Exploring pain in the Andes--learning from the Quichua (Inca) people experience.

There is a mounting recognition that culture profoundly shapes human pain experience. The 28 million indigenous people of the Andes in South America, mainly the Quichua (Inca) people, share a distinctive culture. However, little is known about their pain experience and suffering. The aim of the present study was to explore how Quichua adults perceive, describe, and cope with the pain. An exploratory qualitative/descriptive study was conducted with a convenience sample of 40 Quichua adults, including 15 women and 25 men, in the Northern Highlands of Ecuador. Data were collected through structured interviews of approximately 3 h, using a Quichua questionnaire called "The Nature of Pain" [Nanay Jahua Tapuicuna]. The interviews covered the notions of causation of pain, vulnerability to pain, responses to pain, aggravating factors, frequent locations of pain, types of pain, duration, characteristics of pain, control of pain, pathways to care, and preventive measures of pain. Basic descriptive analyses were performed. The Quichuas' pain experience is complex and their strategies to cope with it are sophisticated. According to the Quichuas, emotions, life events, co-morbid conditions, and spirits, among others factors play an important role in the origin, diagnosis, and treatment of pain. They strongly embrace biomedicine and physicians as well as Quichua traditional medicine and traditional healers. Family members and neighbors are also valuable sources of health care and pain control. The pathway to pain care that the Quichua people prefer is inclusive and pluralistic. The knowledge of the Quichua ethnographic "emic" details of their belief system and coping strategies to control pain are clinically useful not only for the health professional working in the Andes, some Quichua cultural characteristics related to pain could be useful to the culturally competent health practitioner who is making efforts to provide high-quality medical care in rural and multicultural societies around the world.

International migration to Canada: the post-birth health of mothers and infants by immigration class.

There are over 214 million international migrants worldwide, half of whom are women, and all of them assigned by the receiving country to an immigration class. Immigration classes are associated with certain health risks and regulatory restrictions related to eligibility for health care. Prior to this study, reports of international migrant post-birth health had not been compared between immigration classes, with the exception of our earlier, smaller study in which we found asylum-seekers to be at greatest risk for health concerns. In order to determine whether refugee or asylum-seeking women or their infants experience a greater number or a different distribution of professionally-identified health concerns after birth than immigrant or Canadian-born women, we recruited 1127 migrant (and in Canada <5 years) women-infant pairs, defined by immigration class (refugee, asylum-seeker, immigrant, or Canadian-born). Between February 2006 and May 2009, we followed them from childbirth (in one of eleven birthing centres in Montreal or Toronto) to four months and found that at one week postpartum, asylum-seeking and immigrant women had greater rates of professionally-identified health concerns than Canadian-born women; and at four months, all three migrant groups had greater rates of professionally-identified concerns. Further, international migrants were at greater risk of not having these concerns addressed by the Canadian health care system. The current study supports our earlier findings and highlights the need for case-finding and services for international migrant women, particularly for psychosocial difficulties. Policy and program mechanisms to address migrants' needs would best be developed within the various immigration classes.

Cesarean section rate differences by migration indicators.

PURPOSE: To answer the question: are there differences in cesarean section rates among childbearing women in Canada according to selected migration indicators? METHODS: Secondary analyses of 3,500 low-risk women who had given birth between January 2003 and April 2004 in one of ten hospitals in the major Canadian migrant-receiving cities (Montreal, Toronto, Vancouver) were conducted. Women were categorized as non-refugee immigrant, asylum seeker, refugee, or Canadian-born and by source country world region. Stratified analyses were performed. RESULTS: Cesarean section rates differed by migration status for women from two source regions: South East and Central Asia (non-refugee immigrants 26.0 %, asylum seekers 28.6 %, refugees 56.7 %, p = 0.001) and Latin America (non-refugee immigrants 37.7 %, asylum seekers 25.6 %, refugees 10.5 %, p = 0.05). Of these, low-risk refugee women who had migrated to Canada from South East and Central Asia experienced excess cesarean sections, while refugees from Latin America experienced fewer, compared to Canadian-born (25.4 %, 95 % CI 23.8-27.3). Cesarean section rates of African women were consistently high (31-33 %) irrespective of their migration status but were not statistically different from Canadian-born women. Although it did not reach statistical significance, risk for cesarean sections also differed by time since migration (≤2 years 29.8 %, >2 years 47.2 %). CONCLUSION: Migration status, source region, and time since migration are informative migration indicators for cesarean section risk.

Improving qualitative interviews with newly arrived migrant women.

