Eosinopenia in Patients With Typhoid Fever: A Case-Control Study.

Background and objectives Salmonella typhi is involved in one of the most prevalent infectious diseases of South East Asia, typhoid fever, but diagnostic tests cannot be performed regularly in developing countries. The objective of the study is to determine the association of eosinopenia with culture or serology-proven typhoid fever in patients, to determine the association of leukopenia with culture or serology-proven typhoid fever in patients and to determine independent predictors of eosinopenia. Methods This case-control study, done at Fauji Foundation Hospital, Pakistan, included patients with symptoms suggestive of typhoid fever, culture, or serology positive for typhoid fever and excluded patients who had been previously diagnosed with malaria and dengue hemorrhagic fever. After flagging cultures and serology, the records were viewed for leukocyte counts. Data, including age, gender, and clinical symptoms, were also recorded for analysis. Results Out of 200 participants, 59 participants with diagnosed typhoid fever had eosinopenia. There were 29 participants who had been diagnosed with typhoid fever via culture or serology and had leukopenia. Eosinopenia and leukopenia were more likely to be present in patients with a diagnosis of typhoid (OR: 9.60, 20.00). The independent predictors for eosinopenia were DOT enzyme immunoassay (DOT EIA) positive for Salmonella typhi, culture positive for Salmonella typhi and leukopenia (p<0.05). Conclusion The presence of eosinopenia and features or serology suggestive of typhoid would most likely be associated with cultures being positive and, therefore, might provide an efficient means to begin treatment.

Secundum Atrial Septal Defect With Early Presentation of Eisenmenger Syndrome and Right-Heart Failure: A Rare Case Report and Literature Review.

Eisenmenger syndrome, the most advanced form of pulmonary arterial hypertension (PAH), poses a considerable risk to the survival and quality of life of patients. It is more commonly seen in large intra-cardiac defects like ventricular septal defects (VSD) or patent ductus arteriosus (PDA), and rarely in atrial septal defects (ASD). Early diagnosis is the single most important step in the definitive management of the condition; otherwise, only conservative treatment can be offered. In this report, we present the case of a 20-year-old female patient diagnosed with Eisenmenger syndrome secondary to a large secundum ASD. The patient responded well to medical treatment.

Eosinophilic Granulomatosis With Polyangiitis (Churg-Strauss Syndrome) Mimicking a Stroke and Acute Coronary Syndrome: A Case Report.

Churg-Strauss syndrome (CSS) is a rare disease of multiple organ involvement attributed to asthma, eosinophilia, and vasculitis as a diagnostic criterion. Here we report a case of CSS presenting with left leg weakness and chest pain with a diagnosis of myocarditis and neuropathy. Eosinophilia, history of asthma, peripheral neurological damage led to the diagnosis of CSS. Transthoracic echo showed a full-sized segmental wall motion abnormality with normal CT angiography. He responded well to steroid therapy.

COVID-19 Associated Pneumonia and Pleural Effusion Masquerading as Heart Failure in Rheumatic Heart Disease.

The ongoing outbreak of coronavirus disease 2019 (COVID-19) that began in Wuhan, China, became an international emergency when thousands of people were infected around the world. COVID-19 emerged in Pakistan in April 2020, precipitating a nationwide lockdown. While some countries are now recovering from the pandemic, its peak is not estimated to occur in Pakistan until August 2020. We present a case of rheumatic heart disease with fever, myalgia and an unusual radiological finding of the virus. LEARNING POINTS: Unusual radiological findings are being seen in COVID-19 patients.Pleural effusion in a mildly symptomatic patient is a rare presentation of the disease.Early aggressive treatment can produce dramatic improvement in COVID-19 pneumonia.

Clinical Outcomes of Mechanical Prosthetic Valve Thrombosis.

