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      Exploring the impact of Ecuador’s policies on the right to health of Venezuelan migrants during the COVID-19 pandemic: a scoping review

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          Abstract

          Venezuela’s ongoing economic and political crisis has forced >6 million people to emigrate from the country since 2014. In the Andean region, Ecuador is one of the main host countries for Venezuelan migrants and refugees. During the coronavirus disease 2019 (COVID-19) pandemic, specific measures were implemented in the country to control the spread of the disease and its associated impacts. In this context, we conducted a scoping review to understand how policies implemented by the Ecuadorian government during the pandemic impacted Venezuelan migrants’ right to health. The literature search focused on scientific and grey publications between 2018 and 2022 in electronic databases and institutional websites, complemented by snowball sampling and expert advice. Our thematic analysis revealed discrepancies between the rights granted to migrants in Ecuador’s legal framework and their practical implementation during the pandemic, with several instances of policy and programmatic infringement. The disruption of services further complicated migrant’s options for regularization. Some measures, like border closures, negatively impacted migrants’ health, including increased exposure to abuse and violence. While migrants were included in the country’s COVID-19 vaccination plan, they were excluded from other national aid programmes. There are indications of an increase in xenophobia and discrimination stigmatizing migrants as ‘disease carriers’ and ‘resource takers’, resulting in a prioritization of services for the Ecuadorian population. We found limited research on the emergent topic of migrants’ vulnerability and related health system challenges. Future research should include working in border zones, consider socioeconomic factors and further explore the poor implementation of Ecuador’s legal framework towards upholding migrants’ right to health.

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            Evaluating screening approaches for hepatocellular carcinoma in a cohort of HCV related cirrhosis patients from the Veteran’s Affairs Health Care System

            Background Hepatocellular carcinoma (HCC) has limited treatment options in patients with advanced stage disease and early detection of HCC through surveillance programs is a key component towards reducing mortality. The current practice guidelines recommend that high-risk cirrhosis patients are screened every six months with ultrasonography but these are done in local hospitals with variable quality leading to disagreement about the benefit of HCC surveillance. The well-established diagnostic biomarker α-Fetoprotein (AFP) is used widely in screening but the reported performance varies widely across studies. We evaluate two biomarker screening approaches, a six-month risk prediction model and a parametric empirical Bayes (PEB) algorithm, in terms of their ability to improve the likelihood of early detection of HCC compared to current AFP alone when applied prospectively in a future study. Methods We used electronic medical records from the Department of Veterans Affairs Hepatitis C Clinical Case Registry to construct our analysis cohort, which consists of serial AFP tests in 11,222 cirrhosis control patients and 902 HCC cases prior to their HCC diagnosis. The six-month risk prediction model incorporates routinely measured laboratory tests, age, the rate of change in AFP over the past year with the current AFP. The PEB algorithm incorporates prior AFP screening values to identify patients with a significant elevated level of AFP at their current screen. We split the analysis cohort into independent training and validation datasets. All model fitting and parameter estimation was performed using the training data and the algorithm performance was assessed by applying each approach to patients in the validation dataset. Results When the screening-level false positive rate was set at 10%, the patient-level true positive rate using current AFP alone was 53.88% while the patient-level true positive rate for the six-month risk prediction model was 58.09% (4.21% increase) and PEB approach was 63.64% (9.76% increase). Both screening approaches identify a greater proportion of HCC cases earlier than using AFP alone. Conclusions The two approaches show greater potential to improve early detection of HCC compared to using the current AFP only and are worthy of further study. Electronic supplementary material The online version of this article (10.1186/s12874-017-0458-6) contains supplementary material, which is available to authorized users.
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              Venezuela's humanitarian crisis, resurgence of vector-borne diseases, and implications for spillover in the region

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                Author and article information

                Contributors
                Journal
                Health Policy Plan
                Health Policy Plan
                heapol
                Health Policy and Planning
                Oxford University Press (UK )
                0268-1080
                1460-2237
                November 2023
                12 August 2023
                12 August 2023
                : 38
                : 9
                : 1099-1112
                Affiliations
                Independent Researcher , Quito 170157, Ecuador
                Fundacion Octaedro , El Zurriago E8-28 y Shyris, Quito 170505, Ecuador
                departmentDepartment of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst , 715 N Pleasant St, Amherst, Massachusetts 01003, United States
                Author notes
                *Corresponding author. Independent Researcher, Quito 170157, Ecuador. E-mail: claudiaserranocord@ 123456gmail.com
                Author information
                https://orcid.org/0000-0002-0516-3090
                https://orcid.org/0000-0002-2788-9749
                Article
                czad071
                10.1093/heapol/czad071
                10566316
                37572095
                e622174d-774a-4e06-aff7-2bd117a29312
                © The Author(s) 2023. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License ( https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                : 10 May 2023
                : 06 August 2023
                : 09 August 2023
                : 07 August 2023
                : 12 September 2023
                Page count
                Pages: 14
                Funding
                Funded by: Deutsche Forschungsgemeinschaft, DOI 10.13039/501100001659;
                Funded by: Deutsche Forschungsgemeinschaft, DOI 10.13039/501100001659;
                Categories
                Review
                AcademicSubjects/MED00860

                Social policy & Welfare
                refugees,human rights,vulnerable populations,assessment,policy analysis,population movement

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