non-Western Immigrants Research Articles

Participation in cervical cancer screening among immigrants and Danish-born women in Denmark

In this nationwide register-based cohort study, we examined cervical cancer screening participation among immigrants in Denmark by country and region of origin. Furthermore, we assessed whether differences in screening participation between immigrants and Danish-born women were explained by sociodemographic or health-related characteristics, and examined predictors of participation among immigrants. Using high-quality registries, we identified women invited for cervical cancer screening during 2008–2009 and retrieved individual-level data on sociodemographic-, health- and immigration-related characteristics. A total of 610,907 women were followed for up to 2.9 years after screening invitation. We estimated the probability of participation using the Aalen-Johansen estimator and the hazard ratios (HRs) of participation using Cox regression. The probability of participation within follow-up was 74.5% (95% CI, 74.4%–74.6%) in Danish-born women; 61.2% (95% CI, 60.4%–62.1%) in Western immigrants; and 61.3% (95% CI, 60.9%–61.8%) in non-Western immigrants. Participation in immigrants varied by region of origin from 44.3% (95% CI, 41.4%–47.4%) in immigrants from North America, New Zealand and Australia to 67.8% (95% CI, 65.4%–70.3%) in immigrants from South- and Central America. Substantial variation was seen between specific countries of origin. Differences in participation between immigrants and Danish-born women were not explained by sociodemographic or health-related characteristics. Predictors of low participation in immigrants included lower income, unemployment, being unmarried, having a history of schizophrenia or other psychoses, and ≤5 years' stay in Denmark. In conclusion, cervical cancer screening participation in immigrants varied by region and country of origin, but all immigrant groups had lower participation than Danish-born women.

Cerebral palsy among children of immigrants in Denmark and the role of socioeconomic status.

Children of immigrants in Denmark have excess risk for some of the most well-established risk factors for cerebral palsy (CP). To study differences in risk of CP between children of immigrants and children of Danish-born mothers, and explore whether socioeconomic status drives any potential association. A register-based cohort study including 1,274,616 children born in Denmark between 1981 and 2007. Of these, 2807 had a validated CP diagnosis in the Danish CP Register. We estimated the risk of CP as odds ratios (OR) using logistic regression and assessed mediation through socioeconomic status using natural effect models. In children of Danish-born mothers, 2.2/1000 had CP overall and the prevalence was similar for children of immigrants. However, children of immigrants had lower risk of unilateral spastic CP than children of Danish native-born mothers; OR=0.59 (95% CI:0.38-0.91) for Western and OR=0.79 (95% CI:0.61-1.03) for Non-Western immigrants. By contrast, the risk of bilateral spastic CP was higher in children of Non-Western immigrants (OR=1.27 (95% CI:1.05-1.53)), especially from Turkey and Pakistan compared with children of Danish native-born mothers. The mediation analysis revealed an indirect effect (through maternal educational level and household income) with an OR of 1.06 (95% CI:0.99-1.14) for children of Non-Western immigrants. While children of immigrants had lower risk of unilateral spastic CP than children of Danish-born mothers, the risk of bilateral spastic CP was increased in children of Non-Western immigrants. Socioeconomic status did not appear to be a significant contributor to the increased risk of bilateral spastic CP.

Serum vitamin D levels in Berliners of Turkish descent \u2013a cross-sectional study

BackgroundVitamin D levels may differ between migrant and non-migrant populations, especially among non-western immigrants living in a country with limited sun exposure such as Germany. This study examined serum vitamin D concentration and associated factors among Berliners with and without Turkish background.MethodsTwo samples (with and without Turkish roots) were recruited in the inner city of Berlin for a cross-sectional study assessing serum vitamin D concentration. Linear regression analyses were used to examine sociodemographic, lifestyle and medical factors associated with serum vitamin D levels.ResultsIn the analyses, we included 537 subjects (39% men and 61% women, age 43.2 ± 12.5 (mean ± standard deviation) years) with and 112 without Turkish background (46% men and 54% women, age 46.7 ± 14.6 years). The Turkish sample had lower mean (95%-Confidence Interval) vitamin D levels than the non-Turkish sample: 22.7 nmol/L (21.5;23.9) vs 34.7 nmol/L (31.9;37.5), p < 0.001. In the Turkish female subgroup, veiled women had considerably lower levels than unveiled women: 14.4 nmol/L (11.5;17.3) vs 24.9 nmol/L (23.1;26.7), p < 0.001. Multivariable regression analysis revealed that among the Berliners of Turkish descent, being active less than 150 min per day, and being overweight/obese were independently associated with a lower vitamin D concentration. In the non-migrant sample besides being overweight and obese, female sex was associated with lower vitamin D concentrations.ConclusionsSerum vitamin D levels were considerably low in Berliners of Turkish descent, and especially in veiled women. Potentially modifiable factors of low vitamin D levels were high BMI and low physical activity. These findings should be considered in the development of future public health strategies for subpopulations with Turkish migration background.

