Higher 25-hydroxyvitamin D level is associated with increased risk for Behçet's disease.

BACKGROUND & AIM: Previous studies showed a vitamin D deficiency in patients with Behçet's disease, suggesting potential benefits of vitamin D supplementation in the prevention and treatment of Behçet's disease. Interpretation of these studies may be limited by reverse causality or confounding bias. We aim to determine the causal association between serum 25-hydroxyvitamin D [25(OH)D] and the risk of Behçet's disease by Mendelian randomization. METHODS: An allele score formed by four variants (rs2282679, rs10741657, rs12785878 and rs6013897) that were associated with serum 25(OH)D level, was examined using data of genome-wide association study (GWAS) on 999 Behçet's disease and 4417 healthy individuals of Chinese ancestry and validated using data of GWAS on 1215 Behçet's disease and 1278 controls of Turkish ancestry. The primary outcome was the risk of Behçet's disease, evaluated by an inverse variance weighted average of the associations with genetically determined 25(OH)D levels. RESULTS: The inverse variance weighted estimate showed that genetically increased 25(OH)D level was associated with a higher risk of Behçet's disease. In the Chinese cohort, the odds ratio for Behçet's disease in one standard deviation increase of natural log-transformed 25(OH)D level was 3.82 (95% CI: 1.27-11.42). Data from Turkish cohort confirmed the association with Behçet's disease (OR, 95% CI: 4.18, 1.15-15.12). In overall combination of Chinese and Turkish cohorts, the odds ratio for Behçet's disease per standard deviation increase of natural log-transformed 25(OH)D level was estimated to be 3.96 (95% CI: 1.72-9.13; P = 0.001). No significant evidence of pleiotropy and heterogeneity was detected. CONCLUSIONS: On the basis of evidence in 7909 human beings, this study provides the newest indication that a lifelong higher 25(OH)D level is associated with an increased risk of Behçet's disease. Special attention should be paid to the potential harm of long-term or high-dose use of vitamin D supplements in clinical practice.

The impact of ethnic density on dispensing of antipsychotic and antidepressant medication among immigrants in the Netherlands.

PURPOSE: A higher own-group ethnic density in the area of residence is often associated with a lower risk for psychotic disorder. For common mental disorders the evidence is less convincing. This study explores whether these findings are mirrored in data on dispensing of antipsychotics and antidepressants. METHODS: Health insurance data on dispensed medication among all adults living in the four largest Dutch cities were linked to demographic data from Statistics Netherlands. Dispensing of antipsychotics and antidepressants in 2013 was analyzed in relation to the proportion of the own ethnic group in the neighborhood. RESULTS: Higher own-group ethnic density was associated with lower dispensing of antipsychotics among the Moroccan-Dutch (N = 115,455), after adjusting for age, gender, and SES of the neighborhood (ORadj for the highest vs. the lowest density quintile = 0.72 [0.66-0.79]). However, this association vanished after adjustment for household composition (ORadj = 0.93 [0.85-1.03]). Similar results were found for the Turkish-Dutch (N = 105,460) (ORadj = 0.86 [0.76-0.96] and 1.05 [0.94-1.18]). For those of Surinamese (N = 147,123) and Antillean origin (N = 41,430), in contrast, the association between ethnic density and lower risk remained after each adjustment (P < 0.001). For antidepressants, a negative association with own-group ethnic density was consistently found for those of Antillean origin (ORadj = 0.62 [0.52-0.74]) only. CONCLUSION: These data on dispensing of psychomedication confirm the ethnic density hypothesis for psychosis alongside earlier equivocal findings for other mental disorders. The negative association between own-group ethnic density and dispensing of antipsychotics among the Moroccan- and Turkish-Dutch may be explained, at least in part, by a favourable household composition (i.e., living in a family) in high-density neighborhoods.

Talking about intimate partner violence in multi-cultural antenatal care: a qualitative study of pregnant women's advice for better communication in South-East Norway.

