Mortality and causes of death among asylum seekers in the Netherlands, 2002-2005.

BACKGROUND: The world's growing population of asylum seekers faces different health risks from the populations of their host countries because of risk factors before and after migration. There is a current lack of insight into their health status. METHODS: A unique notification system was designed to monitor mortality in Dutch asylum seeker centres (2002-2005). RESULTS: Standardised for age and sex, overall mortality among asylum seekers shows no difference from the Dutch population. However, it differs between subpopulations by sex, age and region of origin and by cause of death. Mortality among asylum seekers is higher than among the Dutch reference population at younger ages and lower at ages above 40. The most common causes of death among asylum seekers are cancer, cardiovascular diseases and external causes. Increased mortality was found from infectious diseases (males, standardised mortality ratio (SMR)=5.44 (95% CI 3.22 to 8.59); females, SMR=7.53 (95% CI 4.22 to 12.43)), external causes (males, SMR=1.95 (95% CI 0.52 to 2.46); females SMR=1.60 (95% CI 0.87 to 2.68)) and congenital anomalies in females (SMR 2.42; 95% CI 1.16 to 4.45). Considerable differences were found between regions of origin. Maternal mortality was increased (rate ratio 10.08; 95% CI 8.02 to 12.83) as a result of deaths among African women. CONCLUSION: Certain subgroups of asylum seekers (classified by age, sex and region of origin) are at increased risk of certain causes of death compared with the host population. Policies and services for asylum seekers should address both causes for which asylum seekers are at increased risk and causes with large absolute mortality, taking into account differences between subgroups.

Induced abortions and teenage births among asylum seekers in The Netherlands: analysis of national surveillance data.

BACKGROUND: Asylum seekers are assumed to be a vulnerable group with respect to sexual and reproductive health. The objective of this study was to quantify induced abortion and teenage birth indicators for this group. METHODS: The population comprised all female asylum seekers aged 15-49 in The Netherlands between September 2004 and August 2005. Information was collected about induced abortions from notification forms and electronic patient files. The central agency for the reception of asylum seekers provided population and birth data. RESULTS: Among asylum seekers the abortion rate (14.4/1000 women) and teenage birth rate (49.1/1000) were higher than average in The Netherlands (8.6/1000 and 5.8/1000). Great differences were found between subgroups. High abortion rates were seen among women who were pregnant on arrival or got pregnant in the first months after arrival at the reception facilities. Abortion and teenage birth rates were particularly high among asylum seekers aged 15-19 from specific parts of Africa and Asia. Abortion ratios were high among asylum seekers aged 30-49 from parts of Europe and Asia. Decreases in the abortion rate and teenage birth rate were observed as the length of stay increased. CONCLUSION: Abortions and teenage births were more common among asylum seekers than among the overall population of The Netherlands. Increased rates were a consequence of subgroups being at high risk. Abortion and teenage birth rates were very high among women who were pregnant on arrival or got pregnant in the first few months after arrival, but decreased as the length of stay increased.

Ethnic differences in HSV1 and HSV2 seroprevalence in Amsterdam, the Netherlands.

Herpes simplex virus type 1 (HSV1) and 2 (HSV2) infection can lead to significant morbidity, and HSV2 is considered a risk factor for HIV transmission. The majority of HSV-infected people are asymptomatic and unaware of their infection. We aimed to determine the HSV1 and HSV2 prevalence among various ethnic groups in a large urban area in the Netherlands. In 2004, serum samples from a population-based serum repository of 1,325 people over 18 years living in Amsterdam were tested for HSV1 and HSV2 antibodies in order to determine high-risk groups. Prevalence ratios were estimated and all analyses were weighted by sex, age, and ethnicity. In the general population of Amsterdam, 67% had HSV1 antibodies, 22% had HSV2 antibodies, 15% had HSV1 and HSV2 antibodies, and 26% had no indication of HSV infection. In multivariate analyses, HSV1 seroprevalence increased with age, and was higher among people of Turkish and Moroccan origin, homosexual men, and individuals with low educational level. HSV2 seroprevalence was associated with increasing age, Surinamese/Antillean background, and having a history of sexually transmitted infections (STI). These differences between ethnic groups in Amsterdam regarding the distribution of HSV1 and HSV2 infection emphasise the importance of an ethnic-specific approach of serological testing as well as campaigns aimed at behavioural change and counselling to raise awareness of the risk of HSV transmission.

