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In the region of Mexico where I work, there's a long history of movement beginning with and even before the Bracero Program... the Bracero Program established male-led migration and now you have a male-led wave of deportations. For example, someone who immigrated as a one year old and came to the U.S., has grown up here and knows no other life… I'm thinking of one young woman whose father was deported, and she then stayed [in the U.S.] for a while after he was deported, but she, too, ended up "coming back" [to Mexico]. That's not to say he doesn't have ties to Mexico as well - he can get legal status [in Mexico] because Mexico recognizes dual nationality - but he was born in the U.S. and he can some day go back. And so, in her case, she was also in a sense "deported" even though she didn't go through a legal deportation or "removal" proceedings, which is a term the government uses. [Extracted from the article]

Immigrants and refugees are less likely to meet diabetes management goals than the general US population. Those with limited English proficiency (LEP) and who need interpreter services (IS) for health care encounters, maybe at higher risk for encountering barriers to optimal diabetes management, and while most receive diabetes care in primary care settings, little is known about the association between IS need and diabetes outcomes. This study aims to determine adherence with diabetes process and outcomes measures among LEP patients in primary care settings, and is a retrospective cohort study of patients with type II diabetes at two large primary care networks in Minnesota from January 1, 2012 through December 31, 2013. Diabetes outcome measure goals were defined as hemoglobin A1C <8%, LDL-C <100 mg/dL, and blood pressure <140/90 mmHg. Process measure goals were defined as hemoglobin A1C measured within the previous 6 months and LDL cholesterol (LDL-C) measured within the previous 12 months. Compared to non-IS patients (N = 11,970), IS patients (N = 1486) were more likely to meet guideline outcome recommendations for blood pressure (Adjusted odds ratio [OR] 2.02; 95% confidence interval [CI] 1.70, 2.40), hemoglobin A1C (OR 1.23; 95% CI 1.08, 1.40), and LDL-C (OR 1.40; 95% CI 1.2, 1.62). Older IS patients and male IS patients were less likely to meet recommendations for hemoglobin A1C (OR 0.70; 95% CI 0.48, 1.02; OR 0.66; CI 0.54, 0.79; respectively) and LDL-C (OR 0.81; 95% CI 0.55, 1.17; OR 0.47; CI 0.39, 0.57; respectively). Healthcare system solutions need to bridge gaps from process to outcomes among LEP patients who require IS in primary care settings. [ABSTRACT FROM AUTHOR]

This piece considers the deseos -- wants, desires, needs -- and dolores -- pain or sorrow -- of individuals in US-Mexico transnational partnerships. For transnational Mexicans, 'desire' manifests as diverse, even contradictory, expressions of emotion. Migration is intertwined with multiple desires within intimate relationships, but is also tied to suffering across borders. Conflicting articulations of deseos y dolores reveal gender politics as well as the broader socioeconomic inequalities that drive migration and result in the transborder movement that separates couples and family members in a transnational space. [ABSTRACT FROM AUTHOR]

This is an introduction to a collection of articles -- 'Affecting Global Movement: The Emotional Terrain of Transnationality' -- that explores discourses of emotion related to global movement. Research on migration rarely captures the affective and emotional dimensions of global processes. This issue is part of an emergent body of scholarship that bridges work on transnational migration with examinations of affect and emotion. Here, we discuss several common themes that the papers collectively address: how emotion shapes, negotiates, and mediates connectedness and disconnectedness along lines of nation, community, and/or kin; the relationship between emotionality and materiality; and the emotional aspects of structural power dynamics in diverse contexts. Such study can inform and aid in the development of policies that incorporate emotional experiences, thereby improving transnational lives. [ABSTRACT FROM AUTHOR]

This article considers diverse migrations from Mexico to the United States, driven by a range of factors, in the context of violence that circulates transnationally. Throughout Mexico violence and kidnappings, increasingly targeted at migrants or their family members, are motivating increased or new flows to the north. Meanwhile, in the United States, nativism is fostering anti-immigrant policies and practices – also framed by violence – aimed at “returning” Mexican nationals south. Such processes are resulting in a simultaneous blurring and reassertion of categories: distinctions between individuals with different motivations to migrate are not easily delineated, and in this case, individuals themselves often experience a form of “mixed migration”, with people migrating both for economic reasons and because they fear for their safety. Drawing on ongoing ethnographic research about migration and deportation, I outline recent experiences of transnational Mexicans to highlight contradictions within United States–Mexico migration and consider the implications for policy. In the current climate of United States immigration control, the possibility of claiming asylum within the United States is unlikely for nearly all Mexicans, underscoring the limitations of categorisation within refugee protection and immigration regimes. [ABSTRACT FROM PUBLISHER]