Objective To evaluate characteristics and outcomes of patients presenting with mechanical prosthetic valve thrombosis in a tertiary cardiac center in Pakistan. Methods This was a prospective and interventional study conducted at Rawalpindi Institute of Cardiology over a period of two years. The clinical characteristics of patients presenting with clinical suspicion of prosthetic valve thrombosis were recorded. They were, then, subjected to streptokinase, redo surgery and heparin based on their hemodynamic stability, thrombus burden and surgical risk. The patients were then followed for the outcomes of the study. Results Out of 576 patients with mechanical valve replacement during the study period, 70 patients had developed prosthetic valve thrombosis. Out of 70 patients, there were 41 female (58.50%) and 29 male (41.50%) participants. The mean age of the participants was 48.40±15.00 years. The overall incidence of mechanical prosthetic valve thrombosis was 12.15%. There were 30 patients (42.80%) with a suboptimal international normalized ratio (INR) and 28 patients (40.00%) were non-compliant to warfarin therapy. The overall incidence of adverse clinical outcome was 18.00%, while the overall mortality rate was 10.00%. The mortality was higher for patients who underwent redo surgery (16.60%) as compared to patients who had received fibrinolytic therapy (9.60%). Conclusion Poor compliance with warfarin and suboptimal INR are the important factors causing mechanical prosthetic valve. Because of lower mortality rate, fibrinolysis with streptokinase is a reasonable treatment option for mechanical prosthetic valve thrombosis.

Fibrin tissue adhesive versus nasal packing in endoscopic nasal surgery: a systematic review and meta-analysis.

BACKGROUND: It has been proposed that fibrin tissue adhesive (FTA) can act as an effective alternative to nasal packing in managing the postoperative symptoms of endoscopic nasal surgery. METHODOLOGY: MEDLINE, Embase, Cochrane Library, The Cumulative Index to Nursing and Allied Health Literature and ClinicalTrials.gov were searched for randomised controlled trials comparing FTA with nasal packing in endoscopic nasal surgery. The primary outcome of interest was bleeding; secondary outcomes included pain, nasal obstruction, infection, adhesions and the formation of granulation tissue. All trials underwent a risk of bias assessment, and a meta-analysis was performed using a random effects model. RESULTS: 315 studies were found, of which four were eligible for inclusion (n = 152). Bleeding was reported in all, with the meta-analysis favouring the packing group, although this was not significant. Nasal obstruction and granulation severity were significantly lower in the FTA group, however, no difference was noted for the outcomes of pain, infection or adhesions. CONCLUSION: Our results indicate minor advantages for using FTA over nasal packing. Unfortunately, the included studies show significant heterogeneity and risk of bias. Based on the available evidence, clinicians must balance the higher cost of FTA against the limited advantages for the patient.

Parental Smoking and Adult Offspring's Smoking Behaviors in Ethnic Minority Groups: An Intergenerational Analysis in the HELIUS Study.

Introduction: To understand smoking behaviors among ethnic minority groups, studies have largely focused on societal factors, with little attention to family influences. Yet studies among majority groups have identified parental smoking as an important risk factor. It is unknown whether this applies to ethnic minority groups. We investigated the association between parental smoking and adult offspring's smoking behaviors among ethnic minority groups with an immigrant background. Methods: We used data from the Healthy Life in an Urban Setting study from Amsterdam (the Netherlands) from January 2011 to December 2015. The sample consisted of 2184 parent-offspring pairs from South-Asian Surinamese, African Surinamese, Turkish, Moroccan, and Ghanaian origin. We collected self-reported smoking data: current status, duration of exposure to parental smoking, number of daily cigarettes, heavy smoking ( > 10 cigarettes/day), and nicotine dependency (using the Fagerström Test). Analyses were stratified by offspring's age, cohabitation with parent, education (parent/offspring), offspring's cultural orientation, and gender concordance within pairs. Logistic regression was used. Results: Overall, parental smoking was associated with offspring's smoking behaviors (eg, current smoking: odds ratio 2.33; 95% confidence interval 1.79-3.03), with little ethnic variation. We found dose-response associations between exposure to parental smoking and offspring's smoking. The associations were similar across different strata but stronger in gender-concordant pairs (3.16; 2.12-4.51 vs. 1.73; 1.15-2.59 in gender-discordant pairs; p-value for interaction .017). Conclusions: Parental smoking is associated with offspring's smoking behaviors in ethnic minority groups across different strata but particularly in gender-concordant pairs. Similar to majority groups, family influences matter to smoking behaviors in ethnic minority groups. Implications: Our findings have deepened our understanding of smoking behaviors among ethnic minority groups. Future studies should simultaneously consider societal factors and parental influences, to comprehensively understand their impact on smoking among ethnic minority groups. Also, smoking patterns among family members should be addressed in individual counselling, irrespective of ethnicity.

