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This study aimed to provide a comprehensive overview of nearly 5 decades of childhood cancer statistics by examining trends and mortality rates in the SEER registry and providing insight into the progress and challenges ahead. We examined major pediatric cancer types, survival, and mortality rates, stratified by sex, age, and race/ethnicity. Our findings provide valuable insights into the progress made diagnostics, therapeutics, and clinical management. They also highlight areas in which further research and development are needed to improve outcomes, reduce treatment-related toxicities, and ensure equitable cancer care for all children and adolescents.
|
39752445_p4
|
39752445
|
Introduction
| 4.031024 |
biomedical
|
Study
|
[
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0.0005733306752517819,
0.00039936191751621664
] |
[
0.924106776714325,
0.0008388212881982327,
0.07472661882638931,
0.00032777301385067403
] |
en
| 0.999997 |
A retrospective analysis was conducted using data from the SEER database, encompassing the period 1975–2019. All children and adolescents (aged 0–19 years; i.e. below the age of 20) with cancer during this time frame were included. We have conducted two main analyses; population based for incidence rates, relative survival and mortality, and we generated a cohort-analysis for general characteristics and overall survival of this cohort. For the population cohort, we depended on the SEER 8 database. Data were extracted using SEER*stat by using the rates, case-listing and survival sessions. For the rates and relative survival sessions, SEER 8 was employed, and for the case-listing session, a data set of SEER 8 , SEER 12 , and SEER 17 was constructed. The datasets were merged and duplicates were removed based on the first primary label and patient identifier. The International Classification of Childhood Cancer (ICCC) site/histology recode was utilized to label all cancers. Race, sex, and survival data were also extracted. For all sessions, the study durations were stratified as follows: 1975–1979, 1980–1989, 1990–1999, 2000–2009, and 2010–2019. These periods were employed as user-defined variables. Age-standardized incidence rates (ASIRs) for each cancer type were obtained to assess incidence trends using the direct method and the 2000 U.S. standard population as a reference. Incidence rates were stratified by sex, age group (<1, 1–4, 5–9, 10–14, and 15–19 years), and race/ethnicity (White, Black, other, and unknown). Average percentage change (APC) and p -values for change over time were calculated and provided by SEER*stat.
|
39752445_p5
|
39752445
|
Study population and definitions
| 4.135359 |
biomedical
|
Study
|
[
0.9991317391395569,
0.0005490928306244314,
0.0003192501317244023
] |
[
0.9991812109947205,
0.00016440078616142273,
0.0005739793414250016,
0.00008037034422159195
] |
en
| 0.999997 |
Ethical approval was not required for this study. The Institutional Review Board (IRB) of King Hussein Cancer Center (KHCC) waived the need for ethical approval as the study posed minimal risk and utilized securely de-identified data.
|
39752445_p6
|
39752445
|
Ethical approval
| 1.152918 |
biomedical
|
Other
|
[
0.7179412245750427,
0.004266620613634586,
0.27779221534729004
] |
[
0.030429847538471222,
0.9681183695793152,
0.0006911317468620837,
0.000760617374908179
] |
en
| 0.999996 |
Survival was determined using the Kaplan-Meier method. We calculated the probability of 5-year overall survival (OS) for each cancer type and stratified the results by sex, age group, and race/ethnicity. Trends in survival over the study period were also assessed. To compare the survival of different subgroups across decades, Cox regression was applied, and the p -values were adjusted using the Holm method (also known as the Holm-Bonferroni method), a stepwise multiple-testing correction used to control the family-wise error rate when performing multiple hypothesis tests. The family-wise error rate is the probability of making at least one false-positive (Type I) error among all the hypothesis tests performed. This adjustment was necessary due to the large sample size and the fact that multiple testing can yield significant p-values by chance. Variables included in our multivariable model were: age, recoded in five-year increments; race; sex; SEER stage; decade, representing the time period or year of diagnosis in ten-year increments; and the ICCC.
|
39752445_p7
|
39752445
|
Statistical methods
| 4.080338 |
biomedical
|
Study
|
[
0.9993430972099304,
0.00045377181959338486,
0.00020315521396696568
] |
[
0.9991521835327148,
0.00026090440223924816,
0.0005063495482318103,
0.00008056169463088736
] |
en
| 0.999997 |
This study rigorously assessed the proportional hazards assumption. We evaluated each covariate within the model for proportional hazards over time, using pairs of decades as categorical predictors alongside clinical variables such as diagnosis type. To assess multicollinearity among the predictors, we computed the Variance Inflation Factors (VIF) for each variable using [insert software/tools]. VIF values below the threshold of 5 were considered acceptable, indicating low multicollinearity. Additionally, we computed Cramér’s V statistics for categorical variables to evaluate associations between the variables. The VIF values for all variables were below 5, with race and SEER stage exhibiting particularly low multicollinearity (VIF < 1.5), indicating that multicollinearity was not a concern in our model. Cramér’s V statistics showed weak associations among the categorical variables, further supporting the absence of multicollinearity concerns.
|
39752445_p8
|
39752445
|
Statistical methods
| 4.108081 |
biomedical
|
Study
|
[
0.9992673993110657,
0.00040178364724852145,
0.00033078136038966477
] |
[
0.9993571639060974,
0.00019389936642255634,
0.0003823123697657138,
0.00006658842175966129
] |
en
| 0.999997 |
Descriptive statistics on extracted individual patients were used to summarize the demographic and clinical characteristics of the study population. Continuous variables were reported as means and standard deviations (SD), and categorical variables were presented as frequencies and percentages. Statistical significance was set at p <0.05, and all tests were two-sided.
|
39752445_p9
|
39752445
|
Statistical methods
| 3.490677 |
biomedical
|
Study
|
[
0.9991551637649536,
0.0005789792048744857,
0.00026586110470816493
] |
[
0.9980960488319397,
0.0013196879299357533,
0.0004558708460535854,
0.00012844572484027594
] |
en
| 0.999999 |
Age-standardized incidence rates (ASIRs) for each cancer type were obtained to assess incidence trends using the direct method and the 2000 U.S. standard population as a reference. Incidence rates were stratified by sex, age group (<1, 1–4, 5–9, 10–14, and 15–19 years), and race/ethnicity (White, Black, other, and unknown). Average percentage change (APC), standard errors and p -values for change over time were calculated All analyses were conducted using SEER*Stat and R software (version 4.2.0). The study was deemed exempt from institutional review board approval, as the SEER database contains de-identified data and posed minimal risk to individual privacy.
|
39752445_p10
|
39752445
|
Statistical methods
| 4.01313 |
biomedical
|
Study
|
[
0.9993177652359009,
0.00032045142143033445,
0.00036174856359139085
] |
[
0.9993460774421692,
0.00030200465698726475,
0.00030215102015063167,
0.0000498289882671088
] |
en
| 0.999995 |
The JoinPoint Regression program (version 4.9.1.0) was employed to assess age-standardized incidence trends by fitting the most straightforward joinpoint model to cancer annual rate data. This analysis aimed to detect significant alterations in trends and determine the significance of apparent changes using the Monte Carlo Permutation method, assuming constant variance and uncorrelated errors . JoinPoint Regression for incidence was conducted on annual age-adjusted rates from SEER 8 registries. We calculated the APC for the whole group and the slope values for the smaller groups (cancer groups according to the ICCC) to provide a more sensitive method to assess changes and fluctuations. Further explanation of the methods can be found elsewhere . Relative survival was used to calculate the net survival in the absence of other causes of death, and the Ederer II method was used to calculate the cumulative expected survival. The U.S. 1970–2018 expected survival table, by individual year and race (White/Black/other), was used to calculate relative survival. To analyze relative survival trends based on the year of diagnosis, JPSurv online software was utilized, which applies JoinPoint survival models to identify shifts in linear trends in cancer death hazards over time [ 11 – 13 ]. The joinpoint survival model is a type of proportional hazard model for survival that extends its functionality to include the effect of the calendar year at diagnosis on the log hazard scale of cancer death. In this model, the effect of the calendar year is assumed to be linear. A maximum of three joinpoints were allowed for the analysis. Average absolute change in survival (AACS) was calculated between the survival joinpoints.
|
39752445_p11
|
39752445
|
JoinPoint regression
| 4.136766 |
biomedical
|
Study
|
[
0.9994856119155884,
0.00033132030512206256,
0.00018301050295121968
] |
[
0.9983654618263245,
0.0004047278198413551,
0.0011381434742361307,
0.00009168341784970835
] |
en
| 0.999997 |
Incidence rates steadily increased over time, starting with 14.23 cases per 100,000 children in 1975–1979 and rising to 15.24 in 1980–1989, 15.98 in 1990–1999, 17.25 in 2000–2009, and 18.89 in 2010–2019. The average annual percentage change (APC) in the incidence of all childhood cancers over the study period was 0.73 for all patients included. The reported changes for different racial groups revealed that Black children had the lowest rate of change (APC 0.48), while White (APC 0.78) and children of other races (APC 0.71) exhibited higher rates of change.
|
39752445_p12
|
39752445
|
Changes in rates
| 4.037695 |
biomedical
|
Study
|
[
0.9991164803504944,
0.0003802221908699721,
0.000503355055116117
] |
[
0.9991568326950073,
0.0002718046889640391,
0.0005178964347578585,
0.000053533360187429935
] |
en
| 0.999998 |
We also found significant increases in the incidence rates of leukemias, myeloproliferative, and myelodysplastic diseases (APC 0.84); lymphomas and reticuloendothelial neoplasms (APC 0.72); CNS and miscellaneous intracranial and intraspinal neoplasms (APC 0.71); soft-tissue and other extraosseous sarcomas (APC 0.43); hepatic tumors (APC 2.17); and germ cell tumors, trophoblastic tumors, and neoplasms of gonads (APC 0.50) . In contrast, the incidence rates of other cancer types, such as neuroblastoma and other peripheral nervous cell tumors (APC 0.14), retinoblastoma (APC 0.21), renal tumors (APC -0.18), and malignant bone tumors (APC 0.23) were relatively stable.
