Mutilations génitales féminines: l'adolescente en quête de réponses [Female genital mutilation: need for answers at the age of adolescence]

En Suisse, le nombre de filles et de femmes migrantes excisées au cours de leur enfance dans leur pays d'origine ou menacées de mutilations génitales rituelles est estimé à 6-7000. Les professionnels de la santé en tant qu'interlocuteurs privilégiés doivent donc être en mesure de répondre aux questions y relatives, non seulement durant l'adolescence, mais aussi dans toutes les phases de la vie. L'absence d'information ou de transmission par des aînées aussi bien avant l'excision qu'au moment de la maturité sexuelle en fait souvent un événement biographique traumatisant. Arrivées en Suisse, le décalage entre les attentes socioculturelles et familiales et le vécu individuel, influencé par le pays d'accueil, peut s'avérer particulièrement difficile à vivre pour les jeunes filles concernées. In Switzerland, the estimated number of survivors after traditional female genital mutilation in the country of origin or girls and adult women at risk is 6-7000. Health professionals must be able to respond adequately to their questions not only during adolescence but through out the different periods of life. The lack of information or transmission by the seniors as well before the excision as at the time of sexual maturity contributes in a large measure to the frequent biographic trauma. It can be very difficult for the girls to deal with the gap between socio cultural and family expectations and their individual life experience in Switzerland.

Carie du biberon: un caillou dans la chaussure de la santé [The impact of childhood caries].

The early childhood caries affect primary dentition before the eruption of the permanent teeth. It is set to extended use of a bottle containing fermentable carbohydrates. The early childhood caries is not only a dental disease: it is a social, cultural and behavioral condition that reflects the practices and beliefs around the child. Swiss data indicate that in aged 2 children, one of for could be affected by this devastating oral disease, mainly in vulnerable populations. The primary care physician has an important role in the screening of preschool children, in determining the risk level of the child for early childhood caries. Physicians can advise families, especially pregnant women, about preventive measures and behavior, leading to a dramatic drop of early childhood caries prevalence.

Système de suivi de la stratégie de lutte contre le VIH/sida en Suisse 2004-2008: étude de faisabilité pour une enquête "sentinelle" auprès des femmes migrantes - d'origine subsaharienne en particulier

[Table des matières] 1. Introduction. 2. Méthodologie. 3. Résultats. 3.1. Données sociodémographiques. 3.2. Comportements sexuels. 3.3. Besoins en conseils concernant le VIH/sida et les autres IST. 3.4. Facteurs associés à l'utilisation du préservatif lors du dernier rapport sexuel. 3.5. Facteurs associés à la condition de femme migrante dans la consultation de la policlinique gynécologique. 3.6. Faisabilité de l'étude. 4. Conclusions. 5. Bibliographie.

Migration et santé : analyse des besoins dans le canton de Vaud

[Table des matières] 1. Introduction. 2. Besoin en matière de programmes offrant une égalité des chances. 3. Programmes de promotion de la santé et de prévention évalués. 4. Mesures prises pour garantir l'égalité des chances d'accès lors de la conception et de la mise en oeuvre des programmes. 5. Participation aux programmes. 6. Quels obstacles à la participation des migrants et quels facteurs susceptibles de l'améliorer?: avis des personnes consultées. 7. Mesures recommandées. 8. Annexes. 9. Références.

Migration et compétence sanitaire : constats et exemple de l'Hôpital de l'enfance à Lausanne

[...] L'objectif de ce travail est d'exposer les notions de "compétence sanitaire" (Health Literacy) et d' "autonomisation" (Empowerment) dans un contexte de prise en charge pédiatrique des enfants de migrants. Nous sommes convaincus que ces deux concepts émergeants dans le domaine de la santé et appliqués au contexte migratoire constituent, sur les plans économiques et de management, des éléments qui peuvent mener à terme à : i) une réduction mesurable des coûts de la santé et ii) une porte d'entrée efficace dans un processus d'intégration - dont l'importance est reconnue sur le plan économique - des migrants dans leur pays d'accueil. Tout au long de ce travail, il apparaîtra comme évident que des données propres à la prise en charge sanitaire pédiatrique des enfants de migrants font actuellement souvent défaut, a fortiori l'application des concepts de compétence sanitaire et d'autonomisation pour cette part de la société. Nous le percevons comme une opportunité de mettre en place les conditions cadres pour combler ce vide. Nous poserons tout d'abord le cadre de ce mémoire au travers de la présentation des concepts de compétence sanitaire et d'autonomisation, en mettant en avant leurs aspects économiques dans les systèmes de santé actuels, en particulier en Suisse. Nous présenterons dans les chapitres 2 et 3 d'une part des données concernant l'état de santé de la population migrante en Suisse et d'autre part la stratégie mise en place au niveau fédéral dans le domaine " migration et santé 2008-2013 ". Le chapitre 4 nous permettra de présenter un "case study" que nous avons intégré à notre travail afin d'apporter des éléments plus concrets aux notions théoriques abordées dans ce mémoire. Nous avons choisi de nous concentrer sur l'Hôpital de l'Enfance de Lausanne (HEL) parce que l'HEL nous semble présenter un cas de structure hospitalière qui fait un effort remarquable de prise en charge médico-psycho-sociale des enfants de migrants. Le chapitre 5, en conclusion, aura pour objectif principal de soutenir que l'inclusion d'une dimension de management/gestion de la santé (représenté ici par l'autonomisation et la compétence sanitaire) introduirait une valeur ajoutée remarquable à l'effort constructif consenti sur le plan médico-social décrit au chapitre précédent. [Auteure, p. 4-5]

