Policy Brief No. 25 - Are Immigrants in Better Health Than Native Canadians?

A number of studies have shown that immigrants tend to be in better health than their fellow citizens in their host countries, at least during the initial period following their arrival. Our work, a systematic review which brings together the results of 77 empirical research studies on this question, demonstrates that while the “healthy immigrant” effect is usually found in adult immigrants, it is another matter for children and older people. The extent of the healthy immigrant selection effect is also much more significant in terms of mortality than of morbidity. Our analysis suggests that immigrant health policies should not be “one size fits all” in type, but need to take into account both the age of immigrants and also those particular health indicators in terms of which the immigrants are most vulnerable

The Healthy Immigrant Effect in Canada: A Systematic Review

Canada’s immigration admissions policy culls for individuals with high human capital (Knowles, 2007). Given the strong links between human capital and health (Jasso et al., 2004) and previous research which suggested the presence of a seemingly universal foreign-born health advantage among Canada’s migrant population, we expected to see the healthy immigrant effect across the life-course and for multiple health outcomes. What we found instead was a pattern much more complex than previously envisioned. Our review uncovered a clear survival advantage for immigrants, owing in part to positive self and state selection processes (at least for non-refugee migrants). However, there is greater variation in the healthy immigrant effect for morbidity. Moreover, viewed through the lens of different life-course stages, we uncovered a strong foreign-born health advantage in adulthood but less so during the perinatal period, childhood/adolescence, and late life. Immigrant selection may be less relevant for the very young and very old, and of course we should thus not expect the presence of a healthy immigrant effect for these groups if that is the case. But even during adulthood when the healthy immigrant effect appears to be most effective, some discrepancies still remain between different immigrant subgroups depending on the type of health measure used (e.g., greater variation for self-rated health but less variation for mental health, disability/functional limitations, risk behaviors, and chronic conditions)

The effect of acculturation on the health of new immigrants to Canada between 2001 and 2005

Poster Presentation When comparing the health of immigrants to the native-born, studies have found what is called a “healthy migrant effect” where immigrants are likely to have a health advantage compared to native-born individuals. In Canada, effect could partially be explained by the strict immigration criteria that select immigrants on their health status (Akresh and Frank, 2008). However, immigrants lose this advantage over time so that their level of health often deteriorates below the one of natives. This deterioration is an important issue for the health of populations in Canada and a challenge to adapt the health system to the needs of immigrants. The Longitudinal Survey of Immigration to Canada (LSIC) provides an original way to assess the effects of acculturation, a process of adopting new cultural norms and practices, which has been often cited as one of the leading causes of immigrant’s health deterioration. The LSIC contains a cohort of 7716 landed immigrants in Canada between October 1st 2000 and September 30th 2001. The objective of this paper is to analyze the effects of acculturation on immigrants’ general health and self-perceived mental health. The analysis is based on multivariate logistic regressions that control for pre-migration and post-migration factors which may potentially confound the relationship between acculturation and health. Our results show that acculturation outcomes proposed by Berry (1997) - integration, assimilation, separation, marginalization- influence the health of immigrants through socioeconomic variables such as education and financial status

Responsiveness of the Scale for the Assessment and Rating of Ataxia and Natural History in 884 Recessive and Early Onset Ataxia Patients

The Scale for the Assessment and Rating of Ataxia (SARA) is the most widely applied clinical outcome assessment (COA) for genetic ataxias, but presents metrological and regulatory challenges. To facilitate trial planning, we characterize its responsiveness (including subitem-level relations to ataxia severity and patient-focused outcomes) across a large number of ataxias, and provide first natural history data for several of them.Subitem-level correlation- and distribution-based analysis of 1637 SARA assessments in 884 patients with autosomal-recessive/early-onset ataxia (370 with 2-8 longitudinal assessments), complemented by linear mixed-effects modeling to estimate progression and sample sizes.While SARA subitem responsiveness varied between ataxia severities, gait/stance showed a robust granular linear scaling across the broadest range (SARA25; 2.7-fold sample size). Use of a novel rank-optimized SARA without subitems finger-chase and nose-finger reduces sample sizes by 20-25%.This study comprehensively characterizes COA properties and annualized changes of the SARA across and within a large number of ataxias. It suggests specific approaches for optimizing its responsiveness that might facilitate regulatory qualification and trial design. This article is protected by copyright. All rights reserved

The ARCA Registry: A Collaborative Global Platform for Advancing Trial Readiness in Autosomal Recessive Cerebellar Ataxias.

