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To examine provider- and patient-related factors associated with diabetes self-management among recent
immigrants

This mixed method systematic review appraises the individual, familial and systemic effect of 9/11 and the war on terror for majority and minority children and youth in North America. The results highlight the broad social consequences of the socio-political transformations associated with the terror context, which cannot be understood only through a trauma focus analysis. The social stereotypes transformed youth experiences of belonging and exclusion. The difference between the consequences for majority and minority youth suggests the need for a broader appraisal of this societal context to support the development of prevention and intervention intersectorial programs.

In 2013, the American Academy of Child and Adolescent Psychiatry outlined 13 principles of cultural competence to guide child and adolescent mental health clinicians.¹ The implementation of these principles through training of new clinicians and continuing education programs is a necessary but complex endeavor. The increasing recognition of the importance of culture in the diagnostic process offers an incentive to increase training in cultural psychiatry. In 1994, the integration of the Outline for Cultural Formulation in the DSM-IV acknowledged the relevance of culture for clinical practice.

Following changes to the Interim Federal Health (IFH) program in Canada in 2012, this study investigates health service providers’ knowledge of the healthcare coverage for refugee claimants living in Quebec. An online questionnaire was completed by 1,772 staff and physicians from five hospitals and two primary care centres in Montreal. Low levels of knowledge and significant associations between knowledge and occupational group, age, and contact with refugees were documented. Social workers, respondents aged 40–49 years, and those who reported previous contact with refugee claimants seeking healthcare were significantly more likely to have 2 or more correct responses. Rapid and multiple changes to the complex IFH policy have generated a high level of confusion among healthcare providers. Simplification of the system and a knowledge transfer strategy aimed at improving healthcare delivery for IFH patients are urgently needed, proposing easy avenues to access rapidly updated information and emphasizing ethical and clinical issues.

Few empirical studies have detailed the specificities of working with interpreters in mental healthcare for children. The integration of interpreters in clinical teams in child mental healthcare was explored in two clinics, in Montreal and Paris. Four focus groups were conducted with interpreters and clinicians. Participants described the development of the working alliance between interpreters and clinicians, the delineation of interpreters’ roles, and the effects of translation on the people in the interaction. Integrating interpreters in a clinical team is a slow process in which clinicians and interpreters need to reflect upon a common framework. An effective framework favours trust, mutual understanding, and valorization of the contribution of each to the therapeutic task. The interpreter’s presence and activities seem to have some therapeutic value.

In this paper, our objectives are first to explore the different ways physicians and interpreters interact with patients’ Lifeworld, and second, to describe and compare communication patterns in consultations with professional and those with family interpreters. We used a qualitative design and conducted analyses of transcriptions of 16 family practice consultations in Montréal in the presence of interpreters. Patterns of communication are delineated grounded in Habermas’ Communicative Action Theory and Mishler’s operational concepts of Voice of Medicine and Voice of Lifeworld. Four communication patterns emerged: (1) strategically using Lifeworld data to achieve biomedical goals, (2) having an interest in the Lifeworld for itself, (3) integrating the Lifeworld with biomedicine and (4) referring to another professional. Our results suggest physicians engage with patients’ Lifeworld and may benefit from both types of interpreters’ understanding of the patient’s specific situations. A professional interpreter is likely to transmit the patient’s Lifeworld utterances to the physician. A family member, on the other hand, may provide extra biomedical and Lifeworld information, but also prevent the patient’s Lifeworld accounts from reaching the physician. Physicians’ training should include advice on how to work with all type of interpreters and interpreters’ training should include mediation competencies in order to enhance their ability to promote the processes of co-construction of meaning.