A qualitative study about the experiences of ethnic minority pregnant women with gestational diabetes.

Gestational diabetes mellitus demands rapid health behaviour changes for the pregnant woman to obtain stable blood glucose levels. In Denmark, the general incidence of gestational diabetes mellitus is about 3%, but more than 4.5% among non-Western immigrants and descendants. Women belonging to ethnic minorities may be particularly challenged by health behaviour changes due to educational, language and cultural barriers. To explore how non-Western ethnic minority pregnant women in Denmark experience the hospital-based information about gestational diabetes mellitus and how they integrate this information into their everyday life. A secondary aim was to investigate how health literacy and distributed health literacy affect this process. Semistructured, qualitative interviews with 11 women. Thematic analysis was conducted with a special focus on health literacy as analytical approach. Three themes were identified: Reaction to the diagnosis, Everyday life and Information needs. All women felt sad and worried by the diagnosis. Some struggled to implement the recommended behaviour changes, and many lacked supports from their spouse. The hospital-based information was positively evaluated, but in some cases, the information was misunderstood. Social networks, language skills, and the ability to seek and assess information were important factors influencing the degree to which the women experienced gestational diabetes mellitus to be a challenge. Women were generally satisfied with the hospital-based information. Women with low health literacy/poor Danish language skills seem to be most challenged by the diagnosis. Future research should examine ways to organise patient-centred health care while simultaneously supporting women's opportunity to increase health literacy through, for example social network and the Internet.

Polio and post-polio syndrome in non-Western immigrants: A new challenge for the healthcare system in Norway.

To explore the health situation and identify specific health challenges in non-Western immigrants with polio in Norway, by comparing their status with Western immigrants with polio and native Norwegians with polio. A questionnaire covering demographics, polio history, life satisfaction, medical, psychological and social conditions was answered by 1,408 persons with polio, among them 34 immigrants from non-Western countries and 32 immigrants from Western countries. The non-Western immigrant polio group had a mean age of 46 years, were highly educated, reported high frequency of mental health problems and only one-third was working. Mean age for contracting polio was 2.8 years. Only 30% was hospitalized in the acute phase and 80% reported severe leg weakness. Use of a powered wheelchair was reported by 72%. Post-polio symptoms had started at a mean age of 31 years. The non-Western immigrant group reported more fatigue, pain and loneliness, and a high proportion reported insufficient assistance from the public health system. The group of non-Western immigrants with polio in Norway reported more health and social problems than the group of Western immigrants with polio or the native Norwegian group with polio, even though they were younger and more highly educated. Their complex psychological and social situation requires active intervention from the health system, and health professionals need extra skills to deal most effectively with their situation.

How Dutch Health-care Neglects Super-diversity

This article is about super-diverse ’healthcare. According to the Dutch ‘Centraal Bureau voor de Statistiek (CBS)’ 23.12% of the Dutch population comes from a country other than the Netherlands [1]. Large groups of immigrants in the Netherlands are now Indonesian, Surinamese, Turkish, Moroccan and Polish. The CBS is concerned about the (physical and mental) health of non-Western immigrants in comparison to the original Dutch [1]. In this article a proposal is made for the reorganization of psychological health care that does justice to our super-diverse society. The building blocks of this proposal come from legislation, international and national guidelines, transcultural psychiatry, and the results of scientific and practical research in healthcare. A prominent place has been given in this proposal for the concepts of 'ethnic matching' and 'all-inclusive multiculturalism' in the workplace. All-inclusive multiculturalism is about the necessity to introduce just and tolerant social super-diversity in the workplace.