|
39752445_p13
|
39752445
|
Changes in rates
| 4.035825 |
biomedical
|
Study
|
[
0.9996097683906555,
0.00018606580852065235,
0.000204228243092075
] |
[
0.9980401396751404,
0.000613243377301842,
0.0012713808100670576,
0.00007523778913309798
] |
en
| 0.999997 |
The increase in leukemias was driven mainly by an increase in precursor cell leukemias (APC, 0.64), which was highest for White females (APC, 0.83), acute myeloid leukemias (AML; APC, 0.88), and chronic myeloproliferative diseases (APC, 2.42). The increase in lymphomas was mainly due to mature non-Burkitt B-cell lymphomas (APC, 0.93). The increase in CNS tumors was mainly due to the incidence of ependymomas (APC, 0.76), which was highest for White females (APC, 1.28); astrocytomas (APC, 0.66), highest for White females (APC, 0.77); and mixed and unspecified gliomas (APC, 1.44). Hepatoblastoma in both sexes and all races had an APC of 2.31. The increased APC of germ cell tumors was led by an increase in malignant gonadal germinomas in the White race (APC, 1.73). Melanoma incidence increased significantly in the White race (APC, 0.73, p = 0.01). A significant increase in the incidence of osteosarcoma in the White race was seen (APC, 0.86), compared to a nonsignificant decrease in the Black race (APC, -0.63; p = 0.23). The incidence of skeletal Ewing sarcoma was steady (APC, -0.22).
|
39752445_p14
|
39752445
|
Changes in rates
| 4.169084 |
biomedical
|
Study
|
[
0.9995669722557068,
0.0002316139143658802,
0.00020136749662924558
] |
[
0.9969679713249207,
0.00035933259641751647,
0.00258373050019145,
0.00008901156252250075
] |
en
| 0.999998 |
Male and female patients across all racial categories had an increased cancer rate over the analyzed periods. For female patients of all races, the incidence increased from 13.82 in 1975–1979 to 18.15 in 2010–2019, with an APC of 0.73. Higher trends were observed for females of White race (APC 0.80) and females of other races (APC 0.75), in comparison to those of Black race (APC 0.22). Likewise, for male patients of all races, the incidence increased from 14.63 in the 1975–1979 to 19.61 in 2010–2019, with an APC of 0.72. The trend was consistent across racial groups, with Black males (APC 0.68), other males (APC 0.67), and White males (APC 0.75) also experiencing increased incidence rates. Full details of rate trends are provided in S1 Table .
|
39752445_p15
|
39752445
|
Changes in rates
| 3.927726 |
biomedical
|
Study
|
[
0.9982424974441528,
0.0005827228887937963,
0.0011747366515919566
] |
[
0.9994070529937744,
0.00031931285047903657,
0.0002309951960342005,
0.000042653111449908465
] |
en
| 0.999996 |
Mortality records showed significant reductions in mortality rates for all children across various demographics over the analyzed period . The age-adjusted all-cause mortality rates for all children declined from 125.0 per 100,000 in 1975–1979 to 52.0 per 100,000 in 2010–2019, indicating a substantial improvement in child health outcomes. A similar trend was observed for cancer as a cause of death among children, with the age-adjusted death rate dropping from 4.9 per 100,000 in 1975–1979 to 2.3 per 100,000 in 2010–2019. When stratified by sex, male patients consistently exhibited higher age-adjusted cancer mortality rates than did female patients. The highest age-adjusted cancer mortality rates were consistently observed in the 15–19 years age group, followed by the 5–9 years and 10–14 years age groups.
|
39752445_p16
|
39752445
|
Age-adjusted all-cause mortality rates
| 4.090977 |
biomedical
|
Study
|
[
0.9986679553985596,
0.0006615869351662695,
0.0006705451523885131
] |
[
0.9991705417633057,
0.00021893221128266305,
0.0005570579087361693,
0.00005349591810954735
] |
en
| 0.999996 |
Kaplan-Meier survival estimates revealed significant improvements in pediatric 5- and 10-year survival. Rates rose from 63.1% ± 0.8% and 58.8% ± 0.8% in 1975–1979 to 85.2% ± 0.2% and 82.7% ± 0.3% in 2010–2019 .
|
39752445_p17
|
39752445
|
Cancer survival trends across study periods
| 3.980377 |
biomedical
|
Study
|
[
0.9983495473861694,
0.0012479553697630763,
0.00040254724444821477
] |
[
0.9985294342041016,
0.0007821698673069477,
0.0005538660334423184,
0.00013456529995892197
] |
en
| 0.999994 |
The survival of each disease generally improved, with significant improvements noted between consecutive decades for most diseases . Leukemias showed a substantial increase in survival, from 48.2% ± 1.7% in 1975–1979 to 85.1% ± 0.4% in 2010–2019. Lymphoma improved from 72.9% ± 1.7% to 94.2% ± 0.3%. CNS and miscellaneous intracranial and intraspinal neoplasms showed improved survival from 58.6% ± 2% to 74.6% ± 0.6%. These improvements were observed consistently across sex, race, and age groups. The data also showed that some diseases (e.g., retinoblastoma) already had high survival (95.8% ± 2.4%) during the earliest study period, and insignificant changes (95.6% ± 0.9%) by the latest decade. Throughout the study period, black children did worse than white children.
|
39752445_p18
|
39752445
|
Cancer survival trends across study periods
| 4.067339 |
biomedical
|
Study
|
[
0.9992210865020752,
0.0005391583545133471,
0.00023974408395588398
] |
[
0.9978826642036438,
0.00036968287895433605,
0.001650710590183735,
0.00009687955025583506
] |
en
| 0.999997 |
Survival of various cancers has generally improved over time, with significant improvements noted between consecutive study periods for several diseases . Precursor cell leukemias (Ia1) demonstrated a significant increase in survival from 55.8% ± 1.9% in 1975–1979 to 89.1% ± 0.4% in 2010–2019, with p -values <0.001 across all periods. Similarly, acute myeloid leukemias (Ib) significantly improved from 22.5% ± 3.3% to 67.5% ± 1.2%, with most decade-wise comparisons yielding p-values <0.001. High survival was noted for Hodgkin lymphomas (IIa) at 86.6% ± 1.6% in 1975–1979, which increased to 97.6% ± 0.3% in 2010–2019.
|
39752445_p19
|
39752445
|
Survival of the most common types of cancer
| 4.047388 |
biomedical
|
Study
|
[
0.9994716048240662,
0.00027181149926036596,
0.0002566895564086735
] |
[
0.9942593574523926,
0.00032988504972308874,
0.005322310607880354,
0.00008841336966725066
] |
en
| 0.999995 |
Astrocytomas (IIIb) exhibited a significant increase from 68.5% ± 2.7% to 81.5% ± 1.1% (p <0.001) between 1980–1989 and 1990–1999. Subsequently, the rates remained relatively stable, with no significant differences between consecutive intervals. Medulloblastomas (IIIc1) demonstrated improved survival from 49.2% ± 4.6% in 1975–1979 to 76.3% ± 1.6% in 2010–2019, with remarkable improvements after 1980 (p = 0.032) and 2010 (p = 0.029). In contrast, mixed and unspecified gliomas (IIId2) showed no significant changes in survival between subsequent periods, with rates of 41.2% ± 5.3% in 1975–1979 and 57.6% ± 1.7% in 2010–2019.
|
39752445_p20
|
39752445
|
Survival of the most common types of cancer
| 4.106195 |
biomedical
|
Study
|
[
0.9994531273841858,
0.0003180929343216121,
0.0002287620009155944
] |
[
0.9989076852798462,
0.0002396999771008268,
0.0007863883511163294,
0.0000661828089505434
] |
en
| 0.999998 |
We found notable improvements in the survival of patients with neuroblastoma or ganglioneuroblastoma (IVa) over the past four decades. The probability increased from 51.8% ± 3.5% in 1975–1979 to 54.7% ± 2.3% in 1980–1989, with no significant change between these periods (p >0.05). Subsequently, significant increases were recorded in 1990–1999 (68.1% ± 1.8%, p <0.001), 2000–2009 (75.8% ± 1%, p <0.001), and 2010–2019 (80.8% ± 1.1%, p <0.001), highlighting the considerable progress in patient outcomes over time.
|
39752445_p21
|
39752445
|
Survival of the most common types of cancer
| 4.075099 |
biomedical
|
Study
|
[
0.9991801381111145,
0.000542698719073087,
0.0002771143917925656
] |
[
0.9979787468910217,
0.0002535347011871636,
0.001675748499110341,
0.00009199941268889233
] |
en
| 0.999998 |
Rhabdomyosarcomas (IXa) displayed significant improvement only from 1975–1979 (47.9% ± 4.5%) to 1980–1989 (63.3% ± 3.2%, p = 0.007), but no significant change occurred afterwards. Nephroblastoma (VIa1) revealed a significant increase in survival from 76% ± 3.5% in 1975–1979 to 94.4% ± 0.8% in 2010–2019 (p = 0.024). Osteosarcomas (VIIIa) showed a slow, nonsignificant improvement in survival over the past four decades from 58.8% ± 3.1% in 1980–1989 to 68.3% ± 1.6% in 2010–2019. Thyroid carcinomas (XIb) maintained high and stable survival at 99.3% ± 0.7% in 1975–1979 and 99.5% ± 0.2% in 2010–2019.
|
39752445_p22
|
39752445
|
Survival of the most common types of cancer
| 4.097635 |
biomedical
|
Study
|
[
0.9994410872459412,
0.0003006269980687648,
0.00025830266531556845
] |
[
0.9982988238334656,
0.0003327579761389643,
0.0012968599330633879,
0.0000715921851224266
] |
en
| 0.999996 |
From 1975–1979 to 2010–2019, distant SEER stage cases increased from 31% to 42%, while unknown/in situ cases substantially decreased from 40% to 5.5%. Localized stages increased from 20% to 36%, and regional cases increased from 9% to 17% . The distribution of SEER stages among children with cancer evolved considerably, and cancer types that were not staged initially were assigned to SEER stages during the later study periods. Localized, regional, and unknown/in situ SEER stages showed substantially better survival than distant stages ( S2 Table ).
|
39752445_p23
|
39752445
|
Factors affecting survival comparing study periods
| 4.055549 |
biomedical
|
Study
|
[
0.9989752769470215,
0.00042590065277181566,
0.0005988957127556205
] |
[
0.9992755055427551,
0.0002466354926582426,
0.0004303103778511286,
0.000047544159315293655
] |
en
| 0.999996 |
Multivariable Cox regression analysis showed improved survival for patients who received a cancer diagnosis in subsequent decades. The hazard ratios (HR) for all-cause mortality significantly decreased, with patients diagnosed in 1980–1989 having an HR of 0.73; 1990–1999, 0.53; 2000–2009, 0.44; and 2010–2019, 0.35; all compared to the HR for 1975–1979. Sex, race, age, and SEER stage also played roles in survival, which dramatically improved for almost all disease categories . Male patients had a slightly higher HR for death than did female patients (1.14) . Patients in the Other and White race categories experienced better survival than those in the Black race category . Patients aged 1 to 14 years at diagnosis (1–4, 5–9, and 10–14 years) showed better survival gains compared to the infant group (0–<1 year) and the oldest (15–19 years) group .