BACKGROUND: Intimate partner violence (IPV) against women constitutes a major public health problem. Antenatal care is considered a window of opportunity to disclose and to communicate about IPV. However, little is known about how women from different ethnic backgrounds wish to communicate about their experiences with IPV during pregnancy in antenatal care. The aim of the present study was to explore how women from different ethnic backgrounds experienced IPV and what their recommendations were about how midwives should communicate about IPV in antenatal care. METHODS: Qualitative individual interviews with eight women who had experienced IPV during pregnancy were conducted and analysed using thematic analysis. The participants were purposively recruited from three crisis shelters in South-East Norway. RESULTS: The participants either had immigrant backgrounds (n = 5) or were ethnic Norwegians (n = 3). All participants received antenatal care by a midwife. Although none of the participants were asked about IPV during antenatal care, they wished to talk about their experiences. Most participants felt that it would be important for the midwife to make them aware that they were victims of violence. Participants offered different suggestions on how and when midwives should talk about IPV. Facilitators to talk about IPV with the midwife were a good relationship with and the trustworthiness of the midwife, information about possible negative health outcomes for the newborn owing to IPV and knowing that the midwife could help them. The main barriers to talk about IPV with the midwife were that the participants were accompanied by their husbands during antenatal care, fear that the Child Welfare Service would take away their children after disclosure and cultural acceptance of violence. Participants with immigrant backgrounds also experienced difficulties in talking about IPV owing to their limited language skills. They thought that professionally trained interpreters with experience of IPV could overcome this barrier. CONCLUSION: Even though none of the participants were asked about IPV in antenatal care, they offered different suggestions on how and when midwives should talk about IPV. Participants irrespective of their ethnical backgrounds perceived antenatal care as a key area to facilitate disclosure of IPV. Midwives' communication and strategic skills to address IPV are crucial for help-seeking women. Training midwives' skills in culture-sensitive communication might help to overcome cultural barriers to talk about violence.

Preferences for birth center care in the Netherlands: an exploration of ethnic differences.

BACKGROUND: To examine the preferences for comprehensive services and facilities in a new proposed birth center which will be established in a large Dutch city, specifically among pregnant women from different ethnic backgrounds. METHODS: The analyses of this study were based on a survey among 200 pregnant women living in The Hague, the Netherlands in 2011. Multiple linear regression was applied to analyze if preferences differ by ethnic background, controlling for various other predictors. RESULTS: Pregnant women had relatively strong preferences for comprehensive services and facilities to be offered by the new proposed birth center compared to both other dimensions of birth center care: extensive practical information and comfortable accommodation. With regard to ethnic differences, non-Dutch women had higher preferences for comprehensive care compared to Dutch women. This difference between Dutch and non-Dutch women increased with their level of education. CONCLUSIONS: Especially for non-Dutch women, birth centers that are able to provide comprehensive services and facilities can potentially be a good setting in which to give birth compared to hospitals or at home. In particular, higher educated non-Dutch women had a preference for the personalized care that could be offered by this new birth center.

[Palliative care for patients with Turkish or Arabic migration background in Lower Saxony : A survey from palliative care professionals' perspective]. / Palliative Versorgung von Menschen mit türkischem oder arabischem Migrationshintergrund in Niedersachsen : Eine Befragung spezialisierter Palliativversorger.

BACKGROUND AND OBJECTIVES: People with a migration background (MB) are an important part of German society. If and how they use specialised palliative care (SPC) has not been studied. We aimed to assess the current SPC for patients with Turkish or Arabic MB (the largest group of immigrants in Germany with a shared ascribed culture) from the point of view of healthcare professionals (HCP) in Lower Saxony. METHOD: All HCPs in institutions providing SPC (n = 90) were invited to participate in an anonymous online survey which contained closed and open questions about care for this patient group, characteristics of the last patient with Turkish or Arabic MB they cared for, and resources and strategies to care for these patients. The survey was analysed using descriptive statistics and qualitative content analysis. RESULTS: Fifty-five HCPs in SPC participated, mostly nurses aged between 40 and 60 years. One fifth had not cared for a patient with Turkish or Arabic MB during the last 12 months. Given their local population, 84.6% estimated that they cared for a lower number of patients than would be representative. In care, problems with communication as well as difficulties to interact with and manage families, and in organising and planning care were most prevalent. Only 21% of participants had access to interpreters. DISCUSSION: Patients with Turkish or Arabic MB seem to be underrepresented in SPC. The high rate of communication problems highlights the necessity of reliable and accessible interpreter services. Most difficulties were of psychosocial nature, showing how important the holistic approach of SPC is in caring for terminally ill patients with Turkish or Arabic MB.

Ethnomedicinal plants of Aydincik District of Mersin, Turkey.

