Changes in smoking due to COVID-19 pandemic among persons of migrant origin compared with the general population: a population-based study.

AIMS: Prior studies have implied that smokers may have changed their smoking behaviour during the COVID-19 pandemic. However, little is known about changes in smoking behaviour and correlates of change due to the pandemic among persons of migrant origin compared with the general population. METHODS: Population-based cross-sectional studies with comparable study protocols and measures, one focusing on persons of migrant origin living in Finland (n = 3587, response rate 60%) and the other on the general Finnish population (n = 3444, response rate 56%), were utilised. The outcome measure was self-reported change in smoking behaviour due to COVID-19 among current smokers. Explanatory factors included sociodemographic-, health-, and COVID-19-related factors. Multinomial logistic regression was used in the analyses. RESULTS: Most of the current smokers reported no change in their smoking behaviour. In the adjusted model, younger age was positively associated with increased smoking, while region of origin (Russia, Africa, Asia, and Latin America) and worrying about getting infected with COVID-19 were associated with decreased smoking among persons of migrant origin. In the general population, younger age, female sex, being other than employed/student, increased loneliness, and decreased contact with close ones were associated with increased smoking, while reduced working capacity and worries that someone close to the respondent will be infected with COVID-19 were associated with decreased smoking. CONCLUSIONS: The findings of this study contribute to better identification of at-risk populations in future crises situations. This will allow for more efficient targeting and tailoring of health promotion services, including smoking cessation.

Potentially traumatic experiences pre-migration and adverse pregnancy and childbirth outcomes among women of Somali- and Kurdish-origin in Finland.

BACKGROUND: Women in precarious conditions in their countries of origin, especially those who have left the country as refugees, may have been victims of serious mental and physical violence. These potentially traumatic experiences may threaten women's reproductive health. This study examines the prevalence of potentially traumatic experiences pre-migration and female genital mutilation/cutting (FGM/C) and their associations with adverse reproductive outcomes among migrant women of Somali- and Kurdish-origin who have been pregnant in Finland. METHODS: Survey and register data of the participants of the Finnish Migrant Health and Wellbeing Study (Maamu), conducted in 2010-2012, were used. Women of 18 to 64 years of age, 185 Somali- and 230 Kurdish-origin, who had at least one pregnancy or birth in Finland were included in the analysis. The survey data were linked to the Finnish Medical Birth Register, the Register of Induced Abortions, and the Care Register for Health Care until 2018. For each outcome, logistic regression was used and adjusted for age, body mass index, time lived in Finland, and the number of births. RESULTS: A total of 67% of Somali-origin and 71% of Kurdish-origin women had experienced potentially traumatic experiences pre-migration and 64% of Somali- and 32% of Kurdish-origin women had also undergone FGM/C. In Kurdish-origin women, complications during pregnancy (e.g. bleeding in the first trimester, known or suspected fetal abnormality, signs of fetal hypoxia, death of the fetus and other problems) were significantly more common among women without potentially traumatic experiences (70%) than among women with potentially traumatic experiences (48%) (p-value 0.005). No associations between potentially traumatic experiences or FGM/C and other adverse reproductive outcomes were observed among Somali- or Kurdish-origin women. CONCLUSION: Past trauma is common among Somali- and Kurdish-origin women and this needs to be evaluated in maternity care. However, we found no association between potentially traumatic experiences pre-migration and adverse reproductive outcomes.

Incidence of SARS-CoV-2 Infection and Factors Associated With Complete COVID-19 Vaccine Uptake Among Migrant Origin Persons in Finland.