|
39752445_p24
|
39752445
|
Factors affecting survival comparing study periods
| 4.080867 |
biomedical
|
Study
|
[
0.9989232420921326,
0.0008209809311665595,
0.0002557877451181412
] |
[
0.9982169270515442,
0.00036572219687514007,
0.0013068020343780518,
0.00011050370085285977
] |
en
| 0.999997 |
The analysis utilizing JoinPoint trends demonstrated a progressive escalation in the annual incidence of total malignancies, reflected by an APC of 0.73 (p <0.05) . This increase was reflected among all races (Mainly, White: slope = 1.34, Black: slope = 0.63; in both p <0.05). This growth was detected in leukemias (slope = 0.34, p <0.05), CNS malignancies (slope = 0.20, p <0.05), and to a lesser extent in germ cell and hepatic malignancies (slope = 0.06, p <0.05) and soft-tissue malignancies (slope = 0.05, p <0.05). It should be noted that APC reflects the change over the study period and takes in consideration the rate of change (correlates with the slope) and the starting rates (denominator). The rates of hepatic tumors were very low in the first decade, and showed the highest APC, as mentioned above. The assessment pinpointed significant shifts for lymphomas and reticuloendothelial neoplasms, with critical junctures or joinpoints appearing in 2005 and 2014. The slope illustrated a decline of -0.06 from 1975–2005, an increase of 1.25 (p <0.05) from 2005–2014, and a subsequent decline of -0.92 from 2014–2019. An additional joinpoint was discerned for other malignant epithelial neoplasms and malignant melanomas (Group XI) in 2005, as the slope shifted upwards from 0.14 (p <0.05) pre-2005 to 0.72* post-2005.
|
39752445_p25
|
39752445
|
JoinPoint analysis
| 4.176279 |
biomedical
|
Study
|
[
0.9994169473648071,
0.0003360572154633701,
0.0002469368337187916
] |
[
0.9989808201789856,
0.00021579444000963122,
0.0007335237460210919,
0.00006976191070862114
] |
en
| 0.999997 |
The 5-year relative survival analysis conducted through JoinPoint demonstrated gradual improvements over the years, with an AACS = 1.11 until 1988 and 0.42 post-1988 . Notably, survival for leukemias displayed significant improvement, reflected in an initial AACS of 5.15, followed by a lower yet steady rate of 0.90. Lymphomas exhibited an annual improvement of 0.58. In addition, survival of CNS malignancies and neuroblastoma also displayed enhancement at annual rates of 0.46 and 0.87, respectively. The survival for retinoblastoma remained relatively consistent, with a modest annual increase of 0.02, reflecting good overall survival. The survival of renal malignancies demonstrated a significant improvement at 3.19 until 1982 and a marginal increase of 0.09 afterwards. Hepatic malignancies showed an annual improvement of 1.2. Malignant bone tumors showed an increasing survival at 1.43 until 1992, followed by a decrease to 0.16.
|
39752445_p26
|
39752445
|
JoinPoint analysis
| 4.134702 |
biomedical
|
Study
|
[
0.9991030693054199,
0.0005369646823965013,
0.00036006298614665866
] |
[
0.9964642524719238,
0.0003920466988347471,
0.003045670920982957,
0.0000979973774519749
] |
en
| 0.999996 |
The analysis of relative survival estimates by JoinPoint regression did not reveal any recent joinpoints. This observation underscores either the absence of substantial advancements in therapeutic strategies for these tumors in recent years or the maintenance of already high survival for many diseases.
|
39752445_p27
|
39752445
|
JoinPoint analysis
| 2.533352 |
biomedical
|
Study
|
[
0.9972796440124512,
0.0007652739877812564,
0.001955026062205434
] |
[
0.9514507055282593,
0.044472355395555496,
0.003551727393642068,
0.0005252693081274629
] |
en
| 0.999997 |
Our study confirmed that cancer mortality has significantly decreased among pediatric patients. The annual age-standardized death rates dropped by almost half, from 4.9 to 2.3 per 100,000. However, these improvements in survival were not consistent across all diseases. Osteosarcoma and rhabdomyosarcoma did not consistently improve over the study period. Our Cox proportional hazards multivariable model revealed that the decade of diagnosis and the distant stage were the strongest predictors of outcome. Additionally, race and age were important predictors, with Black children experiencing worse survival, despite recent improvements and a narrowing of the gap.
|
39752445_p28
|
39752445
|
Discussion
| 4.077221 |
biomedical
|
Study
|
[
0.9991891980171204,
0.0005438722437247634,
0.000266876129899174
] |
[
0.9991235136985779,
0.00018617120804265141,
0.0006010674987919629,
0.00008918326057028025
] |
en
| 0.999996 |
The outcome of leukemias and lymphoma steadily improved. This is attributable to multiple changes in treatment and improvement of supportive care. Although the introduction of multiagent chemotherapy for acute lymphoblastic leukemia (ALL) and AML emerged in the 1950s and 1960s , this approach was further refined during the study period. Risk-based stratification was introduced in the 1980s , and minimal residual disease assessment was incorporated into treatment regimens the 1990s . CNS prophylaxis was intensified using effective intrathecal chemotherapy, high-dose methotrexate was introduced and tyrosine kinase inhibitors that improve the outcome of patients with Philadelphia chromosome–positive ALL were discovered in the 2000s . Similarly, the outcome of AML improved after anthracycline-based induction therapy was introduced , allogeneic hematopoietic stem cell transplantation was incorporated , and the prognostic significance of certain genetic markers, such as FLT3–ITD and NPM1 , was discovered .
|
39752445_p29
|
39752445
|
Discussion
| 4.059358 |
biomedical
|
Review
|
[
0.9963750243186951,
0.00216080853715539,
0.0014641077723354101
] |
[
0.02254369854927063,
0.0015249076532199979,
0.9754343032836914,
0.0004970832960680127
] |
en
| 0.999998 |
The outcome of lymphomas improved during the study period, with the introduction of risk-stratified treatment for Hodgkin lymphoma ; the introduction of the Lymphome Malin B protocol improved the outcomes for pediatric patients with non-Hodgkin lymphoma, particularly those with Burkitt B-cell lymphoma or large-cell lymphomas and the recent addition of rituximab to pediatric diffuse large B-cell lymphoma treatment regimens .
|
39752445_p30
|
39752445
|
Discussion
| 3.866503 |
biomedical
|
Review
|
[
0.9989615678787231,
0.0007720233988948166,
0.0002664120984263718
] |
[
0.40490251779556274,
0.09562895447015762,
0.4968160092830658,
0.002652505412697792
] |
en
| 0.999996 |
The outcome of CNS tumors has dramatically improved due to risk-adapted therapy for medulloblastoma ; the introduction of cisplatin, vincristine, and cyclophosphamide in the treatment of high-risk medulloblastoma ; and molecular subgrouping of medulloblastoma . Advances in surgical and radiotherapy techniques improved the outcome of children with ependymomas , and adding BRAF inhibitors improved the management of low-grade gliomas, though longer time is needed to appreciate the impact of this paradigm shift on outcome .
|
39752445_p31
|
39752445
|
Discussion
| 3.89016 |
biomedical
|
Review
|
[
0.9968371391296387,
0.002000488806515932,
0.0011623433092609048
] |
[
0.016423696652054787,
0.009802707470953465,
0.9731066226959229,
0.0006669263821095228
] |
en
| 0.999996 |
The National Wilms Tumor Study (NWTS) group led the early development of successful protocols for Wilms tumor, thereby dramatically improving patient outcomes. Ongoing international efforts in molecular stratification and fine-tuning of Wilms tumor therapy is further increasing survival .
|
39752445_p32
|
39752445
|
Discussion
| 2.076068 |
biomedical
|
Other
|
[
0.9900063872337341,
0.0025779767893254757,
0.007415667176246643
] |
[
0.022803056985139847,
0.965740442276001,
0.01029625628143549,
0.0011601949809119105
] |
en
| 0.999995 |
The outcome of neuroblastoma, namely high-risk neuroblastoma, has dramatically improved after retinoids and high-dose chemotherapy with stem cell rescue were added to the treatment . The recent incorporation of immunotherapy into high-risk neuroblastoma treatment regimens has also improved survival .
|
39752445_p33
|
39752445
|
Discussion
| 3.366711 |
biomedical
|
Other
|
[
0.9971634745597839,
0.001752824755385518,
0.00108359067235142
] |
[
0.050505828112363815,
0.6565371155738831,
0.28959524631500244,
0.0033618398010730743
] |
en
| 0.999997 |
Rhabdomyosarcoma outlook improved with the introduction of effective chemotherapy and early locoregional control, but further improvements have proved to be very difficult, and survival of patients with intermediate- or high-risk disease remains suboptimal .
|
39752445_p34
|
39752445
|
Discussion
| 2.641435 |
biomedical
|
Other
|
[
0.9924275279045105,
0.004831601865589619,
0.002740769414231181
] |
[
0.02175583876669407,
0.8818681240081787,
0.09241333603858948,
0.003962774761021137
] |
en
| 0.999997 |
For osteosarcoma, introducing cisplatin-based chemotherapy in the 1980s greatly improved the outcome , but that of patients, particularly those with metastatic disease and poor response after neoadjuvant chemotherapy, remains suboptimal. For Ewing sarcoma, the combination of vincristine, doxorubicin, and cyclophosphamide, alternating with ifosfamide and etoposide with interval compression, has improved the outlook for patients with localized Ewing sarcoma .
