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Hamwi S, Barros H, Lorthe E. Migrant-Native Disparities in Obstetric Neuraxial Analgesia Use: The Role of Host-Country Language Proficiency. Anesth Analg 2023; 137:870-881. [PMID: 36716206 DOI: 10.1213/ane.0000000000006370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Neuraxial analgesia (NA) is the most effective modality in managing labor pain with widespread availability in high-income countries. Previous research has reported a differential obstetric NA use among migrant and native women, but the contribution of language barriers is not well understood. We aimed to investigate whether host-country language proficiency among migrant women influences NA use and satisfaction with pain management during labor, when compared to natives. METHODS We conducted a secondary analysis of data collected from 1024 native and 1111 migrant women who had singleton vaginal deliveries between 2017 and 2019 and were enrolled in the nationwide Portuguese baMBINO prospective cohort study. Obstetric NA use, satisfaction with labor pain management, and migrants' Portuguese language proficiency were self-reported. Data were analyzed using robust multilevel Poisson regression, adjusted for maternal region of birth (characterized by the Human Development Index), age, and education. RESULTS Overall, 84.4% of native women gave birth with NA, compared to 81.6%, 71.3%, and 56.9% of migrant women with full, intermediate, and limited language proficiency, respectively. Compared to native women, migrants with intermediate (adjusted risk ratio [aRR] = 0.91 [95% confidence interval {CI}, 0.82-0.99]) and limited (aRR = 0.73 [95% CI, 0.56-0.94]) proficiency were less likely to receive NA. However, no significant differences were observed in pain management satisfaction by language proficiency level. CONCLUSIONS Compared to native women, we observed a differential obstetric NA use across migrant women with different host-country language proficiency levels in Portugal, without affecting satisfaction with labor pain management. Although defining the mechanisms underlying NA use discrepancies requires further research, our findings support systematically evaluating pregnant migrant women's linguistic skills and ensuring their access to adequate obstetric analgesia-related information and interpretation services.
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Affiliation(s)
- Sousan Hamwi
- From the Unidade de Investigação em Epidemiologia (EPIUnit), Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Determinantes da Saúde Perinatal Laboratório, Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Henrique Barros
- From the Unidade de Investigação em Epidemiologia (EPIUnit), Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Determinantes da Saúde Perinatal Laboratório, Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Elsa Lorthe
- Unit of Population Epidemiology, Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Obstetrical Perinatal and Pediatric Epidemiology Research, Université Paris Cité, INSERM, INRA, Centre for Research in Epidemiology and Statistics Paris (CRESS), Paris, France
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Rogger R, Bello C, Romero CS, Urman RD, Luedi MM, Filipovic MG. Cultural Framing and the Impact On Acute Pain and Pain Services. Curr Pain Headache Rep 2023; 27:429-436. [PMID: 37405553 PMCID: PMC10462520 DOI: 10.1007/s11916-023-01125-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE OF REVIEW Optimal treatment requires a thorough understanding of all factors contributing to pain in the individual patient. In this review, we investigate the influence of cultural frameworks on pain experience and management. RECENT FINDINGS The loosely defined concept of culture in pain management integrates a predisposing set of diverse biological, psychological and social characteristics shared within a group. Cultural and ethnic background strongly influence the perception, manifestation, and management of pain. In addition, cultural, racial and ethnic differences continue to play a major role in the disparate treatment of acute pain. A holistic and culturally sensitive approach is likely to improve pain management outcomes, will better cover the needs of diverse patient populations and help reduce stigma and health disparities. Mainstays include awareness, self-awareness, appropriate communication, and training.
