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PubMed2007

"It's like being in a labyrinth:" Hispanic immigrants' perceptions of depression and attitudes toward treatments.

This study aimed to describe Hispanic immigrants' perceptions of depression and attitudes toward treatments and to examine how demographics, acculturation, clinical factors, and past service use were associated with their perceptions and attitudes. A convenience sample of 95 Hispanic immigrant patients was presented a vignette depicting an individual with major depression. Structured interviews that included standardized instruments and open-ended questions were used to query patients about their views of depression and its treatments. Findings showed that Hispanic immigrants perceived depression as a serious condition caused by interpersonal and social factors. Consistent with existing literature, most patients endorsed positive attitudes toward depression treatments yet reported apprehensions toward antidepressants. Demographic factors, acculturation, depressive symptoms, and past mental health service use were related to patients' views of depression and attitudes toward care. This study emphasizes the need to incorporate Hispanic immigrants' perceptions and attitudes into depression treatments.

Acculturation↗

PubMed2007

The sero-prevalence of antibodies to trypanosoma cruzi in Latin American refugees and immigrants to Canada.

BACKGROUND: Chagas' disease is caused by infection with the protozoan agent Trypanosoma cruzi. An estimated sixteen to eighteen million people are infected in Latin America. Outside of endemic regions, Chagas' disease may be transmitted through the transfusion of infected blood components, congenital infection and organ transplantation. We sought to determine the sero-prevalence of antibodies to T. cruzi in a community sample of Latin American refugees and immigrants to Canada. METHODS: This was a sero-prevalence study in Latin American refugees and immigrants living in Canada. Eligible subjects were born in South America, Central America or in Mexico. Participants were recruited from a variety of community settings, as well as from medical clinics. Serum was tested by enzyme-linked immunoassay for antibodies to T. cruzi. RESULTS: A total of 102 participants were enrolled. One sample tested positive for antibodies for T. cruzi. The seroprevalence in our sample was 1.0% (95% CI: 0.2%- 5.3%). INTERPRETATION: We found a low sero-prevalence of Chagas' disease in a community sample of Latin American immigrants and refugees. Physicians who treat Latin American immigrants should consider the risk profile and clinical status of the individual in their decision to screen for Chagas' disease.

Adolescent↗

PubMed2006

Motivations for pregnancy planning among Mexican immigrant women in North Carolina.

OBJECTIVES: To enhance understanding of 1) Mexican immigrant women's attitudes toward planning their pregnancies and the factors that influence their fertility preferences, and 2) the effect of migration on their pregnancy planning decisions. METHODS: Qualitative in-depth interviews were conducted with 11 Mexican immigrant women living in North Carolina. Participants were recruited by means of snowball sampling. Interviews were conducted in Spanish in the women's homes. Interviewing and analysis were conducted iteratively to allow emerging themes and interpretations to be developed and validated in subsequent interviews. RESULTS: The women were strongly motivated to plan their pregnancies. Their primary considerations in pregnancy planning were their ability to give their children a good life and their ability to enjoy their families. Individual personal aspirations did not emerge as an important consideration. Migration intensified the women's felt need to plan their pregnancies. CONCLUSIONS: The Mexican immigrant women in this study had a strong familistic orientation. Far from diminishing their interest in planning their pregnancies, however, the high value they placed on family was their primary motivation for pregnancy planning. Migration to the U.S. intensified their felt need to plan their pregnancies. Understanding of the women's motivations for family planning may help health care providers better address the family planning needs of Mexican immigrant women.

Adult↗

PubMed1989

Tuberculosis in British Columbia among immigrants from five Asian countries, 1982-85.

