The implications of being an international medical graduate (IMG) in Canadian society : a qualitative study of foreign-trained physicians' resettlement, sense of identity and health status

This qualitative research study used grounded theory methodology to explore the settlement experiences and changes in professional identity, self esteem and health status of foreign-trained physicians (FTPs) who resettled in Canada and were not able to practice their profession. Seventeen foreign-trained physicians completed a pre-survey and rated their health status, quality of life, self esteem and stress before and after coming to Canada. They also rated changes in their experiences of violence and trauma, inclusion and belonging, and racism and discrimination. Eight FTPs from the survey sample were interviewed in semi-structured qualitative interviews to explore their experiences with the loss of their professional medical identities and attempts to regain them during resettlement. This study found that without their medical license and identity, this group of FTPs could not fully restore their professional, social, and economic status and this affected their self esteem and health status. The core theme of the loss of professional identity and attempts to regain it while being underemployed were connected with the multifaceted challenges of resettlement which created experiences of lowered selfesteem, and increased stress, anxiety and depression. They identified the re-licensing process (cost, time, energy, few residency positions, and low success rate) as the major barrier to a full and successful settlement and re-establishment of their identities. Grounded research was used to develop General Resettlement Process Model and a Physician Re-licensing Model outlining the tasks and steps for the successfiil general resettlement of all newcomers to Canada with additional process steps to be accomplished by foreign-trained physicians. Maslow's Theory of Needs was expanded to include the re-establishment of professional identity for this group to re-establish levels of safety, security, belonging, self-esteem and self-actualization. Foreign-trained physicians had established prior professional medical identities, self-esteem, recognition, social status, purpose and meaning and bring needed human capital and skills to Canada. However, without identifying and addressing the barriers to their full inclusion in Canadian society, the health of this population may deteriorate and the health system of the host country may miss out on their needed contributions.

Improving the oral health status of functionally independent and dependent seniors residing in long-term care facilities through dental hygiene education /

The purpose of this study was to evaluate the oral health status of residents residing in 2 long-term care facilities and determine if dental hygiene education was required in order to improve their current oral health. The oral health status of 6 independent and 4 dependent individuals residing in 2 long-term care facilities was evaluated. In addition, the current oral health and disease prevention practices employed by 4 caregivers who were responsible for providing oral care to dependent residents in the long-term care facilities were evaluated. Furthermore, an evaluation of the oral care practices of independent residents who were responsible for providing their own care was conducted. Finally, the challenges that caregivers and independent residents faced when performing oral care were determined, and methodological changes were proposed. Using a generic qualitative research methodology, data collection was comprised of semi structured interviews, field observations, and documentation. The oral health status of the residents was reevaluated 3 months later. The findings of this study demonstrated an increase in plaque accumulation, gingival inflammation, and unhealthy gingival tissue colour changes among the residents over the 3-month period. The study revealed that poor oral health among the residents was a result of inadequate oral hygiene care techniques, difficulties accessing oral health care, financial limitations, insufficient care staff, insufficient time for personal care duties, lack of professional development, minimal interprofessional collaboration of health disciplines, and lack of perseverance on the part of the caregivers and residents. Overall, oral health is essential, and maintaining optimal oral health requires increased collaboration and communication between health care providers.

Comprehensive school health, the social determinants of health, and the health status of children

As children are becoming increasingly inactive and obese, there is an urgent need for effective early prevention and intervention programs. One solution is a comprehensive school health (CSH) program, a health promotion initiative aimed at educating students about healthy behaviours and lifestyles, which also provides a link between the school, students, families, and the surrounding community. The purpose of this study was to explore the relationship between different components of CSH programs, as well as three determinants of health (gender, social support, socio-economic status), and physical activity, on the aerobic fitness and body mass index (BMI) of children. A newly developed and pilot-tested survey derived from Health Canada's fourpart CSH model (instruction, social support, support services, and a healthy physical environment) was sent to elementary school principals. Data on the gender, physical activity, parental education, and social support levels of students from these schools were gathered from a previous study. Multiple regression procedures were conducted to estimate the relationships between CSH components, the social determinants of health, physical activity, and BMI and aerobic fitness. Results showed that three CSH components were significantly associated with both BMI and aerobic fitness values in children, but accounted for less than 5% of the variance in both variables. Physical activity partially mediated the relationship between the significant CSH components, BMI, and particularly aerobic fitness. Furthermore, the social determinant and physical activity variables played independent roles in aerobic fitness values. No moderating effects of the social determinants were discovered.

