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BACKGROUND: There is little evidence on experiences in psychiatric care treatment among patients with immigrant or ethnic minority background. Knowledge about their experiences is crucial in the development of equal and high-quality services and is needed to validate instruments applied in national patient experience surveys in Norway. The aim of this scoping review is to assess and summarize current evidence on immigrant and ethnic minorities` experiences in psychiatric care treatment in Europe. METHODS: Guidelines from the Joanna Briggs Institute were followed and the research process adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. The literature search was carried out in Medline, Cinahl, Web of Science, Cochrane database of systematic reviews, Embase, and APA PsychInfo, up to Dec 2022, for articles on immigrant patients` experiences in psychiatric care. Reference lists of included articles were screened for additional relevant articles. Titles and abstracts were screened, and potentially relevant articles read in full-text, by two researchers. Evidence was extracted using an a priori extraction form and summarized in tables and text. Any disagreement between the reviewers regarding inclusion of articles or extracted information details were resolved through discussion between authors. RESULTS: We included eight studies in the scoping review. Immigrant and ethnic minority background patients did not differ from the general population in quantitative satisfaction questionnaires. However, qualitative studies showed that they experience a lack of understanding and respect of own culture and related needs, and difficulties in communication, which do not seem to be captured in questionnaire-based studies. CONCLUSION: Raising awareness about the importance of respect and understanding for patients` cultural background and communication needs for treatment satisfaction should be addressed in future quality improvement work.

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BACKGROUND: Vaccination coverage for COVID-19 varies among immigrant groups in Norway and between different countries. Most likely, childhood/adolescence and consistent contact with the country of birth help form the attitudes to and the desire for vaccination. We therefore compared the vaccination rate among European-born immigrants in Norway and the vaccination coverage in their countries of birth. MATERIAL AND METHOD: Vaccination coverage, the percentage of the adult population that had received at least one vaccination dose, for 22 European countries with universal access to vaccines by 31 August 2021 was retrieved from the European Centre for Disease Prevention and from the Norwegian emergency preparedness register for COVID-19 for the equivalent immigrant groups in Norway on 30 September 2021. Scatter plots with least-squares regression lines showed the association between the vaccination coverage in the country of birth and the rate in the equivalent immigration group in Norway, in total and by time of residence in Norway (< 6 years and ≥ 6 years). RESULT: The model estimated an increase in the vaccination rate in immigrant groups in Norway of 0.64 percentage points for each percentage point increase in the vaccination coverage in their European countries of birth, and explained 63 % of the variation in the vaccination rate in the immigrant groups. There was no statistically significant difference in the co-variation with the country of birth when comparing immigrants with short versus long time of residence. INTERPRETATION: There is a correlation between the vaccination rate for COVID-19 among European-born immigrants in Norway and the coverage in their countries of birth. Attitudes to and desire for vaccination varies between countries and can explain part of the observed differences between immigrant groups in Norway.

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BACKGROUND: High vaccination coverage against COVID-19 limits COVID-19-related infections, hospitalisations and deaths. Studies have shown varying vaccine willingness and vaccine coverage in different minority groups. This study investigates the vaccination coverage among persons with various immigration and country backgrounds in Norway. MATERIAL AND METHOD: The study includes all persons over 18 years of age resident in Norway with a Norwegian national identity number. We used data from Beredt C19, the Norwegian emergency preparedness register for COVID-19, and investigated the association between vaccine status and immigrant and country background using logistic regression models, adjusted for income, education, sex, age, medical risk group and place of residence. RESULTS: Foreign- and Norwegian-born persons with foreign-born parents had a lower COVID-19 vaccine coverage than those who were Norwegian-born with Norwegian-born parents. Vaccination coverage for different country backgrounds varied from around 45 % for persons from Latvia, Bulgaria, Poland, Romania and Lithuania to 92 % for persons from Vietnam, Thailand and Sri Lanka. Those in the former group had from 15 to 18 times (unadjusted) and from 8 to 11 times (adjusted) higher odds of not having been vaccinated as persons with a country background from Norway. INTERPRETATION: There is considerable variation in COVID-19 vaccine coverage between different immigrant groups in Norway. The differences can be explained to some extent by income and education, but this does not explain the bulk of the observed differences. We cannot rule out the possibility that some differences are attributable to weaknesses in the registers.