Objective: We examined incidence of SARS-CoV-2 infection, COVID-19 vaccine uptake and factors associated with complete COVID-19 vaccine uptake among persons of migrant origin in Finland. Methods: Data on laboratory-confirmed SARS-CoV-2 infection and COVID-19 vaccine doses between March 2020 and November 2021 were linked to FinMonik register sample (n = 13,223) and MigCOVID (n = 3,668) survey data using unique personal identifier. Logistic regression was the main method of analyses. Results: Among FinMonik sample, complete COVID-19 vaccine uptake was lower among persons of Russia/former Soviet Union, Estonia, and rest of Africa and higher among persons of Southeast Asia, rest of Asia, and the Middle East/North Africa than among persons originating from Europe/North America/Oceania. Male sex, younger age, migration age (<18 years) and shorter length of residence were associated with lower vaccine uptake among FinMonik sample, whereas younger age, being economically inactive, poorer language skills, experiences of discrimination and psychological distress were associated with lower vaccine uptake among MigCOVID sub-sample. Conclusion: Our Findings point to a further need of tailored and targeted communication and community outreach strategies to increase vaccine uptake among persons of migrant origin.

Association of sociodemographic characteristics with self-perceived access to COVID-19 information and adherence to preventive measures among migrant origin and general populations in Finland: a cross-sectional study.

OBJECTIVES: This study examines how access to COVID-19 information and adherence to preventive measures varies by sociodemographic characteristics, and whether the associations differ among the migrant origin and the general Finnish population. Additionally, the association of perceived access to information with adherence to preventive measures is examined. DESIGN: Cross-sectional, population-based random sample. BACKGROUND: Equity in access to information is crucial for securing individual well-being and successful management of a crisis at population level. SETTING: Persons who have a residence permit in Finland. PARTICIPANTS: Migrant origin population constituted of persons aged 21-66 years born abroad, who took part in the Impact of the Coronavirus on the Wellbeing of the Foreign Born Population (MigCOVID) Survey conducted from October 2020 to February 2021 (n=3611). Participants in the FinHealth 2017 Follow-up Survey conducted within the same time frame, representing the general Finnish population, constituted the reference group (n=3490). OUTCOME MEASURES: Self-perceived access to COVID-19 information, adherence to preventive measures. RESULTS: Self-perceived access to information and adherence to preventive measures was overall high both among the migrant origin and the general population. Perceived adequate access to information was associated with living in Finland for 12 years or longer (OR 1.94, 95% CI 1.05-3.57) and excellent Finnish/Swedish language skills (OR 2.71, 95% CI 1.62-4.53) among the migrant origin population and with higher education (OR 3.56, 95% CI 1.49-8.55 for tertiary and OR 2.87, 95% CI 1.25-6.59 for secondary) among the general population. The association between examined sociodemographic characteristics with adherence to preventive measures varied by study group. CONCLUSIONS: Findings on the association of perceived access to information with language proficiency in official languages highlight the need for rapid multilingual and simple language crisis communications. Findings also suggest that crisis communications and measures designed to influence health behaviours at population level may not be directly transferable if the aim is to influence health behaviours also among ethnically and culturally diverse populations.

Prevalence and risk factors of psychological distress among foreign-born population in Finland: A population-based survey comparing nine regions of origin.

AIMS: Previous research indicates that foreign-born populations experience more psychological distress than general populations. However, it remains unclear how prevalence varies between regions of origin. The role of socio-demographic and migration-related factors also needs to be further investigated. We aimed to (a) compare the prevalence of psychological distress in foreign-born and general Finnish populations, (b) investigate differences in prevalence between nine regions of origin and (c) examine which socio-demographic and migration-related factors are associated with distress among foreign-born populations. METHODS: The study used data from the Survey on Well-Being among Foreign Born Population (FinMonik), a population-based survey (n=6312) of foreign-born populations living in Finland collected between 2018 and 2019 by the Finnish Institute for Health and Welfare. Psychological distress was measured using the Mental Health Inventory-5 (MHI-5), with a cut-off point of 52. Logistic regression was used to adjust analyses by age and sex to determine the prevalence of psychological distress and the associated socio-demographic factors. RESULTS: Psychological distress was more prevalent among those who were foreign born (17.4%) than among the general population (12.9%). Migrants from the Middle East and North Africa had the highest prevalence (29.7%) compared to other regions of origin. Unemployment or economic inactivity, international protection as a reason for migration and beginner-level language proficiency were the main factors increasing the odds for distress among foreign-born populations. CONCLUSIONS: Foreign-born populations experience more psychological distress than the general population, but prevalence varies between regions of origin. Future efforts should aim at a better understanding of the mental health risk factors and the development of targeted interventions for these subpopulations.

