Cultural competence in multi-family psychoeducation groups: The experiences of Russian-speaking immigrant mothers of adults with severe mental illness.

The successful integration of cultural competence with evidence-based practices in mental health services is still limited for particular cultural populations. The current study explored culturally adapted family psychoeducation intervention for immigrants from the former Soviet Union (FSU) in Israel who care for a family member with severe mental illness (SMI). Semi-structured in-depth interviews were conducted with 18 immigrant mothers about their experience of taking part in Russian-speaking multi-family psychoeducation groups (MFPGs). Qualitative content analysis revealed five salient processes and changes that participants attributed to their engagement in the intervention: 1) from a language barrier to utilization of and satisfaction with services; 2) from a lack of information to acquiring new mental health knowledge; 3) from harboring a family secret to exposure and sharing; 4) from social isolation to cultural belonging and support; 5) from families blurring boundaries to physical and emotional separation. The results showed that these changes-linguistic, cognitive, emotional, socio-cultural and relational-improved family coping and recovery. Implications for cultural adaptation of family psychoeducation for Russian-speaking immigrants are discussed.

Genetic Polymorphisms of Cytochromes P450 in Finno-Permic Populations of Russia.

Cytochrome P450 is an enzyme involved in the metabolism of phase 1 xenobiotics, toxins, endogenous hormones, and drugs, including those used in COVID-19 treatment. Cytochrome p450 genes are linked to the pathogenesis of some multifactorial traits and diseases, such as cancer, particularly prostate cancer, colorectal cancer, breast cancer, and cervical cancer. Genotyping was performed on 540 supposedly healthy individuals of 5 Finno-Permic populations from the territories of the European part of the Russian Federation. There was a statistically significant difference between Veps and most of the studied populations in the rs4986774 locus of the CYP2D6 gene; data on the rs3892097 locus of the CYP2D6 gene shows that Izhemsky Komis are different from the Mordovian and Udmurt populations.

Mitochondrial DNA maintenance disorders in 102 patients from different parts of Russia: Mutational spectrum and phenotypes.

Currently, pathogenic variants in more than 25 nuclear genes, involved in mtDNA maintenance, are associated with human disorders. mtDNA maintenance disorders manifest with a wide range of phenotypes, from severe infantile-onset forms of myocerebrohepatopathy to late-onset forms of myopathies, chronic progressive external ophthalmoplegia, and parkinsonism. This study represents the results of molecular genetic analysis and phenotypes of 102 probands with mtDNA maintenance disorders. So far, this is the largest Russian cohort for this group of diseases. Mutations were identified in 10 mtDNA maintenance genes: POLG (n = 59), DGUOK (n = 14), TWNK (n = 14), TK2 (n = 8), MPV17 (n = 2), OPA3 (n = 1), FBXL4 (n = 1), RRM2B (n = 1), SUCLG1 (n = 1) and TYMP (n = 1). We review a mutation spectrum for the DGUOK and TWNK genes, that can be specific for the Russian population. In 34 patients we measured the blood mtDNA copy number and showed its significant reduction. Novel variants were found in 41 cases, which significantly expands the mutational landscape of mtDNA maintenance disorders.

Medicinal plants from the 14th edition of the Russian Pharmacopoeia, recent updates.