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BACKGROUND: Previous research has generally found lower rates of injury incidence in immigrant populations than in native-born populations. Most of this literature relies on mortality statistics or hospital data, and we know less about injuries treated in primary health care. The aim of the present study was to assess use of primary and secondary care for treatment of injuries among immigrants in Norway according to geographic origin and type of injury. METHODS: We conducted a nationwide register-based cohort study of all individuals aged 25-64 years who resided in Norway as of January 1st 2008. This cohort was followed through 2014 by linking sociodemographic information and injury data from primary and secondary care. We grouped immigrants into six world regions of origin and identified immigrants from the ten most frequently represented countries of origin. Six categories of injury were defined: fractures, superficial injuries, open wounds, dislocations/sprains/strains, burns and poisoning. Poisson regression models were fitted to estimate incidence rate ratios separately for injuries treated in primary and secondary care according to immigrant status, geographic origin and type of injury, with adjustment for sex, age, county of residence, marital status and socioeconomic status. RESULTS: Immigrants had a 16% lower incidence of injury in primary care than non-immigrants (adjusted IRR = 0.84, 95% CI 0.83-0.84), and a 10% lower incidence of injury in secondary care (adjusted IRR = 0.90, 95% CI 0.90-0.91). Immigrants from Asia, Africa and European countries outside EU/EEA had lower rates than non-immigrants for injuries treated in both primary and secondary care. Rates were lower in immigrants for most injury types, and in particular for fractures and poisoning. For a subset of injuries treated in secondary care, we found that immigrants had lower rates than non-immigrants for treatment of self-harm, falls, sports injuries and home injuries, but higher rates for treatment of assault, traffic injuries and occupational injuries. CONCLUSIONS: Health care utilisation for treatment of injuries in primary and secondary care in Norway was lower for immigrants compared to non-immigrants. Incidence rates were especially low for immigrants originating from Asia, Africa and European countries outside EU/EEA, and for treatment of fractures, poisoning, self-harm and sports injuries.

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BACKGROUND: The time between early adulthood and midlife is important for obesity development. There is paucity of studies using objectively measured body mass index (BMI) at both time points with full range of midlife cardiovascular risk factors. We aimed to investigate the risk of cardiovascular disease (CVD) mortality associated with different levels of objectively measured change in body weight from early adulthood to midlife, and to assess whether risk is primarily explained by midlife cardiovascular risk factors. METHODS: Pooled data from Norwegian health surveys (1985-2003), Tuberculosis screenings, Conscript data and the Norwegian Educational database were linked to the Cause of Death Registry. Health survey participants with data on objectively measured weight and height in both early adulthood (18-20 years) and midlife (40-50 years) were included, n = 148,021. Cox regression models were used to assess associations between weight change and CVD mortality. RESULTS: Total analysis time included 2,841,174 person years. Mean follow-up was 19 (standard deviation 4) years. Participants being normal weight in early adulthood and obese in midlife had a hazard ratio (HR) of CVD mortality of 2.09 (95% CI 1.74-2.50) relative to those who were normal weight at both times. The corresponding HR of those being obese at both times was 5.15 (3.61-7.36). Adjustment for CVD risk factors attenuated these associations. Gaining ≥15 kg between early adulthood and midlife was associated with higher CVD mortality after adjustment for early adulthood weight (HR 1.51 (1.20-1.89)), and for smoking and education (HR 1.63 (1.30-2.04)), however not after adjustment for mediating CVD risk factors. CONCLUSIONS: Obesity both in early adulthood and in midlife was associated with CVD mortality. Weight gain of ≥15 kg from early adulthood to midlife was also associated with CVD mortality, but not after adjustment for mediating CVD risk factors.