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Affiliation(s)
- Rahel Rogger
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Corina Bello
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Carolina S. Romero
- Anesthesia, Critical Care and Pain Department, Hospital General Universitario de Valencia, Universitad Europea de Valencia, Valencia, Spain
| | - Richard D. Urman
- Department of Anaesthesiology, The Ohio State University, Columbus, OH USA
| | - Markus M. Luedi
- Department of Anaesthesiology and Pain Medicine, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| | - Mark G. Filipovic
- Department of Anaesthesiology and Pain Medicine, Pain Center, Inselspital Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
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Gerhards SM, Schweda M, Weßel M. Medical students' perspectives on racism in medicine and healthcare in Germany: Identified problems and learning needs for medical education. GMS JOURNAL FOR MEDICAL EDUCATION 2023; 40:Doc22. [PMID: 37361250 PMCID: PMC10285372 DOI: 10.3205/zma001604] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/19/2022] [Accepted: 12/21/2022] [Indexed: 06/28/2023]
Abstract
Objective Against the backdrop of considerable lack of research, this study provides the first exploration of medical students' perspectives on racism in medicine and healthcare in Germany. The aim is to identify problems and learning needs for medical education. We address the following research questions: - How do medical students perceive racism in medicine and healthcare in Germany? - How do they address, understand, and discuss different aspects of racism in this context? - What are their expectations regarding the role of medical education? Methods Semi-structured online focus group discussions were conducted with 32 medical students from 13 different medical schools in Germany. The discussions were transcribed and analyzed using qualitative content analysis. Results Based on the analysis of the focus groups, four main hypotheses could be formulated: 1. Medical students perceive racism in medicine and healthcare in Germany as a ubiquitous phenomenon. 2. They have problems to identify racist behaviour and structures due to conceptual knowledge gaps. 3. They are insecure how to deal with racism on a situational level. 4. They hold medical education accountable to tackle racism in medicine and healthcare on various levels. Conclusion Our study raises specific learning needs for addressing racism in medicine and healthcare in Germany. Research from the US-context might inspire innovative approaches for German medical education but needs to take national specificities into account. Further research is needed to prepare the implementation of antiracist training in German medical education.
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Affiliation(s)
- Simon Matteo Gerhards
- Carl von Ossietzky University of Oldenburg, School of Medicine and Health Sciences, Department for Health Services Research, Medical Ethics Division, Oldenburg, Germany
| | - Mark Schweda
- Carl von Ossietzky University of Oldenburg, School of Medicine and Health Sciences, Department for Health Services Research, Medical Ethics Division, Oldenburg, Germany
| | - Merle Weßel
- Carl von Ossietzky University of Oldenburg, School of Medicine and Health Sciences, Department for Health Services Research, Medical Ethics Division, Oldenburg, Germany
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Costa R, Rodrigues C, Dias H, Covi B, Mariani I, Valente EP, Zaigham M, Vik ES, Grylka‐Baeschlin S, Arendt M, Santos T, Wandschneider L, Drglin Z, Drandić D, Radetic J, Rozée V, Elden H, Mueller AN, Barata C, Miani C, Bohinec A, Ruzicic J, de La Rochebrochard E, Linden K, Geremia S, de Labrusse C, Batram‐Zantvoort S, Ponikvar BM, Sacks E, Lazzerini M. Quality of maternal and newborn care around the time of childbirth for migrant versus nonmigrant women during the COVID-19 pandemic: Results of the IMAgiNE EURO study in 11 countries of the WHO European region. Int J Gynaecol Obstet 2022; 159 Suppl 1:39-53. [PMID: 36530012 PMCID: PMC9877819 DOI: 10.1002/ijgo.14472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To describe the perception of quality of maternal and newborn care (QMNC) around the time of childbirth among migrant and nonmigrant women in Europe. METHODS Women who gave birth at a health facility in 11 countries of the WHO European Region from March 2020 to July 2021 were invited to answer an online questionnaire including demographics and childbirth experience. Data were analyzed and compared for 1781 migrant and 20 653 nonmigrant women. RESULTS Migrant women who experienced labor perceived slightly more difficulties in attending routine antenatal visits (41.2% vs 39.4%; P = 0.001), more barriers in accessing facilities (32.9% vs 29.9%; P = 0.001), lack of timely care (14.7% vs 13.0%; P = 0.025), inadequate room comfort and equipment (9.2% vs 8.5%; P = 0.004), inadequate number of women per room (9.4% vs 8.6%; P = 0.039), being prevented from staying with their baby as they wished (7.8% vs 6.9%; P = 0.011), or suffering abuse (14.5% vs 12.7%; P = 0.022) compared with nonmigrant women. For women who had a prelabor cesarean, migrant women were more likely not to receive pain relief after birth (16.8% vs.13.5%; P = 0.039) and less likely to provide informal payment (1.8% vs 4.4%; P = 0.005) compared with nonmigrant women. Overall, the QMNC index was not significantly different for migrant compared with nonmigrant women. CONCLUSION Gaps in overall QMNC were reported by both migrant and nonmigrant women, with improvements to healthcare necessary for all.