ETHNOPHARMACOLOGICAL RELEVANCE: Herbal medicine in Russia has a long history starting with handwritten herbalist manuscripts from the Middle Ages to the officinal Pharmacopoeia of the 21st century. The "herbophilious" Russian population has accumulated a lot of knowledge about the beneficial effects of local medicinal plants. Yet, for a long time, Russian traditional and officinal herbal medicine was not well known to the international audience. In our previous comprehensive review, we discussed the pharmacological effects of specific plants included in the 11th edition of the Pharmacopoeia of the USSR, which was also for a while used in Russia. The 14th edition of the Russian Federation's State Pharmacopoeia was implemented in 2018. AIM OF THE REVIEW: The aims of the present review are: (i) to trace the evolution of medicinal plant handling from handwritten herbalist manuscripts to Pharmacopoeias; (ii) to describe the modern situation with regulatory documents for herbal medicinal products and their updated classification; (iii) to summarize and discuss the pharmacology, safety, and clinical data for new plants, which are included in the new edition of the Pharmacopoeia. METHODS: New medicinal plants included in the 14th edition of the Russian Federation's State Pharmacopoeia were selected. We carefully searched the scientific literature for data related to traditional use, pharmacological, clinical application, and safety. The information was collected from local libraries in Saint-Petersburg, the online databases E-library.ru, Scopus, Web of Science, and the search engine Google scholar. RESULTS: Investigating the evolution of all medicinal plants referred to in the Russian Pharmacopoeias led us to the identification of ten medicinal plants that were present in all editions of civilian Russian Pharmacopoeias starting from 1778. In the 14th edition of the modern Russian Pharmacopoeia, medicinal plants are described in 107 monographs. Altogether, 25 new monographs were included in the 14th edition, and one monograph was excluded in comparison to the 11th edition. Some of the included plants are not endemic to Russia and do not have a history of traditional use, or on the other hand, are widely used in Western medicine. For 15 plants, we described the specificity of their application in Russian traditional medicine along with the claimed dosages and indications in officinal medicine. The pharmacology, safety, and clinical data are summarized and assessed for nine plants, underlining their therapeutic potential and significance for global phytopharmacotherapy. CONCLUSIONS: In this review, we highlight the therapeutical potential of new plants included in the modern edition of the Russian Pharmacopoeia. We hope that these plants will play an imperative role in drug development and will have a priority for future detailed research.

Cervical Cancer Screening Participation among Women of Russian, Somali, and Kurdish Origin Compared with the General Finnish Population: A Register-Based Study.

Migrant-origin women are less prone to cervical screening uptake compared with host populations. This study examined cervical cancer screening participation and factors associated with it in the Finnish mass screening program during 2008-2012 in women of Russian, Somali and Kurdish origin compared with the general Finnish population (Finns) in Finland. The study population consists of samples from the Finnish Migrant Health and Well-being Study 2010-2012 and Health 2011 Survey; aged 30-64 (n = 2579). Data from the Finnish screening register linked with other population-based registry data were utilized. For statistical analysis we employed logistic regression. Age-adjusted screening participation rates were Russians 63% (95% CI: 59.9-66.6), Somalis 19% (16.4-21.6), Kurds 69% (66.6-71.1), and Finns 67% (63.3-69.8). In the multiple-adjusted model with Finns as the reference; odds ratios for screening were among Russians 0.92 (0.74-1.16), Somalis 0.16 (0.11-0.22), and Kurds 1.37 (1.02-1.83). Among all women, the substantial factor for increased screening likelihood was hospital care related to pregnancy/birth 1.73 (1.27-2.35), gynecological 2.47 (1.65-3.68), or other reasons 1.53 (1.12-2.08). Screening participation was lower among students and retirees. In conclusion, screening among the migrant-origin women varies, being significantly lowest among Somalis compared with Finns. Efforts using culturally tailored/population-specific approaches may be beneficial in increasing screening participation among women of migrant-origin.

Epidemiology of dialysis-treated end-stage renal disease patients in Kazakhstan: data from nationwide large-scale registry 2014-2018.

