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Access to primary health care for immigrants: results of a patient survey conducted in 137 primary care practices in Ontario, Canada.

https://arctichealth.org/en/permalink/ahliterature117685
Source
BMC Fam Pract. 2012;13:128
Publication Type
Article
Date
2012
Author
Elizabeth Muggah
Simone Dahrouge
William Hogg
Author Affiliation
CT Lamont Primary Health Care Research Centre, Élisabeth Bruyère Research Institute, Ottawa, ON, Canada. emuggah@bruyere.org
Source
BMC Fam Pract. 2012;13:128
Date
2012
Language
English
Publication Type
Article
Keywords
Adult
Capitation Fee - statistics & numerical data - utilization
Community Health Centers - statistics & numerical data - utilization
Cross-Sectional Studies
Emigrants and Immigrants - statistics & numerical data
Fee-for-Service Plans - statistics & numerical data - utilization
Female
Health Services Accessibility - economics - statistics & numerical data
Health status
Humans
Male
Middle Aged
Ontario
Primary Health Care - economics - statistics & numerical data - utilization
Questionnaires
Self Report
Abstract
Immigrants make up one fifth of the Canadian population and this number continues to grow. Adequate access to primary health care is important for this population but it is not clear if this is being achieved. This study explored patient reported access to primary health care of a population of immigrants in Ontario, Canada who were users of the primary care system and compared this with Canadian-born individuals; and by model of primary care practice.
This study uses data from the Comparison of Models of Primary Care Study (COMP-PC), a mixed-methods, practice-based, cross-sectional study that collected information from patients and providers in 137 primary care practices across Ontario, Canada in 2005-2006. The practices were randomly sampled to ensure an equal number of practices in each of the four dominant primary care models at that time: Fee-For-Service, Community Health Centres, and the two main capitation models (Health Service Organization and Family Health Networks). Adult patients of participating practices were identified when they presented for an appointment and completed a survey in the waiting room. Three measures of access were used, all derived from the patient survey: First Contact Access, First Contact Utilization (both based on the Primary Care Assessment Tool) and number of self-reported visits to the practice in the past year.
Of the 5,269 patients who reported country of birth 1,099 (20.8%) were born outside of Canada. In adjusted analysis, recent immigrants (arrival in Canada within the past five years) and immigrants in Canada for more than 20 years were less likely to report good health compared to Canadian-born (Odds ratio 0.58, 95% CI 0.36,0.92 and 0.81, 95% CI 0.67,0.99). Overall, immigrants reported equal access to primary care services compared with Canadian-born. Within immigrant groups recently arrived immigrants had similar access scores to Canadian-born but reported 5.3 more primary care visits after adjusting for health status. Looking across models, recent immigrants in Fee-For-Service practices reported poorer access and fewer primary care visits compared to Canadian-born.
Overall, immigrants who were users of the primary care system reported a similar level of access as Canadian-born individuals. While recent immigrants are in poorer health compared with Canadian-born they report adequate access to primary care. The differences in access for recently arrived immigrants, across primary care models suggests that organizational features of primary care may lead to inequity in access.
Notes
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PubMed ID
23272805 View in PubMed
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Accounting for Irish Catholic ill health in Scotland: a qualitative exploration of some links between 'religion', class and health.