Social justice and human rights as a framework for addressing social determinants of health: final report of the task group on equity, equality and human rights. Review of social determinants of health and the health divide in the WHO European Region

Most people place very high value on enjoying good health. Consequently, it is generally regarded as unfair that certain groups within society (such as people with lower socioeconomic status) do not enjoy the same level of good health as others. The unfairness or injustice is perceived to be even more acute if inequalities in health correspond with the unequal distribution of other socially produced goods such as income, access to educational opportunities, built environments and opportunities for social participation.Based on these arguments, the public perception that health inequalities are unjust seems to be widespread across societies. Nevertheless, there is also much scepticism about the progress in implementing actual policies to reduce health inequalities. In other words, there seems to be a gap between rhetoric and performance. This report addresses two issues relevant for closing this gap in translating rhetoric into actual policies: why health inequalities are unjust and how normative arguments can be translated into policy, particularly by using the framework of the human right to health.

Perceived ethnic discrimination in relation to smoking and alcohol consumption in ethnic minority groups in The Netherlands: the HELIUS study.

OBJECTIVES: We examined the associations of perceived ethnic discrimination (PED) with smoking and alcohol consumption in ethnic minority groups residing in a middle-sized European city. METHODS: Data were derived from the HELIUS study in Amsterdam, The Netherlands. We included 23,126 participants aged 18-70 years of Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Turkish, and Moroccan origin. We collected self-reported data on PED, current smoking, heavy smoking, nicotine dependence, current drinking, excessive drinking, and alcohol dependence. Logistic regression was used. RESULTS: In general, we observed positive associations in participants of African Surinamese and Ghanaian origin, but no associations in those of South-Asian Surinamese, Turkish, or Moroccan origin. In African Surinamese, the associations were positive for current smoking, nicotine, and alcohol dependence (odds ratios of 1.16; 95% confidence interval: 1.06-1.27, 1.34; 1.15-1.57 and 1.40; 1.20-1.64, respectively). In Ghanaians, positive association was observed for current drinking (1.21; 1.08-1.36). CONCLUSIONS: The associations of PED with smoking and alcohol consumption considerably varied by ethnicity and outcome measure. This suggests that ethnic minority groups in Europe might use different behavioural strategies to cope with PED.

The relationship between ethnic composition of the residential environment and self-reported health among Turks and Moroccans in Amsterdam.

BACKGROUND: Previous studies from the US and UK suggest that neighbourhood ethnic composition is associated with health, positive or negative, depending on the health outcome and ethnic group. We examined the association between neighbourhood ethnic composition and self-reported health in these groups in Amsterdam, and we aimed to explore whether there is spatial variation in this association. METHODS: We used micro-scale data to describe the ethnic composition in buffers around the home location of 2701 Turks and 2661 Moroccans. Multilevel regression analysis was used to assess the association between three measures of ethnic composition (% co-ethnics, % other ethnic group, Herfindahl index) and three measures of self-reported health: self-rated health, Physical and Mental Component Score (PCS, MCS). We adjusted for socioeconomic position at individual and area level. We used geographically weighted regression and spatially stratified regression analyses to explore whether associations differed within Amsterdam. RESULTS: Ethnic heterogeneity and own ethnic density were not related to self-rated health for both ethnic groups. Higher density of Turks was associated with better self-rated health among Moroccans at all buffer sizes, with the most significant relations for small buffers. Higher heterogeneity was associated with lower scores on PCS and MCS among Turks (suggesting worse health). We found spatial variation in the association of the density of the other ethnic group with self-rated health of Moroccans and Turks. We found a positive association for both groups, spatially concentrated in the sub-district Geuzenveld. CONCLUSIONS: Our study showed that the association of ethnic composition with self-reported health among Turks and Moroccans in Amsterdam differed between the groups and reveals mainly at small spatial scales. Among both groups, an association of higher density of the other group with better self-rated health was found in a particular part of Amsterdam, which might be explained by the presence of a relatively strong sense of community between the two groups in that area. The study suggests that it is important to pay attention to other-group density, to use area measurements at small spatial scales and to examine the spatial variation in these associations. This may help to identify neighbourhood characteristics contributing to these type of area effects on urban minority health.