Changing patterns in emergency involuntary admissions in the Netherlands in the period 2000-2004.

BACKGROUND: In England, rates of involuntary admissions increased in subgroups of patients. It is unknown whether this is true in other European countries. AIMS: To establish whether the increase in emergency commitments was uniform across subgroups of patients and dangerousness criteria used to justify commitment in The Netherlands. METHOD: National data on all commitments in the period 2000-2004. RESULTS: Commitments increased from 40.2 to 46.5 (16%) per 100,000 inhabitants. Controlling for population changes in age and sex, relatively large increases were found in patients over 50 years (25-40% increase), in patients with dementia (59%), 'other organic mental disorders' (40%) and substance abuse (36%). 'Arousing aggression', increased most strongly as a dangerousness criterion for commitment (30%). CONCLUSION: Changing patterns of commitments in The Netherlands and England might indicate a wider European shift in diagnoses and reasons for admission of committed patients.

Environmental attributes related to walking and bicycling at the individual and contextual level.

OBJECTIVE: The aim of the present paper was to give insight into the practical consequences of using either single-level or multilevel regression analyses on data from research on environmental determinants of physical activity. METHODS: For this purpose, results from single-level and multilevel regression analyses on comparable attributes of the environment were compared using a combination of individual and aggregated data, merged at the neighbourhood level. RESULTS: Using only individual level data, applying multilevel instead of single-level analyses did not substantially influence the results. However, ignoring the multilevel structure of our data by applying single-level in stead of multilevel analyses resulted in statistically significant associations for all the environmental attributes under study. Moreover, using information on environmental attributes at both the individual and the contextual level to adjust associations at one level for the other level showed that associated environmental attributes tend to be associated either at the individual or at the contextual level. CONCLUSIONS: These results stress the importance for reviews and meta-analyses of recording type of measurement and type of analytical strategy used and incorporating them in the review process. Using advanced multilevel designs will still only partly solve the methodological issues involved in studying environmental attributes associated with physical activity, but it will help in disentangling this complex relationship. Therefore, it is recommended that, whenever there is a presumably relevant grouping (context; eg neighbourhoods) in a study, a multilevel approach should at least be considered.

[Accelerated increase in the number of involuntary admissions following the implementation of the Dutch Act on Compulsory Admission to Psychiatric Hospitals (BOPZ)]. / Versnelde stijging van het aantal inbewaringstellingen na de invoering van de Wet Bijzondere Opnemingen in Psychiatrische Ziekenhuizen (BOPZ).

OBJECTIVE: To determine whether the observed accelerated increase in the number of involuntary admissions in The Netherlands coincides with the implementation of the Dutch Act on Compulsory Admission to Psychiatric Hospitals (BOPZ) in 1994. DESIGN: Retrospective. METHOD: The extent to which the number of involuntary admissions changed after implementation of the BOPZ was examined by means of Poisson regression on the basis of national data from the Patient Registration of Intramural Mental Healthcare for the period 1979-1995 and data from the Healthcare Inspectorate for the period 1992-2004. For this purpose, the curve prior to implementation of the BOPZ was compared with that following its implementation. RESULTS: The number of involuntary admissions of psychiatric patients had more than doubled in 25 years, from 3101 in 1979 to 7450 in 2004. The increase in annual numbers accelerated significantly after implementation of the BOPZ in 1994. CONCLUSION: There was an accelerated increase in the number of involuntary admissions after the implementation of the BOPZ. Other possible contributing factors include an increased number of admissions, shorter hospital stays, and changes in social concepts.

[Prevalence of diabetes mellitus and cardiovascular disease among immigrants from Turkey and Morocco and the indigenous Dutch population]. / Prevalentie van diabetes mellitus en hart- en vaatziekten onder Turkse, Marokkaanse en autochtone Nederlanders.