The influence of immigration from six selected Asian countries--Japan, Korea, Philippines, India, China and Hong Kong--on the incidence of tuberculosis in British Columbia has been examined. During the period 1982-1985 the average annual incidence of bacillary tuberculosis in these immigrants was more than six times as great as the overall British Columbia rate and contributed a quarter of the cases of active bacillary tuberculosis in this province whereas the immigrants from these countries represented only 3.7% of the total population. The clinical patterns of active tuberculosis by birthplace were analysed. A high proportion of cases of lymphadenitis was seen among all immigrants from Asia, particularly those from the Philippines. Both primary and secondary drug resistance was substantially higher than in Canadian-born patients. The frequency of primary drug resistance was higher among patients aged less than 40 years than those aged 40 or more.

British Columbia↗

PubMed2006

Nonsupplemented children of Latino immigrants have low vitamin E intakes and plasma concentrations and normal vitamin C, selenium, and carotenoid intakes and plasma concentrations.

OBJECTIVE: This study sought to determine and evaluate the intakes and plasma concentrations of vitamin E (alpha-tocopherol), gamma-tocopherol, vitamin C, selenium, and carotenoids (alpha-carotene, beta-carotene, beta-cryptoxanthin, lutein/zeaxanthin, and lycopene) of nonsupplemented boys and girls, 4 to 8 years old, of Latino immigrants living in rural Nebraska. DESIGN: Dietary intakes of the Latino children were estimated. Their plasma samples (fasting) were analyzed for vitamin E, vitamin C, selenium, and carotenoid concentrations. Data were evaluated by sex. SUBJECTS: The subjects were a convenience sample of 4- to 8-year-old (n=29), apparently healthy, nonsupplemented children of Latino immigrants living in rural Nebraska. STATISTICAL ANALYSIS: Sex differences in parameter values were determined using general linear models; Pearson r was used for determining correlations. RESULTS: No significant differences in parameter values were observed by sex, with the exception of plasma lutein/zeaxanthin concentration. The majority (69%) had plasma vitamin E (alpha-tocopherol) concentrations<0.516 mg/dL (12 micromol/L), which is indicative of vitamin E inadequacy, and over half (59%) reported consuming less than the Estimated Average Requirement for vitamin E. All subjects had plasma vitamin C and selenium concentrations indicative of adequacy (>0.41 mg/dL or >23 micromol/L, and >6.32 microg/dL or >0.8 micromol/L, respectively), and consumed at least the Recommended Dietary Allowances for these nutrients. The plasma carotenoid concentrations of the children may be useful as norms. CONCLUSIONS: These children of Latino immigrants who did not take supplements had low plasma vitamin E (alpha-tocopherol) concentrations but normal plasma vitamin C and selenium concentrations. IMPLICATIONS: Dietetics professionals and others involved in health care need to work with Latino immigrant parents so that their children consume adequate amounts of vitamin E.

Ascorbic Acid↗

PubMed2006

Antioxidant intake, oxidative stress and inflammation among immigrant women from the Middle East living in Sweden: associations with cardiovascular risk factors.

BACKGROUND AND AIMS: Immigrant women from the Middle East have higher cardiovascular risk compared to native women. Whether low antioxidant intake, oxidative stress or inflammation contributes to risk is unknown. In a cross-sectional study of 157 randomly selected foreign-born women (Iranian and Turkish) and native women living in Sweden, we investigated antioxidant status, oxidative stress (F(2)-isoprostanes) and systemic inflammation (plasma high sensitive C-reactive protein; CRP) markers. We also investigated relationships between F(2)-isoprostanes, CRP and cardiovascular risk factors. METHODS AND RESULT: Dietary intake was assessed using 24-h dietary recalls repeated four times. Micronutrient intake was not consistently different between groups. Serum alpha-tocopherol, but not gamma-tocopherol levels, was lower in Turkish vs. Swedish women (P<0.05). Turkish women had the highest F(2)-isoprostane levels (P<0.05 vs. Iranian women) and CRP levels (P<0.01 vs. Swedish women and P=0.05 vs. Iranian women). In immigrants (n=97), F(2)-isoprostanes correlated positively to insulin levels (r=0.31, P<0.01), and CRP was correlated to obesity and several cardiovascular risk factors (r-values >0.21, P values <0.05). CONCLUSION: The role of antioxidant status is unclear, whereas signs of oxidative stress and inflammation are evident in immigrant women from Middle East, especially Turkish women. Oxidative stress and low-grade inflammation might contribute to the higher cardiovascular risk previously observed in immigrant women. Further larger studies adjusting for more potential confounders are motivated to confirm these results.