BACKGROUND: The epidemiology of dialysis patients has been little studied in developing countries and economies in transition. We examined the prevalence, incidence and mortality rate of dialysis patients in Kazakhstan, via aggregation and utilization of large-scale administrative healthcare data. METHODS: The registry data of 8898 patients receiving dialysis therapy between 2014 and 2018 years were extracted from the Unified National Electronic Health System (UNEHS) and linked with the national population registry of Kazakhstan. We provide descriptive statistics of demographic, comorbidity and dialysis-related characteristics. RESULTS: Among all patients undergoing maintenance dialysis for end-stage renal disease (ESRD), there were 3941 (44%) females and 4957 (56%) males. 98.7% of patients received hemodialysis and 1.3% peritoneal dialysis. The majority of the patients (63%) were ethnic Kazakhs, 18% were Russians and 19% were of other ethnicities. The prevalence and incidence rate in 2014 were 135.2 and 68.9 per million population (PMP), respectively, which were different in 2018 [350.2 and 94.9 PMP, respectively]. Overall mortality rate among dialysis patients reduced from 1667/1000 patient-years [95%Confidence Interval (CI): 1473-1886] (PY) in 2014 to 710/1000PY [95%CI: 658-767] in 2018. We observed 13% lower crude survival probability in females compared to males and in older patients compared to younger ones. Russian ethnicity had 58% higher risk of death, while other ethnicities had 34% higher risk of death compared to in those of Kazakh ethnicity. CONCLUSION: We describe for the first time in Kazakhstan an increase in the prevalence and incidence of ESRD on dialysis, while mortality rate decreased over time, during 2014-2018. We observed statistically significant lower survival probability in female dialysis patients compared to males, in older patients compared to younger ones, and in patients of Russian ethnicity compared to Kazakh.

Migrants Are Underrepresented in Mental Health and Rehabilitation Services-Survey and Register-Based Findings of Russian, Somali, and Kurdish Origin Adults in Finland.

Mounting evidence suggests that migration background increases the risk of mental ill health, but that problems exist in accessing healthcare services in people of migrant origin. The present study uses a combination of register- and survey-based data to examine mental health-related health service use in three migrant origin populations as well as the correspondence between the need and use of services. The data are from the Finnish Migrant Health and Wellbeing Study (Maamu), a comprehensive cross-sectional interview and a health examination survey. A random sample consisted of 5909 working-aged adults of Russian, Somali, and Kurdish origin of which 3000 were invited to participate in the survey and the rest were drawn for a register-based approach. Some of the mental health services, based on registers, were more prevalent in the Kurdish origin group in comparison with the general population and less prevalent in the Russian and Somali origin groups. All the migrant origin groups were underrepresented in rehabilitation services. When affective symptoms were taken into account, all the migrant origin groups were underrepresented in all of the services. This calls for actions to promote mental health, diminish the barriers to access services, and improve the service paths for migrants.

[Nutritional status of children in rural areas of the Komi Republic and Khanty-Mansi Autonomous Okrug - Yugra by anthropometric data].

A characteristic feature of the "global obesity epidemic" in recent decades is the rapid spread of overweight among the rural population. However, there is a lack of objective data on how this process is unfolding in the northern and Arctic regions of the Russian Federation. The aim of the work was to analyze the prevalence of malnutrition and rates of overweight and obesity in children living in Khanty-Mansi Autonomous Okrug - Yugra (KhMAO) and the Komi Republic (KR). Material and methods. We conducted a study of the nutritional status of rural children in the northern regions of the Russian Federation in 2018-2019. The subjects of the study were children aged 3-17 years of KhMAO, ethnic Khanty, Mansi and of various non-indigenous descent in small remote settlements (n=302) and 956 children in the administrative center of the northern district, a town-type residency. We also examined 7-17-year-old children (n=628) in large settlements of the KR, over 90% of them were ethnic Komi. For each individual, body mass index values (BMI) were calculated. The nutritional status was assessed by comparing the individual BMI with the age and sex specific standards set by the Ministry of Health of the Russian Federation (2017). Results and discussion. 74.4% of children aged 3-6 in KhMAO, and 70% of the 7-17-year-old children of KR and KhMAO meet the standards for their age-sex groups; 6.1% of children aged 3-17 are underweight and 19.5% are overweight. Among the 7-17-year-olds, the ratio of the underweight and overweight (including obese) differs significantly in the settlement dwellers of the KR from that in the living in small settlements of KhMAO (p=0.004), as well as in the group of town residents of KhMAO (p=0.017). The children of the KR have slightly higher percentage of the overweight and obese (26.6 vs 25.7 and 24.8% in the town and settlements of KhMAO, respectively), but significantly lower percentage of those who are underweight (1.9 vs 5.0 and 6.8%). The proportion of obese schoolchildren in small remote settlements of KhMAO is higher than that in the large settlements of KhMAO and in large settlements of the KR (13.1, 7.7 and 9.2%, respectively). Conclusion. There were no differences found between ethnic groups, however the role of social and anthropological factors in the formation of the nutritional status differences between the indigenous and non-indigenous children in Western Siberia calls for further investigation.

Immigration, acculturation, and preferred help-seeking sources for depression: comparison of five ethnic groups.

BACKGROUND: Immigrants are more likely than the majority population to have unmet needs for public mental health services. This study aims to understand potential ethnic differences in preferred help-seeking sources for depression in Norway, and how such preferences relate to acculturation orientation. METHODS: A convenience sample of immigrants from Russia (n = 164), Poland (n = 127), Pakistan (n = 128), and Somalia (n = 114), and Norwegian students (n = 250) completed a survey. The sample was recruited from social media platforms, emails, and direct contact. The survey consisted of a vignette describing a moderately depressed person. Respondents were asked to provide advice to the person by completing a modified version of the General Help-Seeking Questionnaire. The immigrant sample also responded to questions about acculturation orientation using the Vancouver Index of Acculturation Scale. RESULTS: Significant differences were found in the endorsement of traditional (e.g., religious leader), informal (e.g., family), and semiformal (e.g., internet forum) help-sources between immigrant groups, and between immigrant groups and the Norwegian respondent group. Immigrants from Pakistan and Somalia endorsed traditional help sources to a greater extent than immigrants from Russia and Poland, and the Norwegian student sample. There were no ethnic differences in endorsement of formal mental help sources (e.g., a medical doctor). Maintenance of the culture of origin as the acculturation orientation was associated with preferences for traditional and informal help sources, while the adoption of mainstream culture was associated with semiformal and formal help-seeking sources. CONCLUSION: Ethnic differences in help-seeking sources need to be considered when designing and implementing mental health services.

The effect of SLC6A3 variable number of tandem repeats and methylation levels on individual susceptibility to start tobacco smoking and on the ability of smokers to quit smoking.

OBJECTIVE: Nicotine acts through the dopamine pathway in the brain affecting reward processing through cigarette consumption. Thus, both genetic and epigenetic factors related to dopamine metabolism may influence individual's smoking behavior. MATERIALS AND METHODS: We studied variations of two variable numbers of tandem repeats (VNTRs), 40 and 30 bp in length, in SLC6A3 gene together with six DNA methylation sites located in a first intron of the gene in relation to several smoking-related phenotypes in a study population consisting of 1230 Whites of Russian origin. RESULTS: Both the 5R allele of 30 bp VNTR and the 9R allele of 40 bp VNTR in SLC6A3 were associated with a reduced risk to tobacco smoking [odds ratio (OR) 0.53, 95% confidence interval (CI) 0.37-0.75; OR 0.62, 95% CI 0.43-0.88]. Although the carriers of 9R allele also had high Fagerström test for nicotine dependence scores (OR 1.65, 95% CI 1.04-2.60), they were still more likely to succeed in smoking cessation (OR 0.59, 95% CI 0.40-0.88). Also, current smokers had more than 2.5-fold likelihood to have increased SLC6A3 methylation levels than former smokers (OR 2.72, 95% CI 1.63-4.53). CONCLUSION: The SLC6A3 5R of 30 bp and 9R of 40 bp VNTR variants may lead to a reduced risk to start smoking through decreased dopamine availability, and can also affect the success in subsequent smoking cessation attempts. Moreover, the elevated mean methylation values in the first intron of SLC6A3 may be related to nicotine dependence via a more active dopamine transporter.

Pregnancy complications in women of Russian, Somali, and Kurdish origin and women in the general population in Finland.