|
39752445_p35
|
39752445
|
Discussion
| 3.946038 |
biomedical
|
Review
|
[
0.9960430860519409,
0.00316062499769032,
0.0007962961681187153
] |
[
0.03614586591720581,
0.10757983475923538,
0.8539625406265259,
0.0023117191158235073
] |
en
| 0.999997 |
From 1975 to 2019, the incidence of pediatric cancer has been on an upward trajectory, with a more pronounced increase in specific cancers, such as precursor cell leukemias (especially among white females) and AML. Other contributors to this trend include mature non-Burkitt B-cell lymphomas, CNS tumors (e.g., ependymomas and astrocytomas), hepatoblastoma, and malignant gonadal germinomas, the latter mainly increasing among the White population. Although the incidence of bone tumors has generally remained stable, osteosarcoma has shown an uptick among White individuals. Although advancements in diagnostic tests could partly explain these trends , the role of environmental factors cannot be dismissed and warrants in-depth epidemiologic scrutiny. For example, although increasing low-dose environmental radiation and increasing maternal age have been suggested as factors, those notions are difficult to prove and do not appear to explain the scale of rising incidence . A previous report suggested there was an increase in childhood leukemia incidence between 1992 and 2004 but only a modest increase in overall childhood cancer incidence in the U.S. . Similar trends have been observed in Australian studies, which also project a continuing rise in childhood cancer rates up to 2035 . The long-term data from the National Registry of Childhood Tumours further corroborate the rising incidence of childhood cancers in the U.K., emphasizing the necessity for ongoing research to understand the underlying factors . Recent SEER data suggest a particular rise in early-onset cancers among adults younger than 50 years, especially among women (aged 30–39 years), while the incidence of cancer is declining in older individuals .
|
39752445_p36
|
39752445
|
Discussion
| 4.302208 |
biomedical
|
Study
|
[
0.9985042810440063,
0.0006151913548819721,
0.0008806051919236779
] |
[
0.5363264679908752,
0.0013979360228404403,
0.4618111252784729,
0.00046444538747891784
] |
en
| 0.999997 |
Our JoinPoint analysis revealed an interesting trend, with striking increase in incidence between 2004 and 2014, followed by a downward trend. This might reflect the interaction between a declining incidence for Hodgkin lymphomas and increasing incidence of non-Hodgkin (non-Burkitt) lymphomas. While this analysis has been a valuable tool in identifying trends in cancer incidence and survival, it does not fully account for external factors that may influence these trends. Public health interventions, advancements in medical technology, and shifts in healthcare policies can significantly affect the patterns observed. Future studies could benefit from integrating these external factors to provide a more comprehensive understanding of cancer trends and outcomes.
|
39752445_p37
|
39752445
|
Discussion
| 4.048958 |
biomedical
|
Study
|
[
0.9996274709701538,
0.00018830338376574218,
0.0001841748016886413
] |
[
0.9977051615715027,
0.0005712321144528687,
0.001640245201997459,
0.00008335596794495359
] |
en
| 0.999996 |
Lifestyle and environmental changes over recent decades, such as increased exposure to pollutants and carcinogens, may have contributed to the rising rates of pediatric cancers. For instance, certain pesticides and parental smoking have been linked to an increased risk of childhood leukemia [ 44 – 46 ]. Moreover, the prevalence of obesity and related metabolic changes might also play a role in this upward trend, with more evidence in young adults . Genetic predispositions, coupled with these environmental factors, underline the complexity of cancer etiology, necessitating multifaceted approaches in both research and public health interventions to address this growing concern.
|
39752445_p38
|
39752445
|
Discussion
| 3.957664 |
biomedical
|
Review
|
[
0.9987962245941162,
0.0005139379063621163,
0.0006898430292494595
] |
[
0.19296519458293915,
0.004547479096800089,
0.8019681572914124,
0.0005191495292820036
] |
en
| 0.999996 |
Racial disparities noted in our analysis is not a new finding. Even in standardized Children’s Oncology Group trials where patients receive same regimens, black children had worse outcomes . This is evident for different cancer types reported in previous analysis of SEER database, but not in patients treated at St. Jude Children’s research hospital, where overlapping outcomes for all cancers were noted regardless of cancer type , suggesting that socioeconomic factors, rather than true biologic factors, are responsible for racial survival disparities.
|
39752445_p39
|
39752445
|
Discussion
| 3.607628 |
biomedical
|
Study
|
[
0.9984183311462402,
0.000670465815346688,
0.0009112722473219037
] |
[
0.9953116774559021,
0.0033029101323336363,
0.0012601568596437573,
0.00012530808453448117
] |
en
| 0.999996 |
There are several limitations to consider in our study. First, the SEER database from which our data were collected does not cover the entire United States. Additionally, older data were collected from the SEER 8 data set, which may not fully represent the current population and treatment practices. Second, we faced limitations in accessing crucial information about treatment modalities, such as specific chemotherapy regimens or surgical approaches due to the retrospective nature of the study. This limited our ability to thoroughly analyze the impact of different treatments on survival outcomes. Finally, although we observed changes in trends over time, we did not definitively identify the underlying causes of the fluctuations. Despite these limitations, our study provides valuable insights into pediatric cancer survival and highlights the need for further research to better understand the factors influencing these trends. Expanding this analysis to include other resources, e.g. Medicaid data, records of second malignancies, and deaths from other causes (e.g., cardiovascular) could provide a more comprehensive understanding of treatment-related toxicity. Integrating these additional data sources would offer a deeper insight into the long-term effects of cancer treatment in children, allowing for a broader analysis of how treatment impacts overall health and mortality.
|
39752445_p40
|
39752445
|
Discussion
| 4.092336 |
biomedical
|
Study
|
[
0.9993379712104797,
0.00039409479359164834,
0.00026788286049850285
] |
[
0.998286783695221,
0.00023075981880538166,
0.0013952533481642604,
0.00008716250158613548
] |
en
| 0.999999 |
Spain is known for its intensive agriculture, providing fruit and vegetables to many of Europe . Its geographical, economic, and social situation is also an attractive factor for foreign nationals wishing to emigrate. In 2022, 7.534.513 foreign-born persons were registered in Spain . Of these, around 1.5 million citizens work in the agricultural sector, where in orchards, greenhouses, nurseries and gardens, migrant workers represent 66.83% of those hired in the sector with the professional category of labourer, and 36.63% as skilled workers. Not in vain, in 2022, the arrival in Spain of 31.219 irregular immigrants was recorded, of which almost 93% of them arrived by sea and by means of precarious boats dedicated to the illegal trafficking of people. By country of origin, the profile of irregular immigrants in Spain corresponds to citizens from Morocco, Guinea, Algeria, Mali, Côte d’Ivoire, Senegal and Tunisia and 1.258.894 regular immigrants, the main nationalities being Colombian (with 172.241 arrivals in Spain), Moroccan (113.725) and Ukrainian (91.621) .
|
39752620_p0
|
39752620
|
Introduction
| 1.149396 |
other
|
Other
|
[
0.009122241288423538,
0.00044582379632629454,
0.9904319643974304
] |
[
0.01775204762816429,
0.9807338714599609,
0.0008762952638790011,
0.0006377981044352055
] |
en
| 0.999994 |
The transformations in the sector in recent decades have led to a greater dependence on MSWs. As a result of the demands of the labor activity and the low wages in the tasks of harvesting and maintenance of crops, since the 1980s, there has been a gradual change where the native population has left the sector and has been replaced by workers of migrant origin . Thus, throughout the year, different agricultural regions concentrate thousands of workers in search of opportunities that they cannot find in their countries of origin . By origin, the usual profile of agricultural migrant workers is that of citizens of African (Maghreb) and Eastern European (Bulgaria and Romania) origin . This collective became, therefore, a determining factor for many crops, such as fruit trees and vineyards, and work in greenhouses, for example .
|
39752620_p1
|
39752620
|
Introduction
| 1.080014 |
other
|
Other
|
[
0.005963504314422607,
0.00042085591121576726,
0.9936156272888184
] |
[
0.011000565253198147,
0.9874643087387085,
0.0008922076085582376,
0.0006430079229176044
] |
en
| 0.999996 |
MFWs could be contracted in advance in their origin countries due to international political agreements (specially women from Morocco in the south of the country, and Latin American and East Europe workers), or in situ spontaneously (which is more common for African men). The employment contract of migrant agricultural workers is usually temporary. Even if MFW characteristics, origins and their working situations differ between regions in Spain, around 58% of them move between provinces for temporary jobs during the different harvesting seasons .
|
39752620_p2
|
39752620
|
Introduction
| 1.84313 |
biomedical
|
Other
|
[
0.6320867538452148,
0.0020418288186192513,
0.3658714294433594
] |
[
0.10634929686784744,
0.8916048407554626,
0.001421632245182991,
0.0006242396193556488
] |
en
| 0.999998 |
This change in the Spanish agricultural labor composition, characterized by the intense use of migrant workers, is directly related to labor precariousness and places these workers in a position susceptible to abuse or exploitation, especially when these workers are in an irregular situation . Over the last decades, the Administrations have been increasing measures to improve these conditions, as well as controls over employers to avoid irregularities and abuses and to ensure that their rights are complied with . The concerns related to labor rights, vulnerability, and social exclusion of these workers have been documented by various national and European sources , causing the agri-food sector to currently face several complex and multifaceted challenges to ensure that agricultural products are produced in conditions of safety and dignity for workers . These precarious living conditions have a direct impact on people’s health and quality of life [ 18 – 20 ]. Precarious employment implies greater mobility that conditions migrant seasonal workers (M S W) access to decent housing or the health system . It also exposes MSW to a higher risk of injury from occupational accidents . Thus, most of the health problems of MSW detected by different studies are associated with socioeconomic inequality, with a high prevalence of musculoskeletal problems derived from working conditions, non-communicable diseases such as diabetes mellitus, cardiac and renal alterations , in addition to communicable diseases prevalent in their places of origin .
|
39752620_p3
|
39752620
|
Introduction
| 3.341886 |
other
|
Study
|
[
0.4836796224117279,
0.0006363997817970812,
0.5156840085983276
] |
[
0.9630756974220276,
0.022282827645540237,
0.014433212578296661,
0.0002081934071611613
] |
en
| 0.999999 |
Although, in absolute data, immigration is equally distributed between men and women (48% men and 52% women), the gender gap among agricultural migrant workers is significant, with women accounting for only 25% of all hires . Women MSW in southern Spain follow a general trend of feminization of migrations motivated by the renationalization of the global care chain . Most women arrive with contracts from their countries of origin to work in intensive agriculture. The working conditions they found upon arrival are marked by exploitation and situations of labor and sexual harassment . Regarding living conditions, sub-Saharan women usually live in farmhouses and greenhouses, sharing small spaces with other women in groups of 4 to 10 people. They share rooms with beds separated by curtains. MSW women of Moroccan origin, and mainly seasonal workers from Huelva, often stay in Spain, encouraged by false promises of work and residence (migrants nearby). Without resources or a support network, MSW women live poorly in settlements where sanitary conditions are minimal and often resort to prostitution in the settlement itself .