https://arctichealth.org/en/permalink/ahliterature179028
Source
Sociol Health Illn. 2004 Jul;26(5):527-56
Publication Type
Article
Date
Jul-2004
Author
Patricia Walls
Rory Williams
Author Affiliation
MRC Social and Public Health Sciences Unit, University of Glasgow. WallsAMP@aol.com
Source
Sociol Health Illn. 2004 Jul;26(5):527-56
Date
Jul-2004
Language
English
Publication Type
Article
Keywords
Adult
Aged
Career Choice
Career Mobility
Catholicism - psychology
Emigration and Immigration - statistics & numerical data
Employment - psychology - statistics & numerical data
Female
Health status
Health Surveys
Humans
Ireland - ethnology
Male
Middle Aged
Minority Groups - education - psychology - statistics & numerical data
Motivation
Prejudice
Protestantism - psychology
Qualitative Research
Questionnaires
Residence Characteristics
Scotland - epidemiology
Social Class
Socioeconomic Factors
Urban Health - statistics & numerical data
Abstract
This paper considers the ways in which accounts from Glasgow Catholics diverge from those of Protestants and explores the reasons why people leave jobs, including health grounds. Accounts reveal experiences distinctive to Catholics, of health-threatening stress, obstacles to career progression within (mainly) private-sector organisations, and interactional difficulties which create particular problems for (mainly) middle class men. This narrows the employment options for upwardly mobile Catholics, who may then resort to self-employment or other similarly stressful options. The paper considers whether the competence of Catholics or Catholic cultural factors are implicated in thwarting social mobility among Catholics or, alternatively, whether institutional sectarianism is involved. We conclude that, of these options, theories of institutional sectarianism provide the hypothesis which currently best fits these data. In Glasgow, people of indigenous Irish descent are recognisable from their names and Catholic background and are identified as Catholic by others. Overt historical exclusion of Catholics from middle class employment options now seems to take unrecognised forms in routine assumptions and practices which restrict Catholic employment opportunities. It is argued that younger Catholics use education to overcome the obstacles to mobility faced by older people and circumvent exclusions by recourse to middle class public-sector employment. This paper aims to link historical, structural and sectarian patterns of employment experience to accounts of health and work, and in so doing to contribute to an explanation for the relatively poor health of Catholic Glaswegians with Irish roots.
PubMed ID
15283776 View in PubMed
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Acculturation and celiac disease risk in second-generation immigrants: a nationwide cohort study in Sweden.

https://arctichealth.org/en/permalink/ahliterature122335
Source
Scand J Gastroenterol. 2012 Oct;47(10):1174-80
Publication Type
Article
Date
Oct-2012
Author
Carl Johan Wingren
Daniel Agardh
Juan Merlo
Author Affiliation
Unit for Social Epidemiology, Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden. carl_johan.wingren@med.lu.se
Source
Scand J Gastroenterol. 2012 Oct;47(10):1174-80
Date
Oct-2012
Language
English
Publication Type
Article
Keywords
Acculturation
Celiac Disease - epidemiology
Child
Child, Preschool
Cohort Effect
Cohort Studies
Cost of Illness
Emigrants and Immigrants - statistics & numerical data
Environmental health
Female
Health Status Disparities
Humans
Incidence
Male
Mothers - statistics & numerical data
Proportional Hazards Models
Registries - statistics & numerical data
Risk assessment
Risk factors
Sweden - epidemiology
Time Factors
Young Adult
Abstract
The burden of celiac disease (CD) is increasingly recognized as a global problem. However, whether this situation depends on genetics or environmental factors is uncertain. The authors examined these aspects in Sweden, a country in which the risk of CD is generally considered to be high. If environmental factors are relevant, CD risk in second-generation immigrant children should be related to maternal length of stay in Sweden before delivery.
Linking the Swedish Medical Birth Registry to other national registries, the authors investigated all singleton children (n = 792,401) born in Sweden between 1987 and 1993. They studied the risk of CD in children before age 6 as a function of the mother's geographical region of birth and length of stay in Sweden before delivery using Cox regression models.
In children whose mothers immigrated to Sweden from a country outside of Europe, a maternal length of stay in Sweden of more than 5 years increased the hazard ratio (HR) of CD (1.73, 95% confidence interval (CI) 1.06-2.81). The authors observed a similar result among children born to mothers from a Nordic country outside of Sweden (HR 1.57, 95% CI 0.89-2.75), but a non-conclusive protective effect was observed in second-generation immigrant children from a non-Nordic European country (HR 0.65, 95% CI 0.39-1.09).
