(33/1128) Immigration and risk of childhood lead poisoning: findings from a case control study of New York City children.
OBJECTIVES: We investigated whether foreign birthplace and residence were associated with an increased risk of childhood lead poisoning. METHODS: We conducted a matched case-control study among New York City children (mean age=3 years) tested for lead poisoning in 2002 (n=203 pairs). Children were matched on age, date of test, and residential area. Blood lead and housing data were supplemented by a telephone survey administered to parents or guardians. Conditional logistic regression analysis was used to examine the relationship of lead poisoning status to foreign birthplace and time elapsed since most recent foreign residence after adjustment for housing and behavioral risk factors. RESULTS: Both foreign birthplace and time since most recent foreign residence had strong adjusted associations with lead poisoning status, with children who had lived in a foreign country less than 6 months before their blood test showing a particularly elevated risk of lead poisoning relative to US-born children with no foreign residential history before their blood test (odds ratio [OR]=10.9; 95% confidence interval [CI]=3.3, 36.5). CONCLUSIONS: Our findings demonstrate an increased risk of lead poisoning among immigrant children. (+info)
(34/1128) Cerebral palsy in a total population of 4-11 year olds in southern Sweden. Prevalence and distribution according to different CP classification systems.
BACKGROUND: The aim of this study was to investigate the prevalence of cerebral palsy (CP) as well as to characterize the CP population, its participation in a secondary prevention programme (CPUP) and to validate the CPUP database. METHODS: The study population was born 1990-1997 and resident in Skane/Blekinge on Jan 1st 2002. Multiple sources were used. Irrespective of earlier diagnoses, neuropaediatrician and other professional medical records were evaluated for all children at the child habilitation units. The CPUP database and diagnosis registers at hospital departments were searched for children with CP or psychomotor retardation, whose records were then evaluated. To enhance early prevention, CP/probable CP was searched for also in children below four years of age born 1998-2001. RESULTS: The prevalence of CP was 2.4/1,000 (95% CI 2.1-2.6) in children 4-11 years of age born in Sweden, excluding post-neonatally acquired CP. Children born abroad had a higher prevalence of CP with more severe functional limitations. In the total population, the prevalence of CP was 2.7/1,000 (95% CI 2.4-3.0) and 48% were GMFCS-level I (the mildest limitation of gross motor function). One third of the children with CP, who were born or had moved into the area after a previous study in 1998, were not in the CPUP database. The subtype classification in the CPUP database was adjusted in the case of every fifth child aged 4-7 years not previously reviewed. CONCLUSION: The prevalence of CP and the subtype distribution did not differ from that reported in other studies, although the proportion of mild CP tended to be higher. The availability of a second opinion about the classification of CP/CP subtypes is necessary in order to keep a CP register valid, as well as an active search for undiagnosed CP among children with other impairments. (+info)
(35/1128) Severe brain co-infection with Cryptococcus neoformans and Mycobacterium tuberculosis in a young, otherwise healthy student recently immigrated from China.
INTRODUCTION: While the incidence of pulmonary and extrapulmonary tuberculosis is growing in patients of advanced age, immunocompromised subjects, and immigrants coming in from developing countries [Keller A, Delavelle J, Howarth N, Bianchi S, Garcia J. Spinal and neurotuberculosis in an Asian immigrant. JBR-BTR 2002;85:136-7; Sabbatani S, Manfredi R, Legnani G. Chiodo F. Tuberculosis in a metropolitan area of northern Italy: epidemiological trends and public health concerns. Eur J Epidemiol 2004;19:501-3], the concomitant occurrence of cerebral cryptococcosis plus brain and respiratory tuberculosis in a young and otherwise healthy patient, without an evident cause of immunodeficiency and without an obvious exposure, is exceedingly rare [Silber E, Sonnenberg P, Koornhof HJ, Morris L, Saffer D. Dual infective pathology in patients with cryptococcal meningitis. Neurology 1998;51:1213-5.]. CASE REPORT: An exceptionally rare case of concurrent central nervous system infection with Cryptococcus neoformans and Mycobacterium tuberculosis in a 25-year-old otherwise healthy Chinese student, who had very recently joined an Italian post-doctoral course, is described. Also described are the diagnostic and therapeutic difficulties encountered in a five-month hospitalization period, when only transient and/or negligible immune system impairments were detected. CONCLUSIONS: This episode of very infrequent concurrent infections should emphasize the need to maintain an elevated clinical suspicion for opportunistic infections and tuberculosis, even in the absence of an obvious immunodeficiency and related epidemiological clues. (+info)
(36/1128) Intercountry adoptions: medical aspects for the whole family.
In the United States, the number of intercountry adoptions has steadily increased in the past 15 years. Healthcare providers should understand the medical aspects of such adoptions in order to better advise families and aid them in making an informed decision when adopting a foreign-born child. Pretravel consultation is addressed, including immunizations, safety issues, and how to create a personalized prophylactic medical travel kit. Review of pictures, videos, and the medical history of the potential adoptive child is also discussed, as is air travel with children. Postemigration medical examinations-including developmental and psychosocial evaluations, general work-up with laboratory studies, and immunizations-are outlined. This article reviews the medical aspects of intercountry adoption for adoptive parents in the United States. The osteopathic approach of caring for the whole family lends itself to advising families on intercountry adoptions. (+info)
(37/1128) Induced abortion in Denmark: effect of socio-economic situation and country of birth.
