“Even if I were to consent, my family will never agree”: exploring autopsy services for posthumous occupational lung disease compensation among mineworkers in South Africa

Context: In the South African mining sector, cardiorespiratory-specific autopsies are conducted under the Occupational Diseases in Mines and Works Act (ODMWA) on deceased mineworkers to determine eligibility for compensation. However, low levels of autopsy utilisation undermine the value of the service. Objective: To explore enablers and barriers to consent that impact on ODMWA autopsy utilisation for posthumous monetary compensation. Methods: In-depth interviews were conducted with mineworkers, widows and relatives of deceased mineworkers as well as traditional healers and mine occupational health practitioners. Results: A range of socio-cultural barriers to consent for an autopsy was identified. These barriers were largely related to gendered power relations, traditional and religious beliefs, and communication and trust. Understanding these barriers presents opportunities to intervene so as to increase autopsy utilisation. Conclusions: Effective interventions could include engagement with healthy mine-workers and their families and re-evaluating the permanent removal of organs. The study adds to our understanding of utilisation of the autopsy services

Impact of U.S. Citizenship Status on Cancer Screening Among Immigrant Women

OBJECTIVES: We evaluated the relationship between U.S. citizenship status and the receipt of Pap smears and mammograms among immigrant women in California. DESIGN: Cross-sectional study using data from the 2001 California Health Interview Survey. PATIENTS/PARTICIPANTS: Noninstitutionalized, civilian women, aged 18 years and older living in California. MEASUREMENTS AND MAIN RESULTS: We analyzed data from the 2001 California Health Interview Survey and used logistic regression models to adjust for sociodemographic factors and for access and utilization of health services. After adjusting we found that U.S. citizen immigrants were significantly more likely to report receiving a Pap smear ever (adjusted prevalence ratio [aPR], 1.05; 95% confidence interval [CI], 1.01 to 1.08), a recent Pap smear (aPR, 1.07; 95% CI, 1.03 to 1.11), a mammogram ever (aPR, 1.17; 95% CI, 1.12 to 1.21), and a recent mammogram (aPR, 1.38; 95% CI, 1.26 to 1.49) as compared to immigrants who are not U.S. citizens. Also associated with receiving cancer screening were income, having a usual source of care, and having health insurance. Hispanic women were more likely to receive Pap smears as compared to whites and Asians. CONCLUSIONS: Not being a U.S. citizen is a barrier to receiving cervical and breast cancer screening. Additional research is needed to explore causal factors for differences in cancer screening rates between citizens and noncitizens