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

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

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

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

Differences in working conditions and employment arrangements among migrant and non-migrant workers in Europe.

OBJECTIVE: To determine migrant workers' exposure to select occupational risks and compare it with that of non-migrant workers in Europe. DESIGN: Based on the European Working Conditions Survey (EWCS-2005, n=29,654 workers, 31 countries) we examined differential prevalence amongst migrant and non-migrant workers' primary paid jobs in terms of employment arrangements (working >10 hours/day, working >5 days/week, on Sundays, without a contract, changes in the work schedule and not free to decide when to take holidays or days off) and working conditions (exposure to hazards including chemical, physical agents, physical load and psychological conditions). For the purpose of this study, a migrant is defined as a person without nationality of the country of residence (n=926). Adjusted prevalence ratios (aPRs) for age, economic sector and education were calculated. RESULTS: Differences in employment arrangements and working conditions were noted by migration status, gender and occupational status. Among non-manual workers, migrant males are more exposed than non-migrant males to negative psychosocial conditions--working at a very high speed (aPR 1.23; 95% CI 1.07-1.42) and shift work (aPR 1.66; 95% CI 1.27-2.17)--and adverse employment arrangements: working on Sundays (aPR 1.91; 95% CI 1.42-2.55), variable starting/finishing times (aPR 1.17; 95% CI 1.04-1.32) and changes in work schedule (aPR 1.56; 95% CI 1.30-1.88). Compared with non-migrant males, male migrant manual workers are the group with a greater number of disparities in terms of exposure to negative working conditions. Female migrant non-manual workers are more exposed to psychosocial conditions - working at very high speed (aPR 1.26; 95% CI 1.10-1.44) and shift work (aPR 1.61; 95% CI 1.29-2.01) while female manual migrant workers were more likely to report standing or walking (aPR 2.43; 95% CI 1.98-2.97), not having a contract (aPR 2.94; 95% CI 2.07-4.10) and not being free to decide days off and holidays (aPR 1.25; 95% CI 1.07-1.48) than non-migrants. CONCLUSION: Migrant workers across Europe are more likely to be exposed to certain working and employment arrangements that may place them at higher risk of future health problems.