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Myanmar is currently facing the burden of non-communicable diseases due to changes in lifestyle and dietary patterns linked to socio-economic development. However, evidence is scarce about changes in the prevalence of diabetes mellitus (DM) over time. We aimed to investigate changes in the prevalence, awareness, treatment and control of DM from 2004 to 2014, among adults aged 25-74 years, in the Yangon region. Two cross-sectional household-based studies, according to World Health Organization STEPwise approach to surveillance (WHO STEPS) methodology, were conducted in 2004 (n = 4448) and 2014 (n = 1372). The overall age-standardized prevalence of DM was 8.3% (95% CI 6.5-10.6) in 2004 and 10.2% (7.6-13.6) in 2014 (p = 0.296). The DM prevalence increased between the study years among elderly participants only, from 14.6% (11.7-18.1) to 31.9% (21.1-45.0) (p = 0.009). Awareness of having DM increased from 44.3% (39.2, 49.6) to 69.4% (62.9-75.2) (p < 0.001). Among participants who were aware of having DM, the proportion under treatment increased from 55.1% (46.8-63.1) to 68.6% (61.5-74.8) (p = 0.015). There was no change in proportion with controlled DM. Adjusted for age, sex and education, mean fasting plasma glucose levels in 2014 were 0.56 mmol/L (0.26-0.84) higher than in 2004. Preventive measures to halt future increases in DM prevalence and to increase the detection of undiagnosed DM cases are needed.

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BACKGROUND: Immigrant populations are often disproportionally affected by chronic diseases, such as type 2 diabetes mellitus (T2DM). Use of information and communication technology (ICT) is one promising approach for better self-care of T2DM to mitigate the social health inequalities, if designed for a wider population. However, knowledge is scarce about immigrant populations' diverse electronic health (eHealth) activities for self-care, especially in European countries. OBJECTIVE: With a target group of first-generation immigrants from Pakistan in the Oslo area, Norway, we aimed to understand their diverse eHealth activities for T2DM self-care in relation to immigration-related user factors specific to this target group: proficiency in relevant languages (Urdu, Norwegian, English), length of residence in Norway, and diagnosis of T2DM compared with general user factors (age, gender, education and digital skills, and self-rated health status). METHODS: Data were from a survey among the target population (N=176) conducted in 2015-2016. Using logistic regression, we analyzed associations between user factors and experiences of each of the following eHealth activities for T2DM self-care in the last 12 months: first, information seeking by (1) search engines and (2) Web portals or email subscriptions; second, communication and consultation (1) by closed conversation with a few acquaintances using ICT and (2) on social network services; and third, active decision making by using apps for (1) tracking health information and (2) self-assessment of health status. Using Poisson regression, we also assessed the relationship between user factors and variety of eHealth activities experienced. The Bonferroni correction was used to address the multiple testing problem. RESULTS: Regression analyses yielded the following significantly positive associations: between Urdu literacy and (1) information seeking by Web portals or email subscriptions (odds ratio [OR] 2.155, 95% CI 1.388-3.344), (2) communication and consultation on social network services (OR 5.697, 95% CI 2.487-13.053), and (3) variety (estimate=0.350, 95% CI 0.148-0.552); between length of residence in Norway and (1) communication and consultation by closed conversation with a few acquaintances using ICT (OR 1.728, 95% CI 1.193-2.503), (2) communication and consultation on social network services (OR 2.098, 95% CI 1.265-3.480), and (3) variety (estimate=0.270, 95% CI 0.117-0.424); between Norwegian language proficiency and active decision making by using apps for self-assessment of health status (OR 2.285, 95% CI 1.294-4.036); between education and digital skills and active decision making by using apps for tracking health information (OR 3.930, 95% CI 1.627-9.492); and between being a female and communication and consultation by closed conversation with a few acquaintances using ICT (OR 2.883, 95% CI 1.335-6.227). CONCLUSIONS: This study implies immigration-related factors may confound associations between general user factors and eHealth activities. Further studies are needed to explore the influence of immigration-related user factors for eHealth activities in other immigrant groups and countries. INTERNATIONAL REGISTERED REPORT: RR2-DOI 10.2196/resprot.5468.

