Impact of immigration on the cost of emergency visits in Barcelona (Spain)

BACKGROUND: The impact of immigration on health services utilisation has been analysed by several studies performed in countries with lower levels of immigration than Spain. These studies indicate that health services utilisation is lower among the immigrant population than among the host population and that immigrants tend to use hospital emergency services at the expense of primary care. We aimed to quantify the relative over-utilisation of emergency services in the immigrant population. METHODS: Emergency visits to Hospital del Mar in Barcelona in 2002 and 2003 were analysed. The country of origin, gender, age, discharge-related circumstances (hospital admission, discharge to home, or death), medical specialty, and variable cost related to medical care were registered. Immigrants were grouped into those from high-income countries (IHIC) and those from low-income countries (ILIC) and the average direct cost was compared by country of origin. A multivariate linear mixed model of direct costs was adjusted by country of origin (classified in five groups) and by the individual variables of age, gender, hospital admission, and death as a cause of discharge. Medical specialty was considered as a random effect. RESULTS: With the exception of gynaecological emergency visits, costs resulting from emergency visits by both groups of immigrants were lower than those due to visits by the Spanish-born population. This effect was especially marked for emergency visits by adults. CONCLUSION: Immigrants tend to use the emergency department in preference to other health services. No differences were found between IHIC and ILIC, suggesting that this result was due to the ease of access to emergency services and to lack of knowledge about the country's health system rather than to poor health status resulting from immigrants' socioeconomic position. The use of costs as a variable of complexity represents an opportunistic use of a highly exhaustive registry, which is becoming ever more frequent in hospitals and which overcomes the lack of clinical information related to outpatient activity

Mixture-risk-assessment of pesticide residues in retail polyfloral honey

[EN] The presence of even tiny quantities of pesticide residues in honey, a traditional healthy product, is a matter of concern for producers, packers and consumers. This paper aims to quantify pesticides in retail brands of polyfloral honey, and to calculate the mixture risk assessment of honey for consumers according to the results obtained from the analyzed samples. A LC-MS/MS multi-residue method was developed and validated for 13 compounds: 11 pesticides (chlorfenvinphos, coumaphos, tau-fluvalinate, amitraz, which are very common in veterinary treatments, and imidacloprid, acetamiprid, simazine, cyproconazole, tebuconazole, chlorpiryphos-methyl, chlorpiryphos, widely used in agricultural practices), and 2 metabolites of amitraz (2,4-DMA and 2,4-DMF). Results showed that the samples contained pesticide residues at different concentrations; however, the MRL in honey for each of the 11 pesticides was never exceeded. The most common were amitraz (from 1 to 50 ¿Ýg/kg) present in 100% of the samples, and coumaphos (up to 14 ¿Ýg/kg) in 63%. The hazard index (HI) for adults was less than 0.002 in all cases, a long way from 1, the value established as the limit of acceptability. Therefore, commercial honey does not represent any significant risk to health. However, considering that residue levels should be present ¡§as low as reasonably achievable¡¿ it is deemed necessary to make an effort to reduce their presence by appropriate agricultural and, above all, beekeeping practices due to acaridae treatments.This study forms part of a project funded by the Ministerio de Economia y Competitividad of Spain (Programa Estatal de Investigacion Desarrollo e Innovacion Orientada a los retos de la sociedad; Project number AGL2013-48646-R), for which the authors are grateful.Juan Borrás, MDS.; Doménech Antich, EM.; Escriche Roberto, MI. (2016). Mixture-risk-assessment of pesticide residues in retail polyfloral honey. Food Control. 67:127-134. https://doi.org/10.1016/j.foodcont.2016.02.051S1271346

The effect on cardiovascular risk factors of migration from rural to urban areas in Peru: PERU MIGRANT Study

BACKGROUND: Mass-migration observed in Peru from the 1970s occurred because of the need to escape from politically motivated violence and work related reasons. The majority of the migrant population, mostly Andean peasants from the mountainous areas, tends to settle in clusters in certain parts of the capital and their rural environment could not be more different than the urban one. Because the key driver for migration was not the usual economic and work-related reasons, the selection effects whereby migrants differ from non-migrants are likely to be less prominent in Peru. Thus the Peruvian context offers a unique opportunity to test the effects of migration. METHODS/DESIGN: The PERU MIGRANT (PEru's Rural to Urban MIGRANTs) study was designed to investigate the magnitude of differences between rural-to-urban migrant and non-migrant groups in specific CVD risk factors. For this, three groups were selected: Rural, people who have always have lived in a rural environment; Rural-urban, people who migrated from rural to urban areas; and, Urban, people who have always lived in a urban environment. DISCUSSION: Overall response rate at enrolment was 73.2% and overall response rate at completion of the study was 61.6%. A rejection form was obtained in 282/323 people who refused to take part in the study (87.3%). Refusals did not differ by sex in rural and migrant groups, but 70% of refusals in the urban group were males. In terms of age, most refusals were observed in the oldest age-group (>60 years old) in all study groups. The final total sample size achieved was 98.9% of the target sample size (989/1000). Of these, 52.8% (522/989) were females. Final size of the rural, migrant and urban study groups were 201, 589 and 199 urban people, respectively. Migrant's average age at first migration and years lived in an urban environment were 14.4 years (IQR 10-17) and 32 years (IQR 25-39), respectively. This paper describes the PERU MIGRANT study design together with a critical analysis of the potential for bias and confounding in migrant studies, and strategies for reducing these problems. A discussion of the potential advantages provided by the case of migration in Peru to the field of migration and health is also presented

WHICH ARE THE LARGEST? WHY LISTS OF MAJOR URBAN AREAS VARY SO GREATLY

Lists of the world's most populous urban areas are surprisingly inconsistent in standard reference sources. These even disagree about which area is the world's largest. We first review the differences found in lists of the 20 largest areas reported by several unofficial sources and by the United Nations. We then demonstrate that variations in the populations and rankings stem mostly from differences in concepts and geographic definitions, and identify six different types of definition in the UN's list. We also offer a set of consistently defined metropolitan areas based on stated guidelines. Case studies for Tokyo, Mexico City, Los Angeles and Beijing include maps to elucidate the administrative areas and statistical definitions in use in each of these urban areas, and illustrate how the varying definitions yield different population totals. We conclude by comparing our consistently defined metropolitan areas with the UN's list of largest urban agglomerations. Copyright (c) 2009 by the Royal Dutch Geographical Society KNAG.