Migration-related changes in smoking among non-Western immigrants in France.

BackgroundMigrants make up a growing share of European populations, and very little is known about the impact of migration on their smoking patterns. We develop a longitudinal analysis of smoking prevalence among native-born and immigrants in France based on retrospective data collected in the 2010 national Baromètre santé health survey.MethodsAnalyses concerned 19 578 individuals aged 18–70 years and born in metropolitan France, in the Maghreb or in sub-Saharan Africa. Person-years with and without smoking were reconstructed using migration and smoking histories and analyzed with discrete-time regression models.ResultsPrior to migration, immigrants from both the Maghreb and sub-Saharan Africa had lower smoking prevalence than the native-born of similar birth cohort, age and education. After migration, the prevalence increased over time among Maghrebin men up to levels beyond those of the native-born (odds ratio: 1.54 [1.09–2.17] for 10 years of residence or more), while it remained much lower throughout among men from sub-Saharan Africa (odds ratio: 0.36 [0.19–0.68] for 10 years of residence or more). Starting at extremely low levels, the prevalence in both groups of women rose considerably after migration. Women from sub-Saharan Africa nearly caught up to the native-born (odds ratio: 0.70 [0.37–1.32] for 10 years of residence or more), but this was not the case for those from the Maghreb (odds ratio: 0.52 [0.33–0.81] for 10 years of residence or more).ConclusionThe findings uncover the low pre-migration prevalence and the diversity of post-migration trajectories. Tobacco control programs targeting recently arrived migrants would contribute to prevent unhealthy assimilation.

Which firms provide jobs for unemployed non-Western immigrants?

ABSTRACTAlthough the refugee immigration crisis is one of the major socio-economic challenges in Europe, we still lack knowledge on what characterizes firms that provide jobs for unemployed immigrants. We provide an answer by investigating firms that recruit unemployed non-Western immigrants using matched employer-employee data from Statistics Sweden. We find large industry differences; firms active in the service sectors, such as the hospitality, transport, and healthcare industries, are much more likely to hire unemployed non-Western immigrants than firms in high-tech and manufacturing industries. In addition, after controlling for educational attainment and industry of occupation, firms with at least one non-Western immigrant manager hire more than four times as many unemployed non-Western immigrants than firms without any non-Western immigrant managers. Public policies that target industries might thus also influence job opportunities for immigrants and, thereby, the possibility of their integration into society.

The association between immigration status and ineligible stool samples for colorectal cancer screening

BackgroundBarriers such as language and literacy might complicate the participation procedure for immigrants in screening programs. We investigated the delivery of a suitable stool sample for participation in the Danish colorectal cancer screening by immigration background. MethodsNational administrative registers were used to link results of faecal blood screening with immigrant status, age, sex, education, income, and marital status. Univariate and multivariate logistic regression models were used to estimate the odds of submitting an ineligible sample. Results558,104 individuals submitted a sample during 2014 and 2015. A total of 2,164 (0.4%) samples were ineligible for faecal analysis. The lowest proportions of ineligible samples were found in the highest educational level (0.2%) and highest income level (0.2%). The highest proportion of ineligible samples was seen in non-Western immigrants (1.6%). After adjustment for age, gender, educational level, income and marital status non-Western immigrants had an increased odds ratio (OR 3.64 CI95% 2.86;4.64) of submitting an ineligible sample, compared to native Danes. Western immigrants did not have an increased odds ratio. ConclusionNon-Western immigrants have more than three times the risk of submitting an ineligible faeces sample for colorectal cancer screening than native Danes. Translation of invitation, information leaflet, and manual into other languages or targeted information for subgroups may help decrease the risk.