There is a paucity of literature on how to conduct research with migrants, particularly those who do not speak the host country language, those who are newly arrived, and those who have a precarious immigration status. In qualitative research, interviewing is a common method for obtaining rich data and participants' points of view. Gathering and presenting all perspectives when interviewing vulnerable migrant women on health-seeking behaviors is challenging. In this article, we explore the process of developing and implementing a data collection plan and an interview guide for a study carried out with migrant women to explore the inhibitors/facilitators for following through on professional referrals for postbirth care. Adaptability and careful attention to multiple factors throughout the process are essential to maximizing participation and enhancing the trustworthiness of the data. Appropriate health policy and care delivery can only originate from health research with diverse migrant populations.

Postpartum depression symptoms in newcomers.

OBJECTIVES: To determine if postpartum depression (PPD) symptoms are more common in newcomer women than in Canadian-born women. METHODS: Refugee, nonrefugee immigrant, asylum-seeking, and Canadian-born new mothers were administered questionnaires for depression, social support, interpersonal violence, and demographic information. We created a PPD variable based on a score of > or = 10 on the Edinburgh Postnatal Depression Scale (EPDS) and performed a logistic regression analysis for PPD. RESULTS: Immigrants (35.1%), asylum seekers (31.1%), and refugees (25.7%) were significantly more likely than Canadian-born (8.1%) women to score > or = 10 (P = 0.008) on the EPDS, with the regression model showing an increased risk (odds ratio) for refugee (4.80), immigrant (4.58), and asylum-seeking (3.06) women. Women with less prenatal care were also more likely to have an EPDS of > or = 10 (P = 0.03). Newcomer women with EPDS scores of > or = 10 had lower social support scores than Canadian-born women (P < 0.0001). CONCLUSIONS: Newcomer mothers have an increased risk for PPD symptoms. Social support interventions should be tested for their ability to prevent or alleviate this risk.

Refugee and refugee-claimant women and infants post-birth: migration histories as a predictor of Canadian health system response to needs.

BACKGROUND: Minority women from conflict-laden areas with limited host-country knowledge are among the most vulnerable migrants. Their risk status and that of their infants is magnified during pregnancy, birth, and post-birth. We conducted a study to determine whether women's postnatal health concerns were addressed by the Canadian health system differentially based on migration status (refugee, refugee-claimant, immigrant, and Canadian-born) or city of residence. METHODS: Women speaking any of 13 languages were recruited (with their infants) from postpartum units in the main Canadian receiving cities for newcomers (Toronto, Montreal, Vancouver; total n = 341 pairs from 10 hospitals) and followed at home after birth. Our primary interest was 'unaddressed concerns'; nurse-identified health concerns based on standards of postpartum care for the woman/infant at 7-10 days post-birth, for which no professional attention had been given or planned. RESULTS: A difference in unaddressed concerns by migration status was not found in our primary model [OR refugees vs. Canadian-born = 1.40 (95% CI: 0.67-2.93); refugee-claimants, 1.20 (0.61-2.34); immigrants, 1.02 (0.56-1.85)] although differences by city of residence remained after controlling for migration status, income, education, maternal region of birth, language ability, referral status, and type of birth [Toronto vs. Vancouver OR = 3.63 (95% CI: 2.00-6.57); Montreal, 1.88 (1.15-3.09)]. The odds of unaddressed concerns were greater in all migrant groups [OR refugees vs. Canadian-born = 2.42 (95% CI: 1.51-3.87); refugee-claimants, 1.64 (1.07-2.49); immigrants, 1.54 (1.00-2.36)] when analyses excluded variables which may be on the causal pathway. INTERPRETATION: Women and their newborn infants living in Toronto or Montreal may require additional support in having their health and social concerns addressed. The definitive effect of migrant group needs confirmation in larger studies.

The childbearing health and related service needs of newcomers (CHARSNN) study protocol.

BACKGROUND: Refugee and asylum-seeking women in Canada may have significant harmful childbearing health outcomes and unmet health and social care needs. The most vulnerable of these women are: those who have left their countries by force (e.g., war, rape or abuse histories), are separated from their families, have limited knowledge of the host country languages, and are visible minorities. Asylum-seekers face additional stresses related to their unknown future status and are marginalized with regards to access to provincial health care systems. The prevalence and severity of health issues in this population is not known nor is the extent of response from social service and health care systems (including variation in provincial service delivery). Understanding the magnitude of health and social concerns of newcomers requires data from a representative sample of childbearing refugee and asylum-seeking women resettling in Canada to permit comparisons to be made with non-refugee immigrant and Canadian-born women. Our research questions are: (1) Do refugee or asylum-seeking women and their infants, experience a greater number or a different distribution of harmful health events during pregnancy, at birth, and during the postpartum period than non-refugee immigrant or Canadian-born women? (2) Are the harmful health events experienced postpartum by asylum-seeking women and their infants, addressed less often (compared to refugees, non-refugee immigrants, and Canadian-born women) by the Canadian health care system as delivered in each of the three major receiving cities for newcomers? METHODS/DESIGN: This is a four-year multi-site prospective cohort study (pregnancy to 4 months postpartum). We will seek to recruit 2400 women [200 in each of 4 groups (refugees, asylum-seekers, non-refugee immigrants, and Canadian-born) from 1 of 12 postpartum hospital units across the 3 largest receiving cities for newcomers to Canada - Montreal, Toronto, and Vancouver]. DISCUSSION: Knowledge of the extent of harmful health events occurring to asylum-seeking, refugee, immigrant, and Canadian-born women, and the response of the health care system to those events and group differences, if they exist, will inform immigration and health policy makers as well as providers of services.

