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Within the prevention programmes of the Italian Ministry of Health, a project aimed to containing the circulation of SARS-CoV-2 virus in the immigrant population in Italy has entrusted to the Regional Health Authority of Sicily Region (Southern Italy). New evidence has been promoted to disseminate and share public health intervention models. The project involved public health institutions across the national territory and was carried out during the COVID-19pandemic. The project reached the general aim through specific objectives, identifying information sources and health indicators, evaluating the impact of COVID-19, and promoting intervention programmes for taking charge immigrant population. Social distancing, although necessary, has further amplified the gap of inequalities in health, confirming major vulnerability for infection. Having filled some knowledge gaps and proposed prevention tools has been useful for the containment of the virus, for a possible resurgence of the phenomenon, for application in other emergency contexts, and for recalibration in new epidemic events.

The COVID-19 pandemic has modified the burden of disease in the population in various ways, depending on different social and economic conditions. Consequently, the pandemic has amplified health disparities, especially among the frail populations. During the pandemic, the incidence among immigrants showed a one- or two-week delay compared to natives, possibly due to delays in diagnosis and access to treatment. Health Authorities had to think new intervention strategies. As part of a project to contain the spread of SARS-CoV-2 among immigrants in Italy, training emerged as a strategic intervention objective. The training included project areas that assessed the impact of the pandemic and public health intervention on immigrants and incorporated best practices from local experiences. The training was addressed to healthcare and social workers and aimed at building institutional networks and skills in caring for vulnerable people. Additionally, the training course was designed to be adaptable and applicable in other emergency contexts.

Italy is a destination country for a growing international migration, accounting for 8.4% of the total population. The COVID-19 pandemic has increased the difficulties in accessing healthcare services among immigrants, and barriers due to linguistic and cultural differences had a significant impact during the pandemic. This paper presents the methodology used in the project 'Epidemiological surveillance and control of COVID-19 in metropolitan urban areas for the containment of SARS-CoV-2 circulation in the immigrant population in Italy', carried out with the technical and financial support of the Italian Ministry of Health. This methodology is aimed to identify and select statements available in the literature, transferable to the Italian context, on the topic of interventions deemed useful in reducing the impact of the COVID-19 pandemic on the foreign population in urban/metropolitan settings.In February 2022, a systematic search was conducted in databases such as Medline, Embase, and Web of Science, as well as on national and international websites (WHO, Italian Institute of Health, and CDC), and on 'RecMap' (included in the 'COVID19 Recommendations' website) to identify guidelines containing recommendations on the management and prevention of COVID-19 among immigrants. The selected recommendations were divided into intervention areas (infection control, vaccination, screening, planning and monitoring, healthcare systems). In the first phase, a group of researchers independently assessed the inclusion of recommendations through three rounds of consensus. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool was used to assess the quality of the included guidelines. In the second phase, an external group of experts independently evaluated the relevance of the included recommendations using a Likert scale. The document is the result of a collaborative work based on evidence from the literature available until that time. The adaptation and adoption of recommendations already formulated by other international organizations on the topic of preparedness and response to the COVID-19 pandemic, evaluated through a consensus process with experts, can be a valid method aimed at producing documents to inform and guide those involved in the care of immigrants in Italy, as well as promoting inclusive forms of prevention in emergency contexts.

Objectives: to quantify the variability of COVID-19 mortality from the beginning of the pandemic to mid-July 2021, in relation to the immigrant status and by Region and period., Design: observational incidence study., Setting and Participants: the study population consists of the residents at the beginning of 2020 in seven Regions (Piedmont, Lombardy, Veneto, Emilia-Romagna, Tuscany, Lazio, Sicily) aged <=74 years., Main Outcome Measures: absolute frequency of deaths occurred in subjects who tested positive for SARS-CoV-2, crude and standardized rates (standard: Italian population at the beginning of 2020), and mortality rates ratios (obtained using Poisson models), by immigrant status and stratified by gender, Region of residence, and period. The study period was divided into 5 subperiods: 22.02.2020-25.05.2020, 26.05.2020-02.10.2020, 03.10.2020-26.02.2021, 27.02.2021-16.07.2021., Results: the study includes more than one half of the Italian population and most of the immigrants residing in the country, who are younger than Italians and experienced fewer COVID-19 deaths. Deaths among those who tested positive varied greatly between Regions and periods; standardized rates showed considerable increases over time among immigrants. In terms of rate ratios, there were excesses among immigrant males in the third period (MRR: 1.46; 95%CI 1.30-1.65) and in the fourth period (MRR: 1.55; 95%CI 1, 34-1.81). Among immigrant females, there is an indication of lower risk in the third period (MRR: 0.79; 95%CI 0.65-0.97) and of greater risk in the fourth period (MRR: 1. 46; 95%CI 1.21-1.77). Finally, the effect is modified by the Region of residence, both in the third and in the fourth period for males and only in the fourth period for females., Conclusions: the risk of premature mortality due to COVID-19 is linked to immigrant status and with an intensity that varies by gender, Region, and period. More accessible tools for prevention, diagnosis and early healthcare can support immigrant communities in managing the risk factors linked to the spread of infections and, in particular, counteract their evolution into more severe disease outcomes.