Poor Returns to Origin-Country Education for Non-Western Immigrants in Italy: An Analysis of Occupational Status on Arrival and Mobility

Previous research on the Italian case has shown that non-Western immigrants are very likely to hold low-qualified jobs and that their occupational mobility chances are rather poor, which suggests low returns to education. In this paper, we investigate whether, and to what extent, immigrants’ different areas of origin moderate the returns to educational degrees obtained in the origin country. Data from a survey on the immigrant population (carried out in 2011‒2012) are used, and, differently from previous studies, we focus on returns to origin-country education with respect to both the socioeconomic status of the first job found on arrival and the subsequent occupational mobility. The results show that almost all non-Western immigrants experience remarkably low returns to post-secondary education on their first job. Contrary to other West-European countries, those returns in Italy are only slightly different by area of origin, which suggests that differences in the transferability and quality of skills are scarcely relevant in a strongly segmented labour market. Rather, the modes of labour market insertion―e.g., formal search methods or relying on contacts with natives―have a sizeable impact on the returns. Origin-country post-secondary degrees are also consistently associated with low returns on subsequent mobility, although highly educated immigrants from new EU member states experience higher chances of upward mobility. In line with some recent findings, recognition of educational credentials seems decisive for the very few non-Western immigrants who are able either to access better-qualified jobs on arrival or to improve their occupational status over time.

Perfect for the Job? Overqualification of Immigrants and their Descendants in the Norwegian Labor Market

Compared to the majority population, studies have shown that non-western immigrants are more likely to work in jobs for which they are overqualified. These findings are based on coarse measures of jobs, and an important question is how sensitive these findings are to the definition of jobs. By using detailed information from Norwegian register data 2014, we provide a methodological innovation in comparing individuals working in the same occupation, industry, sector, firm, and municipality. In this way, we measure the degree of overqualification among workers within more than 653,000 jobs. We differentiate between immigrants and their descendants originating from Western Europe, the New EU countries, other Western countries, the Middle East and North Africa (MENA), Africa and Asia (except MENA countries), and South and Central America, and compare their outcomes with the majority population holding the same jobs. We find that immigrants from all country of origin groups are more likely to be overqualified compared to the majority population and to descendants of immigrants. However, the prevalence of overqualification decreases with time since immigration.

Monitoring the health effects of disasters and environmental hazards: The primary care database as a tool to inform public decision-making

Introduction Public leaders are responsible for minimizing the potential negative effects of disasters and environmental hazards on the health and well-being of exposed citizens. In order to decide upon appropriate measures, decision makers depend heavily on the availability of reliable information on the human health consequences of exposure to specific events, substances or agents. Disaster researchers and epidemiologists can play a crucial role in monitoring activities. The objective of this contribution is to describe how the research possibilities of a particular data infrastructure, the Nivel Primary Care Database (PCD), were used in the context of three disasters and four environmental hazards cases in the Netherlands. Methods The PCD continuously collects and processes electronic health record data (e.g. healthcare utilization, symptoms, diagnoses and prescriptions; coded according to the International Classification of Primary Care) of (i) more than 500 general practices with 1.6 million registered patients (10% of the Dutch population); and (ii) electronic health records of primary care out-of-hours services with a total catchment area of 11.5 million. The PCD can overcome shortcomings from other data sources like body materials, interviews and questionnaires, and allows longitudinal and cross-classified multilevel analyses with patients nested in GPs and postal codes. The three disaster cases involve exposure to the fireworks disaster in Enschede (2000; 23 people killed, 950 wounded: data range 1999–2005); the Volendam New Year's fire (2001; 14 children killed, 350 wounded: data range 2000–2006); and a shooting incident in a shopping mall in Alphen aan den Rijn (2011; 7 people killed, 17 wounded; data range 2010–2011). Environmental hazards cases include: living nearby livestock (especially goat farms) (data range 2007–2017), living in a fruit production area where pesticides are used (data range 2013–2016), living in the vicinity of an industrial area with chemical companies (data range 2006–2008 and 2013–2015). Results The disasters and major crises were accompanied by a significant increase in health care utilization and psychological problems among affected groups and illustrate a pattern of normalization over time. Particular risk groups could be followed through time e.g. non-western immigrants, people with existing psychological problems, and children with or without burns. Industrial and agricultural activity was associated repeatedly with health problems related to airways and lungs (the association between goat farms and pneumonia received special attention). In the pesticides case, PCD data could be combined with a complementary survey providing information on self-perceived symptoms and perceptions, which confirmed that participants mostly did not attribute their health problems to pesticides in fruit production. Almost all of the studies provided information on the prevalence of medically unexplained symptoms and chronic health problems. In one industrial case, municipalities close to the industrial zone could be compared with other communities in the same region as well as a comparison group of patients in a living environment with a similar level of urbanization and industrial activity. Conclusions A major challenge for disaster health researchers and epidemiologists is to understand the association between population health on the one hand, and exposure levels and other factors on the other. The plausibility of this association is of crucial interest to decision makers. Several of the cases illustrate the potential of registry-based monitoring for decision-making. Since the fireworks disaster, the PCD's national coverage and the availability of other geographical datasets have increased substantially. Further optimization is an ongoing process that will increase the potential for future monitoring of the health effects of disasters and environmental hazards.