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OBJECTIVE: We aimed to assess and compare cardiovascular disease (CVD) risk factors and predict the future risk of CVD among Somalis living in Norway and Somaliland. METHOD: We included participants (20-69 years) from two cross-sectional studies among Somalis living in Oslo (n = 212) and Hargeisa (n = 1098). Demographic data, history of CVD, smoking, alcohol consumption, anthropometric measures, blood pressure, fasting serum glucose, and lipid profiles were collected. The predicted 10-year risk of CVD was calculated using Framingham risk score models. RESULTS: In women, systolic and diastolic blood pressure were significantly higher in Hargeisa compared to Oslo (p < 0.001), whereas no significant differences were seen in men. The ratio of total cholesterol to high-density lipoprotein (HDL) cholesterol was significantly higher in Hargeisa compared to Oslo among both men (4.4 versus 3.9, p = 0.001) and women (4.1 versus 3.3, p < 0.001). Compared to women, men had higher Framingham risk scores, but there were no significant differences in Framingham risk scores between Somalis in Oslo and Hargeisa. CONCLUSION: In spite of the high body mass index (BMI) in Oslo, most CVD risk factors were higher among Somali women living in Hargeisa compared to those in Oslo, with similar patterns suggested in men. However, the predicted CVD risks based on Framingham models were not different between the locations.

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AIMS: Educational inequality in cardiovascular disease and in modifiable risk factors changes over time and between birth cohorts. We aimed to assess how cardiovascular disease risk factors mediate educational differences in premature cardiovascular disease mortality and how this varies over birth cohorts and sex. METHODS: We followed 360,008 40-45-year-olds born in the 1930s, 1940s or 1950s from Norwegian health examination surveys (1974-1997) for premature cardiovascular disease mortality. Cox proportional hazard and Aalen's additive survival analyses provided hazard ratios and rate differences of excess deaths in participants with basic versus tertiary education. RESULTS: Relative educational differences in premature cardiovascular disease mortality were stable, whereas absolute differences narrowed from the 1930s to the 1950s cohorts; rate differences per 100 000 person years declined from 170 (95% confidence interval 117, 224) to 49 (36, 61) in men and from 60 (34, 85) to 23 (16, 29) in women. Cardiovascular disease risk factors attenuated rate differences by 69% in both cohorts in men, and in women by 102% in 1930s and 61% in 1950s cohorts. Smoking had the single strongest influence on the educational differences for men in all three cohorts, and for women in the two most recent cohorts. CONCLUSION: Smoking appeared to be the driving force behind educational differences in premature cardiovascular disease mortality in the 1930s to 1950s birth cohorts for men and in the two recent birth cohorts for women. This suggests that strategies for smoking prevention and cessation might have the strongest impact for reducing educational inequality in premature cardiovascular disease mortality.

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[This corrects the article DOI: 10.2196/publichealth.7009.].

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The majority of vegetable oils used in food preparation in Myanmar are imported and sold non-branded. Little is known about their fatty acid (FA) content. We aimed to investigate the FA composition of commonly used vegetable oils in the Yangon region, and the association between the use of palm oil vs. peanut oil and risk factors for non-communicable disease (NCD). A multistage cluster survey was conducted in 2016, and 128 oil samples from 114 households were collected. Data on NCD risk factors were obtained from a household-based survey in the same region, between 2013 and 2014. The oils most commonly sampled were non-branded peanut oil (43%) and non-branded palm oil (19%). Non-branded palm oil had a significantly higher content of saturated fatty acids (36.1 g/100 g) and a lower content of polyunsaturated fatty acids (9.3 g/100 g) than branded palm oil. No significant differences were observed regarding peanut oil. Among men, palm oil users had significantly lower mean fasting plasma glucose levels and mean BMI than peanut oil users. Among women, palm oil users had significantly higher mean diastolic blood pressure, and higher mean levels of total cholesterol and triglycerides, than peanut oil users. Regulation of the marketing of non-branded oils should be encouraged.