A new application of sound resonance technology therapy for the treatment of fibromyalgia: a retrospective analysis.

OBJECTIVE: Chart review to evaluate the effectiveness of a three-phase sound resonance technology therapy (SRTT) protocol for the treatment of fibromyalgia. RESULTS: Initial FIQ scores of 159 consecutive patients ranged from 24 to 80 (mean=58). After Phase 1, ( approximately 1 month into the protocol), FIQ scores had decreased on average by 26 points (n=128, 95% CI 23-30, p<.001). After phase 3 of the protocol 53 patients completed an FIQ questionnaire and the mean decrease in FIQ score was 38 points (95% CI 32-44, p=.004). CONCLUSIONS: This retrospective analysis suggests considerable and rapid relief of the symptoms of fibromyalgia following the use of the three-phase SRTT treatment protocol, which appears to be maintained over several years. Although these results are not conclusive they are remarkable as no other therapy reported in the scientific literature seems as efficacious for fibromyalgia. A follow-up study using an RCT design is warranted.

[Birth order, behavioural problems, and the mother-child relationship in siblings aged 4 to 11 years from a 2-child family]. / Rang de naissance, difficultés de comportement et relation mère-enfant chez des jeunes de 4 à 11 ans de fratries composées de deux enfants.

UNLABELLED: Birth Order, Behavioural Problems, and the Mother-Child Relationship in Siblings Aged 4 to 11 Years From a 2-Child Family OBJECTIVE: This study was designed to define the relation between some sibling characteristics (birth order, sex, and interval between successive births) and some behavioral problems in children, on the one hand, and certain dimensions of the mother-child relationship, on the other hand. METHOD: The sample, from National Longitudinal Survey of Children and Youth, included 1,196 families with 2 biological children aged 4 to 11 years. Behavioural problems and dimensions of the mother-child relationship were assessed by mothers. Repeated-measures multivariate analyses of variance were conducted. RESULTS: Analyses showed that first-born children have more internalized symptoms than second-born children. Second-born children also have more positive interactions with their mothers than first-born children. The interval between successive births does not affect these results. CONCLUSION: Several differences emerged between siblings. Health professionals should take these findings into account in their clinical assessments.

Can teachers' behavior ratings be used to screen early adolescent boys for psychiatric diagnoses?

The present study examined if a short, 22-item teacher rating questionnaire could be used to screen young adolescent boys for psychiatric diagnoses. Subjects were 239 12-year-old boys from a community sample of low socioeconomic status families. Child and parent versions of the Diagnostic Interview Schedule for Children were used to provide DSM-III-R diagnoses. Results show a low to moderate screening value for the Short Social Behavior Questionnaire (S-SBQ) scales, with best results for externalizing disorders. The method used to establish the diagnoses had an impact on the screening efficacy of the S-SBQ, higher prevalence rates resulting in a lower proportion of false-positives for the same cutoff point. Additional research is needed to assess the screening efficacy of the S-SBQ across ages and gender, but results suggest that teacher ratings with the S-SBQ could be used to screen boys with externalizing disorders at the end of elementary school.

Stress during pregnancy affects general intellectual and language functioning in human toddlers.

Prenatal maternal stress has been shown to impair functioning in nonhuman primate offspring. Little is known about the effects of prenatal stress on intellectual and language development in humans because it is difficult to identify sufficiently large samples of pregnant women who have been exposed to an independent stressor. We took advantage of a natural disaster (January 1998 ice storm in Québec, Canada) to determine the effect of the objective severity of pregnant women's stress exposure on general intellectual and language development of their children. Bayley Mental Development Index (MDI) scores and parent-reported language abilities of 58 toddlers of mothers who were exposed to varying levels of prenatal stress were obtained at 2 y of age. The hierarchical multiple regression analyses indicated that the toddlers' birth weight and age at testing accounted for 12.0% and 14.8% of the variance in the Bayley MDI scores and in productive language abilities, respectively. More importantly, the level of prenatal stress exposure accounted for an additional 11.4% and 12.1% of the variance in the toddlers' Bayley MDI and productive language abilities and uniquely accounted for 17.3% of the variance of their receptive language abilities. The more severe the level of prenatal stress exposure, the poorer the toddlers' abilities. The level of prenatal stress exposure accounted for a significant proportion of the variance in the three dependent variables above and beyond that already accounted for by non-ice storm-related factors. We suspect that high levels of prenatal stress exposure, particularly early in the pregnancy, may negatively affect the brain development of the fetus, reflected in the lower general intellectual and language abilities in the toddlers.