Inequalities by immigrant status in depressive symptoms in Europe: the role of integration policy regimes.

PURPOSE: We aimed to study whether country integration policy models were related to inequalities by immigrant status in depressive symptoms in Europe. METHODS: This is a cross-sectional study using data from 17 countries in the sixth wave of the European Social Survey (2012), comparing subjects born either in the country of residence (non-immigrants, N = 28,333) or in a country not classified as "advanced economy" by the IMF (immigrants, N = 2041). Depressive symptoms were assessed with the eight-item version of the Center for Epidemiologic Studies Depression scale. Countries were grouped into three integration policy regimes (inclusive, assimilationist, and exclusionist). Linear regressions were fitted adjusting first by age, sex, and education level, then sequentially by citizenship, perceived discrimination, and socio-economic variables. RESULTS: In all integration regimes, immigrants report significantly more depressive symptoms than non-immigrants. The gap is the largest in exclusionist countries (immigrants score 1.16, 95% CI 0.65-1.68, points higher than non-immigrants in the depression scale), followed by assimilationist countries (0.85 and 0.57-1.13) and inclusive countries (0.60 and 0.36-0.84). Financial strain explains all the associations in inclusive countries, most of it in assimilationist countries, but only a small part in exclusionist countries. CONCLUSIONS: Across most European countries, immigrants seem to experience more depressive symptoms than the population born in the country, mostly reflecting their poorer socio-economic situation. Inequalities are larger in countries with more restrictive policies. Despite some limitations, this study adds new evidence to suggest that immigrants' health is shaped by integration policies in their host country.

Perceived Ethnic Discrimination and the Metabolic Syndrome in Ethnic Minority Groups: The Healthy Life in an Urban Setting Study.

OBJECTIVE: Ethnic differences in the metabolic syndrome could be explained by perceived ethnic discrimination (PED). It is unclear whether PED is associated with the metabolic syndrome. We assessed this association and quantified the contribution of PED to the metabolic syndrome. METHODS: Baseline data were used from the Healthy Life in an Urban Setting study collected in the Netherlands from 2011 to 2014. The population-based sample included South-Asian Surinamese, African Surinamese, Ghanaian, Turkish, and Moroccan participants (aged 18 to 70 years). PED was measured using the Everyday Discrimination Scale. The metabolic syndrome was determined according to the harmonized definition of the International Diabetes Federation, American Heart Association, and others. Logistic regression was used for analysis. population-attributable fraction was used to calculate the contribution of PED. RESULTS: PED was positively associated with the metabolic syndrome in South-Asian Surinamese, African Surinamese, and Moroccan participants (odds ratio [95% confidence interval] = 1.13 [0.99-1.30], 1.15 [1.00-1.32], and 1.19 [1.03-1.38], respectively) after adjusting for potential confounders and mediators. No significant association was observed among Ghanaian and Turkish participants. For the individual components, the associations were statistically significant for blood pressure, fasting glucose, and waist circumference among Surinamese participants. PED was associated with dyslipidemia in Moroccan participants. The population-attributable fractions were 5% for South-Asian Surinamese and Moroccan participants, and 7% for African Surinamese participants. CONCLUSIONS: We found a positive association of PED with the metabolic syndrome in some ethnic groups, with PED contributing around 5% to 7% to the metabolic syndrome among Surinamese and Moroccans. This suggests that PED might contribute to ethnic differences in the metabolic syndrome.

The role of mastery in the relationship between perceived ethnic discrimination and depression: The HELIUS study.