Italia: La chiusura della Casa dell’Emigrante come spunto riflessione sui rientri degli emigrati italiani

In the literature on migration, as well as in social policies regarding this phenomenon, the situation of returning emigrants receives scant attention. This essay establishes an intricate connection between attitudes and policies that prevail in a country regarding emigration and those concerning immigration. The case of Italy provides a prime example for this as it once was a classical country of emigration, only to turn, in recent decades, into a country that appears highly attractive (and relatively accessible) to immigrants. The essay traces the pervasive ambiguity that characterizes this country’s attitudes towards emigration from the beginning of mass emigration shortly after the unification of Italy in 1868 to the emigration policies of the fascist regime of Mussolini and the post-World War II waves of emigration right through to the corresponding ambiguity concerning the status of immigrants in contemporary society, including the indifferent treatment of returning Italian emigrants who constitute a considerable numerical phenomenon. These reflections take their origin from the impending closure of a reception centre in Lazio, the Casa dell’Emigrante near Sant’Elia Fiumerapido, Province of Frosinone, ostensibly for financial reasons. This centre had been the only one of its kind in the whole of Italy dealing officially with the needs of repatriated Italians. It had assisted returning emigrants both with practical matters, such as negotiating the labyrinth of Italian bureaucracy , and with psychological implications of a return, which are often considerable given the time lag of experiences with current social realities and the frequently unrealistic expectations associated with the return. Questions of identity become highly acute in those circumstances. The threatened closure of the centre illustrates the unwillingness of the state to face up to the factual prevalence of migratory experiences in the country as a whole and as a core element of national history, experiences of migration in both directions. The statistics speak for themselves: of the 4.660.427 persons who left Italy between 1880 and 1950, 2.322.451 have returned, almost exactly 50%. To those have to be added 3.628.430 returnees of the 5.109.860 emigrants who left Italy between the end of World War II and 1976 for Europe alone. Attitudes towards people leaving changed ostensibly over time. In the first two decades after Unification parliament on the one hand wanted to show some concern over the fate of its citizens, not wanting to abandon those newly created citizens entirely to their own destiny, while on the other portraying their decisions to emigrate as expressions of individual liberty and responsibility and not necessitated by want and poverty. Emigrants had to prove, paradoxically that they had the requisite means to emigrate when in fact poverty was largely driving them to emigrate. To admit that publicly would have amounted to admission of economic and political failure made evident through emigration. In contrast to that Mussolini’s emigration policies not only enforced large population movements within the territory of Italy to balance unemployment between regions and particularly between North and South, but also declared it citizen’s duty to be ready to move also to the colonies, thereby ‘turning emigration as a sign of social crisis into a sign of national strength and the success of the country’s political agenda’ (Gaspari 2001, p. 34). The duplicity continued even after World War II when secret deals were done with the USA to allow a continuous flow of Italian immigrants and EU membership obviously further facilitated the departure of unemployed, impoverished Italians. With the growing prosperity of Italy the reversal of the direction of migration became more obvious. On the basis of empirical research conducted by one of the author on returning emigrants four types of motives for returning can be distinguished: 1. Return as a result of failure – particularly the emigrants who left during the 1950-1970 period usually had no linguistic preparation, and in any case the gap between the spoken and the written language is enormous with the latter often being insurmountable. This gives rise to nostalgic sentiments which motivates a return into an environment where language is familiar 2. Return as a means of preserving an identity – the life of emigrants often takes place within ghetto-like conditions where familiarity is being reproduced but under restricted conditions and hence not entirely authentic. The necessity for saving money permits only a partial entry into the host society and at the same time any accumulating savings add to the desire to return home where life can be lived fully again – or so it seems. 3. Return of investment – the impossibility to become fully part of another society often motivates migrants to accumulate not so much material wealth but new experiences and competences which they then aim to reinvest in their home country. 4. Return to retire – for many emigrants returning home becomes acute once they leave a productive occupation and feelings of estrangement build up, in conjunction with the efforts of having invested in building a house back home. All those motives are associated with a variety of difficulties on the actual return home because, above all, time in relation to the country of origin has been suspended for the emigrant and the encounter with the reality of that country reveals constant discrepancies and requires constant readjustment. This is where the need for assistance to returning emigrants arises. The fact that such an important centre of assistance has been closed is further confirmation of the still prevailing politics of ambiguity which nominally demand integration from nationals and non-nationals alike but deny the means of achieving this. Citizenship is not a natural result of nationality but requires the means for active participation in society. Furthermore, the experiences of returning immigrants provide important cues for the double ambivalence in which immigrants to Italy live between the demands made on them to integrate, the simultaneous threats of repatriation and the alienation from the immigrants’ home country which grows inexorably during the absence. The state can only regain its credibility by putting an end to this ambiguity and provide to returning emigrants, and immigrants alike, the means of reconstructing strong communal identities.