A multisource approach to health care use: concordance between register and self-reported physician visits in the foreign-born population in Finland.

BACKGROUND: Reliable information on the use of health services is important for health care planning, monitoring and policy. It is critical to assess the validity of the sources used for this purpose, including register and survey-based data. Studies on foreign-born populations' health care use have usually implemented either survey or register data. The concordance of such data among groups of different cultural background remains largely unknown. In this study, we presented an approach to examine routinely how survey and register-related characteristics may explain disagreement found between the two information sources. METHODS: We linked register- and survey-based data pertaining to the Finnish Register of Primary Health Care general physician visits and the Survey on Well-Being among Foreign Born Population (FinMonik, 2018-2019), a nationally representative survey. The sample comprised n = 5,800 informants for whom registered general physician visits were tracked in the 12-month period preceding their participation in the survey. Cohen's kappa was used as measure of multisource concordance, hierarchical loglinear models for the association between single predictors and multisource discrepancy, and a logistic regression model for examining source-related predictors of source discrepancy. Survey weights were used in all sample analyses. RESULTS: Source concordance was poor. When dichotomizing general physician visits (zero vs one or more), 35% of informants had reported one or more visits while none were found from register. Both register- and informant-related predictors were associated to this discrepancy (i.e. catchment area, private health care use, inability to work, region of origin and reason for migration). CONCLUSIONS: We found high discrepancy between the reported and the registered physician visits among the foreign-born population in Finland, with a particularly high number of reported physician visits when none were found in the register. There was a strong association between the specific catchment area and mismatch, indicating that both register under-coverage and survey over-report are plausible and may coexist behind the discrepancy. However, associations of informant's characteristics and mismatch were less pronounced. Implications on the validity of medical information sources are discussed.

The association of depressive and anxiety symptoms with the metabolic syndrome and its components among Russian, Somali, and Kurdish origin adults in Finland: A population-based study.

OBJECTIVE: Positive association of depressive and anxiety symptoms with the metabolic syndrome (MetS) have been reported, however there is little information on these among migrant origin populations. The aim of this study was to examine these associations among diverse migrant origin populations in Finland. METHODS: Data of 318 Russian, 212 Somali, and 321 Kurdish origin participants in the cross-sectional Finnish Migrant Health and Wellbeing Study (Maamu) aged 30-64 years was used. The general population reference group constituted of 786 Health 2011 Survey participants. Depressive and anxiety symptoms were measured with HSCL-25 subscales. Harmonized definition of MetS was used. RESULTS: Depressive symptoms were associated with elevated blood pressure in Kurdish origin (30.1%, 95% CI 22.7-38.8 vs. 19.9%, 95%CI 15.4-25.4 for those with and without symptoms respectively); and elevated waist circumference (72.1%, 95%CI 56.9-83.5 vs. 55.0%, 95%CI 50.6-59.4) and triglycerides (30.8%, 95%CI 16.0-51.0 vs. 11.9%, 95%CI 9.3-15.0) in general population. Anxiety symptoms were associated with MetS (47.0%, 95%CI 37.6-56.7 vs. 31.9%, 95%CI 26.7-37.6) and elevated blood pressure (37.2%, 95%CI 28.3-46.9 vs. 18.8%, 95%CI 14.7-23.6), and with elevated triglycerides in Somali origin (33.0%, 95%CI 14.5-59.0 vs. 5.7%, 95%CI 3.3-9.6) and general population (30.2%, 95%CI 16.4-48.8, 12.8%, 95%CI 9.9-16.2). No associations between low HDL-cholesterol and depressive or anxiety symptoms were observed. CONCLUSION: Cardiometabolic health should be taken into account in mental health services. Future studies should explore the underlying pathways to the observed differences in strengths of associations of depressive and anxiety symptoms with MetS and its components across diverse migrant origin populations.

Mental Health and Traumatization of Newly Arrived Asylum Seeker Adults in Finland: A Population-Based Study.

