Cardiovascular risk factors among Arabic-speaking patients attending Arabic-speaking general practitioners in Sydney, Australia: opportunities for intervention

Diabetes epidemic sweeping the Arab world

The prevalence of type-2 diabetes mellitus (T2DM) has increased dramatically during the last 2 decades, a fact driven by the increased prevalence of obesity, the primary risk factor for T2DM. The figures for diabetes in the Arab world are particularly startling as the number of people with diabetes is projected to increase by 96.2% by 2035. Genetic risk factors may play a crucial role in this uncontrolled raise in the prevalence of T2DM in the Middle Eastern region. However, factors such as obesity, rapid urbanization and lack of exercise are other key determinants of this rapid increase in the rate of T2DM in the Arab world. The unavailability of an effective program to defeat T2DM has serious consequences on the increasing rise of this disease, where available data indicates an unusually high prevalence of T2DM in Arabian children less than 18 years old. Living with T2DM is problematic as well, since T2DM has become the 5^th leading cause of disability, which was ranked 10^th as recently as 1990. Giving the current status of T2DM in the Arab world, a collaborative international effort is needed for fighting further spread of this disease.

Can oral vitamin D prevent the cardiovascular diseases among migrants in Australia? Provider perspective using Markov modelling

The study was designed to model the effectiveness and cost effectiveness of oral Vitamin D supplementation as a primary prevention strategy for cardiovascular disease among a migrant population in Australia. It was carried out in the Community Health Service, Kensington, Melbourne. Best-case scenario analysis using a Markov model was employed to look at the health care providers' perspective. Adult migrants who were vitamin D deficient and free from cardiovascular disease visiting the medical centre at least once during the period from 1 January 2010 to 31 December 2012 were included in the study. The blood pressure-lowering effect of vitamin D was taken from a published meta-analysis and applied in the Framingham 10 year cardiovascular risk algorithm (with and without oral vitamin D supplements) to generate the probabilities of cardiovascular events. A Markov decision model was used to estimate the provider costs associated with the events and treatments. Uncertainties were derived by Monte Carlo simulation. Vitamin D oral supplementation (1000 IU/day) for 10 years could potentially prevent 31 (interquartile range (IQR) 26 to 37) non-fatal and 11 (IQR 10 to 15) fatal cardiovascular events in a migrant population of 10,000 assuming 100% compliance. The provider perspective incremental cost effectiveness per year of life saved was AU$3,992 (IQR 583 to 8558). This study suggests subsidised supplementation of oral vitamin D may be a cost effective intervention to reduce non-fatal and fatal cardiovascular outcomes in high-risk migrant populations.

Acculturation and obesity among migrant populations in high income countries--a systematic review

Background

There is evidence to suggest that immigrant populations from low or medium-income countries to high income countries show a significant change in obesogenic behaviors in the host society, and that these changes are associated with acculturation. However, the results of studies vary depending on how acculturation is measured. The objective of this study is to systematically review the evidence on the relationship between acculturation - as measured with a standardized acculturation scale - and overweight/obesity among adult migrants from low/middle countries to high income countries.

Methods

A systematic review of relevant studies was undertaken using six EBSCOhost databases and following the Centre for Reviews and Dissemination’s Guidance for Undertaking Reviews in Health Care.

Results

The initial search identified 1135 potentially relevant publications, of which only nine studies met the selection criteria. All of the studies were from the US with migrant populations from eight different countries. Six studies employed bi-directional acculturation scales and three used uni-directional scales. Six studies indicated positive general associations between higher acculturation and body mass index (BMI), and three studies reported that higher acculturation was associated with lower BMI, as mainly among women.

Conclusion

Despite the small number of studies, a number of potential explanatory hypotheses were developed for these emerging patterns. The ‘Healthy Migrant Effect’ may diminish with greater acculturation as the host culture potentially promotes more unhealthy weight gain than heritage cultures. This appears particularly so for men and a rapid form of nutrition transition represents a likely contributor. The inconsistent results observed for women may be due to the interplay of cultural influences on body image, food choices and physical activity. That is, the Western ideal of a slim female body and higher values placed on physical activity and fitness may counteract the obesogenic food environment for female migrants.