BACKGROUND: Equal access to health care is considered a key in Scandinavian healthcare policy. However, problematic differences between the socio-economic situation of immigrants and that of native Scandinavians are increasingly challenging this aspect of the Scandinavian welfare model. The present study focuses on how socio-economic characteristics and country of birth are associated with induced abortion. METHODS: A structured questionnaire was used to collect information among 1351 women requesting abortion and a control group of 1306 women intending birth. RESULTS: The strongest factor associated with the decision to have an abortion was being single (OR 39.1; 23.8-64.2), followed by being aged 19 years or below (OR 29.6; 13.4-65.5), having two children or more (OR 7.05; 5.29-9.39) and being unskilled (OR 2.48; 1.49-4.10), student (OR 2.29; 1.52-3.43) or unemployed (OR 1.65; 1.11-2.46). When evaluating the effect of social exposure on abortion among Danish-born and foreign-born women, the higher rate of abortion among non-Westerners was found to be caused by the composition of non-Westerners more often being unemployed, having a low income and having two or more children rather than the fact that they are coming from a non-Western country. CONCLUSION: Immigrant women comprise a vulnerable group, with a poor socio-economic status. This situation exposes immigrant women to increased risk of induced abortion. In a society with an increasing heterogeneous population, the vulnerable situation of immigrant women has to be addressed, if equal access to health care is to be maintained. (+info)
(38/1128) Family history of cancer: is it an accurate indicator of cancer risk in the immigrant population?
BACKGROUND: Patients' self-reports of family history of cancer influence physician cancer screening recommendations. Little is known about rates of reporting a family history of cancer in the immigrant population. METHODS: The study used a nationally representative probability sample of adults, 18 years of age and older, living in the United States (N=5010) who had responded to the 2005 Health Information Trends Survey (HINTS). Likelihood of reporting a family history of cancer was examined as a function of nativity status (foreign-born vs US-born) and control variables. RESULTS: Immigrants were approximately one-third as likely as nonimmigrants to report a family history of cancer (odds ratio [OR], 0.35; 95% confidence index [95% CI], 0.25-0.48) after controlling for sociodemographic and cancer knowledge variables. CONCLUSIONS: When healthcare providers are assessing cancer risk and making screening recommendations, they should take into account that among foreign-born patients, and especially nonwhite foreign-born patients, self-reported family history of cancer (FHC) may misrepresent their cancer risk. Failure to account for low rates of reporting FHC among immigrants could inadvertently contribute to existing disparities in cancer screening and use of genetic testing by immigrants and ethnic minorities. (+info)
(39/1128) Education and postgraduate education of psychiatrists in the Soviet Union and their integration into a new milieu. A view from the present to the past of former Soviet psychiatrists.
The article presents the problems and difficulties that psychiatrists from the former Soviet Union (FSU) have to cope with in Israel. Immigration and acculturation in a new milieu is a complex process and even more complicated for those whose specialty is medicine and particularly psychiatry. There is a wide gap between the skills and knowledge that new immigrants brought with them from the FSU and the professional demands in the new country. Psychiatry and psychiatric education in the FSU were determined by the cultural practices and traditions of the region and the organizational principles of the USSR which were very different than those of western society and the State of Israel. In comparison to the West, postgraduate psychiatric training in the USSR was shorter and less rigorous with an emphasis on biological therapy. Soviet "psychotherapy" was more reality oriented and more authoritarian than in the West, stressing "collective" group therapy. We describe the basic principles of Soviet medical education and the radically different social, intellectual and political history of the former Soviet Union. We relate the experiences of psychiatrists in the FSU in learning dynamic psychotherapy and the difficulties connected with this education. Moreover, the process of educating psychiatric residents is described from a supervisor's point of view. This complex process led to some major difficulties. In order to cope with the difficulties the supervisor employed a broad variety of means and techniques: an introductory course and a basic seminar about fundamental cornerstones of psychotherapy were offered. (+info)
(40/1128) Mexican American adolescents' cultural orientation, externalizing behavior and academic engagement: the role of traditional cultural values.
This study of 598 7th grade students of Mexican origin examined the role of traditional cultural values as a mediator of the effects of immigrant status, Mexican cultural orientation and Anglo cultural orientation on adolescent externalizing behavior and academic engagement. Immigrant status of adolescents and their maternal caregivers uniquely predicted increased Mexican cultural orientation and decreased Anglo cultural orientation, and both Mexican and Anglo cultural orientation related positively to adolescents' endorsement of traditional cultural values. Endorsement of traditional cultural values related, in turn, to decreased externalizing behaviors and increased academic engagement and these findings were replicated across adolescent and teacher report of these two outcomes. Tests of mediation provided further evidence to support these pathways. Findings support the central importance of traditional cultural values as a protective resource that explains why immigrant youth exhibit fewer externalizing problems and increased academic engagement when compared to their second and third generation peers. (+info)