Introduction. Interpreters often join immigrants and physicians to permit communication.
Objective. To describe the content of talk about health problems and medications during clinical encounters involving interpreters [professionals (PI) or family members (FI)].
Methods. We analysed one regularly scheduled encounter for each of 16 adult patients with his family physician and their usual interpreter (10 with a PI and 6 with a FI). A different PI, not involved in the consultations, translated the non-English or French parts. We coded all utterances about each medical problem and each medication using six health problem and 16 medication topics from MEDICODE, a validated coding scheme.
Results. Physicians and patients addressed an average of 3.6 problems and 3 medications per encounter. No psychosocial problems were discussed in encounters involving FIs. On average, three topics were discussed per problem. In order of frequency, they were follow-up, explanations of the condition, non-drug management, consequences, self-management and emotions about the problem. Encounters involving PIs were more likely than encounters with FIs to include discussions of emotions about the problem (42% versus 4%, P = 0.001) and indications for follow-up (88% versus 28%, P < 0.001). An average of 6.5 topics was discussed per medication. Commonest topics discussed were medication class, how the drug was being used, achieved effect and expected effect.
Conclusions. One can address multiple problems and share vital information even in the presence of a language barrier. When FIs are interpreting, physicians would do well to make a particular effort to bring the patient’s psychological and emotional issues into the interaction.

We analyzed the impact of a requirement introduced in December 2010 that all applicants to the Canadian Institutes of Health Research indicate whether their research designs accounted for sex or gender. We aimed to inform research policy by understanding the extent to which applicants across health research disciplines accounted for sex and gender. We conducted a descriptive statistical analysis to identify trends in application data from three research funding competitions (December 2010, June 2011, and December 2011) (N = 1459). We also conducted a qualitative thematic analysis of applicants’ responses. Here we show that the proportion of applicants responding affirmatively to the questions on sex and gender increased over time (48% in December 2011, compared to 26% in December 2010). Biomedical researchers were least likely to report accounting for sex and gender. Analysis by discipline-specific peer review panel showed variation in the likelihood that a given panel will fund grants with a stated focus on sex or gender. These findings suggest that mandatory questions are one way of encouraging the uptake of sex and gender in health research, yet there remain persistent disparities across disciplines. These disparities represent opportunities for policy intervention by health research funders.

This article draws on an exploratory study of the experiences of precarious status migrants in their attempts to access healthcare. We surveyed 211 men and women migrants and did 31 semi-structured follow-up interviews. For the purposes of this article, we report on the 78 respondents who were either recruited to Canada specifically as workers (temporary foreign workers) or who had no access to income support and were therefore likely to be working (undocumented workers). We begin the article with an overview of the literature linking migration status to difficult healthcare access and higher risk of OHS problems. After presenting our methods, we turn to the results, outlining how migrant workers are using a combination of social networks, Quebec professionals and transnational healthcare connections to address their health concerns. Our findings offer insight to OHS professionals seeking to understand the differential outcomes for immigrants faced with workplace accidents or illnesses. Can difficult access to healthcare become a barrier to full recourse in cases of workplace injury or illness among migrant workers ?

Une analyse des pratiques préventives en santé et sécurité au travail (SST) a été faite dans le cadre d’une étude portant sur les enjeux de gestion ainsi que les conditions de travail et de vie des travailleurs étrangers temporaires (TÉT) employés dans les secteurs de l’horticulture, de la transformation alimentaire et autres secteurs non agricoles. Cette analyse qualitative s’est basée sur deux sources de données. Des entrevues individuelles ont été menées auprès d’employeurs (n = 17), de représentants d’organismes non gouvernementaux (n = 13), de commissions de protection des travailleurs (n = 3) et des représentants gouvernementaux (n = 7). Quatre focus groups ont été réalisés avec des TÉT (n = 31). Selon les répondants, la fréquence des lésions chez les TÉT ne suscite pas de préoccupations particulières, bien que les instances publiques de surveillance de la SST ne soient pas en mesure de documenter la situation des TÉT. Les résultats de l’analyse indiquent que les pratiques préventives de SST sont inégales, allant des pires (résumé en espagnol des consignes inscrites dans le guide des employés) aux meilleures pratiques (vidéos, simulations, formations adaptées en espagnol, pictogrammes) incluant le compagnonnage avec un contremaître hispanophone ou bilingue. Selon les représentants consulaires et syndicaux, deux problèmes de SST méritent une attention particulière : la manipulation des pesticides et les accidents routiers. Plusieurs pratiques de SST auprès des TÉT devraient être améliorées, notamment les formations sur les manipulations sécuritaires des pesticides, pratique qui devrait être imposée à toutes les entreprises, grandes et petites. L’adaptation des mesures de protection de la SST est une obligation morale envers les TÉT qui font partie intégrante de l’économie québécoise.

