Guidelines for Reducing the Negative Public Health Impacts of Medical Tourism

Étude de cas / Case study

A Grey Area of Rights and Knowledge: Displacement in Colombia, South-South Migration and Health Equity

Globalization and liberalization of the economies have produced among others drastic effects on the human mobility, generating confusion, enhancing discrimination and a lack of respect to the rights of several migrant collectives. In this article we analyse several challenges for the study of these phenomena, based on the case of the neglected health rights of Colombian women, who have been forced to displace by the country's internal conflict, and are thus pushed to cross the border to Ecuador. The article identifies several knowledge gaps that could allow and advance a better understanding of these critical subjects. The paper - a think piece -is based upon a general review of documents and studies on the relation between migration and health. The supporting theory on the research comes from international organisations such as the WHO and IOM, NGOs, grass-roots organisations and academic research. This paper shows the need for focusing on the reality of supra states which globalization has generated, and t e urgency of securing the access to essential health preconditions to migrant populations. These issues can no longer be neglected and should be included on agendas at international level, widening the approach of programs to the displaced/immigrant population by taking into account the need to ensure the essential health preconditions (equity), prevention, and protection. Further, it is clear that women and children require a better protection with enhanced prevention and responding measures to sexual abuse, stigmatisation, violence and the respect of their rights.

Ethics of care in supporting disabled forced migrants: interactions with professionals and ethical dilemmas in health and social care in the South-East of England

This article explores the interactions between disabled forced migrants with care needs and professionals and the restrictive legal, policy and practice context that health and social care professionals have to confront, based on the findings of a qualitative study with 45 participants in the South-East of England. In-depth interviews were conducted with 15 forced migrants who had diverse impairments and chronic illnesses (8 women and 7 men), 13 family caregivers and 17 support workers and strategic professionals working in social care and the third sector in Slough, Reading and London. The legal status of forced migrants significantly affects their entitlements to health and social care provision, resulting in prolonged periods of destitution for many families. National asylum support policies, difficult working relationships with UK Border Agency, higher eligibility thresholds and reduced social care budgets of local authorities were identified as significant barriers in responding to the support needs of disabled forced migrants and family caregivers. In this context, social workers experienced considerable ethical dilemmas. The research raises profound questions about the potential and limitations of health and social care policies, provision, and practice as means of protection and support in fulfilling the human rights of forced migrants with care needs.

Estimating the effects of United States food safety and agricultural health standards on agro-food exports from Latin America and the Caribbean

Includes bibliography

Application of information and communication technologies for health systems in Belgium, Denmark, Spain, the United Kingdom and Sweden

Incluye Bibliografía

GABARAP deficiency modulates expression of NaPi-IIa in renal brush-border membranes

Renal reabsorption of inorganic phosphate (P(i)) is mainly mediated by the Na(+)-dependent P(i)-cotransporter NaPi-IIa that is expressed in the brush-border membrane (BBM) of renal proximal tubules. Regulation and apical expression of NaPi-IIa are known to depend on a network of interacting proteins. Most of the interacting partners identified so far associate with the COOH-terminal PDZ-binding motif (TRL) of NaPi-IIa. In this study GABA(A) receptor-associated protein (GABARAP) was identified as a novel interacting partner of NaPi-IIa applying a membrane yeast-two-hybrid system (MYTH 2.0) to screen a mouse kidney library with the TRL-truncated cotransporter as bait. GABARAP mRNA and protein are present in renal tubules, and the interaction of NaPi-IIa and GABARAP was confirmed by using glutathione S-transferase pulldowns from BBM and coimmunoprecipitations from transfected HEK293 cells. Amino acids 36-68 of GABARAP were identified as the determinant for the described interaction. The in vivo effects of this interaction were studied in a murine model. GABARAP(-/-) mice have reduced urinary excretion of P(i), higher Na(+)-dependent (32)P(i) uptake in BBM vesicles, and increased expression of NaPi-IIa in renal BBM compared with GABARAP(+/+) mice. The expression of Na(+)/H(+) exchanger regulatory factor (NHERF)1, an important scaffold for the apical expression of NaPi-IIa, is also increased in GABARAP(-/-) mice. The absence of GABARAP does not interfere with the regulation of the cotransporter by either parathyroid hormone or acute changes of dietary P(i) content.

