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The “immigrant health paradox” has captured the attention of researchers struggling to understand why immigrants to the United States appear to have health advantages that would not be predicted by their socioeconomic position. This research extends prior analyses through examination of the potential role of environmental factors in explaining the immigrant health paradox. We use data from the Phoenix Area Social Survey, a survey conducted in 2006 of approximately 800 individuals. Multilevel ordered logistic models examine three health outcomes: self-rated health, heat stress, and asthmatic symptoms. An innovation is our multiple considerations of contextual factors, including neighborhood amenities, disorder, traffic counts, and the heat index. We have three key findings: (1) frequent local migration has negative impacts on health, (2) the local neighborhood environment partially mediates differences between US-born non-Hispanic Whites and foreign-born Hispanics, and (3) subjective measures of the local environment tend to have greater effects than objective measures. In sum, our analyses suggested a need for studies of place and health to consider migration and residential history as a factor shaping health outcomes. Further, regarding the immigrant paradox, the results suggest the need to move beyond a dichotomous measure of immigration contrasting international migrants with native-born residents. [ABSTRACT FROM AUTHOR]

Context: People living in rural areas face barriers when seeking health care, often experiencing difficulties accessing health providers or facilities. Little is known about barriers to the use of health care confronting people with multiple sclerosis (MS) in rural areas. Purpose: To identify any rural/urban differences in access and barriers to health services, including MS-focused care, among people with MS. Methods: The data were collected in a survey of 1,518 people with MS living in all 50 States. The study included three geographic subgroups: urban areas; adjacent rural areas; and more remote rural areas. Findings: We found significant rural/urban differences in access and barriers to care among people with MS, especially for MS-focused care. Significantly smaller proportions of people with MS from adjacent and more remote rural areas reported no difficulty getting MS-related care than their urban counterparts. Conclusions: Greater difficulty accessing MS-related care experienced by people with MS in rural areas has negative implications for the quality of the MS care they receive. [ABSTRACT FROM AUTHOR]

Introduction: Role of surgery in the management of de novo stage IV breast cancer (BC) remains controversial. We aimed to determine the survival benefit of primary surgery on the basis of metastatic pattern., Materials and Methods: A retrospective cohort study based on the SEER database was conducted to identify patients with de novo stage IV BC diagnosed between 2010 and 2015. Patients were divided into surgery and non-surgery group, and propensity score weighting was used to balance clinicopathologic factors between groups., Results: Of 8142 de novo stage IV BC patients, 1891 (23%) cases were managed with surgery and 6251 (77%) cases were managed without surgery. There were 3821 all-cause deaths and 3291 BC specific deaths over a median follow-up of 22 months. The weighted 3-year overall survival (OS) for the surgery group was 54.5%, compared to 47.7% (P < 0.001) for the non-surgery group. The magnitude of the survival difference with surgery was significantly correlated with metastatic patterns (P interaction <0.05). Significant survival improvements in surgery group compared with non-surgery group were observed in patients with bone-only metastasis (adjusted HR = 0.83, P < 0.05) or multiple metastases with bone involved (adjusted HR = 0.76, P < 0.05), whereas survival inferiority of surgery was found for patients with multiple visceral organs-only metastases (adjusted HR = 2.08, P < 0.05)., Conclusion: The survival benefit offered by surgery for de novo stage IV BC varies by metastatic patterns. Decisions for primary surgery of de novo stage IV BC patients should be tailored according to metastatic pattern., (Copyright © 2019. Published by Elsevier Ltd.)

The novel influenza A(H1N1)pdm09 virus caused an influenza pandemic in 2009. IgM, IgG, and IgA antibody responses to A(H1N1)pdm09 hemagglutinin (HA) following A(H1N1)pdm09 virus infection were analyzed to understand antibody isotype responses. Age-matched control sera collected from U.S. residents in 2007 and 2008 were used to establish baseline levels of cross-reactive antibodies. IgM responses often used as indicators of primary virus infection were mainly detected in young patient groups (≤5 years and 6 to 15 years old), not in older age groups, despite the genetic and antigenic differences between the HA of A(H1N1)pdm09 virus and pre-2009 seasonal H1N1 viruses. IgG and IgA responses to A(H1N1)pdm09 HA were detected in all age groups of infected persons. In persons 17 to 80 years old, paired acute- and convalescent-phase serum samples demonstrated ≥4-fold increases in the IgG and IgA responses to A(H1N1)pdm09 HA in 80% and 67% of A(H1N1)pdm09 virus-infected persons, respectively. The IgG antibody response to A(H1N1)pdm09 HA was cross-reactive with HAs from H1, H3, H5, and H13 subtypes, suggesting that infections with subtypes other than A(H1N1)pdm09 might result in false positives by enzyme-linked immunosorbent assay (ELISA). Lower sensitivity compared to hemagglutination inhibition and microneutralization assays and the detection of cross-reactive antibodies against homologous and heterologous subtype are major drawbacks for the application of ELISA in influenza serologic studies., (Copyright © 2014, American Society for Microbiology. All Rights Reserved.)

This study aimed to compare perinatal outcomes in native Chinese, foreign-born and US-born Chinese-American women by analysing a cohort of 950,624 singleton pregnancies in south-east China and 293,849 singleton births from the US live and stillbirth certificates from 1995 to 2004. Only births at 28 weeks or later were included. Compared with US-born Chinese-American women, native Chinese and foreign-born Chinese-American women had substantially lower risks of having a small-for-gestational age (SGA) infant (adjusted relative risk [aRR] ranging from 0.46 to 0.66) or preterm birth (aRR ranging from 0.53 to 0.82). While having a White or Black father had a reduced risk of SGA (aRR=0.45 and 0.62, respectively), it has an increased risk for preterm birth (aRR=1.13 and 1.57, respectively). Infants with Chinese father and foreign-born mother were heavier than those with Chinese father and US-born mothers. All findings were statistically significant. Our findings demonstrated the protective role of foreign-born status on low birthweight and preterm delivery. The paternal contribution to fetal size is substantial., (© 2011 Blackwell Publishing Ltd.)

Objective: To provide references for the evolvement of medical devices labeling and manual administration in China,, Methods: By content analysis, 10 juristic documents relevant to device labeling and manual were collected from FDA website, compared to which, the federal regulation was mainly analyzed., Results: There are five main differences of device labeling regulation between U.S.A. and China: juristic system, administrative scope, administrative target, characteristics and practice,, Conclusions: A set of comprehensive juristic system for device labeling has been established by FDA. from which China should draw experience, to administrate the prescription devices and the over-the-counter devices in classification, and set up device labeling guidance, thus guarantee the safety and efficacy of device.