Asylum seekers frequently experience potentially traumatic events (PTEs), but the type and frequency vary depending on the country of origin. The cumulative effect of multiple PTEs and other stressors expose asylum seekers to a significant risk of mental ill health. The aim of the study was to examine the prevalence of PTEs, depression and anxiety symptoms, risk for psychological trauma, psychotropic medication use and previous mental health diagnoses among adult asylum seekers in the Asylum Seekers Health and Wellbeing (TERTTU) Survey (n = 784 respondents, participation rate 78.6%). A substantial majority (88.7%, 95% CI 86.9-90.3) of asylum seekers reported one or more PTEs before arriving to Finland. PTEs during the asylum-seeking journey were reported at 12.0% (95% CI 10.7-13.4), however, when examined by region of origin, the proportion was 34.5% (95% CI 29.5-39.8) for asylum seekers from Africa (excluding North Africa). Significant symptoms of depression were reported by 41.7% (95% CI 39.6-43.9) of asylum seekers and symptoms of anxiety by 34.2% (95% CI 32.1-36.2). Half of the asylum seekers were assessed as having at least a medium-risk for psychological trauma. Prevalence rates were higher among females and asylum seekers from Africa. This study highlights the importance of using screening tools to identify asylum seekers with severe mental health problems that may need referral to further assessment and treatment. Asylum seekers from Africa (excluding North Africa) should be given additional attention in initial health screenings and examinations.

Response Activity in Mixed-Method Survey Data Collection-The Methods Used in a Survey among the Foreign-Born Population in Finland (FinMonik).

In terms of the number of respondents, Survey on Well-Being among Foreign Born Population (FinMonik) is so far the most extensive survey carried out among the population with foreign background in Finland. It comprises a wide range of self-reported data, including information on the respondent's health, well-being and access to care, which can be widely utilized in planning and assessing integration, health and welfare policies. A mixed-method approach (an electronic questionnaire, a paper questionnaire and phone interviews) was used in collecting the data which consists of responses by 6836 respondents aged 18-64 years. All response types included, the response rate was 53.1% (n = 6836). This study describes in detail the methods used in the FinMonik survey. In addition, we describe the demographics of the respondents partaking in each response format. The aim of the study is to promote the development of mixed-method survey as a way of collecting reliable data that can be used to enhance foreign-born people's health, well-being and access to health care. The survey responses will be used as a baseline in observing the respondents' well-being through the register-based data available in several national registers on health, medicine use and access to care as well as the data collected in the study Impact of Coronavirus Epidemic on Well-Being among Foreign Born Population Study (MigCOVID). Furthermore, the FinMonik study protocol will be repeated every four years.

Iranian and Iraqi torture survivors in Finland and Sweden: findings from two population-based studies.

BACKGROUND: Most refugees and other forced migrants have experienced potentially traumatic events (PTEs). Torture and other traumatic experiences, as well as various daily stressors, impact the mental health and psychosocial well-being of war-affected populations. METHODS: The study includes two population-based samples of Iranian and Iraqi men living in Finland and Sweden. The Finnish Migrant Health and Well-being Study (Maamu) was conducted in 2010-2012. The Linköping study was conducted in Sweden in 2005. In both samples, health and well-being measures, social and economic outcomes as well as health service utilization were reported. RESULTS: The final sample for analysis consisted of two groups of males of Iranian or Iraqi origin: 278 residents in Finland and 267 residents in Sweden. Both groups were subdivided according to the reported PTEs: Torture survivors; Other PTEs; No PTEs. Migrants that reported PTEs, torture survivors in particular, had significantly poorer social and health outcomes. Torture survivors also reported lower trust and confidence in authorities and public service providers, as well as more loneliness, social isolation and experiences of discrimination. CONCLUSIONS: Torture and other PTEs prevalent in refugee and migrant populations create a wide-ranging and long-term impact in terms of increased risk of various types of adverse social and health conditions. Early identification through systematic and effective screening should be the first step in guiding migrants and refugees suffering from experiences of torture and other PTEs to flexible, multidisciplinary services.

Use of Health Services and Unmet Need among Adults of Russian, Somali, and Kurdish Origin in Finland.

Equal access to health care is one of the key policy priorities in many European societies. Previous findings suggest that there may be wide differences in the use of health services between people of migrant origin and the general population. We analyzed cross-sectional data from a random sample of persons of Russian (n = 692), Somali (n = 489), and Kurdish (n = 614) origin and the Health 2011 survey data (n = 1406) representing the general population in Finland. Having at least one outpatient visit to any medical doctor during the previous 12 months was at the same level for groups of Russian and Kurdish origin, but lower for people of Somali origin, compared with the general population. Clear differences were found when examining where health care services were sought: people of migrant origin predominantly visited a doctor at municipal health centers whereas the general population also used private and occupational health care. Self-reported need for doctor's treatment was especially high among Russian women and Kurdish men and women. Compared to the general population, all migrant origin groups reported much higher levels of unmet medical need and were less satisfied with the treatment they had received. Improving basic-level health services would serve besides the population at large, the wellbeing of the population of migrant origin.

Cervical Cancer Screening Participation among Women of Russian, Somali, and Kurdish Origin Compared with the General Finnish Population: A Register-Based Study.

Migrant-origin women are less prone to cervical screening uptake compared with host populations. This study examined cervical cancer screening participation and factors associated with it in the Finnish mass screening program during 2008-2012 in women of Russian, Somali and Kurdish origin compared with the general Finnish population (Finns) in Finland. The study population consists of samples from the Finnish Migrant Health and Well-being Study 2010-2012 and Health 2011 Survey; aged 30-64 (n = 2579). Data from the Finnish screening register linked with other population-based registry data were utilized. For statistical analysis we employed logistic regression. Age-adjusted screening participation rates were Russians 63% (95% CI: 59.9-66.6), Somalis 19% (16.4-21.6), Kurds 69% (66.6-71.1), and Finns 67% (63.3-69.8). In the multiple-adjusted model with Finns as the reference; odds ratios for screening were among Russians 0.92 (0.74-1.16), Somalis 0.16 (0.11-0.22), and Kurds 1.37 (1.02-1.83). Among all women, the substantial factor for increased screening likelihood was hospital care related to pregnancy/birth 1.73 (1.27-2.35), gynecological 2.47 (1.65-3.68), or other reasons 1.53 (1.12-2.08). Screening participation was lower among students and retirees. In conclusion, screening among the migrant-origin women varies, being significantly lowest among Somalis compared with Finns. Efforts using culturally tailored/population-specific approaches may be beneficial in increasing screening participation among women of migrant-origin.

Migrants Are Underrepresented in Mental Health and Rehabilitation Services-Survey and Register-Based Findings of Russian, Somali, and Kurdish Origin Adults in Finland.

Mounting evidence suggests that migration background increases the risk of mental ill health, but that problems exist in accessing healthcare services in people of migrant origin. The present study uses a combination of register- and survey-based data to examine mental health-related health service use in three migrant origin populations as well as the correspondence between the need and use of services. The data are from the Finnish Migrant Health and Wellbeing Study (Maamu), a comprehensive cross-sectional interview and a health examination survey. A random sample consisted of 5909 working-aged adults of Russian, Somali, and Kurdish origin of which 3000 were invited to participate in the survey and the rest were drawn for a register-based approach. Some of the mental health services, based on registers, were more prevalent in the Kurdish origin group in comparison with the general population and less prevalent in the Russian and Somali origin groups. All the migrant origin groups were underrepresented in rehabilitation services. When affective symptoms were taken into account, all the migrant origin groups were underrepresented in all of the services. This calls for actions to promote mental health, diminish the barriers to access services, and improve the service paths for migrants.

Prevalence and determinants of vitamin D deficiency and insufficiency among three immigrant groups in Finland: evidence from a population-based study using standardised 25-hydroxyvitamin D data.

OBJECTIVE: We investigated the determinants of serum 25-hydroxyvitamin D [S-25(OH)D] and dietary vitamin D sources among three immigrant groups in Finland and compared their S-25(OH)D to the general Finnish population. DESIGN: Cross-sectional population-based Migrant Health and Wellbeing Study and the nationally representative Finnish Health 2011 Survey. S-25(OH)D was standardised according to the Vitamin D Standardisation Program. Vitamin D sources were assessed by interview. SETTING: Six different municipalities in Finland (60°-63°N). PARTICIPANTS: Immigrants aged 18-64 years (446 Russians, 346 Somalis, 500 Kurds), 798 Finns aged 30-64 years. RESULTS: The mean of S-25(OH)D was 64 (95 % CI 62, 66), 44 (95 % CI 41, 46), 35 (95 % CI 34, 37) and 64 (95 % CI 62, 66) nmol/l for Russians, Somalis, Kurds and Finns, respectively. S-25(OH)D among Somalis and Kurds was lower compared with Finns (P < 0·001). The prevalence of vitamin D deficiency (S-25(OH)D <30 nmol/l) and insufficiency (S-25(OH)D <50 nmol/l) was higher among immigrants than Finns (P < 0·001). Vitamin D-rich foods differed between the groups; vitamin D-fortified fat spread consumption was higher among Somalis (91 %) than among Russians (73 %) and Kurds (60 %); fish was less consumed among Kurds (17 %) than among Russians (43 %) and Somalis (38 %); and 57 % Russians, 56 % Kurds and 36 % Somalis consumed vitamin D-fortified dairy daily (P < 0·001 for all). Daily smoking, alcohol consumption and winter blood sampling were determinants of vitamin D insufficiency (P ≤ 0·03). Older age, physical activity, fish and vitamin D-fortified dairy consumption were associated with lower odds of insufficiency (P ≤ 0·04). CONCLUSIONS: Vitamin D status differed among immigrant groups and the determinants are, to some degree, associated with learned or existing cultural behaviours.

Pre-migration traumatic experiences, post-migration perceived discrimination and substance use among Russian and Kurdish migrants-a population-based study.

BACKGROUND AND AIMS: The associations between traumatic events, substance use and perceived discrimination have been rarely studied among migrants in host countries. We examined whether pre-migration potentially traumatic experiences (PTEs) or perceived discrimination (PD) are associated with substance use among migrants with voluntary (Russians) and forced (Kurds) migration backgrounds. DESIGN: Cross-sectional interview and health examination data from the Finnish Migrant Health and Wellbeing Study were used. The target sample (n = 1000 for each group) was drawn from the national population register using stratified random sampling by participants' country of birth and native language. SETTING: Population-based data were collected from six cities in Finland during 2010-12. PARTICIPANTS: The participation rates were 68% (Russians) and 59% (Kurds). The analytical sample size varied (Russians n = 442-687, Kurds n = 459-613), as some participants completed only interview, health examination or short interview. The majority of Kurds had a refugee background (75%) while Russians had mainly migrated for other reasons (99%). MEASUREMENTS: The three main outcomes were self-reported binge drinking, daily smoking and life-time cannabis use. PTEs and PD were self-reported in the interview. Socio-demographic background, migration-related factors and current affective symptoms were adjusted for. FINDINGS: Among Kurds, PTEs were associated with binge drinking [adjusted odds ratio (aOR) = 2.65, 95% confidence interval (CI) = 1.30-5.42] and PD was associated with life-time cannabis use (aOR = 3.89, 95% CI = 1.38-10.97) after adjusting for contextual factors. Among Russians, PTEs were associated with life-time cannabis use adjusting for contextual factors (aOR = 2.17, 95% CI = 1.12-4.18). CONCLUSIONS: In Finland, pre-migration traumatic experiences appear to be associated with life-time cannabis use among the Russian migrant population (voluntary migration) and binge drinking among the Kurdish migrant population (forced migration). Perceived discrimination in Finland appears to be associated with life-time cannabis use among Kurdish migrants.

Advance directives in European long-term care facilities: a cross-sectional survey.