Autosomal recessive cerebellar ataxias (ARCAs) form an ultrarare yet expanding group of neurodegenerative multisystemic diseases affecting the cerebellum and other neurological or non-neurological systems. With the advent of targeted therapies for ARCAs, disease registries have become a precious source of real-world quantitative and qualitative data complementing knowledge from preclinical studies and clinical trials. Here, we review the ARCA Registry, a global collaborative multicenter platform (>15 countries, >30 sites) with the overarching goal to advance trial readiness in ARCAs. It presents a good clinical practice (GCP)- and general data protection regulation (GDPR)-compliant professional-reported registry for multicenter web-based capture of cross-center standardized longitudinal data. Modular electronic case report forms (eCRFs) with core, extended, and optional datasets allow data capture tailored to the participating site's variable interests and resources. The eCRFs cover all key data elements required by regulatory authorities [European Medicines Agency (EMA)] and the European Rare Disease (ERD) platform. They capture genotype, phenotype, and progression and include demographic data, biomarkers, comorbidity, medication, magnetic resonance imaging (MRI), and longitudinal clinician- or patient-reported ratings of ataxia severity, non-ataxia features, disease stage, activities of daily living, and (mental) health status. Moreover, they are aligned to major autosomal-dominant spinocerebellar ataxia (SCA) and sporadic ataxia (SPORTAX) registries in the field, thus allowing for joint and comparative analyses not only across ARCAs but also with SCAs and sporadic ataxias. The registry is at the core of a systematic multi-component ARCA database cluster with a linked biobank and an evolving study database for digital outcome measures. Currently, the registry contains more than 800 patients with almost 1,500 visits representing all ages and disease stages; 65% of patients with established genetic diagnoses capture all the main ARCA genes, and 35% with unsolved diagnoses are targets for advanced next-generation sequencing. The ARCA Registry serves as the backbone of many major European and transatlantic consortia, such as PREPARE, PROSPAX, and the Ataxia Global Initiative, with additional data input from SPORTAX. It has thus become the largest global trial-readiness registry in the ARCA field

Living with myotonic dystrophy; what can be learned from couples? a qualitative study

Contains fulltext : 96062.pdf (publisher's version ) (Open Access)BACKGROUND: Myotonic dystrophy type 1 (MD1) is one of the most prevalent neuromuscular diseases, yet very little is known about how MD1 affects the lives of couples and how they themselves manage individually and together. To better match health care to their problems, concerns and needs, it is important to understand their perspective of living with this hereditary, systemic disease. METHODS: A qualitative study was carried out with a purposive sample of five middle-aged couples, including three men and two women with MD1 and their partners. Fifteen in-depth interviews with persons with MD1, with their partners and with both of them as a couple took place in the homes of the couples in two cities and three villages in the Netherlands in 2009. Results : People with MD1 associate this progressive, neuromuscular condition with decreasing abilities, describing physical, cognitive and psychosocial barriers to everyday activities and social participation. Partners highlighted the increasing care giving burden, giving directions and using reminders to compensate for the lack of initiative and avoidant behaviour due to MD1. Couples portrayed the dilemmas and frustrations of renegotiating roles and responsibilities; stressing the importance of achieving a balance between individual and shared activities. All participants experienced a lack of understanding from relatives, friends, and society, including health care, leading to withdrawal and isolation. Health care was perceived as fragmentary, with specialists focusing on specific aspects of the disease rather than seeking to understand the implications of the systemic disorder on daily life. CONCLUSIONS: Learning from these couples has resulted in recommendations that challenge the tendency to treat MD1 as a condition with primarily physical impairments. It is vital to listen to couples, to elicit the impact of MD1, as a multisystem disorder that influences every aspect of their life together. Couple management, supporting the self-management skills of both partners is proposed as a way of reducing the mismatch between health services and health needs

Arts appliqués : étalage : rapport d'analyse de situation de travail /

La couv. porte en outre: La formation professionnelle au secondaireInséré dans un portefeuill

Arts appliqués : aménagement d'intérieur et étalage : étude préliminaire /

La couv. porte en outre: La formation professionnelle au secondaireBibliogr.: p. 24Notes (part. bibliogr.) au bas des p

L\u27effet de la sélection de l’immigrant en bonne santé au Canada: Une revue systématique

Au Canada, la politique d\u27immigration favorise les individus ayant un capital humain élevé (Knowles, 2007). Étant donné les liens étroits entre le capital humain et la santé (Jasso et al., 2004) et le fait que les recherches suggèrent la présence d\u27un avantage de santé universel au sein de la population immigrante au Canada, nous nous attendions à observer l\u27effet de la sélection de l’immigrant en bonne santé à tous les stades du parcours de vie et sur des problèmes de santé multiples. Notre examen suggère plutôt un modèle plus complexe qu’envisagé initialement. Cette synthèse indique que les immigrants ont clairement un avantage de survie, partiellement attribuable aux processus de sélection positifs aux niveaux individuel et étatique (sauf peut-être pour les réfugiés). Cependant, l’avantage de santé des immigrants varie grandement lorsque mesuré par la morbidité. En outre, en examinant les différentes étapes du parcours de vie des immigrants, on constate une meilleure santé des immigrants à l\u27âge adulte, mais souvent inférieur pour la période périnatale, l’enfance/adolescence et aux âges avancés. Le processus de sélection des immigrants ne semble pas opérer de la même manière chez les immigrants très jeunes et très âgés que chez les adultes. Si tel est le cas, nous ne devrions pas envisager un avantage de santé des immigrants au sein de ces groupes. Même à l\u27âge adulte, âge auquel l\u27effet de la sélection de l’immigrant en bonne santé semble être le plus marqué, certaines divergences subsistent entre les sous-groupes d\u27immigrants selon le type de mesure de la santé utilisé (par ex., une plus grande variation de la santé auto-déclarée, mais une variation moindre pour la santé mentale, invalidités/incapacités, les comportements à risque et les maladies chroniques)