Desigualdades en salud en poblaciones inmigradas a España. Una revisión de la literatura

Antecedentes/Objetivos: Tras el crecimiento de la inmigración extranjera de la pasada década, este estudio tiene como objetivo analizar la evidencia científica generada en los últimos quince años sobre la salud de la población inmigrante en España que aborda la influencia de determinantes sociales y/o las desigualdades en comparación con la población española. Métodos: Se realizó un estudio de revisión mediante la metodología de scoping review y se efectúo una búsqueda de la literatura científica publicada desde 1998 hasta 2013 en España. Se consultaron las bases de datos de medline y medes. Se combinaron 3 filtros temáticos: a) desigualdades sociales: se utilizó el propuesto por Borrell y Malmusi (Informe SESPAS 2010); b) inmigración: términos MeSH Emigrants and Immigrants, Emigration and Immigration, Transients and Migrants, Ethnic Groups; c) España: se utilizó el desarrollado por Valderas et al. (Rev Esp Cardiol 2006). Se seleccionaron estudios sobre desigualdades sociales en salud con población inmigrante procedente de países tales como Latinoamérica, África, Asia o Europa del Este. Resultados: Se seleccionaron 27 artículos. La mayoría fueron publicados en los años 2009 y 2010 (n = 17). Doce utilizaron encuestas poblacionales de salud de ámbito nacional (n = 6) y autonómicas (n = 6). Un total de 23 se centraron en población adulta mayor de 15 años. Los indicadores más frecuentemente analizados fueron el estado de salud percibido (n = 9) y la salud mental (n = 7). La población inmigrante está expuesta a determinantes sociales más desfavorables que la autóctona (clase social, renta, condiciones de empleo y trabajo, apoyo social, discriminación). A pesar de una menor prevalencia de enfermedades crónicas, parece presentar mayores problemas de salud mental y peor percepción de salud, sobretodo en mujeres y a mayor tiempo de estancia. También se reportan menores prevalencias de tabaquismo y consumo de alcohol, uso de fármacos y menor mortalidad, así como mayor sedentarismo y obesidad, sobre todo en mujeres, y violencia del compañero íntimo. Conclusiones: Los estudios exploran un amplio abanico de indicadores de salud en población adulta e infantil. A pesar de su recién llegada, las peores condiciones de vida se traducen en desigualdades sociales en la salud que afectan a la población inmigrante. Se detectan algunas lagunas de conocimiento y aspectos metodológicos a mejorar. Se hace necesario analizar la evolución de estas desigualdades en el nuevo contexto económico y considerando el previsible deterioro del efecto inmigrante sano.

Características generales de los artículos originales incluidos en las revisiones bibliográficas sobre salud e inmigración en España

Fundamentos: La realidad socio-demográfica configurada en España a partir de la incorporación de la población inmigrante requiere analizar las necesidades y prioridades generadas por esta situación en todos los ámbitos, incluido el de la investigación en salud. El objetivo del presente estudio es conocer las características generales de los artículos incluidos en una revisión bibliográfica sobre este tema y realizada en el marco del Subprograma de Salud e Inmigración del CIBERESP. Métodos: Revisión bibliográfica de los artículos originales publicados en español o inglés en el periodo 1998-2012. Se seleccionaron artículos realizados en España y que cumplieran la definición de inmigrante de la Organización Internacional de Migraciones. La búsqueda bibliográfica se realizó en Medline y MEDES. Se analizó la distribución temporal de la producción y las características generales de los artículos mediante frecuencias absolutas y relativas. Resultados: En la búsqueda inicial se identificaron 2.625 artículos (2.434 Medline y 191 Medes-MEDicina), finalmente se incluyeron los 311 que cumplían criterios de inclusión. La mayoría eran estudios epidemiológicos de diseño transversal realizados con datos primarios. En el 69% se comparó a la población inmigrante con la autóctona. En 217, (70%) la temática principal fue la relacionada con enfermedades transmisibles. En 256 (82%) el periodo producción fue entre 2004 y 2011. En 220 (71%) el país de origen fue la forma más común de clasificación de la población inmigrante. Conclusiones: Las enfermedades transmisibles fueron el principal objeto de investigación de los estudios desarrollados en España sobre salud de la población inmigrante. La mayoría de estudios incluyen a la población autóctona como grupo de comparación.