The risk of CD among second-generation immigrants seems to be conditioned by maternal length of stay in Sweden before delivery, suggesting that environmental factors contribute to the variation in CD risk observed across populations.
PubMed ID
22827636 View in PubMed
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Active tuberculosis among homeless persons, Toronto, Ontario, Canada, 1998-2007.

https://arctichealth.org/en/permalink/ahliterature136298
Source
Emerg Infect Dis. 2011 Mar;17(3):357-65
Publication Type
Article
Date
Mar-2011
Author
Kamran Khan
Elizabeth Rea
Cameron McDermaid
Rebecca Stuart
Catharine Chambers
Jun Wang
Angie Chan
Michael Gardam
Frances Jamieson
Jae Yang
Stephen W Hwang
Author Affiliation
St. Michael's Hospital, Toronto, Ontario, Canada. khank@smh.ca
Source
Emerg Infect Dis. 2011 Mar;17(3):357-65
Date
Mar-2011
Language
English
Publication Type
Article
Keywords
Adult
Emigrants and Immigrants - statistics & numerical data
Female
Homeless Persons - statistics & numerical data
Humans
Male
Middle Aged
Ontario - epidemiology
Risk factors
Tuberculosis - diagnosis - epidemiology - mortality
Abstract
While tuberculosis (TB) in Canadian cities is increasingly affecting foreign-born persons, homeless persons remain at high risk. To assess trends in TB, we studied all homeless persons in Toronto who had a diagnosis of active TB during 1998-2007. We compared Canada-born and foreign-born homeless persons and assessed changes over time. We identified 91 homeless persons with active TB; they typically had highly contagious, advanced disease, and 19% died within 12 months of diagnosis. The proportion of homeless persons who were foreign-born increased from 24% in 1998-2002 to 39% in 2003-2007. Among foreign-born homeless persons with TB, 56% of infections were caused by strains not known to circulate among homeless persons in Toronto. Only 2% of infections were resistant to first-line TB medications. The rise in foreign-born homeless persons with TB strains likely acquired overseas suggests that the risk for drug-resistant strains entering the homeless shelter system may be escalating.
Notes
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PubMed ID
21392424 View in PubMed
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Acute admissions among immigrants and asylum seekers to a psychiatric hospital in Norway.

https://arctichealth.org/en/permalink/ahliterature71248
Source
Soc Psychiatry Psychiatr Epidemiol. 2003 Sep;38(9):515-9
Publication Type
Article
Date
Sep-2003
Author
Valentina Cabral Iversen
Gunnar Morken
Author Affiliation
Østmarka Hospital, Dept. of Neuroscience, Faculty of Medicine, NTNU, Box 3008, Lade 7441, Trondheim, Norway. valentina.iversen@medisin.ntnu.no
Source
Soc Psychiatry Psychiatr Epidemiol. 2003 Sep;38(9):515-9
Date
Sep-2003
Language
English
Publication Type
Article
Keywords
Adult
Catchment Area (Health)
Culture
Emigration and Immigration - statistics & numerical data
Female
Hospitals, Psychiatric
Humans
Incidence
Male
Mental Disorders - epidemiology - ethnology
Mental Health Services - utilization
Norway - epidemiology
Patient Admission - statistics & numerical data
Prevalence
Sex Distribution
Abstract
OBJECTIVE: The purpose of the present study was to compare admission rates, including admission by coercion, length of hospital stay and diagnosis among immigrants, asylum seekers and Norwegian-born patients. MATERIAL: All admissions (n=3053) to Østmarka Hospital during the period 1995-2000 were examined. A sample including all immigrants (94) and asylum seekers (39) as well as a control group of 133 Norwegians was analysed. RESULTS: Immigrants and Norwegians had the same relative risk of admission (1.07). The relative risk of admission was higher for asylum seekers compared to Norwegians (8.84). There were differences in the diagnoses given at discharge in the three groups of patients, both among men (chi2=22.33, df=6, p
PubMed ID
14504736 View in PubMed
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Adaptive governance and institutional strategies for climate-induced community relocations in Alaska.

