Health and access to care for undocumented migrants living in the European Union: a scoping review.

BACKGROUND: Literature on health and access to care of undocumented migrants in the European Union (EU) is limited and heterogeneous in focus and quality. Authors conducted a scoping review to identify the extent, nature and distribution of existing primary research (1990-2012), thus clarifying what is known, key gaps, and potential next steps. METHODS: Authors used Arksey and O'Malley's six-stage scoping framework, with Levac, Colquhoun and O'Brien's revisions, to review identified sources. Findings were summarized thematically: (i) physical, mental and social health issues, (ii) access and barriers to care, (iii) vulnerable groups and (iv) policy and rights. RESULTS: Fifty-four sources were included of 598 identified, with 93% (50/54) published during 2005-2012. EU member states from Eastern Europe were under-represented, particularly in single-country studies. Most study designs (52%) were qualitative. Sampling descriptions were generally poor, and sampling purposeful, with only four studies using any randomization. Demographic descriptions were far from uniform and only two studies focused on undocumented children and youth. Most (80%) included findings on health-care access, with obstacles reported at primary, secondary and tertiary levels. Major access barriers included fear, lack of awareness of rights, socioeconomics. Mental disorders appeared widespread, while obstetric needs and injuries were key reasons for seeking care. Pregnant women, children and detainees appeared most vulnerable. While EU policy supports health-care access for undocumented migrants, practices remain haphazard, with studies reporting differing interpretation and implementation of rights at regional, institutional and individual levels. CONCLUSIONS: This scoping review is an initial attempt to describe available primary evidence on health and access to care for undocumented migrants in the European Union. It underlines the need for more and better-quality research, increased co-operation between gatekeepers, providers, researchers and policy makers, and reduced ambiguities in health-care rights and obligations for undocumented migrants

Which health research gets used and why? An empirical analysis of 30 cases

Background: While health research is considered essential for improving health worldwide, it remains unclear how it is best organized to contribute to health. This study examined research that was part of a Ghanaian-Dutch research program that aimed to increase the likelihood that results would be used by funding research that focused on national research priorities and was led by local researchers. The aim of this study was to map the contribution of this research to action and examine which features of research and translation processes were associated with the use of the results. Methods: Using Contribution Mapping, we systematically examined how 30 studies evolved and how results were used to contribute to action. We combined interviews with 113 purposively selected key informants, document analysis and triangulation to map how research and translation processes evolved and contributions to action were realized. After each case was analysed separately, a cross-case analysis was conducted to identify patterns in the association between features of research processes and the use of research. Results: The results of 20 of the 30 studies were used to contribute to action within 12 months. The priority setting and proposal selection process led to the funding of studies which were from the outset closely aligned with health sector priorities. Research was most likely to be used when it was initiated and conducted by people who were in a position to use their results in their own work. The results of 17 out of 18 of these user-initiated studies were translated into action. Other features of research that appeared to contribute to its use were involving potential key users in formulating proposals and developing recommendations. Conclusions: Our study underlines the importance of supporting research that meets locally-expressed needs and that is led by people embedded in the contexts in which results can be used. Supporting the involvement of health sector professionals in the design, conduct and interpretation of research appears to be an especially worthwhile investment

Operational research in low-income countries: what, why, and how?

Operational research is increasingly being discussed at institutional meetings, donor forums, and scientific conferences, but limited published information exists on its role from a disease-control and programme perspective. We suggest a definition of operational research, clarify its relevance to infectious-disease control programmes, and describe some of the enabling factors and challenges for its integration into programme settings. Particularly in areas where the disease burden is high and resources and time are limited, investment in operational research and promotion of a culture of inquiry are needed so that health care can become more efficient. Thus, research capacity needs to be developed, specific resources allocated, and different stakeholders (academic institutions, national programme managers, and non-governmental organisations) brought together in promoting operational research

Thermodynamic model of flue gas cooling path and implications on heavy metal recovery from MSWI fly ash

