ENgage YOung people earlY (ENYOY): a mixed-method study design for a digital transdiagnostic clinical - and peer- moderated treatment platform for youth with beginning mental health complaints in the Netherlands.

BACKGROUND: The onset of mental disorders typically occurs between the ages of 12 and 25, and the burden of mental health problems is the most consequential for this group. Indicated prevention interventions to target individuals with subclinical symptoms to prevent the transition to clinical levels of disorders, even leading to suicide, have shown to be effective. However, the threshold to seek help appears to be high. Digital interventions could offer a solution, especially during the Covid-19 pandemic. This implementation study will investigate the digital indicated prevention intervention ENgage YOung people Early (ENYOY), the Dutch version of the original Moderated Online Social Therapy Platform (MOST+) from Australia. In addition, the relationship between stress biomarkers, symptoms and outcome measures of youth using the platform will be investigated in this study. METHODS: The MOST+ platform will be adapted, translated and developed for the situation in the Netherlands in collaboration with a Youth Panel. A prospective cohort of 125 young people (16-25 years) with beginning mental health complaints will be on the platform and followed for a year, of which 10 participants will have an additional smart watch and 10 participants will be asked to provide feedback about the platform. Data will be collected at baseline and after 3, 6 and 12 months. Outcome measures are Psychological Distress assessed with the Kessler Psychological Distress Scale (K10), Social and occupational functioning (measures by the SOFAS), positive mental health indicators measured by the Positive Health Instrument, stress biomarkers with a smart-watch, website journeys of visitors, and feedback of youth about the platform. It will be a mixed-method study design, containing qualitative and quantitative measures. DISCUSSION: This trial will specifically address young people with emerging mental health complaints, and offers a new approach for treatment in the Netherlands. Considering the waiting lists in (child and adolescent)-psychiatry and the increase in suicides among youth, early low-threshold and non-stigmatizing help to support young people with emerging psychiatric symptoms is of crucial importance. Moreover, this project aims to bridge the gap between child and adolescent and adult psychiatry. TRIAL REGISTRATION: Netherlands Trial Register ID NL8966 , retrospectively registered on the 19th of October 2020.

Asthma beliefs among mothers and children from different ethnic origins living in Amsterdam, the Netherlands.

BACKGROUND: Doctors and patients hold varying beliefs concerning illness and treatment. Patients' and families' explanatory models (EMs) vary according to personality and sociocultural factors. In a multi-ethnic society, it is becoming increasingly significant that doctors understand the different beliefs of their patients in order to improve patient/doctor communication as well as patient adherence to treatment. METHODS: Twelve focus groups were formed, consisting of 40 children diagnosed with asthma, as well as 28 mothers of these children. These groups included mothers and children of different ethnicities who were living in Amsterdam, the Netherlands. In order to understand the beliefs that both mothers and children hold regarding asthma and its treatment, the explanatory models were analysed and compared. RESULTS: Study findings show that mothers and children, regardless of ethnicity and age, have their own EMs. Overall, there is a great deal of uncertainty related to the causes, consequences, problems, and symptoms of asthma and its treatment. It also seems that many concerns and feelings of discomfort are the result of lack of knowledge. For instance, the fact that asthma is not seen as a chronic disease requiring daily intake of an inhaled corticosteroid, but rather as an acute phenomenon triggered by various factors, may be very relevant for clinical practice. This particular belief might suggest an explanation for non-adherent behaviour. CONCLUSION: A thorough understanding of the mothers' and children's beliefs regarding the illness and its treatment is an important aspect in the management of asthma. Gaining an understanding of these beliefs will provide a foundation for a solid clinician-patient/family partnership in asthma care. Although ethnic differences were observed, the similarities between the mothers' and children's beliefs in this multi-ethnic population were striking. In particular, a common belief is that asthma is considered an acute rather than a chronic condition. In addition, there is a lack of knowledge about the course and the self-management of asthma. Health care providers should be aware of these commonly held beliefs, and this information could be shared in educational programs.

Adherence to inhaled corticosteroids in children with asthma and their parents.

