Frequency of illness in mother‐infant dyads

The purpose of this study was to identify the frequency and types of illnesses experienced by mothers and their infants who were in the second half of the first year of life, the actions taken concerning these illnesses, the number of days the mother was hospitalized or in bed because of illness, and the subjective health status of both as rated by the mothers. During home visits mothers (N = 182) completed the Health Status Interview. They were asked about infant and maternal illness in the previous month and the actions taken in response to them. The number and types of illnesses reported indicate that mothers of full‐term infants who were healthy at birth must deal with a number of minor illnesses in themselves and in their infants. The possible relationship of maternal illness to stress is discussed and suggestions are given for interventions by health professionals.     

Variations in health behaviours among inner city 12‐year‐olds from four ethnic groups

Objectives. To describe factors that contribute to variations in health‐related behaviours and attitudes among inner city 12‐year‐olds. To see if there was an identifiable patterning by ethnic group.

Design. Semi‐structured interviews with a stratified sample of 12‐year‐old students and their parents from four ethnic groups, attending state secondary schools in two inner London boroughs.

Results. Bangladeshi young people were significantly more likely to receive school meals. There was no variation in reported snacking between the groups. Girls and Bangladeshi students were less likely to report exercising outside school (33% of Bangladeshi boys reported not exercising outside school compared to 5% of boys from all other groups). Bangladeshi boys and their parents were more likely to report that bullying or worries about racial violence prevented them from going out after school. White young people were more likely to report experimenting with and the regular use of cigarettes and alcohol. Use of alcohol and cigarettes was also associated with gender, religion and strength of religious observance. White parents were the least likely to report restricting their child's social activities as a way of influencing behaviour and expressed more concerns about their child's potential for health‐damaging behaviour than parents in all other groups.

Conclusion. This study shows that ethnicity alone is insufficient and inadequate in explaining variations in health behaviours among inner city teenagers. A complex mix of personal, cultural and social factors including ethnicity shape the behaviours and attitudes of these young people.     

Adversities of acculturation? Prevalence of obesity among immigrants

I study factors associated with prevalence of obesity among immigrants as the length of their stay in the US becomes longer. Using the National Health Interview Surveys for 1990-2004, I create 'synthetic cohorts' of immigrants that allow controlling for two important determinants of obesity: age at arrival and period of arrival in the US. I find that immigrants with a BA degree did not experience any change in obesity as their stay in the US advanced. Obesity among those without a BA degree, however, increased with duration of stay. Similarly, while some ethnic groups experienced increase in obesity with duration, others did not. For those who experienced increase in obesity with duration, the rise was higher during the first five years of residence than later and greater for those who arrived at a relatively young age.     

Assessment of adolescent mother‐infant attachment

Findings from repeated observations of first‐time adolescent mothers indicate that these mothers did adapt to the role of mother. Broussard's NPI and deChateau's OMIB were two instruments used, along with questionnaires. Recommendations for nursing interventions are included.     

Husbands’ knowledge and attendance at wives’ postpartum care among rural farmers

Abstract

We examined husbands’ knowledge and attendance at their wives’ postpartum visit in a sample of rural husband-and-wife farmer dyads in central Malawi. A cross-sectional matched-pairs survey of 70 husband-and-wife farmer dyads, who lived in rural communities in Ntcheu district, and had a live birth in the past year was conducted. Data were collected using an interviewer-administered, structured postpartum questionnaire adapted from WHO Safe Motherhood Needs Assessment Questionnaires. Many husbands did not know about postpartum assessments and education their wives received from health facilities. Percent agreement between dyads’ responses was lower on questions referring to assessments than to education. The odds of reporting that the woman received postpartum assessments were greater among husbands than among wives. Fifty-nine percent of husbands did not go with their wives for 1-week postpartum visits. Top three reasons for not attending visits were: at work, out of town, and did not see the need.     

Health care providers’ perspectives on the provision of prenatal care to immigrants

In addition to facing barriers to health care and experiencing poor health status, immigrants to Canada and Sweden tend to have more negative birth outcomes than the native-born population, including low birth weight and perinatal mortality rates. Explored through interviews with health care professionals, including midwives, nurse practitioners, social workers and obstetrician gynaecologists, this paper evaluates their experiences in providing prenatal care to immigrants in Hamilton, Ontario, Canada. Results reveal the complexity of delivering care to immigrants, particularly with respect to expectations surrounding language, culture and type and professionalism of care. The paper concludes by discussing future research options and implications for the delivery of prenatal care to this population.     