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OBJECTIVES: To investigate the association between urban-rural location and the occurrence of diabetes mellitus (DM) in the Yangon Region, and to estimate the proportion of urban and rural participants already diagnosed with DM, and of those, the proportion under treatment and under control. DESIGN: Two cross-sectional studies, using the WHO STEPs methodology. SETTING: The Yangon Region of Myanmar, urban and rural areas. PARTICIPANTS: Men and women, aged 25-74 years, included during the study period from September-November 2013 (urban) and 2014 (rural areas) (n=1372). Institutionalised people, physically and mentally ill person, monks and nuns were excluded. RESULTS: The age-standardised prevalence of DM was 12.1% in urban and 7.1% in rural areas (p=0.039). In urban areas, the prevalence of DM was lowest in the highest educational groups (p<0.001). There were no differences in DM prevalence between gender or income levels. In rural areas, those who were physically inactive had a low intake of fruit and vegetable and were overweight/obese had a higher DM prevalence than others. In a logistic regression, the OR for DM in rural compared with urban areas was 0.38 (0.22, 0.65), adjusted for sociodemographic variables and behavioural risk factors. In urban areas, 43.1% of participants had the experience of receiving blood glucose measurements by a doctor or health worker, and 61.5% of all cases of DM were already diagnosed, 78.7% were under treatment and 45.8% were under control. The corresponding proportions in rural areas were 26.4%, 52.4%, 78.1% and 32.0%, respectively. CONCLUSION: The prevalence of DM in the Yangon Region was high, and significantly higher in urban than in rural areas. More health services are needed to serve this population with a large proportion of undiagnosed diabetes. Preventive measures to halt and reduce the prevalence of DM are urgently needed.

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BACKGROUND: Sociodemographic and health-related factors are often investigated for their association with the active use of electronic health (eHealth). The importance of such factors has been found to vary, depending on the purpose or means of eHealth and the target user groups. Pakistanis are one of the biggest immigrant groups in the Oslo area, Norway. Due to an especially high risk of developing type 2 diabetes (T2D) among this population, knowledge about their use of eHealth for T2D self-management and prevention (self-care) will be valuable for both understanding this vulnerable group and for developing effective eHealth services. OBJECTIVE: The aim of this study was to examine how commonly were the nine types of eHealth for T2D self-care being used among our target group, the first-generation Pakistani immigrants living in the Oslo area. The nine types of eHealth use are divided into three broad categories based on their purpose: information seeking, communication, and active self-care. We also aimed to investigate how sociodemographic factors, as well as self-assessment of health status and digital skills are associated with the use of eHealth in this group. METHODS: A survey was carried out in the form of individual structured interviews from September 2015 to January 2016 (N=176). For this study, dichotomous data about whether or not an informant had used each of the nine types of eHealth in the last 12 months and the total number of positive answers were used as dependent variables in a regression analysis. The independent variables were age, gender, total years of education, digital skills (represented by frequency of asking for help when using information and communication technology [ICT]), and self-assessment of health status. Principal component analyses were applied to make categories of independent variables to avoid multicollinearity. RESULTS: Principal component analysis yielded three components: knowledge, comprising total years of education and digital skills; health, comprising age and self-assessment of health status; and gender, as being a female. With the exception of closed conversation with a few specific acquaintances about self-care of T2D (negatively associated, P=.02) and the use of ICT for relevant information-seeking by using search engines (not associated, P=.18), the knowledge component was positively associated with all the other dependent variables. The health component was negatively associated with the use of ICT for closed conversation with a few specific acquaintances about self-care of T2D (P=.01) but not associated with the other dependent variables. Gender component showed no association with any of the dependent variables. CONCLUSIONS: In our sample, knowledge, as a composite measure of education and digital skills, was found to be the main factor associated with eHealth use regarding T2D self-care. Enhancing digital skills would encourage and support more active use of eHealth for T2D self-care.