OBJECTIVE: We compared the prevalence of gestational diabetes and hypertensive disorders in the most recent pregnancy among women of Russian, Somali, and Kurdish origin and women in the general population in Finland. METHODS: The study groups were selected from population-based samples of 18- to 64-year-old women. The women were of Russian (n = 318), Somali (n = 583), and Kurdish (n = 373) origin or from the general population (n = 243), and had given birth in Finland between 2004 and 2014. The data were obtained from the National Medical Birth Register and the Hospital Discharge Register. Data on gestational diabetes and hypertensive disorders were extracted based on relevant International Classification of Diseases, Tenth Revision codes. The main statistical methods were logistic regression analyses adjusted for age, parity, body mass index, socioeconomic status, and smoking. RESULTS: The prevalence of gestational diabetes was 19.1% in Kurdish, 14.4% in Somali, 9.3% in Russian, and 11.8% in the general population. The prevalence of hypertensive disorders was 5.4% in the general population, 3.8% in Somali, 3.1% in Kurdish, and 1.7% in Russian. When adjusted for confounders, Kurdish women had two-fold odds for gestational diabetes (odds ratio = 1.98; 95% confidence interval = 1.20-3.32) compared with the general population, but the odds for hypertensive disorders did not differ between groups. CONCLUSION: Women of Kurdish origin were more likely to develop gestational diabetes. Studies with larger samples are required to confirm these findings to develop prevention strategies for later development of type 2 diabetes. Future research including other migrant groups is recommended to identify differences in pregnancy complications among the women in migrant and general population.

Migrating in Later Lives: Collective Identities of Russian-Speaking Women in Finland.

Combining insights from transnational anthropology, anthropology of postsocialism, and the narrating identity approach in cultural gerontology, this paper investigates how Russian-speaking migrant women living in Finland account for their ageing. It is based on ethnographic fieldwork in an urban-based club for Russian-speaking seniors, including written and oral life stories. The research shows that Russian-speaking women have a very strong sense of collective identity that is anchored in master stories of (post) socialism, their transnational life trajectories, and families. First, women's active participation in the club for seniors generates a site of collective identity, which draws on a shared cultural and linguistic background. Their communal workplace identities continue to nourish their ageing in Finland and their participation in the club. Second, women's family positions, in particular as mothers and grandmothers, specifically in transnational families, forms another type of collective, which defines their ageing. Third, in response to migration, women also construct a transnational collective identity, which manifests in the ways they emphasize their relatedness to both Russia and Finland through their family histories. At the same time, ageing is an intensely individual process, and the paper explores how transnational seniors experience their ageing individually yet in dialogue with these collective identities. These findings call for more recognition of transnational and collective-based accounts of ageing to extend the framework of cultural gerontology.

Differences in caesarean delivery and neonatal outcomes among women of migrant origin in Finland: A population-based study.

BACKGROUND: In Finland, limited information is available on neonatal disparities among women of migrant origin. OBJECTIVE: This study investigated differences in caesarean delivery and neonatal outcomes between women of migrant origin and Finnish women in Finland. METHODS: The study was based on nationwide data from the Medical Birth Register of Finland. Our study included information on the most recent singleton birth of women delivering between January 2004 and December 2014 (N = 382 233). Women were classified into nine regional categories based on their country of origin. Generalized linear models were used to describe associations between country of origin and pregnancy outcomes adjusted for maternal age, socio-economic status, pre-pregnancy body mass index, parity, marital status, smoking during pregnancy, and delivery year. Finnish women were the reference group. RESULTS: Among the study population, almost 92% of women were of Finnish origin; the remaining 8% were of migrant origin. Among the migrant women, those of Russian/former USSR origin were the largest group (n = 11 994); the smallest group was women of Latin American/Caribbean origin (n = 739). Compared with Finnish women, women of sub-Saharan African, South Asian, and East Asian origin were at greater risk of emergency caesarean delivery, preterm birth, low birthweight, and lower five-minute Apgar scores for newborns. Latin American/Caribbean-origin women were at increased risk of both elective and emergency caesarean delivery and lower five-minute Apgar scores compared with Finnish women. Women of Russian/former USSR origin overall had a lower risk of caesarean delivery and poor neonatal outcomes compared with Finnish women. CONCLUSIONS: We identified sub-Saharan African, South Asian, and East Asian women as higher-risk groups, and women from Russia/former USSR as a lower-risk group, for emergency caesarean delivery and poor neonatal outcome compared with Finnish women. More research is needed to identify the reasons for these differences by country of origin in Finland.