Cerebral palsy among children of immigrants in Denmark and the role of socioeconomic status

Introduction The proportion of births by immigrants has been increasing rapidly in Denmark during the last decades. Children of immigrants have higher risk of being born preterm and with low birth weight, which are strong determinants for cerebral palsy (CP), compared with children born to Danish women. Objective To investigate differences in risk of CP between children of Danish-born mothers and children of immigrants and to explore to what degree socioeconomic status mediates the potential association between maternal immigrant status and CP. Method We conducted a register-based study including 1,274,653 children born in Denmark between 1981 and 2007 of whom 2807 had CP (2.2 per 1000). Mothers’ country of origin derived from nationwide registers was used to determine the mothers’ immigrant status. Children with CP were identified by linkage with the Danish National Cerebral Palsy Registry that includes all pre- and perinatal acquired CP cases that have been validated by neuro-pediatricians at age one to six years. Odds ratios (OR) of CP according to maternal immigrant status were estimated by using multiple logistic regression. We studied whether a potential association was explained by maternal educational level or household income by performing mediation analysis applying a counterfactual approach. Results In this study, 141,540 (11.1%) were immigrants; 3.5% from Western and 7.6% Non-Western countries. Children of immigrants from Western and Non-Western countries had lower risk of unilateral spastic CP than children of Danish mothers; OR = 0.6 (95% VI: 0.4–0.9) and OR = 0.8 (95% CI: 0.6–1.0), respectively. Children of Non-Western immigrants had higher risk of bilateral spastic CP compared with children of Danish mothers; OR = 1.3 (95% CI: 1.1–1.5), and it was the Turkish (OR = 1.7 (95%CI: 1.2–2.4) and Pakistani (OR = 1.7 (95% CI: 1.0–2.9) immigrants that accounted for the increased risk. Results from mediation analysis indicated that the association between maternal immigrant status and bilateral spastic CP was not mediated by socioeconomic status. Due to insufficient statistical power, the mediation analysis was not applicable for unilateral spastic CP. Conclusion Our results show that the risk of CP in children born in Denmark between 1981 and 2007 differed according to maternal country of origin. The higher risk of bilateral spastic CP in children of Non-Western immigrants, in particular Turkish and Pakistani, does not seem to be explained by inequality in education or household income. Future research should investigate whether the increased risk is caused by consanguineous parenthood, lifestyle factors, or suboptimal prenatal and obstetric care for immigrants.

Ethnic inequalities in child and adolescent health in the Scandinavian welfare states: The role of parental socioeconomic status - a systematic review.

