Ethnicity as a risk indicator for musculoskeletal disease, long consultation times and care utilization A prospective visitor study of 438 consecutive adult consultations of a primary health care centre

This article shows the influence of ethnicity (people born outside Sweden and in Sweden) and social class (socioeconomic class) on the distribution of diagnoses, consultation time and health care utilization in primary health care controlled for sex, age, marital status and educational level. The study was designed as a prospective primary health care utilization study during 7 consecutive weeks. Of a total of 439 adults who lived in the residential area, 290 were born in Sweden and 149 were born elsewhere. The data were analysed unmatched with logistic regression and Poisson regression in main effect models. People born outside Sweden received significantly more diagnoses per consultation than people born in Sweden. The strongest independent risk indicator for musculoskeletal disease was being born outside Sweden, with an estimated odds ratio (OR) of 5.01, 95% confidence interval (CI) = 2.70–8.72. Age over 44 was associated with increased odds for musculoskeletal disease. Respiratory disease, as an indicator of less serious disease, were significantly less common among people born outside Sweden (OR = 0.53, 95% CI = 0.33–0.87). Being born outside Sweden was a risk indicator for consultations longer than 30 minutes (OR = 3.03, 95% CI=1.18–7.43). There were no differences between people born in Sweden and those born elsewhere in health and utilization. Social class was not associated with any of the dependent variables.     

The influence of social and ethnic segmentation on consultation in primary health care

This paper analyses the utilization of primary health care by a population of whom 28% were not born in Sweden. The study emphasizes the impact of demography, housing and economic factors on the structure of the residential area. Households with meagre financial resources, large families and most of the immigrant population were tenants in multiple-occupancy blocks. Further, when demographic development was analysed over a decade, high turnover and a low median age were found in 2 of the multiple-occupancy areas, indicating social instability. The study revealed a process of both socioeconomic and ethnic segmentation (non-spatial segregation in a residential area). The age- and sex-standardized relative risks (RR) showed that the population in subareas consisting of multiple-occupancy housing in socially unstable areas also had an increased risk of having to visit primary health care. There were no differences in the number of visits to primary health care between people born in Sweden and those born outside Sweden (relative risk (RR) = 1.09,95% confidence interval (CI) = 0.90–1.30), but those born outside Sweden more often made visits that lasted longer than 30 minutes (odds ratio (OR) = 3.75, 95% CI = 2.09–6.71).     

Out-of-home care among immigrant children in Sweden: a national cohort study

We used data from several national registers for ten entire birth cohorts ( n  > 1 million) to examine the representation of first generation immigrant children among first time entries into out-of-home care (foster or residential care) at ages 7–12 and 13–17. Logistic regression models were used to adjust results for socioeconomic background factors. Immigrant children were categorised in six groups relating to birth country/continent. Compared with Swedish-born peers, immigrant children from non-European countries had between two- and three-fold sex and birth-year adjusted odds for being placed in care for the first time at ages 7–12. After adjustments for five socioeconomic background variables, none of these overrisks remained. Instead there was a tendency towards immigrant background being associated with reduced risks, statistically significant for immigrant children born in non-Nordic European countries. Immigrant children had between two- and six-fold age and birth-year adjusted odds for entering care for the first time during adolescence. After adjusting the results for socioeconomic background, only immigrant children born in Sub-Saharan Africa or in Asia outside the Middle East had significant overrisks for care entries at ages 13–17 (odds ratio = 1.5).     

The Impact of Health-Related Emotions on Belief Formation and Behavior

We present a theoretical model of health beliefs and behaviors that explicitly takes into account the emotional impact of possible bad news (i.e., illness), ex-ante in the form of anxiety and ex-post in the form of disappointment. Our model makes it possible to explain (simultaneously) a number of anomalies such as ’low’ testing rates, heterogeneous perceptions of risk levels, underestimation of health risk, ostriches and hypochondriacs, over-use and under-use of health services, patient preference for information when relatively certain of not being ill, yet avoiding information when relatively certain of being ill, etc. Our model matches observed patterns both in health beliefs and health behaviors and irrational health beliefs and behaviors can be characterized as the optimal response under a given structure of emotions and preferences.     

Trust, risk and control within an indigenous–non-indigenous social service partnership

Partnerships between organisations are seen as one of the building blocks of the 'third way' approach to welfare provision in both Europe and New Zealand. While there is much discussion on building social capital and partnership working, such partnerships are usually perceived as being between government and community or private organisations. There is a gap in the literature in two specific areas: partnerships formed between two community-based social service organisations and partnerships formed between indigenous, or immigrant peoples, and non-indigenous organisations. This article explores such a partnership – that between the Ngai Tahu Maori Law Centre (an indigenous organisation) and the Dunedin Community Law Centre (a non-indigenous organisation). The article analyses this relationship and strategies employed by both organisations to develop trust, diminish risk and equalise control. Lastly, the article suggests that the model of interaction articulated here could be promulgated to other sites within the social services in New Zealand and the Americas, and within the European context.     

