[Health care usage by minimum income citizens in Amsterdam; a cross-sectional study into claims within the Dutch basic health insurance scheme]. / Het zorggebruik van minima in Amsterdam.

OBJECTIVE: Gaining more insight into any differences in care expenses between minimum and higher income groups. DESIGN: Cross-sectional study among 6,709 citizens of Amsterdam aged 19 years and over. METHOD: Data on declared health care expenses from 2012 were linked to personal income and to public health survey data. Through weighted logistic regression analysis, differences in expenses for primary care, hospital care, mental health care and other care were compared for minimum and higher income groups, controlling for demographic characteristics, educational level and health status. RESULTS: Minimum income groups claimed more often for mental health care costs (11%) than higher income groups (7%). However, after controlling for demographic characteristics, educational level and health status this difference was not significant. Further, minimum income groups claimed fewer expenses for hospital care, but this difference was not significant. The number of claims for other care did not differ. The size of the expenses differed between income groups. Expenses for primary care among minimum income groups were lower versus those for higher earners. Expenses for hospital care, mental health care and other care were higher, but not to a statistically significant level. CONCLUSION: Minimum income groups claim lower costs for primary care. On the other hand, the number of claims for mental health care, hospital care and other care is equal or higher than that of higher income citizens, as is the size of the claimed expenses.

Validation of the SQUASH Physical Activity Questionnaire in a Multi-Ethnic Population: The HELIUS Study.

PURPOSE: To investigate the reliability and validity of the SQUASH physical activity (PA) questionnaire in a multi-ethnic population living in the Netherlands. METHODS: We included participants from the HELIUS study, a population-based cohort study. In this study we included Dutch (n = 114), Turkish (n = 88), Moroccan (n = 74), South-Asian Surinamese (n = 98) and African Surinamese (n = 91) adults, aged 18-70 years. The SQUASH was self-administered twice to assess test-re-test reliability (mean interval 6-7 weeks) and participants wore an accelerometer and heart rate monitor (Actiheart) to enable assessment of construct validity. RESULTS: We observed low test-re-test reliability; Intra class correlation coefficients ranged from low (0.05 for moderate/high intensity PA in African Surinamese women) to acceptable (0.78 for light intensity PA in Moroccan women). The discrepancy between self-reported and measured PA differed on the basis of the intensity of activity: self-reported light intensity PA was lower than measured but self-reported moderate/high intensity PA was higher than measured, with wide limits of agreement. The discrepancy between questionnaire and Actiheart measures of moderate intensity PA did not differ between ethnic minority and Dutch participants with correction for relevant confounders. Additionally, the SQUASH overestimated the number of participants meeting the Dutch PA norm; Cohen's kappas for the agreement were poor, the highest being 0.30 in Dutch women. CONCLUSION: We found considerable variation in the test-re-test reliability and validity of self-reported PA with no consistency based on ethnic origin. Our findings imply that the SQUASH does not provide a valid basis for comparison of PA between ethnic groups.

Prevalence and risk-factors for depression in elderly Turkish and Moroccan migrants in the Netherlands.

BACKGROUND: Western societies host increasing number of elderly labour migrants from Turkey and Morocco. The article studied the prevalence of clinically significant depressive symptoms among elderly Turkish and Moroccan migrants compared with native Dutch elderly and if differences in prevalence rates were explained by known risk factors for depression and/or ethnic, migration-related factors. METHODS: 330 Turkish, 299 Moroccan, and 304 Dutch elderly (55-74 years) were interviewed (cross-sectionally) using the Center for Epidemiologic Depression Scale (CES-D). Potential risk factors included sex, income level, marital status, ethnic origin, chronic physical illnesses, limitations in daily functioning, migration and acculturation questions. RESULTS: The prevalence of self-reported depressive symptoms (CES-D>or=16) was very high in elderly migrants, 33.6% for Moroccan and 61.5% for Turkish elderly. The prevalence of depressive symptoms in the native Dutch sample was similar to earlier studies in the Netherlands and abroad: 14.5%. Among migrants education and income level was very low and they had a high number of physical limitations and chronic medical illnesses. This only explained part of the ethnic differences found. In all three samples, depressive symptoms were associated with sex, chronic physical illness and physical limitations. In multivariate analysis, ethnic origin was uniquely associated with the presence of clinically significant depressive symptoms. Only a small number of remigration and acculturation items were associated with depressive symptoms in bivariate analysis. CONCLUSIONS: The prevalence of clinically significant depressive symptoms among elderly migrants from Turkey and Morocco in the Netherlands is very high. Ethnicity was a strong independent risk factor.

[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.

[Travel advice on the prevention of infectious diseases insufficiently obtained by indigenous and non-native inhabitants of Amsterdam, the Netherlands]. / Onvoldoende bereik van reizigersadvisering over infectieziektepreventie onder autochtone en allochtone Amsterdammers.

OBJECTIVE: To determine the travel behaviour of inhabitants of Amsterdam, the Netherlands, with respect to age and ethnicity, as well as the impact of travel advice, in particular regarding hepatitis A vaccination of Turkish and Moroccan children. DESIGN: Descriptive. METHOD: In a sample of 2000 inhabitants of Amsterdam, a survey was carried out during the period October 1999-November 2000 on seeking medical advice prior to travelling. In addition, 429 Turkish and Moroccan parents were questioned about hepatitis A vaccination of their children when travelling to their country of origin. RESULTS: In the three years preceding the survey one third of the Amsterdam population travelled to a country where infectious diseases such as malaria and hepatitis A were endemic. Many travellers (18%) went to Asia, Central or Latin America and Africa. Others (12%) travelled to the Middle-East or North Africa. One third of the travellers had sought advice from the Municipal Public Health Service of Amsterdam. Other travellers were advised by their general practitioner (10%). A large group (38%) did not seek any advice at all. Almost one third of the travellers went to their country of origin, particularly Turkish and Moroccan inhabitants of Amsterdam. Seventy percent of Turkish and Moroccan travellers had not sought travel advice. More than half the Turkish and Moroccan parents did not have their children vaccinated against hepatitis A when travelling to their country of origin. CONCLUSION: One fifth of the indigenous Dutch population received no travel advice. More than half of Turkish and Moroccan children travelling to their country of origin were not vaccinated against hepatitis A.

Risk groups for overweight and obesity among Turkish and Moroccan migrants in The Netherlands.

OBJECTIVES: The association between sociodemographic factors and acculturation with overweight/obesity in Turks and Moroccans was studied to identify target groups for prevention. STUDY DESIGN: A cross-sectional study was undertaken among a sample of 1384 Turks and Moroccans aged 35-74 years in Amsterdam, The Netherlands. METHODS: Data were collected by structured face-to-face interviews. Body mass index (BMI) was calculated from self-reported height and weight data. Sociodemographic variables collected were sex, age, educational level, marital status, parity and income level. Acculturation was measured by cultural orientation and length of residence in The Netherlands. Data of 1095 Turks and Moroccans were analysed using logistic regression, with overweight/obesity (BMI 25.0) as the dependent variable. RESULTS: The prevalence of overweight/obesity was high (57-89%). Age, marital status, parity, income level, cultural orientation and length of residence were not associated or only weakly associated with overweight/obesity. Educational level and overweight/obesity were strongly associated in Turkish women (odds ratio 4.56; 95% confidence intervals 1.54-13.51). CONCLUSIONS: The high prevalence of overweight/obesity in Turkish and Moroccan migrants varies little across sociodemographic groups and is not associated with acculturation. Poorly educated Turkish women are at particularly high risk.