Uptake of health services for common mental disorders by first-generation Turkish and Moroccan migrants in the Netherlands.

BACKGROUND: Migration and ethnic minority status have been associated with higher occurrence of common mental disorders (CMD), while mental health care utilisation by non-Western migrants has been reported to be low compared to the general population in Western host countries. Still, the evidence-base for this is poor. This study evaluates uptake of mental health services for CMD and psychological distress among first-generation non-Western migrants in Amsterdam, the Netherlands. METHODS: A population-based survey. First generation non-Western migrants and ethnic Dutch respondents (N = 580) participated in structured interviews in their own languages. The interview included the Composite International Diagnostic Interview (CIDI) and the Kessler psychological distress scale (K10). Uptake of services was measured by self-report. Data were analysed using weighting techniques and multivariate logistic regression. RESULTS: Of subjects with a CMD during six months preceding the interview, 50.9% reported care for mental problems in that period; 35.0% contacted specialised services. In relation to CMD, ethnic groups were equally likely to access specialised mental health services. In relation to psychological distress, however, Moroccan migrants reported less uptake of primary care services (OR = 0.37; 95% CI = 0.15 to 0.88). CONCLUSION: About half of the ethnic Dutch, Turkish and Moroccan population in Amsterdam with CMD contact mental health services. Since the primary purpose of specialised mental health services is to treat "cases", this study provides strong indications for equal access to specialised care for these ethnic groups. The purpose of primary care services is however to treat psychological distress, so that access appears to be lower among Moroccan migrants.

Depressive and anxiety disorders in different ethnic groups: a population based study among native Dutch, and Turkish, Moroccan and Surinamese migrants in Amsterdam.

INTRODUCTION: To explore ethnic differences in psychopathology, this study examined the prevalence of depressive and anxiety disorders among different ethnic groups in Amsterdam and determined whether ethnic differences can be explained by socio-demographic differences. METHODS: A population-based sample of 321 Dutch, 231 Turkish, 191 Moroccan, 87 Surinamese/Antilleans was interviewed by well-trained bilingual interviewers, using the CIDI 2.1. Educational level and income were used as indicators of socio-economic status. RESULTS: The weighed 1-month prevalence of depressive and/or anxiety disorders was 6.6% (Dutch), 18.7% (Turkish), 9.8% (Moroccans) and 1.2 % (Surinamese/Antilleans). Among Moroccans, the prevalence of affective disorders seemed higher in men than in women, among the Turkish the opposite was observed. Ethnic differences in prevalence could not be explained by socioeconomic differences. CONCLUSION: Turkish women and men and Moroccan men in Amsterdam seem to have a higher risk of current affective disorders. Ethnicity is an independent predictor of common mental disorders in the Netherlands.

Bridging the gap between doctors and policymakers: the use of scientific knowledge in local school health care policy in The Netherlands.

BACKGROUND: The decentralization of school health care policy in The Netherlands was followed by an increase in diversity, which was most often not evidence-based. This study aims to clarify the use of scientific knowledge in school health care policy-making processes: multi-actor processes in networks, trying to solve certain problems. METHODS: Case-study design in four Municipal Health Service regions, using documents and half-structured interviews as data sources. RESULTS: Scientific knowledge is used by only 42% of the actors in 58% of decision-making rounds in policy-making processes. 'Recent' regional data on health indicators are used more often than 'established' (inter)national knowledge of theoretical models. Mainly school health professionals use knowledge as a resource to influence the policy process. Other actors (e.g. managers and municipalities) use formal power, money or 'initiative' as their main resources. Powerful actors put forward less scientific knowledge than actors in dependent positions. Individual actors with a combined scientific and political frame of reference put forward knowledge most frequently, especially in complex networks with many actors, more than one powerful actor, more than one arena, more than one dominant resource and more than one dominant frame of reference. CONCLUSION: The use of scientific knowledge in school health care policy-making processes can and must be improved. Liaison officers can bridge the gap between doctors and policymakers, especially in complex policy networks. They combine a scientific and a political frame of reference and act upon scientific knowledge as a resource in their efforts to influence the policy-making process.

Birth weight and carotid intima-media thickness: new perspectives from the atherosclerosis risk in young adults (ARYA) study.

PURPOSE: Although intrauterine growth retardation (IUGR) is associated with increased risk of cardiovascular disease (CVD) in adult life, it is unclear whether the relationship is present at younger ages. Furthermore, current debate suggests that postnatal factors might be at least as important as prenatal conditions. The authors investigated whether low birth weight leads to an increased risk of subclinical atherosclerosis in a population-based sample of 750 Dutch men and women, aged 27 to 30 years. METHODS: Information about birth characteristics was available from the original charts of the Municipal Health Service, Utrecht, The Netherlands. Cardiovascular risk factors were evaluated by a questionnaire. The extent of atherosclerosis, assessed by carotid intima-media thickness (CIMT), was measured in both common carotid arteries. RESULTS: Overall, birth weight was not related to common CIMT. However, in the lowest tertile of birth length an inverse association between birth weight and common CIMT was observed. Moreover, low birth weight was significantly associated with increased common CIMT in those who showed exaggerated postnatal growth. CONCLUSIONS: These findings suggest that low birth weight is only associated with increased common CIMT in young adulthood in those who experienced severe IUGR and in those who showed exaggerated postnatal growth.