Peer-supported diabetes prevention program for Turkish- and arabic-speaking communities in australia

In Australia, type 2 diabetes and prediabetes are more prevalent in culturally and linguistically diverse (CALD) communities than mainstream Australians. Purpose. To develop, implement, and evaluate culturally sensitive peer-supported diabetes education program for the prevention of type 2 diabetes in high-risk middle-aged Turkish- and Arabic-speaking people. Methods. A two-day training program was developed. Ten bilingual peer leaders were recruited from existing health and social networks in Melbourne and were trained by diabetes educators. Each leader recruited 10 high-risk people for developing diabetes. Questionnaires were administered, and height, weight, and waist circumference were measured at baseline and three months after the intervention. The intervention comprised two 2-hour group sessions and 30 minutes reinforcement and support telephone calls. Results. 94 individuals (73% women) completed the program. Three months after the program, the participants' mean body weight (before = 78.1 kg, after = 77.3; Z score = -3.415, P = 0.001) and waist circumference (Z = -2.569, P = 0.004) were reduced, their diabetes knowledge was enhanced, and lifestyle behaviours were significantly improved. Conclusions. A short diabetes prevention program delivered by bilingual peers was associated with improved diabetes awareness, changed lifestyle behaviour, and reduction in body weight 3 months after intervention. The findings are encouraging and should stimulate a larger control-designed study.

Experiences of migration and the determinants of obesity among recent Iranian immigrants in Victoria, Australia

OBJECTIVES

There is evidence to suggest that immigrant groups from low- or medium-human development index countries show a significant adoption of obesogenic behaviors and experience weight gain following migration to Australia. The objective of this study is to understand the changes that Iranian immigrants experience in relation to the determinants of obesity after migration to Victoria, Australia.

DESIGN

We conducted five focus group discussions with 33 recent Iranian immigrants. This study took an interpretive qualitative approach to data analysis using the constant comparative method.

RESULTS

Participants discussed individual level acculturation (e.g., in diet, body size, attitudes), as well as environmental level changes (e.g., physical/structural and sociocultural) that occurred after immigration. Stress during the initial immigration transition, which affected diet and physical activity habits, was a common experience among participants. Gender and the effect of political/religious changes were also important factors. Participants' discourse largely focused on their ability and willingness to adopt positive health behaviors after migration.

CONCLUSION

This study provides insight into the effect of migration on the determinants of obesity among Iranian immigrants in Victoria, Australia, and offers a contrast with the existing evidence by considering the experience of a group that is generally well educated, often emigrates for reasons related to personal freedom as opposed to material deprivation, and has rates of obesity similar to high-income countries.

Feasibility, acceptability and impact of a telephone support service initiated in primary medical care to help Arabic smokers quit

Evidence-based tobacco control in ethnic minorities is compromised by the near absence of rigorous testing of interventions in either prevention or cessation. This randomised controlled trial was designed to evaluate the feasibility, acceptability and impact of a culturally specific cessation intervention delivered in the context of primary medical care in the most culturally diverse region of New South Wales. Adult Arabic smokers were recruited from practices of 29 general practitioners (GPs) in south-west Sydney and randomly allocated to usual care (n = 194) or referred to six sessions of smoking cessation telephone support delivered by bilingual psychologists (n = 213). Although 62.2% of participants indicated that telephone support would benefit Arabic smokers, there were no significant differences at 6 or 12 months between intervention and control groups in point prevalence abstinence rates (11.7% vs 12.9%, P = 0.83; 8.4% vs 11.3%, P = 0.68, respectively) or the mean shift in stage-of-change towards intention to quit. As participants and GPs found telephone support acceptable, we also discuss redesign and the unfulfilled obligation to expand the evidence base in tobacco control from which the ethnic majority already benefits.