Les travailleurs immigrants, et plus spécialement les immigrants récents, sont souvent définis comme une population plus vulnérable quant aux risques de lésions professionnelles et de l’absence prolongée du travail. Cette vulnérabilité est liée au fait que plusieurs d’entre eux rencontrent des barrières linguistiques et culturelles qui peuvent teinter leur rencontre avec les intervenants, en plus de moins bien connaître le système de santé et de compensation et en plus d’être plus souvent concentrés dans des secteurs d’activité à plus haut risque de lésions professionnelles. La recherche en réadaptation au travail a permis de découvrir au cours des vingt-cinq dernières années de nombreux déterminants de l’absence prolongée du travail. Il a été reconnu notamment que les représentations de la douleur et les attentes de traitement pouvaient influencer l’issue d’un traitement chez les travailleurs qui suivent un programme de réadaptation. Des émotions telles la peur du mouvement et l’anticipation de conséquences négatives de la douleur sur la vie personnelle ont également été décelées. Cet article propose une réflexion théorique sur les enjeux de la réadaptation au travail dans le contexte de la rencontre interculturelle. Cette réflexion s’appuie, entre autres, sur une recension critique des écrits portant sur l’influence de l’appartenance ethnoculturelle sur le processus de réadaptation publiée par l’IRSST (Côté 2012) qui visait à déterminer les principaux facteurs qui influencent ce processus. L’article que nous proposons met l’accent plus spécialement sur la question de la communication thérapeute-patient qui apparaît comme centrale dans le processus thérapeutique et qui se décline d’une certaine façon en contextes interculturels.

Des études démontrent que la fréquence des lésions professionnelles chez les travailleurs d’agences de location de personnel est la plus élevée parmi les secteurs industriels au Québec. L’absence de réglementation spécifique aux relations de travail triangulaires entre l’entreprise cliente, l’agence et le travailleur serait le principal facteur en cause dans la négligence de leur protection de la santé et la sécurité au travail (SST). Le présent article décrit les pratiques préventives de SST dont ont bénéficié 42 travailleurs d’agences de location de personnel des régions de Québec et de Montréal. L’analyse qualitative compare, entre les travailleurs immigrants et non immigrants, leur exposition aux risques, leur accès à une formation ainsi qu’aux équipements de protection individuelle, et le soutien qui leur est accordé pour déclarer une lésion professionnelle lorsqu’ils sont victimes d’un accident ou d’une maladie. Les résultats démontrent que les travailleurs immigrants, ayant recours aux agences pour trouver un emploi d’insertion sur le marché du travail, sont affectés à des emplois parmi les plus pénibles et dangereux. Ni l’agence, ni l’entreprise cliente n’assurent une protection adéquate, et le collectif des travailleurs de l’entreprise cliente souvent les ignore.