OBJECTIVE: To gain insight into the prevalence of diabetes mellitus and cardiovascular disease among Turkish and Moroccan immigrants in the Netherlands. DESIGN: Secondary analysis of data from a cross-sectional study in 1999/'00. METHOD: The prevalence of self-reported diabetes and cardiovascular disease was studied in a sample of 743 Turkish, 641 Moroccan and 537 ethnic Dutch persons aged 35 to 74 years from the population of Amsterdam, the Netherlands, using an oral questionnaire. Ethnic differences in the prevalence of diabetes and cardiovascular disease were studied by logistic regression analysis controlling for age, sex and educational level. Further, in the case of diabetes, we examined whether or not the differences could be explained by overweight and physical inactivity, and in the case of cardiovascular disease we investigated the relationship with smoking and diabetes. In addition, the association between diabetes and cardiovascular disease was investigated. RESULTS: The Turkish and Moroccan population reported diabetes more often than did the ethnic Dutch (12.3, 12.4 and 3.0%, respectively). The differences were still present after controlling for sex, age, educational level, overweight and physical inactivity. Cardiovascular disease was more prevalent among the Turks (10.6%) than among the indigenous Dutch population (5.0%), but this was not true for the Moroccans (5.4%). The difference between Turkish and ethnic Dutch people still persisted after controlling for educational level, overweight, physical inactivity, smoking and diabetes. The association between diabetes and cardiovascular disease was consistent for all groups studied. CONCLUSIONS: The prevalence of diabetes was higher among Turkish and Moroccan immigrants than among the indigenous Dutch population. Cardiovascular disease was more prevalent among the Turks, but not among the Moroccans. The association between diabetes and cardiovascular disease was consistent for all three ethnic groups.

[Increased proportion of elementary school children with asthmatic symptoms in the Netherlands, 1984/85-1994/95; a literature review]. / Toegenomen percentage basisschoolkinderen met astmatische klachten in Nederland, 1984/'85-1994/'95; een literatuuronderzoek.

OBJECTIVE: To investigate whether the prevalence of asthmatic symptoms among children in the Netherlands has changed. DESIGN: Literature study. METHOD: Investigations into the prevalence of children with asthmatic symptoms were collected from Medline, Embase and various libraries if they had been performed between 1984/'85 and 1994/'95 and had used the so-called WHO or Region list. 23 studies were selected with data on 76,353 elementary school pupils. Linear regression analysis, weighed for the number of children, was used to determine if the proportions of children with asthmatic symptoms had increased over the years. RESULTS: In 10 years the prevalence of recent shortness of breath had increased by 107% (from 4.16 to 8.63%), that of recent wheeze by 16% (from 10.64 to 12.35%), that of recent attacks of breathlessness with wheezing by 17% (from 5.29 to 6.19%), and for chronic cough by 259 (from 1.05 to 3.77%) to 272% (from 3.14 to 11.68%). The prevalence of doctor-diagnosed asthma had increased by 120% (from 2.82 to 6.19%). CONCLUSION: There had been a pronounced increase in the percentage of primary schoolchildren with asthmatic symptoms between 1984/'85 and 1994/'95. The prevalence of doctor-diagnosed asthma increased faster then did key symptoms of asthma.

Exercise and physical activity: an analysis of answers to an open-ended survey question.

In this paper 708 comments made in response to an open-ended question at the end of a lifestyle survey are analysed in order to explore issues in exercise behaviour. Quantitative and qualitative techniques are used. Five areas are identified as important in shaping people's exercise behaviour: 1) Health-related factors; 2) Factors related to available facilities; 3) Issues of behavioural change; 4) Issues of health information and promotion; and 5) Miscellaneous issues. Each of the five areas of responses is discussed and related to current theory on exercise behaviour. Three substantive conclusions are drawn. Firstly, environmental change might be important to people but not necessarily in a personalized way. Secondly, health problems are an important barrier to exercising. Thirdly, health promotion possibly targets sedentary individuals too much. With regard to the methodology, the open-ended question proves to yield interesting information. However, a single powerful factor cannot be found in the data and the data seems to suffer from a problem of low-explained variance.

The effect of a health promotion campaign on mortality in children.