Does a routinely measured blood pressure in young adolescence accurately predict hypertension and total cardiovascular risk in young adulthood?

BACKGROUND: It is insufficiently known if routine blood pressure (BP) measurement by school doctors has added predictive value for later hypertension and cardiovascular risk. OBJECTIVE: To assess whether screening of BP in adolescence has additional predictive value to already routinely collected indicators of later hypertension and cardiovascular risk. METHODS: In the Dutch city of Utrecht, routine BPs and anthropometry were collected from school health records of 750 adolescents. In The Hague, standardized repeated BP measurements and anthropometry were available for 262 adolescents. Of both cohorts, 998 now young adults were recently re-examined. Predictors of adult hypertension, systolic blood pressure (SBP) > or = 140 mmHg and/or diastolic blood pressure (DBP) > or = 90 mmHg) and 10-year cardiovascular risk were analysed by logistic regression and area under receiver operator characteristics curve (AUC). RESULTS: A total of 167 young adults had hypertension. Single adolescent SBP and DBP predicted hypertension: odds ratio (OR) 1.04 per mmHg [95% confidence interval (CI): 1.03-1.06], OR 1.02 (1.00-1.04), respectively, but with little discriminative power. Gender, adolescent body mass index (BMI) and age combined predicted hypertension: AUC 0.71 (0.67-0.75), which slightly improved by adding SBP: AUC 0.74 (0.70-0.77); difference in AUC 0.03 (0.002-0.06). SBP exclusively predicted hypertension within men: OR 1.03 (1.01-1.04), AUC: 0.59 (0.53-0.65), and within women: OR 1.08 (1.05-1.11), AUC 0.74 (0.67-0.82). However, an adolescent BP of > or = 120 mmHg did not efficiently detect hypertensive men, while it detected 57.9% of hypertensive women. Only young adult men had meaningful 10-year cardiovascular risks, which only SBP predicted: OR risk score > 95th percentile 1.04 (1.02-1.07), AUC 0.67 (0.60-0.75). CONCLUSION: A single routine BP measurement in adolescent girls efficiently predicts young adult hypertension. In adolescent boys, BP predicts young adult 10-year cardiovascular risk.

Adolescent blood pressure and blood pressure tracking into young adulthood are related to subclinical atherosclerosis: the Atherosclerosis Risk in Young Adults (ARYA) study.

BACKGROUND: Increased blood pressure (BP) in young adulthood is associated with cardiovascular morbidity and mortality. Longitudinal studies of patients at young ages are, however, limited. Our aim was to study the relationships of adolescent BP and tracking of BP into young adulthood with subclinical atherosclerosis, as assessed by carotid intima-media thickness (CIMT), at the age of 28 years. METHODS: The Atherosclerosis Risk in Young Adults (ARYA) study comprises of a community-based sample of 750 subjects aged 27 to 30 years. In the 352 men and 398 women, at least one BP measurement was recorded at a mean age of 13 years in school health records. Recently, all participants completed a questionnaire on cardiovascular risk factors, had a fasting blood sample drawn, and underwent an ultrasound examination of both common carotid arteries to assess CIMT. RESULTS: Linear regression showed that adolescent systolic BP was associated with thickening of the intima-media (an increase of 7.5 microm in CIMT per standard deviation increase in systolic BP; 95% CI 4.3 to 10.6). Similar relations were found for pulse pressure and mean arterial pressure. When sex, age, and body mass index at adolescence and young adulthood and adult BP were taken into account, the relations attenuated, but for pulse pressure they remained statistically significant. Furthermore, subjects who tracked in the highest systolic BP and pulse pressure levels from adolescence into young adulthood showed the thickest CIMT. CONCLUSION: Our findings strengthen the notion that elevated BP at adolescence and a relative increase in BP from adolescence to adulthood unfavorably affect cardiovascular risk, as indicated by increased CIMT.

Gestational age and birth weight in relation to aortic stiffness in healthy young adults: two separate mechanisms?

BACKGROUND: Impaired vascular development due to intrauterine growth retardation and postnatal-induced vascular damage by an unfavorable cardiovascular risk profile may both cause stiffer arteries in later decades. METHODS: Of 524 young adults, participating in the Atherosclerosis Risk in Young Adults (ARYA) study, data on birth characteristics were obtained from the original medical records of the Municipal Health Service and the extent of aortic stiffness was assessed using carotid-femoral pulse wave velocity (PWV). RESULTS: The PWV showed an inverse trend with gestational age (linear regression coefficient (beta) = -0.07 m/sec per 1 week; P =.064) whereas it was positively related to birth weight (beta = 0.33 m/sec per 1 kg; P =.020), adjusted for blood pressure (BP), gender, age, and each other. After exclusion of the 26 prematurely born infants, the association with gestational age was attenuated (beta = -0.03 m/sec per 1 week; P =.582), whereas the relation with birth weight hardly changed (beta = 0.30 m/sec per 1 kg; P =.041). In an analysis in which we excluded the 26 subjects with diabetic mothers the birth weight-PWV relation was attenuated (beta = 0.21 m/sec per 1 kg; P =.169). CONCLUSIONS: Our findings suggest that prematurity drives the relation of gestational age and PWV, whereas risk of impaired glucose tolerance drives the relation of birth weight and PWV. We hypothesized that two separate mechanisms might be involved in the development of arterial stiffness in healthy young adults.