ETHNOPHARMACOLOGICAL RELEVANCE: This survey presents crucial ethnopharmacological data on medicinal plants used by indigenous people who live in the Aydincik district of Mersin in Turkey. AIM OF THE STUDY: To provide a knowledge base of herbal therapies from the Aydincik region with their traditional use, plant parts and administration methods besides computing some statistical values. MATERIALS AND METHODS: Plant samples that have been collected by spice-sellers or residents from Aydincik for therapeutic purposes were recorded by visiting the villages during the study period, and then brought to the laboratory to diagnose the taxa. In addition, the relative frequency citation (RFC), use values (UV), informant consensus factor (ICF) and fidelity level (FL) were computed. RESULTS: In this research conducted between 2013 and 2015, 91 taxa associated with 41 families, including 1 fern & 2 gymnosperms were defined they have been used for centuries in terms of the healing by visiting 10 villages & 5 spice-sellers in Aydincik. Lamiaceae, Rosaceae, Araceae, Asteraceae, Cupressaceae, Orchidaceae and Pinaceae have been determined as the most used families for therapeutic purposes. The study revealed that most of the locals concurred on the use of Juniperus oxycedrus fruits & leaves to cure gastro-intestinal diseases that demonstrated the highest fidelity level (0.98). 22 taxa have not matched with any studies conducted in and around the region. CONCLUSION: The light of the information obtained during the investigation demonstrates that the medicinal plants have been mostly utilized as analgesics (0.78 ICF). The most data were acquired from the mountain villagers & Yuruk nomads, having average ages of 65. From the viewpoint of ethnobotany, the district has remained valuable due to the winding roads, ongoing hundreds of kilometers over the mountains and along the coast is very difficult to drive making Aydincik too far from large cities and mass tourism centers.

Ethnobotany of medicinal plants used in Antakya: A multicultural district in Hatay Province of Turkey.

ETHNOPHARMACOLOGICAL RELEVANCE: We have compiled information about the medicinal plants used in folk medicine in the district of Antakya. Since its establishment by King Seleucus I in 300 B.C., Antakya (old Antioch) has hosted nearly 20 civilizations. Antakya, neighboring Northwestern Syria, is located on the western end of the "Silk Road" and was one of the great centers of Graeco-Roman world. Today, Antakya is a cosmopolitan city in which Arabic and Turkish are widely spoken, and where distinct ethnic and religious communities, such as Arab Alawite, Arab Christian, Arab Sunni, Turk Sunni, Armenian, and Jewish, have been living together in harmony for centuries. In addition, the rich flora in the vicinity of Antakya also renders the area interesting in terms of ethnobotanical fieldwork. AIM OF THE STUDY: This study aimed to compile the information about plants used for medicinal purposes by local people in the district of Antakya. This city is a significant region in terms of ethnobotanical fieldwork, owing to its cosmopolitan structure, long history, relatively preserved traditional community structure, and rich flora. Furthermore, we sought to compare the ethnomedicinal data geographically, cross-culturally, and historically. MATERIALS AND METHODS: The ethnobotany of medicinal plants used in the district of Antakya has been investigated through two separate studies; one was conducted in 1975, interviewing 29 people, and the other was conducted in 2011-2013, interviewing 182 people. The use value (UV) and informant consensus factor (FIC) values of the plants were calculated. In order to interpret the authenticity and sources of the compiled ethnomedicinal information, previous publications that contain information about the similar medicinal uses of plants identified in our region were reviewed and evaluated meticulously. A comparison with the data obtained from other regions of Turkey and from other Mediterranean regions, as well as a cross-cultural analysis between the ethnic groups within the study area, was performed by implementation of the Jaccard index (JI) RESULTS: Throughout the study, information about 202 medicinal plant taxa was compiled. Among these plants, 39 have either not yet been mentioned in ethnobotanical or medicinal studies, or have been used for a medicinal purpose other than those encountered in the literature review. The ethnomedicinal information we gathered from the study area exhibits close similarities to the ethnomedicinal information of other Southern and Eastern Mediterranean countries where Arabic is spoken, as well as to that of Northern and Western Mediterranean countries where Latin languages are spoken. In addition to these similarities, in most cases, this ethnomedicinal information shows hybrid features of ethnomedicinal knowledge from Eastern and Western Mediterranean countries. CONCLUSION: Based on a literature survey, we found that the cited medicinal uses for 43 plants have also been corroborated by other various biological testings. This finding strongly suggests the importance of ethnobotanical studies in the development of new medicines. We believe that this study has compiled rich ethnomedicinal information that reflects the cosmopolitan structure of Antakya in a very good way.

A cross-cultural comparison of folk plant uses among Albanians, Bosniaks, Gorani and Turks living in south Kosovo.

BACKGROUND: Kosovo represents a unique hotspot of biological and cultural diversity in Europe, which allows for interesting cross-cultural ethnobotanical studies. The aims of this study were twofold: 1) to document the state of traditional knowledge related to local (esp. wild) plant uses for food, medicine, and handicrafts in south Kosovo; and 2) to examine how communities of different ethnic groups in the region (Albanians, Bosniaks/Gorani, and Turks) relate to and value wild botanical taxa in their ecosystem. METHODS: Field research was conducted in 10 villages belonging to the Prizren municipality and 4 villages belonging to the Dragash municipality, located in the Sharr Mountains in the southern part of Kosovo. Snowball sampling techniques were used to recruit 139 elderly informants (61 Albanians, 32 Bosniaks/Gorani and 46 Turks), for participation in semi-structured interviews regarding the use of the local flora for medicinal, food, and handicraft purposes. RESULTS: Overall, we recorded the local uses of 114 species were used for medicinal purposes, 29 for food (wild food plants), and 20 in handicraft activities. The most important species used for medicinal purposes were Achillea millefolium L., Sambucus nigra L., Urtica dioica L., Tilia platyphyllos Scop. Hypericum perforatum L., Chamomilla recutita (L.) Rauschert, Thymus serpyllum L. and Vaccinium myrtillus L. Chamomilla recutita was the most highly valued of these species across the populations surveyed. Out of 114 taxa used for medicinal purposes, only 44 species are also included in the European Pharmacopoeia. The predominantly quoted botanical families were Rosaceae, Asteraceae, and Lamiaceae. Comparison of the data recorded among the Albanian, Bosniak/Gorani, and Turkish communities indicated a less herbophilic attitude of the Albanian populations, while most quoted taxa were quoted by all three communities, thus suggesting a hybrid character of the Kosovar plant knowledge. CONCLUSION: Cross-cultural ethnobiological studies are crucial in the Balkans not only for proposing ways of using plant natural resources, which could be exploited in sustainable local development projects (e.g. focusing on eco-tourism and small-scale trade of medicinal herbs, food niche and handicrafts products), but also for fostering collaboration and reconciliation among diverse ethnic and religious communities.

Explanatory factors for first and second-generation non-western women's inadequate prenatal care utilisation: a prospective cohort study.

BACKGROUND: Little research into non-western women's prenatal care utilisation in industrialised western countries has taken generational differences into account. In this study we examined non-western women's prenatal care utilisation and its explanatory factors according to generational status. METHODS: Data from 3300 women participating in a prospective cohort of primary midwifery care clients (i.e. women with no complications or no increased risk for complications during pregnancy, childbirth and the puerperium who receive maternity care by autonomous midwives) in the Netherlands (the DELIVER study) was used. Gestational age at entry and the total number of prenatal visits were aggregated into an index. The extent to which potential factors explained non-western women's prenatal care utilisation was assessed by means of blockwise logistic regression analyses and percentage changes in odds ratios. RESULTS: The unadjusted odds of first and second-generation non-western women making inadequate use of prenatal care were 3.26 and 1.96 times greater than for native Dutch women. For the first generation, sociocultural factors explained 43% of inadequate prenatal care utilisation, socioeconomic factors explained 33% and demographic and pregnancy factors explained 29%. For the second generation, sociocultural factors explained 66% of inadequate prenatal care utilisation. CONCLUSION: Irrespective of generation, strategies to improve utilisation should focus on those with the following sociocultural characteristics (not speaking Dutch at home, no partner or a first-generation non-Dutch partner). For the first generation, strategies should also focus on those with the following demographic, pregnancy and socioeconomic characteristics (aged ≤ 19 or ≥ 36, unplanned pregnancies, poor obstetric histories (extra-uterine pregnancy, molar pregnancy or abortion), a low educational level, below average net household income and no supplementary insurance.

Understanding medication adherence among patients of Turkish descent with type 2 diabetes: a qualitative study.