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Affiliation(s)
- Raquel Costa
- EPIUnit ‐ Instituto de Saúde PúblicaUniversidade do PortoPortoPortugal,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR)PortoPortugal,Lusófona University/HEI‐Lab: Digital Human‐environment Interaction LabsLisbonPortugal
| | - Carina Rodrigues
- EPIUnit ‐ Instituto de Saúde PúblicaUniversidade do PortoPortoPortugal,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR)PortoPortugal
| | - Heloísa Dias
- Regional Health Administration of the AlgarveLisbonPortugal
| | - Benedetta Covi
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Ilaria Mariani
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Emanuelle Pessa Valente
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Mehreen Zaigham
- Department of Obstetrics and GynecologyInstitution of Clinical Sciences Lund, Lund University, Lund and Skåne University HospitalMalmöSweden
| | - Eline Skirnisdottir Vik
- Department of Health and Caring SciencesWestern Norway University of Applied SciencesBergenNorway
| | - Susanne Grylka‐Baeschlin
- Research Institute of Midwifery, School of Health SciencesZHAW Zurich University of Applied SciencesWinterthurSwitzerland
| | - Maryse Arendt
- Beruffsverband vun de Laktatiounsberoderinnen zu Lëtzebuerg asbl (Professional Association of Lactation Consultants in Luxembourg)LuxembourgLuxembourg
| | - Teresa Santos
- Universidade EuropeiaLisbonPortugal,Plataforma CatólicaMed/Centro de Investigação Interdisciplinar em Saúde (CIIS) da Universidade Católica PortuguesaLisbonPortugal
| | - Lisa Wandschneider
- Department of Epidemiology and International Public Health, School of Public HealthBielefeld UniversityBielefeldGermany
| | - Zalka Drglin
- National Institute of Public HealthLjubljanaSlovenia
| | | | | | - Virginie Rozée
- Sexual and Reproductive Health and Rights Research UnitInstitut National d'Études Démographiques (INED)ParisFrance
| | - Helen Elden
- Institute of Health and Care Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of Obstetrics and Gynecology, Region Västra GötalandSahlgrenska University HospitalGothenburgSweden
| | - Antonia N. Mueller
- Research Institute of Midwifery, School of Health SciencesZHAW Zurich University of Applied SciencesWinterthurSwitzerland
| | - Catarina Barata
- Instituto de Ciências Sociais, Universidade de LisboaLisbonPortugal
| | - Céline Miani
- Department of Epidemiology and International Public Health, School of Public HealthBielefeld UniversityBielefeldGermany,Sexual and Reproductive Health and Rights Research UnitInstitut National d'Études Démographiques (INED)ParisFrance
| | - Anja Bohinec
- National Institute of Public HealthLjubljanaSlovenia
| | | | - Elise de La Rochebrochard
- Sexual and Reproductive Health and Rights Research UnitInstitut National d'Études Démographiques (INED)ParisFrance
| | - Karolina Linden
- Institute of Health and Care Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Sara Geremia
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Claire de Labrusse
- School of Health Sciences (HESAV)HES‐SO University of Applied Sciences and Arts Western SwitzerlandLausanneSwitzerland
| | - Stephanie Batram‐Zantvoort
- Department of Epidemiology and International Public Health, School of Public HealthBielefeld UniversityBielefeldGermany
| | | | - Emma Sacks
- Department of International HealthJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Marzia Lazzerini
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
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Navarro-Prado S, Sánchez-Ojeda MA, Marmolejo-Martín J, Kapravelou G, Fernández-Gómez E, Martín-Salvador A. Cultural influence on the expression of labour-associated pain. BMC Pregnancy Childbirth 2022; 22:836. [PMID: 36376827 PMCID: PMC9664611 DOI: 10.1186/s12884-022-05173-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/01/2022] [Indexed: 11/16/2022] Open
Abstract