Objectives: to evaluate the impact on total mortality of the COVID-19 pandemic in Italy, by country of birth., Design: historic cohort study based on administrative databases., Setting and Participants: the study is based on subjects included in the Base Register of Individuals of the Italian National Institute of Statistics on 01.01.2019, aged 35-64 years, and followed-up until 31.07.2021., Main Outcome Measures: age-standardized mortality rates were computed to analyse trends in overall mortality by country of birth grouped in three categories: 1. Italy and other high developed countries; 2. European countries with strong migratory pressure (EU-SMP); 3, non-European countries with strong migratory pressure (non-EU-SMP). Variations in mortality rates during the pandemic (March 2020-July 2021) with respect to the pre-pandemic period (January 2019-February 2020) were measured and compared across groups using mortality rate ratios (MRR) estimated by Poisson regression models, separately for men and women., Results: the cohort includes 26,199,241 individuals, of whom 172,847 died during the follow-up. Over the whole period, mortality was consistently lower in individuals born in non-EU-SMP countries as compared to those born in Italy and other high developed countries. During the first pandemic wave (March-April 2020), individuals born in non-EU-SMP countries had higher excesses as compared to those born in Italy or other high developed countries (MRRs: 1.42 vs 1.28 in men and 1.30 vs 1.11 in women). Similar results were observed during the pandemic period October 2020-April 2021, when the MRRs were 1.37 vs 1.20 in men and 1.30 vs 1.11 in women. In the same period, the excess mortality among individuals born in EU-SMP did not significantly differ from that observed among those born in Italy and other high developed countries., Conclusions: in Italy, excess mortality during the COVID-19 pandemic was higher among immigrants born in non-EU-SMP countries as compared to the native population and immigrants born in high developed countries.

Objectives: to describe differences in the incidence of SARS-CoV-2 infections between Italians and foreigners residing in seven Italian Regions during the different phases of the pandemic and by gender., Design: retrospective observational study., Setting and Participants: all confirmed SARS-CoV-2 infections from 02.02. 2020 to 16.07.2021 in the seven Regions under study were included. Italian resident population calculated by the National Institute of Statistics as of 01.01.2020 was used to calculate the rates. The considered period is divided into 5 sub-periods (phases)., Main Outcome Measures: number of confirmed SARS-CoV-2 infections in the five phases of the pandemic and crude rates by citizenship (Italian vs foreign). Distribution of infections by age group and by week. Crude and age-adjusted incidence rates ratios (IRR) were calculated, by Region, gender, and phase of the pandemic., Results: an epidemic curve delay was observed in foreigners in the first phase of the epidemic, in particular in the northern Regions, the most affected in that phase. The first phase of the epidemic was characterized by a greater proportion of cases occurred in people aged over 60 years than the other phases, both in Italians and in foreigners. The incidence among foreigners is higher during the summer of 2020 (intermediate period: June-September 2020) and during the last period (May-July 2021) in all Regions. The overall figure shows a lower incidence among foreigners than Italians, except for males in Tuscany., Conclusions: the lower incidence rates among foreigners should be interpreted with caution as the available data suggest that it is at least partly attributable to less access to diagnostic tests. Regional differences found in the study deserve further research together with the effect of gender and country of origin.

Objectives: to examine the differences in SARS-CoV-2 infection and hospitalization rates among migrant populations in Veneto Region (Northern Italy), according to the geographic area of origin., Setting and Participants: all residents in Veneto Region aged <65 years were included in the analyses. All subjects infected by SARS-CoV-2 and hospitalized for COVID-19 were identified by means of the regional biosurveillance system., Main Outcome Measures: age- and gender-specific infection and hospitalization rates were stratified by geographic area of origin and were estimated using the number of incident cases over the resident population in Veneto on 01.01.2021. Incidence rate ratios (IRR) for infection and hospitalization rates were estimated using a Poisson model, adjusted for age and gender, among migrants compared to Italians., Results: compared to Italians, SARS-CoV-2 infection rates were significantly higher among migrants from Central and South America and Central and South Asia, lower among those from North Africa and High-Income Countries (HIC), and were approximately halved for those coming from Other Asian Countries (mainly represented by China). Hospitalization rates were significantly higher for all migrant populations when compared to Italians, with the exception of those coming from HIC. Neither age nor gender seemed to modify the association of the geographic area of origin with SARS-CoV-2 infection and hospitalization rates. IRR for SARS-CoV-2 infection of migrants compared to Italians showed how migrants from Other Asian Countries had the lowest infection rates (-53%), followed by people from HIC (-25%), North Africa (-21%), and Eastern Europe (-10%). Higher infection rates were present for Central and South America and Central and South Asia (+17% and +10, respectively). Hospitalization rates were especially high among migrants from Central and South Asia, Africa, and Central and South America, ranging from 1.84 to 3.14 times those observed for Italians., Conclusions: a significant heterogeneity in SARS-CoV-2 infection and hospitalization rates of migrant populations from different geographic areas of origin were observed. The significantly lower incidence rate ratio for infections, compared to that observed for hospitalizations, is suggestive of a possible under-diagnosis of SARS-CoV-2 infection among migrant populations. Public health efforts should be targeted at increasing support among migrants to contrast the spread of the pandemic by potentiating vaccination campaigns, contact tracing, and COVID-19 diagnostic tests.