拉丁美洲国家应对气候变化法律与政策分析

为有效应对气候变化,拉丁美洲国家在参与气候变化国际谈判的同时,还制定了相应的应对气候变化的法律、政策和行动计划,形成了两种推进方式：以气候变化法律为主、政策为辅的法律主导方式,以气候变化政策为主、少有甚至没有相关立法的政策主导方式。整体上看,拉丁美洲国家在应对气候变化上取得了较大进展,尤其是在气候变化综合性立法上取得了突破,在发展中国家中处于领先地位;气候变化国家政策正顺应时代潮流加速发展。在气候变化立法上,拉丁关洲国家在发展中国家中处于领先地位,在气候变化政策上,拉丁美洲国家正加快发展速度。由于受到多方面因素的制约,拉丁美洲国家在制定与实施应对气候变化法律与政策时仍面临一定阻力,个别国家在应对气候变化上徘徊不前,须尽快弥补政策空白。     

Attachment and adaptive skills in children of international adoption

The attachment pattern of a sample of 168 internationally adopted children was explored in this study using the semi‐structured Friends and Family Interview. The pattern was analysed in relation to the development of adaptive skills as an expression of the children's resilience. The secure attachment pattern rates were slightly lower and the insecure attachment patterns were considerably higher than those of normative samples from the previous studies. The children from Eastern Europe demonstrated a more insecure attachment pattern (odds ratio [OR]= 2.46; confidence interval [CI]= 1.23–3.94), and their scores on the adaptive skills scales were lower than the scores of children from other countries (OR = 2.62; 95% CI = 1.02–6.72). These results help to identify the groups at risk of failing to develop secure attachment patterns and appropriate adaptive skills, and should provide valuable information for designing effective interventions.     

Differential Impacts of Stressful Life Events and Social Support on the Mental Health of Mainland Chinese Immigrant and Local Youth in Hong Kong: A Resilience Perspective

Based on a resilience perspective, this study attempted to explorethe risk and protective factors influencing the mental healthof immigrant and local youths in Hong Kong. A structured questionnairewhich consisted of The Chinese Adolescents Life Events Checklist,The Perceived Satisfaction of Social Support Scale and The BriefSymptoms Inventory was used. Two hundred and ten local and immigrantyouths between the age of 15 and 20 were individually interviewedby the trained interviewers. Contrary to our hypotheses, thefindings revealed that immigrant youth had better mental healthand similar levels of stress than local youth. Moreover, peersupport was found to exert a strong impact on the mental healthof immigrant youth. While ‘Interpersonal relationshipdifficulties’ was identified as a common risk factor facedby local and immigrant youths, immigrant youth faced additionalrisk factors in relation to a change to a new school and parentalconflicts. On the other hand, endurance of hardship, socialcompetence and peer support were considered as the protectivefactors that might be associated with better mental health inimmigrant youth. The implications of this study included: toadopt a resilience perspective to understand the protectivemechanisms that enhance the mental health of immigrant youth;to develop a national strategy to build up the interpersonalrelationship skills of youth in a society; and to organize specificprogrammes to strengthen the peer system and tackle parentalconflicts in immigrant youths.     

HEALTH NEEDS OF MIGRANT VIETNAMESE WOMEN IN SOUTH‐WEST BRISBANE: AN EXPLORATORY STUDY

This study was conducted in the southwest area of Brisbane, Australia, and is designed to explore and assess the health needs of Vietnamese migrant women. The needs of this group are becoming increasingly urgent due to ageing of the original immigrant refugee community and decreased capacity for support from their children and families. The study used a qualitative research strategy involving focus groups and in‐depth interviews with Vietnamese women between 18–65 years and interviews with Vietnamese health care providers. It shows that the women have had to deal with culture shock, low self‐esteem, lack of friends and relatives, unrecognized professional skills and most importantly in health terms, low socioeconomic status. Significant barriers to access health services and to improved health and well‐being were also identified, such as language difficulties, transportation, time, and knowledge about health education. Recognition of specific requirements of sub‐populations as well as broader socio‐economic and cultural determinants of health should be a guide to more effective planning and implementation of health promotion strategies. The changing needs, over time, of these sub‐populations should also be recognized.     