Shortening of gestational length among native-born and immigrants in Spain (1997–2008)

During the last decade there have been significant socio-demographic changes in Spain with potential impact on gestational length. The aim of the study was to describe the evolution of gestational age during 1997–2008, separately for native-born and immigrant population, in order to assess their contribution to the overall pattern of gestational length. A cross-sectional study of 5,018,229 singleton births born between 1997 and 2008 was carried out. The annual mean of gestational age was calculated and compared by means of ANOVA test, globally and also separately for natives and immigrants. Proportions of deliveries by gestational age and maternal characteristics were calculated in 4 periods and compared by means of Chi-square tests. Crude and adjusted multinomial logistic regression models were fitted separately for native-born and immigrant women. Our results show that in the last 12 years a progressive shortening in the mean gestational age has taken place in Spain. While the overall decrease of gestational length along the period was 1.5 days, closer to that in Spanish women (1.3 days), it was 2.3 days among immigrants. In both groups this shortening was mainly due to an increase in the proportion of 37–39 weeks deliveries at the expense of a substantial decrease in those with 40 weeks. These trends remained after controlling for known confounding variables such as maternal age, parity and occupation. Further analysis of its causes and public health implications are recommended.     

Midwives¿ views on factors that contribute to health care inequalities among immigrants in Sweden: A qualitative study

ABSTRACT: INTRODUCTION: Ethnic and socioeconomic inequalities in the Swedish health care system have increased. Most indicators suggest that immigrants have significantly poorer health than native Swedes. The purpose of this study was to explore the views of midwives on the factors that contribute to health care inequality among immigrants. METHODS: Data were collected via semi-structured interviews with ten midwives. These were transcribed and related categories identified through content analysis. RESULTS: The interview data were divided into three main categories and seven subcategories. The category "Communication" was divided into subcategories "The meeting", "Cultural diversity and language barriers" and "Trust and confidence". The category "Potential barriers to the use of health care services" contained two subcategories, "Seeking health care" and "Receiving equal treatment". Finally, the category "Transcultural health care" had subcategories "Education on transcultural health care" and "The concept". CONCLUSIONS: This study suggests that midwives believe that health care inequality among immigrants can be the result of miscommunication which may arise due to a shortage of meeting time, language barriers, different systems of cultural beliefs and practices and limited patient-caregiver trust. Midwives emphasized that education level, country of origin and length of stay in Sweden play a role when an immigrant seeks health care. Immigrants face more difficulties when seeking health care and in receiving adequate levels of care. However, different views among the midwives were also observed. Some midwives were sensitive to individual and intra-group differences, while some others viewed immigrants as a group of "others". Midwives' beliefs about subgroup-specific health services vs. integrating immigrants' health care into mainstream health care services should be investigated further. Patients' perspective should also be considered.     

Is migration to Canada associated with unhealthy weight gain? Overweight and obesity among Canada's immigrants

This paper aims to address a gap in our understanding of immigrant health issues by examining the determinants of excess weight--an important indicator of current and future health. The paper combines data drawn from recent large health surveys to identify how the weight of recent immigrants compares with that of native-born people, and how the likelihood of becoming overweight or obese changes with additional years in Canada. We find evidence that on average, immigrants are substantially less likely to be obese or overweight upon arrival in Canada. These measures converge slowly to native-born levels, but there is marked variation by the ethnicity of the immigrant. Since changes in weight will reflect choices with respect to diet and activity, the extent to which overweight and obesity rates change with years in Canada may reflect the extent to which immigrants interact with or are influenced by members of their ethnic group who reside in the same area. We find evidence that ethnic group social network effects exert a quantitatively important influence on the incidence of being overweight and obese for members of most ethnic minorities, tempering the process of adjustment to Canadian lifestyle norms that may be driving excess weight gain with additional years in Canada.     

Recognition as care: a longitudinal study of Arabic immigrants’ experiences of diabetes training in Denmark

This longitudinal study provides critical insight into the social processes of municipal diabetes training for Arabic-speaking immigrants in Denmark focusing on participants’ experiences. Our study builds on observations of three diabetes courses and 36 interviews with participants at the start of, immediately following or 30–36 months after the courses. Lifestyle change and responsibility were dominant messages in the courses; over time and depending on their daily social context, participants selectively accepted and incorporated these messages. However, in retrospect, participants highlighted other meaningful benefits; these centred on reducing isolation and being met on their own terms regarding language and logistics. Most importantly, they remembered when treated with attention and respect by professionals and the mutual acknowledgement between participants. We use Axel Honneth’s notions of rights-based and solidarity-based recognition to analyse what was at stake in these experiences, and we engage Annemarie Mol’s concept of a logic of care to show how recognition unfolded practically during the training. We propose that participants’ wider social context and experiences of misrecognition situated the training experiences concerned with recognition. We also show exceptions. The sociality, which for some generated solidarity-based recognition, felt intimidating for others. We argue that the silent processes of recognition in the diabetes training carried significant meaning for participants, and that over time, many highlighted these as benefits rather than lifestyle change and responsibility.     

The use of patient mix‐adjusted control charts to compare in‐hospital costs of care

We introduce a technique for patient mixadjusting charts and compared differences between unadjusted and patient mixadjusted results. Our data came from coronary artery bypass graft (CABG) surgery patients at Baptist Medical Center, Oklahoma City, Oklahoma. We first developed an unadjusted control chart to compare monthly changes in CABG surgery costs and then used a published model to patient mixadjust our control chart information. Before adjustment, the average log costs for three of ten months were outside the 90% control limit lines, and there was a trend toward increasing costs. After adjustment, two months had average costs outside the 90% lower control limit lines, and the trend toward increasing costs had been explained by differences in patient acuity.     