|
39752620_p4
|
39752620
|
Introduction
| 1.174794 |
other
|
Other
|
[
0.010234691202640533,
0.0004799126763828099,
0.989285409450531
] |
[
0.05051194131374359,
0.9472661018371582,
0.0012620148481801152,
0.0009599744225852191
] |
en
| 0.999997 |
The COVID-19 pandemic situation increased the health vulnerability of migrants. In Spain, mobility was limited except for essential activities, such as work in intensive agriculture. Due to unequal employment, housing, and living conditions that migrant workers usually face, complying with prevention measures to limit COVID-19 transmission was complicated, including continuous hand washing, mandatory use of masks, and home confinement [ 24 , 32 – 34 ]. Consequently, the risk of disease transmission during the pathogenic period was higher in the migrant population than in the native population [ 35 – 38 ]. Different studies provide epidemiological data on the impact of COVID-19 on virus transmission in the migrant population , on living conditions in settlements , or inequalities in care, safety, and health of agricultural workers [ 40 – 42 ]. These studies offer epidemiological and social perspectives on the impact of COVID-19, addressing issues such as the spread of the virus, living conditions in settlements, and disparities in care and occupational safety, thus providing a comprehensive view of the challenges faced by agricultural workers in different contexts. The agri-food sector was considered strategic per article 15 Royal Decree 463/2020, which declares a state of alarm and establishes the necessary measures to guarantee food supply throughout the national territory .
|
39752620_p5
|
39752620
|
Introduction
| 3.907549 |
biomedical
|
Study
|
[
0.9798938035964966,
0.0006177254836075008,
0.01948847807943821
] |
[
0.7793992757797241,
0.007816759869456291,
0.2125183790922165,
0.00026563595747575164
] |
en
| 0.999998 |
The existing support landscape for MSWs in Spain before the pandemic was characterized by structural challenges, including limited access to healthcare, inadequate housing, and the complexities of navigating legal and social services, often exacerbated by language barriers and uncertain immigration status. During the pandemic, both local authorities and NGOs implemented extraordinary measures to care for MSWs, including temporary housing to ensure social distancing, mass testing, and stricter labor regulations to enhance safety in the workplace. Health education initiatives were carried out by NGOs, often in collaboration with agricultural companies, to inform MSWs about prevention measures and facilitate access to healthcare services .
|
39752620_p6
|
39752620
|
Introduction
| 2.120359 |
biomedical
|
Other
|
[
0.675035297870636,
0.00610020337626338,
0.31886449456214905
] |
[
0.03146761283278465,
0.9650557637214661,
0.002875171834602952,
0.0006014980026520789
] |
en
| 0.999997 |
However, the support landscape had its challenges. The inability to stop working, poor housing conditions, and cultural and linguistic differences hampered adherence to primary and secondary prevention measures, impacting the health of seasonal workers and their access to healthcare services. Additionally, the precarious nature of MSWs’ employment and housing conditions contributed to the difficulty of implementing preventive measures effectively .
|
39752620_p7
|
39752620
|
Introduction
| 2.078789 |
biomedical
|
Other
|
[
0.9253194332122803,
0.00519951619207859,
0.06948110461235046
] |
[
0.15798847377300262,
0.8385962843894958,
0.002110334811732173,
0.0013048523105680943
] |
en
| 0.999997 |
Additional deeper analysis of the perspective of professionals from various sectors involved in caring for this vulnerable population, such as NGOs, social services, trade unions, local institutions, and health services, would help to understand the challenges inherent in providing services to this group . To address this gap, this study delves both into the difficulties experienced by MSW in complying with prevention measures during the COVID-19 pandemic, the health consequences of the pandemic on them and the actions undertaken to promote compliance with these measures in four Spanish regions that host high numbers of MSWs (Catalonia, La Rioja, Murcia, and Andalusia) from the health and social professionals’ perspective.
|
39752620_p8
|
39752620
|
Introduction
| 2.508646 |
biomedical
|
Study
|
[
0.8835774064064026,
0.0021169132087379694,
0.11430560797452927
] |
[
0.9962548017501831,
0.003307648468762636,
0.00031363690504804254,
0.00012388743925839663
] |
en
| 0.999997 |
The study is part of a larger mix-methods research project that aims to assess the impact of job insecurity and social exclusion on the health of migrant men and women working in the agricultural sector in Spain . This qualitative study focuses on the experiences shared by social and health professionals during the COVID-19 pandemic in four specific regions of Spain: Catalonia, La Rioja, Murcia, and Andalusia.
|
39752620_p9
|
39752620
|
Study design
| 2.149447 |
biomedical
|
Study
|
[
0.905083417892456,
0.0022347308695316315,
0.0926818773150444
] |
[
0.9961658716201782,
0.0034376862458884716,
0.00023441943631041795,
0.00016205149586312473
] |
en
| 0.999998 |
We employed a descriptive qualitative approach that allows researchers, from a naturalistic perspective, to describe little-known phenomena and interpret participants’ experiences in their everyday environments . This method allowed us to explore and understand how the COVID-19 pandemic affected MSW, focusing on the perceptions of those involved in the migrants’ care in a social and healthcare context.
|
39752620_p10
|
39752620
|
Study design
| 2.693187 |
biomedical
|
Study
|
[
0.9305874109268188,
0.000908716581761837,
0.06850387901067734
] |
[
0.9912113547325134,
0.008191879838705063,
0.00046327398740686476,
0.00013339299766812474
] |
en
| 0.999998 |
S ix of the authors of this article, three men and three women conducted the interviews. We conducted 87 semi-structured personal and online interviews (80 individual and 6 in pair interviews) with 92 participants (55 women and 37 men) between 24 th October 2021 and 8 th July 2022. The interviews involved professionals from public and social entities involved assisting MSWs: NGO staff, health workers, social workers and educators, intercultural mediators, agricultural trade unions, and people with managerial positions in public institutions ( Table 1 ). Participants were selected by purposive sampling and met the following inclusion criteria: professionals working in public and social entities in the four above mentioned regions, whose professional tasks included assisting MSWs, and had a minimum of six months’ experience working with them. The interviews lasted, on average, 60 minutes. Much of the information was collected face-to-face in different locations, although telematic interviews were also used due to the pandemic and the successive health restrictions.
|
39752620_p11
|
39752620
|
Participants and data collection
| 2.439177 |
biomedical
|
Study
|
[
0.8568210601806641,
0.0022881017066538334,
0.14089086651802063
] |
[
0.9967759251594543,
0.0029143076390028,
0.0001925615215441212,
0.00011712820560205728
] |
en
| 0.999998 |
The interviews were recorded, and the information was transcribed verbatim for subsequent analysis with ATLAS.ti web. Five authors were involved in coding the transcriptions and conducting an inductive reflexive thematic analysis focusing on those aspects of the interviews relating to Covid-19 . First, an initial code tree based on the interview script was designed and applied. After repeated reading of the interviews, the different units of meaning (sentences or paragraphs) referring to COVID-19 were identified and assigned the code "COVID-19". They were then re-read and inductively coded to create new emerging codes that described and summarized the meaning of the sentences or paragraphs. All resulting codes were grouped into code families according to their similarity, forming the first subcategories that allowed the identification of the final categories, subthemes and themes shown in the results. An example of the coding process could be consulted in Fig 1 .
|
39752620_p12
|
39752620
|
Data analysis
| 3.806203 |
biomedical
|
Study
|
[
0.9632840752601624,
0.0008364954846911132,
0.03587948903441429
] |
[
0.9988752007484436,
0.0008514528744854033,
0.0002253710408695042,
0.00004794282358488999
] |
en
| 0.999997 |
We obtained the approval from the Ethics Committee for Research with Medicines of the Universitary Hospital Arnau de Vilanova- Lleida Territorial Management . Interviews were digitally recorded after obtaining verbal and written consent from the participants, who were informed of the study’s aims and were guaranteed anonymity and confidentiality in expressing their opinions.
|
39752620_p13
|
39752620
|
Ethical considerations
| 1.628152 |
biomedical
|
Study
|
[
0.8363300561904907,
0.002962154569104314,
0.1607077717781067
] |
[
0.5375596284866333,
0.45982760190963745,
0.0013288019690662622,
0.0012839732225984335
] |
en
| 0.999997 |
The research report process followed the Consolidated Criteria for Reporting and Publication of Qualitative Research (COREQ) . Methodological rigor was ensured throughout the study following the quality criteria of Guba and Lincoln . Credibility, transferability, and confirmability were used as quality criteria to guarantee the rigor of the research process. Credibility was enhanced by the triangulation of the interpretation of the analysis results among different researchers and by providing verbatim quotes in the results section to support their joint interpretation. Dependability was guaranteed as five authors were involved in collecting and codifying the data independently. Then, they made an independent proposal for the results, discussing and agreeing later on the most appropriate one. Confirmability was enhanced as all the authors have lengthy experience in qualitative research and migration and by the heterogeneity of the participant profiles (social services, NGOs, health services, activism), all with broad experience in working with migrant farmworkers. Transferability was achieved through the description of the context and the participant profiles.
|
39752620_p14
|
39752620
|
Rigor
| 3.98453 |
biomedical
|
Study
|
[
0.7799168825149536,
0.0008857912034727633,
0.2191973775625229
] |
[
0.9938704967498779,
0.004423835314810276,
0.001636195695027709,
0.00006946291250642389
] |
en
| 0.999998 |
We structured the results into three main themes: 1) COVID’s extraordinary experience of cross-sectoral collaboration, 2) Compliance or non-compliance of MSW with the preventive and containment measures of COVID-19?, and 3) COVID exacerbated common health and healthcare problems of MWS. Their corresponding subthemes, categories and subcategories can be seen in Table 2 . These themes explain how in order to mitigate the impact of the pandemic, both public authorities and NGOs implemented extraordinary measures. However, adequate adherence to primary prevention measures (which included maintaining a safe distance, surface and hand disinfection, and the use of protective masks and personal protective devices) and secondary prevention measures (screening, early diagnosis and detection of cases, and case and contact control aimed at breaking chains of transmission) was hampered by several factors. These obstacles included the inability to stop working, poor housing conditions (water and electricity shortages, housing location, and overcrowding), and challenges related to cultural and linguistic differences. These circumstances impacted the health of seasonal workers and their access to healthcare services.