Previous research has shown that in the Netherlands there is a certain degree of preventable mortality associated with long-distance travel, particularly among children of ethnic minority descent. In 1985 a health promotion campaign was launched in Amsterdam with the aim of reducing travel-related deaths by increasing knowledge in ethnic minority communities about the risks involved in travel. In the present study, two data sets are used to examine the possible effects of this health promotion campaign on travel-related mortality in children. The first data set, which was collected locally, indicates that the number of Amsterdam children dying abroad has dropped considerably since 1985. This is particularly true within one group which is highly likely to exhibit risky travel behavior. The second data set, which was collected nationally, shows that an upward trend in mortality among children aged 0-14 years before 1985 has in fact changed into a downward trend since 1985. A similar pattern is observed in the Netherlands as a whole, but to a significantly less pronounced degree than in Amsterdam. Although the influence of extraneous factors can never be fully dismissed, the analysis provides support for the conclusion that the health promotion campaign did in fact succeed in reducing the number of travel-related deaths.

Sports, exercise, and other causes of injuries: results of a population survey.

Mortality rates and injuries requiring medical treatment associated with sports and exercise are generally low. However, higher injury rates are reported for athletes and members of sports clubs. This study focuses on the sport- and exercise-related injury rate for various age and sex groups in the general population and how sport and exercise injury rates compare with those for other activities. The data presented are based on telephone interviews. Of the participants (N = 6,596), 335 (5.1%) reported having sustained an injury in the previous month; 46% of injuries among males and 14% of those among females were sport or exercise related. The data show a downward trend in sport- and exercise-related injury rates with increasing age. It is concluded that, as a proportion of all injuries sustained, the sport- and exercise-related injury rate is high, particularly among males. Possible future research on sport- and exercise-related injuries is discussed.

Health lifestyle behaviour and socio-demographic characteristics. A study of Varna, Glasgow and Edinburgh.

In this paper a lifestyle perspective is taken to study the various influences on four health related behaviours, i.e. cigarette smoking, diet behaviour, alcohol use and exercise. Of interest is how these behaviours are distributed over four socio-demographic indicators, i.e. the respondents gender, educational level, employment status and age. As a third factor the respondent's city of residence, Varna in Bulgaria and Glasgow and Edinburgh in Scotland, is taken into consideration. Data collected by telephone from 268 respondents from Varna, 827 respondents from Glasgow and 275 respondents from Edinburgh are considered. Large differences in the prevalence of health behaviours are found, with respondents in Varna behaving least healthily and respondents in Edinburgh behaving most healthily, and this is also true at sub-group level. Alcohol use is the exception, and here the opposite relationship between health behaviour and city of residence is found. Females generally behave more healthily than males, however, this pattern is not consistent for all health behaviours. Better educated and employed respondents behave in a more healthy way compared with less well educated and unemployed respondents and this is true in all three cities, with the difference being particularly large in Scotland. An 'economic' and a 'self-care' explanation are put forward to explain the patterns observed but both explanations are found wanting. It is proposed that integrating various theoretical models is necessary to further develop our understanding of health lifestyle behaviour.

Seasonal variation in alcohol use.

OBJECTIVE: The objective of this article is to describe and quantify seasonality in a number of indicators on alcohol use. METHOD: The data analyzed cover a period between 1988 and 1994, and are collected by a telephone survey of persons living in Glasgow and Edinburgh, Scotland. The analysis is on data from 29,256 respondents. Cosinor analysis is the analytical instrument applied; a dummy variable is incorporated in the analysis to model the December peak in alcohol use. RESULTS: Annual seasonality in alcohol use excluding drinking behavior in December, is highest in the summer. Seasonality with regard to changes in the proportion of respondents who report drinking alcohol in the previous month, or in the proportion of less regular heavy drinkers, is, although statistically significant, not very pronounced. With regard to drinking five or more drinks on 11 or more occasions in the past month the level of seasonality is very pronounced. The December peak in alcohol use powerfully influences the proportion of respondents who report drinking alcohol in the previous month, and the proportion of irregular and regular heavy drinkers. CONCLUSIONS: The data support previous advice that health promotion and health policy activities in relation to alcohol use should take place during the December festive period and, if one aims at heavy drinking, the summer.

The mathematical relationship between the number of events in which people are injured and the number of people injured.

In this paper the mathematical relationship between the number of times people sustained injuries and the number of people injured is discussed. The number of injury-causing events in a population will be larger than the number of people injured as people can be injured on more than one occasion. The Poisson distribution is used as a way to study the relationship between the two different sets of numbers. A practical example is given of injuries sustained while running. From this it seems that injury proneness needs to be considered in studying those who were injured on more than one occasion while running during the past year.