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BACKGROUND: Various indicators of childhood socioeconomic position have been related to cardiovascular disease (CVD) risk in adulthood. We investigated the impact of shared family factors on the educational gradient in midlife CVD risk factors by assessing within sibling similarities in the gradient using a discordant sibling design. METHODS: Norwegian health survey data (1980-2003) was linked to educational and generational data. Participants with a full sibling in the health surveys (228,346 individuals in 98,046 sibships) were included. Associations between attained educational level (7-9 years, 10-11 years, 12 years, 13-16 years, or >16 years) and CVD risk factor levels in the study population was compared with the corresponding associations within siblings. RESULTS: Educational gradients in risk factors were attenuated when factors shared by siblings was taken into account: A one category lower educational level was associated with 0.7 (95% confidence interval 0.6 to 0.8) mm Hg higher systolic blood pressure (27% attenuation), 0.4 (0.4 to 0.5) mmHg higher diastolic blood pressure (30%), 1.0 (1.0 to 1.1) more beats per minute higher heart rate (21%), 0.07 (0.06 to 0.07) mmol/l higher serum total cholesterol (32%), 0.2 (0.2 to 0.2) higher smoking level (5 categories) (30%), 0.15 (0.13 to 0.17) kg/m2 higher BMI (43%), and 0.2 (0.2 to 0.2) cm lower height (52%). Attenuation increased with shorter age-difference between siblings. CONCLUSION: About one third of the educational gradients in modifiable CVD risk factors may be explained by factors that siblings share. This implies that childhood environment is important for the prevention of CVD.

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BACKGROUND: A variety of eHealth services are available and commonly used by the general public. eHealth has the potential to engage and empower people with managing their health. The prerequisite is, however, that eHealth services are adapted to the sociocultural heterogeneity of the user base and are available in a language and with contents that fit the users' preference, skills, and abilities. Pakistani immigrants in the Oslo area, Norway, have a much higher risk of Type-2 diabetes (T2D) than their Norwegian counterparts do. In spite of having access to information and communication technology (ICT) and the Internet, ICT skills in this population are reported to be relatively low. Further, there is insufficient information about their use of and attitudes toward eHealth services, necessitating investigation of this group in particular. OBJECTIVE: This study targets first-generation immigrants from Pakistan living in the Oslo area and examines their use of and attitudes toward eHealth services, specifically: information searches, communication using ICT, and use of ICT for self-management or decision making, all concerning T2D. METHODS: Due to a high prevalence of low literacy among the target population, we employed questionnaire-based individual interviews. The questionnaire was developed by implementing potentially relevant theoretical constructs (technology acceptance model (TAM) and health belief model (HBM)) as measures. To explore issues around language, culture, and general ICT skills, we also implemented questions that we assume were particularly relevant in the context studied but do not appear in any theoretical frameworks. The questionnaire was revised to reflect results of a pilot study involving 10 participants. We employed culturally sensitive sampling methods to reach informants who could otherwise fail to be included in the survey. RESULTS: This paper presents a survey protocol. The data collection is ongoing. The aim is to collect 200 responses in total by March 2016. CONCLUSIONS: For eHealth to become an influential social innovation, equal access to eHealth services regardless of users' language, culture, and ICT skills is a prerequisite. Results from this study will be of importance for understanding how people who may not maximally benefit from eHealth services today could be targeted in the future.

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BACKGROUND: Young men are difficult to reach with conventional nutrition information and they have a low intake of vegetables and whole grain cereals. Few intervention studies have focused on improving young men's consumption of vegetables and whole grains. OBJECTIVE: A 5-month intervention focusing on a combination of increased availability of healthy foods and nutritional information was developed to stimulate the intake of vegetables and semi-whole grain bread among a group of young men in the Norwegian military. SUBJECTS: A total of 376 recruits in the intervention group and 105 recruits in the control group participated in the entire study. RESULTS: The average daily increase in consumption of vegetables was 82 g (p<0.001), and semi-whole grain bread 47 g (p<0.001) between baseline and follow-up in the intervention group. No significant changes were observed in the control group. Differences between intervention and control group at follow-up were significant (p<0.001) for vegetables and semi-whole grain bread, when controlling for baseline values, and seasonal variation for vegetables. The recruits in the intervention group received higher scores on the questions concerning nutritional knowledge after the intervention, compared to baseline (p<0.001). There was a significantly higher increase in the intake of vegetables among the recruits who increased the number of correct answers to the knowledge questions (ß-value: 0.14, p<0.05) than among the others. There was no significant change in scores of food satisfaction after the intervention. CONCLUSION: The combination of increased availability of healthy food items and nutrition information was an effective way to increase the intake of vegetables and semi-whole grain bread, without a reduction in food satisfaction, among young men in the military.