Immigrant Workers in the Massachusetts Health Care Industry: A Report on Status and Future Prospects

Given the vital picture of foreign-born health care workers, this study has the following objectives: To document the labor market position of foreign-born workers in the sector at various levels (national, statewide, sub-regional) including patterns of occupational concentration during the last decade or so, prospects for occupational mobility, wages, geographic concentration, employment by type of establishment (hospitals, community health centers, etc.) and workforce development opportunities; To document, whenever possible, the socio-economic and demographic characteristics of foreign-born workers in the sector, including country of origin and gender among others; To document the qualitative contribution of foreign-born workers in the health care delivery environment, especially through cultural and linguistic competence as well as cross cultural communications; To document promising institutional practices in Massachusetts (mainly collaborations and workforce development activities) aimed at improving or modifying the conditions for foreign-born workers and enhancing the labor pool for employers; To document the important role that institutions (universities, research organizations, hospitals, unions and professional associations, government and the non-profit sector) play in shaping the labor market prospects of foreign-born workers in the health care sector; To document critical shortages in some health care professions and occupations; To outline public policy recommendations for broad dissemination

Immigrant Workers in the Massachusetts Health Care Industry Executive Summary

Health care in Massachusetts is a $9 billion industry, vital to the state's economy. It employs almost half a million people, who work in 16,353 establishments. With 72,480 job openings projected between 2000 and 2010, health care has also been an industry needing a continuous stream of new employees as well as workers who can be steadily moved up to more demanding jobs. Immigrants have a robust presences across the spectrum of health care in Massachusetts, filling critical vacancies. Clustered at the high-end skill level are medical scientists (52 percent immigrants), pharmacists (40 percent immigrants )and physicians and surgeons (28 percent immigrants). They bring millions of dollars in education and training to the state. Immigrants are also clustered in lower skilled occupations. They may serve as aides in nursing, psychiatry and home health care and may remian stuck in those jobs because of inadequate education and English skills. A concern for communities is the wasted potential they represent. In an industry where worker shortages loom, immigrants could be trained to help fill the gaps. While workforce development policies have not been able to keep pace with the changing needs of the health care labor market and its workers, there are a number of promising practices and models meant to improve the labor market outcomes for immigrant health care workers. They are reviewed in the stud

Immigrant Workers in the Massachusetts Health Care Industry: A Report on Status and Future Prospects

Given the vital picture of foreign-born health care workers, this study has the following objectives: To document the labor market position of foreign-born workers in the sector at various levels (national, statewide, sub-regional) including patterns of occupational concentration during the last decade or so, prospects for occupational mobility, wages, geographic concentration, employment by type of establishment (hospitals, community health centers, etc.) and workforce development opportunities; To document, whenever possible, the socio-economic and demographic characteristics of foreign-born workers in the sector, including country of origin and gender among others; To document the qualitative contribution of foreign-born workers in the health care delivery environment, especially through cultural and linguistic competence as well as cross cultural communications; To document promising institutional practices in Massachusetts (mainly collaborations and workforce development activities) aimed at improving or modifying the conditions for foreign-born workers and enhancing the labor pool for employers; To document the important role that institutions (universities, research organizations, hospitals, unions and professional associations, government and the non-profit sector) play in shaping the labor market prospects of foreign-born workers in the health care sector; To document critical shortages in some health care professions and occupations; To outline public policy recommendations for broad dissemination

Second asymptomatic carotid surgery trial (ACST-2) : a randomised comparison of carotid artery stenting versus carotid endarterectomy

Background: Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. Methods: ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362. Findings: Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86-1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91-1·32; p=0·21). Interpretation: Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable