Anita J. Gagnon

Evidence-based clinical guidelines for immigrants and refugees

(see Appendix 2, available at [www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.090313/-/DC1][1] for summary of recommendations and clinical considerations) There are more than 200 million international migrants worldwide,[1][2] and this movement of people has implications for individual and

ADVANCING GERIATRIC NURSING PRACTICE: Randomized Controlled Trial of Nurse Case Management of Frail Older People

OBJECTIVES: To compare the effects of nurse case management with usual care provided to community‐dwelling frail older people in regard to quality of life, satisfaction with care, functional status, admission to hospital, length of hospital stay, and readmission to emergency department.

Somali women and their pregnancy outcomes postmigration: data from six receiving countries

Objective  This study aimed to investigate pregnancy outcomes in Somali‐born women compared with those women born in each of the six receiving countries: Australia, Belgium, Canada, Finland, Norway and Sweden.

Postpartum Depression Symptoms in Newcomers

Objectives: To determine if postpartum depression (PPD) symptoms are more common in newcomer women than in Canadian-born women. Methods: Refugee, nonrefugee immigrant, asylum-seeking, and Canadian-born new mothers were administered questionnaires for depression, social support, interpersonal violence, and demographic information. We created a PPD variable based on a score of ⩾10 on the Edinburgh Postnatal Depression Scale (EPDS) and performed a logistic regression analysis for PPD. Results: Immigrants (35.1%), asylum seekers (31.1%), and refugees (25.7%) were significantly more likely than Canadian-born (8.1%) women to score ⩾10 (P = 0.008) on the EPDS, with the regression model showing an increased risk (odds ratio) for refugee (4.80), immigrant (4.58), and asylum-seeking (3.06) women. Women with less prenatal care were also more likely to have an EPDS of ⩾10 (P = 0.03). Newcomer women with EPDS scores of ⩾10 had lower social support scores than Canadian-born women (P < 0.0001). Conclusions: Newcomer mothers have an increased risk for PPD symptoms. Social support interventions should be tested for their ability to prevent or alleviate this risk.

Predictors of Women’s Perceptions of the Childbirth Experience

OBJECTIVE To determine the factors that predict womens perceptions of the childbirth experience and to examine whether these vary with the type of birth a woman experiences. DESIGN Prospective cohort study. SETTING The postpartum units of two eastern Canadian hospitals. PARTICIPANTS Six hundred fifty two women and their newborns. DATA COLLECTION Data were collected in hospital at 12 to 48 hours postpartum using self-report questionnaires and chart review. MAIN OUTCOME MEASURE Perception of the childbirth experience was measured for women having a vaginal and emergency cesarean birth using the Questionnaire Measuring Attitudes About Labor and Delivery and planned cesarean birth using the Modified Questionnaire Measuring Attitudes About Labor and Delivery. RESULTS Of the 20 predictors of womens childbirth perceptions, the strongest were type of birth; degree of awareness, relaxation, and control; helpfulness of partner support; and being together with the infant following birth. CONCLUSIONS Of the predictors of a quality birth experience, most were amenable to nursing interventions: enhancement of patient awareness, relaxation, and control; promotion of partner support; and provision of immediate opportunities for women to be with their babies.

International migration and adverse birth outcomes: role of ethnicity, region of origin and destination

Background The literature on international migration and birth outcomes shows mixed results. This study examined whether low birth weight (LBW) and preterm birth differed between non-migrants and migrant subgroups, defined by race/ethnicity and world region of origin and destination. Methods A systematic review and meta-regression analyses were conducted using three-level logistic models to account for the heterogeneity between studies and between subgroups within studies. Results Twenty-four studies, involving more than 30 million singleton births, met the inclusion criteria. Compared with US-born black women, black migrant women were at lower odds of delivering LBW and preterm birth babies. Hispanic migrants also exhibited lower odds for these outcomes, but Asian and white migrants did not. Sub-Saharan African and Latin-American and Caribbean women were at higher odds of delivering LBW babies in Europe but not in the USA and south-central Asians were at higher odds in both continents, compared with the native-born populations. Conclusions The association between migration and adverse birth outcomes varies by migrant subgroup and it is sensitive to the definition of the migrant and reference groups.