OBJECTIVE: This study examined the mediating and moderating role of one's sense of mastery in the relationship between perceived ethnic discrimination and depression. METHOD: Questionnaire data from participants of the Healthy Life in an Urban Setting (HELIUS) study were used, containing responses from 9,141 Surinamese, Turkish, Moroccan, and Ghanaian immigrant adults, aged 18 to 70, living in Amsterdam, the Netherlands. RESULTS: Results of path modeling indicated that perceptions of ethnic discrimination were positively related to depression symptomatology, and this relationship was moderated and partially mediated by mastery. Results remained fairly robust across sex, educational level, immigrant generation, and ethnicity. CONCLUSION: This study indicated that mastery may both serve a moderating and mediating role in the relationship between perceived ethnic discrimination and depression, suggestive of a process in which the impact of perceiving discrimination becomes increasingly more deteriorating over time. Thus, interventions focused on mastery may potentially be beneficial to improve ethnic minority mental health. (PsycINFO Database Record

Association of perceived ethnic discrimination with general and abdominal obesity in ethnic minority groups: the HELIUS study.

BACKGROUND: Discrimination is associated with obesity, but this may differ according to the type of obesity and ethnic group. This study examines the association of perceived ethnic discrimination (PED) with general and abdominal obesity in 5 ethnic minority groups. METHODS: We used cross-sectional data from the HELIUS study, collected from 2011 to 2015. The study sample included 2297 Ghanaians, 4110 African Surinamese, 3021 South-Asian Surinamese, 3562 Turks and 3868 Moroccans aged 18-70 years residing in Amsterdam, the Netherlands. Body mass index (BMI) was used as a measure for general obesity, and waist circumference (WC) for abdominal obesity. PED was measured using the Everyday Discrimination Scale. We used linear regression models adjusted for sociodemographics, psychosocial stressors and health behaviours. In additional analysis, we used standardised variables to compare the strength of the associations. RESULTS: In adjusted models, PED was significantly, positively associated with BMI in the South-Asian Surinamese (ß coefficient 0.338; 95% CI 0.106 to 0.570), African Surinamese (0.394; 0.171 to 0.618) and Turks (0.269; 0.027 to 0.510). For WC, a similar pattern was seen: positive associations in the South-Asian Surinamese (0.759; 0.166 to 1.353), African Surinamese (0.833; 0.278 to 1.388) and Turks (0.870; 0.299 to 1.440). When stratified by sex, we found positive associations in Surinamese women, Turkish men and Moroccan men. The strength of the associations with BMI and WC was comparable in the groups. Among the Ghanaians, no significant associations were observed. CONCLUSIONS: Ethnic and sex variations are observed in the association of PED with both general and abdominal obesity. Further research on psychosocial buffers and underlying biological mechanisms might help in understanding these variations.

Ethnic Variations in Prognosis of Patients with Dementia: A Prospective Nationwide Registry Linkage Study in The Netherlands.

BACKGROUND: Data on dementia prognosis among ethnic minority groups are limited in Europe. OBJECTIVE: We assessed differences in short-term (1-year) and long-term (3-year) mortality and readmission risk after a first hospitalization or first ever referral to a day clinic for dementia between ethnic minority groups and the ethnic Dutch population in the NetherlandsMethods: Nationwide prospective cohorts of first hospitalized dementia patients (N = 55,827) from January 1, 2000 to December 31, 2010 were constructed. Differences in short-term and long-term mortality and readmission risk following hospitalization or referral to the day clinic between ethnic minority groups (Surinamese, Turkish, Antilleans, Indonesians) and the ethnic Dutch population were investigated using Cox proportional hazard regression models with adjustment for age, sex, and comorbidities. RESULTS: Age-sex-adjusted short-term and long-term risks of death following a first hospitalization with dementia were comparable between the ethnic minority groups and the ethnic Dutch. Age- and sex-adjusted risk of admission was higher only in Turkish compared with ethnic Dutch (HR 1.57, 95% CI,1.08-2.29). The difference between Turkish and the Dutch attenuated and was no longer statistically significant after further adjustment for comorbidities. There were no ethnic differences in short-term and long-term risk of death, and risk of readmission among day clinic patients. CONCLUSION: Compared with Dutch patients with a comparable comorbidity rate, ethnic minority patients with dementia did not have a worse prognosis. Given the poor prognosis of dementia, timely and targeted advance care planning is essential, particularly in ethnic minority groups who are mired by cultural barriers and where uptake of advance care planning is known to be low.