This paper considers the deportation of Mexican nationals from the United States, focusing on migrants with ties to a small, rural community in the Mexican state of San Luis PotosI and several locations throughout the U.S. West and Southwest. I trace the imagined futures of deportees, situating their forced removal within past returns and contemporary transnational lives. The narratives of deportees and those close to them repeatedly focus on uncertainty and insecurity: "¿Quien sabe? [Who knows?]" is a common refrain among deportees, family and friends of those deported, and undocumented migrants fearing deportation. While the U.S. state deports Mexican nationals with a sense of finality, those affected by deportation, including even deportees themselves, have few options outside of future migration to the United States. Agricultural hardship in home communities, a global economic crisis, and increasing violence throughout Mexico are likely to link the trajectories of deportees to continued transnational movement. [ABSTRACT FROM AUTHOR]

The article reviews the book "Chocolate and Corn Flour: History, Race, and Place in the Making of 'Black' Mexico" by Laura A. Lewis.

Purpose: The purpose of this study was to develop and validate a new comprehensive patient-reported measure of treatment burden-the Patient Experience with Treatment and Self-management (PETS).Methods: A conceptual framework was used to derive the PETS with items reviewed and cognitively tested with patients. A survey battery, including a pilot version of the PETS, was mailed to 838 multi-morbid patients from two healthcare institutions for validation.Results: A total of 332 multi-morbid patients returned completed surveys. Diagnostics supported deletion and consolidation of some items and domains. Confirmatory factor analysis supported a domain model for scaling comprised of 9 factors: medical information, medications, medical appointments, monitoring health, interpersonal challenges, medical/healthcare expenses, difficulty with healthcare services, role/social activity limitations, and physical/mental exhaustion. Scales showed good internal consistency (α range 0.79-0.95). Higher PETS scores, indicative of greater treatment burden, were correlated with more distress, less satisfaction with medications, lower self-efficacy, worse physical and mental health, and lower convenience of healthcare (Ps < 0.001). Patients with lower health literacy, less adherence to medications, and more financial difficulties reported higher PETS scores (Ps < 0.01).Conclusion: A comprehensive patient-reported measure of treatment burden can help to better characterize the impact of treatment and self-management burden on patient well-being and guide care toward minimally disruptive medicine. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Schistosoma Haematobium," by B.S. Kaplan, and K. Meyers in the October 12, 2000 issue.

To understand the implications of the forensic anthropological practice of "ancestry" estimation, we explore terminology that has been employed in forensic anthropological research. The goal is to evaluate how such terms can often circulate within social contexts as a result, which may center forensic anthropologists as constituting "race" itself through analysis and categorization. This research evaluates terminology used in anthropological articles of the Journal of Forensic Sciences between 1972 and 2020 (n = 314). Terminology was placed into two categories: classifiers and descriptors. Classifiers were standardized into one of five options: "race," "ancestry," "population," "ethnic," or "other." Descriptors included terms used to describe individuals within these classificatory systems. We also compared these terms to those in the NamUs database and the U.S. census. Our results found that the terms "ancestry" and "race" are often conflated and "ancestry" largely supplanted "race" in the 1990s without a similar change in research approach. The NamUs and census terminology are not the same as that used in forensic anthropological research; illustrating a disconnect in the terms used to identify the missing, unidentified, and in social contexts with those used in anthropological research. We provide histories of all of these terms and conclude with suggestions for how to use terminology in the future. It is important for forensic anthropologists to be cognizant of the terms they use in medicolegal contexts, publications, and in public and/or professional spaces. The continued use of misrepresentative and improper language further marginalizes groups and perpetuates oppression rooted in systemic racism. [ABSTRACT FROM AUTHOR]