https://arctichealth.org/en/permalink/ahliterature113760
Source
Proc Natl Acad Sci U S A. 2013 Jun 4;110(23):9320-5
Publication Type
Article
Date
Jun-4-2013
Author
Robin Bronen
F Stuart Chapin
Author Affiliation
Resilience and Adaptation Program, Alaska Institute for Justice, University of Alaska, Fairbanks, AK 99775, USA. rbronen@yahoo.com
Source
Proc Natl Acad Sci U S A. 2013 Jun 4;110(23):9320-5
Date
Jun-4-2013
Language
English
Publication Type
Article
Keywords
Alaska
Climate change
Conservation of Natural Resources - methods
Consumer Participation
Emigration and Immigration - statistics & numerical data
Environmental Policy
Humans
Residence Characteristics
Abstract
This article presents governance and institutional strategies for climate-induced community relocations. In Alaska, repeated extreme weather events coupled with climate change-induced coastal erosion impact the habitability of entire communities. Community residents and government agencies concur that relocation is the only adaptation strategy that can protect lives and infrastructure. Community relocation stretches the financial and institutional capacity of existing governance institutions. Based on a comparative analysis of three Alaskan communities, Kivalina, Newtok, and Shishmaref, which have chosen to relocate, we examine the institutional constraints to relocation in the United States. We identify policy changes and components of a toolkit that can facilitate community-based adaptation when environmental events threaten people's lives and protection in place is not possible. Policy changes include amendment of the Stafford Act to include gradual geophysical processes, such as erosion, in the statutory definition of disaster and the creation of an adaptive governance framework to allow communities a continuum of responses from protection in place to community relocation. Key components of the toolkit are local leadership and integration of social and ecological well-being into adaptation planning.
Notes
Cites: Ann N Y Acad Sci. 2010 May;1196:1-35420593524
Cites: Environ Manage. 2008 Apr;41(4):487-50018228089
PubMed ID
23690592 View in PubMed
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ADHD medication in offspring of immigrants - does the income level of the country of parental origin matter?

https://arctichealth.org/en/permalink/ahliterature293027
Source
BMC Psychiatry. 2018 01 08; 18(1):3
Publication Type
Evaluation Studies
Journal Article
Research Support, Non-U.S. Gov't
Date
01-08-2018
Author
Arzu Arat
Viveca Östberg
Bo Burström
Anders Hjern
Author Affiliation
Department of Medicine, Karolinska Institute, 171 76, Stockholm, Sweden. arzu.arat@chess.su.se.
Source
BMC Psychiatry. 2018 01 08; 18(1):3
Date
01-08-2018
Language
English
Publication Type
Evaluation Studies
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adolescent
Attention Deficit Disorder with Hyperactivity - drug therapy - economics - ethnology
Central Nervous System Stimulants - economics - therapeutic use
Child
Developing Countries
Emigrants and Immigrants - statistics & numerical data
Female
Humans
Income - statistics & numerical data
Logistic Models
Male
Odds Ratio
Parents
Registries
Social Class
Sweden
Abstract
Child psychiatric treatment facilities vary greatly worldwide and are virtually non-existent in many low-income countries. One of the most common psychiatric disorders in childhood is ADHD, with an estimated prevalence of 3-5% in Sweden. Previous studies have shown a similar prevalence of ADHD in minority and majority children in Sweden and the UK. However, clinical studies demonstrated that children from immigrant families living in Sweden received less psychiatric care than those of native-born parents. We tested the hypothesis that the consumption of child psychiatric care in immigrant families would be determined by the availability of such treatment in the parents' country of origin. Patterns of medication for attention-deficit hyperactivity disorder (ADHD) were studied as a proxy for child psychiatric care.
