Search Results (7)

Background/Objectives: Health outcome determinants affecting Human Papillomavirus (HPV) vaccination among the adult female population are scarce in Spain. This study aimed to describe the health outcomes and determinants of HPV vaccination in women 18–65 years attending lower genital tract outpatient clinics across regions of Spain. Methods: This was a cross-sectional, multicenter, non-interventional, descriptive, and comparative nationwide study. Sociodemographic characteristics and health outcomes included obstetric, gynecological and HPV vaccination antecedents, together with patient-reported outcomes related to HPV infection. Statistical analysis included multivariate logistic regression models. Results: Among 2004 adult women recruited, 1907 (95.2%) were eligible for analysis. Vaccine uptake was 48.8%; 81.6% among women who were ever HPV positive (adjusted OR = 2.16 [95% CI: 1.59–2.93], p < 0.001), but 65.9% among women with an active infection, which acted as a negative factor for vaccination (OR = 0.63 [0.45–0.87], p = 0.005), as did increasing age (OR = 0.92 [0.90–0.93], p < 0.001); the higher the age, the lower the adjusted likelihood of being vaccinated. HPV knowledge and adequate physician-provided information were weakly associated with vaccination likelihood. A history of conization (OR = 7.48 [5.34–10.47], p < 0.001), use of contraception (OR = 1.49 [1.13–1.96], p = 0.004), infection with high-risk or unknown-risk HPV genotypes (OR = 1.86 [1.23–2.82], p = 0.003 and OR = 1.68 [1.17–2.42], p = 0.006, respectively), and Spanish nationality (OR = 2.46 [1.68–3.61], p < 0.001) were identified as factors associated with a higher vaccination likelihood. Conclusions: This study found that HPV vaccination uptake is improvable. Previous HPV infection favored vaccination; however, active infection and increasing age acted against vaccination. HPV knowledge and adequate healthcare professional information appeared to favor vaccination, along with, most notably, a history of cervical surgery (conization), contraceptive use, or infection with high-risk or unknown-risk HPV genotypes. Spanish women had a higher likelihood of receiving HPV vaccination than foreign residents. Full article

Background/Objectives: Unpaid medical expenses incurred by foreign nationals represent a growing concern for healthcare systems amid increasing international mobility. Japan, which lacks mandatory public insurance coverage for non-resident visitors, faces particular vulnerability in terms of uncompensated hospital care. This study aims to identify factors contributing to unpaid medical charges among uninsured, non-resident foreign patients hospitalized at a tertiary care facility in Tokyo. Methods: This retrospective observational analysis was conducted using medical and administrative data from patients admitted between January 2023 and February 2025. Patients who received elective medical tourism care were excluded. Data on demographics, length of hospital stay, care intensity, payment status, and third-party financial assistance were analyzed. Logistic regression models were applied to assess predictors of nonpayment. Results: Among 153 eligible cases, 9 patients (5.9%) had outstanding hospital bills upon discharge. Compared with those with completed payments, the unpaid group experienced longer admissions, more intensive care utilization, and higher total charges. Notably, the absence of third-party financial support (primarily travel insurance) was significantly associated with unpaid charges. Multivariate analysis identified this factor as the main independent predictor (adjusted odds ratio [OR]: 0.12; 95% confidence interval [CI]: 0.02–0.915; p = 0.040). Total amount of billing was also statistically significant (adjusted odds ratio [OR]: 1.01; 95% confidence interval [CI]: 1.00–1.01; p = 0.039). Conclusions: These findings highlight the importance of private insurance in mitigating financial risk in hospitals. Implementing policy measures to promote or require insurance enrollment, along with streamlined reimbursement systems, may contribute to sustainable care delivery for international patients. Full article