Background: In primary care there is a need for more quality measures of person-centered outcomes, especially ones applicable to patients with multiple chronic conditions (MCCs). The aim of this study was to derive and validate a short-form version of the Patient Experience with Treatment and Self-management (PETS), an established measure of treatment burden, to help fill the gap in quality measurement. Methods: Patient interviews (30) and provider surveys (30) were used to winnow items from the PETS (60 items) to a subset targeting person-centered care quality. Results were reviewed by a panel of healthcare providers and health-services researchers who finalized a pilot version. The Brief PETS was tested in surveys of 200 clinic and 200 community-dwelling MCC patients. Surveys containing the Brief PETS and additional measures (e.g., health status, medication adherence, quality of care, demographics) were administered at baseline and follow-up. Correlations and t-tests were used to assess validity, including responsiveness to change of the Brief PETS. Effect sizes (ES) were calculated on mean differences. Results: Winnowing and panel review resulted in a 34-item Brief PETS pilot measure that was tested in the combined sample of 400 (mean age = 57.9 years, 50% female, 48% white, median number of conditions = 5). Reliability of most scales was acceptable (alpha > 0.70). Brief PETS scores were associated with age, income, health status, and quality of chronic illness care at baseline (P <.05; rho magnitude range: 0.16–0.66). Furthermore, Brief PETS scores differentiated groups based on marital and education status, presence/absence of a self-management routine, and optimal/suboptimal medication adherence (P <.05; ES range: 0.25–1.00). Declines in patient-reported physical or mental health status over time were associated with worsening PETS burden scores, while improvements were associated with improving PETS burden scores (P <.05; ES range: 0.04–0.44). Among clinic patients, 91% were willing to complete the Brief PETS as part of their clinic visits. Conclusions: The Brief PETS (final version: 32 items) is a reliable and valid tool for assessing person-centered care quality related to treatment burden. It holds promise as a means of giving voice to patient concerns about the complexity of disease management. [ABSTRACT FROM AUTHOR]

Purpose: Having multiple chronic conditions (MCCs) can lead to appreciable treatment and self-management burden. Healthcare provider relational quality (HPRQ) -- the communicative and interpersonal skill of the provider -- may mitigate treatment burden and promote selfmanagement. The objectives of this study were to 1) identify the associations between HPRQ, treatment burden, and psychosocial outcomes in adults with MCCs, and 2) determine if certain indicators of HPRQ are more strongly associated than others with these outcomes. Patients and methods: This is a cross-sectional survey study of 332 people with MCCs. Patients completed a 7-item measure of HPRQ and measures of treatment and self-management burden, chronic condition distress, self-efficacy, provider satisfaction, medication adherence, and physical and mental health. Associations between HPRQ, treatment burden, and psychosocial outcomes were determined using correlational analyses and independent samples t-tests, which were repeated in item-level analyses to explore which indicators of HPRQ were most strongly associated with the outcomes. Results: Most respondents (69%) were diagnosed with $3 chronic conditions. Better HPRQ was found to be associated with less treatment and self-management burden and better psychosocial outcomes (P<0.001), even after controlling for physical and mental health. Those reporting 100% adherence to prescribed medications had higher HPRQ scores than those reporting less than perfect adherence (P<0.001). HPRQ items showing the strongest associations with outcomes were "my healthcare provider spends enough time with me", "my healthcare provider listens carefully to me", and "I have trust in my healthcare provider". Conclusion: Good communication and interpersonal skills of healthcare providers may lessen feelings of treatment burden and empower patients to feel confident in their self-management. Patient trust in the provider is an important element of HPRQ. Educating healthcare providers about the importance of interpersonal and relational skills could lead to more patient-centered care. [ABSTRACT FROM AUTHOR]

Adherence to diabetic care guidelines among US immigrants remains low. This study assesses adherence to diabetic care guidelines by country-of-origin and language among a limited English-proficient (LEP) population. Timely completion of diabetic measures and acceptable levels of hemoglobin A1c (A1c), low density lipoprotein (LDL) cholesterol, and blood pressure (BP) were compared between LEP and English-proficient (EP) patients in this 2013 retrospective cohort study of adult diabetics. More LEP patients met BP targets (83 vs. 68 %, p < 0.0001) and obtained LDL targets (89 vs. 85 %, p = 0.0007); however, they had worse LDL control (57 vs. 62 %, p = 0.0011). Ethiopians and Somalians [adjusted OR (95 % CI) = 0.44 (0.30, 0.63)] were less likely than Latin Americans to meet BP goals. LEP patients outperformed EP peers on several diabetic outcomes measures with important variation between groups. These data highlight the success of a safety net hospital in improving diabetes management among diverse populations. [ABSTRACT FROM AUTHOR]