Solid residuals of municipal solid waste incineration (MSWI), i.e. bottom ash and fly ash contain significant quantities of heavy metals. Nearly 80’000 tons of MSWI fly ash is produced annually in Switzerland. From the combustion of waste wood, another 6’000t of waste wood fly ash arise annually, which show heavy metal concentrations in the range of MSWI fly ash. In Switzerland, the current practice is to stabilize and dispose of the residues from waste incineration on landfills or underground storage. For MSWI fly ash, heavy metal recovery through acid leaching will be mandatory from 2026 onwards. For waste wood fly ash, heavy metals will have to be recovered from 2024 onwards and it is a matter of discussion, whether a co-treatment with MSWI fly ash could be expedient. The heavy metals are recovered from MSWI fly ash through acid fly ash leaching (FLUWA process). The MSWI fly ash here represents a mix of the different ash fractions (boiler- and electrostatic precipitator ashes) that arise along the flue gas cooling path. With regard to the obligation of heavy metal recovery from MSWI fly ash, it has not yet been conclusively defined whether the heavy metal recovery from boiler ash is expedient from a technical and ecological point of view, as little data exists on its geochemical characteristics and heavy metal binding forms. The recovery of metals from the waste makes a valuable contribution to a sustainable closure of material cycles, as metals from primary raw material mining can partly be returned to the material cycle and the environmental pollution though land-filling is minimized. This thesis focusses on inventory of volatile heavy metals (e.g. Zn, Pb, Cu, Cd) in MSWI fly ash. Detailed characterization in combination with leaching experiments allow new insights on their chemical and mineralogical composition, heavy metal binding forms and leachability. Thermodynamic modeling was used as complemen-tary approach to investigate ash-forming processes and transport mechanisms occurring during cooling of the flue gas. The influence of flue gas composition on phase assemblages and the formation conditions of PCDD/-F thereby represent further investigated aspects. It has been shown that the MSWI boiler ashes are significantly different materials than the electrostatic precipitator ash and that their share on the bulk fly ash is approximately 25 - 30%. The boiler ash consists mainly of acid-buffering and inert refractory minerals, as well as amorphous glass phase and shows considerably lower heavy metal concentrations than the electrostatic precipitator ash. The thermodynamic simulations predict, that Zn and Cu in the boiler ash fractions are preferably stable as silicates (Zn2SiO4) and oxides (e.g. ZnO, Fe2ZnO4, CuO), phases that have also been analytically verified. The elec-trostatic precipitator ash is dominated by a chloride and sulfate matrix which shows a low acid-buffering capacity and shows much higher concentrations in the heavy metals of interest (Zn, Cd, Cu, Pb), predominantly in the form of easily soluble salts. These obser-vations suggest that the electrostatic precipitator ash shows a higher potential for heavy metal recovery. The thermodynamic simulations confirm that the S/Cl ratio in the flue gas primarily controls the predicted equilibrium phase assemblages, while variations in O2 concentration affects the composition of the ash to a minor extent. The thermodynamic modelling further indicate that the formation of gaseous PCDD/-F should take place at extremely reducing conditions which are not expected for typical bulk flue gas conditions. It is suggested that necessary reducing conditions may establish, e.g. in close vicinity to the combustion of plastic or other solid particles. The results of this thesis give new in- sights into the ash-forming processes during the cooling of the flue gas and contribute to a better understanding of speciation of heavy metals in the ash, as well as of the leachability of individual fractions of MSWI fly ash and waste wood fly ash. The data may serve as a basis for life cycle assessment and to concretize the enforcement aid for heavy metal recovery. In particular, further development of thermodynamic modelling approach opens opportunity for theoretical investigation of the combustion condition in the incineration plant, optimization of the combustion process and potential minimization of toxic organic pollutants

Utilisation of sexual health services by female sex workers in Nepal

Background The Nepal Demographic Health Survey (NDHS) in 2006 showed that more than half (56%) of the women with sexually transmitted infections (STIs), including HIV, in Nepal sought sexual health services. There is no such data for female sex workers (FSWs) and the limited studies on this group suggest they do not even use routine health services. This study explores FSWs use of sexual health services and the factors associated with their use and non-use of services. Methods This study aimed to explore the factors associated with utilisation of sexual health services by FSWs in the Kathmandu Valley of Nepal, and it used a mixed-method approach consisting of an interviewer administered questionnaire-based survey and in-depth interviews. Results The questionnaire survey, completed with 425 FSWs, showed that 90% FSWs self-reported sickness, and (30.8%) reported symptoms of STIs. A quarter (25%) of those reporting STIs had never visited any health facilities especially for sexual health services preferring to use non-governmental clinics (72%), private clinics (50%), hospital (27%) and health centres (13%). Multiple regression analysis showed that separated, married and street- based FSWs were more likely to seek health services from the clinics or hospitals. In- depth interviews with 15 FSWs revealed that FSWs perceived that personal, structural and socio-cultural barriers, such as inappropriate clinic opening hours, discrimination, the judgemental attitude of the service providers, lack of confidentiality, fear of public exposure, and higher fees for the services as barriers to their access and utilisation of sexual health services. Conclusion FSWs have limited access to information and to health services, and operate under personal, structural and socio-cultural constraints. The ‘education’ to change individual behaviour, health worker and community perceptions, as well as the training of the health workers, is necessary