OBJECTIVES: To explore perspectives of Turkish migrants with type 2 diabetes mellitus (T2DM) on adherence to oral hypoglycaemic agents (OHA). DESIGN: In-depth interviews with 21 T2DM patients of Turkish descent recruited from primary care and community sources in Ghent, Belgium, using a theoretical sampling procedure. Analysis was guided by a grounded theory approach, using Nvivo 8. RESULTS: Respondents reported a multitude of barriers and facilitators of adherence to OHA. Some of these barriers are distinctive for T2DM patients of Turkish descent. Respondents' causal beliefs about stress and the Belgian climate often led to non-adherence during less stressful periods, like summer holidays in Turkey. Some respondents adjusted their medication use to food intake or during Ramadan fasting. Concerns about OHA were the main reason for the widespread use of herbal medicine in this sample. The religious framework used to interpret diabetes led, in combination with feelings of depression, to non-adherence in some respondents while it facilitated medication adherence in others. A potential gender effect with respect to the self-management of OHA was observed. Non-distinctive factors include: beliefs about OHA, polypharmacy, beliefs about the course of diabetes, forgetfulness, the perception of the doctor's medical expertise, feelings of depression and social support. CONCLUSION: Health care providers should explore in detail and regularly patients' perspectives on illness beliefs, medication beliefs and their trust in doctors' medical expertise as this will provide useful starting points for promoting medication adherence. Whenever possible health care workers should engage with their patients in therapeutic alliances.

[Words before actions- the significance of counselling in the Praena-Test era]. / Worte vor Taten - der Stellenwert der Beratung in der Ära des Praena-Tests.

Due to new offers in prenatal diagnostics pregnant women are forced to make choices. In Switzerland physicians are obliged to inform previous to prenatal tests and to obtain informed consent. Considering the complexity of this information and the consequences of a positive result, counselling is challenging, especially in an intercultural context. A questionnaire-based study compared information processing, test interpretation and emotional response of pregnant women from Switzerland and adjacent countries with Turkish women. Knowledge of the latter was significantly lower and they found counselling more unsettling, but their acceptance of prenatal tests was significantly higher. An empathetic approach and the right words are decisive, and counselling will even gain importance when considering the increase in options patients are confronted with.

Les nouvelles offres dans le diagnostic prénatal contraignent les femmes enceintes à faire des choix. En Suisse, les médecins ont le devoir d'informer au sujet des tests prénataux et en obtenir le consentement. Compte tenu de la complexité, ce conseil est exigeant, avant tout dans un contexte interculturel. Une étude basée sur des questionnaires a comparé les connaissances et les réactions émotionnelles des femmes enceintes de Suisse avec des femmes venant de la Turquie. Cela a montré que les connaissances de ces dernières étaient moindres et qu'elles se sentaient plus insécurisées tout en montrant une acceptation significativement plus élevée relativement au diagnostic prénatal. Une attitude empathique et des mots bien choisis sont décisifs et leur importance va encore prendre de l'ampleur avec l'augmentation des options à disposition des patientes.

Factors associated with not using folic acid supplements preconceptionally.

OBJECTIVE: Neural tube defects are among the most common birth defects worldwide. Folic acid intake from one month before to three months after conception reduces the likelihood of neural tube defects by at least 50%. Since 1995, several campaigns have been organised in the Netherlands which resulted in 51% of pregnant women using folic acid supplements during the entire recommended period in the northern part of the Netherlands in 2005. Our research question was to gain insight into the current prevalence and factors associated with inadequate pregnancy-related use of folic acid supplements. DESIGN: Data from the DELIVER study were used, which is a population-based cohort study. SETTING: Twenty midwifery practices across the Netherlands in 2009 and 2010. SUBJECTS: In total 5975 pregnant women completed a questionnaire covering items on sociodemographic and lifestyle factors, including folic acid intake. RESULTS: Of our study population, 55·5% (3318/5975) used folic acid supplements before conception. Several sociodemographic and lifestyle factors were associated with no preconception use of folic acid, of which non-Western ethnicity and not having a partner had the largest effect size. CONCLUSIONS: In the Netherlands, the folic acid intake before conception is suboptimal and has not improved over recent years. Fortification of staple foods with folic acid should be reconsidered as it would provide a more effective means of ensuring an adequate intake, especially for those groups of women who are unlikely to plan their pregnancies or to receive or respond to health promotion messages.