|
39752620_p15
|
39752620
|
Results
| 4.028948 |
biomedical
|
Study
|
[
0.9972959160804749,
0.0011094912188127637,
0.0015946191269904375
] |
[
0.998772919178009,
0.00034888036316260695,
0.0008106378954835236,
0.00006757790106348693
] |
en
| 0.999996 |
In order to mitigate the impact of the pandemic in MFWs, local and regional authorities and NGOs implemented extraordinary measures, sometimes coordinately, which had rarely happened before.
|
39752620_p16
|
39752620
|
1. COVID’s extraordinary experience of cross-sectoral collaboration
| 1.419452 |
other
|
Other
|
[
0.203548401594162,
0.002571295015513897,
0.79388028383255
] |
[
0.005569480359554291,
0.9935729503631592,
0.0005184335168451071,
0.0003392436483409256
] |
en
| 0.999997 |
The priority was that MSW were not dispersed and had accommodation . Local and provincial public administrations required farmers to provide decent housing conditions for workers to comply with safety measures. Even so, given the inadequacy of the accommodation and the difficulty of converting it, the administrations set up temporary accommodation facilities for them, such as shelters. This measure was also aimed at preventing some of the MSW from finding themselves destitute and homeless.
|
39752620_p17
|
39752620
|
1.1. Convergence and Synergy in measures taken by regional and local authorities
| 1.058651 |
other
|
Other
|
[
0.004217043519020081,
0.0009659482748247683,
0.9948170781135559
] |
[
0.0025319023989140987,
0.9965092539787292,
0.00036967452615499496,
0.0005891660111956298
] |
en
| 0.999997 |
Because of the overcrowding of these housing facilities, outbreaks occurred because M S W could not apply the recommended and established biosecurity recommendations on the need to maintain safe interpersonal distance. It led to a reassessment of the maximum permissible capacity of the shelters, consequently reducing the number of infections in these facilities.
|
39752620_p18
|
39752620
|
1.1. Convergence and Synergy in measures taken by regional and local authorities
| 1.731709 |
biomedical
|
Other
|
[
0.9071992039680481,
0.016465280205011368,
0.07633548229932785
] |
[
0.04812274128198624,
0.9471681714057922,
0.0009685505647212267,
0.0037404834292829037
] |
en
| 0.999997 |
However, there was less government intervention in the permanent settlements. Even so, during the pandemic, resources such as drinking water taps, portable toilets, and rubbish collection were also installed. Participants recognized that most of these facilities were not maintained over time.
|
39752620_p19
|
39752620
|
1.1. Convergence and Synergy in measures taken by regional and local authorities
| 1.290245 |
other
|
Other
|
[
0.09815508127212524,
0.001992515055462718,
0.8998523354530334
] |
[
0.03220584988594055,
0.966254711151123,
0.0007678700494579971,
0.0007715564570389688
] |
en
| 0.999995 |
For those people who had to remain in isolation because they were positive or in close contact but did not have adequate housing, the different institutions provided houses, shelters, hostels, or prefabricated dwellings for their isolation.
|
39752620_p20
|
39752620
|
1.1. Convergence and Synergy in measures taken by regional and local authorities
| 1.620772 |
biomedical
|
Other
|
[
0.7275006175041199,
0.0324590727686882,
0.24004028737545013
] |
[
0.026770232245326042,
0.971311092376709,
0.0005095502710901201,
0.0014091318007558584
] |
en
| 0.999997 |
However, the facilities did not always meet adequate conditions for this, nor were the seasonal workers properly informed of their situation, rights and obligations. Participants reported violent episodes with MSW during their stay in these dwellings. Also, there were cases of escape attempts because they did not understand why they had to stay there without being able to go to work, or because they did not agree to comply with the prescribed isolation or quarantine measures, and the state security forces had to intervene on some occasions.
|
39752620_p21
|
39752620
|
1.1. Convergence and Synergy in measures taken by regional and local authorities
| 1.334926 |
other
|
Other
|
[
0.06165751814842224,
0.0020405231043696404,
0.9363019466400146
] |
[
0.08365897834300995,
0.9143000841140747,
0.0006838957197032869,
0.0013571038143709302
] |
en
| 0.999999 |
The solidarity initiatives taken by NGOs during the pandemic included health education about COVID to MSW and the provision of food and hygiene measures.
|
39752620_p22
|
39752620
|
1.2. Solidarity Initiatives taken by NGOs during the pandemic: Prevention, food and hygiene
| 1.422773 |
other
|
Other
|
[
0.26008352637290955,
0.004213182721287012,
0.7357033491134644
] |
[
0.0027917521074414253,
0.9962329268455505,
0.0006559798493981361,
0.00031935039442032576
] |
en
| 0.999997 |
Health education . Since NGOs worked in settlements and with the seasonal population before the pandemic, they often facilitated bringing the health system closer to the most vulnerable populations. On their own initiative or in collaboration with agricultural companies or the health system, they educated seasonal workers on prevention and case-control measures and close contacts, as well as providing materials in different languages. To make health education more efficient among MSW, NGOs and administrations used professional mediators, people from different backgrounds, or recognized figures in the community to overcome language and cultural barriers.
|
39752620_p23
|
39752620
|
1.2. Solidarity Initiatives taken by NGOs during the pandemic: Prevention, food and hygiene
| 1.933561 |
biomedical
|
Other
|
[
0.5053859353065491,
0.004662769380956888,
0.4899512827396393
] |
[
0.01008162647485733,
0.9888685941696167,
0.0007633506902493536,
0.000286479335045442
] |
en
| 0.999996 |
Food and hygiene . NGOs provided food to the settlements and set up soup kitchens for seasonal workers. They also facilitated disinfection by providing the necessary materials such as water, masks and disinfectants in the settlements to prevent further spread of the virus.
|
39752620_p24
|
39752620
|
1.2. Solidarity Initiatives taken by NGOs during the pandemic: Prevention, food and hygiene
| 1.616895 |
biomedical
|
Other
|
[
0.7440577149391174,
0.004775011446326971,
0.25116726756095886
] |
[
0.00814590323716402,
0.9910269379615784,
0.00041878363117575645,
0.0004084293614141643
] |
en
| 0.999998 |
Screening strategies . In order to bring the prevention and control measures foreseen in the different action protocols closer to the population, the health system activated mobile units to the settlements and other areas frequented by MSW to carry out PCR diagnostic tests and distribute hygiene and protection materials to them.
|
39752620_p25
|
39752620
|
1.3. Health system efforts to screen and vaccinate MWS
| 1.893289 |
biomedical
|
Other
|
[
0.9561885595321655,
0.005114205181598663,
0.03869715705513954
] |
[
0.023447638377547264,
0.9752278923988342,
0.0005878440570086241,
0.0007366402423940599
] |
en
| 0.999996 |
However, health professionals in health centers sometimes lacked the time in their working day to go to the settlements or rural areas where MSW lived or worked, so in some communities, staffing was increased to care for the seasonal population.
|
39752620_p26
|
39752620
|
1.3. Health system efforts to screen and vaccinate MWS
| 1.750858 |
biomedical
|
Other
|
[
0.7703359723091125,
0.028380056843161583,
0.20128396153450012
] |
[
0.046746931970119476,
0.95081627368927,
0.000813372025731951,
0.0016234359936788678
] |
en
| 0.999996 |
Vaccination strategies . Similarly, health institutions agreed on the importance of vaccinating the seasonal population and promoted outreach strategies. In some cases, vaccination was compulsory in order to be able to work, something that was not the case in other professions.
|
39752620_p27
|
39752620
|
1.3. Health system efforts to screen and vaccinate MWS
| 1.759429 |
biomedical
|
Other
|
[
0.7804103493690491,
0.010885757394134998,
0.2087039053440094
] |
[
0.010129791684448719,
0.9878498911857605,
0.0013810967793688178,
0.000639161909930408
] |
en
| 0.999998 |
Initially, seasonal workers were reluctant to be vaccinated, but this gradually changed as the pandemic progressed and more and more people in their environment became infected. Likewise, vaccination was particularly difficult for seasonal workers in an irregular administrative situation. Hence, placing vaccination points close to their place of work or residence was once again influential in getting them vaccinated.
|
39752620_p28
|
39752620
|
1.3. Health system efforts to screen and vaccinate MWS
| 1.839502 |
biomedical
|
Other
|
[
0.8053588271141052,
0.0050719669088721275,
0.1895691454410553
] |
[
0.013972600921988487,
0.983992874622345,
0.0014131420757621527,
0.000621323415543884
] |
en
| 0.999996 |
Participants working in public institutions, having planned and implemented real-time measures for an unexpected pandemic, described that learning and continuous reviewing protocols would improve performance in subsequent campaigns.
|
39752620_p29
|
39752620
|
1.4. Lessons learned and good practices of cross-sectoral collaboration and networking
| 1.665325 |
biomedical
|
Other
|
[
0.6208123564720154,
0.006924717221409082,
0.3722629249095917
] |
[
0.02721824124455452,
0.969689130783081,
0.002389300847426057,
0.0007032997673377395
] |
en
| 0.999996 |
The participants considered the mobilization and joint work between public and social institutions to be exceptionally positive, considering it critical to the correct application and continuous revision of the protocols. They also pointed out the importance of companies getting involved in applying measures to prevent contagion among workers, as this significantly reduced the number of contagions.
|
39752620_p30
|
39752620
|
1.4. Lessons learned and good practices of cross-sectoral collaboration and networking
| 1.626147 |
other
|
Other
|
[
0.37562471628189087,
0.0026653443928807974,
0.6217098832130432
] |
[
0.049446411430835724,
0.947838306427002,
0.0021199514158070087,
0.000595400168094784
] |
en
| 0.999998 |
Likewise, the increase in inspections by the administrations prevented overcrowding and improved accommodation conditions. Moreover, increasing the number of places available in shelters has prevented people from sleeping rough, as has been the case in previous years.
|
39752620_p31
|
39752620
|
1.4. Lessons learned and good practices of cross-sectoral collaboration and networking
| 1.059305 |
other
|
Other
|
[
0.010271589271724224,
0.0011020589154213667,
0.9886263012886047
] |
[
0.0024189408868551254,
0.9965446591377258,
0.0004962170496582985,
0.0005401328671723604
] |
en
| 0.999995 |
About seasonal workers’ compliance with the rules established for the containment of Covid-19, participants shared two types of discourses: one that identifies them as good at complying with the rules and the other that attributes incorrect compliance with the measures to them.