The text describes the effects of the pandemic on the dynamics of migration flows from abroad to Italy in 2020. The composition and demographic structure of the population of foreign origin are described in order to understand which areas of immigration and integration are most affected by the pandemic.It has been observed that, although the downward trend in migration flows predates the spread of COVID-19, the pandemic has led to a drastic decrease in migration flows towards our country, where a stable foreign presence has settled over the years. The transformation of Italy into a country of stable integration is also witnessed by the growing number of foreigners who become Italian through the acquisition of citizenship, a process that not even the pandemic has slowed down. Instead, the possible effects of the pandemic on economic and labour integration and inclusion, particularly of the many children and young people of foreign origin living in our country, are worrying.

COVID-19 acted on health inequalities in two ways: directly, in terms of infection risk and outcomes; indirectly, through effects on the economy, which exacerbated social inequalities. Immigrants have particularly suffered the effects of the pandemic.The Italian National Institute for Health, Migration and Poverty (INMP) has promoted the project "Epidemiology of SARS-CoV-2 (COVID-19) infection and use of health services in immigrant and vulnerable population groups in Italy" in collaboration with the Regions of Piedmont, Lombardy, Veneto, Emilia-Romagna, Tuscany, Lazio, and Sicily, to assess the impact of the pandemic in the immigrant population.This is an observational population-based study design, based on weekly monitoring data from the COVID-19 National Surveillance System of the Italian National Health Institute (ISS). The observation period was split into five sub-periods: February-May 2020 (wave I), June-September 2020 (intermediate period I), October 2020-January 2021 (wave II), February-April 2021 (wave III), May-July 2021 (intermediate period II).Access to diagnostic testing was higher among Italians; the incidence curve showed a lower level of infection among immigrants during the three waves and higher in the two intermediate periods. Age-standardized hospitalization rates were higher among immigrants both in noncritical care areas and in the intensive care unit, particularly in the intermediate stages of the epidemic. Immigrant standardized mortality rates were higher than those of Italians since the third period among males and in the fourth period among females.Differences were also observed on a regional basis and by the immigrants' area of origin.

In the last decades a significant increase of the migratory phenomenon from South Asian countries to the western world has occurred due to several factors, such as economic crisis, political instabilities, persecutions and wars. It is well established that South Asians (SA) have a higher prevalence of coronary artery disease (CAD) and premature onset of myocardial infarction episodes than other populations. This higher predisposition might be caused by genetic factors, common in both SA residing in their birth country and in those residing abroad, but it may also be due to the new spatial environment in which they live. We have found a higher prevalence of traditional cardiovascular risk factors in SA compared with other populations; in particular abdominal obesity, caused by an unhealthy diet rich in refined carbohydrates and saturated fats, plays a key role in the development of insulin-resistance, diabetes, dyslipidemia and hypertension, leading to the increase risk of CAD in SA. Even emerging risk factors were found to be higher in this ethnic group; indeed, the evidence of higher levels of pro-thrombotic and pro-inflammatory factors, such as lipoprotein(a) and pro-inflammatory adipokines, as well as the influence of air pollution and psychosocial stress, may have consequences on the risk, treatment and outcomes of CAD in this population.

Objectives: to evaluate maternal and child healthcare, avoidable hospitalisation, access to emergency services among immigrants in Italy., Design: cross sectional study of some health and health care indicators among Italian and foreign population residing in Italy in 2016-2017., Setting and Participants: indicators based on the national monitoring system coordinated by the Italian National Institute for Health, Migration and Poverty (INMP) of Rome, calculated on perinatal care (CedAP), hospital discharge (SDO), emergency services (EMUR) archives for the years 2016-2017, by of the following regions: Piedmont, Trento, Bolzano, Emilia-Romagna, Tuscany, Umbria, Lazio, Basilicata, Sicily., Main Outcome Measures: number and timeliness of pregnancy visits, number of ultrasounds, invasive prenatal investigations; perinatal mortality rates, birth weight, Apgar score at 5 minutes, need for neonatal resuscitation; standardized rates of avoidable hospitalisation and access to emergency services by triage code., Results: more often than Italians, immigrant women have during pregnancy: less than 5 gynaecological examination (16.3% vs 8.5%), first examination after the 12th week of gestational age (12.5% vs 3.8%), less than 2 ultrasounds (3.8% vs 1.0%). Higher perinatal mortality rates among immigrants compared to Italians (3.6 vs 2.3 x1,000). Higher standardized rates (x1,000) among immigrants compared to Italians of avoidable hospitalisation (men: 2.1 vs 1.4; women: 0.9 vs 0.7) and of white triage codes in emergency (men: 62.0 vs 32.7; women: 52.9 vs 31.4)., Conclusions: study findings show differences in access and outcomes of healthcare between Italians and immigrants. National monitoring system of indicators, coordinated by INMP, represents a useful tool for healthcare intervention policies aimed to health equity.