This was a register study of dispensed stimulant medication during 2013-2014 in Swedish national birth cohorts from 1995-2009. The study population, consisting of nearly 1.4 million children, was divided by national income of the parental country of origin and whether the parents were native Swedes, European immigrants, non-European immigrants or a mixture. Logistic regression was used to calculate the odds ratios of having been dispensed at least one ADHD drug during 2013, with adjustments for gender, family status indicating whether the child is living with both parents, household income and area of residence.
Having parents born in low-income (OR [95% confidence interval] 0.27 [0.24-0.29]) or middle-income (European: OR 0.23 [0.20-0.26], non-European: OR 0.39 [0.34-0.41]) countries was associated with lower ADHD treatment levels than having parents born in high-income countries (European: OR 0.60 [0.54-0.66], non-European: OR 0.68 [0.59-0.79]), when compared to children of parents born in Sweden. In families with a background in low or middle income countries, there was no significant association between household income and ADHD medication, while in children with Swedish and mixed backgrounds high level of disposable income was associated with lower levels of ADHD medication.
The use of child psychiatric care by immigrant families in Sweden was largely associated with the income level of the country of origin.
Notes
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PubMed ID
29310624 View in PubMed
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Advantages and limitations of web-based surveys: evidence from a child mental health survey.

https://arctichealth.org/en/permalink/ahliterature147314
Source
Soc Psychiatry Psychiatr Epidemiol. 2011 Jan;46(1):69-76
Publication Type
Article
Date
Jan-2011
Author
Einar Heiervang
Robert Goodman
Author Affiliation
Centre for Child and Adolescent Mental Health, Unifob Health, Bergen, Norway. Einar.Heiervang@rbup.uib.no
Source
Soc Psychiatry Psychiatr Epidemiol. 2011 Jan;46(1):69-76
Date
Jan-2011
Language
English
Publication Type
Article
Keywords
Adolescent
Age Factors
Child
Cost-Benefit Analysis - statistics & numerical data
Costs and Cost Analysis - methods - statistics & numerical data
Cross-Sectional Studies - economics - statistics & numerical data
Emigrants and Immigrants - statistics & numerical data
Female
Health Surveys - economics - methods - standards
Humans
Internet - economics - standards - statistics & numerical data
Interviews as Topic - methods - standards - utilization
Male
Mental Disorders - diagnosis - epidemiology - psychology
Norway - epidemiology
Poverty - psychology - statistics & numerical data
Prevalence
Questionnaires - economics - standards
Risk factors
Urban Population - statistics & numerical data
Abstract
Web-based surveys may have advantages related to the speed and cost of data collection as well as data quality. However, they may be biased by low and selective participation. We predicted that such biases would distort point-estimates such as average symptom level or prevalence but not patterns of associations with putative risk-factors.
A structured psychiatric interview was administered to parents in two successive surveys of child mental health. In 2003, parents were interviewed face-to-face, whereas in 2006 they completed the interview online. In both surveys, interviews were preceded by paper questionnaires covering child and family characteristics.
The rate of parents logging onto the web site was comparable to the response rate for face-to-face interviews, but the rate of full response (completing all sections of the interview) was much lower for web-based interviews. Full response was less frequent for non-traditional families, immigrant parents, and less educated parents. Participation bias affected point estimates of psychopathology but had little effect on associations with putative risk factors. The time and cost of full web-based interviews was only a quarter of that for face-to-face interviews.
Web-based surveys may be performed faster and at lower cost than more traditional approaches with personal interviews. Selective participation seems a particular threat to point estimates of psychopathology, while patterns of associations are more robust.
PubMed ID
19921078 View in PubMed
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Age- and sex-related prevalence of diabetes mellitus among immigrants to Ontario, Canada.