Relación en España de la duración de la gestación y del peso al nacer con la nacionalidad de la madre durante el período 2001-2005

Fundamento: La asociación de la inmigración con el bajo peso al nacimiento (BP) y el parto pretérmino (PP) es un importante indicador de inequidades en salud. El objetivo de este estudio es analizar las diferencias entre BP y el PP según la nacionalidad de la madre. Métodos: Los datos proceden del Boletín Estadístico de Nacimientos. Durante el período de estudio hubo 1.878.718 recién nacidos. La nacionalidad fue considerada como variable de exposición (española-inmigrante). Las variables de efecto son BP (nacimientos de 37 o más semanas de gestación con un peso inferior a 2.500 gramos) y PP (recién nacidos con menos de 37 semanas de gestación). Se calcularon odds ratios simples y ajustadas por posibles variables de confusión mediante regresión logística. Resultados: La prevalencia de BP y PP entre las mujeres españolas fue de 7,9% y 3,2% respectivamente, mientras que en las extranjeras fue de 7,3% y 2,4% respectivamente. En comparación con las españolas, el riesgo más bajo de PP lo presentaron las mujeres procedentes de África del Norte (ORa= 0,77 IC95%0,74-0,80). Con respecto al BP el riesgo más bajo se observó en madres de Sudamérica (ORa=0,62 IC95%0,59-0,65) y Europa del Este (ORa=0,65 IC95%0,60-0,71). Conclusión: Los recién nacidos de madre extranjera presentan menos riesgo de BP y PP que los autóctonos, posiblemente como consecuencia del sesgo por la condición de ser inmigrante sano y por la menor frecuencia de prácticas de riesgo durante la gestación de las mujeres inmigrantes.

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.

Do Legal Immigrants and Natives Compete in the Labour Market? Evidence from Catalonia

The precondition for labour-market competition between immigrants and natives is that both are willing to accept jobs that do not differ in quality. To test this hypothesis, in this paper we compare the working conditions between immigrants and natives in Catalonia. Comparing immigrants’ working conditions in relation to their native counterparts is not only a useful analysis for studying the extent to which immigrants and low-skilled native workers are direct competitors in the labour market, but also allows us to contribute to the literature on this issue by moving away from the conventional approach used in previous studies. Our results indicate that: i) natives and immigrants display a different taste for job (dis)amenities; ii) Catalan-born workers might be in direct competition with EU15 immigrants, while non-Catalan Spanish workers might be competing with Latin American immigrants, and; iii) African-born immigrants are the group in the Catalan workforce that by far face the worst working conditions.