Overall 410 scientific papers on the health of immigrants in Italy published from January 2010 to September 2019 were tracked on PubMed and classified by methodology adopted and health issue investigated. Results were compared with a similar review carried out for the decade 2000-2009. The number of available papers has almost tripled. Infectious diseases, although no longer accounting for the majority of publications, are still a well-represented issue; within this field, parasitic infections have been increasingly investigated over time. Many studies published in the last decade addressed adherence to cancer screening, workplace accidents, cardiovascular risk factors and cardiovascular diseases. Based on the characteristics of the immigrant population (country of origin, migration path, length of stay in Italy, socio-economic status), and taking into account the rapid changes in the distribution of risk factors and pathologies at global level, informative gaps can be identified to be filled with new lines of research. Another priority for the epidemiological community is to disseminate the already available evidence to the whole staff of the National Health Service.

The monograph on immigrants' health recently published by Epidemiologia & Prevenzione provides an updated contribution to this subject by the Italian Network of Longitudinal Metropolitan Studies. This paper suggests methodological and thematic aspects that should be addressed by future studies in order to provide the knowledge relevant to social and health policies: networking with researchers and with the subjects dealing in various ways with immigration as well as the preparation of a communication plan aimed at the community and at decision makers are the methodological aspects on which the possibility of studies generating actions depends. Among the objects of investigation the health of the second generations, the study of drug prescriptions and of the access to Emergency Room as well as the evaluation of the interventions implemented by each municipality seem the most relevant. The need of a timely and periodic monitoring of the health outcomes is also underlined and the possibility of a study on the health of migrants during their migrant journey is proposed.

Objectives: to describe and compare cardiovascular risk prevalence in a large sample of Italian and foreign fifty-year-old residents in Veneto Region (Northern Italy) who do not have a co-pay fee exemption for cardiovascular diseases. Data collection comes from standardized and objective measurements carried out by health personnel of the Department of Prevention of the Local Health Agency 7 of Veneto Region., Design: cross-sectional study., Setting and Participants: Italian and foreign fifty-years-old residents who do not have a co-pay fee exemption for cardiovascular diseases were extracted from the registry list, excluding people already affected by diabetes, hypertension, hypercholesterolemia or cardiovascular diseases, and received a written invitation to participate., Main Outcomes Measures: adherents were studied through standardized questionnaires about their lifestyles (tobacco, alcohol, weight excess, central obesity, physical inactivity), anthropometric measurements (height, weight, body mass index, waist circumference), the direct measurement of blood pressure and a finger-stick for glucose and cholesterol. Educational level was also recorded in a large subgroup of adherents. Risk factor prevalence has been described and analyzed by geographical area of origin, separately for men and women and adjusted for educational level., Results: among the invited people, 3,420 out of 5,088 accepted the invitation (67.2%); the adherence was lower among foreign women. Both foreign women and men showed lower prevalence of healthy lifestyles compared to Italian participants (women: 20.3% vs. 34.3%; men: 13.2 vs. 25.6%). These differences remained large and statistically significant after adjusting for educational level. The prevalence of hypertension and of hypercholesterolemia/hyperglycaemia (finger stick) was higher among foreign women than among Italian (39.1% vs. 28.4%); remarkably, the prevalence of hyperglycaemia was 8.7% vs.1.9%., Conclusions: the majority of foreign residents can be reached through a personal invitation to participate in a cardiovascular prevention intervention. Foreign participants show a higher prevalence of cardiovascular risk factors compared to Italian residents. It is advisable to implement a strategy involving both the health personnel of the Department of Prevention and the General practitioners aiming at improving individual and community healthy choices and at an early recognition of diabetes mellitus, hypertension, and hypercholesterolemia onset among foreign residents.

Background: The aim of this study was to analyze the characteristics and outcomes of patients with acute coronary syndrome (ACS) in relation to country of origin., Methods: The study population included patients living in the Emilia-Romagna Region and discharged from 2012 to 2014 with a diagnosis of acute myocardial infarction (with [STEMI] and without ST-elevation). The study outcomes were: percutaneous coronary intervention (PCI) within 48 hours of admission for STEMI, 30-day all-cause mortality, 1-year all-cause mortality, 1-year major adverse cardiac and cerebrovascular events (MACCE), and adherence to post-infarction medications. The relationship between outcomes and citizenship was investigated using multiple regression analysis. Potential confounders were identified among diagnoses recorded in the index hospitalization and in all hospitalizations occurring 2 years prior to the index hospitalization., Results: Of the 23 884 study patients, 647 (2.7%) were non-Italians. The mean age of onset of ACS was lower among immigrants (56 years) than among Italians (73 years). Thirty-day mortality was 9.6% while 1-year mortality and MACCE were 19.8% and 20.8%, respectively. The proportion of PCI within 48 hours was 63.2%, while patients adherent to medications were 31.0%. Compared with Italians, patients from Africa and Asia had a reduced probability of undergoing PCI and were less adherent to medications. Adjusted mortality rates were similar between Italians and immigrants, while patients from Asia had a 62% increased probability of experiencing a MACCE during follow-up., Conclusions: Compared with Italians, immigrant citizens with ACS were younger, less likely to undergo PCI, and less adherent to drug treatment after discharge. Further studies are warranted to identify the determinants of these disparities and to develop organizational models tailored to the specific needs of immigrant patients.