Poor adherence to inhaled corticosteroids (ICSs) may contribute to the recent rise in asthma morbidity. In general, appropriate adherence to ICSs is a complex process that is influenced by various determinants. The purpose of this study was to identify factors that were associated with adherence to ICSs in children with asthma and their parents in a multi-ethnic population in Amsterdam, the Netherlands. Two hundred and thirty-two children, aged 7-17 years, with paediatrician diagnosed asthma and their parents completed questionnaires examining socio-demographics, asthma control, knowledge of asthma and other determinants of adherence. Adherence to ICSs was assessed by self-report and pharmacy record data. We used logistic regression analyses to identify factors associated with adherence to ICSs in children and parents separately. We found no differences in adherence between the different ethnic groups. In the multivariate analysis for children, well-controlled asthma (OR: 4.12; CI: 1.50-11.3) was associated with poorer adherence, whereas positive subjective view of parents (OR: 0.45; CI:0.25-0.81) and self-efficacy (OR:0.51; CI: 0.35-0.75) were inversely associated with poorer adherence. A consistent result with the multivariate models for parents was the inversely significant association between poorer adherence and positive subjective view of parents to use ICSs (OR: 0.39; CI:0.19-0.77). Regardless of ethnic background, children positively stimulated by their parents to use ICSs showed a better adherence than children who experienced less positive influences. These results emphasise the importance of involving parents in the treatment of their child's asthma in order to enhance adherence to ICSs.

Health-related quality of life in children with asthma from different ethnic origins.

This study aimed to identify and explain differences in health-related quality of life (QoL) between immigrant and non-immigrant children with asthma. In 274 children (7-17 years of age) generic and asthma-related QoL were assessed. The association between ethnicity and QoL was studied in linear regression model analyses. For the asthma-related QoL, unadjusted analyses showed significant ethnic differences. The non-immigrant children had the highest scores, which implies a better QoL. After adjusting for asthma control and socioeconomic status (SES), ethnic differences disappeared. These results suggest that immigrant children have a similar QoL to that of non-immigrant children from a comparable SES, when their asthma is under control.

Predictors of asthma control in children from different ethnic origins living in Amsterdam.

To identify factors associated with asthma control in a multi-ethnic paediatric population. We interviewed 278 children with paediatrician diagnosed asthma (aged 7-17 years) and one of their parents. Asthma control was assessed with the Asthma Control Questionnaire (ACQ). Detailed information about sociodemographic variables, asthma medication, knowledge of asthma, inhalation technique and environmental factors were collected. Turkish and Moroccan parents were interviewed in their language of choice. Logistic regression analyses were used to identify correlates of asthma control. Of the 278 children, 85 (30.6%) were Dutch, 84 (30.2%) were Moroccan, 58 (20.9%) were Turkish and 51 (18.3%) were Surinamese. Overall, almost 60% had a status of well-controlled asthma, as indicated by the ACQ. Only 51 of the 142 (35.9%) Moroccan and Turkish parents had a good comprehension of the Dutch language. In logistic regression analyses the risk of having uncontrolled asthma was significantly higher among Surinamese children (OR 2.3; 95% CI 1.06-4.83), respondents with insufficient comprehension of the Dutch language (OR 2.3; 95% CI 1.08-4.78), children using woollen blankets (OR 9.8; 95% CI 1.52-63.42), and significantly lower among male (OR 0.5; 95% CI 0.31-0.91) and non-daily users of inhaled corticosteroids (OR 0.6; 95% CI 0.38-1.07). In conclusion, ethnicity as well as insufficient comprehension of the Dutch language appeared to be independent risk factors for uncontrolled asthma. Special attention should be given to children from immigrants groups for example by calling in an interpreter by physicians when comprehension is insufficient.

Results of breast cancer screening in first generation migrants in Northwest Netherlands.

