Self-management, health service use and information seeking for diabetes care among recent immigrants in Toronto

INTRODUCTION

Our objective was to explore self-management practices, health services use and information-seeking for type 2 diabetes care among adult men and women from four recent immigrant communities in Toronto.

METHODS

A structured questionnaire was adapted for the Canadian context and translated into 4 languages. A total of 184 participants with type 2 diabetes-130 recent immigrants and 54 Canadian-born-were recruited in both community and hospital settings.

RESULTS

Recent immigrants were significantly less likely than the Canadian-born group to perform regular blood glucose and foot checks and significantly more likely than the Canadian-born group to be non-smokers, participate in regular physical activity and reduce dietary fat. Recent immigrants were significantly less likely than the Canadian-born group to use a specialist, alternative provider and dietician and less likely to report using dieticians, nurses and diabetes organizations as sources of diabetes-related information. Important differences were observed by sex and country of origin.

CONCLUSION

Findings suggest that diabetes prevention and management strategies for recent immigrants must address linguistic, financial, informational and systemic barriers to information and care.

Somatic Symptoms in a Community Sample of Ethiopian Immigrants in Toronto, Canada

Objective:

This study examines the occurrence and correlates of somatization in a sample of adult Ethiopian immigrants and refugees residing n Toronto, Canada.

Methods:

A random sample of 342 adult (≥ 18 years of age) Ethiopian immigrants and refugees in Toronto completed structured face-to-face interviews. The Diagnostic Interview Schedule (DIS) Somatization Disorder Module was used to collect data on somatic symptoms. The Composite International Diagnostic Interview (CIDI) was used to assess major depression and generalized anxiety disorder.

Results:

Nearly two-thirds of the study participants reported having had at least one somatic symptom, and 5% reported experiencing medically unexplained symptoms in the 12 months preceding the interview. Individuals with major depression had significantly increased number of somatic symptoms compared to those without major depressive disorder. In a multivariate linear regression analysis, controlling for major depressive disorder, a higher level of somatization was associated with older age, pre-migration trauma, and post-migration stressful life events, and limited English proficiency.

Conclusion:

The findings of the study suggest that somatic symptoms are prevalent among individuals in cross-cultural transition and symptom level was associated with pre-migration trauma, post-migration stressors and mental disorder, particularly depressive disorder. The data also indicate a need for primary care physicians to routinely screen immigrant minority clients who present with somatic complaints for common and treatable psychiatric conditions, such as depression. In minority immigrant communities, somatic symptoms may reflect psychiatric problems.

Gender and the smoking behaviour of Ethiopian immigrants in Toronto

The objective of this paper is to present descriptive data on gender and smoking among Ethiopian immigrants in Toronto, Canada. The study used a cross-sectional epidemiological survey design (N = 342). The main outcome measures identified subjects as current (regular or occasional) smokers, daily smokers and former smokers. Overall, 20.8% of the individuals in the sample were current smokers and 15.7% were daily smokers. Although smoking rates (current and daily) were significantly higher among males compared to females, nearly twice as many female as male daily smokers reported that they began smoking post-migration (60.0% vs. 30.2%). Furthermore, 80.0% of female compared to nearly 56% of male daily smokers reported that they were smoking more post-migration. A significantly higher proportion of males compared to females were former daily smokers (17.8% vs. 4.4%). These findings present a challenge for public health professionals in terms of preventing the adoption of smoking among Ethiopian females and facilitating smoking cessation among Ethiopian males. Correlates with current smoking suggested that smoking prevention and cessation programs in newcomer immigrant communities may benefit from incorporating social, economic and religious contexts of these newcomers' lives from a gender-specific perspective.

Psychological and physical sequelae of intimate partner violence among women with limitations in their activities of daily living

OBJECTIVE

To compare the psychological and physical sequelae of physical/sexual intimate partner violence in women with and without activity limitations.

METHODS

We analyzed data from the Canadian 1999 General Social Survey. We included women reporting intimate partner violence in the previous 5 years (n = 897).

RESULTS

As a result of the violence, women with activity limitations were significantly more likely to feel ashamed/guilty (21.7 vs. 14.5%), depression/anxiety (31.5 vs. 19.8%), fearful (43.0 vs. 33.0%), lowered self-esteem (35.2 vs. 21.1%), increased caution/awareness (20.3 vs. 10.9%), and problems relating to men (16.4 vs. 5.4%). Significantly more women with activity limitations reported physical injury from violence (57.0 vs. 36.6%) and having to take time off from everyday activities (42.1 vs. 30.3%). Women with activity limitations had higher medication use for sleeping problems (OR = 3.17, 95% CI = 1.36, 5.73), anxiety (OR = 3.29, 95% CI = 1.75, 6.19) and depression (OR = 2.63, 95% CI = 1.41, 4.90).

CONCLUSION

Results suggest an additive effect between intimate partner violence and activity limitations that adds disproportionately to the burden of health for women with activity limitations.

The role of physicians in mammography referral for older Caribbean women in Canada

BACKGROUND

Despite the fact that the proportion of immigrant and minority women who consult a general practitioner about their health is similar to that of their Canadian-born counterparts, studies suggest that they are less likely to be screened for breast cancer. This study examines physician characteristics associated with mammography referral and perceived barriers to mammography among family physicians serving the Caribbean community of Toronto.

METHODS

The study consisted of a mail-back family physician survey.