Aims: Adult non-Western immigrants in Scandinavia tend to be worse off in terms of health than native-born populations, which cannot be fully ascribed to their often lower socioeconomic status (SES). This review examines if differences in health status are also present between non-Western immigrant and majority children in Denmark, Norway and Sweden, and if SES explains the differences. Methods: Following PRISMA guidelines, relevant Scandinavian peer-reviewed quantitative publications since 1990 were identified through a systematic search of PubMed, EMBASE, Scopus, Web of Science and SveMed. Of 1197 identified publications, 27 remained relevant after applying inclusion criteria: 3 Danish, 6 Norwegian and 18 Swedish studies. Results: Non-western immigrant children had overall poorer outcomes compared with ethnic majority children in Denmark, Norway and Sweden in health issues covered by the included studies: diabetes, obesity, oral and mental health, and well-being. However, in diabetes, obesity and mental health, non-Western immigrant children from certain countries and regions, and descendants of non-Western immigrants had similar/more favourable outcomes than majority children. In mental health and well-being, ethnic inequalities were strongly associated with SES, while for diabetes, obesity and oral health, differences remained significant after adjusting for SES. Conclusions: Overall poorer health outcomes in non-Western immigrant compared with majority children in Scandinavia cannot be fully explained by SES. Evidence points to additional mechanisms at individual, household, societal or policy levels, including reasons for migration, culture and societal discrimination. Finally, methodological issues may influence study outcomes, e.g. heterogeneity of populations studied and socioeconomic variables included.

Vitamin D deficiency in immigrants

Vitamin D deficiency and rickets are more common in non-western immigrants and refugees than in the native population. Severe vitamin D deficiency (serum 25-hydroxyvitamin D <25 nmol/l) may occur in up to 50% of children and adults of non-western origin. They are not used to sunshine exposure due to the often excessive sunshine in the country of origin. They usually have a more pigmented skin. Non-western immigrants and refugees often wear skin-covering clothes due to religious or cultural tradition. The food contains little vitamin D with the exception of fatty fish. In addition, many immigrants have a low calcium intake. Complaints may include fatigue, pain in shoulders, ribs, lower back and thighs. Neonates and young children may have spasms and convulsions due to hypocalcemia. Older children and adolescents may have bone pain, muscle weakness and skeletal deformities. Widening of the wrist, chest deformities and bowing of the legs may occur, and longitudinal growth is delayed. In adults, muscle weakness and bone pain are predominant. Laboratory examination may show hypocalcemia and hypophosphatemia and elevated alkaline phosphatase. The serum 25(OH)D is below 25 nmol/l in case of severe vitamin D deficiency with symptoms. Impaired 25-hydroxylation or 1α-hydroxylation may occur in case of severe liver or renal disease or by genetic causes. Radiographs of wrists or knees may show widening of the growth plates and cupping of radius and ulna may confirm the diagnosis. In adolescents and adults, radiographs of painful bones may show pseudofractures or Looser zones. Rickets and osteomalacia are treated by vitamin D3 2000 IU/d in infants, 3000–6000 IU/d in older children in combination with calcium 500 mg /d. In osteomalacia, the adult vitamin D3 dose is 2000–3000 IU/d, combined with calcium 1000–2000 mg/d. Prevention of vitamin D deficiency can be done with vitamin D3 400–800 IU/d, depending on age. Nutritional measures include fortification of milk or other foods.

Immigration and Integration Policy and Labour Market Attainment Among Immigrants to Scandinavia

Insufficient integration of immigrants into the labour market has been identified as a major problem in the Scandinavian countries Denmark, Norway and Sweden. Integration depends, inter alia, on immigration and integration policy, and for most of the post-war period the policies of the three countries displayed strong similarities. However, in the early 2000s Denmark increasingly deviated from its two neighbours, introducing more restrictive immigration and stricter integration policies. Comparing both pre- and post-reform immigrants across Scandinavia, we assess the wider impact of this comprehensive policy reversal by tracking the evolution of employment and earnings gaps between 1993 and 2006. We use large data sets with individual-level register information allowing us to account for immigrant labour force composition and to examine sub-groups of immigrants. The results do not indicate that the Danish reforms had any clear-cut effect on either employment or earnings among non-Western immigrants. Moreover, integration in Norway and Sweden was not unequivocally worse despite the absence of similar reforms, raising questions regarding the aptness of the Danish reversal.

Acculturation and Expectations?: &lt;i&gt;Investigating Differences in Generalised Trust between Non-Western Immigrants and Ethnic Danes&lt;/i&gt;

This article investigates different sources of generalised trust among ethnic Danes and non-Western immigrants together with the gap in trust levels across the two groups. New survey data from Denmark were utilised, and the variables included socioeconomic resources, interethnic contact, perceptions of institutional fairness, timespan in Denmark, national identification and language proficiency. The results showed that interethnic contact and institutional fairness matter less for immigrants than for Danes vis-a-vis trust and that these variables alone do not explain the trust gap. The results also showed that their interactions with ethnicity reduce the trust gap for respondents with little interethnic contact or negative perceptions of institutions. Share of lifespan spent in Denmark also correlated negatively with social trust for immigrants. The results are discussed as the reflection of dynamic acculturation and changing expectations rather than socialisation or distinctly personal experiences.

