The goal of this literature review is to provide a critical overview of existing research on the health of immigrant youth within the last decade. Although the review focuses primarily on Canada, the findings have implications for public health planning, policy, and settlement/immigration services in other immigrant-receiving countries. The main objectives are: (i) to locate relevant literature written in the past 10 years (January 1998-January 2008); (ii) to undertake a critical review of retrieved studies; (iii) to highlight gaps in the current state of our knowledge and make recommendations for future research directions. The review focuses on the influence of migration experience on health of youth.

This manuscript explores predictors of access to sexual health services among urban immigrant adolescents who live in Toronto, Canada. Surveys (n = 1216) were collected from pre-existing youth groups in community settings. A binary logistic multivariate model was developed to examine associations between access to sexual health services and a series of individual, interpersonal, and structural variables. Sexual activity, age, race, and social resources each had significant partial impact on access to sexual health services. Among young women, those with more social resources had significantly accessed services more often than those with fewer resources, but among men there was no difference as a function of social resources. Although immigration predicted access to sexual health services on its own, it was not statistically significant in this model when other variables were included. Immigration status, in and of itself, was not a predictor of youth's access to sexual health services. The impact of immigration status appears to occur because of its association with other variables, such as race. Implications for practice are discussed.

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BackgroundCardiovascular disease (CVD) is a leading cause of death among homeless people. This study examines CVD risk factors and 30-year CVD risk in a population of homeless individuals with mental illness.MethodsCVD risks factors were assessed in 352 homeless individuals with mental illness in Toronto, Canada, at the time of their enrollment in the At Home/Chez Soi Project, a randomized trial of a Housing First intervention. The 30-year risk for CVD (coronary death, myocardial infarction, and fatal or nonfatal stroke) was calculated using published formulas and examined for association with need for mental health services, diagnosis of psychotic disorder, sex, ethnicity, access to a family physician and diagnosis of substance dependence.ResultsThe 30-year CVD risk for study participants was 24.5 ± 18.4%, more than double the reference normal of 10.1 ± 7.21% (difference = −13.0% 95% CI −16.5% to −9.48%). Univariate analyses revealed 30-year CVD risk was greater among males (OR 3.99, 95% CI 2.47 to 6.56) and those who were diagnosed with substance dependence at baseline (OR 1.94 95% CI 1.23 to 3.06) and reduced among those who were non-white (OR 0.62 95% CI 0.39 to 0.97). In adjusted analyses, only male sex (OR 4.71 95% CI 2.76 to 8.05) and diagnosis of substance dependence (OR 1.78 95% CI 1.05 to 3.00) remained associated with increased CVD risk.ConclusionsHomeless people with mental illness have highly elevated 30-year CVD risk, particularly among males and those diagnosed with substance dependence. This study adds to the literature by reporting on CVD risk in a particularly vulnerable population of homeless individuals experiencing mental illness, and by using a 30-year CVD risk calculator which provides a longer time-frame during which the effect of modifiable CVD risk factors could be mitigated.Trial registrationCurrent Controlled Trials ISRCTN42520374Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1472-4) contains supplementary material, which is available to authorized users.

Background Inadequate health human resources is a key challenge to advancing child survival in Ghana. Nurses are an essential human resource to target because they represent the largest portion of the health workforce. Building on lessons learned from our pilot pediatric nurse training project and World Health Organization guidelines for transforming and scaling up health professional education, this project aimed to; train 500 pediatric nurse specialists through a one-year training program; develop and integrate a critical mass of pediatric nursing faculty and establish a national standardized pediatric nursing curriculum. This study aimed to evaluate the effectiveness of a national pediatric nurse training program in Ghana at the end of 4 years, including eight cohorts with 330 graduates. Methods This was a mixed-method evaluation with surveys, focus groups and a pre-test/post-test design. Before and after surveys were used to measure knowledge and confidence at baseline and graduation. Objective Structured Clinical Examinations (OSCE) were used to measure clinical skills at baseline, graduation, and 14 months follow-up. At the end of every module, surveys were used to measure students’ satisfaction. Focus groups at graduation qualitatively measured program outcomes. Repeat focus groups and surveys at 14 months after graduation captured the graduates’ career progress, experiences reintegrating into the health system and long-term program outcomes. Results Overall, the graduates completed the program with significantly increased knowledge, confidence, and clinical skills. They also had increased job satisfaction and were able to apply what they learned to their jobs, including leadership skills and gender-sensitive care. Data from 14-month follow-up OSCEs showed that all graduates remained competent in communication, physical assessment, and emergency care, although some obtained a lower mark compared to their performance at graduation. This finding is linked with the observation that the amount of mentorship, support from leadership and equipment that the graduates accessed from their respective facilities varied. Conclusions Mixed-methods evaluations demonstrated significant increases in knowledge confidence and skills by completing the program and maintenance of skills more than 1 year after graduation. Findings have implications for those working on the design, implementation, and evaluation of nursing education interventions in low- and middle-income countries.