https://arctichealth.org/en/permalink/ahliterature144119
Source
CMAJ. 2010 May 18;182(8):781-9
Publication Type
Article
Date
May-18-2010
Author
Maria Isabella Creatore
Rahim Moineddin
Gillian Booth
Doug H Manuel
Marie DesMeules
Sarah McDermott
Richard H Glazier
Author Affiliation
Centre for Research on Inner City Health, Keenan Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Universityof Toronto, Toronto, Ont.
Source
CMAJ. 2010 May 18;182(8):781-9
Date
May-18-2010
Language
English
Publication Type
Article
Keywords
Adult
Age Distribution
Aged
Diabetes Mellitus - epidemiology
Educational Status
Emigrants and Immigrants - statistics & numerical data
Female
Humans
Logistic Models
Male
Middle Aged
Ontario - epidemiology
Population Surveillance
Prevalence
Risk assessment
Risk factors
Sex Distribution
Social Class
Abstract
The majority of immigrants to Canada originate from the developing world, where the most rapid increase in prevalence of diabetes mellitus is occurring. We undertook a population-based study involving immigrants to Ontario, Canada, to evaluate the distribution of risk for diabetes in this population.
We used linked administrative health and immigration records to calculate age-specific and age-adjusted prevalence rates among men and women aged 20 years or older in 2005. We compared rates among 1,122,771 immigrants to Ontario by country and region of birth to rates among long-term residents of the province. We used logistic regression to identify and quantify risk factors for diabetes in the immigrant population.
After controlling for age, immigration category, level of education, level of income and time since arrival, we found that, as compared with immigrants from western Europe and North America, risk for diabetes was elevated among immigrants from South Asia (odds ratio [OR] for men 4.01, 95% CI 3.82-4.21; OR for women 3.22, 95% CI 3.07-3.37), Latin America and the Caribbean (OR for men 2.18, 95% CI 2.08-2.30; OR for women 2.40, 95% CI: 2.29-2.52), and sub-Saharan Africa (OR for men 2.31, 95% CI 2.17-2.45; OR for women 1.83, 95% CI 1.72-1.95). Increased risk became evident at an early age (35-49 years) and was equally high or higher among women as compared with men. Lower socio-economic status and greater time living in Canada were also associated with increased risk for diabetes.
Recent immigrants, particularly women and immigrants of South Asian and African origin, are at high risk for diabetes compared with long-term residents of Ontario. This risk becomes evident at an early age, suggesting that effective programs for prevention of diabetes should be developed and targeted to immigrants in all age groups.
Notes
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PubMed ID
20403889 View in PubMed
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Age at adiposity rebound and body mass index trajectory from early childhood to adolescence; differences by breastfeeding and maternal immigration background.

https://arctichealth.org/en/permalink/ahliterature283643
Source
Pediatr Obes. 2017 Feb;12(1):75-84
Publication Type
Article
Date
Feb-2017
Author
M. Besharat Pour
A. Bergström
M. Bottai
J. Magnusson
I. Kull
T. Moradi
Source
Pediatr Obes. 2017 Feb;12(1):75-84
Date
Feb-2017
Language
English
Publication Type
Article
Keywords
Adiposity - physiology
Adolescent
Body mass index
Body Weight
Breast Feeding - statistics & numerical data
Child
Child, Preschool
Emigration and Immigration - statistics & numerical data
Female
Follow-Up Studies
Humans
Linear Models
Longitudinal Studies
Male
Mothers
Risk factors
Sweden
Abstract
This paper aims to assess association between breastfeeding and maternal immigration background and body mass index development trajectories from age 2 to 16?years.
A cohort of children born in Stockholm during 1994 to 1996 was followed from age 2 to 16?years with repeated measurement of height and weight at eight time points (n?=?2278). Children were categorized into groups by breastfeeding status during the first 6?months of life and maternal immigration background. Body mass index (BMI) trajectories and age at adiposity rebound were estimated using mixed-effects linear models.
Body mass index trajectories were different by breastfeeding and maternal immigration status (P-value?
PubMed ID
26910193 View in PubMed
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