Migration and the current European socioeconomic conditions necessitate an evaluation/assessment, as detailed as possible, of the spread of seasonal infectious diseases in order to reduce inequalities in the healthcare system. The "Scuola di Formazione in Medicina Generale" of Lazio, in collaboration with the Community of Sant'Egidio of Rome, organized an influenza/flu vaccination campaign for homeless people, migrants and the poor in order to check their health conditions and prevent the spread of the most common infectious diseases. People were asked to fill in an anamnestic form, including personal details (name, surname, gender, date of birth and nationality) so that they could be classified according to specific health risks; they were also asked to give a short account of their medical history. During the clinical examination, the general conditions of the patients were evaluated, and some parameters, such as blood pressure, heart rate and oxygen saturation, were reported on the form. At the end of the interview, the participants were immunized with an influenza trivalent vaccine. Vulnerability and the risk of chronic and disabling diseases were assessed on the basis of anamnestic data, such as blood pressure, in order to evaluate the actual need for immunization. The 486 forms, collected and validated, revealed an average age of 37, and an average blood pressure of 129/82 mmHg. By dividing the participants into 4 groups based on their continent of origin (Europe, Asia, Africa, America), it became evident that the majority of them came from Europe (227), while a smaller number came from the other three continents. From the observation of the collected data, it can be stated that vaccinations are the principal weapon against the spread of seasonal infectious diseases in those categories of patients considered vulnerable because of their disadvantaged socioeconomic and sanitary conditions. The MMG (general practitioner), in collaboration with voluntary organizations, plays a central role in the management of these types of patients.

The Istat "National Health Interview Surveys" (NHISs; 2005 and 2013) and the ad hoc interview surveys "Social conditions and integration of foreign citizens in Italy" (2011-2012) offer a wide range of information about health conditions and accessibility to health services of immigrants in Italy. NHIS, in particular, based on samples of about 60,000 families for a total of almost 120,000 individuals, allows to analyse changes in health conditions over the years and to make comparative analyses between foreign citizens and Italians. The survey "Conditions and social integration of foreign citizens", carried out on a national sample of about 10.000 households with at least one resident foreign citizen (more than 20,000 individuals), for the first time in Italy gives the chance to lead in-depth analyses in terms of health and social integration of foreigners. It also allows to study the relationships between indicators, distinguishing against major nationalities, thorugh explanatory models.

Background: Commuting accidents represent the leading cause of work-related fatalities among women in Italy. For working women, the journey from home to work is the most dangerous part of the day., Objectives: Analysis of data on fatal commuting accidents in order to identify risk factors among women., Methods: INAIL Statistical Data (2009-2013) related to fatal commuting were analyzed by gender, age, immigration, activities, geographical area, working time, month and day of the week., Results: Italian and immigrant women die mainly from commuting accidents (207 cases out of 371; 56%), a significant number of immigrant women also die in commuting accidents involving no vehicles (4%); Italian and immigrant men die mainly from causes related to the work environment (48%), especially immigrants (54%), and not from commuting accidents (921 out of 3997; 23%). Prevalent age at commuting fatality is 35-49 years, and among immigrant women 18-34. Deaths among women occur mostly in Northeast Italy, and among women working in health and social services; among immigrant women accommodation and catering services are also relevant. The highest number of fatal accidents among men occurs in Northwest Italy, among men working in wholesale trade. All fatalities take place mainly going to work, between 5-10 a.m., among women from October to December, among men from July to September, among Italian women are significantly higher on Saturday, among immigrant women on Sunday. Deaths among men are significantly higher in the eighth hour of work, between 3- 8 p.m. and on Monday among Italian workers, on Wednesday among immigrant men., Conclusions: Commuting fatalities among women, according to INAIL Statistical Data, show specific risk conditions by age, immigration, work activity, geographical area, working time, month and day of the week that require targeted preventive policies.

The aim of this study was to identify possible inequalities in the quality of health care services for the management of conditions such as cardiovascolar diseases, psychiatric disorders, appendectomy, and hysterectomy, offered to the immigrant population in the Umbria region (central Italy). Hospital discharge data covering the period 2009-2012 were analysed and crude and standardized hospitalization rates per 100,000 calculated. Immigrants were found to have an increased risk of undergoing procedures such as appendectomy and hysterectomy for benign disease, indicating a greater degree of nonappropriateness in this category of users. In the young immigrant population, admissions were mainly due to reproductive health problems in women, and injuries/trauma in men. The results of this study confirm that, despite regional efforts to reduce social inequalities and consequently inequalities in health, through regional legislation, information to the population, training of healthcare personnel, and cultural mediation, some inequalities are present in the quality of health care delivered to foreign-born persons in the region. Hence, there is a need to strengthen information campaigns for immigrants, to keep them informed of their rights, and to strengthen training courses among healthcare and social workers.