Differences between only children and children with 1 sibling referred to a psychiatric clinic: a test of Richards and Goodman's findings.

OBJECTIVE: To test Richards and Goodman's hypothesis that a higher proportion of only children under age 5 years assessed in a psychiatric department do not present a psychiatric diagnosis, compared with preschool children with 1 sibling, and to investigate other variables relative to children in this age group with no psychiatric disorder, in light of Richards and Goodman's findings. METHOD: We gathered data from 169 children under age 5 years seen in the psychiatric department of a large pediatric hospital in Montreal, Quebec. RESULTS: First, bivariate analysis showed no differences between the proportion of only children and children with 1 sibling regarding absence of a psychiatric diagnosis. Second, multivariate logistic regression analysis revealed that child's age and mother's child-rearing attitudes were significant variables. Younger children (that is, age 0 to 2 years) and children whose mothers had "adequate" child-rearing attitudes (that is, not exhibiting significant impatience, rejection, stubbornness, neglect, or overprotectiveness) were more likely to have no disorder. CONCLUSION: These findings run counter to Richards and Goodman's results and suggest that other variables, such as child's age and mother's behaviour, are significant predictors of children under age 5 years having no diagnosis.

[The use of theatre in the psychosocial readaptation of patients with mental disorders: participants' perspectives]. / Le jeu théâtral comme médium thérapeutique en réadaptation psychosociale: le point de vue des participants.

BACKGROUND: Therapy using theatrical activity was proposed to six clients with severe and persistent mental health problems. The purpose of this study was to determine what meaning the participants attributed to this experience and which aspects of the therapy they considered influential for their progress. METHOD: A formal approach, based on the opinions of the actors, was used in order to optimize the quality of the interventions. The application was as closely linked as possible to a real theatrical experience. An analysis of the qualitative data collected from a questionnaire and a semi-structured interview of three subjects selected from a purposive sampling was done by way of successive cycles of data reduction. RESULTS AND PRACTICE IMPLICATIONS: The participants valued the flexibility and versatility of the theatrical experience. They perceived the presence of the public as essential to enhancing their experience of pleasure and personal competency. Therapy using theatrical activity appears to be relevant in the field of psychosocial rehabilitation.

Factors associated with depression in pregnant immigrant women.

This study examined psychosocial risk factors for depressive symptomatology in a community sample of pregnant immigrant women in Montreal, Canada. One hundred and nineteen participants were recruited through hospitals and responded to questionnaires assessing depression, somatic symptoms, functional status, social support, stressful life events and marital adjustment. Forty-two percent of participants scored above the cut-off for depression. Depressive symptoms were associated with poorer functional status and more somatic symptoms. Depressed women reported a lack of social support, more stressful life events and poorer marital adjustment. Transitions associated with migration may place pregnant immigrant women at high risk for depression.

[The use of theatre as promoter of change in social skills]. / Le jeu théâtral comme inducteur de changement dans les habiletés sociales.

This article presents a case study on the use of acting with six people suffering from severe and long-lasting psychotic state. The study aims at elaborating the hypothesis on the use of this activity in readaptation. The effect of expression therapy on the development of social skills has rarely been substantiated by empirical studies. The literature review points out a poor generalization of social skills following social skills training ; it also allows a description of the acting and its therapeutic potential. A qualitative methodology is applied to an investigation conducted in a psychiatric day center and uses the description of behavior before and after the program. The results indicate resemblances between the therapeutically acquired social skills and the social behavior from everyday life. The use of acting in therapy would contribute at the generalization of social skills.

Obstetrical complications and violent delinquency: testing two developmental pathways.

This study focused on the interaction between specific obstetrical complications and early family adversity in predicting violent behavior during childhood and adolescence, in a sample of 849 boys from low socioeconomic areas of Montreal, Canada. Obstetrical complication data from medical records were used to create three scales using a nonlinear principal component analysis followed by rotation. Family adversity and teacher-rated physical aggression were assessed when the boys were in kindergarten and self-reports of delinquency were collected when they were 17. Elevated scores on the Deadly Risk Situation scale of obstetrical complications (preeclampsia, umbilical cord prolapse, and induced labor) increased the risk of being violent at both 6 and 17 years of age, only among boys who grew up in high adverse familial environments. Moreover, this interaction partly accounted for the continuity between violence in childhood and adolescence. Interventions for young pregnant women from deprived environments and their babies are discussed in light of these results.