Adult↗

PubMed2004

Acculturation and physical activity among North Carolina Latina immigrants.

The objective of this study was to examine the association between acculturation and physical activity among first generation Latina (Hispanic women) immigrants living in North Carolina. As part of the multi-site Women's Cardiovascular Health Network, 671 first generation Latina immigrants 20-50 years of age completed in-person interviews on physical activity, acculturation (measured by a language scale, length of residence in the US, and age at arrival in the US) and other potential individual and contextual correlates of physical activity. All statistical models were adjusted for age, general health, number of children in the home, marital status, and education, with self-reported physical activity as the dependent variable. Among participants, 37.4% met recommendations for physical activity, 41.9% reported insufficient activity, and 20.7% reported no moderate or vigorous activity. Latinas with higher English language acculturation were more likely to be physically active than women with lower English language acculturation. Likewise, women who arrived to the US when they were younger than 25 years were more likely to be physically active than women who arrived when they were 25 years or older. Length of residence in the US was not associated with physical activity. These relationships persisted when restricting the sample to Mexican born women. We conclude that among first generation immigrants living in North Carolina, those with higher English language acculturation or who arrived to the US at younger ages were more likely to report being physically active. These findings suggest that future epidemiologic studies and physical activity interventions should measure and tailor programs based on English-language use and age of arrival to the US among Latina immigrants.

Acculturation↗

PubMed2006

Do Dutch doctors communicate differently with immigrant patients than with Dutch patients?

The aim of this study was to gain deeper insight into relational aspects of the medical communication pattern in intercultural consultations at GP practices in the Netherlands. We ask whether there are differences in the verbal interaction of Dutch GPs with immigrant and Dutch patients. Data were drawn from 144 adult patient interviews and video observations of consultations between the patients and 31 Dutch GPs. The patient group consisted of 61 non-Western immigrants (Turkish, Moroccan, Surinamese, Antillean, Cape Verdian) and 83 Dutch participants. Affective and instrumental aspects of verbal communication were assessed using Roter's Interaction Analysis System (RIAS). Patients' cultural background was assessed by ethnicity, language proficiency, level of education, religiosity and cultural views (in terms of being more traditional or more modern). Consultations with the non-Western immigrant patients (especially those from Turkey and Morocco) were well over 2 min shorter, and the power distance between GPs and these patients was greater when compared to the Dutch patients. Major differences in verbal interaction were observed on the affective behavior dimensions, but not on the instrumental dimensions. Doctors invested more in trying to understand the immigrant patients, while in the case of Dutch patients they showed more involvement and empathy. Dutch patients seemed to be more assertive in the medical conversation. The differences are discussed in terms of patients' ethnic background, cultural views (e.g. practicing a religion) and linguistic barriers. It is concluded that attention to cultural diversity does matter, as this leads to different medical communication patterns. A two-way strategy is recommended for improving medical communication, with implications for both doctor and patient behavior.

Adult↗

PubMed2006

John Henryism, self-reported physical health indicators, and the mediating role of perceived stress among high socio-economic status Asian immigrants.

This study examined the relationship between John Henryism (a strong behavioral predisposition to engage in high effort coping with difficult barriers to success) and self-reported physical health among high socio-economic (SES) status Asian immigrants to the USA. Cross-sectional data were collected from a community sample of 318 self-identified Chinese and Indian immigrants aged 18-73, averaging 10.2 yr lived in the US. In addition to the John Henryism Active Coping Scale, health status was measured using ordinal ratings of global self-rated health, somatic symptoms and physical health functioning. We also evaluated whether perceived stress would explain the relationship between John Henryism and health. Controlling for demographic factors, regression analyses showed that higher John Henryism significantly predicted better self-rated health and physical functioning, and fewer somatic symptoms. These relationships were significantly and fully mediated (for physical functioning and somatic symptoms) or partially mediated (for self-rated health) by lower perceived stress. Results suggest that John Henryism relates to better health among high SES Asian immigrants in part by reducing perceived stress. To better understand and improve health in all racial/ethnic groups, especially racial minorities and immigrants, more research is needed on John Henryism and perceived stress as important psychosocial mechanisms intervening between environmental exposures and health outcomes.