Objective: In the last decades, increased numbers of travel to tropical destinations in combination with the enormous influx of immigrants have led to an increased number of imported malaria cases in developed countries. There is a group of immigrants regularly resident in malaria free areas, which travel to malaria endemic countries to visit their friends and relatives (VFRs). VFRs represent a high-risk group of contracting malaria. Publications presenting original data on malaria in VFRs were selected for a literature review., Methods: We considered all data regarding prevalence of malaria in VFRs compared to the other groups of travelers, length of trip, group characteristics such as age, sex, country visited, and adherence to pre-travel recommendations, in particular, the compliance on the use of chemoprophylaxis, where such information was available. Studies related to malaria importation in VFRs in children and pregnant women were also included., Results: Review of the literature revealed significant variations in the proportion of VFRs among imported malaria cases which may be due to differences in immigrant populations across the reporting countries. However, in studies focused on those at higher risk such as children and pregnant women, the prevalence of imported malaria was significantly higher compared to other types of travelers., Discussion: Adherence to adequate preventive measures was low in VFRs. Significant reasons for not seeking pre-travel advice were economic and cultural issues, fear of the side effects due to chemoprophylaxis, and misconception about life-long immunity against malaria, and consequently, a low awareness about malaria risk. In order to implement preventive strategies focused on this high-risk group, prospective studies, which better define determinants of the risk of malaria in VFRs, are needed.

Introdution: Immigration is growing and immigrants' presence is important also in the health care system, thereby services reorientation and a multicultural approach are needed., Objective: To explore health care professionals' training needs of Turin Azienda Città della Salute e della Scienza in taking care of foreign users., Methods: An ad hoc 4-sections questionnaire was built: (1) Knowledge, attitudes and perceptions; (2) Lived and Training; (3) Improvement in cultural competence; (4) Socio-demographic data. Questions were dichotomous (yes/no), closed and short open. Doctors, nurses, speech therapists and support staff of the "Head and Neck" Department were involved., Results: One hundred seventy-six operators answered (75%). Less than 20% (n=34) knew the normative concerning immigrants' health services use; tubercolosis, venereal diseases and AIDS were believed to be the most frequent diseases in foreign users. Female sex (p=0.008) and allied health care profile (trend p=0051) were significantly associated to consider clients' values important, while a previous training was associated to the need of improving their knowledge (p=0.0002). The most important training needs were: meaning of illness and care, perception of prevention, hygiene and self-care practices and perception of care. Among the most effective strategies: lecture and discussion, group work and filmography., Conclusion: The analysis shows the main needing education areas and the training strategies which operators considered more effective.

Objectives: to describe occupational injury risk, comparing regular foreign workers with Italians, by main work characteristics and age., Design: analysis of incidence and risk of total and severe occupational injury by Country of birth, stratified by economic activity, skill level, geographical area of work, firm size and age., Setting and Participants: sample of 7% of workers registered in the Italian National Institute of Social Insurance (INPS) database. The workers considered were male private sector employees aged from 16 to 55 years old who worked between 2000 and 2005 as apprentice or blue collar. Two groups were distinguished: immigrants from high migratory pressure Countries (PFPM) and immigrants from high-income Countries (PSA; Italians comprised). The three main nationalities considered were the most relevant in Italy: Moroccans, Albanians, and Romanians., Main Outcome Measures: all occupational injuries; severe occupational injuries based on the type of damage., Results and Conclusions: PFPM workers have a higher risk of injury compared to PSA both for total (Relative Risk - RR: 1.45) and severe ones (RR: 1.56), particularly in engineering (RR: 1.64) and trade (RR: 1.61). Moroccans have always the greatest risks (RR: 1.86); Romanians are protected on total injuries (RR: 0.80), but have excess of risk of severe injuries (RR: 1.31). Among young people there aren't differences by Country of birth, but the rate decreases as age increases in PSA, while in PFPM it increases as age increases. In this study, injury risk in regular foreign workers were measured more accurately than official statistics: Whip-Salute database can provide useful information for planning prevention programmes of immigrant work-related injuries.

Here we report the case of a 19-year-old somalian man who has been admitted to our emergency department because of an important lumbago without trauma. The physical examination on arrival showed a diffuse painful percussion of the left paraspinal muscles without neurological impairment. The laboratory exams displayed a significant elevation of the inflammatory response (CRP 154 mg/l, procalcitonin 0,05 µg/l), the blood cultures were negative and a thoracic and lumbar computed tomography (CT) was not conclusive. The unclear clinical picture led to a magnetic resonance imaging, showing the presence of an abscess in the left thoraco-lumbar paraspinal musculature with ongoing invasion of the epidural space. The clinical picture became dramatic as the patient suddenly developed a frank nuchal rigidity associated with an acute confusional state, caused by the rupture of the abscess in the meningeal space with secondary meningitis, confirmed by a lumbar puncture, where S. aureus was found.

Aim: To evaluate the prevalence of sexually transmitted infections (HIV, HBV, HCV, Treponema pallidum) in a cohort of foreign female sex workers observed in Palermo from 1999 to 2008., Materials and Methods: Authors conducted a prospective observational study on 239 foreign female sex workers aged between 18 and 36 years old. The nation of origin was Nigeria, Romania, Ucraina, Bulgaria., Results: Overall, the diagnosis of IST was placed in 17 women, 7.1% of the population under study. In 14 cases we observed a single infection: HIV in 5 cases; syphilis and HBV in 4 cases; HCV in only one case. In the remaining three women were diagnosed a co-infection with HIV and HBV, HIV and HCV, HIV and syphilis LUE. In our study, a statistically significant correlation (p<0.0001) was observed between the non-constant condom use and a higher frequency of HIV, HCV and syphilis infection. This correlation was not statistically significant in the women with HBV infection., Conclusions: The results of this study show a higher morbidity of this specific population, and, consequently, the need to start as soon as possible specific programs of intervention which can ensure the health of these women. Language and cultural barriers, as well as immigration concern among all vulnerable populations, form barriers to healthcare access.