|
39752620_p32
|
39752620
|
2. Compliance or non-compliance of MSW with the preventive and containment measures of COVID-19?
| 1.201896 |
other
|
Other
|
[
0.033240411430597305,
0.0010887725511565804,
0.9656708836555481
] |
[
0.05322757363319397,
0.9448109269142151,
0.0011071263579651713,
0.0008543526637367904
] |
en
| 0.999996 |
2 . 1 . 1 . Maintaining the safety distance between MSW . At work . Informants explained that companies established guidelines so that, even in the open air, seasonal workers were kept at a certain distance at all times. In addition, work and transport to the fields were planned based on bubble groups, in which they worked with individual teams.
|
39752620_p33
|
39752620
|
2.1. Challenges in practice to implement prevention measures
| 1.158237 |
other
|
Other
|
[
0.026224177330732346,
0.0015249967109411955,
0.972250759601593
] |
[
0.006507286336272955,
0.992546021938324,
0.00045210501411929727,
0.0004945637774653733
] |
en
| 0.999995 |
Meanwhile, other companies did not set guidelines to respect social distance in the workplace, even in closed environments.
|
39752620_p34
|
39752620
|
2.1. Challenges in practice to implement prevention measures
| 1.065128 |
other
|
Other
|
[
0.0038252430967986584,
0.0007939164061099291,
0.9953808784484863
] |
[
0.0033154143020510674,
0.9952113032341003,
0.0008051103795878589,
0.0006681197555735707
] |
en
| 0.999998 |
However, the continuous movement of workers between localities and autonomous communities facilitated the transmission of the virus, reducing the effectiveness of the measures taken.
|
39752620_p35
|
39752620
|
2.1. Challenges in practice to implement prevention measures
| 1.804586 |
biomedical
|
Other
|
[
0.9646168351173401,
0.002144627505913377,
0.03323860093951225
] |
[
0.07714139670133591,
0.9192211627960205,
0.0023427552077919245,
0.001294681802392006
] |
en
| 0.999997 |
In accommodation . Due to the substandard and overcrowded conditions in which the most vulnerable MSW live, it was difficult, if not impossible, for them to respect the safety distance between people and quarantine measures recommended during the pandemic. However, the continuous movement of workers between localities and autonomous communities facilitated the transmission of the virus, reducing the effectiveness of the measures taken.
|
39752620_p36
|
39752620
|
2.1. Challenges in practice to implement prevention measures
| 1.677895 |
biomedical
|
Other
|
[
0.673922598361969,
0.004231525119394064,
0.3218458592891693
] |
[
0.0270219836384058,
0.9716173410415649,
0.0006388216279447079,
0.0007218315731734037
] |
en
| 0.999997 |
2 . 1 . 2 . Hygiene , disinfection and MSW’s use of protective face masks . At work . Just as labor regulations stipulate that the contracting companies must provide safety devices at work, the companies did not provide them with masks or hand disinfectant products in several cases.
|
39752620_p37
|
39752620
|
2.1. Challenges in practice to implement prevention measures
| 1.446141 |
other
|
Other
|
[
0.17209763824939728,
0.0046402085572481155,
0.8232622146606445
] |
[
0.005373533349484205,
0.9938805103302002,
0.00041687232442200184,
0.00032899194047786295
] |
en
| 0.999997 |
Even when they did receive them, they were sometimes dirty or in a condition that made them practically unusable. In addition, the workers did not have the money to buy masks either, not least because of the high prices and low accessibility of the masks.
|
39752620_p38
|
39752620
|
2.1. Challenges in practice to implement prevention measures
| 1.293002 |
other
|
Other
|
[
0.16464996337890625,
0.003665424883365631,
0.8316845893859863
] |
[
0.013522598892450333,
0.9849812984466553,
0.0008152211084961891,
0.0006808741600252688
] |
en
| 0.999998 |
For the most vulnerable MSW living in farmhouses or shacks, measures such as hand washing, and surface disinfection were practically impossible to carry out due to the lack of running water.
|
39752620_p39
|
39752620
|
In settlements
| 1.77453 |
biomedical
|
Other
|
[
0.875995934009552,
0.0067829652689397335,
0.1172211542725563
] |
[
0.048831090331077576,
0.9491404891014099,
0.0007737657870166004,
0.0012546342331916094
] |
en
| 0.999996 |
2 . 1 . 3 . Performance of screening tests . PCR testing among MSW . Health institutions encountered resistance or desertion to take the PCR test, as testing positive meant risking the possibility of working or being under the control of the administration. Furthermore, traveling to take the PCR test was another reason why people chose not to take the test, even when transport was free. Sometimes, people who refused to take the test were also ineligible for other services provided by the associations, such as shelter or canteen, or for employment through the administration or trade unions, as taking the PCR was a prerequisite.
|
39752620_p40
|
39752620
|
In settlements
| 2.313951 |
biomedical
|
Other
|
[
0.968428373336792,
0.007059967145323753,
0.024511603638529778
] |
[
0.32290858030319214,
0.6743579506874084,
0.0011188349453732371,
0.0016146594425663352
] |
en
| 0.999998 |
Some MSW considered it essential to know their status and adapted well to measures to protect their health. If they were free of COVID-19, it was used as a guarantee of being able to work, even if they also did so with a particular fear of being positive.
|
39752620_p41
|
39752620
|
In settlements
| 1.576569 |
biomedical
|
Other
|
[
0.5699743628501892,
0.01130076963454485,
0.4187248945236206
] |
[
0.008709763176739216,
0.990121603012085,
0.0005660018068738282,
0.0006026623887009919
] |
en
| 0.999996 |
Since PCR results were not obtained on the spot, there was great difficulty in communicating the results when they were positive due to the high mobility of the seasonal population, the frequent number of telephone changes, the concealment of the MSW themselves so that they could not be located and prevented from working, or the use of the same documentation by more than one person.
|
39752620_p42
|
39752620
|
Communication of PCR results to MSW
| 1.964753 |
biomedical
|
Other
|
[
0.9770542979240417,
0.008031749166548252,
0.014914063736796379
] |
[
0.32296687364578247,
0.6730836629867554,
0.0010371621465310454,
0.0029122973792254925
] |
en
| 0.999997 |
Registration in the health system program was also administratively complex, as the program was not prepared to take records from people without a health card or those who were not previously registered in any national health system. Also, name registration errors resulted in duplicate registration of the same person.
|
39752620_p43
|
39752620
|
Registration of PCR results from MSW
| 1.695746 |
other
|
Other
|
[
0.390718936920166,
0.01876966841518879,
0.5905113220214844
] |
[
0.043548583984375,
0.9546793699264526,
0.000574250181671232,
0.0011978123802691698
] |
en
| 0.999996 |
2 . 2 . 1 . MSW concealed symptoms for fear of losing work time and/or being evicted from the home . The administration’s measures stated that the person should not go to work after testing positive, being in close contact with a positive case, or having symptoms compatible with COVID-19. Therefore, some people concealed their status in order to be allowed to continue going to work.
|
39752620_p44
|
39752620
|
2.2. Grounds for MSW non-compliance with the preventive measures
| 1.346804 |
other
|
Other
|
[
0.10456598550081253,
0.007228408474475145,
0.8882055878639221
] |
[
0.008002573624253273,
0.9910635948181152,
0.00029586307937279344,
0.0006380174309015274
] |
en
| 0.999997 |
Thus, participants identified that MSW experienced the COVID phenomenon as an impediment that would not allow them to work. In hiding these conditions, they deployed different strategies to deny being screened or identified as positive by the administrations, such as hiding or changing their telephone number to avoid losing their job opportunities.
|
39752620_p45
|
39752620
|
2.2. Grounds for MSW non-compliance with the preventive measures
| 1.370018 |
other
|
Other
|
[
0.07172182202339172,
0.0022033220157027245,
0.9260749220848083
] |
[
0.11094742268323898,
0.886885404586792,
0.0009250771254301071,
0.0012421401916071773
] |
en
| 0.999996 |
For all these reasons, the most significant identification difficulties were with the temporary population in an irregular administrative situation, without a contract, and those living in settlements. They needed more resources, were more afraid of being identified, were more challenging to locate, and depended more on work for their livelihoods.
|
39752620_p46
|
39752620
|
2.2. Grounds for MSW non-compliance with the preventive measures
| 1.041463 |
other
|
Other
|
[
0.005625287536531687,
0.0009186401730403304,
0.9934560656547546
] |
[
0.00661707017570734,
0.9918462634086609,
0.0006959614693187177,
0.0008408137364313006
] |
en
| 0.999996 |
In households, MSW developed defensive strategies such as expelling infected people from the house or work crew, denying that they lived there to protect them, and avoiding having to be quarantined as close contacts.
|
39752620_p47
|
39752620
|
2.2. Grounds for MSW non-compliance with the preventive measures
| 1.694453 |
biomedical
|
Other
|
[
0.7193019390106201,
0.005864093080163002,
0.2748339772224426
] |
[
0.025712957605719566,
0.9728114008903503,
0.0007761718006804585,
0.0006994889117777348
] |
en
| 0.999998 |
2 . 2 . 2 . Cultural barriers and different conceptions of health/disease between MSW and the native population . The participants found that the fact that the virus did not affect them in principle in their daily lives made COVID seem unimportant to them. Moreover, due to misinformation about the mode of infection and the severity of COVID-19, seasonal workers denied the possibility that COVID-19 could affect them, or at least not significantly.
|
39752620_p48
|
39752620
|
2.2. Grounds for MSW non-compliance with the preventive measures
| 2.184802 |
biomedical
|
Study
|
[
0.9724231362342834,
0.0023085433058440685,
0.025268273428082466
] |
[
0.931323766708374,
0.06706154346466064,
0.0010265044402331114,
0.0005882190889678895
] |
en
| 0.999999 |
Similarly, people who had experienced hardship in their migration journey and those who had lived with various serious endemic diseases in their countries did not attach importance to a disease with (a priori) mild symptoms.
|
39752620_p49
|
39752620
|
2.2. Grounds for MSW non-compliance with the preventive measures
| 1.72996 |
biomedical
|
Other
|
[
0.8971922993659973,
0.0025396214332431555,
0.10026809573173523
] |
[
0.0873970165848732,
0.9101780652999878,
0.0014975718222558498,
0.0009274112526327372
] |
en
| 0.999996 |
Therefore, in asymptomatic or mildly symptomatic positive cases, they did not see the need to follow the guidelines set by the administrations, even less so if they implied a mobility limitation and consequently had to stop working. However, in some cases, the perception of the risk involved in COVID changed as they saw cases of people close to them who were severely affected as a result of infection.