A history of trauma is common in refugee populations and appropriate treatment is frequently avoided. Using a convenience sample of 64 patients in a Somali primary care clinic, a culture and trauma specific intervention was developed to address retention into appropriate treatment. One goal of the intervention was to improve the rate of engagement in psychotherapy after a mental health referral and to test the effect of psychotherapy on health care utilization using a staged primary care clinical tool. Forty-eight percent of patients given a mental health referral engaged in psychotherapy. Patients engaging in psychotherapy had higher baseline utilization and over 12 months trended towards less emergency room use and more primary care. Our findings suggest that the intervention improved referral and retention in mental health therapy for East African refugee women. [ABSTRACT FROM AUTHOR]

Purpose: Patients with multiple chronic conditions (multimorbidity) often require ongoing treatment and complex self-care. This workload and its impact on patient functioning and well-being are, together, known as treatment burden. This study reports on factors that patients with multimorbidity draw on to lessen perceptions of treatment burden. Patients and methods: Interviews (n=50) and focus groups (n=4 groups, five to eight participants per group) were conducted with patients receiving care in a large academic medical center or an urban safety-net hospital. Interview data were analyzed using qualitative framework analysis methods, and themes and subthemes were used to identify factors that mitigate burden. Focus groups were held to confirm these findings and clarify any new issues. This study was part of a larger program to develop a patient-reported measure of treatment burden. Results: Five major themes emerged from the interview data. These included: 1) problem-focused strategies, like routinizing self-care, enlisting support of others, planning for the future, and using technology; 2) emotion-focused coping strategies, like maintaining a positive attitude, focusing on other life priorities, and spirituality/faith; 3) questioning the notion of treatment burden as a function of adapting to self-care and comparing oneself to others; 4) social support (informational, tangible, and emotional assistance); and 5) positive aspects of health care, like coordination of care and beneficial relationships with providers. Additional subthemes arising from focus groups included preserving autonomy/independence and being proactive with providers. Conclusion: Patients attempt to lessen the experience of treatment burden using a variety of personal, social, and health care resources. Assessing these factors in tandem with patient perceptions of treatment burden can provide a more complete picture of how patients fit complex self-care into their daily lives. [ABSTRACT FROM AUTHOR]

Background: We wanted to examine the association between Medicaid managed care (MMC) and changing immunization coverage in New Mexico, a predominantly rural, poor, and multiethnic state.Methods: As part of a multimethod assessment of MMC, we studied trends in quantitative data from the National Immunization Survey (NIS) using temporal plots, Fisher's exact test, and the Cochran-Armitage trend test. To help explain changes in immunization rates in relation to MMC, we analyzed qualitative data gathered through ethnographic observations at safety net institutions: income support (welfare) offices, community health centers, hospital emergency departments, private physicians' offices, mental health institutions, managed care organizations, and agencies of state government.Results: Immunization coverage decreased significantly after implementation of MMC, from 80% in 1996 to 73% in 2001 for the 4:3:1 vaccination series (Fisher's exact test, P = .031). New Mexico dropped in rank among states from 30th for this vaccination series in 1996 to 50th in 2001. A significant decreasing trend (Cochran-Armitage P = .025) in coverage occurred between 1996 and 2001. Findings from the ethnographic study revealed conditions that might have contributed to decreased immunization coverage: (1) reduced funding for immunizations at public health clinics, and difficulties in gaining access to MMC providers; (2) informal referrals from managed care organizations and contracting physicians to community health centers and state-run public health clinics; and (3) increased workloads and delays at community health centers, linked partly to these informal referrals for immunizations.Conclusions: Medicaid reform in New Mexico did not improve immunization coverage, which declined significantly to among the lowest in the nation. Reduced funding for public health clinics and informal referrals may have contributed to this decline. These observations show how unanticipated and adverse consequences can result from policy interventions in complex insurance systems. [ABSTRACT FROM AUTHOR]