Waste Wood Fly Ash Treatment in Switzerland: Effects of Co-Processing with Fly Ash from Municipal Solid Waste on Cr(VI) Reduction and Heavy Metal Recovery

In Switzerland, waste wood fly ash (WWFA) must be treated before deposition on landfills due to its high pollutant load (Cr(VI) and heavy metals). Acid fly ash leaching, the process used for heavy metal recovery from municipal solid waste incineration fly ash (MSWIFA), represents a possible treatment for heavy metal depletion and Cr(VI) reduction in WWFA. The co-processing of WWFA with MSWIFA during acid fly ash leaching was investigated in laboratory- and industrial- scale experiments with different setups. Of interest were the effects on heavy metal recovery efficiency, the successful outcome of Cr(VI) reduction and consumption of neutralizing chemicals (HCl, H2O2). Detailed chemical and mineralogical characterization of two WWFA types and MSWIFA showed that MSWIFA has higher concentrations in potentially harmful elements than WWFA. However, both WWFA types showed high concentrations in Pb and Cr(VI), and therefore need treatment prior to deposition. Depending on the waste wood proportion and quality, WWFA showed chemical and mineralogical differences that affect leaching behavior. In all experimental setups, successful Cr(VI) reduction was achieved. However, WWFA showed higher consumption of HCl and H2O2, the latter resulting in a particularly negative effect on the recovery of Pb and Cu. Thus, co-processing of smaller WWFA portions could be expedient in order to diminish the negative effects of Pb and Cu recovery

Characterization of MSWI fly ashes along the flue gas cooling path and implications on heavy metal recovery through acid leaching

This study reports on detailed chemical and mineralogical characterization of the different municipal solid waste incineration ashes forming along the flue gas path of plants with separate dust removal and neutralization. In pursuit of optimizing heavy metal recovery through acid leaching, the metal extractability from empty pass ashes (EA), boiler ashes (BOA) and the electrostatic precipitator ashes (ESPA) was evaluated and compared. The focus was laid on matrix phases affecting leachability (e.g. alkalinity, oxidation–reduction potential), as well as on distribution and concentration of recoverable heavy metals and their binding forms. The data showed, that EA and BOA are geochemically similar and are essentially composed of two different materials: the heavy metal poor airborne ash particles and the Zn- and Pb-rich sulfate deposits that condensate on heat exchanger surfaces. Variation in relative amount and chemical composition of the deposits is responsible for fluctuations in bulk composition of EA and BOA. The ESPA shows different chemical and mineralogical characteristics than EA and BOA. The ESPA is enriched in the volatile heavy metals Zn, Pb, Cu, Cd and Sn, which are mainly incorporated in chlorides and sulfates. The high content of salt-bound and thus easily soluble heavy metals together with the lower alkalinity and lower oxidation–reduction potential indicates, that ESPA has a better leachability compared to EA and BOA. The EA and BOA, on the other hand, do not show any significant differences in leachability. The data may contribute to a basis for re-evaluating disposal routes of ash fractions with poor extraction properties

Inventory of MSWI Fly Ash in Switzerland: Heavy Metal Recovery Potential and Their Properties for Acid Leaching

From the year 2021 on, heavy metals from Swiss municipal solid waste incineration (MSWI) fly ash (FA) must be recovered before landfilling. This is predominantly performed by acid leaching. As a basis for the development of defined recovery rates and for the implementation of the recovery process, the authorities and plant operators need information on the geochemical properties of FA. This study provides extended chemical and mineralogical characterization of all FA produced in 29 MSWI plants in Switzerland. Acid neutralizing capacity (ANC) and metallic aluminum (Al0) were additionally analyzed to estimate the effort for acid leaching. Results show that all FA samples are composed of similar constituents, but their content varies due to differences in waste input and incineration conditions. Based on their geochemical properties, the ashes could be divided into four types describing the leachability: very good (6 FA), good (10 FA), moderate (5 FA), and poor leaching potential (8 FA). Due to the large differences it is suggested that the required recovery rates are adjusted to the leaching potential. The quantity of heavy metals recoverable by acid leaching was estimated to be 2420 t/y Zn, 530 t/y Pb, 66 t/y Cu and 22 t/y Cd