Self-reported health status and lifestyle behaviours of the residents of the Town of Fort Erie, Ontario, as related to the Canadian Community Health Survey

The purpose of this cross sectional survey design was to examine self-reported health status and lifestyle behaviours of the residents of the Town of Fort Erie, Ontario, as related to the Canadian Community Health Survey. Using a mail-out survey, entitled the Fort Erie Survey of Health (FESH), a probability cluster sampling technique was used to measure self-reported health status (present health, health conditions, health challenges, functional health limitations) and lifestyle behaviour (smoking, alcohol use, drug use, physical activity, fruit and vegetable consumption, body weight, and gaming). Each variable was described and analyzed in relation to socio-economic variables, age and gender. The findings from this study were compared to the Canadian Community Health Survey 2000/2001. Overall, 640 surveys were completed. The majority of Fort Erie residents rated their present health as good and were satisfied with their overall health and quality of life. The main chronic conditions reported were arthritis, back pain and heart disease. Other main health problems reported were vision, sleeping and chronic pain. Overall, 14.6% smoke; 58.8% engaged in physical activity either occasionally or never as opposed to regularly engaging in physical activity; 52.1% did not eat the required daily fruits and vegetables; and 40.0% were in the overweight category. Persons who practiced one healthy lifestyle behaviour were more likely to practice other healthy promoting behaviours. Therefore, health promotion programs are best designed to address multiple risk factors simultaneously. The ffiSH was generally consistent with the Canadian Community Health Survey in the overall findings. A small number of inconsistencies were identified that require further exploration to determine if they are unique to this community.

A Quantitative Study of Social Capital Components, Self-Reported Health Status and Social Determinants of Health

This quantitative descriptive co-relational study used telephone survey interviews and stratified random sampling to collect data related to Social Capital (SC) and its components (trust and safety, reciprocity, civic engagement and collective action) and selected determinants of health variables in Niagara Region, Canada. Among the four components of social capital, trust and safety levels were highest among all participants (m=5.42, SD=1.0), with community engagement yielding the lowest mean score for the sample (m=1.93, SD=.8). Reciprocity had the strongest association with all other components of SC (r=0.51). Those most likely to report low levels of SC and health were unattached and low-income females. Males were more likely to report higher trust and safety levels and higher levels of self-rated health. In this study, a linear relationship between self-reported health status and SC was not found. Marital and employment status were associated with differences in mean scores of SC and self-reported health.

The determinants of the health status in a developing country: results from the Colombian case

El artículo busca encontrar evidencia empírica de los determinantes de la salud, como una medición de capital salud en un país en desarrollo después de una profunda reforma en el sector salud. Siguiendo el modelo de Grossman (1972) y tomando factores institucionales, además de las variables individuales y socioeconómicas. Se usaron las encuestas de 1997 y 2000 donde se responde subjetivamente sobre el estado de salud y tipo de afiliación al sistema de salud. El proceso de estimación usado es un probit ordenado. Los resultados muestran una importante conexión entre las variables individuales, institucionales y socioeconómicas con el estado de salud. El efecto de tipo de acceso al sistema de salud presiona las inequidades en salud.

Lifestyle and health status in a sample of Swedish women four years after pregnancy : a comparison of women with a history of normal pregnancy and women with a history of gestational diabetes mellitus

Background: Despite the recommendations to continue the regime of healthy food and physical activity (PA) postpartum for women with previous gestational diabetes mellitus (GDM), the scientific evidence reveals that these recommendations may not be complied to. This study compared lifestyle and health status in women whose pregnancy was complicated by GDM with women who had a normal pregnancy and delivery. Methods: The inclusion criteria were women with GDM (ICD-10: O24.4 A and O24.4B) and women with uncomplicated pregnancy and delivery in 2005 (ICD-10: O80.0). A random sample of women fulfilling the criteria (n = 882) were identified from the Swedish Medical Birth Register. A questionnaire was sent by mail to eligible women approximately four years after the pregnancy. A total of 444 women (50.8%) agreed to participate, 111 diagnosed with GDM in their pregnancy and 333 with normal pregnancy/ delivery. Results: Women with previous GDM were significantly older, reported higher body weight and less PA before the index pregnancy. No major differences between the groups were noticed regarding lifestyle at the follow-up. Overall, few participants fulfilled the national recommendations of PA and diet. At the follow-up, 19 participants had developed diabetes, all with previous GDM. Women with previous GDM reported significantly poorer self-rated health (SRH), higher level of sick-leave and more often using medication on regular basis. However, a history of GDM or having overt diabetes mellitus showed no association with poorer SRH in the multivariate analysis. Irregular eating habits, no regular PA, overweight/obesity, and regular use of medication were associated with poorer SRH in all participants. Conclusions: Suboptimal levels of PA, and fruit and vegetable consumption were found in a sample of women with a history of GDM as well as for women with normal pregnancy approximately four years after index pregnancy. Women with previous GDM seem to increase their PA after childbirth, but still they perform their PA at lower intensity than women with a history of normal pregnancy. Having GDM at index pregnancy or being diagnosed with overt diabetes mellitus at follow-up did not demonstrate associations with poorer SRH four years after delivery.