Condiciones de trabajo y salud de los trabajadores inmigrantes en España. Revisión bibliográfica

Fundamentos: La relación entre inmigración, trabajo y salud constituye uno de los retos más importantes en salud laboral y más concretamente en España por el importante incremento de proporción inmigrante acontecido en el mercado laboral. El objetivo de esta investigación es conocer la relación entre las condiciones de trabajo y sus efectos en la salud de trabajadores inmigrantes en España. Métodos: Revisión bibliográfica de artículos científicos originales en español e inglés Medline y Medes (1998-2012). Se revisaron los textos completos de los artículos incluidos. Resultados: Se incluyeron 20 estudios, 13 con metodología de investigación cuantitativa y 7 cualitativa. Los temas tratados abordaban problemas específicos de salud relacionados con el trabajo (principalmente lesiones por accidente de trabajo), incapacidad laboral y diferencias en condiciones de trabajo y empleo. Los hallazgos de los estudios mostraron mayor incidencia de lesiones por accidentes de trabajo, menores tasas de incapacidad laboral, mayor prevalencia de presentismo laboral, exposición a factores psicosociales y precariedad laboral en la población inmigrante. Conclusiones: A pesar de la singularidad del proceso demográfico migratorio, los problemas de salud y determinantes identificados no difieren de los referenciados en otros países, en otros contextos y en otros momentos.

A metasynthesis of qualitative studies regarding opinions and perceptions about barriers and determinants of health services’ accessibility in economic migrants

Background: Access to health services is an important health determinant. New research in health equity is required, especially amongst economic migrants from developing countries. Studies conducted on the use of health services by migrant populations highlight existing gaps in understanding which factors affect access to these services from a qualitative perspective. We aim to describe the views of the migrants regarding barriers and determinants of access to health services in the international literature (1997–2011). Methods: A systematic review was conducted for Qualitative research papers (English/Spanish) published in 13 electronic databases. A selection of articles that accomplished the inclusion criteria and a quality evaluation of the studies were carried out. The findings of the selected studies were synthesised by means of metasynthesis using different analysis categories according to Andersen’s conceptual framework of access and use of health services and by incorporating other emergent categories. Results: We located 3,025 titles, 36 studies achieved the inclusion criteria. After quality evaluation, 28 articles were definitively synthesised. 12 studies (46.2%) were carried out in the U.S and 11 studies (42.3%) dealt with primary care services. The participating population varied depending mainly on type of host country. Barriers were described, such as the lack of communication between health services providers and migrants, due to idiomatic difficulties and cultural differences. Other barriers were linked to the economic system, the health service characteristics and the legislation in each country. This situation has consequences for the lack of health control by migrants and their social vulnerability. Conclusions: Economic migrants faced individual and structural barriers to the health services in host countries, especially those with undocumented situation and those experimented idiomatic difficulties. Strategies to improve the structures of health systems and social policies are needed.

Work-related health problems among resident immigrant workers in Italy and Spain

Background: in both Spain and Italy the number of immigrants has strongly increased in the last 20 years, currently representing more than the 10% of workforce in each country. The segregation of immigrants into unskilled or risky jobs brings negative consequences for their health. The objective of this study is to compare prevalence of work-related health problems between immigrants and native workers in Italy and Spain. Methods: data come from the Italian Labour Force Survey (n=65 779) and Spanish Working Conditions Survey (n=11 019), both conducted in 2007. We analyzed merged datasets to evaluate whether interviewees, both natives and migrants, judge their health being affected by their work conditions and, if so, which specific diseases. For migrants, we considered those coming from countries with a value of the Human Development Index lower than 0.85. Logistic regression models were used, including gender, age, and education as adjusting factors. Results: migrants reported skin diseases (Mantel-Haenszel pooled OR=1.49; 95%CI: 0.59-3.74) and musculoskeletal problems among those employed in agricultural sector (Mantel-Haenszel pooled OR=1.16; 95%CI: 0.69-1.96) more frequently than natives; country-specific analysis showed higher risks of musculoskeletal problems among migrants compared to the non-migrant population in Italy (OR=1.17; 95% CI: 0.48-1.59) and of respiratory problems in Spain (OR=2.02; 95%CI: 1.02-4.0). In both countries the risk of psychological stress was predominant among national workers. Conclusions: this collaborative study allows to strength the evidence concerning the health of migrant workers in Southern European countries.

Associative Behaviours and Political Participation of EU migrants

Civic culture is structured on a network of interpersonal associations with different degrees of formalization. According to theories on civic and political action, certain agents, such as associations, play a key role in setting targets, socializing or coordinating sociopolitical actions, among other functions. Associations strengthen the political and civic system of societies. Likewise, they are a vehicle for individuals’ integration, which is particularly important in the case of immigrants. For these, associations are both a vehicle for integration and an instrument for political participation. This article explores the use and purpose of associations according to immigrants from Romania, Poland, the United Kingdom and Germany living in Spain.

