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Providing medical care for undocumented migrants in Denmark: what are the challenges for health professionals?
Natasja K Jensen, Marie Norredam, Tania Draebel, Marija Bogic, Stefan Priebe, Allan Krasnik
BMC Health Services Research , 2011, DOI: 10.1186/1472-6963-11-154
Abstract: The study was carried out as part of an EU-project on European Best Practices in Access, Quality and Appropriateness of Health Services for Immigrants in Europe (EUGATE). This presentation is based on 12 semi-structured interviews with general practitioners (9) and emergency room physicians (3) in Denmark.The emergency room physicians express that treatment of undocumented migrants is no different from the treatment of any other person. However, care may become more complicated due to lack of previous medical records and contact persons. Contrary to this, general practitioners explain that undocumented migrants will encounter formal barriers when trying to obtain treatment. Additional problems in the treatment of undocumented migrants include language issues, financial aspects for general practitioners, concerns about how to handle the situation including possibilities of further referrals, and an uncertainty as to whether to involve the police.The health professionals in our study describe that undocumented migrants experience an unequal access to primary care facilities and that great uncertainties exist amongst health professionals as how to respond in such situations. The lack of official policies concerning the right to health care for undocumented migrants continue to pass on the responsibility to health professionals and, thereby, leaves it up to the individual to decide whether treatment can be obtained or not.In the public debate, undocumented migrants are often recognized only as a threat to national states, while other aspects such as the rights of undocumented migrants are frequently overlooked. Although it has been estimated that there may be as many as 1.9 to 3.8 million undocumented migrants in the European Union [1], these people remain invisible to policy makers in many countries [2-4]. Due to the unrecorded nature of the phenomenon, it is difficult to establish its exact extent; however, it has been estimated that up to 5,000 undocumented migrants
Health care seeking among detained undocumented migrants: a cross-sectional study
Tina Dorn, Manon Ceelen, Ming-Jan Tang, Joyce L Browne, Koos JC de Keijzer, Marcel CA Buster, Kees Das
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-190
Abstract: This cross-sectional study includes both respondents who did and did not seek care, namely undocumented migrants who have been incarcerated in a detention centre while awaiting expulsion to their country of origin. A consecutive sample of all new arrivals was studied. Data were collected through structured interviews and reviews of medical records.Among the 224 male migrants who arrived at the detention centre between May and July 2008, 173 persons were interviewed. 122 respondents met inclusion criteria. Only half of the undocumented migrants in this study knew how to get access to medical care in the Netherlands if in need. Forty-six percent of respondents reported to have sought medical help during their stay in the Netherlands while having no health insurance (n = 57). Care was sought most frequently for injuries and dental problems. About 25% of these care seekers reported to have been denied care by a health care provider. Asian migrants were significantly less likely to seek care when compared to other ethnic groups, independent from age, chronic health problems and length of stay in the Netherlands.The study underlines the need for a better education of undocumented patients and providers concerning the opportunities for health care in the Netherlands. Moreover, there is a need to further clarify the reasons for the denial of care to undocumented patients, as well as the barriers to health care as perceived by undocumented migrants.Illegal migration is a fact of live in many European countries. In the Netherlands, the number of undocumented migrants was estimated 130,000 in 2005 [1]. This group includes people who entered the country clandestinely, overstayed their visas, violated the terms of their admission, or were rejected as asylum seekers. The access to health care of this group is compromised due to various obstacles. First, in the Netherlands, it is impossible for undocumented migrants to join the national health insurance system, leading to a decrea
Undocumented migrants lack access to pregnancy care and prevention
Hans Wolff, Manuella Epiney, Ana P Lourenco, Michael C Costanza, Jacqueline Delieutraz-Marchand, Nicole Andreoli, Jean-Bernard Dubuisson, Jean-Michel Gaspoz, Olivier Irion
BMC Public Health , 2008, DOI: 10.1186/1471-2458-8-93