The relationships between sexual behaviour and health lifestyle.

The aim of this paper is to study sociodemographic and lifestyle differences between different AIDS/HIV risk groups in the general population. Respondents reporting more than three sexual partners in the previous five years, dichotomized into condom and non-condom users, are contrasted with the remaining respondents. The data consists of 7,717 interviews collected by telephone in the metropolitan areas of London, Glasgow and Edinburgh. The data show that while age and marital status are strongly related to sexual behaviours, there is evidence of individuals engaging in risky behaviours in all age and marital status groups. The relationship between sexual behaviours and occupational status is weak; there is a considerable and consistent difference between sexually more active and sexually less active respondents with regard to healthy 'lifestyle' indicators, such as smoking, alcohol use, exercise and safety behaviour, but this difference is less strong with regard to condom use. The paper supports the conclusion that in concentrating resources on the young and on unmarried individuals large numbers of individuals at an elevated risk for AIDS/HIV in other population groups will be missed. The strong relationships between indicators of health lifestyle and sexual behaviour seem to be a factor to be considered in the development of future AIDS/HIV-related health interventions.

Relationships between changes in health and fitness and the perception of exercise.

This article examines the answers respondents gave to two questions about their perception of recent changes in their health and fitness in relation to the answers respondents gave to questions asking if they thought (a) more exercise would improve their health, (b) they got as much exercise as needed, and (c) they were as active as others of a similar age. A theoretical model is discussed that emphasizes the importance of a change in the perception of health and fitness as a cue to reevaluating exercise and leisure time-related beliefs, attitudes, and behaviors. Data from 9,125 female and 7,157 male respondents collected by telephone in the urban areas of Glasgow and Edinburgh were analyzed. The analysis indicated a strong relationship between individuals reporting a negative change in health or fitness and those individuals being of the opinion that more exercise would improve their health, that they got less exercise than they needed, and were less active than others of a similar age.

Seasonal variation in leisure time physical activity.

In this paper seasonal variation in leisure time physical activity for exercise is studied and quantified with regard to several popular exercise activities and taking the respondents gender, occupational status, and age into consideration. The analysis concerns data collected by telephone in Scotland between January 1989 and March 1992. Data from 7,202 male and 9,284 female respondents is used in the analysis; cosinor analysis using GLIM is applied. Considerable seasonal variation was found affecting both outdoor and indoor activities. During the peak phase in July, 32% of the respondents reported exercising for at least 20 min three or more times during the previous week, in the winter period this decreased to 23%. Older respondents were found to exercise more later in the year and also showed seasonal variation to a larger extent than younger respondents. This is particularly so for those respondents who exercise at a relatively high frequency.

Trends in Scottish cigarette smoking by gender, age and occupational status, 1984-1991.

Data from the General Household Survey (GHS) for the period 1984-1988 and data from the RUHBC-CATI (Research Unit in Health and Behavioural Change - Computer Assisted Telephone Interview) survey for the period 1988 to 1991 are pooled to study changes in the cigarette smoking prevalence in Scotland. It is concluded that the Scottish smoking prevalence shows a slight downward trend for males and a slight upward trend for females. There is some evidence for an earlier decrease in smoking prevalence related to a lower smoking uptake among younger generations, however, the current pattern of smoking among the youngest age group shows an increase. The reported difference in smoking prevalence between those in manual and non-manual occupations seems to be increasing among females and decreasing among males.

Relationships between leisure time physical activity for exercise and other health-related behaviors.

In this article the relationships between physical activity for exercise and other health-related behaviors is studied. The data analyzed were collected during 1991 by telephone in Glasgow and Edinburgh and concern 2418 male and 3053 female respondents between 18 and 60 years of age. In the analysis, respondents who reported exercising less than once in the previous week were contrasted with respondents who reported exercising more often. Compared with respondents exercising less often, respondents who reported exercising more often reported being smokers and adding salt to their food significantly less often, and more often reported drinking alcohol, using low-fat spread and engaging in weight-losing behavior. No significant relation was found between physical activity for exercise and seat-belt use among males and blood pressure checking among males and females.