Stillbirths and infant deaths among migrants in industrialized countries

Introduction. The relation of migration to infant outcomes is unclear. There are studies which show that some migrant groups have similar or even better outcomes than those from the receiving country. Equally, raised risk of adverse outcomes for other migrant groups has been reported. Objective. We sought to determine (1) if migrants in western industrialized countries have consistently higher risks of stillbirth, neonatal mortality, or infant mortality, (2) if there are migrant sub‐groups at potentially higher risk, and (3) what might be the explanations for any risk differences found. Design and Setting. Systematic review of the literature on perinatal health outcomes among migrants in western industrialized countries. Methods and Main outcome measures. Drawing on a larger systematic review of perinatal outcomes and migration, we reviewed studies including mortality outcomes (stillbirths and infant deaths). Results. Eligible studies gave conflicting results. Half (53%) reported worse mortality outcomes, one third (35%) reported no differences and a few (13%) reported better outcomes for births to migrants compared to the receiving country population. Refugees were the most vulnerable group. For non‐refugees, non‐European migrants in Europe and foreign‐born blacks in the United States had the highest excess mortality. In general, adjustment of background factors did not explain the increased mortality rate among migrants. Regarding causes of death, higher preterm birth rates explained the increased mortality figures among some migrant groups. The increased mortality from congenital anomalies may be related to restricted access to screening, but also to differing attitudes to screening and termination of pregnancy. Conclusions. Mortality risk among babies born to migrants is not consistently higher, but appears to be greatest among refugees, non‐European migrants to Europe, and foreign‐born blacks in the US. To understand this variation better, more information is needed about migrant background, such as length of time in receiving country and receiving country language fluency. Additional data on demographic, health care, biological, medical, and socioeconomic risk factors should be gathered and analyzed in greater detail.

One-week survey of pain intensity on admission to and discharge from the emergency department: a pilot study.

The purpose of this pilot study was to determine the incidence and severity of pain intensity in patients 4 years of age and older presenting to the noncritical ward of the emergency department (ED). All patients presenting to the ED of two university hospitals (one general, one pediatric) who were triaged to the noncritical ward during 12 h/day for 1 week were asked to report their pain intensity on admission and again asked just prior to discharge home. The chromatic analogue scale with a range of 0-10 was used as the measure of pain intensity. Pain reports were obtained from half of all patients (58% of adults, 47% of children) admitted during the study week. Approximately one-third (29% of adults and 31% of children) reported no pain on admission, but half of both age groups (52% of adults, 48% of children) reported pain 4/10 or higher. On discharge, one-third of both groups reported pain 4/10 or higher. Eleven percent of both adults and children reported pain 1.5/10 or higher on discharge than on admission. Adult patients with musculoskeletal complaints had the highest pain intensities (mean score admission-discharge, 5.6-4.7/10; other categories, <5). For children, neurological complaints, exclusively headaches, were highest (mean score admission-discharge, 4.8-5.2/10; other categories, <5). Children accompanied by their mothers alone had poorer pain improvement (no change) than children accompanied by their fathers alone or both parents (score improvement of 1). It thus appears that pain is a problem for the majority of patients presenting to the ED. An important percentage of patients leave the ED with more pain than when they arrived. Further investigation is warranted to determine factors predicting poor pain resolution during an ED visit.

In-Hospital Formula Supplementation of Healthy Breastfeeding Newborns:

The UNICEF/WHO Baby-Friendly Hospital Initiative suggests that breastfeeding activities in hospital are important to later breastfeeding. Understanding reasons for in-hospital supplementation may help to optimize the successful implementation of this initiative. The objective was to identify predictors of in-hospital initial formula supplementation of healthy, breastfeeding newborns. The authors analyzed 564 Canadian mother-infant pairs and interviewed nurses. Half of the study infants (47.9%) received formula in hospital; the median age at first supplementation was 8.4 hours. Risk for supplementation was affected by birth occurring between 7 PM and 9 AM (hazard ratio [HR] varied with time) and high maternal trait anxiety (HR = 1.61, 95% confidence interval [CI] = 1.01, 2.59). The following variables were protective against supplementation: planning to exclusively breastfeed (HR = 0.46, 95% CI = 0.33, 0.64), planning to breastfeed for ≥ 3 months (HR = 0.56, 95% CI = 0.37-0.86), childbirth education (HR = 0.61, 95% CI = 0.43, 0.86), mother born in Canada (HR = 0.68, 95% CI = 0.53, 0.87), completion of community college (HR = 0.76, 95% CI = 0.59, 0.98), male infant (HR = 0.78, 95% CI = 0.61, 0.99), and breastfeeding at delivery (HR varied with time). Nurses reported breastfeeding problems, infant behavior, and maternal fatigue as reasons for supplementing. Reassessing patterns of night feeds and encouraging breastfeeding at delivery may decrease supplementation. Trait anxiety reduction and the role of infant gender in supplementation merit further study.

Glossary: migration and health

The literature on migration and health is quite heterogeneous in how migrants are labelled and how the relation between migration and health is conceptualised. A narrative review has been carried out. This glossary presents the most commonly used terms in the field of migration and health, along with synonyms and related concepts, and discusses the suitability of their use in epidemiological studies. The terminology used in migrant health is ambiguous in many cases. Studies on migrant health should avoid layman terms and strive to use internationally defined concepts.