[Barriers in the attendance of health care interventions by immigrants]. / Subjektiv erlebte Barrieren von Personen mit Migrationshintergrund bei der Inanspruchnahme von Gesundheitsmaßnahmen.

AIM: Analysis of barriers regarding attendance at the health care system under consideration of cultural and migration-related factors. METHOD: Cross-sectional survey with immigrants from Turkey (n = 77), Spain (n = 67), Italy (n = 95) and German resettlers from the former Soviet Union (n = 196), recruited on migration and addiction services of the German Caritasverband, the Arbeiterwohlfahrt and migrant organizations. RESULTS: Spanish and Italian immigrants mainly search for help within their families and social environment. Immigrants from the former Soviet Union use home remedies and experience more linguistic difficulties as barriers for the use of health services, just like Turkish immigrants. Turkish immigrants reported feeling misunderstood regarding their cultural peculiarities by the expert staff as another main barrier. Other major influencing factors were German language proficiency and the subjective wellbeing in Germany. CONCLUSION: The consideration of cultural-related as well as linguistic factors in health care services is an essential contribution for improving health care of immigrants.

Ethnic differences in blood pressure and hypertensive complications during pregnancy: the Generation R study.

The aim was to investigate ethnic differences in blood pressure levels in each trimester of pregnancy and the risk of gestational hypertensive disorders and the degree to which such differences can be explained by education and lifestyle-related factors. The study included 6215 women participating in a population-based prospective cohort study from early pregnancy onward in Rotterdam. Ethnicity was assessed at enrollment. Blood pressure was measured in each trimester. Information about gestational hypertensive disorders was available from medical charts. Lifestyle factors included smoking, alcohol, caffeine intake, folic acid supplementation, sodium and energy intake, body mass index, and maternal stress. Associations and explanatory pathways were investigated using linear and logistic regression analysis. Dutch pregnant women had higher systolic blood pressure levels as compared with women in other ethnic groups in each trimester of pregnancy. Compared with Dutch women, Turkish and Moroccan women had lower diastolic blood pressure levels in each trimester. These differences remained after adjusting for education and lifestyle factors. Turkish and Moroccan women had a lower risk of gestational hypertension as compared with Dutch women (odds ratio, 0.32 [95% CI, 0.18-0.58] and odds ratio, 0.28 [95% CI, 0.14-0.58]), and Cape Verdean women had an elevated risk of preeclampsia (odds ratio, 2.22 [95% CI, 1.22-4.07]). Differences could not be explained by education or lifestyle. Substantial ethnic differences were observed in blood pressure levels and risk of gestational hypertensive disorders in each trimester of pregnancy, and a wide range of variables could not explain these differences.

Ethnic diversity outpatient clinic in paediatrics.

BACKGROUND: The health status of chronic sick ethnic minority children in the Netherlands is unequal compared with indigenous Dutch children. In order to optimize the health care for these children a specific patient-oriented clinic in ethnic-cultural diversity: the Mosaic Outpatient Clinic (MOC) was integrated in the general Paediatric Outpatient Departments (POPD) of three hospitals in Amsterdam. METHODS: Feasibility of the MOC, factors influencing the health care process and encountered bottlenecks in health care were studied in ethnic minority children with asthma, diabetes type 1 or metabolic disease originating from Morocco, Turkey and Surinam. Feasibility was determined by the number of patients attended, support from the paediatric medical staff and willingness of the patients to participate. Influences on the health care process comprised parents' level of knowledge of disease, sense of disease severity, level of effort, linguistic skills, health literacy, adherence to treatment and encountered bottlenecks in the health care process. Moreover, the number of admissions and visits to the POPD in the years before, during and after the MOC were analysed. RESULTS: In 2006 a total of 189 ethnic minority children were seen. Integration of the MOC within the general POPD of the hospital is feasible. The ability of the parents to speak and understand Dutch was found to be 58%, functional health literacy was 88%; sufficient knowledge of disease and sense of disease severity were 59% and 67%, respectively. The main bottlenecks in the healthcare process: poor knowledge of disease, limited sense of disease severity and low health literacy in the parents proved to be the best predictors for decreased adherence. After attending the MOC there was a decrease in the number of admissions and visits to the POPD for asthma while the number of visits increased in patients with diabetes and the amount of no-shows decreased in patients with a metabolic disease. CONCLUSION: Integration of a MOC in the general POPD is feasible and appreciated by the parents, provides more insight in the problems ethnic minority children and their parents face and shows promising directions for optimizing adherence in these children.

