising offspring during a period of milder climatic conditions. Although sample sizes were small, we found large performance differences between F1s and F2s, which suggested that either heterosis was associated with epistasis in F1s, that F2s experienced outbreeding depression, or that both phenomena occurred. These findings indicate that the performance of dispersers may be affected more by fine-scale genetic differentiation than previously assumed in this and comparable systems.     

On fitness and partial migration in a large herbivore – migratory moose have higher reproductive performance than residents

Partially migratory populations comprise both resident and migratory individuals. These tactics may coexist if their demographic contribution to future generations (i.e. fitness) are equal or vary temporally with environmental conditions, or if individuals switch between being migrant and resident. Alternatively, the choice of movement tactic can be based on individual attributes such as age, competitive ability or personality. In the latter cases, the two tactics are not expected to have similar average fitness. In this study, we examined the effect of movement tactic on reproductive performance and survival of 82 GPS‐marked female moose and their offspring in a partial migratory population in central Norway. The results indicated higher growth in the migrating part of the population because migrating females produced more twins than resident females. We found no differences in pregnancy rates or survival of adults or their offspring, indicating a net fitness benefit of being migrant. We found the average shoulder height of residents to be slightly lower than of migrants, but doubt that this affected their migration ability. A more likely explanation is that migratory females are both more fecund and grow bigger because of better conditions in their summer ranges. This may be a temporal phenomenon if the fitness differences between migratory and resident moose vary according to environmental fluctuations.     

Size and socio-economic resources of core discussion networks in the Netherlands: differences by national-origin group and immigrant generation

This study examines differences in the size and socio-economic resources of core discussion networks across national-origin groups and immigrant generation. The analysis is based on the Netherlands Longitudinal Lifecourse Study (2008–10), a nationally representative, large-scale survey of the Dutch population that contains an over-sample of first- and second-generation immigrants from Turkey and Morocco, the two largest non-western immigrant groups in the Netherlands. Results show that Dutch majority members have larger and more resourceful core discussion networks than Turks and Moroccans. Second-generation immigrants from Turkey and Morocco have larger core discussion networks than their foreign-born parents. However, there is no clear evidence for intergenerational increase in resources. The larger and more resourceful core discussion networks of the Dutch are partly attributable to the Dutch being higher educated and employed more often.     

Social integration and identity of immigrants from western countries,the FSU and Ethiopia in Israel

This study of immigrants’ integration in Israel centers on one major subjective parameter, namely the immigrant's identity. To explain it we explore a series of possible factors: demographic variables, economic status, and human and social capital characteristics. Three recent immigrant groups are examined: from Western countries, from the former Soviet Union (FSU), and from Ethiopia. These immigrants came to Israel during the last two decades from different societies, following different immigration circumstances and various motives.

The findings, based on the 2007 Ruppin survey data, point to the significant impact of the identity as perceived by veteran Israelis on the immigrants’ self-identity for the three groups under study. Also, different variables affect each of the immigrant groups. FSU immigrants behaved according to most of our hypotheses, whereas Western and Ethiopian immigrants did not. Findings are discussed in light of the debate on measuring and defining immigrants’ identity.     

Immigrant reproductive dysfunction facilitates ecological speciation

The distributions of species are not only determined by where they can survive – they must also be able to reproduce. Although immigrant inviability is a well‐established concept, the fact that immigrants also need to be able to effectively reproduce in foreign environments has not been fully appreciated in the study of adaptive divergence and speciation. Fertilization and reproduction are sensitive life‐history stages that could be detrimentally affected for immigrants in non‐native habitats. We propose that “immigrant reproductive dysfunction” is a hitherto overlooked aspect of reproductive isolation caused by natural selection on immigrants. This idea is supported by results from experiments on an externally fertilizing fish (sand goby, Pomatoschistus minutus). Growth and condition of adults were not affected by non‐native salinity whereas males spawning as immigrants had lower sperm motility and hatching success than residents. We interpret these results as evidence for local adaptation or acclimation of sperm, and possibly also components of paternal care. The resulting loss in fitness, which we call “immigrant reproductive dysfunction,” has the potential to reduce gene flow between populations with locally adapted reproduction, and it may play a role in species distributions and speciation.     

Whose Tangle is it Anyway? The African‐American Family,Poverty and United States Kinship

The comparison between United States immigrant and African‐American families presented by Daniel Patrick Moynihan in his 1965 report to President Lyndon Johnson remains the most popular folk model for explaining success, failure and mutual aid in poverty. Despite being savaged by social science in its first two decades and largely ignored in the last two, the Moynihan model is an enduring part of popular discourses on race, intensified by contemporary immigrant success narratives. Based on over three years of participant observation research among homeless African‐American and Latino men and their families and Latin‐American immigrants engaging in small business creation in New York City, I argue that Moynihan's empirically valid claim that certain immigrant family forms are more suited to mutual aid in crisis is misused to present the African‐American family as dysfunctional when its kinship norms are actually typically American.     

Issues addressed by tuberculosis in France in 2003

The incidence of tuberculosis in France has not declined since 4 years. In fact, there is a constant decline in the whole country but a slight increase in the Paris region. As in other big cities in the world, the recent increase in cases in Paris is mainly due to immigrants. In contrast, HIV coinfection accounts for a small and decreasing part of the cases. Moreover, the rates of resistance and multiresistance to antituberculous drugs are low and stable indicating that the treatment of active diseases is satisfactory. The respective part of cases due either to primary infections or to reactivations is unknown. In order to control tuberculosis in Paris, we need to implement better infection control policy with active screening of contacts of patients with active tuberculosis as well as treatment of latent tuberculosis infections.