Health status and participation in a range of activities in an Australian community

Introduction: The aim of the research was to determine the relationship between levels of participation in a community and self-assessed health status of people in a rural and regional setting.
Method: A cross-sectional design, using a mailed, self-administered questionnaire was used. Questionnaires were mailed to a random sample of people aged 18 years and over who were registered on the electoral roll of a regional city and rural area, the Barwon and Otway regions of Victoria, Australia. The sample consisted of 1752 participants: 990 females (57%), 739 males (42%) and 23 sex undisclosed (1%). The range of participants was 18-98 years, and the mean age was 50.53 years (SD = 17.19).
Results: Self-assessed physical and mental health were measured using the SF-12 scale. Participants with low incomes, and those with low self-assessed physical and mental health scores, were significantly more likely than other participants to agree with one or more of the social isolation items, indicating that they experienced some social isolation. Low levels of participation in social, sports, leisure or support activities were associated with low self-assessed physical and mental health. Disengagement with the local community was associated with low levels of self-assessed mental health. While younger people were more likely than older people to participate in social, sports, leisure or support activities, they were less involved as members of their community. Females were more likely than males to have been involved in five or more sports, leisure or support activities. Participation in civic activities was associated with high income. Levels of participation in the four different types of activities were combined (social activities, sport, leisure or support activities, community and group activities, and civic activities). Participants classified as low participators were more likely to be older participants, to have a low income and to have low scores for both physical and mental health.
Conclusions: An association was found between health and community participation in a range of activities, and between health and engagement with the community in this rural and regional population. These findings are consistent with those reported from similar research with a metropolitan population sample. The current research suggests that the groups of people of most concern in terms of low participation rates, are people who have low incomes, people aged over 65 years, people who may be defined as possessing poor physical health and people who may be defined as possessing poor mental health. The relationship between age, community participation and health is complex and needs further exploration because it is not known whether poor health reduces community participation or whether reduced community participation results in poor health. However, current research suggests that developing and implementing strategies to promote people's engagement with and involvement in their local community is one important way of promoting the health of the community as a whole.

In the shadow of the volcanoes: the impact of intervention on the nutrition and health status of Rwandan refugee children in Zaire two years from the exodus

Objective: To evaluate the public health and nutritional situation of refugee children in Katale camp, Eastern Zaire, after two years of nutritional and health intervention from 1994 to 1996.
Design: Cross-sectional survey using a two-stage cluster sampling method. Anthropometric data were collected from 28 May 1996 to 4 June 1996. Retrospective review of food basket monitoring data over the preceding six months and the United Nations High Commission for Refugees' weekly mortality data was conducted. Measles immunisation coverage data were surveyed simultaneously, using child health records.
Main outcome measures: Nutritional status measured by weight-for-height index (W/H), measles immunisation status, average daily energy content of the general food ration and crude mortality rate.
Setting: Katale refugee camp, Zaire, June 1996.
Analysis: Weight-for-height index and proportion of immunised children were computed using EPINUT, part of EPINFO computer package.
Results: Malnutrition was found to be most prevalent in children aged six to 29 months old (W/H < -2 Z-score and/or oedema: 6.2%; 95% CI: 3.4%, 10.6%), among whom the malnutrition rate was almost double the overall malnutrition prevalence (W/H < -2 Z-score and/or oedema: 3.5% (95% CI: 1.5%, 7.2%). The general food ration, although conforming to the World Food Program minimum standards of adequacy in terms of variety (being composed of cereals, oil, beans, blended cereal and legume mixes and salt), provided only 6240 kJ on average (95% CI: 5040, 7140 kJ) per person per day, thus meeting only 57% to 84% of the minimum energy requirements for an adult, and falling well below the needs for sub groups with higher nutritional requirements such as children, pregnant and breastfeeding women and the sick. Measles immunisation coverage in children nine to 59 months was 88.6%. The crude mortality rate was found to be 0.3 per 10 000 per day. Refugees received 15 litres of clean water per person per day.
Conclusion: Public health interventions in Katale camp 1994 to 1996 had reduced mortality and morbidity rates dramatically. This was not reflected in the malnutrition rates for children under five years, that remained stable after an initial fall despite two years of nutritional intervention. The factors contributed to this were related to an inadequate general food ration (due to food shortages), lack of ability to supplement the diet, (due to economic restrictions that were imposed in the camp) and inequities in the food distribution process (due to food being siphoned off by camp leaders for military purposes).

Supplement use is associated with health status and health-related behaviors in the 1946 British birth cohort.

