J Love

A metasynthesis of qualitative studies regarding opinions and perceptions about barriers and determinants of health services’ accessibility in economic migrants

BackgroundAccess to health services is an important health determinant. New research in health equity is required, especially amongst economic migrants from developing countries. Studies conducted on the use of health services by migrant populations highlight existing gaps in understanding which factors affect access to these services from a qualitative perspective. We aim to describe the views of the migrants regarding barriers and determinants of access to health services in the international literature (1997–2011).MethodsA systematic review was conducted for Qualitative research papers (English/Spanish) published in 13 electronic databases. A selection of articles that accomplished the inclusion criteria and a quality evaluation of the studies were carried out. The findings of the selected studies were synthesised by means of metasynthesis using different analysis categories according to Andersen’s conceptual framework of access and use of health services and by incorporating other emergent categories.ResultsWe located 3,025 titles, 36 studies achieved the inclusion criteria. After quality evaluation, 28 articles were definitively synthesised. 12 studies (46.2%) were carried out in the U.S and 11 studies (42.3%) dealt with primary care services. The participating population varied depending mainly on type of host country. Barriers were described, such as the lack of communication between health services providers and migrants, due to idiomatic difficulties and cultural differences. Other barriers were linked to the economic system, the health service characteristics and the legislation in each country. This situation has consequences for the lack of health control by migrants and their social vulnerability.ConclusionsEconomic migrants faced individual and structural barriers to the health services in host countries, especially those with undocumented situation and those experimented idiomatic difficulties. Strategies to improve the structures of health systems and social policies are needed.

Effectiveness of long-term (twelve months) nonsurgical weight loss interventions for obese women with polycystic ovary syndrome: a systematic review

Polycystic ovary syndrome (PCOS) affects 2%–26% of women of reproductive age and is often accompanied by obesity. Modest weight loss reduces health risks and ameliorates effects of the syndrome. Weight loss interventions are mainly of short duration and have limited success. A systematic review of the literature was carried out to assess the efficacy of long-term (12 months), nonsurgical weight loss interventions for women with PCOS. Fifteen databases were searched, resulting in eight papers that met the search criteria. Comparison of results and meta-analysis was difficult due to heterogeneity of studies. Behavioral components of interventions were poorly described, and compliance was difficult to ascertain. The results suggested that the inclusion of a lifestyle component improves outcomes, but protocols must be clearly described to maintain study validity and to identify successful behavioral strategies.

The experiences of women with polycystic ovary syndrome on a very low-calorie diet

Polycystic ovary syndrome (PCOS) is variously reported to affect between 5% and 26% of reproductive age women in the UK and accounts for up to 75% of women attending fertility clinics due to anovulation. The first-line treatment option for overweight/obese women with PCOS is diet and lifestyle interventions. However, optimal dietary guidelines are missing, with very little research having been done in this area. This paper presents the findings from a qualitative study (using semistructured interviews) of ten obese women who had PCOS and who had used LighterLife Total (LLT), a commercial weight loss program which utilizes a very low-calorie diet in conjunction with behavioral change therapy underpinned by group support. We investigated the women’s history of obesity, their experiences of other diets compared with LLT, and the on-going impact that this has had on their lives. Findings show that most women reported greater success using this weight loss program in terms of achieving and maintaining weight loss when compared with other diets. Furthermore, all the women nominated LLT as their model weight loss intervention with only a few modifications.

Enablement and positive ageing: a human rights-based approach to older people and changing demographics

ABSTRACT Human rights and the laws that protect them provide the framework for a civilised society. The present paper will examine the experience of older people in a rapidly changing modern world, a world in which opportunity to grow old is afforded to more people but one in which doing so positively and in accordance with their human rights is not assured. Taking Scotland as its focus, but mindful of wider experiences, the paper will look firstly at the notion of human rights, global demographic change and the challenges facing the realisation of human rights amongst older people in the UK. Next, using Scotland as a case study, the paper will explore the philosophy, policy and practice that shape the experience of growing old in an advanced western society. Finally, the paper will reflect upon ways of overcoming injustice and social exclusion amongst older people, pointing the way towards a more civilised society where older people are assured of their human rights. The latter will involve a human rights-based approach to working with older people, informed by applying the PANEL principles of ‘participation’, ‘accountability’, ‘ non-discrimination’, ‘empowerment’ and ‘legality’.

Occupational risks among immigrant workers in Europe compared to autochthonous workers

Objectives The global increase in geographical mobility among workers has translated into a major demographic change in Europe. Migratory flows have taken place primarily in response to the labour demand of expanding national economies. However, the entry into the labour force has not been easy for migrants. We aim to compare the prevalence of six occupational risk factors among immigrants and autochthonous workers in Europe. Methods Data used comes from the European Working Condition Survey (EWCS-2005, n=29 654 workers from 31 European countries). We examined differential prevalence rates in immigrant and autochthonous workers of: working >5 days/week, regular shift-working, repetitive hand/arm movements, exposure to noise (need to raise voice to talk to people), working in tiring/painful positions and working at very high speeds. Exposure was considered to be those reporting working in each condition almost/all of their working-time. Immigrant was defined as a person without citizenship of the country where the interviews were conducted. Prevalence ratios were adjusted for age, gender and education (adjusted-PR). Results Four of the occupational risks examined were found to be associated with immigration status: repetitive movements (adjusted-PR=1.4; 95% CI 1.2 to 1.5), noise-exposure (1.5; 1.3 to 1.8), working in tiring/painful positions (1.4; 1.2 to 1.6) and very high speeds (1.5; 1.2 to 1.6); the exceptions: shift working and working >5 days/week. Conclusions Immigrant workers in Europe are faced with additional occupational risks compared to autochthonous workers. Notwithstanding the limitations of the dataset in regards to the low sample size of the migrant group, the findings suggest that special attention must be paid to their working conditions.

P1-215 Depression in different welfare state regimes in Europe: the role of attitudes towards state responsibility for an adequate standard of living

Introduction Recent cross-national research by Levecque et al (Journal of Health and Social Behaviour, in press) has shown that the health effects of social experiences are attenuated, boosted or even reversed by the sociopolitical context. More specifically, it was found that the link between economic hardship and depression varies between different welfare state regimes in Europe. Objectives Currently, we assess whether this variation in depressing effect is totally attributable to differences in welfare state arrangements or whether welfare state attitudes play a significant role as well. Is economic hardship more depressing when the individual considers the state as the main provider for an adequate standard of living, or is the risk of depression higher when emphasis is put on self-provision and individual responsibility? Methods Analyses are based on data for 23 countries in the European Social Survey 2006–2007 (N=41686). Multilevel linear regressions are performed. Depression is measured using the Center for Epidemiologic Studies Depression Scale (CES-D 8). Results We find that experiencing economic hardship is significantly more depressing for individuals who consider the state as the main responsible for providing an adequate standard of living. This pattern is observed in all welfare state regimes and remains significant when controlling for gender, age, having a partner, educational level, social support and locus of control. Conclusion The link between economic hardship and depression is dependent on both structural welfare state arrangements and welfare state attitudes.