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.

[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.

Changing patterns in reported sexual practices in the population: multiple partners and condom use.

OBJECTIVE: To determine whether the pattern of change with regard to condom use and multiple sexual partners is influenced by gender or educational level. DESIGN: Findings from data collected from 1987 to 1990 about changes in condom use and multiple-partner activities are presented, based on telephone interviews with 9416 participants aged 18 to 44 years resident in central Scotland, UK. METHODS: Change in patterns over time were modelled in a multivariate logistic regression using a linear interactive modelling program. RESULTS: Several models showing changes in the proportion of multiple-partner respondents and condom users yielded a complicated pattern of behavioural change in educational status and gender. CONCLUSIONS: There is a large difference in reported condom use and multiple sexual partners by gender, but the difference is decreasing over time. Better educated respondents increased their use of condoms while less educated respondents showed a decrease in the proportion of multiple partners.

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 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.

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.

Differences in total tooth extraction between an urban and a rural area in the Netherlands.

Differences in total tooth loss between an urban and a rural area (dentist-patient ratio 1:2500 and 1:5700 respectively) have been studied. Patients who participated in this study were those who received total tooth extraction during the calendar yr 1982 (urban area) and 1983 (rural area). The overall dentist response was 90%, the combined patient response was 75%. During the year, in the urban area 137 cases of total tooth extraction were recorded; in the rural area this was 237. This frequency is equivalent to 109 and 226 total tooth extractions per 100,000 inhabitants, respectively. The age and sex distribution of the urban and rural population could not account for this difference. The rural population had a lower educational level and more people insured in a State Health Scheme, which is related to income. The frequency of symptomatic attenders was highest in the rural area among those who were insured in a State Health Scheme. It is concluded that differences in numbers of total extractions between the rural and urban areas cannot be explained entirely by differences in population characteristics.

Pathways to full mouth extraction.

The process of not attending the dentist is a vicious cycle in which anxiety plays a crucial role. A research project concerning the disease and non-disease reasons for full mouth extraction provided an opportunity to describe the dental histories in terms of dental attendance pattern and related factors which resulted in full dentures. Three profiles of dental histories could be outlined: 1) The regular attenders (19%). Because of their age (means = 47 yr), their positive attitude towards dentistry together with their positive attitude towards full dentures, it is suggested that the possibilities of keeping the natural dentition were exhausted so that full mouth extraction was an acceptable solution. 2) The symptomatic attenders (38%). Because anxiety, which was widespread in this group, was not based on negative experiences, it is suggested that anxiety is caused by social learning. Together with their positive attitude towards full dentures, the high prevalence of full dentures in their social environment and their low socioeconomic status, the conclusion is drawn that these patients lived in a culture which supports behavior that leads to total tooth loss. 3) Once regular attenders (43%). In this group anxiety leads to a negative perception of dental visits and to a negative attitude towards dentists. As a consequence dental visits are deferred, which results in deterioration of the dentition. Experiences with dentists are distorted in a negative way, which increases dental anxiety. Facilitated by a positive attitude towards full dentures, their bad dental condition finally urges them to take full dentures at early age.

Dental hygienists' influence on the patients' knowledge, motivation, self-care, and perception of change.

The purpose of this study was to assess the success of the dental hygienist in the dental health education of dental patients in general dental practice. Special emphasis was laid on health education in the field of periodontics. The answers on a questionnaire of 159 dental patients who visited a dental hygienist were compared with the answers of 302 dental patients who had never visited a dental hygienist. The comparison was done by means of t-test and regression analysis on specially developed scales with regard to knowledge, motivation, self-care, and perception of change. On all scales the dental patients who visited a dental hygienist scored better. This difference remained when social demographic variables and the dentist's influence were taken into account. This indicates that the dental hygienist is successful in the behavioral aspect of her work.

Attitudes of two groups of dentists towards dental hygienists.

The purpose of the study was to assess whether cooperation with a dental hygienist was based on pursuit of financial gain or on aspirations to improve patient care. To this end a questionnaire was sent to 972 dentists. 412 dentists replied, of whom 178 had patients treated by a dental hygienist. Questions were asked regarding practice profile, preventive orientation and dentists' opinion about the material and immaterial value of cooperation with a dental hygienist. Discriminant analysis showed that the main distinguishing factor between dentists who did and dentists who did not cooperate with dental hygienists was their opinion about the quality of the dental hygienists' work in relation to the non-financial costs for patients, insurance companies, and dentists. The difference in the dentists' opinions about the direct profitability of dental hygienists was not significant. The conclusion can be drawn that the orientation of Dutch dentists towards care for their patients plays a more important role in a dentist's decision to cooperate with a dental hygienist than is usually presumed.

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.

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.

Leisure time physical activity behavior in three British cities.

This article provides baseline information on leisure time physical activity. The data were collected in 1989 by telephone in the cities of London, Glasgow and Edinburgh. Twenty-eight percent of the respondents living in London reported that they engage in physical activity for exercise three or more times per week. For Glasgow and Edinburgh these figures are 24% and 28% respectively. Female respondents, respondents in the lower occupational categories and older respondents exercised on average less than male respondents, respondents from the higher occupational categories and younger respondents. Walking was the most popular form of physical activity for exercise in the three cities, for all age groups, all occupational groups and both sexes. Female respondents, respondents from the lower occupational categories and older respondents engaged in less strenuous physical activities. The differences between groups were independent of the stringency of the definition of exercise. The data showed that levels of leisure time physical activity for exercise do not meet standards which are advocated internationally. However, the levels and patterns found are similar to those found in North American studies. It would appear that the differences between the two Scottish cities and London are small.

Leisure time physical activity in Scotland: trends 1987-1991 and the effect of question wording.

In this article data collected between 1987 and 1991 is analyzed to identify changes in the proportion of sedentary individuals in Edinburgh and Glasgow. In the primary question, which asked the respondents about physical activity for exercise such as walking, running and swimming, a wording change deleting the prompt to specific activities is taken into consideration. The data were collected by telephone on 13,586 respondents. A considerable decrease in the proportion of sedentary individuals in both cities was observed between 1987 and 1991. This decrease could not be related to changes in specific sporting activities. The change to an unprompted question led to a 14% lower estimate of physical activity. This was almost fully explained by a change in the estimate of the proportion of walkers. Older respondents in particular were affected by the question change.

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.

[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.

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.