The impact of poverty and immigrant background on children's school satisfaction: evidence from Norway

Children's school enjoyment and satisfaction with their teachers is crucial to their quality of life. Still, we have little knowledge about what shapes positive outcomes in this respect, and to what extent groups of children and youth differ from each other. This article compares immigrant children with Norwegian children from low-income families and with a reference group of children from normal-income families. The children were interviewed at age 10–12 years, and again at age 13–15 years; thus, we can follow changes over time. Immigrant children from income-poor families express significantly higher school and teacher satisfaction than any other category of 10–12-year-olds. However, for the 13–15-year-olds, there are no systematic differences between group averages, but there are more signs of polarisation among low-income immigrant children. Explanations for these patterns are sought in the literature on social capital in immigrant families.     

Major Depressive Disorder and Cardiovascular Disease in African-American Women

Major depression is a risk factor for cardiovascular disease (CVD). This study used the National Survey of American Life (NSAL) to examine the co-occurrence of major depressive disorder (MDD) and CVD in a nationally representative sample of African American women (n = 2,216). Results from a series of logistic regression models indicated high rates of MDD and CVD in the sample, and the African American women with MDD were 1.59 times more likely to have CVD compared to those without MDD. High rates of MDD/CVD co-morbidity appeared across those living in and not living in poverty. These individuals demonstrated greater functional impairment and were high users of mental health services. Our findings validate that MDD and CVD co-occur and the need for more holistic interventions are warranted. The interface of co-morbid health conditions is critical to developing integrated models of care. Integrated health care systems are central for improving physical and mental health outcomes. These findings facilitate developing targeted assessment procedures and culturally appropriate treatment interventions. Increased knowledge regarding the role of gender, chronic health conditions, and the burden of mental illness in African American Women provides the opportunity to examine other chronic health conditions co-occurring with MDD.     

Caregiver depression and child behaviour problems: A longitudinal mixed effects approach

Caregiver mental health has a powerful influence on child well‐being. Both maternal depression and paternal depression predict behaviour problems in young children. However, little is known about the nature of this link over time. The present study leveraged a large sample of at‐risk families to examine the impact of maternal and paternal depression on trajectories of child behaviour from age 3 to 15. Data came from the At‐Home substudy of the Fragile Families and Child Well‐Being Study, which observed a cohort of children born 1998–2000 in 20 large American cities (N = 1,090). Multiple imputation by chained equations addressed missing data to maximize available information without biasing models. Linear mixed effects models tested the association between caregiver depression and child behaviour over 12 years; interaction models tested whether this association changed as children transitioned into adolescence. Results showed caregiver depression is related with increases in both child internalizing and externalizing problems, and these relationships strengthened over time. Findings inform risk trajectories of distinct behavioural problems, shedding light on the development of child psychopathology and highlighting opportunities for intervention.     

Gender Differences in Determinants of Self-Rated Health Among African American in Omaha Nebraska: A Church-Based Study

Abstract

This study assessed the gender differences in determinants of fair/poor self-rated health among African American churchgoers in Omaha, Nebraska. Using data collected from 353 African American (245 women and 108 men) by the Center for Reducing Health Disparities at the University of Nebraska Medical Center in 2017, univariate and multivariate logistic regressions were performed to examine the gender differences in the relationships between fair/poor self-rated health and potential health determinants. Overall, 14.3% of women and 17.6% of men reported fair/poor self-rated health. There was a significant association between depression and poor/fair self-rated health among women (p?=?0.044) and men (p?=?0.001). For women, the fully controlled model confirmed the crude association between perceived poor/fair self-rated health and heart disease (OR = 3.10) and education (OR = 2.19). For men, the final model identified significant determinants of perceived fair/poor self-rated health such as depression (OR = 12.51) and diabetes (OR = 3.89). When assessing gender differences in determinants of self-rated health, similarities are higher than differences between the two groups. In both groups, the presence of depression was the strongest determinant of poor health. Future research should assess the immunological aspects of the association between psychological factors and perceived chronic diseases.     

Health and Well–Being in the Young Old and Oldest Old

Most individuals experience a decline in health status during old age. Paradoxically, there are proposals that older adults nevertheless maintain a positive sense of well–being, an indicator of successful aging. Data from the Berlin Aging Study (BASE: Baltes & Mayer, 1999), a locally representative sample of men and women aged 70 to 100+ ( N = 516, M = 85 years), suggest that cumulative health–related chronic life strains set a constraint on the potential of oldest old individuals to experience the positive side of life. The young old in BASE reported significantly higher positive SWB than did the oldest old. Chronic illness and functional impairments (e.g., vision, hearing, mobility, strength) limit well–being especially in very old age.     

