Purchases of psychotropic drugs among the migrant population in Finland: a nationwide register-based cohort study

Abstract Background Migrant populations may have different mental health service needs when compared with native populations. One indicator of service use is the use of psychotropic medication. The aim of this study was to compare the purchases of psychotropic drugs among different migrant populations with the native population in Finland. Methods Foreign-born participants (n = 184 805) and their Finnish-born controls (n = 185 183) were identified from the Finnish Central Population Register. Information on their purchases of psychotropic drugs in 2011–15 was collected from the National Prescription Register. A washout period of 2009–10 was used to define incident purchases. Cox regression analysis was the statistical method used. Results At least one incident purchase of a psychotropic drug was identified for 11.1% of migrant women, 11.4% of Finnish-born women, 8.7% of migrant men and 9.8% of Finnish-born men. When controlled for age, sex, marital status, socioeconomic status and social assistance, migrants were less likely to purchase psychotropic drugs (adjusted hazard ratio 0.96, 95% confidence interval 0.93–0.98), but there was variation between different drug categories. Recent migrants and migrants from Asia and Sub-Saharan Africa were least likely to purchase drugs. Migrants from Nordic countries and other Western countries most closely resembled the Finnish-born controls. Conclusions Recent migrants in Finland appear to use fewer psychotropic drugs than native Finns. It is important to analyze the reasons for this pattern, as they may indicate delays in access to care or benefits. The heterogeneity of migrant populations must also be considered when developing services to better address their needs.

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Continuity of antipsychotic medication use among migrant and Finnish-born populations with a psychotic disorder: a register-based study

Psychological Medicine ◽

10.1017/s003329172100218x ◽

2021 ◽

pp. 1-11

Author(s):

Venla Lehti ◽

Heidi Taipale ◽

Mika Gissler ◽

Antti Tanskanen ◽

Martta Elonheimo ◽

...

Keyword(s):

Psychotic Disorder ◽

Psychotic Disorders ◽

Cox Regression ◽

Sub Saharan Africa ◽

Antipsychotic Treatment ◽

Involuntary Hospitalization ◽

Cox Regression Analysis ◽

Migrant Populations ◽

Sub Saharan ◽

New Treatment

Abstract Background Higher incidence of psychotic disorders and underuse of mental health services have been reported among many migrant populations. This study examines the initiation and continuity of antipsychotic treatment among migrants and non-migrants with a non-affective psychosis during a new treatment episode. Methods This study is based on a nationwide sample of migrants and Finnish-born controls. Participants who were diagnosed with a psychotic disorder in 2011–2014 were identified from the Care Register for Health Care (n = 1693). Information on purchases of antipsychotic drugs in 2011–2015 was collected from the National Prescription Register. The duration of antipsychotic treatment since diagnosis was estimated using the PRE2DUP model. Cox regression analysis was used to study factors that are associated with discontinuing the use of medication. Results There were fewer initiators of antipsychotic treatment after being diagnosed with psychosis among migrants (68.1%) than among Finnish-born patients (73.6%). After controlling for sociodemographic background and factors related to the type of disorder and treatment, migrants were more likely to discontinue medication (adjusted hazard ratio 1.28, 95% confidence interval 1.08–1.52). The risk of discontinuation was highest among migrants from North Africa and the Middle East and Sub-Saharan Africa and among recent migrants. Non-use of antipsychotic treatment before being diagnosed with psychosis, involuntary hospitalization and diagnosis other than schizophrenia were associated with earlier discontinuation both among migrants and non-migrants. Conclusions Migrants with a psychotic disorder are less likely to continue antipsychotic treatment than non-migrants. The needs of migrant patients have to be addressed to improve adherence.

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Resting Heart Rate predicts all-cause mortality in sub-Saharan African Patients with Heart Failure: Insight from the Douala Heart failure registry (Do-HF)

10.1101/2020.11.24.20237701 ◽

2020 ◽

Author(s):

Anastase Dzudie ◽

Blaise Barche ◽

Sidick Mouliom ◽

Ariane Nouko ◽

Fogue Raissa ◽

...

Keyword(s):

Heart Failure ◽

Heart Rate ◽

Cox Regression ◽

Sub Saharan Africa ◽

Resting Heart Rate ◽

Cox Regression Analysis ◽

Increased Risk ◽

All Cause Mortality ◽

Sub Saharan

AbstractBackgroundHigher resting heart rate (HR) is associated with mortality amongst Caucasians with heart failure (HF), but its significance has yet to be established in sub-Saharan Africans in whom HF differs in terms of characteristics and etiologies.ObjectivesWe assessed the association of HR with all-cause mortality in patients with HF in sub-Saharan Africa.MethodsThe Douala HF registry (Do–HF) is an ongoing prospective data collection on patients with HF receiving care at four cardiac referral services in Douala, Cameroon. Patients included in this report were followed-up for 12 months from their index admission, for all-cause mortality. We used Cox-regression analysis to study the association of HR with all-cause mortality during follow-up.ResultsOf 347 patients included, 343 (98.8%) completed follow-up. The mean age was 64±14 years, 176 (50.7%) were female, and median admission HR was 85 bpm. During a median follow-up of 12 months, 78 (22.7%) patients died. Mortality increased steadily with HR increase and ranged from 12.2% in the lower quartile of HR (≤69 bpm) to 34.1% in the upper quartile of HR (>100 bpm). Hazard ratio of 12-month death per 10 bpm higher heart rate was 1.16 (1.04–1.29), with consistent effects across most subgroups, but a higher effect in participants with hypertension vs those without (interaction p=0.044).ConclusionHeart rate was independently associated with increased risk of all-cause mortality in this study, particularly among participants with hypertension. The implication of this finding for risk prediction or reduction should be actively investigated.

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Predictors of three-month mortality among hospitalized older adults in Togo

10.21203/rs.3.rs-38973/v2 ◽

2020 ◽

Author(s):

Fifonsi Adjidossi GBEASOR-KOMLANVI ◽

Martin Kouame TCHANKONI ◽

Akila Wimima BAKOUBAYI ◽

Matthieu Yaovi LOKOSSOU ◽

Arnold SADIO ◽

...

Keyword(s):

Older Adults ◽

Hospital Mortality ◽

Cox Regression ◽

Sub Saharan Africa ◽

Mortality Data ◽

Kaplan Meier ◽

All Cause Mortality ◽

Hospitalized Older Adults ◽

Sub Saharan

Abstract Background: Assessing hospital mortality and its predictors is important as some of these can be prevented through appropriate interventions. Few studies have reported hospital mortality data among older adults in sub-Saharan Africa. The objective of this study was to assess the mortality and associated factors among hospitalized older adults in Togo.Methods: We conducted a prospective cohort study from February 2018 to September 2019 among patients ≥50 years admitted in medical and surgical services of six hospitals in Togo. Data were recorded during hospitalization and through telephone follow-up survey within 90 days after admission. The main outcome was all-cause mortality at 3 months. Survival curves were estimated using the Kaplan-Meier method and Cox regression analyses were performed to assess predictors of mortality.Results: The median age of the 650 older adults included in the study period was 61 years, IQR: [55-70] and at least one comorbidity was identified in 59.7% of them. The all-cause mortality rate of 17.2% (95%CI: 14.4-20.4) and the majority of death (93.7%) occurred in hospital. Overall survival rate was 85.5% and 82.8% after 30 and 90 days of follow-up, respectively. Factors associated with 3-month mortality were the hospital level in the health pyramid, hospitalization service, length of stay, functional impairment, depression and malignant diseases.Conclusion: Togolese health system needs to adjust its response to an aging population in order to provide the most effective care.

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The History of Christian Missions to Africa

Oxford Research Encyclopedia of African History ◽

10.1093/acrefore/9780190277734.013.56 ◽

2019 ◽

Author(s):

Norman Etherington

Keyword(s):