The antibiotic knowledge, attitudes and behaviors of patients, doctors and pharmacists in the WHO Eastern European region - a qualitative, comparative analysis of the culture of antibiotic use in Armenia, Georgia, Kazakhstan, Moldova, Russia and Tajikistan.

BACKGROUND: To reduce antimicrobial resistance (AMR), initiatives such as surveillance activities and activities to increase knowledge about how and why antibiotics (ABs) are (mis)used are needed. More surveillance systems are in place in the WHO Western European region than in the Eastern region, and only sparse knowledge exists about the current culture of AB use in the Eastern European countries. OBJECTIVE: To investigate AB knowledge, attitudes and behaviors in countries in the WHO Eastern European region in order to identify overall similarities and differences across the region and how AB knowledge, attitudes and behavior patterns may be influenced by the national health care system. METHODS: Semi-structured interviews were conducted in Armenia, Georgia, Kazakhstan, Moldova, Russia and Tajikistan with patients, doctors and pharmacists. In total, 80 interviews were carried out. A directed content analysis was applied, followed by a comparative analysis, identifying the similarities and differences in AB attitudes, knowledge and behaviors between the countries and discussing how the national health care systems might influence these patterns. RESULTS: Cross-national patterns were identified regarding patients seeking ABs over-the-counter (OTC), patient variations in their requests for ABs when consulting doctors, and, finally, doctors and pharmacists appearing knowledgeable about ABs and their uses, with doctors displaying careful attitudes towards AMR. Indications of national differences between the countries included the ability of patients to afford ABs, prescribing practices of doctors and pharmacist attitudes towards selling ABs without prescriptions. Multiple aspects involved in patient and pharmacist AB decision making were detected, such as various rationales involved in buying/selling ABs OTC, implying that these processes are more complex than previously reported in the literature. CONCLUSIONS: Similarities across the Eastern European region could be seen in patient needs and uses of antibiotics obtained OTC at community pharmacies, whereas doctors appeared more influenced by specific structures of the national healthcare system.

Genome-wide sequence analyses of ethnic populations across Russia.

The Russian Federation is the largest and one of the most ethnically diverse countries in the world, however no centralized reference database of genetic variation exists to date. Such data are crucial for medical genetics and essential for studying population history. The Genome Russia Project aims at filling this gap by performing whole genome sequencing and analysis of peoples of the Russian Federation. Here we report the characterization of genome-wide variation of 264 healthy adults, including 60 newly sequenced samples. People of Russia carry known and novel genetic variants of adaptive, clinical and functional consequence that in many cases show allele frequency divergence from neighboring populations. Population genetics analyses revealed six phylogeographic partitions among indigenous ethnicities corresponding to their geographic locales. This study presents a characterization of population-specific genomic variation in Russia with results important for medical genetics and for understanding the dynamic population history of the world's largest country.

An international cross-cultural study of nursing students' perceptions of caring.

BACKGROUND: Single studies suggest that nursing students perceive caring as more an instrumental than expressive behaviour and indicate some differences between caring perceptions in junior and senior nursing students. However, there are limited studies investigating caring perceptions in nursing students across multiple cultures. OBJECTIVE: To determine perceptions of caring in Slovene, Croatian, Chinese and Russian nursing students and explore whether there are statistically significant differences in perceptions of caring between countries and between first and third-year nursing students. DESIGN: A cross-sectional descriptive study design was used. SETTINGS AND PARTICIPANTS: The study included 604 nursing students enrolled in first and third year in seven different nursing faculties in four countries: Slovenia; China; Croatia; and the Russian Federation. METHODS: The 25-item Caring Dimension Inventory (CDI-25) was used to measure caring perceptions. We also included demographic questions regarding age, gender, country, year of study and type of study. Demographic data were analysed using descriptive analysis while a two-way analysis of variance (ANOVA) adjusted for unequal sample sizes was performed together with a post hoc analysis of the results. RESULTS: The results of two-way ANOVA showed that both main effects (country and year of study) were statistically significant, as well as their interaction at the 0.05 significance level. The main effect for country was F(3, 596) = 3.591, p < 0.0136 indicating a significant difference in CDI-25 between Slovenia (M = 108.9, SD = 9.2), Russian Federation (M = 107.1, SD = 8.2), China (M = 102.8, SD = 9.7) and Croatia (M = 110.0, SD = 8.6). CONCLUSIONS: Perceptions of caring in nursing students differ across countries, probably due to different educational systems, curricula, cultural differences and societal values. Implementing caring theories in nursing curricula could help students to cultivate caring during their education.