Background Every woman expresses pain differently during birth since it depends on a multitude of predictive factors. The medical care received, companionship during birth, cultural background and language barriers of the women in labour can influence on the expression of pain. This study aims to evaluate the expression of pain during birth and its associated factors in women treated in a Spanish border town. Methods The study included 246 women in labour. The expression of pain during labour was evaluated using the validated ESVADOPA scale. A descriptive analysis and association study were performed between cultural identity and dimensions of the scale. Multiple linear regression models were performed to assess the association between cultural identity, origin, language barrier, and companionship during labour. Results The women included in the study comprised 68.7% Berbers, 71.5% Muslims and 82.1% were accompanied during labour. An association between cultural identity and greater body expression of pain (p = 0.020; Cramer’s V = 0.163) in addition to its verbal expression was found during the latent phase of labour, (p = 0.028; Cramer’s V = 0.159). During the active phase of labour, cultural identity was associated with pain expression through greater body response, verbal expression, expression of the facial muscles, anxiety, inability to relax and vegetative symptoms. The different factors studied that had a predictive value were companionship (p = 0.027) during the latent phase of labour and Berber origin (p = 0.000), language barrier (p = 0.014) and companionship (p = 0.005) during the active phase of labour. The models designed predict pain expression in the latent phase by companionship and type of companionship (β = 1.483; 95%CI = 0.459–2.506, β = 0.238; 95%CI = 0.029–0. 448, respectively), and in the active phase by background, language barrier and companionship (β = 0.728; 95%CI = 0.258–1.198, β = 0.738; 95%CI = 0.150–1.326, β = 1.888; 95%CI = 0.984–2.791, respectively). Conclusion Culture, origin, language barrier and companionship during labour influences the manner in which women in labour express their pain. An understanding of this may help midwives correctly interpret the signs of pain expression and be able to offer the appropriate assistance depending on a woman's particular characteristics. There is a clear need for new models of maternity care that will take the cultural and language characteristics of women in labour into consideration. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05173-1.
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Guðmundsdóttir EÝ, Nieuwenhuijze M, Einarsdóttir K, Hálfdánsdóttir B, Gottfreðsdóttir H. Use of pain management in childbirth among migrant women in Iceland: A population-based cohort study. Birth 2022; 49:486-496. [PMID: 35187714 PMCID: PMC9545143 DOI: 10.1111/birt.12619] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/25/2022] [Accepted: 01/28/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Immigration is rapidly increasing in Iceland with 13.6% of the population holding foreign citizenship in 2020. Earlier findings identified inequities in childbirth care for some women in Iceland. To gain insight into the quality of intrapartum midwifery care, migrant women's use of pain management methods during birth in Iceland was explored. METHODS A population-based cohort study including all women with a singleton birth in Iceland between 2007 and 2018, in total 48 173 births. Logistic regression analyses with odds ratios (ORs) and 95% confidence intervals (CIs) were used to investigate the relationship between migrant backgrounds defined as holding foreign citizenship and the use of pain management during birth. The main outcome measures were use of nonpharmacological and pharmacological pain management methods. RESULTS Data from 6097 migrant women were included. Migrant women had higher adjusted OR (aORs) for no use of pain management (aOR = 1.23 95% CI [1.12, 1.34]), when compared to Icelandic women. Migrant women also had lower aORs for the use of acupuncture (0.73 [0.64, 0.83]), transcutaneous electrical nerve stimulation (TENS) (0.92 [0.01, 0.67]), shower/bath (0.73 [0.66, 0.82]), aromatherapy (0.59 [0.44, 0.78]), and nitrous oxide inhalation (0.89 [0.83, 0.96]). Human Development Index (HDI) scores of countries of citizenship <0.900 were associated with lower aORs for the use of various pain management methods. CONCLUSIONS Our results suggest that being a migrant in Iceland is an important factor that limits the use of nonpharmacological pain management, especially for migrant women with citizenship from countries with HDI score <0.900.