|
39752620_p50
|
39752620
|
2.2. Grounds for MSW non-compliance with the preventive measures
| 1.7642 |
biomedical
|
Other
|
[
0.8630118370056152,
0.05873958393931389,
0.07824856042861938
] |
[
0.059661149978637695,
0.9342299699783325,
0.001296670758165419,
0.004812201019376516
] |
en
| 0.999997 |
The health problems related to the pandemic, added to the health problems already faced by MFW due to their social and labor conditions. Moreover, access to healthcare services was complicated due to communications problems.
|
39752620_p51
|
39752620
|
3. COVID exacerbated common health and healthcare problems of MWS
| 1.616317 |
biomedical
|
Other
|
[
0.7396312355995178,
0.005365770775824785,
0.25500303506851196
] |
[
0.0157706867903471,
0.9824364185333252,
0.0010424607899039984,
0.0007505327230319381
] |
en
| 0.999998 |
3 . 1 . 1 . Physical health . The informants explained that the seasonal population has health problems that they carry with them due to their living and working conditions, which are marked by vulnerability. They also pointed out that the incidence of COVID among the seasonal population, in many cases, was not as high as the administrations and associations might have expected at first.
|
39752620_p52
|
39752620
|
3.1. Imprints on physical and mental health of MSW
| 1.773843 |
biomedical
|
Other
|
[
0.8485990762710571,
0.004517741035670042,
0.14688321948051453
] |
[
0.0715857744216919,
0.9254986643791199,
0.0018101487075909972,
0.0011054043425247073
] |
en
| 0.999997 |
3 . 1 . 2 . Mental health . Due to the lack of support networks in Spain and the fact that in their countries, the pandemic was also affecting their families and relatives, the mental health of MSW also suffered. In addition, people placed in isolation centers for having been positive or in close contact with a positive person also felt sadness and loneliness because they were unable to communicate with their families due to a lack of digital devices.
|
39752620_p53
|
39752620
|
3.1. Imprints on physical and mental health of MSW
| 1.718172 |
biomedical
|
Other
|
[
0.6457246541976929,
0.004928529728204012,
0.3493468165397644
] |
[
0.022479718551039696,
0.9756302237510681,
0.0012291964376345277,
0.0006608684197999537
] |
en
| 0.999999 |
3 . 2 . 1 Neglect of other diseases . Due to COVID, there were hardly any face-to-face consultations in health centers, which meant that the health protocols for specific attention to immigrants, through which serious illnesses can be detected even in a latent or asymptomatic state, were not applied.
|
39752620_p54
|
39752620
|
3.2. The Odyssey of Care for MSW: Access and quality of healthcare
| 1.647831 |
biomedical
|
Other
|
[
0.8749576807022095,
0.015865754336118698,
0.10917655378580093
] |
[
0.013251381926238537,
0.9843117594718933,
0.0008545265300199389,
0.0015822964487597346
] |
en
| 0.999996 |
3.2.2. Telemedicine : increasing communication barriers and decreasing trust in the health system . Language barriers and diminished confidence . The language was a significant barrier to communication for the administrations to carry out health education or tracing work among MSW, even more so when communication was by telephone. The fact that health care was provided by telephone rather than face-to-face during the pandemic decreased the accessibility of health services for MSW. In addition, it was less efficient in diagnosing or following up on different ailments due to communication and language barriers. All this led to a decrease in the confidence of seasonal workers in the health system, as they felt that it did not answer their health problems.
|
39752620_p55
|
39752620
|
3.2. The Odyssey of Care for MSW: Access and quality of healthcare
| 2.429265 |
biomedical
|
Other
|
[
0.9038357734680176,
0.00898206140846014,
0.08718212693929672
] |
[
0.11431079357862473,
0.8827903866767883,
0.0019536656327545643,
0.0009450985235162079
] |
en
| 0.999997 |
f the digital divide among immigrants already existed before COVID-19, the fact that they did not have a digital device from which they could make an appointment for health care or receive a call made accessibility to health consultations even more complicated.
|
39752620_p56
|
39752620
|
Increasing communication barriers
| 1.528285 |
other
|
Other
|
[
0.43779563903808594,
0.008154083974659443,
0.5540503263473511
] |
[
0.0071846600621938705,
0.9917214512825012,
0.0006084428168833256,
0.0004853802965953946
] |
en
| 0.999996 |
Despite the difficulties, NGOs acted as "interpreters" in answering health calls. Therefore, the NGOs pointed out the vital importance of the existence of cultural mediators in health centers and their involvement in both face-to-face and telephone consultations.
|
39752620_p57
|
39752620
|
Increasing communication barriers
| 1.473377 |
other
|
Other
|
[
0.11733346432447433,
0.00420729536563158,
0.8784592747688293
] |
[
0.007257798220962286,
0.9917823076248169,
0.0005770159768871963,
0.00038281947490759194
] |
en
| 0.999997 |
This study has highlighted, from the point of view of health and social professionals, the difficulties faced by MSW in complying with prevention measures during the COVID-19 pandemic and the impact this had on their overall health. Among the various problems identified were the precarious situation of MSW, high mobility, displacement, overcrowding, fear of losing their jobs, stigma, and language and cultural barriers. These difficulties are related to multiple social asymmetries linked to living and working conditions and migration structures, processes, and policies, structural elements that can be interpreted as the first obstacle that hindered the measures’ implementation.
|
39752620_p58
|
39752620
|
Discussion
| 3.491485 |
biomedical
|
Study
|
[
0.9812023639678955,
0.001261091441847384,
0.017536576837301254
] |
[
0.9987186193466187,
0.0007963287062011659,
0.00040866193012334406,
0.00007634224311914295
] |
en
| 0.999999 |
In the context of these structural inequalities, the agricultural sector, largely dependent on the migrant population, continued to need labor during the pandemic, directly affecting the effectiveness of the measures adopted by the authorities. However, the central government, regional governments, trade unions, and third-sector organizations were forced to implement containment measures to manage demand in a pandemic scenario. These sought to facilitate the mobility of workers within the country and the arrival of regular migrant workers from Eastern Europe and North Africa . However, despite efforts to meet the sector’s needs, some employers opted for irregular recruitment of MSW, mainly from the Maghreb and sub-Saharan countries . As the results of this study show, this dynamic created a complex scenario in a pandemic context, as the combination of the urgency of the demand for labor, mobility restrictions, and the irregular hiring of workers affected the effective implementation of preventive measures and ended up affecting the physical and mental health of workers. Moreover, the arrival of both regular and irregular workers posed additional challenges in implementing and monitoring preventive measures.
|
39752620_p59
|
39752620
|
Discussion
| 1.670642 |
other
|
Study
|
[
0.043971948325634,
0.000631066330242902,
0.9553969502449036
] |
[
0.9668453931808472,
0.032029785215854645,
0.0006675382028333843,
0.00045724320807494223
] |
en
| 0.999995 |
Thus, the COVID-19 crisis has exposed, from a European perspective, the deep-rooted structural problem in the continent’s agro-industry, especially in the south, where migrant labor operates under precarious conditions . In 2020, the European Commission issued guidelines to facilitate the mobility of workers deemed essential . Additionally, the New Pact on Migration and Asylum addressed migration as a key issue for the EU and offered a common framework for managing migration and asylum based on solidarity among all member states . These initiatives focused more on managing irregular migration and prioritizing market demands than on improving rights and safeguarding the health of migrants, specifically MFWs . In countries like Italy, actions were limited to the regularization of irregular migrant workers and the implementation of a “health pass” as a requirement for employment . This resulted in new roles and responsibilities for migrant workers, paving the way for the regularization of their status , but without substantial improvements in their social and working conditions in the short or medium term . On the other hand, Germany and Austria opted to allow the employment of migrants in agriculture and care, exempting them from travel bans, measures criticized for not ensuring adequate health protections for workers and being more oriented towards ensuring food availability for the entire population . In the UK, following the lockdown, agricultural organizations voiced concerns about the economic impact on agriculture due to the lack of labor, and the solution involved facilitating the importation of labor from countries like Romania and Bulgaria .
|
39752620_p60
|
39752620
|
Discussion
| 1.243613 |
other
|
Other
|
[
0.004956407938152552,
0.0006776463706046343,
0.994365930557251
] |
[
0.012210738845169544,
0.9834077954292297,
0.003370581427589059,
0.0010109329596161842
] |
en
| 0.999995 |
Shifting our attention back to the findings of this research centered around the Spanish example, one of the patterns identified in the measures implemented was job insecurity and precariousness of life linked to the irregular administrative situation. This condition led to a shadow economy characterized by substandard wages and abusive business practices, among others, which fostered inequality and inequity between native citizens and immigrants . This group’s need to remain active to secure income led workers to hide some of their symptoms for fear of losing employment opportunities. As a result, they were likely to remain in informality and consequently out of reach of health and care services . According to informants, the absence of access to health and care services exposes these irregular migrant workers to more significant difficulties in addressing and treating their health problems, potentially contributing to the spread of disease and the aggravation of pre-existing medical conditions. In the context of the COVID-19 pandemic, the lack of adequate health care impacted individuals and had broader public health implications by making these MSW potential disease vectors.
|
39752620_p61
|
39752620
|
Discussion
| 3.100601 |
biomedical
|
Study
|
[
0.892015278339386,
0.0012591913109645247,
0.10672551393508911
] |
[
0.9823613166809082,
0.01633928343653679,
0.0011067544110119343,
0.00019259761029388756
] |
en
| 0.999998 |
In this context, mass vaccination, as one of the significant pandemic containment measures, was ineffective in high-incidence and mobility scenarios. Personal protection measures were the best allies in breaking the chains of transmission and thus reducing the incidence of cases . As the results show, the workers sometimes had to procure measures and personal protective equipment to protect themselves and their relatives or household members from suspected or confirmed cases . Employers’ ineffective distribution of protective materials was a challenge for professionals in the sector and, by extension, for the population as a whole .
|
39752620_p62
|
39752620
|
Discussion
| 2.340186 |
biomedical
|
Other
|
[
0.9446421265602112,
0.002606262220069766,
0.052751678973436356
] |
[
0.21961893141269684,
0.7754136919975281,
0.0040505449287593365,
0.0009168718243017793
] |
en
| 0.999996 |
Subsets and Splits
SQL Console for rntc/test-pp-aa
The query retrieves a sample of documents that are clinical cases with an educational score above 3, providing limited analytical value.
Clinical Cases Sample
Returns a sample of 100 clinical case documents, providing a basic overview of the document type's content.