Adaptation, Psychological↗

PubMed1997

Screening in special populations: a "case study" of recent Vietnamese immigrants.

PURPOSE: To determine how the medical and social profile of a particular special population, Vietnamese immigrants, should be used to tailor screening protocols that differ from those designed for the general population. PATIENTS AND METHODS: A consecutive series of Vietnamese immigrants living in the United States for less than 6 months were evaluated by interviewer-administered standardized questionnaire and medical record review. A total of 99 new Vietnamese immigrants (47 women and 52 men) aged 19 to 71 years presenting for primary care to two neighborhood health centers between October 1994 and June 1995 were identified. Data collected included smoking status, alcohol use (CAGE questionnaire), depression (Vietnamese Depression Scale [VDS]), PPD status, stool ova and parasites, hepatitis B and syphilis serologies. RESULTS: Overall, 32% were smokers and significantly more men than women smoked (54% vs. 9%) (P < .00001). Although 24% of patients used alcohol, none responded positively to any of the CAGE questions. Using the VDS, 17% (17 of 99) were depressed; age 40 and older was the only sociodemographic factor associated with depression (P < .00001). Ova or parasites were found in 51% (41 of 80), and 63% of those infected (26 of 41) required treatment for pathogenic infections. Seventy percent (66 of 94) tested positive on the tuberculin skin test (PPD), and antituberculous medication was recommended in 39% (37 of 94). Eighty-three percent (80 of 96) had been exposed to hepatitis B, and 14% (13 of 96) were chronic hepatitis B carriers. CONCLUSIONS: Caring for special populations provides an opportunity to institute appropriate unique screening tests not recommended for the general population. In the case of new Vietnamese immigrants, routine screening protocols should include the following: testing for tuberculosis by PPD, stool ova and parasite examinations, hepatitis B serologies, and assessment for depression and smoking status. The CAGE questionnaire may not be an effective instrument for detecting alcohol abuse in this particular population.

Adult↗

PubMed2002

Lived experiences of immigrant nurses in New South Wales, Australia: searching for meaning.

Recognising the potential value of immigrant nurses in multicultural Australia, this study sought to understand immigrant nurses' experiences in order to throw some light on their under representation in the nursing workforce. Using a Heideggerian phenomenological approach the purpose of this study was to explore, describe and analyse the lived experiences of five immigrant nurses, four from non-English-speaking backgrounds, practising in New South Wales, Australia. Through naturalistic open-ended interviews, the everyday experiences of immigrant nurses were described and hermeneutically analysed. The lived experiences, and the meaning of such experiences which emerged from analysis included: professional negation, experienced in lack of support; otherness, experienced in cultural separateness; silencing, experienced in language and communication difficulties and a number of other related experiences and feelings. The study highlights the continuing existence of a social and cultural distance between nurses of the dominant culture and nurses from culturally and linguistically diverse backgrounds.

Communication↗

PubMed2003

[Imported hookworm infection in African immigrants in Spain: study of 285 patients].

BACKGROUND AND OBJECTIVE: Hookworm infection is a worldwide intestinal parasitic disease affecting more than one billion people. It represents an important public health problem in rural areas of developing countries. In our environment, it is generally considered an imported disease due to the immigration process. PATIENTS AND METHOD: Retrospective observational study of African immigrants diagnosed with hookworm infection at the Immigration and Tropical Medicine Unit of the Hospital of Mataró over the period 1984-1999. RESULTS: We identified 285 patients, mainly young males, from Gambia or Senegal, with a precarious job who had arrived in Spain 3 years earlier or less. Abdominal pain was the commonest reason for consultation (28.8%) cases. Non digestive symptoms were 35.6% and 4.6% remained assymptomatic. 60% had a concomitant infectious disease. Laboratory tests showed iron-deficiency anemia in 28.4% and eosinophilia in 52.3%. 70% of patients did not come to visit after treatment. CONCLUSIONS: Microbiologic stool examination is recommended as part of the health assessment of immigrants from countries where hookworm infection is highly prevalent, even in the absence of abdominal symptoms or abnormalities of the red and white blood series.