RESULTS

Among the 64 physicians who responded to the survey, over half reported that they were "very likely" to refer women for mammography during a regular preventive check-up. Among physician variables, only the amount of time spent on patient education was significantly associated with the likelihood of referral. Regarding perceived barriers, for male physicians, patient refusal and intervention causing patient discomfort were significantly associated with referral. For female physicians, only forgetting to provide service was identified as a significant barrier to referral.

INTERPRETATION

An increased emphasis on patient education may help to increase screening referral among all physicians. Gender differences in perceived barriers to referral suggest that the gender of the physician is of major importance to the Caribbean community.

Rural physicians' perspectives on cervical and breast cancer screening: a gender-based analysis

Several studies highlight the role of physicians in determining cervical and breast cancer screening rates, and some urban studies report higher screening rates by female physicians. Rural women in North America remain underscreened for breast and cervical cancers. This survey was conducted to determine if there were significant gender differences in practices and perceptions of barriers to breast and cervical cancer screening among rural family physicians in Ontario, Canada. One hundred ninety-one family physicians (response rate 53.1%) who practiced in rural areas, small towns, or small cities completed a mail questionnaire. The physicians' mean age was 44.4 years (SD 9.9), and mean number of years in practice was 16.6 years (SD 10.3). Over 90% of physicians reported that they were very likely to conduct a Pap test and clinical breast examination (CBE) during a periodic health examination, and they had high levels of confidence and comfort in performing these procedures. Male (68%) and female (32%) physicians were similar in their likelihood to conduct screening, levels of confidence and comfort, and knowledge of breast and cervical cancer screening guidelines. However, the self-reported screening rates for Pap tests and CBE performed during last year were higher for female than male physicians (p < 0.01). Male physicians reported they were asked more frequently by patients for a referral to another physician to perform Pap tests and CBE (p < 0.001). Also, male physicians perceived patients' embarrassment as a stronger barrier to performing Pap tests (p < 0.05) and CBE (p < 0.01) than female physicians. No gender differences were observed in screening rates or related barriers to mammography referrals. These findings suggest that physicians' gender plays a role in sex-sensitive examination, such as Pap tests and CBE. There is a need to facilitate physician-patient interactions for sex-sensitive cancer screening examinations by health education initiatives targeting male physicians and women themselves. The feasibility of providing sex-sensitive cancer screening examinations by a same-sex health provider should also be explored.

Primary prevention of violence against women

The best mechanisms to prevent violence against women were reviewed in a critical appraisal conducted by the University Health Network Women's Health Program. Several promising primary interventions were identified. These included: educational and policy-related interventions to change social norms, early identification of abuse by health and other professionals, programs and strategies to empower women, safety and supportive resources for victims of abuse, and improved laws and access to the criminal justice system. The policy recommendations emerging from this analysis are presented.

Negative consequences of acculturation on health behaviour, social support and stress among pregnant Southeast Asian immigrant women in Montreal: an exploratory study

It is frequently assumed that migrant status constitutes a health risk because migration is inevitably associated with a period of significant adjustment and stress. This paper describes the role of acculturation in understanding the relationship between migration and low birthweight (LBW). Psychosocial and behavioural risk factors for LBW were explored using semi-structured interviews with 17 pregnant Southeast Asian women who represented different levels of acculturation. Findings suggested that acculturation had negative consequences for immigrant women. Higher levels of acculturation were associated with dieting during pregnancy, inadequate social support and stressful life experiences.

Refugees' time perspective and mental health

OBJECTIVE

The authors' goal was to investigate factors protective of the mental health of refugees, with a particular focus on time splitting and suppression of the past.

METHOD

Structured interviews covering premigration and postmigration stresses, personal and social resources, and mental health were given to 1,348 Southeast Asian refugees resettled in Vancouver, British Columbia, and to a comparison sample of 319 residents of Vancouver. Both groups of subjects also performed a task designed to measure orientation toward past, present, and future.

RESULTS

Compared with resident Canadians, refugees were more likely to exhibit an atomistic time perspective in which past, present, and future are split. Temporal atomism and avoidance of nostalgia were associated with a lower risk of depression than were other time perspectives.

CONCLUSIONS

Under conditions of extreme adversity, time splitting and suppression of the past may be adaptive strategies, mitigating the risk of depression.

The effect of acculturation on low birthweight in immigrant women

The interpretation of variations in perinatal morbidity by immigration status has been difficult. Of particular concern is the lack of attention to adaptive capacity. This study explores the effect of acculturation on term low birthweight (LBW) in five ethnic groups representing different immigration experiences. Using Quebec birth certificates (1979-1988), two birth cohorts were defined to control for the effects of repeat pregnancies. Bivariate and logistic regression analyses were used to examine the relationship between acculturation and term LBW. In both birth cohorts the more acculturated women experienced significantly higher rates of term LBW. The odds ratio for term LBW (1.6) was also significantly higher for the more acculturated group but this effect was only observed in the second birth cohort. These findings imply that in addition to other conventional factors, the level of acculturation of the mother should be assessed in perinatal risk identification systems.

Immigrant and refugee children in Canada

In view of Canada's commitment to immigration, understanding the sources of successful adaptation by immigrant and refugee children is vital. This paper reviews the literature on the mental health of migrant children and suggests an agenda for future research.

The assessment of depression: a model for quality review of emergency psychiatry

Of 167 patients appearing in the psychiatric emergency room of a metropolitan hospital, 68 were categorized as significantly depressed by the Zung depression scale but only 43 were considered depressed by clinician-interviewers. The use of a patient self-rating scale, which in this setting permitted the identification of deficiencies in the recognition of depression, is applicable to quality review in a variety of clinical settings.