Il existe une littérature importante sur les comités de santé et de sécurité (CSS) et leur efficacité, toutefois aucune étude ne s’est intéressée aux CSS dans les petites entreprises (PE) multiethniques, et ce, malgré l ‘importance de ces dernières dans les métropoles comme Montréal. Le présent article traite des facteurs favorisant la présence et le fonctionnement des CSS dans les PE multiethniques de Montréal. Des entrevues auprès des responsables de la SST de 28 PE montréalaises et avec les professionnels de santé au travail qui œuvrent dans ces entreprises ont permis de réaliser cette analyse secondaire, spécifique aux CSS. Notons que ces entrevues ont été réalisées dans le cadre d’une étude sur les stratégies favorables de prise en charge de la santé et sécurité au travail (SST) dans les PE embauchant de façon importante des travailleurs immigrants (Gravel et coll., 2013). Les résultats indiquent que les facteurs favorables à l’implantation et au fonctionnement des CSS sont : la taille de l ‘entreprise, le secteur d ‘activité, la présence d ‘un syndicat, la présence d ‘arguments favorables à la SST, le type d’entreprise, la présence d’un responsable de la SST occupant une fonction en gestion des ressources humaines ou en SST, détenant une formation universitaire dans un de ces deux champs ou en administration. Deux autres facteurs contribuent également : la formation universitaire du dirigeant et, enfin, l ‘utilisation des services des acteurs externes en SST. Les résultats mettent en doute la croyance selon laquelle les PE n’ont pas de CSS, surtout celles qui embauchent de façon importante des immigrants. Parmi ces dernières, on observe un phénomène d’homogénéité ethnique au sein de la hiérarchie. Les dirigeants, les superviseurs et les travailleurs sont souvent originaires des mêmes pays. Dans ces entreprises, les CSS sont généralement non paritaires et ont été implantés depuis peu de temps.

We used data from the 1991–2006 Canadian Census Mortality and Cancer Follow-up Study to compare all-cause mortality for immigrants with that of the Canadian-born population. The study addressed two related questions. First, do immigrants have a mortality advantage over the Canadian-born? Second, if immigrants have a mortality advantage, does it persist as their duration of residence increases? The analysis fitted sex-stratified hazard regression models for the overall sample and for selected countries of birth (UK, China, India, Philippines, and the Caribbean). Predictors were assessed at baseline. Mortality was lower among immigrants than the Canadian-born even after adjusting for a selected group of socio-demographic and socio-economic factors. The mortality differences persisted even after long residence in Canada, but appeared to be dependent on the age of the individual and the country of origin. Interpreted in light of known explanations of immigrant mortality advantage, the results mostly reflect selection effects.

Working partnerships between the public health sector and community based organisations with a true involvement of women and men from practicing communities will allow for more sensitive and congruent clinical

While working with trained interpreters in health care is strongly recommended, few studies have looked at the subtle differences in communication processes between trained and ‘ad hoc’ interpreters, such as adult family members. Using Habermas’ Communicative Action Theory (CAT) which distinguishes between the Lifeworld (contextually grounded experiences) and the System (decontextualized rules), we analysed 16 family practice consultations with interpreters, 10 with a trained interpreter and 6 with a family member. We found clear differences in communication patterns between consultations with a trained interpreter and consultations with a family member as interpreter. In both cases the Lifeworld is frequently interrupted and the outcomes are similar: the Lifeworld is rarely heard and acknowledged by the physician. Physicians interrupt the Voice of the Lifeworld significantly more with a trained interpreter than with a family member. Family members and trained interpreters also interrupt the Voice of the Lifeworld just as much. However, these interruptions differ in their functions (both physicians and interpreters interrupt to keep the interview on track to meet the biomedical goals; family interpreters interrupt to control the agenda). We have identified patients’ resistance when physicians ignore their Lifeworld, but this resistance is usually only transmitted by professional interpreters (and not by family interpreters). We identified specific risks of working with family interpreters: imposing their own agenda (vs. the patient’s one) and controlling the consultation process. Even if the collaboration with trained interpreters becomes more widespread, work with ‘ad hoc’ interpreters will continue to occur. Therefore, institutions should provide training and organizational support to help physicians and patients to achieve communication in all situations.