Today's society is highly impacted by immigration, as well as healthcare system. It is becoming increasingly common and frequent to establish relationships with patients with different cultural backgrounds. The aim of this study is analyzing Italian nurses' perception of the relational dynamics with foreign patients, to determine its evolution, and to identify the variables which can affect the quality of care. The study is both qualitative and quantitative with descriptive aim, using a questionnaire that assesses the theoretical-practical level of preparation, both perceptive and effective, of nurses when assisting foreign patients. To evaluate the emotional and experiential impact of the relationship with foreign patients, the difficulties encountered while establishing such relationship, and the resolution strategies - both effective and potential. The sample, composed of 101 Italian nurses employed at SanRaffaele Hospital in 6 specific Operational Units, resulted in a total of 91 returned questionnaires during the period May-June 2011. The data was analyzed through statistical instruments and compared to the results of a similar study done in 2004. The experience of intercultural nursing is seen by the sample as interesting and rewarding. The vast majority of nurses have positive responses. The more frequent issues are those connected with communication with foreign patients, and those connected with the increase workload due the presence of foreign patients. Nurses responded to difficulties more with human skills than with specific abilities, and tend to delegate the problem to the Cultural Mediation service. This new issue has a very high impact on nurses. The emerged difficulties have not decreased over time, this due to the lack of a proper policy within health care facilities in recent years, with the exception of a little improvement on the academic education. However the current academic education does not provide solutions useful in the everyday routing. This study, despite the small sample and a rather narrow degree of analysis, likes to draw attention on the topic both of nurses and on health care facilities managerial team in order to develop a effective startegie to deal with the emerged issues.

Starting from the analysis of three Spanish novels written by African authors emigrated in Spain, the article focuses on different medical practices adopted locally, in Africa and in Europe. El Metro, Más allá del mar de arena and Rebeldía give the different disease treatments imagine, showing, on the one hand, the official medicine, and on the other hand, the traditional medicine. In some cases, it is emphasized little contradictions, doubts, and anxieties often experienced by immigrants, even when they are faced with the type of treatment to be undertaken. One of the many mosaic pieces of the world is highlighted: in fact, habits and cultures are very different in a society where more and more people with different physical appearance, language, religion, and customs live understanding that what "belongs" to the other is not necessarily something "distant" and extraneous, but something that can enrich our cultural identity for our open-mindedness.

The VIII Municipality of Rome is characterized by a high poverty rate, by the presence of many immigrant communities and by the lack of health services available to vulnerable social groups. In 2005 , the " Servizio di Medicina Solidale" of the University Hospital of "Tor Vergata", for the first time intervened in this Municipality regarding Immigrant Health. The paper describes the activities and organization of this service from January 2005 to December 2007. It demonstrates a complex epidemiological picture of 2,374 immigrants, characterized by a young population, mostly women with reproductive health issues, followed by children with infectious and nutritional problems and, ultimately, adults who accessed the service, firstly for gastroenterological problems, secondly for cardiovascular problems and finally for dysmetabolic disorders. The paper describes the culture-centered actions of Health Promotion and Health Education in order to improve health awareness and promote integration of immigrants. The study indicates that the limited number of hospital admissions ( n.20) with respect to the number of outpatient visits (n.70.000) in the first seven years of the service " Medicina Solidale" has significantly reduced the number of unnecessary admissions to emergency wards. In conclusion it is notable that the cost of such intervention results eight times inferior to emergency admissions and further confirms that a Community medicine approach is sustainable.

In developing countries, tuberculosis (TBC) is commonly associated with inadequate socio-economic and sanitary conditions. Currently, in Western countries, TBC is often linked with HIV infection, an ageing population or trans-global migration. Approximately two out of ten TB cases worldwide are extra-pulmonary, of which abdominal tuberculosis accounts for 11%-16%. The Mycobacterium tuberculosis complex involves the abdomen as primary or secondary localization (hematogenous spread or from pulmonary foci or infected neighbouring organs). Abdominal TBC can infect the gastrointestinal tract, peritoneum, mesentery, abdominal lymph nodes, liver, spleen, and pancreas. Diagnosis of abdominal tuberculosis is difficult because of vague and non-specific clinical features and due to the differential diagnosis with other granulomatous diseases such as Crohn's Disease. It is of great importance for clinicians to pay great attention to tubercular aetiology as a possible cause of gastrointestinal symptoms. Here we describe the clinical case of a young immigrant patient with intestinal TB for whom the wrong initial diagnosis led to a delay in the correct diagnosis and a worsening of the already serious general conditions.