Neural tube defects in Mexican-Americans living on the US-Mexico border: The effects of folic acid and dietary folate

Neural tube defects (NTDs) are malformations of the developing brain and spinal cord; the most common are anencephaly and spina bifida. Evidence from many populations suggests that 50% of NTDs can be prevented through daily consumption of folic acid. A recent study has reported that folic acid may not protect populations of Mexican descent. This finding has serious implications for women living along the US-Mexico border. Not only is risk high in these Mexican American women compared with other US women; they also differ markedly in supplemental folic acid and dietary folate consumption, and in NTD-related risks (e.g., obesity, diabetes). This case-control study investigated whether folic acid supplements and dietary folate reduces NTDs in Mexican Americans. Cases included liveborn, stillborn, electively and spontaneously aborted NTD-affected fetuses and infants occurring in the 14-county Texas-Mexico border. Controls were randomly selected from unaffected live births, frequency matched to cases by hospital and year. An in-person interview of 110 case and 113 control mothers solicited data on folic acid supplements, dietary folate, and other covariates. Consumption of folic acid-containing vitamins before conception was only 5% for both case and control women. Taking vitamins the trimester before conception had no apparent effect, after adjusting for covariates [odds ratio (OR) = 1.0, 95% confidence interval (CI) = 0.3–3.4]. Combining folate from vitamins and diet showed a 20% risk reduction for women consuming at least 400 μg of folate daily [OR = 0.8, 95% CI = 0.5–1.5]; however, this estimate is statistically indistinguishable from the null. Although consistent with an inherent ineffectiveness of supplemental folic acid, that so few women consumed multivitamins during the critical time severely limited the assessment of folic acid in this population. A reduced folate response in Mexican descent women may be due to a genetic heterogeneity for metabolizing folate. Alternatively, folate intakes may be insufficient to overcome other underlying risk factors. In conclusion, determining whether folic acid reduces NTD risk in Mexican American women requires further study in populations with higher folic acid exposures. Meanwhile, we should pursue all recommended prevention strategies to reduce risk, including motivating Mexican American women of childbearing age to take folic acid routinely. ^

Tumour border configuration in colorectal cancer: proposal for an alternative scoring system based on the percentage of infiltrating margin.

AIMS Information on tumour border configuration (TBC) in colorectal cancer (CRC) is currently not included in most pathology reports, owing to lack of reproducibility and/or established evaluation systems. The aim of this study was to investigate whether an alternative scoring system based on the percentage of the infiltrating component may represent a reliable method for assessing TBC. METHODS AND RESULTS Two hundred and fifteen CRCs with complete clinicopathological data were evaluated by two independent observers, both 'traditionally' by assigning the tumours into pushing/infiltrating/mixed categories, and alternatively by scoring the percentage of infiltrating margin. With the pushing/infiltrating/mixed pattern method, interobserver agreement (IOA) was moderate (κ = 0.58), whereas with the percentage of infiltrating margins method, IOA was excellent (intraclass correlation coefficient of 0.86). A higher percentage of infiltrating margin correlated with adverse features such as higher grade (P = 0.0025), higher pT (P = 0.0007), pN (P = 0.0001) and pM classification (P = 0.0063), high-grade tumour budding (P < 0.0001), lymphatic invasion (P < 0.0001), vascular invasion (P = 0.0032), and shorter survival (P = 0.0008), and was significantly associated with an increased probability of lymph node metastasis (P < 0.001). CONCLUSIONS Information on TBC gives additional prognostic value to pathology reports on CRC. The novel proposed scoring system, by using the percentage of infiltrating margin, outperforms the 'traditional' way of reporting TBC. Additionally, it is reproducible and simple to apply, and can therefore be easily integrated into daily diagnostic practice.

An investigation of the association between obesity, acanthosis nigricans, and fasting serum insulin level in 6--9 year old children living on the El Paso-Juarez U.S.-Mexico border

The objectives of this study were to investigate the relationship between fasting serum insulin levels and Acanthosis Nigricans (AN) (a dermatological condition characterized by hyperpigmentation and thickening of the skin in specific body areas such as the neck and knuckles) and obesity among 6 to 9 year old children. Children were selected at random from a pediatric clinic located on the U.S.-Mexico border. Because none of the children participants had a weight for height at or above the 97th percentile of the CDC growth charts, obesity was defined as weight for height at or above the 95th percentile and at risk of overweight between the 85 th and 95th percentiles of the CDC growth charts. Anthropometrics, blood samples for fasting serum insulin and blood glucose, and a picture of the neck were obtained at baseline (n = 85) and 6 months later (n = 49). None of the children partipating had high fasting serum insulin levels and only 2 children had AN degree 2 (moderately severe). At baseline children with a weight for height at or above the 95th, percentile had 15 units less of insulin than children who weighed less. However, 6 months later this was not confirmed, thus the baseline result is considered to be an anomaly. Eventhough statistical significance was not reached, results showed that children without AN had 5 percentiles lower weight for height than children with AN. The most important recommendation from this study is the need to monitor longitudinal growth in children to characterize the individual child's growth pattern. AN seems to be related to longitudinal growth changes. ^