This paper examines the compensation process for work-related injuries and illnesses by assessing the trajectories of a sample of immigrant and non-immigrant workers (n = 104) in Montreal. Workers were interviewed to analyze the complexity associated with the compensation process. Experts specialized in compensation issues assessed the difficulty of the interviewees’ compensation process. Immigrant workers faced greater difficulties with medical, legal, and administrative issues than non-immigrants did. While immigrant workers’ claim forms tended to be written more often by employers or friends (58% vs. 8%), the claims were still more often contested by employers (64% vs. 24%). Immigrant workers were less likely to obtain a precise diagnosis (64% vs. 42%) and upon returning to work were more likely to face sub-optimal conditions. Such results throw into relief issues of ethics and equity in host societies that are building their economy with migrant workers.

Nous connaissons actuellement la plus grande crise historique de déplacements de réfugiés; les conflits armés et la pauvreté alimentent le flux de réfugiés vers l’Europe et l’Amérique du Nord. Les enfants représentent jusqu’à 50 % de certaines vagues de réfugiés (au moins 6 millions dans la guerre syrienne) et sont considérés comme un groupe vulnérable ayant des besoins spécifiques. Les psychologues et les autres professionnels qui fournissent des services de santé mentale aux enfants réfugiés doivent s’assurer que les interventions qu’ils effectuent sont appropriées et efficaces. Cet article présente une compréhension du contexte actuel des réfugiés ainsi que des expériences d’adversité et des conséquences associées à ces vécus traumatiques sur le plan de la santé mentale des enfants. Basé sur les récentes recherches dans le domaine, il discute également des perspectives d’intervention. 

This brief paper addresses the limitations of the current conceptual models of violent radicalization. Beyond understanding the path leading from radicalization of opinion to violent radicalization, it proposes to consider the non-violent outcomes of radicalization of opinions in the current social context and to study these outcomes in multiple settings for both minorities and majorities. Moving beyond the implicit linearity of current models and promoting a systemic vision would help to decrease the actual profiling of targeted communities and support the design of community-based prevention programs structured on these alternative outcomes, and in particular on the emergence of social solidarities in groups expressing discontent with the status quo.

The World Health Organization’s proposals for posttraumatic stress disorder (PTSD) in the 11th edition of the International Classification of Diseases, scheduled for release in 2018, involve a very brief set of symptoms and a distinction between two sibling disorders, PTSD and Complex PTSD. This review of studies conducted to test the validity and implications of the diagnostic proposals generally supports the proposed 3-factor structure of PTSD symptoms, the 6-factor structure of Complex PTSD symptoms, and the distinction between PTSD and Complex PTSD. Estimates derived from DSM-based items suggest the likely prevalence of ICD-11 PTSD in adults is lower than ICD-10 PTSD and lower than DSM-IV or DSM-5 PTSD, but this may change with the development of items that directly measure the ICD-11 re-experiencing requirement. Preliminary evidence suggests the prevalence of ICD-11 PTSD in community samples of children and adolescents is similar to DSM-IV and DSM-5. ICD-11 PTSD detects some individuals with significant impairment who would not receive a diagnosis under DSM-IV or DSM-5. ICD-11 CPTSD identifies a distinct group who have more often experienced multiple and sustained traumas and have greater functional impairment than those with PTSD.

Purpose – In large urban centres, immigrants are employed by businesses in which there is a high incidence of serious or fatal occupational injuries. This paper aims to present findings on the lack of knowledge and understanding in terms of: explanations for the implementation or lack of, procedures; technical expertise in prevention and the inability of the internal actors to implement changes.

Design/methodology/approach – A study design with a comparison group is used. The observation sample is comprised of 21 small businesses (SB), of which 16 meet the following criteria: the enterprise had fewer than 50 employees; and at least 25 per cent of the workers were born outside the country. The other five serve as a comparison group; the only difference in these SB is that they employ fewer (<25 per cent) immigrant workers.

Findings – The findings indicate that SB employing immigrants have totally or partially failed to implement health and safety management in area of occupational health and safety.

Practical implications – Implementation of safety management is impeded by numerous factors, including a partial or biased understanding, from managers and workers, on occupational health and safety rules. Democratic participation is to be encouraged so that management and workers get more involved in actual prevention strategies implementing health and safety measures.

