FACTS Special Issue on Migration and Health

Migration is a global phenomenon involving hundreds of millions of people, with major social and economic impacts on migrants in their countries of origin and destination and on their communities. In the U.S., California is by far the most affected state by these population movements. The University of California Global Health Institute (UCGHI), Center of Expertise on Migration and Health (COEMH) is devoted to systematically studying the health consequences of global population movements and developing more effective strategies to address them. A key objective of the Center is to enhance educational opportunities related to migration and health. To do this, the Center implements graduate education, conducts research on immigrant and refugee communities, establishes distance education opportunities, and develops transnational collaborations. These activities provide a rich, real-world environment for training the next generation of leaders who will respond to emerging health issues related to migration. The Center’s annual Research Training Workshop is one such activity, resulting in rich discussions, cross-disciplinary interactions, and invaluable learning opportunities. This special issue on migration and health stems from the Research Training Workshop held on June 21-23, 2011, which was organized by COEMH. The workshop brought nineteen graduate students and postdoctoral fellows together in a multi-disciplinary setting to present their research and receive constructive feedback from University of California faculty members. Each paper presented in this special issue represents a unique issue related to migration and health.L'immigration est un phénomène mondial qui concerne des centaines de millions de personnes, et qui a des conséquences socio-économiques majeures sur les migrants dans leur pays d'origine et dans leur pays de destination, et également sur leurs communautés. Aux Etats-Unis, la Californie est de loin l'état le plus touché par ces mouvements de population. Le COEMH (Center of Expertise on Migration and Health) de l’UCGHI (University of California Global Health Institute), est spécialisé dans l'étude systématique des conséquences des mouvements de population sur la santé et dans l'élaboration de stratégies efficaces pour y remédier. L'un des objectifs clés du Centre est d'accroître les opportunités d'apprentissage liées à l'immigration et à la santé. Pour cela, le Centre met un œuvre un enseignement supérieur, conduit des recherches sur les communautés d'immigrants et de réfugiés, crée des opportunités d'enseignement à distance, et développe des collaborations transnationales. Ces activités constituent un environnement concret permettant de former la prochaine génération de dirigeants qui devra faire face aux problèmes de santé émergents liés à l'immigration. Le Research Training Workshop est l'une des initiatives annuelles du Centre. Il consiste en des débats approfondis, des interactions pluridisciplinaires et des opportunités d'apprentissage utiles. Ce numéro spécial consacré à l'immigration et à la santé découle du Research Training Workshop organisé par le COEMH du 21 au 23 juin 2011. Cet atelier a réuni dix-neuf étudiants diplômés et post-doctorants dans un contexte pluridisciplinaire qui ont présenté leurs travaux de recherche et reçu des commentaires constructifs de la part des membres de la faculté de l'Université de Californie. Chaque article de ce numéro spécial traite d'un sujet spécifique lié à l'immigration et à la santé.La migración es un fenómeno de escala mundial que involucra a cientos de millones de personas  y tiene un impacto social y económico tanto en los inmigrantes, como ensus países de origen y  destino, y en las comunidades en las que viven. En los Estados Unidos, el estado más afectado por estos movimientos de población es  California. El Centro de Expertos en Migración y Salud (COEMH por sus siglas en inglés) del Instituto de Salud Global de la Universidad de California (UCGHI por sus siglas en inglés) se dedica a realizar estudios sistemáticos sobre las consecuencias que estos  movimientos de población mundial tienen sobre la salud,  a fin de crear estrategias efectivas para abordarlos. Un objetivo clave del Centro es mejorar las oportunidades educativas relacionadas con la inmigración y la salud.  Para ello, el Centro imparte enseñanza universitaria, realiza estudios sobre las comunidades de inmigrantes y refugiados, crea oportunidades de educación a distancia y desarrolla colaboraciones transnacionales. Estas actividades proporcionan un ambiente rico en experiencias reales  para formar a la próxima generación de líderes que darán respuesta a los problemas de salud emergentes relacionados con la migración. Una de estas oportunidades que el Centro ofrece anualmente es el Taller de Formación e Investigación  que propicia profusos debates, e interacciones interdisciplinarias, además de valiosas oportunidades de aprendizaje. Este número especial sobre inmigración y salud nació a partir del Taller de Formación e Investigación celebrado del 21 al 23 de junio de 2011, organizado por COEMH. El taller reunió a 19 estudiantes de postgrado y becarios posdoctorales en un entorno multidisciplinario dónde pudieron presentar sus investigaciones y escuchar opiniones constructivas por parte del cuerpo de docentes de la Universidad de California. Cada trabajo presentado en este número especial representa un aspecto único relacionado con la migración y la salud