Are immigrants healthier than native-born Canadians? A systematic review of the healthy immigrant effect in Canada

Objectives: Immigrants are typically healthier than the native-born population in the receiving country and also tend to be healthier than non-migrants in the countries of origin. This foreign-born health advantage has been referred to as the healthy immigrant effect (HIE). We examined evidence for the HIE in Canada.

Design: We employed a systematic search of the literature on immigration and health and identified 78 eligible studies. We used a narrative method to synthesize the HIE across different stages of the life-course and different health outcomes within each stage. We also examined the empirical evidence for positive selection and duration effects – two common explanations of migrants’ health advantage and deterioration, respectively.

Results: We find that the HIE appears to be strongest during adulthood but less so during childhood/adolescence and late life. A foreign-born health advantage is also more robust for mortality but less so for morbidity. The HIE is also stronger for more recent immigrants but further research is needed to determine the critical threshold for when migrants’ advantage disappears. Positive selection as an explanation for the HIE remains underdeveloped.

Conclusions: There is an absence of a uniform foreign-born health advantage across different life-course stages and health outcomes in Canada. Nonetheless, it remains the case that the HIE characterizes the majority of contemporary migrants since Canada’s foreign-born population consists mostly of core working age adults.     

Does the amount of formal care affect informal care? Evidence among over-60s in France

This paper investigates the causal effect of the amount of formal care used on the informal care received by formal care users. We use an original instrument for formal care volume based on local disparities (NUTS 3 level, 96 units) in the price of formal care. Using the French CARE survey, we use a two-part model to assess the effect of formal care on the extensive and the intensive margin of informal care. An increase in the amount of formal care is found to be associated with a small decrease in the probability of using informal care. Heterogeneity tests show that this negative effect is mainly driven by help for daily activities provided by women. At the intensive margin, informal care is not significantly affected by the amount of formal care. Reforms increasing subsidies for formal care can thus be suspected to have a limited effect on informal care arrangements.

     

Aspects of outpatient palliative care in Germany—a survey among office-based physicians

Background  

Currently, palliative care is widely discussed. The aim of this study is to explore different aspects of the ambulatory treatment environment of palliative care patients and its structure in Germany from the viewpoint of caring physicians.     

Home care or long‐term care? Setting the balance of care in urban and rural Northwestern Ontario,Canada

The objective of the study was to determine the extent to which community care packages could be provided at a lower cost than facility-based long-term care (LTC) for 864 individuals on the LTC waiting list in urban and rural parts of Northwestern Ontario, Canada. A sequential mixed methods design was used entailing a retrospective chart review, the formation of case vignettes, the creation of community care packages with an 'expert panel' of care managers, the costing of care packages and the calculation of potential diversion rates from LTC. Data collection took place in Northwestern Ontario between the months of March and June 2008. Eight per cent of individuals in the urban area and 50% of individuals from the rural areas could potentially be safely diverted to the community and provided with a community care package at a cost lower than facility-based LTC. There is potential for home and community care to substitute for more costly long-term care, but doing so requires building capacity in this sector, particularly in rural areas, which are currently underserviced. Reconfiguring the 'balance of care' may lead to long-term cost efficiencies for an ageing population.     

A meta‐analytic study of the effects of childbirth education on the parent‐infant relationship

The purpose of this study was to analyze studies that tested the effects of childbirth education on the parent‐infant relationship. Using meta‐analysis techniques, published and unpublished childbirth education research literature from 1960 to 1981 was analyzed. From the analysis of 27 studies, it was found that childbirth education is beneficial to the parent‐infant relationship. A greater magnitude of effect was found for middle income parents, as compared to parents with low income. Moderate effects were found in both the behavioral and attitudinal components of die parent‐infant relationship. Several methodologic flaws in the research were found. Many researchers either demonstrated allegiance to childbirth education, conducted the research while knowledgeable of the composition of the groups or taught the classes, or used instruments without reliability or validity testing. Recommendations for future childbirth education research, relating to the philosophical foundation of research, the foci of study, and methodologic considerations, have been made.     

Do Mexican immigrants substitute health care in Mexico for health insurance in the United States? The role of distance

Although language and culture are important contributors to uninsurance among immigrants, one important contributor may have been overlooked - the ability of immigrants to return to their home country for health care. This paper examines the extent to which uninsurance (private insurance and Medicaid) is related to the ability of immigrants to return to Mexico for health care, as measured by spatial proximity. The data for this study are from the Mexican Migration Project. After controlling for household income, acculturation and demographic characteristics, arc distance to the place of origin plays a role in explaining uninsurance rates. Distance within Mexico is quite important, indicating that immigrants from the South of Mexico are more likely to seek care in their communities of origin (hometowns).