To determine breast cancer screening results according to country of birth data were used from the breast cancer screening organization of the Comprehensive Cancer Centre Amsterdam, The Netherlands. Overall (age-adjusted) attendance of the breast cancer screening was 76% for women aged 50-69. Attendance was significantly lower for women born in non-western countries (Surinam 59%, Turkey 44% and Morocco 37%) and for women with residence in Amsterdam (68%). Referral and detection rates for women from non-western countries were 5.1 and 2.2 per 1000 screened women, respectively, compared with 8.8 and 4.0 for women born in The Netherlands (P<0.05). The positive predictive value was 45% for women born in The Netherlands and western countries and 43% for women born in non-western countries. Although women born in non-western countries attend breast cancer screening less frequently than women born in The Netherlands, they also have a low detection rate. The latter finding justifies a passive attitude towards the low attendance.

Ethnic differences in disability risk between Dutch and Turkish scaffolders.

The number of native Dutch and Turkish workers receiving a permanent disability pension in the Netherlands is still rising. To assess ethnic differences in disability risk between Dutch and Turkish scaffolders, a retrospective study was conducted within a large scaffolding company. Medical files for the period 1981-2000 were used to gather information on ethnicity, age at entering service, age at becoming disabled, years of employment, the year to receive a disability pension, the disability diagnosis, and the percentage rating of the disability pension. In the past 20 yr, 131 Turkish and 125 Dutch scaffolders have become disabled. Musculoskeletal disorders were the primary reason for the diagnosis. No differences in diagnoses were observed, except for a small difference in cardiovascular disease. Turkish scaffolders started their work at an older age, received the disability pension at an older age, and had a longer duration of employment. Turkish scaffolders faced disability 2.48 (95% confidence interval 1.94-3.18) times more often than their Dutch colleagues, adjusted for age. Explanations for the differences in disability risk between Dutch and Turkish scaffolders are sought in the older age at start of employment, lower mobility in the labour market, and less access to medical and social care. In future, employers, general practitioners, occupational health physicians and social security workers, as stakeholders in reintegration, should sufficiently attune their activities concerning care and cure for Turkish construction workers on long-term sick leave or during reintegration into other work.

Breast cancer risk among first-generation migrants in the Netherlands.

We investigated breast cancer incidence in migrants in the Netherlands in 1988-1998. The standardised incidence ratio for breast cancer in Northwest-Netherlands was statistically significantly reduced for women born in Surinam (0.56), Turkey (0.29) and Morocco (0.22). The proportion of women with advanced stages (III and IV) did not differ significantly between migrants and women born in the Netherlands.

[Incidence of cervical cancer in women in North-Holland by country of birth from 1988-1998]. / Incidentie van baarmoederhalskanker naar geboorteland bij vrouwen in Noord-Holland in 1988-1998.

OBJECTIVE: To describe the incidence of cervical cancer in women in North-Holland by country of birth. DESIGN: Descriptive epidemiological study based on data from cancer registries. METHOD: The number of cases of cervical cancer in North-Holland for the period 1988-1998 was determined using data from the regional cancer registry of the Comprehensive Cancer Centre, Amsterdam. Based on data from the Netherlands Cancer Registry, a comparison was made between the observed (O) and the expected (E) number of cases by area of residence (i.e., Amsterdam versus the rest of North-Holland) and by the woman's country of birth. RESULTS: In the period 1988-1998, the incidence of cervical cancer among women living in North-Holland was significantly higher than that of the nation as a whole (O/E-ratio: 1.2; 95% CI: 1.1-1.2). In particular, the incidence of cervical cancer for women living in Amsterdam (O/E-ratio: 1.5; 95% CI: 1.4-1.6), and for women born in Morocco (O/E-ratio: 2.1; 95% CI: 1.4-3.1) or Surinam (O/E-ratio: 1.5; 95% CI: 1.1-2.0) was much higher. The country of birth was unknown in 10% of the women. The percentage of patients with extension of the disease outside the uterus (TNM-stages II-IV) did not differ between women born in the Netherlands and those born abroad. CONCLUSION: The incidence of cervical cancer during the period 1988-1998 was significantly higher for women living in Amsterdam and for women born in Morocco or Surinam than that for the Netherlands as a whole. No significant difference in stage of disease at diagnosis was observed between women born in the Netherlands versus those born abroad.

