Length Of Time In Country Research Articles

Including ethnic minorities in dementia research: Recommendations from a scoping review.

IntroductionEthnicity influences dementia etiology, prognosis, and treatment, while culture shapes help‐seeking and care. Despite increasing population diversity in high‐income settlement countries, ethnic minorities remain underrepresented in dementia research. We investigated approaches to enhance the recruitment, and consistent collection and analysis of variables relevant to, ethnic minorities in dementia studies to make recommendations for consistent practice in dementia research.MethodsWe did a scoping review, searching Embase, PsycINFO, Medline, CENTRAL, and CINAHL between January 1, 2010 and January 7, 2020. Dementia clinical and cohort studies that actively recruited ethnic minorities in high‐income countries were included. A steering group of experts developed criteria through which high‐quality studies were identified.ResultsSixty‐six articles were retrieved (51 observational; 15 experimental). Use of interpreters and translators (n = 17) was the most common method to facilitate participant recruitment. Race and ethnicity (n = 59) were the most common variables collected, followed by information on native language (n = 14), country of birth (n = 9), and length of time in country of settlement (n = 8). Thirty‐three studies translated or used a culturally validated instrument. Twenty‐three articles conducted subgroup analyses based on ethnicity. Six high‐quality studies facilitated inclusion through community engagement, collected information on multiple aspects of ethnic diversity, and adjusted/substratified to analyze the impact of ethnicity on dementia.DiscussionWe make recommendations for consistent recruitment, collection, and reporting of variables relating to ethnic and cultural diversity in dementia research.

Challenges, coping responses and supportive interventions for international and migrant students in academic nursing programs in major host countries: a scoping review with a gender lens

BackgroundInternational and migrant students face specific challenges which may impact their mental health, well-being and academic outcomes, and these may be gendered experiences. The purpose of this scoping review was to map the literature on the challenges, coping responses and supportive interventions for international and migrant students in academic nursing programs in major host countries, with a gender lens.MethodsWe searched 10 databases to identify literature reporting on the challenges, coping responses and/or supportive interventions for international and migrant nursing students in college or university programs in Canada, the United-States, Australia, New Zealand or a European country. We included peer-reviewed research (any design), discussion papers and literature reviews. English, French and Spanish publications were considered and no time restrictions were applied. Drawing from existing frameworks, we critically assessed each paper and extracted information with a gender lens.ResultsOne hundred fourteen publications were included. Overall the literature mostly focused on international students, and among migrants, migration history/status and length of time in country were not considered with regards to challenges, coping or interventions. Females and males, respectively, were included in 69 and 59% of studies with student participants, while those students who identify as other genders/sexual orientations were not named or identified in any of the research. Several papers suggest that foreign-born nursing students face challenges associated with different cultural roles, norms and expectations for men and women. Other challenges included perceived discrimination due to wearing a hijab and being a ‘foreign-born male nurse’, and in general nursing being viewed as a feminine, low-status profession. Only two strategies, accessing support from family and other student mothers, used by women to cope with challenges, were identified. Supportive interventions considering gender were limited; these included matching students with support services' personnel by sex, involving male family members in admission and orientation processes, and using patient simulation as a method to prepare students for care-provision of patients of the opposite-sex.ConclusionFuture work in nursing higher education, especially regarding supportive interventions, needs to address the intersections of gender, gender identity/sexual orientation and foreign-born status, and also consider the complexity of migrant students’ contexts.

International migration as a determinant of emergency caesarean.

High caesarean rates are of concern given associated risks. International migrant women (women born abroad) represent a substantial proportion of women giving birth in high-income countries (HICs) and face social conditions that may exacerbate childbearing health risks. Among migrant women, emergency rather than planned caesareans, tend to be more prevalent. This method of delivery can be stressful, physically harmful and result in an overall negative birth experience. Research establishing evidence of risk factors for emergency caesareans in migrants is insufficient. (1) Describe potential pathways (with a focus on modifiable factors) by which migration, using internationally recommended migration indicators: country of birth, length of time in country, fluency in receiving-country language, migration classification and ethnicity, may lead to emergency caesarean; and (2) propose a framework to guide future research for understanding "potentially preventable" emergency caesareans in migrant women living in HICs. "Potentially preventable" emergency caesareans in migrant women are likely due to several modifiable, interrelated factors pre-pregnancy, during pregnancy and during labour. Migration itself is a determinant and also shapes other determinants. Complications and ineffective labour progress and/or foetal distress and ultimately the decision to perform an emergency caesarean may be the result of poor health (i.e., physiological effects), lack of support and disempowerment (i.e., psychological effects) and sub-optimal care. Understanding the direct and indirect effects of migration on emergency caesarean is crucial so that targeted strategies can be developed and implemented for reducing unnecessary caesareans in this vulnerable population.