Pre-migration traumatic experiences, post-migration perceived discrimination and substance use among Russian and Kurdish migrants-a population-based study.

BACKGROUND AND AIMS: The associations between traumatic events, substance use and perceived discrimination have been rarely studied among migrants in host countries. We examined whether pre-migration potentially traumatic experiences (PTEs) or perceived discrimination (PD) are associated with substance use among migrants with voluntary (Russians) and forced (Kurds) migration backgrounds. DESIGN: Cross-sectional interview and health examination data from the Finnish Migrant Health and Wellbeing Study were used. The target sample (n = 1000 for each group) was drawn from the national population register using stratified random sampling by participants' country of birth and native language. SETTING: Population-based data were collected from six cities in Finland during 2010-12. PARTICIPANTS: The participation rates were 68% (Russians) and 59% (Kurds). The analytical sample size varied (Russians n = 442-687, Kurds n = 459-613), as some participants completed only interview, health examination or short interview. The majority of Kurds had a refugee background (75%) while Russians had mainly migrated for other reasons (99%). MEASUREMENTS: The three main outcomes were self-reported binge drinking, daily smoking and life-time cannabis use. PTEs and PD were self-reported in the interview. Socio-demographic background, migration-related factors and current affective symptoms were adjusted for. FINDINGS: Among Kurds, PTEs were associated with binge drinking [adjusted odds ratio (aOR) = 2.65, 95% confidence interval (CI) = 1.30-5.42] and PD was associated with life-time cannabis use (aOR = 3.89, 95% CI = 1.38-10.97) after adjusting for contextual factors. Among Russians, PTEs were associated with life-time cannabis use adjusting for contextual factors (aOR = 2.17, 95% CI = 1.12-4.18). CONCLUSIONS: In Finland, pre-migration traumatic experiences appear to be associated with life-time cannabis use among the Russian migrant population (voluntary migration) and binge drinking among the Kurdish migrant population (forced migration). Perceived discrimination in Finland appears to be associated with life-time cannabis use among Kurdish migrants.

Correlates of gastroenterology health-services utilization among patients with gastroesophageal reflux disease: a large database analysis.

BACKGROUND: Gastroesophageal reflux disease (GERD) is associated with high utilization of health care services. Diagnostic tests usually are not required to establish GERD diagnosis, but endoscopy is recommended for patients with alarm symptoms such as dysphagia and unintentional weight loss, and those whose symptoms are not relieved by proton pump inhibitors (PPIs) therapy. Evidence on the correlates of utilization of gastroenterology health services among GERD patients is limited. The study aim was to examine associations of patient and physician's characteristics with high utilization of gastroenterology services. METHODS: In a cross-sectional study using the database of the second largest integrated care organization in Israel, data of all adult GERD patients (N = 75,219) in 2012-2015 were analyzed. High utilization of services was assessed using two dependent variables analyzed separately: undergoing two or more gastroscopies or having six or more visits to a gastroenterology consultant during the study-period. RESULTS: Overall, 11,261 (15.0%) patients had two or more gastroscopies and 23,703 (31.5%) had six or more visits to a gastroenterology consultant. The likelihood of high utilization of gastroscopy increased with age; in immigrants from the Former Soviet Union versus patients who were born in Israel; residents of Jerusalem, the south, the north and Haifa districts versus the center district; in patients with high PPI purchases, and in patients who belonged to clinics in which the physician-manger had no board certification. The correlates were similar for visits to a gastroenterology consultant. CONCLUSIONS: Patient and physician's characteristics were related to high utilization of gastroenterology services among GERD patients. The associations with age and country of birth might reflect more severe disease. The regional differences warrant further research and interventions at the district level. Training in gastroenterology of primary care physicians without a board certification is warranted.