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Affiliation(s)
| | - Marianne Nieuwenhuijze
- Research Centre for Midwifery ScienceAcademie Verloskunde MaastrichtZuydThe Netherlands,CAPHRI School for Public Health and Primary CareMaastricht UniversityMaastrichtThe Netherlands
| | - Kristjana Einarsdóttir
- Faculty of MedicineCentre of Public Health SciencesUniversity of IcelandReykjavíkIceland
| | | | - Helga Gottfreðsdóttir
- Department of MidwiferyFaculty of NursingUniversity of IcelandReykjavíkIceland,Department of Obstetrics and GynecologyWomen's ClinicLandspítali University HospitalReykjavíkIceland
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Brebion M, Bonnet MP, Sauvegrain P, Saurel-Cubizolles MJ, Blondel B, Deneux-Tharaux C, Azria E. Use of labour neuraxial analgesia according to maternal immigration status: a national cross-sectional retrospective population-based study in France. Br J Anaesth 2021; 127:942-952. [PMID: 34511258 DOI: 10.1016/j.bja.2021.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 07/27/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Disparities in neuraxial analgesia use for childbirth by maternal origin have been reported in high-resource countries. We explored the association between maternal immigrant status (characterised separately by geographic continental origin and Human Development Index [HDI] of maternal country of birth) and neuraxial analgesia use. We hypothesised that immigrant women from low-resource countries may have more limited access to neuraxial analgesia than native French women. METHODS The study population, extracted from the 2016 National Perinatal Survey, a cross-sectional study of a representative sample of births in France, included only women who initially wished to deliver with neuraxial analgesia. We used multivariable multilevel logistic regression to explore the association between immigrant status and both use of neuraxial analgesia and its timely administration. RESULTS Among the 6070 women included, 88.1% gave birth with neuraxial analgesia and 15.8% were immigrants. There was no difference in neuraxial analgesia use between native French women and either immigrant women by geographic continental region of origin, or immigrants from countries with low HDI. However, immigrants from countries with very high HDI were more likely to give birth with neuraxial analgesia (adjusted odds ratio [aOR]=2.6; 95% confidence interval (CI), 1.2-5.8; P=0.018) and its timeliness <60 min after admission (aOR=1.8; 95% CI, 1.2-2.7; P=0.005) compared with native French women. CONCLUSIONS In France, immigrant women from low-resource countries have similar access to labour neuraxial analgesia to native French women. Our results suggest differential neuraxial analgesia use in favour of immigrant women from very high HDI countries compared with native women.
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Affiliation(s)
- Myriam Brebion
- Paris University, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetric Perinatal and Paediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France.
| | - Marie-Pierre Bonnet
- Paris University, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetric Perinatal and Paediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France; Sorbonne University, GRC 29, DMU DREAM, Department of Anaesthesia and Intensive Care, Armand Trousseau Hospital, AP-HP, Paris, France
| | - Priscille Sauvegrain
- Paris University, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetric Perinatal and Paediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Marie-Josèphe Saurel-Cubizolles
- Paris University, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetric Perinatal and Paediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Béatrice Blondel
- Paris University, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetric Perinatal and Paediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Catherine Deneux-Tharaux
- Paris University, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetric Perinatal and Paediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Elie Azria
- Paris University, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetric Perinatal and Paediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France; Maternity Unit, Notre Dame de Bon Secours - Groupe Hospitalier Paris-Saint-Joseph Hospital, Paris University, Paris, France
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The association between primary language and quality of recovery following caesarean section: a prospective observational study. Int J Obstet Anesth 2020; 44:68-73. [DOI: 10.1016/j.ijoa.2020.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 07/02/2020] [Accepted: 07/15/2020] [Indexed: 12/28/2022]
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Freiberg A, Wienke A, Bauer L, Niedermaier A, Führer A. Dental Care for Asylum-Seekers in Germany: A Retrospective Hospital-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082672. [PMID: 32295091 PMCID: PMC7215588 DOI: 10.3390/ijerph17082672] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/08/2020] [Accepted: 04/10/2020] [Indexed: 12/16/2022]
Abstract
Background: The growing immigration to Germany led to more patients whose medical needs are divergent from those of the domestic population. In the field of dental health care there is a debate about how well the German health system is able to meet the resulting challenges. Data on asylum-seekers' dental health is scarce. This work is intended to reduce this data gap. Methods: We conducted this retrospective observational study in Halle (Saale), Germany. We included all persons who were registered with the social welfare office (SWO) in 2015 and received dental treatments. From the medical records, we derived information such as complaints, diagnoses, and treatments. Results: Out of 4107 asylum-seekers, the SWO received a bill for 568 people. On average, there were 1.44 treatment cases (95%-CI: 1.34-1.55) and 2.53 contacts with the dentist per patient (95%-CI: 2.33-2.74). Among those, the majority went to the dentist because of localized (43.2%, 95%-CI: 38.7-47.7) and non-localized pain (32.0%, 95%-CI: 27.8-36.2). The most widespread diagnosis was caries (n = 469, 98.7%, 95%-CI: 97.7-99.7). Conclusion: The utilization of dental care is lower among asylum-seekers than among regularly insured patients. We assume that the low prevalence rates in our data indicate existing access barriers to the German health care system.