Crowding Out or Welfare Promotion? How Foreign Aid Affects Social Expenditures in Latin American Welfare Systems

Foreign assistance constitutes a significant share of government revenue in many low‐ and middle‐income economies and is targeted at poverty reduction and the promotion of social and economic well‐being. This study therefore examines fiscal responses by Latin American welfare states to the inflow of such aid. As a form of external non‐tax revenue, aid can function as a substitution for public welfare expenditure, with a crowding out effect being the likely outcome. This article investigates whether overall aid and aid that is particularly targeted at the social sector substitutes public welfare provision and, if so, whether it also substitutes its function. A time‐series cross‐section analysis of 19 Latin American countries for the period 1980–2008 provides limited support for the assumption that foreign aid payments influence the welfare budget. It is only the health care sector in middle‐income countries which experiences a small decrease in expenditures. Social security and education expenditures are not affected.     

Depression Among Korean Immigrant Elders Living in Canada and the United States: A Comparative Study

Korean immigrant elders in North America experience a high level of depression. This study explored the correlates of depression among a sample of 245 Korean immigrant elders living in metropolitan cities in Canada (n = 128) and a southwestern state in the United States (n = 117), using a stress-coping framework. Results revealed discrepancies between the 2 subgroups. Years since immigration and number of health concerns were positively associated, and English proficiency was negatively associated with depressive symptoms among Korean immigrant elders in the United States; only health status was significant among Korean immigrant elders in Canada. Implications of the study are presented.     

Prosocial Tendencies among Chinese American Children in Immigrant Families: Links to Cultural and Socio‐demographic Factors and Psychological Adjustment

The present study examined relations between prosocial tendencies (dispositional sympathy and prosocial behavior) and psychological adjustment using a multi‐method and multi‐informant approach in a socioeconomically diverse sample of first‐ and second‐generation Chinese American children from immigrant families (N = 238, M age = 9.2 years). We tested the concurrent associations between: (a) children's dispositional sympathy (rated by parents, teachers, and children, and observed prosocial behavior), (b) psychological adjustment (parent‐ and teacher‐reported externalizing problems and social competence); and (c) cultural and socio‐demographic factors (children's Chinese and American orientations, family Socioeconomic Status (SES), only child status, and children's age, sex, and social desirability). Results from correlations and structural equation modeling suggested that different measures of prosocial tendencies related differently to children's psychological adjustment. Parent‐ and teacher‐rated sympathy were associated with higher child social competence and lower externalizing problems within, but not across, reporter. By contrast, child‐rated sympathy was associated with higher teacher‐rated social competence, and observed prize donation was associated with lower teacher‐rated externalizing problems. Different measures of prosocial tendencies also showed different relations to cultural and socio‐demographic factors. These findings suggest that prosocial tendencies are not a unitary construct in Chinese American immigrant children: the manifestations of prosocial tendencies and their adjustment implications might depend on the context and/or targets of these tendencies.     

Determinants of Household Insurance Coverage Among Low‐Income Families from Boston,Chicago, and San Antonio: Evidence from the Three‐City Study*

Objectives. In this article we examine correlates of health insurance coverage for low‐income households. Methods. Using data from the Welfare, Children, and Families Project (1999–2001), a sample of 2,402 low‐income families from Boston, Chicago, and San Antonio, we estimate two logistic regressions, one that predicts health insurance coverage for one focal child in each household and another that assesses the odds that all children in the household have coverage. Results. The children of poorly‐educated, immigrant, and Mexican‐origin parents are at an elevated risk of lacking insurance. These characteristics also increase the risk of incomplete household coverage. Mexican‐origin children and households are at particularly high risk of lacking complete coverage, a fact partially reflecting their residential concentration in states with high uninsurance rates, such as Texas. Conclusions. Serious holes in the health‐care safety net affect poor Americans differently based on their state of residence, race, ethnicity, and household structure.     

Storytelling as a tool: A family-based intervention for newly resettled Syrian refugee children

The conflict in Syria has resulted in a humanitarian emergency and one of the largest refugee crises in history. The Canadian government has welcomed over 40,000 Syrian refugees. Stressors caused by instability, conflict, and the resettlement process put refugee children at high risk for mental health problems. Anxiety is a common problem experienced by refugee children. Thus, early intervention is crucial to promote their adequate adaptation and development. This study explores the impact and value of a culturally specific family-based storybook intervention for newly resettled Syrian refugee children. Six refugee families participated. Anxiety symptoms were measured before and after the intervention, and families shared their experiences, thoughts, and feedback regarding the intervention. The results showed a significant decrease in children's anxiety symptoms. Furthermore, qualitative analyses demonstrated that the intervention was culturally relevant to Syrian refugee families and that it was effective in promoting children's overall well-being, agency, and family connectedness.