Cross-border movement and women's health: how to capture the data

IntroductionThe movement of women across international borders is occurring at greater rates than ever before, yet the relationship between migration and women's health has been under-explored. One reason may be difficulty measuring migration variables including country of birth, length of time in country, immigration status, language ability, and ethnicity. A range of social, environmental, cultural, and medical characteristics associated with the pre-, during- and post-migration phases are also important to consider. The objective of this paper is to present challenges and solutions in measuring migration and related variables via survey-like questionnaires administered to international migrant women.MethodsThe development, validation, and translation of two questionnaires subsequently applied in studies of migrant women during pregnancy, birth and postpartum were used as case examples to highlight related measurement issues.ResultsChallenges: (1) Measuring socio-cultural, medical and environmental variables across the pre-during-post migration phases (since questions must be framed so that data relating to each phase of migration are captured); (2) Obtaining data for complex patterns of migration (i.e., multiple movements between multiple destinations); and (3) answering long questions across a time continuum.Solutions: (1) Using interviewer-assisted rather than self-administered questions; (2) Adding probes and explanations to 'walk' participants through their migration experiences; (3) Identifying variables (e.g., trafficking) better captured using non-questionnaire data collection methods or better not collected (e.g., ethnicity) due to extreme variations in meaning.ConclusionCarefully constructed and translated survey questionnaires are practical tools for the collection of a breadth of migrant data. These data, including detailed accounts of countries lived in, length of time in those countries, immigration status, change in status, language fluency, and health insurance eligibility offer rich descriptions of the population under study and make research findings with regards to migration more interpretable. Analyses by a range of migration indicators are facilitated through survey-like questionnaire data of this type.

Migration and perinatal health surveillance: An international Delphi survey

ObjectiveWhile the perinatal health of migrants has been identified as a priority by many governments, there is no consensus on indicators for monitoring migration and perinatal health. The Reproductive Outcomes and Migration international research collaboration and the EURO-PERISTAT project convened an expert panel to recommend migration indicators for national and international monitoring of migration and perinatal health. Study designA Delphi consensus process involved 38 perinatal clinicians, epidemiologists, and experts in health information systems from 22 countries who completed one or more questionnaires. Panel members ranked migration indicators from a list inventoried from the published literature. ResultsCountry of birth was considered ‘essential’ or ‘recommended’ for routine collection by 100% of respondents, followed by length of time in country (88%), language fluency (70%), immigration status (67%), and ethnicity as defined by maternal parents’ place of birth (55%). Feasibility with ‘minor’ or ‘no modifications’ to current data collection systems was highest for country of birth (69%), followed by length of time in country (61%). Other indicators were judged to be less feasible. In respect to migration, the perinatal health indicators considered to be ‘essential’ by 94% of respondents included fetal, neonatal, and infant mortality. A smaller proportion (73%) considered maternal mortality to be ‘essential’. ConclusionsA strong consensus was achieved for including country of birth in core perinatal health indicator sets. Length of time in country was also recommended as a second indicator for routine data collection. Specific studies should be undertaken to complement routine data collection on: immigration status, language fluency, and ethnicity as defined by maternal parents’ place of birth.

A Comparative Analysis of Cigarette, Alcohol, and Illicit Drug Use among an Ethnically Diverse Sample of Hispanic, African American, and Non-Hispanic White Adolescents

Longitudinal findings are presented on lifetime, past year, and magnitude of use of cigarettes, alcohol, and illicit drugs among non-Hispanic White (NHW), African-American, Cuban, Nicaraguan, Colombian, and Puerto Rican adolescent boys. The T-3 sample included 5,370 adolescents of whom 3,403 were Hispanic. About one-half the Hispanic sample was foreign born. Significant increases in lifetime use and magnitude of use of all three substances were found over the three data collection periods for all six groups. NHW and Hispanic adolescents had higher substance use rates than African-Americans. Most differences were not significant for NHW and Hispanic subgroups. Foreign-born Hispanics reported positive relationships between length of time in country and substance use. Significant relationships were found in two instances. Length of time in country was related to lifetime use of all substances for Cubans and for past year use of alcohol and illicit drugs. It was also significantly related to lifetime and past year use of alcohol and for lifetime illicit drug use among Nicaraguans. Although substance use did not vary greatly for different Hispanic groups, the authors suggest caution be used in offering generalizations, especially among young groups with diverse nativity and immigration histories.

Child health outcomes among central American refugees and immigrants in Belize

The purpose of this study was to investigate the effect of international migration, including refugee status, upon child health outcomes. Data were drawn from a survey conducted in 1989 in three settlements in Belize, Central America, that have a high proportion of refugees and economic immigrants living side-by-side with the local population. In two of the settlements, the entire population of mothers with children under 6 was interviewed; in the third settlement a two-thirds random sample was interviewed. Health history data were obtained for 255 children of 134 mothers, from whom sociodemographic data were also collected. The majority of children were born to Salvadoran or Guatemalan mothers, but native and naturalized Belizeans in the survey communities were included for comparison purposes. Migration, the exposure variable, was characterized by mother's residency/refugee legal status, nationality, and duration of time in country. Socioeconomic and proximate control variables were included as suggested by the Mosley-Chen framework. Despite normal birthweight averaging 3374 g, a large proportion of children are at the lowest percentiles of the weight-for-age curves (44% below the tenth percentile for the international reference population). A high incidence of diarrheal and respiratory illnesses (30% and 47% of children, respectively, having frequent episodes), and 50% of children with measles vaccination appropriate for age, indicate a population with high potential morbidity. Logistic regression was used to model the effects of migration on weight-for-age and frequency of diarrheal and respiratory tract episodes independent of socioeconomic and proximate factors, as suggested by the Mosley-Chen framework. Once these socioeconomic and proximate variables were controlled for, migration contributed little to the models. It appears that the poverty of migrants—irrespective of legal status, origin, or length of time in country—may override migration. Also, study findings suggest that the children of refugees and immigrants have intense health needs even in a relatively benign social environment, as do the children of native Belizeans. The study affirmed the utility of the Mosley-Chen framework, and further tests in other migration contexts are suggested. Current efforts of government and non-governmental programs to direct public health measures towards whole settlements rather than to groups defined by legal status should be supported. Policies that decrease socioeconomic marginalization by integrating refugees and immigrants into the local labor force, educational facilities, and health services may contribute to improved child health.