The effectiveness of a perinatal education programme on smoking, infant care, and psychosocial health for ethnic Turkish women.

OBJECTIVE: antenatal programmes might be effective in preventing unhealthy lifestyles, poor maternal infant care practices, and poor psychosocial health in ethnic minority women, but there are few evidence-based interventions. For this reason an antenatal education programme, called 'Happy Mothers, Happy Babies' (HMHB) was systematically designed for ethnic Turkish women in the Netherlands. DESIGN: in a non-randomised trial Turkish women attending HMHB (HMHB group) were compared with those receiving care as usual (control group). SETTING: Parent-Child Centres, which provide integrated maternity and infant care. PARTICIPANTS: in both the HMHB (n=119) and the control (n=120) group, questionnaires were administered by ethnic Turkish interviewers at three (T0) and eight (T1) months of pregnancy, and two (T2) and six (T3) months after birth. FINDINGS: at baseline, women in the HMHB group had significantly lower educational levels, were less frequently in paid employment, had less knowledge about smoking, and showed more often mildly depressive symptoms. Adjusted analyses showed that HMHB was effective in improving knowledge about smoking (OR=2.73; 95% CI 1.40, 5.31), intention to engage in prevention of sudden infant death syndrome (SIDS) (OR=8.08; 95% CI 3.34, 19.56) and short-term SIDS prevention behaviour (OR=2.22; 95% CI=1.18, 4.19). However, no intervention effect was found for smoking during pregnancy, SIDS prevention behaviour on the long term, soothing behaviour, serious depressive symptoms, and parent-child attachment. KEY CONCLUSIONS: although we could not demonstrate intervention effects on all outcome measures, the HMHB programme appears to be highly welcome, and reaches an underserved minority group at increased risk for adverse perinatal outcomes. IMPLICATIONS FOR PRACTICE: the HMHB programme is one of the first systematically developed antenatal interventions for ethnic minority women. The programme can be used as a basic antenatal programme, and as a screening opportunity for women who smoke or show serious depressive symptoms.

"Poppies are democracy!" A critical geopolitics of opium eradication and reintroduction in Turkey.

Historical scholarship in traditional geopolitics often relied on documents authored by states and by other influential actors. Although much work in the subfield of critical geopolitics thus far has addressed imbalances constructed in official, academic, and popular media due to a privileging of such narratives, priority might also be given to unearthing and bringing to light alternative geopolitical perspectives from otherwise marginalized populations. Utilizing the early-1970s case of the United States' first "war on drugs," this article examines the geopolitics of opium-poppy eradication and its consequences within Turkey. Employing not only archival and secondary sources but also oral histories from now-retired poppy farmers, this study examines the diffusion of U.S. antinarcotics policies into the Anatolian countryside and the enduring impressions that the United States and Turkish government created. In doing so, this research gives voice to those farmers targeted by eradication policies and speaks more broadly to matters of narcotics control, sentiments of anti-Americanism, and notions of democracy in Turkey and the region, past and present.

Multidrug-resistant Acinetobacter baumannii infections in three returning travelers evacuated from Algeria, Thailand, and Turkey after hospitalization in local intensive care units.

We report three cases of returning travelers evacuated from Algeria, Thailand, and Turkey by aero-medical repatriation, following overseas hospitalization in local intensive care units for accidental injuries or medical problems. All three patients presented with imipenem-resistant Acinetobacter baumannii infections. One died whereas two recovered.

Traditional ecologies of the opium poppy and oral history in rural Turkey.

Cultivated in the Eastern Mediterranean region for millennia, the opium poppy (Papaver somniferum) was profoundly significant in the economies, ecologies, cultures, and diets of the peoples of many towns and villages of rural Anatolia. When the United States compelled Turkey to eradicate cultivation of the plant in the early 1970s in order to diminish the flow of heroin into America, farmers were obliged to deal with not only changes in their incomes but also profound changes in their relationships with the land and the state. Although Turkish officials later allowed production to resume in a highly controlled manner for pharmaceutical purposes, significant socioeconomic and ecological dimensions of Turkey's poppy-growing communities were forever changed. Interviewing now-retired poppy farmers, I employ oral history as my primary source of historical evidence to reconstruct these past ecologies and associated social relationships and to give voice to the informants.