Abstract: Prospective cohort study including pregnant undocumented migrants presenting to the University hospital from February 2005 to October 2006. The control group consisted of a systematic sample of pregnant women with legal residency permit wishing to deliver at the same public hospital during the same time period.161 undocumented and 233 control women were included in the study. Mean ages were 29.4 y (SD 5.8) and 31.1 y (SD 4.8) (p < 0.02), respectively. 61% of undocumented women (controls 9%) were unaware of emergency contraception (OR 15.7 (8.8;28.2) and 75% of their pregnancies were unintended (controls 21%; OR 8.0 (4.7;13.5)). Undocumented women consulted for an initial pregnancy visit more than 4 weeks later than controls and only 63% had their first visit during the first trimester (controls 96%, p < 0.001); 18% had never or more than 3 years ago a cervical smear test (controls 2%, OR 5.7 (2.0;16.5)). Lifetime exposure to violence was similar in both groups, but undocumented migrants were more exposed during their pregnancy (11% vs 1%, OR 8.6 (2.4;30.6)). Complications during pregnancy, delivery and post-partum were similar in both groups.Compared to women who are legal residents of Geneva, undocumented migrants have more unintended pregnancies and delayed prenatal care, use fewer preventive measures and are exposed to more violence during pregnancy. Not having a legal residency permit therefore suggests a particular vulnerability for pregnant women. This study underscores the need for better access to prenatal care and routine screening for violence exposure during pregnancy for undocumented migrants. Furthermore, health care systems should provide language- and culturally-appropriate education on contraception, family planning and cervical cancer screening.An estimated 8'000 to 12'000 undocumented migrants live and work in the canton of Geneva, representing 1.8 to 2.9% of the 440'982 resident population [1,2]. These so-called undocumented migrants live in Genev
Chlamydia trachomatis prevalence in undocumented migrants undergoing voluntary termination of pregnancy: a prospective cohort study
Hans Wolff, Ana Louren?o, Patrick Bodenmann, Manuella Epiney, Monique Uny, Nicole Andreoli, Olivier Irion, Jean-Michel Gaspoz, Jean-Bernard Dubuisson
BMC Public Health , 2008, DOI: 10.1186/1471-2458-8-391
Abstract: This prospective cohort study included all pregnant, undocumented women presenting from March 2005 to October 2006 to the University hospital for ToP. The control group consisted of a systematic sample of pregnant women with legal residency permit coming to the same hospital during the same time period for ToPOne hundred seventy five undocumented women and 208 women with residency permit (controls) were included in the study. Mean ages were 28.0 y (SD 5.5) and 28.2 y (SD 7.5), respectively (p = 0.77). Undocumented women came primarily from Latin-America (78%). Frequently, they lacked contraception (23%, controls 15%, OR 1.8, 95% CI 1.04;2.9). Thirteen percent of undocumented migrants were found to have CTI (compared to 4.4% of controls; OR 3.2, 95% CI 1.4;7.3).This population of undocumented, pregnant migrants consisted primarily of young, Latino-American women. Compared to control women, undocumented migrants showed higher prevalence rates of genital CTI, which indicates that health professionals should consider systematic screening for STI in this population. There is a need to design programs providing better access to treatment and education and to increase migrants' awareness of the importance of contraception and transmission of STI.Geneva (Switzerland), as one of the wealthiest areas of the world, is a common target of illegal migration. Most of these undocumented migrants, also called "illegals" or "clandestines", leave their home country because of difficult economic conditions. An estimated 8,000 to 12,000 undocumented migrants, who lack legal residential permit, live and work in the canton of Geneva [1], representing 1.4 to 3.5% of the 434,500 resident population. Because of their difficult living conditions, separation from their families, permanent threat of being caught by the police, and exclusion from the health care system, it is reasonable to believe that undocumented migrants are in poor health. Since undocumented migrants do not have any social p
Registry data for cross-country comparisons of migrants' healthcare utilization in the EU: a survey study of availability and content
Signe Nielsen, Allan Krasnik, Aldo Rosano
BMC Health Services Research , 2009, DOI: 10.1186/1472-6963-9-210
Abstract: A questionnaire survey on availability of healthcare utilization registries in which migrants can be identified was carried out among all national statistic agencies and other relevant national health authorities in the 27 EU countries in 2008-9 as part of the Migrant and Ethnic Minority Health Observatory-project (MEHO). The information received was compared with information from a general survey on availability of survey and registry data on migrants conducted by Agency of Public Health, Lazio Region, Italy within the MEHO-project; thus, the information on registries was double-checked to assure accuracy and verification.Available registry data on healthcare utilization which allow for identification on migrants on a national/regional basis were only reported in 11 EU countries: Austria, Belgium, Denmark, Finland, Greece, Italy, Luxembourg, the Netherlands, Poland, Slovenia, and Sweden. Data on hospital care, including surgical procedures, were most frequently available whereas only few countries had data on