"Re-huminization": the role of human-animal similarity in predicting prejudice towards immigrants and non-human animals

Research implies that there ~ay be an association between attitudes toward margil1alized human outgroups and non-human animals. Very few studies, however, have specifically tested this relation empirically. The general purpose of the present research was to determine if such a relation exists and if perceptions of human-animal similarity avail as a common predictor of both types of attitudes. Ideological orientations associated with prejudiced attitudes (Social Dominance Orientation, Right-Wing Authoritarianism, and Universal Orientation) were also examined as individual differences in predicting perceptions of human-animal similarity. As predicted, people who endorsed prejudiced attitudes toward human outgroups (Study 1) and immigrants in particular (Studies 2 and 3), were more likely to endorse prejudiced attitudes toward non-human animals. In Study 2, perceptions that humans are superior (versus similar) to other animals directly predicted higher levels of prejudice toward non-human animals, whereas the effect of human superiority beliefs on immigrant prejudice was mediated by dehumanization. In other words, greater perceptions of humans as superior (versus similar) to other animals "allowed for" greater dehumanization of immigrants, which in turn resulted in heightened immigrant prejudice. Furthermore, people higher in Social Dominance Orientation or Right-Wing Authoritarianism were particularly likely to perceive humans as superior (versus similar) to other animals, whereas people characterized by a greater Universal Orientation were more likely to perceive humans and non-human animals as similar. Study 3 examined whether inducing perceptions of human-animal similarity through experimental manipulation would lead to more favourable attitudes toward non-human animals and immigrants. Participants were randomly assigned to read one of four 11 editorials designed to highlight either the similarities or differences between humans and other animals (i.e., animals are similar to humans; humans are similar to animals;~~nimals are inferior to humans; humans are superior to animals) or to a neutral control condition. Encouragingly, when animals were described as similar to humans, prejudice towards non-human animals and immigrants was significantly lower, and to some extent this finding was also true for people naturally high in prejudice (i.e., high in Social Dominance Orientation or Right-Wing Authoritarianism). Inducing perceptions that nonhuman animals are similar to humans was particularly effective at reducing the tendency to dehumanize immigrants ("re-humanization"), lowering feelings of personal threat regarding one's animal-nature, and at increasing inclusive intergroup representations and empathy, all of which uniquely accounted for the significant decreases in prejudiced attitudes. Implications for research, theory and prejudice interventions are considered.

Redistribution and attitudes toward immigrants: A European perspective

We investigate whether the dependence of immigrants on welfare benefits leads to opposition to further immigration by natives and immigrants in a pooled cross-section of 21 European countries for the 2004{2010 period. Explicitly controlling for the dependence of immigrants and natives on benefits we find that higher benefit take-up rates among immigrants than among natives lead to less favourable attitudes of natives towards immigration. Interestingly, we do not find similar stylised facts for immigrants' attitudes towards immigration.

Redistribution and attitudes toward immigrants: A European perspective

We investigate whether the dependence of immigrants on welfare benefits leads to opposition to further immigration by natives and immigrants in a pooled cross-section of 21 European countries for the 2004-2010 period. Explicitly controlling for the dependence of immigrants and natives on benefits we find that higher benefit take-up rates among immigrants than among natives lead to less favourable attitudes of natives towards immigration. Interestingly, we do not find similar stylised facts for immigrants' attitudes towards immigration.

Health inequality between immigrants and natives in Spain: the loss of the healthy immigrant effect in times of economic crisis

Background: The immigrant population living in Spain grew exponentially in the early 2000s but has been particularly affected by the economic crisis. This study aims to analyse health inequalities between immigrants born in middle- or low-income countries and natives in Spain, in 2006 and 2012, taking into account gender, year of arrival and socioeconomic exposures. Methods: Study of trends using two cross-sections, the 2006 and 2012 editions of the Spanish National Health Survey, including residents in Spain aged 15–64 years (20 810 natives and 2950 immigrants in 2006, 14 291 natives and 2448 immigrants in 2012). Fair/poor self-rated health, poor mental health (GHQ-12 > 2), chronic activity limitation and use of psychotropic drugs were compared between natives and immigrants who arrived in Spain before 2006, adjusting robust Poisson regression models for age and socioeconomic variables to obtain prevalence ratios (PR) and 95% confidence interval (CI). Results: Inequalities in poor self-rated health between immigrants and natives tend to increase among women (age-adjusted PR2006 = 1.39; 95% CI: 1.24–1.56, PR2012 = 1.56; 95% CI: 1.33–1.82). Among men, there is a new onset of inequalities in poor mental health (PR2006 = 1.10; 95% CI: 0.86–1.40, PR2012 = 1.34; 95% CI: 1.06–1.69) and an equalization of the previously lower use of psychotropic drugs (PR2006 = 0.22; 95% CI: 0.11–0.43, PR2012 = 1.20; 95% CI: 0.73–2.01). Conclusions: Between 2006 and 2012, immigrants who arrived in Spain before 2006 appeared to worsen their health status when compared with natives. The loss of the healthy immigrant effect in the context of a worse impact of the economic crisis on immigrants appears as potential explanation. Employment, social protection and re-universalization of healthcare would prevent further deterioration of immigrants’ health status.