Mammographic screening attendance among immigrant and minority women: a systematic review and meta-analysis.

Background Groups of immigrant and minority women are more often diagnosed with advanced stage breast cancer than other women. Mammographic screening aims to reduce mortality from breast cancer through early detection in asymptomatic women. Purpose To compare mammographic screening attendance among immigrant and minority women to that of other women. Material and Methods A literature search of PubMed, Embase, Google Scholar, and Cochrane identified 1369 papers published between January 1995 and March 2016. In the review, we included 33 studies investigating mammographic screening attendance among immigrant and/or minority women. In a meta-analysis, we included 19 of the studies that compared attendance among immigrant and/or minority women with that among other women, using a random effects model. Results The review included studies from Europe, North America, and Oceania, with 42,666,093 observations of opportunities for mammographic screening. Attendance was generally lower among immigrant and minority women compared to other women (46.2% vs. 55.0%; odds ratio = 0.64, 95% confidence interval = 0.56-0.73; P < 0.05, I2 = 99.9%). Non-Western immigrants had lower attendance rates than other immigrants. Conclusion Immigrant and minority women had lower mammographic screening attendance than other women, which could potentially put them at increased risk for more advanced breast cancer. This review emphasizes the importance of continued efforts to engage with the preventative health needs of diverse populations in attempts to achieve equality in access to, and use of, care.

Homeownership and residential stability: does tenure really make a difference?

ABSTRACTHomeownership has long been associated with a myriad of economic, social and civic benefits, prompting countries such as Norway to expand access to homeownership for socio-economically disadvantaged households. In this paper, we explore the impact of homeownership on residential stability using a longitudinal data-set of renters who applied for a state mortgage programme in Norway between 2004 and 2010. These data allow us to specifically address the issue of selection bias in our analysis. We find that even after controlling for a wide range of demographic, socio-economic and housing market characteristics, homeownership has a substantial, positive impact on residential stability. This effect is stronger for groups that are more marginalised in Norwegian housing and labour markets, including East European and non-Western immigrants. The Norwegian case suggests homeownership policy can help to promote social goals, but also highlights the importance of providing welfare supports in tandem with access to mortgage credit in order to reduce the risks of homeownership for lower-income households.

Psychometric testing of immigrants and natives in an acute psychiatry facility.

The diagnostic process after referral to an acute psychiatric treatment facility consists of more than the clinical investigation and laboratory tests. Psychometric tests in a broad range of languages may be such an augmentation of our diagnostic armamentarium. Whether such tests are in use, and how they are distributed among different patient categories was the aim of the study. All referrals in one calendar year (N=1168), as they are depicted in the hospital computerized medical records, were investigated. Fifty-six (6.1%) out of 926 ethnic Norwegians and six (3.0%) out of 198 non-Western immigrants were tested, whereas none of the 44 Western immigrants. The difference between ethnic Norwegians and the immigrants was significant (Z=-3.05 and P=0.002). Psychometric tests were thus almost not in use, and even lesser so in immigrants. Mean number of resident days was higher among those tested, 11.7 (SD=11.2) versus those not tested, 7.4 (SD=10.4) days, t=2.97 and P=0.004. Length of stay for ethnic Norwegians did not differ from that for non-Western immigrants 11.4 versus 11.7, respectively. The patients tested were older than those not tested. Mean age was 43.0 (SD=14.4) versus 38.8 (SD=12.1), with a t=2.65 and P=0.03. The difference in resident days between all immigrants and ethnic Norwegians was significant with a Z=- 2.232 and P=0.026. Level of testing was higher in ethnic Norwegians, and the tested patients stayed longer, maybe indicating more room for testing. Whether this low test-activity influences treatment quality is an unsettled question.