care outside the hospital. Regarding identification of migrants, five countries reported having information on both citizenship and country of birth, one reported availability of information on country of birth, and five countries reported availability of information on citizenship.Lack of registry data in 16 EU countries, shortage of data on healthcare utilization, and the diversity in the definition of migrant status hampers cross-national comparisons and calls for an urgent establishment of registries, expansion of the existing registry information, and adoption of a common, generally acceptable definition and identification method of migrants across the EU.Migrant health and access to healthcare are fundamental elements of integration and human rights. Most EU countries grant equal access to healthcare for migrants with permanent residence compared to non-migrants [1,2]; nevertheless, differences in health care utilization between migrants and the indigeno
Coordination between primary and secondary healthcare in Denmark and Sweden
Sarah Wadmann,Martin Strandberg-Larsen,Karsten Vrangb?k
International Journal of Integrated Care , 2009,
Abstract: Introduction: Insights into effective policy strategies for improved coordination of care is needed. In this study we describe and compare the policy strategies chosen in Denmark and Sweden, and discuss them in relation to interorganisational network theory. Policy practice: The policy initiatives to improve collaboration between primary and secondary healthcare in Denmark and Sweden include legislation and agreements aiming at clarifying areas of responsibility and defining requirements, creation of links across organisational boarders. In Denmark many initiatives have been centrally induced, while development of local solutions is more prominent in Sweden. Many Danish initiatives target the administrative level, while in Sweden initiatives are also directed at the operational level. In both countries economic incentives for collaboration are weak or lacking, and use of sanctions as a regulatory mean is limited. Discussion and conclusion: Despite a variety of policy initiatives, lacking or poorly developed structures to support implementation function as barriers for coordination. The two cases illustrate that even in two relatively coherent health systems, with regional management of both the hospital and general practice sector, there are issues to resolve in regard to administrative and operational coordination. The interorganisational network literature can provide useful tools and concepts for interpreting such issues.
Healthcare seeking behavior among subjects with irritable bowel syndrome
Yaser R. Al Huthail
Saudi Medical Journal , 2013,
Abstract: The behaviors exhibited by individuals who seek healthcare for irritable bowel syndrome (IBS) are numerous, varied, and sometimes controversial, and/or inconsistent. This study aims to review the factors associated with these healthcare seeking behaviors. Through a selective review of the literature, articles were identified by using the following search terms: IBS, healthcare seeking, conventional and non-conventional treatment, cultural factors, and gender differences. The roles of different factors associated with healthcare seeking are discussed.
Portuguese Migrants in Switzerland: Healthcare and Health Status Compared to Portuguese Residents  [PDF]
Luís Alves, Ana Azevedo, Henrique Barros, Fred Paccaud, Pedro Marques-Vidal
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0077066
Abstract: Background Most migrant studies have compared health characteristics between migrants and nationals of the host country. We aimed at comparing health characteristics of migrants with nationals from their home country. Methods Portuguese national health survey (2005-6; 30,173 participants aged 18-75 years) and four national health surveys conducted in Switzerland (2002, 2004, 2007 and 2011, totalling 1,170 Portuguese migrants of the same age range). Self-reported data on length of stay, cardiovascular risk factors, healthcare use and health status were collected. Results Resident Portuguese were significantly older and more educated than migrants. Resident Portuguese had a higher mean BMI and prevalence of obesity than migrants. Resident Portuguese also reported more frequently being hypertensive and having their blood pressure screened within the last year. On the contrary, migrant Portuguese were more frequently smokers, had a medical visit in the previous year more frequently and self-rated their health higher than resident Portuguese. After adjustment for age, gender, marital status and education, migrants had a higher likelihood of smoking, of having a medical visit the previous year, and of self-rating their current health as good or very good than resident Portuguese. Compared to Portuguese residents, cholesterol screening in the previous year was more common only among migrants living in Switzerland for more than 17 years. Conclusion Portuguese migrants in Switzerland do not differ substantially from resident Portuguese regarding most cardiovascular risk factors. Migrants consider themselves healthier than Portuguese residents and more often had a recent medical visit.