Chronic Obstructive Pulmonary Disease Mortality in Diesel-Exposed Railroad Workers

Diesel exhaust is a mixture of combustion gases and ultrafine particles coated with organic compounds. There is concern whether exposure can result in or worsen obstructive airway diseases, but there is only limited information to assess this risk. U.S. railroad workers have been exposed to diesel exhaust since diesel locomotives were introduced after World War II, and by 1959, 95% of the locomotives were diesel. We conducted a case–control study of railroad worker deaths between 1981 and 1982 using U.S. Railroad Retirement Board job records and next-of-kin smoking, residential, and vitamin use histories. There were 536 cases with chronic obstructive pulmonary disease (COPD) and 1,525 controls with causes of death not related to diesel exhaust or fine particle exposure. After adjustment for age, race, smoking, U.S. Census region of death, vitamin use, and total years off work, engineers and conductors with diesel-exhaust exposure from operating trains had an increased risk of COPD mortality. The odds of COPD mortality increased with years of work in these jobs, and those who had worked ≥ 16 years as an engineer or conductor after 1959 had an odds ratio of 1.61 (95% confidence interval, 1.12–2.30). These results suggest that diesel-exhaust exposure contributed to COPD mortality in these workers. Further study is needed to assess whether this risk is observed after exposure to exhaust from later-generation diesel engines with modern emission controls

A Pilot Binational Study of Health Behaviors and Immigration

In the US, Mexican immigrant women often have better health outcomes than non-Hispanic white women despite a greater health risk profile. This cross-sectional pilot study compared women living in Chavinda, Michoacán (n = 102) to women who had migrated from Mexico to Madera, California (n = 93). The interview gathered information on acculturation and risk behaviors including smoking, alcohol use and number of sexual partners. The results suggest that more acculturated women living in the US are more likely to consume alcohol. US residence and higher acculturation level was marginally associated with having more than one sexual partner. There were no differences between odds of smoking among Chavinda and Madera women. While results with acculturation are not consistently significant due to small sample sizes, the results are suggestive that acculturation among immigrant Hispanic women in the US may be associated with adverse health behaviors, and selective migration seems less likely to account for these differences

Case Report: Potential Arsenic Toxicosis Secondary to Herbal Kelp Supplement

CONTEXT: Medicinal use of dietary herbal supplements can cause inadvertent arsenic toxicosis. CASE PRESENTATION: A 54-year-old woman was referred to the University of California, Davis, Occupational Medicine Clinic with a 2-year history of worsening alopecia and memory loss. She also reported having a rash, increasing fatigue, nausea, and vomiting, disabling her to the point where she could no longer work full-time. A thorough exposure history revealed that she took daily kelp supplements. A urine sample showed an arsenic level of 83.6 μg/g creatinine (normal < 50 μg/g creatinine). A sample from her kelp supplements contained 8.5 mg/kg (ppm) arsenic. Within weeks of discontinuing the supplements, her symptoms resolved and arsenic blood and urine levels were undetectable. DISCUSSION: To evaluate the extent of arsenic contamination in commercially available kelp, we analyzed nine samples randomly obtained from local health food stores. Eight of the nine samples showed detectable levels of arsenic higher than the Food and Drug Administration tolerance level of 0.5 to 2 ppm for certain food products. None of the supplements contained information regarding the possibility of contamination with arsenic or other heavy metals. The 1994 Dietary Supplement Health and Education Act (DSHEA) has changed the way dietary herbal therapies are marketed and regulated in the United States. Less regulation of dietary herbal therapies will make inadvertent toxicities a more frequent occurrence. RELEVANCE TO CLINICAL PRACTICE: Clinicians should be aware of the potential for heavy metal toxicity due to chronic use of dietary herbal supplements. Inquiring about use of dietary supplements is an important element of the medical history

Activation of inflammatory responses in human U937 macrophages by particulate matter collected from dairy farms: an in vitro expression analysis of pro-inflammatory markers