BACKGROUND: End-of-life care practices in long-term care facilities (LTCFs) are the focus of growing attention in Europe, due to rapidly increasing number of older persons living in LTCFs. The knowledge about end-of-life discussions or existence of written advance directives in the European LTCFs is scarce. This study's aim is to investigate the prevalence of written advance directives and their sociodemographic associates, among recently deceased LTCF residents, in six European countries. METHODS: Data from the European Union-funded PACE database were collected from 322 LTCFs in six European countries in 2014. The assessments were performed by using two questionnaires designed for LTCF administrative staff and for staff member.LTCFs were selected within each country by using proportional stratified random sampling procedure. Facilities with certain types and sizes were included from each country.Multilevel multivariate analyses were performed to evaluate associations between written advance directives and selected predictors. RESULTS: In total, 32.5 % of the 1384 deceased LTCF residents had a written advance directive with a range from 0% to 77 % between countries. The proportion of the most common advance directive, 'Do not resuscitate in case of cardiac or respiratory arrest (DNR)', varied correspondingly from 0% to 75%.LTCF type (OR 2.86 95% CI 1.59 to 5.23) and capability of expressing at the time of admission (OR 3.26 95% CI 2.26 to 4.71) were the independent predictors for advance directive. Residents living in LTCFs where physician was available were less likely to have advance directive compared with residents from LTCFs where physician was not available. CONCLUSION: Extensive differences for prevalence of written advance directive exist between countries among older LTCF residents in Europe. Timely and appropriate response to LTCF resident's health needs and preferences efforts advance care planning.

Asylum seekers health and wellbeing (TERTTU) survey: study protocol for a prospective total population health examination survey on the health and service needs of newly arrived asylum seekers in Finland.

INTRODUCTION: Health, well-being and health service needs of asylum seekers have emerged as urgent topics following the arrival of 2.5 million asylum seekers to the European Union (EU) between 2015 and 2016. However, representative information on the health, well-being and service needs of asylum seekers is scarce. The Asylum Seekers Health and Wellbeing (TERTTU) Survey aims to: (1) gather population-based representative information; (2) identify key indicators for systematic monitoring; (3) produce the evidence base for development of systematic screening of asylum seekers' health, well-being and health service needs. METHODS AND ANALYSIS: TERTTU Survey is a population-based prospective study with a total population sample of newly arrived asylum seekers to Finland, including adults and children. Baseline data collection is carried out in reception centres in 2018 and consists of a face-to-face interview, self-administered questionnaire and a health examination following a standardised protocol. Altogether 1000 asylum seekers will be included into the study. Baseline data will be followed up with national electronic health record data encompassing the entire asylum process and later with national register data among persons who receive residency permits. ETHICS AND DISSEMINATION: Ethical approval has been granted by the Coordinating Ethics Committee of the Helsinki and Uusimaa Hospital District. Participation is voluntary and based on written informed consent. Results will be widely disseminated on a national and international level to inform health and welfare policy as well as development of services for asylum seekers. Results of the study will constitute the evidence base for development and implementation of the initial health assessment for asylum seekers on a national level.

The association between anthropometric measures and glycated haemoglobin (HbA1c) is different in Russian, Somali and Kurdish origin migrants compared with the general population in Finland: a cross-sectional population-based study.

BACKGROUND: Persons of African and Middle-Eastern origin living in European countries have a high prevalence of type 2 diabetes, accompanied by high prevalence of obesity among women but not always among men. The aim of this study was to examine whether there are differences in the association between anthropometric measures and glucose levels measured with glycated haemoglobin and fasting blood glucose among persons of migrant origin in Finland. METHODS: Cross-sectional population-based data of the 30-64 year-old participants in the health examination of the Migrant Health and Wellbeing Study was used, selecting persons without diabetes (Russian origin n = 293, Somali origin n = 184, Kurdish origin n = 275). The reference group were non-diabetic participants in the Health 2011 Survey (n = 653), representative of the general Finnish population. Anthropometric measures included body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR) and waist-to-hip ratio (WHR, available for Maamu Study participants only). RESULTS: Depending on whether continuous or categorical anthropometric measures were used, age, sex and anthropometrics explained 13-18% of variation in HbA1c among persons of Russian origin, 5-10% among persons of Somali origin, 1-3% among persons of Kurdish origin and 11-13% among the general population. Also depending on whether continuous or categorical anthropometric measures were used, age, sex and anthropometrics explained 13-19% of variation in fasting blood glucose among persons of Russian origin, 15-20% among persons of Somali origin, 13-17% among persons of Kurdish origin and 16-17% among the general population. With exception for BMI, strength of the association between continuous anthropometric measures and HbA1c was significantly lower among persons of Kurdish origin compared with the general Finnish population (p = 0.044 for WC and p = 0.040 for WHtR). CONCLUSIONS: A low degree of association between anthropometric measures and HbA1c was observed among persons of Kurdish origin. Findings of this study suggest caution is warranted when using HbA1c as a screening tool for glucose impairment among persons without diabetes in populations of diverse origin.