The role of the enterprises in tackling the immigration theme was significant in the last few years, though within a context of tensions, necessity of flexible approaches, and swaying feelings. However, the world of the entrepreneurs has certainly contributed to the promotion of quality of life and to the process of integration, through a few actions, such as education, the use of mediators for culture, cooperation with projects aimed at family conjunctions, regularizations, code of ethics. The acknowledgement that the immigrant workers is more prone to acquire health and safety culture is a step forward, as well as the co-existence of cultures is per se a positive factor toward behavioral changes. An industrial policy favoring work for itself, equity and merit, while creating moments of encounter, certainly facilitates good organization and integration, and delineates pathways for responsibility for immigrant workers as well. The occupational plant physician can proactively play a fundamental role for safety and health promotion for immigrant workers, considering the special relationship based on trust and the moments of encounter within the workplace, clear occasion "to treat every patient with the same care and diligence, regardless of ethnicity, religion, nationality, social condition", as the Hyppocrates oath states.

In Italy, almost 18% of the immigrants work in the construction industry, the principal sector of occupation for such workers. In the province of Bergamo, during 2009-2010, 29.5% of workers in construction industry were immigrants. According to the protocol proposed by SIMLII, during 2009 910 workers underwent health surveillance, 708 were Italians, 202 immigrants. The prevalence of occupational diseases was related to years of service in construction industry and not to the origin of the workers. Nationality was not related with limitations in fitness for work. As regards lifestyles, particularly for smoking, alcohol drinking, drug consumption (declared and tested), immigrant workers showed a more virtuous behaviour than the Italians. According to the data issued by the local health authority, immigrant workers were most frequently involved in fatal accident at work than Italians. Therefore, there is a compelling call for action aimed at safety and prevention in workplaces, together with specific education for immigrants.

Observations from the trade union patronages report that migrants more often that before seek for their assistance, for various reasons, including health and safety at work. We have noticed, besides the "healthy migrant effect" (now decreasing), a certain mobility within occupations, as well as autonomous enterprise developments. Occupational injuries that we see in migrant workers tend to be less serious, potentially because of the greater instability and fear at work (and quick return to work), with informal patterns of health care. Under notification, greater frequency of temporary compensations are also present, likely related to higher vulnerability of migrant worker and to different access and quality of health services. As for the occupational diseases, we have observed an increase in notifications for migrant workers, mainly related to a greater knowledge and exercise of health care and insurance rights and options. Our Patronage experience enables to state that migrants are prone to accept uncomfortable conditions, high rhythm and heavy workloads and that health and safety at work is perceived as a factor not immediately necessary as compared to other issues such as work itself, residence permit, housing. On one side, society at large has to take care of such issues; on the other side, the occupational health system should proceed to a new cultural approach, using also appropriate indicators of process and outcome today available, while integrating the well known motto from Ramazzini, considering questions proper for migrant workers.

Starting from January 1997 we prospectively evaluated all cases of acute hepatitis B admitted to two of the main Infectious Diseases Units in Catania (eastern Sicily). The survey was extended throughout a 10-year period up to December 2007. Between 1997 and 1999 we observed 21 cases of acute hepatitis B; between 2000 and 2002 18 cases; between 2003 and 2005 22 cases and, finally, 37 cases were reported in the period 2006-2007. We found an increase in acute hepatitis B cases among people aged 26 to 44 years (from 38% in 1997-99 to 70% in 2006-07). A progressive decrease in intravenous drug abuse as a risk factor for acute hepatitis B was also observed (from 61% to 14%) together with a parallel increase in cases due to sexual transmission (from 19% to 56%) and outpatient cosmetic surgical procedures. Mean time to serum HBsAg negativization was longer in the last period (2006-07), with 6 cases out of 37 showing HBsAg persistence beyond 12 months from the clinical onset. Furthermore, in 2006-07 there were 12 cases (42%) of acute hepatitis due to HBV genotypes A and F. In our area, a progressive drop of hepatitis B cases due to intravenous drug abuse occurred, whereas heterosexual and iatrogenic cases increased. Cases due to HBV non-D genotypes may well be related to migration from endemic areas towards Sicily.

TBC is a major infectious emergency in the world. OMS suggest that there are 8 millions of affected every year and 2 millions of deaths. Italy is considered a country with low prevalence, but the increase of the immigration from Africa Asia and Est Europa (country with high risk) imposes attention to the problem. The delivery is a critical moment to investigate people at risk of disease. The infection of the newborn can happen intrauterine or in the expulsive period, but is possible also at home, from somebody affected by an active pulmonary disease. Diagnosis in the newborn is not easy for the aspecificity of clinical signs and for the frequent initial negativeness of Mantoux test. Culture of placenta, gastric aspirate, tracheal secretions, urine would be requested, cerebrospinal fluid if necessary. Neonatal disease needs therapy with isoniazide, rifampicine, pirazinamide and, or ethambutol, or streptomycin. Profilaxis of a newborn from a woman affected by an active form of tuberculosis or living with people affected by an active pulmonary form consists in giving isoniazide until diagnostic tests are negative and in removing the sicks (only with pulmonary disease). New dangerous kinds of pharmacological multiresistent tuberculosis are appeared in the last years in the world and, with the coinfection HIV-TBC and the reorganization of the surveillance system, represents the major obligation for the next years.