Abstract Background The purpose of the present study was to investigate activation of inflammatory markers in human macrophages derived from the U937 cell line after exposure to particulate matter (PM) collected on dairy farms in California and to identify the most potent components of the PM. Methods PM from different dairies were collected and tested to induce an inflammatory response determined by the expression of various pro-inflammatory genes, such as Interleukin (IL)-8, in U937 derived macrophages. Gel shift and luciferase reporter assays were performed to examine the activation of nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) and Toll-like-receptor 4 (TLR4). Results Macrophage exposure to PM derived from dairy farms significantly activated expression of pro-inflammatory genes, including IL-8, cyclooxygenase 2 and Tumor necrosis factor-alpha, which are hallmarks of inflammation. Acute phase proteins, such as serum amyloid A and IL-6, were also significantly upregulated in macrophages treated with PM from dairies. Coarse PM fractions demonstrated more pro-inflammatory activity on an equal-dose basis than fine PM. Urban PM collected from the same region as the dairy farms was associated with a lower concentration of endotoxin and produced significantly less IL-8 expression compared to PM collected on the dairy farms. Conclusion The present study provides evidence that the endotoxin components of the particles collected on dairies play a major role in mediating an inflammatory response through activation of TLR4 and NF-κB signaling

Pneumoconiosis from Agricultural Dust Exposure among Young California Farmworkers

BackgroundAgricultural workers are exposed to airborne pollutants, including organic and inorganic (mineral) dusts.ObjectivesLung autopsy specimens from consecutive coroner's cases of Hispanic males in Fresno County, California, (n = 112) were obtained to determine whether mineral dust exposure in agricultural work leads to pneumoconiosis.MethodsThe left lung was fixed by inflation. We evaluated airway and parenchymal pathology using standardized diagnostic criteria and semiquantitative grading schemata, including the grading of small airways for fibrosis and birefringent mineral dust particles. We analyzed lung dust burden on a subset of 37 lungs following bleach digestion, using scanning electron microscopy (SEM), X-ray spectrometry (XRS) and image analysis, and by X-ray diffraction for crystalline silica (CSi). Farmworkers comprised 51.5% and nonfarmworkers 48.5% of the samples.ResultsProximal airways demonstrated little mineral dust accumulation, but membranous and respiratory bronchioles had wall thickening, remodeling, and inflammation associated with carbonaceous and mineral dust deposition. These changes were independently associated with agricultural work, cigarette smoking, and increased age. Mineral dust small airways disease, pneumoconiosis (macules and nodules), and pathologic changes consistent with chronic bronchitis, emphysema, and interstitial fibrosis predominated in farmworkers compared with nonfarmworkers. CSi, determined gravimetrically, and aluminum silicate particles, determined by SEM/XRS, were increased in the lungs of farmworkers compared with nonfarmworkers and were significantly (p &lt; 0.05) associated with small airway disease and pneumoconiosis.ConclusionMineral dust exposure is associated with increased small airway disease and pneumoconiosis among California farmworkers; however, the clinical significance and natural history of these changes remains to be determined

The ethical issues regarding consent to clinical trials with pre-term or sick neonates: a systematic review (framework synthesis) of the empirical research

Background: Conducting clinical trials with pre-term or sick infants is important if care for this population is to be underpinned by sound evidence. Yet approaching parents at this difficult time raises challenges for the obtaining of valid informed consent to such research. This study asked: what light does the empirical literature cast on an ethically defensible approach to the obtaining of informed consent in perinatal clinical trials? Methods: A systematic search identified 49 studies. Analysis began by applying philosophical frameworks which were then refined in light of the concepts emerging from empirical studies to present a coherent picture of a broad literature. Results: Between them, studies addressed the attitudes of both parents and clinicians concerning consent in neonatal trials; the validity of the consent process in the neonatal research context; and different possible methods of obtaining consent. Conclusions: Despite a variety of opinions among parents and clinicians there is a strongly and widely held view that it is important that parents do give or decline consent for neonatal participation in trials. However, none of the range of existing consent processes reviewed by the research is satisfactory. A significant gap is evaluation of the widespread practice of emergency ‘assent’, in which parents assent or refuse their baby’s participation as best they can during the emergency and later give full consent to ongoing participation and follow-up. Emergency assent has not been evaluated for its acceptability, how such a process would deal with bad outcomes such as neonatal death between assent and consent, or the extent to which late parental refusal might bias results. This review of a large number of empirical papers, while not making fundamental changes, has refined and developed the conceptual framework from philosophy for examining informed consent in this context

Ramucirumab plus docetaxel versus placebo plus docetaxel in patients with locally advanced or metastatic urothelial carcinoma after platinum-based therapy (RANGE): a randomised, double-blind, phase 3 trial

Few treatments with a distinct mechanism of action are available for patients with platinum-refractory advanced or metastatic urothelial carcinoma. We assessed the efficacy and safety of treatment with docetaxel plus either ramucirumab-a human IgG1 VEGFR-2 antagonist-or placebo in this patient population