Trends in the use of benzodiazepine receptor agonists among working-age adults in Belgium from 2004 to 2018.

Introduction: The use of psychotropics, such as benzodiazepine receptor agonists (BzRAs), among working-age adults in Belgium has shown educational differences. However, it is unclear how work status plays a role in this relationship. Therefore, this research aims to investigate whether work status explains observed educational differences in BzRA use. In addition, considering medicalisation processes, where non-medical factors, such as work status, are increasingly associated with medical mental health care-seeking behavior, this research also aims to investigate whether work status explains observed educational differences in BzRA use, regardless of mental health status. Methods: Data are obtained from the Belgian Health Interview Survey (BHIS). Four successive waves are covered: 2004, 2008, 2013, and 2018. The weighted data represent a sample of 18,547 Belgian respondents aged 18 to 65 years old. Poisson regression models are used to analyze the research aims. Time evolutions are plotted using marginal means postestimation. Results: The average use of BzRAs shows a slight decline over the waves studied (2004 = 5.99, 2008 = 5.88, 2013 = 5.33, 2018 = 4.31). Educational and work status differences in BzRA use are observed, regardless of mental health status. Individuals with longer education report lower use compared to individuals with shorter education, and individuals who are unemployed, (pre-)retired, or sick or disabled report higher use compared to employed individuals. Furthermore, work status acts as a mediator, partially explaining educational differences in BzRA use, regardless of mental health status. Discussion: Work-related uncertainty leads to increased prescribing and medication use, regardless of mental health. Medicalisation and pharmaceuticalisation processes detach social problems from their social roots and treat them as personal failures. The marginalization of the social roots of unemployment, sick leave and involuntary (pre-)retirement has led to a personalization of responsibility. Negative feelings arising from such work statuses may cause isolated, non-specific symptoms for which medical treatment is sought.

Assessing Provider Bias in General Practitioners' Assessment and Referral of Depressive Patients with Different Migration Backgrounds: Methodological Insights on the Use of a Video-Vignette Study.

Although the prevalence of common mental health conditions such as depression and anxiety, is higher among people with a migration background, these groups are generally underrepresented in all forms of institutionalized mental health care. At the root of this striking discrepancy might be unequal referral by health care practitioners. In this article we describe the development of a quasi-experimental video vignette methodology to assess potential forms of unequal diagnosing, treatment and referral patterns, based on clients' migration background and asylum status. The presented methodology also allows to explore whether potential differences are related to provider bias, i.e. underlying attitudes and expectations held by general practitioners. Potential assets and drawbacks of this methodology are discussed in detail.

The silver lining of greying: Ageing discourses and positioning of ageing persons in the field of social health insurance.

Contemporary ageing discourses and policies perceive being active as the key to a good later life and thereby focus on individual responsibility and self-care. Drawing on website articles and press releases of Belgian sickness fund agencies, this study analyses the ageing discourses and positioning of ageing persons of these organisations. A discourse analysis was performed using positioning theory to analyse how sickness fund agencies discursively construct the ageing process and position ageing persons, and to investigate how these positioning acts are related to sickness fund agencies' roles as social insurer, social movement, social entrepreneur and private insurer. Our results reveal three storylines on ageing; ageing as a medical problem, ageing as a new stage in life and ageing as a natural life process. These storylines are applied to construct ageing and position ageing persons in different ways. Depending on their role, sickness fund agencies take on a different position drawing on these different storylines. We also show how these storylines reproduce the moral framework on how to age well and thereby disempower ageing persons. Our results underline the importance of multidimensional perspectives on ageing.

From economic survival to recreation: contemporary uses of wild food and medicine in rural Sweden, Ukraine and NW Russia.

BACKGROUND: There are many ethnobotanical studies on the use of wild plants and mushrooms for food and medicinal treatment in Europe. However, there is a lack of comparative ethnobotanical research on the role of non-wood forest products (NWFPs) as wild food and medicine in local livelihoods in countries with different socio-economic conditions. The aim of this study was to compare the present use of wild food and medicine in three places representing different stages of socio-economic development in Europe. Specifically we explore which plant and fungi species people use for food and medicine in three selected rural regions of Sweden, Ukraine and the Russian Federation. METHODS: We studied the current use of NWFPs for food and medicine in three rural areas that represent a gradient in economic development (as indicated by the World Bank), i.e., Småland high plain (south Sweden), Roztochya (western Ukraine), and Kortkeros (Komi Republic in North West Russia). All areas were characterised by (a) predominating rural residency, (b) high forest coverage, and (c) free access to NWFPs. A total of 205 in-depth semi-structured interviews were conducted with local residents in the three study areas. The collected NWFPs data included (1) the species that are used; (2) the amount harvested, (3) uses and practices (4) changes over time, (5) sources of knowledge regarding the use of NWFPs as wild food and medicine and (6) traditional recipes. RESULTS: In Sweden 11 species of wild plant and fungi species were used as food, and no plant species were used for medicinal purposes. In Ukraine the present use of NWFPs included 26 wild foods and 60 medicinal species, while in Russia 36 food and 44 medicinal species were reported. CONCLUSIONS: In the economically less developed rural areas of Ukraine and Russia, the use of NWFPs continues to be an important part of livelihoods, both as a source of income and for domestic use as food and medicine. In Sweden the collection of wild food has become mainly a recreational activity and the use of medicinal plants is no longer prevalent among our respondents. This leads us to suggest that the consumption of wild food and medicine is influenced by the socio-economic situation in a country.

Resilience of Andean urban ethnobotanies: a comparison of medicinal plant use among Bolivian and Peruvian migrants in the United Kingdom and in their countries of origin.

ETHNOPHARMACOLOGICAL RELEVANCE: Analysing why and how ethnobotanical traditions 'survive' is important for a better understanding of migrants' health care behaviour. This study investigates the use of traditional medicinal plants among first generation migrants from Bolivia and Peru in London, in relation to practices among their peers in their respective home countries in order to assess changes in traditional health care among newcomer communities. MATERIALS AND METHODS: A total of 98 semi-structured interviews were conducted in London (UK), Cochabamba (Bolivia) and Lima (Peru). Voucher specimens of all reported species were collected and identified. By comparing data on active plant uses and their applications, overlap and differences between health care practices before and after migration could be outlined. RESULTS: In London, people can rely on more biomedical alternatives and have access to less traditional herbal remedies as compared to their countries of origin. In general, Peruvians and Bolivians in London continued to use traditional medicine for common, self-limiting ailments that were also widespread in their countries of origin. The same widely used (either readily available cosmopolitan or culturally relevant) plant species appeared in the post-migration group. In general, less freshly available medicinal species were used in London and more edible, primary food species were consumed for medicinal purposes after migration. CONCLUSIONS: Bolivian and Peruvian migrants in London clearly proved to be resilient in their use of home-remedies when faced with the changes that come with migration. The observed ethnobotanical coping strategies are characterised by: (1) the preservation of culturally salient species (cultural key stone species); (2) a positive influence of the presence of cultural diversity (cultural edge effect), (3) a creative blending of different kinds of knowledge and resources, noticeable in an increased use of dried, processed alternatives and food species; and (4) a reliance on social networks for the exchange of plant material.