Objectives: In South Korea, there has been a continuous decrease in the incidence of tuberculosis (TB) attributable to a national TB elimination program; however, TB still poses a significant socioeconomic burden. This study aimed to analyze factors associated with successful TB treatment and to identify refractory patient groups with unfavorable outcomes. Methods: We analyzed anonymized data on 89,150 patients with TB provided by the Korea Disease Control and Prevention Agency. Specifically, we collected independent variables, which were categorized as individual, regional, and medical facility factors. Individual factors included age, sex, nationality, TB type, drug-resistant status, category of TB, housing type, underlying disease status, number of referrals, and smoking status. Regional factors referred to the region where the TB case was reported. Medical facility factors included the first visit to a medical facility, categorized by hospital type and the distinction between private–public mix (PPM) and non-PPM depending on the presence or absence of dedicated TB nurses. These factors were analyzed in relation to treatment success to identify refractory patient groups with unfavorable outcomes. Results: Multivariable logistic regression analysis revealed the following significant factors associated with successful TB treatment: sex, nationality, status of drug-resistant TB, category of TB, number of referrals, region of TB registry, underlying diseases, and smoking status. Specifically, compared with their relevant counterparts, male patients had a lower rate of successful treatment (adjusted odds ratio [aOR]: 0.66, reference [Ref.]: women); Korean nationals had a higher rate of treatment success (aOR: 7.20, Ref. foreign residents in Korea); resistant TB was associated with a lower rate of treatment success (aOR: 0.35, Ref.: non-resistant TB status); newly treated patients had a higher rate of treatment success (aOR: 1.75, Ref.: retreatment patient); switching hospitals once (aOR: 1.78), never (aOR: 1.41), or twice (aOR: 1.37) was associated with increased treatment success (Ref.: three or more times); having zero (aOR: 1.45), one (aOR: 1.31), or two (aOR: 1.24) underlying diseases was associated with a higher rate of treatment success (Ref. three or more underlying diseases); and past smokers (aOR: 1.40) and non-smokers (aOR: 1.35) had a higher rate of treatment success (Ref.: current smokers). Conclusions: Our study identified several factors contributing to unfavorable treatment outcomes in tuberculosis patients, including male patients, foreign residents in Korea, drug-resistant TB, retreatment patients, frequent hospital switching, multiple underlying diseases, and current smoking status. These research findings could inform the development of efficient management strategies and policies for improving the treatment success rate among patients with TB. Full article

Introduction: The “migrant” term indicates a resident born in a country other than the host country. Resident foreigners made up 8.4% of the total Italian population in 2020. The Sicilian trend reflects the national one, with 190,974 resident foreigners as of 1th January 2020. The aim of this study was to identify the presence of tumors in foreign patients residing in the RTI’s provinces of interest in 2003–2017 and to analyze the clinical-biological variables. Materials and Methods: We analyzed 3541 foreign patients with tumors (out of a total of 160,912 patients) residing in the RTI’s provinces of interest in 2003–2017. Foreign patients were identified by tax code. Tumors are described ((number and percentage). Results: Of the 3541 foreign patients, 36% were male and 64% were female. They resided in the provinces of Catania (42.6%), Messina (29.9%), Siracusa (20.7%), and Enna (6.6%). They came from Europe (57%), Africa (22.4%), the Americas (12.03%), Asia (5.08%), and Oceania (1.80%); 0.3% were stateless. The average age was 58 for males and 54.4 for females. The number of tumors (excluding non-melanoma skin tumors) was 3715. Sixty-two males and 98 females had one or more multiple tumors. In foreign females, the three most common tumors were breast (28%), thyroid (9%), and cervical (6%) tumors. Most breast cancers were diagnosed as stage T1 (35%) or T2 (26%). In foreign males, the three most common tumors were lung (13%), bladder (12%), and prostate (11%) tumors. Conclusions: The growing presence of foreign citizens in the provinces studied calls for more attention on oncology-related problems and more careful surveillance of changes in incidence and mortality by the RTI. Full article

Although patient mobility has increased over the world, in Europe there is a lack of empirical studies. The aim of the study was to compare foreign non-resident patients versus domestic patients for the particular Catalan case, focusing on patient characteristics, hospitalisation costs and differences in costs depending on the typology of the hospital they are treated. We used data from the 2012 Minimum Basic Data Set-Acute Care hospitals (CMBD-HA) in Catalonia. We matched two case-control groups: first, foreign non-resident patients versus domestic patients and, second, foreign non-resident patients treated by Regional Public Hospitals versus other type of hospitals. Hospitalisation costs were modelled using a GLM Gamma with a log-link. Our results show that foreign non-resident patients were significantly less costly than domestic patients (12% cheaper). Our findings also suggested differences in the characteristics of foreign non-resident patients using Regional Public Hospitals or other kinds of hospitals although we did not observe significant differences in the healthcare costs. Nevertheless, women, 15–24 and 35–44 years old patients and the days of stay were less costly in Regional Public Hospitals. In general, acute hospitalizations of foreign non-resident patients while they are on holiday cost substantially less than domestic patients. The typology of hospital is not found to be a relevant factor influencing costs. Full article