Perceived ethnic discrimination and depressive symptoms: the buffering effects of ethnic identity, religion and ethnic social network.

PURPOSE: Perceived ethnic discrimination (PED) is positively associated with depressive symptoms in ethnic minority groups in Western countries. Psychosocial factors may buffer against the health impact of PED, but evidence is lacking from Europe. We assessed whether ethnic identity, religion, and ethnic social network act as buffers in different ethnic minority groups in Amsterdam, the Netherlands. METHODS: Baseline data were used from the HEalthy Living In a Urban Setting study collected from January 2011 to June 2014. The random sample included 2501 South-Asian Surinamese, 2292 African Surinamese, 1877 Ghanaians, 2626 Turks, and 2484 Moroccans aged 18-70 years. Depressive symptoms were assessed using the Patient Health Questionnaire-9. PED was measured with the Everyday Discrimination Scale. Ethnic identity was assessed using the Psychological Acculturation Scale. Practicing religion was determined. Ethnic social network was assessed with the number of same-ethnic friends and amount of leisure time spent with same-ethnic people. RESULTS: PED was positively associated with depressive symptoms in all groups. The association was weaker among (a) those with strong ethnic identity in African Surinamese and Ghanaians, (b) those practicing religion among African Surinamese and Moroccans, (c) those with many same-ethnic friends in South-Asian Surinamese, Ghanaians, and Turks, and (d) those who spend leisure time with same-ethnic people among African Surinamese and Turks. CONCLUSIONS: Ethnic identity, religion, and ethnic social network weakened the association between PED and depressive symptoms, but the effects differed by ethnic minority group. These findings suggest that ethnic minority groups employ different resources to cope with PED.

All-cause and cause-specific mortality of different migrant populations in Europe.

This study aimed to examine differences in all-cause mortality and main causes of death across different migrant and local-born populations living in six European countries. We used data from population and mortality registers from Denmark, England & Wales, France, Netherlands, Scotland, and Spain. We calculated age-standardized mortality rates for men and women aged 0-69 years. Country-specific data were pooled to assess weighted mortality rate ratios (MRRs) using Poisson regression. Analyses were stratified by age group, country of destination, and main cause of death. In six countries combined, all-cause mortality was lower for men and women from East Asia (MRRs 0.66; 95 % confidence interval 0.62-0.71 and 0.76; 0.69-0.82, respectively), and Other Latin America (0.44; 0.42-0.46 and 0.56; 0.54-0.59, respectively) than local-born populations. Mortality rates were similar for those from Turkey. All-cause mortality was higher in men and women from North Africa (1.09; 1.08-1.11 and 1.19; 1.17-1.22, respectively) and Eastern Europe (1.30; 1.27-1.33 and 1.05; 1.01-1.08, respectively), and women from Sub-Saharan Africa (1.34; 1.30-1.38). The pattern differed by age group and country of destination. Most migrants had higher mortality due to infectious diseases and homicide while cancer mortality and suicide were lower. CVD mortality differed by migrant population. To conclude, mortality patterns varied across migrant populations in European countries. Future research should focus both on migrant populations with favourable and less favourable mortality pattern, in order to understand this heterogeneity and to drive policy at the European level.

Perceived Discrimination and Health among Immigrants in Europe According to National Integration Policies.