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Socioeconomic and migration status as predictors of emergency caesarean section: a birth cohort study. BMC Pregnancy Childbirth 2020; 20:32. [PMID: 31931761 PMCID: PMC6958756 DOI: 10.1186/s12884-020-2725-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 01/07/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Women with a migration background are reportedly at a higher risk of emergency caesarean section. There is evidence that this is due in part to suboptimal antenatal care use and quality of care. Despite the fact that migrant women and descendants of migrants are often at risk of socioeconomic disadvantage, there is, in comparison, scarce and incomplete evidence on the role of socioeconomic position as an independent risk factor for emergency caesarean delivery. We therefore investigate whether and how migration background and two markers of socioeconomic position affect the risk of an emergency caesarean section and whether they interact with each other. METHODS In 2013-2016, we recruited women during the perinatal period in Bielefeld, Germany, collecting data on health and socioeconomic and migration background, as well as routine perinatal data. We studied associations between migration background (1st generation migrant, 2nd/3rd generation woman, no migration background), socioeconomic status (educational attainment and net monthly household income), and the outcome emergency caesarean section. RESULTS Of the 881 participants, 21% (n = 185) had an emergency caesarean section. Analyses showed no association between having an emergency caesarean section and migration status or education. Women in the lowest (< 800€/month) and second lowest (between 800 and 1750€/month) income categories were more likely (aOR: 1.96, CI: 1.01-3.81; and aOR: 2.36, CI: 1.27-4.40, respectively) to undergo an emergency caesarean section than women in the higher income groups. CONCLUSIONS Migration status and education did not explain heterogeneity in mode of birth. Having a low household income, however, increased the chances of emergency caesarean section and thereby contributed towards producing health disadvantages. Awareness of these findings and measures to correct these inequalities could help to improve the quality of obstetric care.
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Zolitschka KA, Miani C, Breckenkamp J, Brenne S, Borde T, David M, Razum O. Do social factors and country of origin contribute towards explaining a "Latina paradox" among immigrant women giving birth in Germany? BMC Public Health 2019; 19:181. [PMID: 30755186 PMCID: PMC6373125 DOI: 10.1186/s12889-019-6523-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 02/08/2019] [Indexed: 11/12/2022] Open
Abstract
Background The “Latina paradox” describes the unexpected association between immigrant status, which is often correlated to low socioeconomic status, and low prevalence of unfavourable birth outcomes. Social (e.g. culture, religion) and/or non-social factors related to country of origin are potentially responsible for this paradox. Methods Questionnaire survey of 6413 women delivering in three large obstetric hospitals in Berlin (Germany) covering socioeconomic and migration status, country of origin (Turkey, Lebanon), and acculturation. Data was linked with routine obstetric data. Logistic regressions were performed to assess the effect of acculturation, affinity to religion and country of origin on preterm birth and small-for-gestational-age (SGA). Results Immigrant women with a low level of acculturation (reference) were less likely to have a preterm birth than those who were highly acculturated (aOR: 1.62, 95%CI: 1.01–2.59), as were women from Turkey compared to non-immigrants (aOR: 0.49, 95%CI: 0.33–0.73). For SGA, we found no epidemiologic paradox; conversely, women from Lebanon had a higher chance (aOR: 1.72, 95%CI: 1.27–2.34) of SGA. Affinity to religion had no influence on birth outcomes. Conclusions There is evidence that low acculturation (but not affinity to religion) contributes towards explaining the epidemiologic paradox with regard to preterm birth, emphasising the influence of socioeconomic characteristics on birth outcomes. The influence of Turkish origin on preterm birth and Lebanese origin on SGA suggests that non-social factors relating to the country of origin are also at play in explaining birth outcome differences, and that the direction of the effect varies depending on the country of origin and the outcome. Electronic supplementary material The online version of this article (10.1186/s12889-019-6523-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kim Alexandra Zolitschka
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany.