Dans cette étude, nous avons utilisé un cadre théorique relevant de l'écologie politique afin de construire un modèle critique et systémique pour expliquer comment il est possible de gérer une maladie infectieuse émergente, comme le SRAS, dans notre univers mondialisé. Nous espérons qu'un tel modèle contribuera à la mise en place de politiques de gestion des risques plus réalistes. Nous commençons par établir et analyser les interactions qui, dans l'environnement social et humain, ont facilité l'apparition de l'épidémie de SRAS dans un contexte local, celui de Toronto. Ensuite, nous montrons que cette épidémie a mis en lumière les insuffisances profondément ancrées du système actuel de gestion mondiale de la santé. Nous mettons l'accent sur le fait que, en cette ère de mondialisation, il est imprudent de trop concentrer efforts sur le plan local. L'analyse des épidémies doit plutôt se faire dans une perspective mondiale, et doit tenir compte du fait que les liens entre les pays développés et les pays en développement relèvent de l'écologie politique. We adopt a political ecology framework to delineate a critical and systemic model that explains how an emerging infectious disease (EID), such as SARS, is dealt with in our globalized world. It is our hope that such a model will contribute to the development of more realistic risk-management policies. First, we focus on identifying and analyzing particular social and human-environment interactions that facilitated the spread of SARS within a local Toronto context. Second, we describe how the SARS outbreak brought to light the deeply rooted inadequacies involved in the current system of global health governance. We stress that in our globalized world it is unwise to focus too narrowly on the local context. The analysis of disease outbreaks must adopt a global perspective that considers the political ecological nature of the relationships between the developed and developing world.

Background COVID-19 has created unprecedented challenges for health systems worldwide. Since the confirmation of the first COVID-19 case in Ghana in March 2020 Ghanian health workers have reported fear, stress, and low perceived preparedness to respond to COVID-19, with those who had not received adequate training at highest risk. Accordingly, the Paediatric Nursing Education Partnership COVID-19 Response project designed, implemented, and evaluated four open-access continuing professional development courses related to the pandemic, delivered through a two-pronged approach: e-learning and in-person. Methods This manuscript presents an evaluation of the project's implementation and outcomes using data for a subset of Ghanaian health workers (n = 9966) who have taken the courses. Two questions were answered: first, the extent to which the design and implementation of this two-pronged strategy was successful and, second, outcomes associated with strengthening the capacity of health workers to respond to COVID-19. The methodology involved quantitative and qualitative survey data analysis and ongoing stakeholder consultation to interpret the results. Results Judged against the success criteria (reach, relevance, and efficiency) the implementation of the strategy was successful. The e-learning component reached 9250 health workers in 6 months. The in-person component took considerably more resources than e-learning but provided hands-on learning to 716 health workers who were more likely to experience barriers to accessing e-learning due to challenges around internet connectivity, or institutional capacity to offer training. After taking the courses, health workers' capacities (addressing misinformation, supporting individuals experiencing effects of the virus, recommending the vaccine, course-specific knowledge, and comfort with e-learning) improved. The effect size, however, varied depending on the course and the variable measured. Overall, participants were satisfied with the courses and found them relevant to their well-being and profession. An area for improvement was refining the content-to-delivery time ratio of the in-person course. Unstable internet connectivity and the high upfront cost of data to access and complete the course online were identified as barriers to e-learning. Conclusions A two-pronged delivery approach leveraged distinct strengths of respective e-learning and in-person strategies to contribute to a successful continuing professional development initiative in the context of COVID-19.

The use of the Objective Structured Clinical Exam (OSCE) to measure the clinical competency of health care professionals is well established in many training institutions globally because of their high validity and reliability. In the context of a pediatric nursing partnership program in Ghana (the SickKids-Ghana Pediatric Nursing Education Partnership [PNEP]), we aimed to develop a national, accredited, competency-based curriculum. The integration of the OSCE into the curriculum was novel in the Ghanaian setting. It served as a standardized method for student assessment of higher clinical competencies, including both skills and attitudes, compared to conventional methods. Using mixed-methods, we previously found that the PNEP curriculum effectively increased graduates’ knowledge, confidence, and clinical skill in pediatric nursing. This manuscript aims to reflect on the development of the OSCE stations, case scenarios, and rating materials, with particular reference to the methodological approach and lessons learned. We further reflect on the feedback from faculty and students pertaining to the usefulness of the OSCE as an assessment tool and the inclusion of standardized patients to assess communication skills. Adaptations required to safely conduct the OSCEs in the context of the COVID-19 pandemic have also been highlighted. Our findings throughout the OSCE development, implementation, and testing processes in Ghana could aid and inform similar tool development for nursing education institutions in the West African region and other resource-limited settings.