20Th Century ◽

French Revolution ◽

18Th Century ◽

Sub Saharan Africa ◽

Foreign Born ◽

13Th Century ◽

Christian Missions ◽

Late 20Th Century ◽

History Of ◽

Sub Saharan

Christianity came very early to Africa, as attested by the Gospels. The agencies by which it spread across North Africa and into the Kingdom of Aksum remain largely unknown. Even after the rise of Islam cut communications between sub-Saharan Africa and the churches of Rome and Constantinople, it survived in the eastern Sudan kingdom of Nubia until the 15th century and never died in Ethiopia. The documentary history of organized missions begins with the Roman Catholic monastic orders founded in the 13th century. Their evangelical work in Africa was closely bound up with Portuguese colonialism, which both helped and hindered their operations. Organized European Protestant missions date from the 18th-century evangelical awakening and were much less creatures of states. Africa was a particular object of attention for Evangelicals opposed to slavery and the slave trade. Paradoxically this gave an impetus to colonizing ventures aimed at undercutting the moral and economic foundations of slavery in Africa. Disease proved to be a deadly obstacle to European- and American-born missionaries in tropical Africa, thus spurring projects for enrolling local agents who had acquired childhood immunity. Southern Africa below the Zambezi River attracted missionaries from many parts of Europe and North America because of the absence of the most fearsome diseases. However the turbulent politics of the region complicated their work by restricting their access to organized African kingdoms and chieftaincies. The prevalent mission model until the late 19th century was a station under the direction of a single European family whose religious and educational endeavors were directed at a small number of African residents. Catholic missions acquired new energy following the French Revolution, the old Portuguese system of partnership with the state was displaced by enthusiasm for independent operations under the authority of the Pope in Rome. Several new missionary orders were founded with a particular focus on Africa. Mission publications of the 19th and 20th centuries can convey a misleading impression that the key agents in the spread of African Christianity were foreign-born white males. Not only does this neglect the work of women as wives and teachers, but it diverts attention from the Africans who were everywhere the dominant force in the spread of modern Christianity. By the turn of the 20th century, evangelism had escaped the bounds of mission stations driven by African initiative and the appearance of so-called “faith missions” based on a model of itinerant preaching. African prophets and independent evangelists developed new forms of Christianity. Once dismissed as heretical or syncretic, they gradually came to be recognized as legitimate variants of the sort that have always accompanied the acculturation of religion in new environments. Decolonization caught most foreign mission operations unawares and required major changes, most notably in the recruitment of African clergy to the upper echelons of church hierarchies. By the late 20th century Africans emerged as an independent force in Christian missions, sending agents to other continents.

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Malaria and risk of lymphoid neoplasms and other cancer: a nationwide population-based cohort study

BMC Medicine ◽

10.1186/s12916-020-01759-8 ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Katja Wyss ◽

Fredrik Granath ◽

Andreas Wångdahl ◽

Therese Djärv ◽

Michael Fored ◽

...

Keyword(s):

Cox Regression ◽

Health Agency ◽

Malaria Diagnosis ◽

B Cell Lymphoma ◽

Population Based ◽

Sub Saharan Africa ◽

Lymphoid Neoplasms ◽

Hazard Ratios ◽

Increased Risk ◽

Sub Saharan

Abstract Background Malaria is associated with Burkitt lymphoma among children in Sub-Saharan Africa. No longitudinal studies have assessed the long-term risk of other lymphoma or cancer overall. Here, we investigated the risk of lymphoid neoplasms and other cancer after malaria. Methods We included 4125 patients diagnosed with malaria in Sweden in 1987–2015, identified either through the National Surveillance Database at the Public Health Agency of Sweden, the National Inpatient and Outpatient Register, or by reports from microbiology departments. A comparator cohort (N = 66,997) matched on sex, age and birth region was retrieved from the general population and an additional cohort with all individuals born in Sub-Saharan Africa registered in the Total Population Register in 1987–2015 (N = 171,756). Incident lymphomas and other cancers were identified through linkage with the Swedish Cancer Register. Hazard ratios (HRs) were assessed using Cox regression with attained age as the timescale. Results A total of 20 lymphoid neoplasms and 202 non-haematological cancers were identified among malaria patients during a mean follow-up of 13.3 and 13.7 years, respectively. The overall risk of lymphoid neoplasms was not significantly increased (hazard ratio [HR] 1.24, 95% confidence interval [CI] 0.79–1.94), neither did we find any association with all-site non-haematological cancer (HR 0.89, 95% CI 0.77–1.02). However, in the Sub-Saharan Africa cohort, we observed an increased risk of lymphoid neoplasms after malaria diagnosis (HR 2.39, 95% CI 1.06–5.40), but no difference in the risk of other cancer (HR 1.01, 95% CI 0.70–1.45). The association could not be explained by co-infection with HIV or chronic hepatitis B or C, since the risk estimate was largely unchanged after excluding patients with these comorbidities (HR 2.63, 95% CI 1.08–6.42). The risk became more pronounced when restricting analyses to only including non-Hodgkin and Hodgkin lymphomas (HR 3.49, 95% CI 1.42–8.56). Conclusion Individuals born in malaria-endemic areas and diagnosed with malaria in Sweden had an increased risk of lymphoid neoplasms, especially B cell lymphoma. There was no association with cancer overall nor did single malaria episodes confer an increased risk in travellers.