Late life second move housing choices of international retiree migrants

Purpose – Many international retirement migrants are amenity movers undertaking the first move in the late life course model of migration. The purpose of this paper is to examine second moves within the retirement destination community to test whether the model of late life course migration accurately portrays the motivations and housing choices local movers make after retiring to another country. Design/methodology/approach – The paper combines secondary data and survey results to examine the composition of the retiree migrant population in the Alicante province of Spain. The socioeconomic characteristics and housing choices of those who have made a second move since retiring to Spain are compared with those who have not moved through a series of t-tests and chi-square tests. Findings – The paper finds that those who have made a second move within Spain are somewhat typical of second movers in the late life course. They are likely to cite mobility or health problems as a reason for moving and appear to recognize the need for a home that provides living area on one floor. Yet, they are choosing to move within an area that does not provide them with access to informal family care givers. Research limitations/implications – The data are restricted to retirees of two nationalities in one province of Spain. Further research is suggested in other locations and with retirees of other nationalities for comparison. Practical implications – Because many international retirees do not plan to return to their countries of origin, they will create demand for formal in-home care services and supportive retiree housing in the near future in their retirement destination countries. Originality/value – This paper provides understanding of a growing consumer housing segment in retirement destinations.

Examining retirement housing preferences among international retiree migrants

Housing demand models based on individual consumer’s utility function reflect preferences about the structure and lot, neighborhood, and location as related to socioeconomic characteristics of the occupants. As a growing proportion of aging residents in many countries are undertaking late life moves, their preferences will have an influence on destination housing markets. We examine the characteristics, attitudes and preferences about retirement housing among immigrant retirees currently living in traditional housing in a retirement destination in Alicante, Spain. Using results from a survey of German and British retirees living in the region, we find through logistic regression that preference for retirement housing is associated with aging and gaining access to in-home support services.

Fast X-ray transients towards the Galactic bulge with the Rossi X-ray Timing Explorer

In X-ray binaries, rapid variability in X-ray flux of greater than an order of magnitude on time-scales of a day or less appears to be a signature of wind accretion from a supergiant companion. When the variability takes the form of rare, brief, bright outbursts with only faint emission between them, the systems are called supergiant fast X-ray transients (SFXTs). We present data from twice-weekly scans of the Galactic bulge by the Rossi X-ray Timing Explorer that allow us to compare the behaviour of known SFXTs and possible SFXT candidates with the persistently bright supergiant X-ray binary 4U 1700−377. We independently confirm the orbital periods reported by other groups for SFXTs SAX J1818.6−1703 and IGR J17544−2619. The new data do not independently reproduce the orbital period reported for XTE J1739−302, but slightly improve the significance of the original result when the data are combined. The bulge source XTE J1743−363 shows a combination of fast variability and a long-term decline in activity, the latter behaviour not being characteristic of supergiant X-ray binaries. A far-red spectrum of the companion suggests that it is a symbiotic neutron star binary rather than a high-mass binary, and the reddest known of this class: the spectral type is approximately M8 III.

Linking tourism, retirement migration and social capital

A general trend in the study of international retirement migration has been the increased attention paid to the social contacts and network connections of the migrants in both the destination and the origin areas. These studies have examined the extent to which migrants build social relationships with their neighbours and the host society while also maintaining social links with their countries of origin, addressing the central role that leisure travel plays in sustaining increasingly dispersed social networks and maintaining the social capital of these networks and of the individuals involved in them. Using a case study approach to examine British retirement migration to Spain, we explore the relevance of transnational social networks in the context of international retirement migration, particularly the intensity of bidirectional visiting friends and relatives (VFR) tourism flows and the migrants’ social contacts with friends and/or family back in their home country. Building on the concept of social capital and Putnam's distinction between bonding and bridging social capital, we propose a framework for the analysis of the migrants’ international social networks. The results of a study conducted based on a sample of 365 British retirees living in the coast of Alicante (Spain) show both the strength of the retirees’ international bonding social capital and the role of ‘VFR's travel and communication technologies in sustaining the migrants’ transnational social practices and, ultimately, their international bonding social capital. It also provides evidence for the reinforcing links between tourism-related mobility and amenity-seeking migration in later life.

SeismicWaveTool: Continuous and discrete wavelet analysis and filtering for multichannel seismic data

A MATLAB-based computer code has been developed for the simultaneous wavelet analysis and filtering of multichannel seismic data. The considered time–frequency transforms include the continuous wavelet transform, the discrete wavelet transform and the discrete wavelet packet transform. The developed approaches provide a fast and precise time–frequency examination of the seismograms at different frequency bands. Moreover, filtering methods for noise, transients or even baseline removal, are implemented. The primary motivation is to support seismologists with a user-friendly and fast program for the wavelet analysis, providing practical and understandable results.

Impact of economic crisis on mental health of migrant workers: what happened with migrants who came to Spain to work?