Africa South of the Sahara↗

PubMed1998

Reiter's syndrome among Asian shipboard immigrants: the case of The Golden Venture.

OBJECTIVE: To assess the incidence of Reiter's syndrome aboard The Golden Venture, a ship carrying illegal immigrants from China to the United States. METHODS: After identification of an index case, we conducted telephone interviews with medical staff at immigrant detention centers in Pennsylvania, New York, and Virginia. When a potential case was identified at one facility, we performed a site inspection, reviewing the medical records of all detainees and performing histories and physicals on all those with joint and/or ocular complaints. RESULTS: We identified two patients, both HLA B27 positive, with Reiter's syndrome. The observed incidence (0.87%) approximated the predicted incidence but may have underestimated the actual incidence. We review the history of shipboard Reiter's syndrome, and discuss the pathogenic roles of HLA B27 and particular infectious agents. CONCLUSION: Continued transportation of illegal immigrants from China and other parts of the world is likely to result in occasional clusters of Reiter's syndrome. Physicians treating immigrant populations should remain aware of the possibility of reactive arthritis.

Adult↗

PubMed2003

Intergenerational value discrepancies in immigrant and host-national families and their impact on psychological adaptation.

This study investigated the relationship between intergenerational value discrepancies and psychological adaptation among adolescents with immigrant background (mean age=15.5 years) in Norway and Sweden. Results from two cohorts (parents and their children) of immigrant and host-national families in the two countries (n=574) indicated that immigrant adolescents on the whole neither differed from their host peers with respect to psychological adaptation nor on value discrepancies. Value discrepancies were weakly related to psychological adaptation. Results are discussed as to whether the findings may reflect a general phenomenon for all adolescents or specific to those with immigrant background.

Adaptation, Psychological↗

PubMed1998

Is new immigrant screening for tuberculosis still worthwhile?

BACKGROUND: new immigrant screening in the 1980s showed that the official Port of Arrival (POA) system performed poorly, that there was a significant yield in terms of clinical tuberculosis, and that preventive measures (chemoprophylaxis and BCG) were appropriate in a substantial minority Data for the 1990s was sought for comparison. METHODS: prospective data on new immigrant screening for 1990-1994 inclusive in the Blackburn, Hyndburn and Ribble Valley local government areas were analysed, and compared with previous 1983-1988 data. RESULTS: of the 2242 new immigrants screened, 1333 were from Pakistan, 604 from India and 305 from the rest of the world. A total of 898 (40%) were found via the POA system, but 1344 (60%) were only identified by local links with the Family Health Services Authority (FHSA). Ten cases of active tuberculosis were found (0.45%), chemoprophylaxis was given to 19/465 (4.1%) of children aged 0-15 years, and BCG vaccination to 530/1705 (31%) of those aged under 30 years. CONCLUSIONS: between 1990-1994 the official POA system continued to perform poorly. The yield of new tuberculosis cases detected was lower than in the 1980s. Chemoprophylaxis at 4% and BCG vaccination at 31% showed that preventive health measures were appropriate for over one-third of new immigrants aged under 30.

Adolescent↗

PubMedDate not supplied

[Comparison of Spanish gypsy and foreign immigrant maltreated children admitted to protection centers].