To test the Hispanic and Immigrant Paradoxes—i.e., survival advantages despite a worse risk factor profile—and the modifying role of neighborhood context, we examined associations between patient ethnicity, birthplace, neighborhood Hispanic density and neighborhood poverty among 166,254 female breast cancer patients diagnosed 1995–2009 in Texas, U.S. Of all, 79.9% were non-Hispanic White, 15.8% Hispanic U.S.-born, and 4.2% Hispanic foreign-born. We imputed birthplace for the 60.7% of Hispanics missing birthplace data using multiple imputation. Shared frailty Cox proportional hazard models (patients nested within census tracts) adjusted for age, diagnosis year, stage, grade, histology, urban/rural residence, and local mammography capacity. Whites (vs. U.S.-born Hispanics) had increased all-cause and breast cancer mortality. Foreign-born (vs. U.S.-born) Hispanics had increased all-cause and breast cancer mortality. Living in higher Hispanic density neighborhoods was generally associated with increased mortality, although associations differed slightly in magnitude and significance by ethnicity, birthplace, and neighborhood poverty. We found no evidence of an Immigrant Paradox and some evidence of a Hispanic Paradox where protective effects were limited to U.S.-born Hispanics. Contrary to prior studies, foreign birthplace and residence in higher Hispanic density neighborhoods were associated with increased mortality. More research on intersections between ethnicity, birthplace and neighborhood context are needed. Full article

This research, which forms part of a larger study on Mental disorder and use of public sector psychiatric services among foreign residents in the canton of Ticino, focuses on the relationship between migration and health. Aim: The aim is to describe adult users of the public psychiatric services in three Swiss regions (Ticino, Zurich and Vaud), identifying possible differences linked to nationality, in relation to socio-demographic and clinical characteristics and contact with the services. Method: The patients involved in the study were all those between 20 and 49 years of age who had contacted the out-patient or in-patient psychiatric services in the regions concerned at least once during 1995 – in total 6794 in-patients and 13199 outpatients. For each of five nationality groups (Swiss, Italian, Iberian, ex-Yugoslavian and ‘Other’) the annual rate of first admission to psychiatric hospital was calculated as were the annual rates of in-patients and out-patients prevalence. Annual rates of in-patients and out-patients prevalence were also calculated for each diagnostic category, defined according to the International Classification of Diseases (ICD-10). Results and conclusions: The study confirmed the difficulty of describing similar patterns across the regions, due to a number of factors (problems of data standardisation, different migration and integration histories in the different host regions, regional differences in the psychiatric services offered: characteristics particular to the public psychiatric service, the importance of private psychiatric services, the existence of a health service network specifically for immigrants, etc.). Despite these difficulties, three different groups emerged in terms of in-patient and out-patient prevalence rates and, particularly, rates of first hospital admission: non-Italian and non-Iberian foreigners, who had the highest rates, Italians and Iberians, who had the lowest rates, and Swiss, who were generally in-between. The lower rates of the Italians and Iberians might be linked to a “positive selection” effect (healthy migrant effect), whereas for certain individuals in the ‘Other’ nationality group more complex factors could play an aggravating role (greater difficulty of integration, precarious status, the fact of having lived through particularly traumatic experiences in their countries of origin). As regards diagnosis, among out-patients those individuals originating in former Yugoslavia and ‘Other’ countries showed the highest rates of neurotic, stress-related and somatoform disorders (F4) and affective disorders (F3) (in certain cases roughly twice the rate shown by the Swiss, Italians and Iberians), which could be attributable to post-traumatic stress or to adjustment disorders, probably linked to factors such as type of migration, forced family separation, dramatic life events, languagerelated social and cultural problems. In contrast, no particularly important nationality- related differences were evident in hospital diagnostic rates. Some differences emerged with regard to reasons for out-patient referrals and to the number and duration of hospitalisations, which were generally higher among the Swiss and Italians; these data could be indicators of shorter psychiatric histories, of emergency first hospitalisations with no after-care follow-up, or of early interruption of treatment among non-Italian foreign nationals. Full article