Assessment of exposure to chemical agents and ergonomic stressors in tanneries in Kanpur, India.

In developing countries qualitative assessment of exposure at the workplace may be an essential tool in evaluating hazardous working conditions. This survey reports on qualitative assessment of exposure to chemicals, dust, and ergonomic stressors among 298 workers in 15 tanneries in Kanpur, India. In general, chemical exposure and dermal exposure were highest among beamhouse workers, less for workers involved in dry finishing activities, and lowest for those performing the wet finishing of hides. Dermal exposure was rated as high to very high during beamhouse activities, reflecting direct contact with wet hides and manual handling of hides in soak tanks. Relevant dust exposure was observed only during dry finishing activities. Most workers experienced severe postural load due to working in trunk flexion and rotation for more than 50% of their daily work time. In addition, manual materials handling with loads over 20 kg frequently occurred. The size of the tannery, in general a reflection of state of technology, showed no systematic influence on exposure profiles. The survey suggested that mechanization of material transfer and application of trolleys reduced the work time with trunk flexion and rotation and implied less manual lifting. The presence of local exhaust ventilation in large tanneries seemed to reduce the chemical exposure. This survey has demonstrated the importance of rapid appraisal techniques for evaluating hazardous conditions at the workplace. In developing countries this approach may facilitate occupational hygiene research and practice.

Respiratory disorders, skin complaints, and low-back trouble among tannery workers in Kanpur, India.

In a cross-sectional survey health complaints among 418 laborers in 15 Indian tanneries were studied. Low-back pain (61%), asthma (38%), dermatitis (23%), and chronic bronchitis (14%) were the most frequently reported complaints in the 12 months prior to the survey. In general, beamhouse workers reported the highest prevalence but only chronic low-back pain was significantly elevated compared with workers in the finishing departments. When using individual exposure estimates, clear associations were presented among manual lifting over 20 kg and low-back pain (OR = 3.5) and skin exposure and dermatitis (OR = 2.6). Frequent lifting of loads was also associated with self-reported asthma. About 44% of the laborers reported at least one period of sickness absence, and 17% were involved in a serious occupational accident that required a visit to the local physician. Logistic regression analysis showed that sickness absence occurred more often in small tanneries (OR = 2.7) and also was significantly associated with low-back pain (OR = 3.3) and occupational accidents (OR = 2.2). This epidemiologic survey on health complaints in tannery workers is among the few in occupational populations in low-income countries. For many reasons these populations are easily overlooked. The results of this descriptive study indicate that there is a clear need for epidemiologic surveys in these countries to obtain information on working conditions and associated health problems.

Body mass index of tannery workers in Kanpur, India.

During two cross sectional surveys in 1988 and 1994 the body mass index among tannery workers in Kanpur, India and its association with exposure to chemicals, dust and awkward ergonomic conditions, socio-economic and health status were studied. Fifty six per cent of the workers had in 1988 a BMI of less than 18.50, the cut-off value for malnutrition. In 1994 the proportion of malnourished workers had decreased to 41 per cent, being statistically significant lower than in 1988. Workers with a high exposure to lifting weights of more than 20 kg had significantly lower BMI than workers without this exposure. No other differences in mean BMI were found between workers without exposure to chemicals, dust and other awkward ergonomic conditions and workers with high or very high exposures, nor did the mean BMI of workers with occupational related conditions such as dermatitis, work related respiratory symptoms and low back pain differ from those without these conditions. There was no association between mean BMI and industrial modifications. In the 1994 survey workers who took sick leave in the year prior to the survey, workers of small/medium sized tanneries and workers without an ESI card had significantly lower BMI than workers without sick leave, workers of large tanneries and workers with an ESI card. Mean BMI of labourers with a monthly income of less than Rs 550 was significantly lower than that of tannery staff not engaged in leather work in this income group. No association was found between mean BMI and smoking, use of alcohol, educational level and income. The nutritional status of labourers in developing countries deserves more attention within the field of occupational health and safety.

An occupational health programme for adults and children in the carpet weaving industry, Mirzapur, India: a case study in the informal sector.