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Prognostic Factors of Time to First Abortion After Sexual Debut Among Fragile State Congolese Women: A Survival Analysis

10.21203/rs.3.rs-62236/v1 ◽

2020 ◽

Author(s):

Michael Ekholuenetale ◽

Charity Ehimwenma Ekholuenetale ◽

Amadou Barrow

Keyword(s):

Formal Education ◽

Cox Regression ◽

Sexual Debut ◽

Statistical Significance ◽

Unwanted Pregnancy ◽

Total Sample ◽

Sub Saharan Africa ◽

High Prevalence ◽

Sub Saharan ◽

Adverse Pregnancy

Abstract Background: Despite the common restrictive abortion laws, abortion remains widespread in sub-Saharan Africa (SSA) countries. Women still utilize abortion services and put their lives and health at risk because abortion can only be procured illegally in private facilities such as mid-level or small patent medicine store that may be manned by unskilled providers or through a non-medicated approach. The objective of this study was to determine median years and factors of time to first abortion after sexual debut among Congolese women.Methods: We used data from the most recent Republic of Congo Demographic and Health Survey (DHS). A total sample of 3,622 women aged 15-49 years was analyzed. We estimated the overall prevalence of abortion and median years to first abortion. Furthermore, we examined the factors of time to first abortion after sexual debut using multivariable Cox regression and reported the estimates using adjusted Hazard Ratio (aHR) and 95% confidence intervals (CI). Statistical significance was determined at p<0.05.Results: The prevalence of abortion was 60.0% and median years of time to first abortion after sexual debut was 9.0. The prominent reasons for abortion were due to too short birth interval (23.8%), lack of money (21.0%) and that husband/partner did not need a child at that time (14.0%). Women’s age and region were notable factors in timing to first abortion. Furthermore, women from poorer, middle, richer and richest households had 34%, 67%, 86% and 94% higher risk of abortion respectively, when compared with women from poorest households. Women currently in union/living with a man and formerly in union had 41% and 29% reduction in the risk of abortion respectively, when compared with those never in union. In addition, women with primary and secondary+ education had 42% and 76% higher risk of abortion respectively, when compared with women with no formal education. Conclusion: There was high prevalence of abortion with short years at first abortion. Abortion was associated with women’s characteristics. There is need for unwanted pregnancy prevention intervention and the improvement in pregnancy care to reduce adverse pregnancy outcomes among women.

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Obstetric anal sphincter injury by maternal origin and length of residence: a nation-wide cohort study

10.22541/au.162335805.59619526/v1 ◽

2021 ◽

Author(s):

Ingvil Sorbye ◽

Sukhjeet Bains ◽

Siri Vangen ◽

Johanne Sundby ◽

Benedikte Lindskog ◽

...

Keyword(s):

Cohort Study ◽

Anal Sphincter ◽

Sub Saharan Africa ◽

Foreign Born ◽

Maternal Origin ◽

Length Of Residence ◽

Sphincter Injury ◽

Anal Sphincter Injury ◽

Sub Saharan ◽

Primiparous Women

Objective: To estimate the association between maternal origin and obstetric anal sphincter injury (OASI), and assess if associations differed by length of residence. Design: Population-based cohort study. Setting: The Medical Birth Registry of Norway. Population: Primiparous women with vaginal livebirth of a singleton cephalic fetus between 2008 and 2017 (n=188 658). Methods: Multivariable logistic regression models estimated aORs for OASI with 95% CI by maternal region of origin and birthplace. We stratified models on length of residence and paternal birthplace. Main outcome measures: OASI. Results: Overall 6 373 cases of OASI were identified (3.4% of total cohort). Women from South Asia were most likely to experience OASI (6.2%; aOR 2.24, 95% CI 1.93–2.60), followed by those from Southeast/East Asian/Pacific (5.7%; 1.83, 1.64–2.04), and Sub-Saharan Africa (5.2%; 1.97, 1.72–2.26), compared to women originating from Norway. Among women born in the same region, those with short length of residence in Norway (0–4 years), showed higher odds of OASI. Migrant women across most regions of origin had reduced risk of OASI if they had a Norwegian compared to foreign-born partner. Conclusions: Primiparous women from Asian regions and Sub-Saharan Africa had up to two-fold risk of OASI, compared to women originating from Norway. Migrants with short residence and those with a foreign-born partner had higher risk of OASI, implying that some of the risk differential is due to sociocultural factors. Some migrants, especially new arrivals, may benefit from special attention during labour to reduce morbidity and achieve equitable outcomes.