OBJECTIVES: To determine whether there are differences between Spanish gypsy and foreign immigrant children admitted to protection centers in the characteristics of the maltreatment, social and familial factors linked to maltreatment, and health status. METHODS: The social and health reports of 83 Spanish gypsy and 105 foreign immigrant children admitted to protection centers of the Aragonese Institute for Social Services (Instituto Aragones de Servicios Sociales [IASS]) because of maltreatment from January 1994 to December 2003 were reviewed. Maltreatment, its types, and warning signs were defined and assessed according to the guidelines drawn up by the IASS. The social and familial risk factors associated with maltreatment were determined according to national studies. Health status was assessed following protocols used by the IASS. A descriptive and comparative statistical study was performed. RESULTS: The Spanish gypsy children were mostly in the age group of 0-5 years, while foreign immigrants were mostly in the age group of 12-17 years. Spanish gypsy children showed a greater frequency of physical and emotional neglect and/or abandonment (p < 0.001) and were more likely to have families with problems of crime (odds ratio [OR] = 16.5; 95% confidence interval [95%CI], 6.7-40.7), drug/alcohol abuse (OR = 8.8; 95%CI, 3.7-21) and families with more than one social and health risk factor (OR = 9.3; 95%CI, 3.8-22.8). Spanish gypsy children showed a greater frequency of neurological disorders, disabling diseases, absent or incomplete immunizations, and dermatologic diseases. Foreign immigrant children showed a greater frequency of physical and psychological and/or sexual abuse (p < 0.001) and were more likely to live in a single parent family (OR = 7.9; 95%CI, 2.2-27.7). CONCLUSIONS: Identifying the differences between these two groups of maltreated children could be useful for professionals working in the community social services in charge of developing intervention strategies for the prevention and early detection of maltreatment, as well as for professionals in charge of the health of these children during their stay in a protection center.

Adolescent↗

PubMed1999

Preventive behavior among recent immigrants: Russian-speaking women and cancer screening in Israel.

This study examined the risk profile and preventive practices aimed at female reproductive cancer in a national sample of 620 women aged over 35, who immigrated to Israel from the former Soviet Union after 1989. The study setting typifies a more general problem of the encounter between East European immigrants and western-type health cultures and medical systems. It has shown that universal access to preventive care may not translate into its optimal utilization among marginalized population groups. Specifically, while being at moderate to high cancer risk, Russian immigrants avoid screening activities; gynecological check-ups, breast examination and mammography. This is a reversal of the pre-emigration pattern: two thirds of respondents underwent cancer screening in their home country and only one third in Israel. The risk groups for late detection of cancer are the women least integrated into the mainstream society: those over 60, unemployed or having unskilled jobs. Women without regular primary care providers showed the lowest cancer awareness and minimal screening activity. Even those who knew the key cancer facts, believed in their own susceptibility and in the benefit of early detection, in practice did little to avert the danger. Three explanations for the discrepancy between cognition and practice are suggested: (a) the immigrants' low health motivation, reflecting their downward social mobility and preoccupation with resettlement problems; (b) low self-efficacy and external locus of control over health, typical of ex-Soviet citizens and (c) communicative and other cultural barriers to health care services.

Adult↗

PubMed1998

High rate of asthma among immigrants.

Articles dealing with the epidemiological aspects of asthma were carefully reviewed in order to support or reject our clinical impression of increased rate of asthma among immigrants. Particular emphasis was put on data on very high or very low rates of asthma. The proposed theories to explain these differences were critically examined. The prevalence of asthma in China and in Africa is 1-2% and 0.5-5%, respectively. The prevalence of the disease in other indigenous populations ranges between 0.5% and 12%. On the other hand, asthma is much more frequently seen in Australia and in New Zealand (approximately 20-25%), where peoples' ancestors immigrated from distant areas. Statistical meta-analysis found a significant difference between the rates of asthma in the two groups of populations (P < 0.001). Immunoglobulin E levels of immigrants in Sweden are higher than those of native Swedes. Similarly, cord blood immunoglobulin E concentrations are more elevated in neonates whose mothers emigrated to Germany from Eastern countries than in those of native German mothers. There is an increased rate of IgE-mediated asthma among immigrant populations.

Asthma↗