The health status of migrants in Australia: a review

This review summarizes the findings of studies conducted in Australia between 1980 and 2008 that focused on the health status of migrants in one or more of Australia's National Health Priority Areas (NHPAs), identifies gaps in knowledge, and suggests further research directions. Systematic literature searches were performed on CINAHL, MediText, PsycINFO, and MEDLINE. It was found that the majority of migrants enjoy better health than the Australian-born population in the conditions that are part of the NHPAs, with the exception of diabetes. Mediterranean migrants have particularly favorable health outcomes. The migrant health advantage appears to deteriorate with increasing duration of residence. Many of the analyzed studies were conducted more than 10 years ago or had a narrow focus. Little is known about the health status of migrants with respect to a number of NHPAs, including musculoskeletal conditions and asthma.The health status of recently arrived migrant groups from the Middle East and Africa has not been explored in detail.

Clinicoepidemiological characteristics of HIV-infected immigrants attended at a tropical medicine referral unit

BACKGROUND

Migration is a growing phenomenon with a well-known impact in infectious diseases epidemiology. Currently, immigrants represent almost 10% of the Spanish population. The majority come from countries where the prevalence of chronic viral illnesses is higher than in Spain.

METHODS

To describe clinicoepidemiological features of human immunodeficiency virus (HIV)-infected immigrants attending our Unit and to compare differential characteristics depending on geographical origin, information from all new immigrants from January 1997 to December 2006 was collected.

STUDY DESIGN

noninterventional retrospective chart review.

RESULTS

We screened 1,609 patients of whom 77 (4.8%) were HIV antibody (Ab) positive. Of these, 80% were sub-Saharan Africans (SSAFR) and 20% were South-Central Americans (SCA). HIV prevalence was higher in SSAFR (5.6% vs 3.2%; p= 0.04). Overall, of those who were HIV Ab positive, 70% were male (median age 30 years), 59% heterosexuals, 9% hepatitis C virus coinfected, 8.6% hepatitis B virus coinfected, and 34% showed a positive tuberculin skin test. Median CD4 cell count was 263 cells/microL, median HIV-ribonucleic acid viral load 4.6 Log/mL, and 48% had a late diagnosis [acquired immunodeficiency syndrome (AIDS)-defining illness or <200 CD4 microL at the time of diagnosis]. Only 68% of patients for whom antiretroviral therapy was indicated actually started therapy and 22% were lost to follow-up just after diagnosis. SCA had lower CD4 cell counts (26 vs 168 cells/microL; p= 0.016), higher viral loads (5.3 vs 4.8 Log; p= 0.001), and were more likely to have an AIDS-defining illness (53% vs 21%; p= 0.04) compared to SSAFR. Tuberculin skin test reactivity was more common among SSAFR versus SCA [adjusted by CD4 count, odds ratio (OR) 6.3 and 95% confidence interval (CI): 0.65-60.5]. The main risk factor for late diagnosis was geographical origin: OR 4.6 (95% CI: 1.11-19.3) (SCA vs SSAFR; adjusted by the interval between the date of arrival in Spain and the date of HIV diagnosis).

CONCLUSIONS

Almost half the HIV-infected immigrants were diagnosed in late stages. Patients were frequently lost to follow-up, and a significant minority did not start highly active antiretroviral therapy when indicated. SCA seem to have more severe immunosuppression at the time of diagnosis than SSAFR. Early voluntary routine HIV screening should be promoted.

Toward cultural competence in cancer genetic counseling and genetics education: lessons learned from Chinese-Australians

PURPOSE

In societies such as Australia with a strong multicultural makeup, culturally determined attitudes to genetics, testing, and counseling may be incompatible with current genetics service provision.

METHODS

An ethnographic investigation using purposive sampling to increase subject diversity was used to explore the range of beliefs about kinship and inheritance using Chinese-Australians as a case. Participants comprised a sample of 15 Chinese-Australians who had been recruited through several community-based organizations.

RESULTS

The level of acculturation does not correlate with holding beliefs about inheritance, kinship, and causes of hereditary cancer that are based on "Western" biomedical or traditional concepts. Mismatch between beliefs may exist within families that can impact participation in cancer genetic testing. Family history taking that underpins the surveillance, management, and referral to genetic counseling where there is a strong family history of breast, ovarian, or colorectal cancer can also be impacted unless recognition is made of the patrilineal concept of kinship prevalent in this Chinese-Australian community.