Use of dietary supplements may be one of a number of health-related behaviors that cluster together. The current study investigated the underlying diet, health-related characteristics, and behaviors of users and nonusers of dietary supplements in a longitudinal study of health. Participants (n = 1776) completed a 5-d food diary including information on dietary supplement use (vitamins, minerals, and nutraceuticals) at age 53 y. Sociodemographic information and data on smoking, alcohol, and physical activity were obtained along with anthropometric measurements, blood pressure, and a blood sample (nonfasting subjects). A significantly greater percentage of women reported supplement use compared with men (45.1 vs. 25.2%). Supplement use was associated with lower BMI, lower waist circumference, higher plasma folate and plasma vitamin B-12 concentrations, nonsmoking, participation in physical activity, and nonmanual social class in women and with plasma folate concentrations and participation in physical activity in men. Nonsupplement users tended to be nonconsumers of breakfast cereals, fruit, fruit juice, yogurt, oily fish, and olive oil and had lower dietary intakes of potassium, magnesium, phosphorus, iron, and vitamin C even after adjustment for sociodemographic and behavioral factors. Overall, supplement users tended to differ from nonsupplement users on a range of health-related behaviors and health status indicators, although there were fewer significant associations in men. Similarly, dietary supplements users tended to have underlying diets that, were healthier and those taking supplements may be the least likely to need them. These results support the notion of a clustering of healthy behaviors and cardiovascular risk factors, particularly for women.

Parent-reported health status of overweight and obese Australian primary school children: a cross-sectional population survey

Introduction: Childhood overweight/obesity is associated with poor physical and psychosocial health in clinical samples. However, there is little information on the health status of overweight and obese children in the community, who now represent a large proportion of the child population. We examined parent-reported child health and well-being and parent concern about child weight by body mass index (BMI) category in a population sample of primary school children.

Design: A stratified two-stage random cluster sample of 24 primary schools representative of the state of Victoria, Australia.

Measures: BMI (weight/height2) transformed to normalised Z-scores using the 1990 UK Growth Reference; the Child Health Questionnaire (CHQ), a 13-scale 50-item parent-completed measure of health and well-being; parent self-reported height and weight; parent concern about child's weight.

Results: Data were available for 2863 children aged 5-13 y (50.5% male), of whom 17% were overweight and 5.7% obese. Using logistic regression analyses with 'normal weight' as the referent category, obese boys were at greater risk of poor health (ie <15th centile) on seven of the 12 CHQ scales: Physical Functioning (odds ratio (OR) 2.8), Bodily Pain (OR 1.8), General Health (OR 3.5), Mental Health (OR 2.8), Self Esteem (OR 1.8), Parent Impact¾Emotional (OR 1.7) and Parent Impact¾Time (OR 1.9). Obese girls were at greater risk of poor health on only two scales: General Health (OR 2.1) and Self Esteem (OR 1.8). Forty-two percent of parents with obese children and 81% with overweight children did not report concern about their child's weight. Parents were more likely to report concern if the child was obese (OR 21.3), overweight (OR 3.5) or underweight (OR 5.4) than normal weight (P<0.05). Concern was not related to child gender, parental BMI or parental education after controlling for child BMI. Perceived health and well-being of overweight/obese children varied little by weight category of the reporting parent (overweight vs non-overweight).

Conclusions: Parents were more likely to report poorer health and well-being for overweight and obese children (particularly obese boys). Parental concern about their child's weight was strongly associated with their child's actual BMI. Despite this, most parents of overweight and obese children did not report poor health or well-being, and a high proportion did not report concern. This has implications for the early identification of such children and the success of prevention and intervention efforts.

Effects of high-intensity progressive resistance training on self-reported health status in older persons with type 2 diabetes

Purpose: To evaluate the influence of high-intensity progressive resistance training (PRT) on self-reported physical and mental health in older persons with type 2 diabetes.

Methods: We performed a 12-month RCT with 36 overweight men and women with type 2 diabetes (aged 60-80 years) who were randomly assigned to a moderate weight-loss diet plus PRT (PRT&WL) or a moderate weight-loss diet plus a control (stretching) program (WL). Gymnasium-based training for 6 months was followed by an additional 6 months of home-based training. The SF-36 (v1) questionnaire was used to obtain physical (PCS) and mental (MCS) health component summary scores at baseline, 6 and 12 months.

Results: Subject retention was 81% and 72% after 6 and 12 months respectively. Exercise adherence during gymnasium- and home-based training was 88% and 73% for the PRT&WL group, and 85% and 78.1% for the WL group respectively. In a regression model adjusted for age and sex, PCS improved in the PRT&WL group compared to the WL group after 6 months of gymnasium-based training (2.3 versus -2.0, p = 0.05), which persisted after 12 months training (0.7 versus -4.1, p = 0.03). There were no between-group differences at 6 or 12 months for the MCS.

Conclusion: High-intensity PRT was effective in improving self-reported physical health, but not mental health. PRT provides an effective exercise alternative in lifestyle management for older adults with type 2 diabetes.