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Shifting Maghreb migration may prompt EU cooperation

Emerald Expert Briefings ◽

10.1108/oxan-db225788 ◽

2017 ◽

Keyword(s):

Sub Saharan Africa ◽

North African ◽

Content Type ◽

Migrant Populations ◽

Bilateral Relations ◽

Sub Saharan ◽

Alternative Routes ◽

The Impact ◽

Difficult Transition ◽

The Eu

Subject Migration impact on Maghreb. Significance Morocco hosted a summit on African migration on October 31, calling for a common African stance to the growing migration challenge. EU incentives to Libya and Sahelian governments have decreased migrant crossings from Libya, which has been the primary channel for sea crossings. As a result, more migrants are using alternative routes in Morocco, Algeria and Tunisia and staying longer in those countries. Shifting migration trends are forcing North African governments to think about the impact of growing sub-Saharan migrant populations within their borders. Impacts Sub-Saharan migrants could become lightning rods for governments in North Africa struggling with high unemployment and low economic growth. North African policies towards migrant populations will affect bilateral relations with governments in sub-Saharan Africa (SSA). The EU may need to pay more attention to Tunisia, which is grappling with economic problems and a difficult transition.

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Geographic Monitoring of Insecticide Resistance Mutations in Native and Invasive Populations of the Fall Armyworm

Insects ◽

10.3390/insects12050468 ◽

2021 ◽

Vol 12 (5) ◽

pp. 468

Author(s):

Sudeeptha Yainna ◽

Nicolas Nègre ◽

Pierre J. Silvie ◽

Thierry Brévault ◽

Wee Tek Tay ◽

...

Keyword(s):

Insecticide Resistance ◽

Fall Armyworm ◽

Sub Saharan Africa ◽

Pest Species ◽

Resistance Mutations ◽

Chinese Populations ◽

Bt Resistance ◽

Native Populations ◽

Sub Saharan ◽

Lepidopteran Pest

Field evolved resistance to insecticides is one of the main challenges in pest control. The fall armyworm (FAW) is a lepidopteran pest species causing severe crop losses, especially corn. While native to the Americas, the presence of FAW was confirmed in West Africa in 2016. Since then, the FAW has been detected in over 70 countries covering sub-Saharan Africa, the Middle East, North Africa, South Asia, Southeast Asia, and Oceania. In this study, we tested whether this invasion was accompanied by the spread of resistance mutations from native to invasive areas. We observed that mutations causing Bt resistance at ABCC2 genes were observed only in native populations where the mutations were initially reported. Invasive populations were found to have higher gene numbers of cytochrome P450 genes than native populations and a higher proportion of multiple resistance mutations at acetylcholinesterase genes, supporting strong selective pressure for resistance against synthetic insecticides. This result explains the susceptibility to Bt insecticides and resistance to various synthetic insecticides in Chinese populations. These results highlight the necessity of regular and standardized monitoring of insecticide resistance in invasive populations using both genomic approaches and bioassay experiments.

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Long-term effectiveness of smoking cessation courses for Turkish-speaking migrants in Switzerland

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.268 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

R Paz Castro ◽

C Salis Gross ◽

S Haug

Keyword(s):

Smoking Cessation ◽

Harm Reduction ◽

Cox Regression ◽

Health Inequity ◽

Cox Regression Analysis ◽

Migrant Populations ◽

Culturally Adapted ◽

One Year

Abstract Background Migrant populations usually report higher smoking rates. Among those migrant populations, Turkish- and Kurdish-speaking migrants are often overrepresented. Providing equal access to health services is one of major challenges of our time. The need for adapted smoking-cessation treatments for Turkish-speaking populations to achieve equity in health led, in 2006, to the development and implementation of the Tiryaki-Kukla smoking-cessation program in Switzerland. Since 2006, 5'305 Turkish-speaking migrants in Switzerland were reached with tobacco-related information and the offer of tailored treatment. In short, the treatment was grounded in behavioral therapy and was adapted from the weekly group-counseling sessions applied by the Cancer League Zurich. The adaptation focused on language, cultural and health literacy issues. The aims of the study were to evaluate one-year quit rates for smoking-cessation courses held from 2006 to 2018 and investigate whether certain characteristics predict long-term abstinence. Methods Evaluation of the program included a pre/post questionnaire (session 1/ 3 months after the quit day) and a follow-up telephone call twelve months after the quit day. To elucidate factors associated with long-term abstinence, Cox regression analysis and Weighted Generalized Equation Models were used. Results Of the 478 who participated in smoking-cessation courses, 45.4% declared themselves non-smokers at one-year follow-up. Characteristics associated with long-term abstinence were length of the course (eight vs. six sessions), adherence to the course, use of pharmacotherapy or NRT products, and baseline level of dependence. Conclusions Our findings are consistent with existing evidence supporting culturally-adapted smoking cessation interventions to reduce health inequity in migrant populations. However, achieving harm reduction in smokers with higher dependence scores remains challenging. Key messages A culturally-adapted smoking cessation course showed effective to reduce health inequity. One challenge remains: Achieving harm reduction in migrants with higher dependence scores.

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