CONCLUSION

This community-based study confirmed and validated views and beliefs on inheritance and kinship and inherited cancer attributed to senior family members by Chinese-Australians who attended cancer genetic counseling. Barriers to communication can occur where there may be incompatibility within the family between "Western" and traditional beliefs. The findings were used to develop strategies for culturally competent cancer genetic counseling with Australian-Chinese patients. These include nonjudgmental incorporation of their belief systems into the genetic counseling process and avoidance of stereotyping. They have also influenced the development of genetics education materials to optimize family history taking.

Understanding community beliefs of Chinese-Australians about cancer: Initial insights using an ethnographic approach

Ethnography was employed to investigate the hypothesis that the cultural meaning of cancer is one of the possible barriers to access of cancer services. The objectives were to identify indigenous terminologies, taxonomies and illness explanatory models of cancer in a community-based sample of 15 Chinese-Australians and a sample of 16 informants who had been recruited through two Sydney familial cancer clinics. Many of the informants included in their narrative terms that seemed to match Western biomedical explanations for cancer. The majority of informants also maintained traditional Chinese beliefs, despite high acculturation and beliefs in biomedical explanations about cancer. Explanations of illness including cancer, referred to the following concepts: (i) karma (yeh), (ii) retribution (bao ying), (iii) fate (ming yun) or Heaven's or God's will, (iv) geomancy (feng-shui), (v) touched evil (zhong chia), (vi) misfortune or bad luck (shui wan, dong hark); (vii) offending the gods or deities requiring prayers or offerings for appeasement; and (viii) kong-tau (spells invoked through human intervention). Taking into consideration the heterogeneity of the Chinese population, the findings provide an insight into Chinese illness conceptualization that may assist health professionals to develop an understanding of how the cultural explanatory models affect access to screening services, communication of diagnosis of cancer and management of treatment regimen.

Health and literacy in first- and second-generation Moroccan Berber women in the Netherlands: Ill literacy?

Aim

The present study was aimed at investigating the role of literacy and generation in the self-reported general health status of Moroccan Berber speaking women in the Netherlands.

Method

Fifty women in our sample (N = 75) were first generation women, from which group 25 were literates and 25 illiterates. Another group of 25 literate women belonged to the second generation. The three groups were matched for demographic characteristics. Questionnaires were administered reflecting all concepts under study. We hypothesized that, within the first generation, illiterates compared with literates would report worse health. Our second hypothesis was that literates of the first generation compared with those of the second generation would have a similar health condition.

Results

After controlling for age, having a job, and having an employed partner, the first generation literates compared with the illiterates of the first generation indeed reported significantly better health. Additionally, we did not find any differences in health condition between both literate groups, even after controlling for age, number of children, and marital status. Health complaints that were most frequently reported by both groups, concerned pain in shoulders, back and head.

Conclusions

Our results underline the importance of offering immigrants optimal access to opportunities and facilities that can improve their literacy and reading ability.

Estimates of smoking and related behaviour in an immigrant Lebanese community: does survey method matter?

OBJECTIVE

To estimate the prevalence of smoking, stage-of-change and GP advice to quit in the Sydney Lebanese community and whether these findings varied by survey method.

METHOD

Three methods--telephone interviews using sampling from the electronic White Pages, personal interviews of a household member selected using cluster sampling and a mailed survey using an electoral roll sample--were used in separate surveys of persons born in Lebanon living in three postcode areas of Sydney in 1997.

RESULTS

Smoking prevalence was consistent across the three methods, with male smoking averaging 49% and female smoking averaging 29%. About two-thirds of smoking respondents across each of the survey methods had no plans for quitting.

CONCLUSIONS

As smoking prevalence did not vary across the three sampling and survey methods used here, the simplest and most inexpensive method (the electronic White Pages and telephone surveying of identifiable ethnic surnames) should be preferred.

IMPLICATIONS

Smoking prevalence in the Sydney Lebanese community is determined consistently using a variety of survey methods.