Social implications – Active participation of workers in workplace is essential in global health improvement, as related by Armataya Sen on concept of “substantial freedom”.

Originality/value – The paper focuses on health and safety management in SB employing immigrants

Purpose – In large urban centres, immigrants are employed by businesses in which there is a high incidence of serious or fatal occupational injuries. This paper aims to present findings on the lack of knowledge and understanding in terms of: explanations for the implementation or lack of, procedures; technical expertise in prevention and the inability of the internal actors to implement changes.

Design/methodology/approach – A study design with a comparison group is used. The observation sample is comprised of 21 small businesses (SB), of which 16 meet the following criteria: the enterprise had fewer than 50 employees; and at least 25 per cent of the workers were born outside the country. The other five serve as a comparison group; the only difference in these SB is that they employ fewer (<25 per cent) immigrant workers.

Findings – The findings indicate that SB employing immigrants have totally or partially failed to implement health and safety management in area of occupational health and safety.

Practical implications – Implementation of safety management is impeded by numerous factors, including a partial or biased understanding, from managers and workers, on occupational health and safety rules. Democratic participation is to be encouraged so that management and workers get more involved in actual prevention strategies implementing health and safety measures.

Social implications – Active participation of workers in workplace is essential in global health improvement, as related by Armataya Sen on concept of “substantial freedom”.

Originality/value – The paper focuses on health and safety management in SB employing immigrants

S’il est vrai que la migration suscite une renégociation des repères identitaires, il est aussi vrai que cette négociation se fait habituellement dans un contexte de minorisation. Cette renégociation est souvent analysée sous l’angle des expériences postmigratoires, mais il s’avère aussi pertinent de la resituer plus loin dans le temps et dans l’espace. L’expérience minoritaire dans le pays d’origine contribue à la renégociation des repères identitaires en contexte de migration. C’est le cas des familles berbères que nous avons rencontrées dans une recherche portant sur la transmission familiale de valeurs chez les familles récemment immigrées du Maghreb. Minoritaires dans leurs pays d’origine par rapport à la communauté arabo-musulmane, ces familles sont aussi minoritaires au Québec où elles sont étiquetées comme « immigrantes » et souvent assimilées à « Arabes » et « Maghrébins ». Confrontées à ces formes d’étiquetage globalisantes, elles développent des stratégies visant à réaffirmer l’identité berbère. À travers l’analyse des récits des familles rencontrées, nous proposons d’explorer ces recompositions identitaires à partir des représentations du rapport berbère-arabe historiquement situées dans l’expérience prémigratoire et des représentations de leur statut d’« immigrant » au Québec.

Dans l’article, nous nous sommes interrogées sur le rôle des réseaux transnationaux et locaux – soit les réseaux constitués de proches dispersés géographiquement et ceux développés en contexte migratoire – pour soutenir les familles immigrantes à trois moments clés du cycle de vie, notamment la naissance, la maladie et la mort. Souvent, les familles doivent composer avec ces événements en l’absence de leurs réseaux de proches et elles sont donc amenées à faire appel à de nouvelles ressources et stratégies pour leur gestion. À travers l’analyse de récits de familles maghrébines vivant au Québec, nous examinons l’interface entre les liens transnationaux et locaux ainsi que leurs rôles respectifs dans la gestion des événements du cycle de vie ciblés.

This article examines legal discourses on precarious status children in Canada over the last decade. Drawing on different theoretical frameworks and taking into account laws and court decisions, the paper will examine the way in which precarious status children are regarded as powerless subjects in need of protection and as threatening others. The article argues that these two apparently contrasting discourses are embedded within specific socio-historical constructions of childhood and children’s citizenship which deny and limit their agency and conceive of their claim to membership as illegitimate. In the case of precarious status children, illegality and citizenship need to be redefined in a developmental perspective, questioning the potential risks associated with prevalent moral and social assumptions on childhood.