Browsing by Author "O’Brien, Beverley"
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Item Contributions and challenges of cross-national comparative research in migration, ethnicity and health: Insights from a preliminary study of maternal health in Germany, Canada and the UK(2011) Salway, Sarah; Higginbottom, Gina; Reime, Birgit; Bharj, Kuldip K.; Chowbey, Punita; Foster-Boucher, Caroline; Friedrich, Jule; Gerrish, Kate; Mumtaz, Zubia; O’Brien, BeverleyBackground: Public health researchers are increasingly encouraged to establish international collaborations and to undertake cross-national comparative studies. To-date relatively few such studies have addressed migration, ethnicity and health, but their number is growing. While it is clear that divergent approaches to such comparative research are emerging, public health researchers have not so far given considered attention to the opportunities and challenges presented by such work. This paper contributes to this debate by drawing on the experience of a recent study focused on maternal health in Canada, Germany and the UK. Discussion: The paper highlights various ways in which cross-national comparative research can potentially enhance the rigour and utility of research into migration, ethnicity and health, including by: forcing researchers to engage in both ideological and methodological critical reflexivity; raising awareness of the socially and historically embedded nature of concepts, methods and generated ‘knowledge’; increasing appreciation of the need to situate analyses of health within the wider socio-political setting; helping researchers (and research users) to see familiar issues from new perspectives and find innovative solutions; encouraging researchers to move beyond fixed ‘groups’ and ‘categories’ to look at processes of identification, inclusion and exclusion; promoting a multi-level analysis of local, national and global influences on migrant/minority health; and enabling conceptual and methodological development through the exchange of ideas and experience between diverse research teams. At the same time, the paper alerts researchers to potential downsides, including: significant challenges to developing conceptual frameworks that are meaningful across contexts; a tendency to reify concepts and essentialise migrant/minority ‘groups’ in an effort to harmonize across countries; a danger that analyses are superficial, being restricted to independent country descriptions rather than generating integrated insights; difficulties of balancing the need for meaningful findings at country level and more holistic products; and increased logistical complexity and costs. Summary: In view of these pros and cons, the paper encourages researchers to reflect more on the rationale for, feasibility and likely contribution of proposed cross-national comparative research that engages with migration, ethnicity and health and suggests some principles that could support such reflection.Item Effect of older maternal age on the risk of spontaneous preterm labor: a population-based study(2009) McIntyre, Safina; Newburn-Cook, Christine V.; O’Brien, Beverley; Demianczuk, Nestor N.To determine if older maternal age (35 years and older) at first birth was an independent risk factor for spontaneous preterm labor, we conducted a retrospective population-based cohort study. Using provincial perinatal data, we developed separate risk models for low- and high-risk women using multivariate logistic regression. We found that older maternal age exerted a direct and independent effect on spontaneous preterm labor for both nulliparous women with no preexisting chronic illnesses or pregnancy complications (low-risk) and nulliparous women who did not have any preexisting chronic illnesses, but developed one or more pregnancy complications (high-risk). Over the past several decades, the proportion of women delaying the birth of their first child until 35 years and older has increased significantly in developed countries, both in North America and Europe. In the United States, for example, births to nulliparous women 35 to 39 years of age and women 40 to 44 years increased by 36% and 70%, respectively (Cnattingius & Stephannson, 2002; Heffner, 2004). With increasing numbers of women postponing childbearing until their later reproductive years, there is increased awareness and concern among women and health care providers about the impact of advanced maternal age on maternal morbidity, the increased risk of obstetric interventions, and adverse pregnancy outcomes, including preterm birth. The results of studies on the relation between increased maternal age and preterm birth have led to inconsistent conclusions. One limitation was the failure by most researchers to investigate the heterogeneity of preterm birth. Therefore, we conducted a retrospective population-based cohort study to determine if older maternal age (35 years and older) at first birth was an independent risk factor for spontaneous preterm labor. To our knowledge this was the first such study designed specifically to examine if older maternal age acts directly or indirectly on the risk of spontaneous preterm labor. Realizing that not all women of older maternal age are a homogeneous group, we developed separate risk models for low- and high-risk women. We found that older maternal age exerted a direct and independent effect on spontaneous preterm labor for both nulliparous women with no preexistisng illnesses or pregnancy complications (low-risk) and nulliparous women who did not have any preexisting chronic illnesses but developed one or more pregnancy complications (high-risk). It is important to identify risk factors for preterm birth that are amenable to change; resulting interventions possibly could have long-lasting and far-reaching effects.