Objectives: To assess changes in mental health in a sample of migrant workers after the eruption of the economic crisis in Spain. Methods: 318 migrant workers were interviewed. Mental health, sociodemographic, and economic crisis related variables were obtained through face-to-face (2008) and phone (2011) interviews. Prevalence of poor mental health (PMH) was compared (2011–2008) and multivariate logistic regression models were fitted. Results: Change in prevalence of PMH was higher in men (aOR 4.63; 95 % CI 2.11–10.16). Subgroups of men showing the largest detrimental mental health effects were: unemployed, with low salaries (≤1,200 euros) and those reporting family burden. An increase of PMH was found in women, without significant associations. Conclusions: Mental health of migrant workers in Spain has worsened during the economic crisis.

Astrophysical parameters and orbital solution of the peculiar X-ray transient IGR J00370+6122

Context. BD + 60° 73 is the optical counterpart of the X-ray source IGR J00370+6122, a probable accretion-powered X-ray pulsar. The X-ray light curve of this binary system shows clear periodicity at 15.7 d, which has been interpreted as repeated outbursts around the periastron of an eccentric orbit. Aims. We aim to characterise the binary system IGR J00370+6122 by deriving its orbital and physical parameters. Methods. We obtained high-resolution spectra of BD + 60° 73 at different epochs. We used the fastwind code to generate a stellar atmosphere model to fit the observed spectrum and obtain physical magnitudes. The synthetic spectrum was used as a template for cross-correlation with the observed spectra to measure radial velocities. The radial velocity curve provided an orbital solution for the system. We also analysed the RXTE/ASM and Swift/BAT light curves to confirm the stability of the periodicity. Results. BD + 60° 73 is a BN0.7 Ib low-luminosity supergiant located at a distance ~3.1 kpc, in the Cas OB4 association. We derive Teff = 24 000 K and log gc = 3.0, and chemical abundances consistent with a moderately high level of evolution. The spectroscopic and evolutionary masses are consistent at the 1-σ level with a mass M∗ ≈ 15 M⊙. The recurrence time of the X-ray flares is the orbital period of the system. The neutron star is in a high-eccentricity (e = 0.56 ± 0.07) orbit, and the X-ray emission is strongly peaked around orbital phase φ = 0.2, though the observations are consistent with some level of X-ray activity happening at all orbital phases. Conclusions. The X-ray behaviour of IGR J00370+6122 is reminiscent of “intermediate” supergiant X-ray transients, though its peak luminosity is rather low. The orbit is somewhat wider than those of classical persistent supergiant X-ray binaries, which when combined with the low luminosity of the mass donor, explains the low X-ray luminosity. IGR J00370+6122 will very likely evolve towards a persistent supergiant system, highlighting the evolutionary connection between different classes of wind-accreting X-ray sources.

Is health a right for all? An umbrella review of the barriers to health care access faced by migrants

Objective. To synthesise the scientific evidence concerning barriers to health care access faced by migrants. We sought to critically analyse this evidence with a view to guiding policies. Design. A systematic review methodology was used to identify systematic and scoping reviews which quantitatively or qualitatively analysed data from primary studies. The main variables analysed were structural and contextual barriers (health system organisation) as well as individual (patients and providers). The quality of evidence from the systematic reviews was critically appraised. From 2674 reviews, 79 were retained for further scrutiny, and finally 9 met the inclusion criteria. Results. The structural barriers identified were the lack of health insurance and the high cost of drugs (non-universal health system) and organisational aspects of health system (social insurance system and national health system). The individual barriers were linguistic and cultural. None of the reviews provided a quality appraisal of the studies. Conclusions. Barriers to health care for migrants range from entitlement in non-universal health systems to accessibility in universal ones, and determinants of access to the respective health services should be analysed within the corresponding national context. Generate social and institutional changes that eliminate barriers to access to health services is essential to ensure health for all.

Challenges in Lifestyle Migration Research: Reflections and Findings about the Spanish Crisis

The lifestyle migration conceptual framework is based on the motivation for moving reported by the migrants themselves. We discuss the operability of this approach, which is built on the subjective assessments of individuals. It diminishes the actual importance of economic factors and has an underlying ideological element associated with the categorisation of people according to their nationality. A comparative analysis of residential variations by nationalities between 2005 and 2010 in Alicante (Spain) shows that, when faced with the economic crisis, the so-called lifestyle migrants are changing their mobility patterns in a way similar to the rest of the migrants. This calls into question the adequacy of juxtaposing lifestyle and labour migration. Both theory and research show that this duality, instead of clarifying applied research, makes it more difficult. We argue that the lifestyle migration framework is inadequate to study changes in mobility patterns, particularly when using a quantitative approach.