The Indo-Dutch Environmental and Sanitary Engineering Project under Ganga action Plan in Kanpur and Mirzapur is being executed within the framework of Indo-Dutch bilateral development cooperation. The project aims to integrate technological, social and health related improvements. It is expected that the development approach and methodology can be replicated in other urban settlements in India. The project is being supplemented by a training and institutional strengthening programme, which will facilitate the transfer of new technologies and improvements in operation and maintenance of these new technologies. One of the project's goals is to improve living conditions in the targeted areas by installing drinking water and drainage systems. A socio-economic unit (SEU) in the project supports these technical interventions by encouraging the community to participate in project activities. The Occupational Health Programme in Mirzapur was conceived by the SEU to improve the health and living conditions of child and adult weavers. At the start of the programme, 200 weavers and 60 non-weaver workers from Mirzapur city, matched for age and socio-economic status, were interviewed and underwent a physical examination. The mean age of the weavers is 27 years, reflecting the relatively large percentage of child labour (13.5%). Illiteracy among them is 73%, whereas 14% have had only a primary education. 64.5% of the carpet weavers are Muslims and 35.6% are Hindus. 61% own a loom or work in a family owned loom shed. 95% of the weavers have a monthly income of less than 600 Rs. Complaints of a persistent cough and cough with expectoration, backache, the common cold and joint pains occurred more often in the weaver population than in the comparison group and have been identified as 'occupational hazards'. An intervention programme has been implemented based on the results of the occupational health survey. These interventions include awareness camps, installment of plexiglass tiles for light improvement in the loom sheds, training of community health volunteers and house-to-house health education. Another essential part of the programme is the provision of functional literacy classes for child and adult labourers in the carpet weaving industry. Occupational health as an entry point proved to be a successful approach in this segment of the informal sector, where child labour plays an important role.

Occupational health and the environment in an urban slum in India.

The Indo-Dutch Environmental & Sanitary Engineering Project under the Ganga action Plan in Kanpur and Mirzapur is being executed within the Indo-Dutch bilateral development cooperation framework. The project aims to integrate physical, social and health related improvements. It is expected that the development approach and methodology can be replicated in other urban settlements in India. The project is being supplemented by a training and institutional strengthening programme to facilitate the transfer of new technologies and improvement of operation and maintenance of the new facilities. The project is also aimed at the improvement of the living conditions of the population, by installing drinking water and drainage systems. A socio-economic unit in the project supports the technical interventions by enhancing the community to participate in project activities. The Occupational Health Programme in Jajmau, an industrial slum of Kanpur, aims to improve the working conditions of tannery workers. Four hundred and ninety-seven tannery workers and 80 employees not engaged in leather work, from 20 tanneries, were interviewed and underwent physical examination. The mean age of tannery workers was 32 years, about half of them recently migrated to Kanpur. The majority of the workers are illiterate, have temporary jobs and 85% have a monthly income between 300 and 600 Rs. Occupational morbidity was 28.2%. Regular meetings with tannery owners, the training of tannery workers in first aid, and support for the installation of safety and health councils in tanneries are the main programme activities.(ABSTRACT TRUNCATED AT 250 WORDS)

Children who cross cultures.

The subject of this study is the effects of transcultural sojourn and culture shock on the psycho-social development and school achievement of Dutch children. One hundred and three Dutch children in the age range 6-17 years who stayed abroad with their parents for at least two years and returned to Holland were compared with 81 Dutch classmates of the same age and sex. The class teacher and parent(s) were the informants. The transcultural group showed more behavioural problems on the Dutch version of the Child Behavior Checklist developed by Achenbach. Parents of the transcultural group regarded their children on a modified Graham & Rutter questionnaire as less happy than the control parents. However, no differences were found for academic achievement or problem behaviour at school as assessed by the teacher version of the CBCL, the 'Teacher's Report Form' (TRF). Organizations which send their employees abroad should direct more attention to employees' children. Attention given by parents and teachers to language problems and school performance should not pre-empt close attention to the psycho-social development of children.