Migrant workers’ occupation and healthcare-seeking preferences for TB-suspicious symptoms and other health problems: a survey among immigrant workers in Songkhla province, southern Thailand  [cached]
Naing Tinzar,Geater Alan,Pungrassami Petchawan
BMC International Health and Human Rights , 2012, DOI: 10.1186/1472-698x-12-22
Abstract: Background Much of the unskilled and semi-skilled workforce in Thailand comprises migrant workers from neighbouring countries. While, in principle, healthcare facilities in the host country are open to those migrants registered with the Ministry of Labour, their actual healthcare-seeking preferences and practices, as well as those of unregistered migrants, are not well documented. This study aimed to describe the patterns of healthcare-seeking behaviours of immigrant workers in Thailand, emphasizing healthcare practices for TB-suspicious symptoms, and to identify the role of occupation and other factors influencing these behaviours. Methods A survey was conducted among 614 immigrant factory workers (FW), rubber tappers (RT) and construction workers (CW), in which information was sought on socio-demography, history of illness and related healthcare-seeking behaviour. Mixed effects logistic regression modeling was employed in data analysis. Results Among all three occupations, self-medication was the most common way of dealing with illnesses, including the development of TB-suspicious symptoms, for which inappropriate drugs were used. Only for GI symptoms and obstetric problems did migrant workers commonly seek healthcare at modern healthcare facilities. For GI illness, FW preferred to attend the in-factory clinic and RT a private facility over government facilities owing to the quicker service and greater convenience. For RT, who were generally wealthier, the higher cost of private treatment was not a deterrent. CW preferentially chose a government healthcare facility for their GI problems. For obstetric problems, including delivery, government facilities were utilized by RT and CW, but most FW returned to their home country. After adjusting for confounding, having legal status in the country was associated with overall greater use of government facilities and being female and being married with use of both types of modern healthcare facility. One-year estimated period prevalence of TB-suspicious symptoms was around 6% among FW but around 27% and 30% in RT and CW respectively. However, CW were the least likely to visit a modern healthcare facility for these symptoms. Conclusions Self medication is the predominant mode of healthcare seeking among these migrant workers. When accessing a modern healthcare facility the choice is influenced by occupation and its attendant lifestyle and socioeconomic conditions. Utilization of modern facilities could be improved by reducing the current barriers by more complete registration coverage and better provisi
Screening for latent tuberculosis infection among undocumented immigrants in Swiss healthcare centres; a descriptive exploratory study
Patrick Bodenmann, Paul Vaucher, Hans Wolff, Bernard Favrat, Fanny de Tribolet, Eric Masserey, Jean-Pierre Zellweger
BMC Infectious Diseases , 2009, DOI: 10.1186/1471-2334-9-34
Abstract: All consecutive undocumented patients that visited two urban healthcare centres for vulnerable populations in Lausanne, Switzerland for the first time were offered tuberculosis screening with an interferon-γ assay. Preventive treatment was offered if indicated. Adherence to treatment was evaluated monthly over a nine month period.Of the 161 participants, 131 (81.4%) agreed to screening and 125 had complete examinations. Twenty-four of the 125 patients (19.2%; CI95% 12.7;27.2) had positive interferon-γ assay results, two of which had active tuberculosis. Only five patients with LTBI completed full preventive treatments. Five others initiated the treatment but did not follow through.Screening for tuberculosis infection in this hard-to-reach population is feasible in dedicated urban clinics, and the prevalence of LTBI is high in this vulnerable population. However, the low adherence to treatment is an important public health concern, and new strategies are needed to address this problem.Each year, more than 8 million people develop active tuberculosis (TB) worldwide with regional variability. It is the most common cause of death from communicable diseases [1,2]. Movement of people between countries has a large influence on the incidence of TB in Western-Europe [3-5]. Several studies have shown that most reported cases are due to reactivation of infections acquired abroad but that transmission to other people in the host country is rare [6-9]. Therefore, screening for tuberculosis among immigrants is performed in many developed countries with the aim of detecting and treating the active disease [10,11] or a latent tuberculosis infection (LTBI) [12-14]. The introduction of interferon-γ assays has improved specificity for detecting LTBI compared with the tuberculin skin test [15,16]. This promises a considerable improvement in the cost-effectiveness of targeted screening programs [17-20]. However, there is no clear consensus regarding the true benefits of screening and it
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