BACKGROUND: Discrimination harms immigrants' health. The objective of this study was to analyze the association between perceived discrimination and health outcomes among first and second generation immigrants from low-income countries living in Europe, while accounting for sex and the national policy on immigration. METHODS: Cross-sectional study including immigrants from low-income countries aged ≥15 years in 18 European countries (European Social Survey, 2012) (sample of 1271 men and 1335 women). The dependent variables were self-reported health, symptoms of depression, and limitation of activity. The independent variables were perceived group discrimination, immigrant background and national immigrant integration policy. We tested for association between perceived group discrimination and health outcomes by fitting robust Poisson regression models. RESULTS: We only observed significant associations between perceived group discrimination and health outcomes in first generation immigrants. For example, depression was associated with discrimination among both men and women (Prevalence Ratio-, 1.55 (95% CI: 1.16-2.07) and 1.47 (95% CI: 1.15-1.89) in the multivariate model, respectively), and mainly in countries with assimilationist immigrant integration policies. CONCLUSION: Perceived group discrimination is associated with poor health outcomes in first generation immigrants from low-income countries who live in European countries, but not among their descendants. These associations are more important in assimilationist countries.

Association between Integration Policies and Immigrants' Mortality: An Explorative Study across Three European Countries.

BACKGROUND: To integrate immigrants into their societies, European countries have adopted different types of policies, which may influence health through both material and psychosocial determinants. Recent studies have suggested poorer health outcomes for immigrants living in countries with poorly rated integration policies. OBJECTIVE: To analyse mortality differences of immigrants from the same country of origin living in countries with distinct integration policy contexts. METHODS: From the mortality dataset collected in the Migrant Ethnic Health Observatory (MEHO) project, we chose the Netherlands (linked data from 1996-2006), France (unlinked; 2005-2007) and Denmark (linked; 1992-2001) as representatives of the inclusive, assimilationist and exclusionist policy models, respectively, based on the Migrant Integration Policy Index. We calculated for each country sex- and age-standardized mortality rates for Turkish-, Moroccan- and local-born populations aged 20-69 years. Poisson regression was used to estimate the mortality rate ratios (MRRs) for cross-country and within-country comparisons. The analyses were further stratified by age group and cause of death. RESULTS: Compared with their peers in the Netherlands, Turkish-born immigrants had higher all-cause mortality in Denmark (MRR men 1.92; 95% CI 1.74-2.13 and women 2.11; 1.80-2.47) but lower in France (men 0.64; 0.59-0.69 and women 0.58; 0.51-0.67). A similar pattern emerged for Moroccan-born immigrants. The relative differences between immigrants and the local-born population were also largest in Denmark and lowest in France (e.g., Turkish-born men MRR 1.52; 95% CI 1.38-1.67 and 0.62; 0.58-0.66, respectively). These patterns were consistent across all age groups, and more marked for cardiovascular diseases. CONCLUSIONS: Although confounders and data comparability issues (e.g., French cross-sectional data) may affect the findings, this study suggests that different macro-level policy contexts may influence immigrants' mortality. Comparable mortality registration systems across Europe along with detailed socio-demographic information on immigrants may help to better assess this association.

The contribution of perceived ethnic discrimination to the prevalence of depression.

BACKGROUND: European research on the association between perceived ethnic discrimination (PED) and health is importantly lacking. It is also unknown how much PED contributes to disease prevalence. In this study, we quantified the contribution of PED to depression in five ethnic groups in a middle-size European city. METHODS: We used cross-sectional data from the HELIUS study (Healthy Life in an Urban Setting), collected from January 2011 to June 2013 in Amsterdam, The Netherlands. We included a random sample of 1753 ethnic Dutch, 1143 South-Asian Surinamese, 1794 African Surinamese, 1098 Ghanaians and 850 Turks, aged 18-70 years. PED was assessed using the Everyday Discrimination Scale. Patient Health Questionnaire-9 was used for assessing depressive symptoms and major depressive disorder (MDD). We used logistic regression and calculated the contribution of PED to depressive symptoms and MDD using the population attributable fractions. RESULTS: Depressive symptoms and MDD were most common in Turks and South-Asian Surinamese, and lowest in ethnic Dutch. PED had a positive association with depressive symptoms and MDD in only the ethnic minority groups. The contributions of PED to depressive symptoms and MDD were around 25% in both the Surinamese groups, and Turks, and ∼15% in Ghanaians. CONCLUSION: We conclude that PED contributes considerably to depression in ethnic minority groups in a European context. As such, ethnic inequalities in depression could be reduced substantially if ethnic minority groups would not perceive any ethnic discrimination. We encourage more European research on the health impact of PED.