Disparities in treatment of diabetes and hypertension among groups of foreign origin and the general Finnish population.

BACKGROUND: Migrants from low-income countries are more predisposed to diabetes and cardiovascular risks than host European natives, but how treatment targets are met in migrant patients is unclear. We examined health service use and treatment of diabetes and hypertension among selected migrant groups and the general Finnish population and compared prevalence of cardiovascular risk factors between patients and non-patients. METHODS: Cross-sectional data from randomly sampled 30- to 64-year-old participants (387 Russian, 198 Somali and 343 Kurdish origin migrants) of the Migrant Health and Wellbeing Survey (2010-2012) were used. Health 2011 survey data (n = 1086) were used as a comparison group. RESULTS: Compared with the general population, diabetes-related doctor/nurse visits were more frequent among Russian and Somali, but not the Kurdish group. Use of prescribed antidiabetic and antihypertensive drugs were significantly lower among Russians (78%/56%) and Kurdish (68%/58%), but not in Somalis (85%/62%) compared with the general population (96%/78%). Obesity, elevated blood pressure and elevated glucose levels were more prevalent in patients than non-patients, and over 60% of patients and over 70% of non-patients had elevated plasma low density lipoprotein cholesterol. Differences in cardiovascular disease (CVD) risk profiles between patients and non-patients were not associated with socio-economic factors. CONCLUSIONS: This study indicates disparities in prevalence and management of diabetes and hypertension and their associated risk factors among ethnic groups. Diabetes, CVD risks and treatment outcomes in patients were sub-optimal, especially among foreign origin groups. Comprehensive health promotion strategies are needed to improve cardiometabolic health in vulnerable populations.

Births and induced abortions among women of Russian, Somali and Kurdish origin, and the general population in Finland -comparison of self-reported and register data.

BACKGROUND: Since reproductive health is often considered a highly sensitive topic, underreporting in surveys and under coverage of register data occurs frequently. This may lead to inaccurate information about the reproductive health. This study compares the proportion of women having births and induced abortions among migrant women of Russian, Somali and Kurdish origin in Finland to women in the general Finnish population and examines the agreement between survey- and register-based data. METHODS: The survey data from the Migrant Health and Wellbeing Study conducted in 2010-2012 and data from the Health 2011 Survey with corresponding information on women in the general population were used in this study. The respondents were women aged 18-64: 341 Russian, 176 Somali and 228 Kurdish origin women and 630 women in the general population. The survey data were linked to the Finnish Medical Birth Register and the Register of Induced Abortions. RESULTS: In the combined (survey and register) data, migrant groups aged 30-64 had a higher proportion (89-96%) compared to the general population (69%) of women with at least one birth. Under-coverage of registered births was observed in all study groups. Among women aged 18-64, 36% of the Russian group and 24% of the Kurdish group reported more births in the survey than in the register data. In the combined data, the proportions of Russian origin (69%) and Kurdish origin (38%) women who have had at least one induced abortion in their lifetime are higher than in the general population (21%). Under-reporting of induced abortions in survey was observed among Somali origin women aged 18-29 (1% vs. 18%). The level of agreement between survey and register data was the lowest for induced abortions among the Somali and Russian groups (- 0.01 and 0.27). CONCLUSION: Both survey- and register-based information are needed in studies on reproductive health, especially when comparing women with foreign origin with women in the general population. Culturally sensitive survey protocols need to be developed to reduce reporting bias.