| | - Céline Miani
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Jürgen Breckenkamp
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Silke Brenne
- Department of Gynaecology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Alice Salomon Hochschule, Berlin, Germany
| | | | - Matthias David
- Department of Gynaecology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Oliver Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
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Bozorgmehr K, Biddle L, Preussler S, Mueller A, Szecsenyi J. Differences in pregnancy outcomes and obstetric care between asylum seeking and resident women: a cross-sectional study in a German federal state, 2010-2016. BMC Pregnancy Childbirth 2018; 18:417. [PMID: 30355297 PMCID: PMC6201533 DOI: 10.1186/s12884-018-2053-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 10/10/2018] [Indexed: 11/18/2022] Open
Abstract
Background Despite large numbers of asylum seekers, there is a lack of evidence on pregnancy outcomes and obstetric care of asylum seeking women in Germany. Methods Cross-sectional study (2010–2016) using administrative data of the main referral hospital for pregnant asylum seekers of the reception center of a large federal state in South Germany. Inclusion criteria: women aged 12–50 years, admitted in relation to pregnancy, childbirth or post-partum complications. Outcomes: differences between asylum seekers and residents in the prevalence of high-risk pregnancy conditions, abortive outcomes/stillbirths, peri- and postnatal maternal complications, neonatal complications, and caesarean sections. Analysis: odds ratios (OR) and 95% confidence intervals (CI) obtained by single and multiple logistic regression analysis. Attributable fractions among the exposed (Afe) and among the total population (Afp) were calculated for selected outcomes. Results Of 19,864 women admitted in relation to pregnancy, childbirth or post-partum complications, 2.9% (n = 569) were asylum seekers. Adjusted odds for high-risk pregnancy conditions (OR = 0.76, 95%CI: 0.63–0.91, p < 0.0001), caesarean sections (OR = 0.84, 95%CI 0.66–1.07, p = 0.17) and perinatal complications (OR = 0.65, 95%CI: 0.55–0.78, p < 0.0001) were lower; those for abortive outcomes/stillbirths (OR = 1.58, 95%CI: 1.11–2.20, p = 0.01) and postnatal complications (OR = 1.80, 95%CI: 0.93–3.19, p = 0.06) higher among asylum seeking women relative to residents in models adjusted for age, length of admission, and high-risk pregnancy conditions. The Afe for abortive outcomes and stillbirths among asylum seekers was 40.3% (95% CI, 16.3–56.5) and the Afp was 1.8%. The Afe for postnatal complications was 53.1% (95% CI, 7.1–74.0) and the Afp was 3.1%. Conclusion Asylum seeking women are at higher risk of abortive outcomes/stillbirths and show a tendency towards higher postnatal complications. This excess risk calls for adequate responses by health care providers and policy makers to improve outpatient postnatal care in reception centers and mitigate adverse birth outcomes among asylum seeking women. Although further research is needed, scaling-up midwivery care, improving outreach by maternity care teams, and routinely identifying and addressing mental illness by psychosocial services could be ways forward to improve outcomes in this population. Electronic supplementary material The online version of this article (10.1186/s12884-018-2053-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kayvan Bozorgmehr
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius Arkaden, INF 130.3, 69120, Heidelberg, Germany.
| | - Louise Biddle
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius Arkaden, INF 130.3, 69120, Heidelberg, Germany
| | - Stella Preussler
- Institute for Medical Biometry and Informatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Andreas Mueller
- Clinic of Gynaecology, Karlsruhe City Hospital, Karlsruhe, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius Arkaden, INF 130.3, 69120, Heidelberg, Germany
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