Determinants of the intention of preconception care use: lessons from a multi-ethnic urban population in the Netherlands.

OBJECTIVES: To investigate the determinants of the intention of preconception care use of women in a multi-ethnic urban population. METHODS: The ASE-model-a health behaviour model-was used as an explanatory framework. A representative sample was taken from the municipal population registers of two districts in Rotterdam, the Netherlands, 2009-2010. 3,225 women (aged 15-60 years) received a questionnaire, which was returned by 631: 133 Dutch, 157 Turkish and Moroccan, and 341 Surinamese and Antillean. Descriptive, univariate and multivariate analyses were performed. RESULTS: The multiple logistic analyses showed that intention to attend preconception care was significantly higher in women with a Turkish and Moroccan background (ß 1.02, P = 0.006), a higher maternal age (ß 0.04, P = 0.008) and a positive attitude (ß 0.50, P < 0.001). Having no relationship (ß -1.16, P = 0.004), multiparity with previous adverse perinatal outcome (ß -1.32, P = 0.001), a high educational level (ß -1.23, P = 0.03), having paid work (ß -0.72, P = 0.01) and experienced barriers level (ß -0.15, P = 0.003) were associated with less intention to use preconception care. CONCLUSIONS: Modifiable determinants as attitude and barriers can be addressed to enhance preconception care attendance.

An urban perinatal health programme of strategies to improve perinatal health.

Promotion of a healthy pregnancy is a top priority of the health care policy in many European countries. Perinatal mortality is an important indicator of the success of this policy. Recently, it was shown that the Netherlands has relatively high perinatal death rates when compared to other European countries. This is in particular true for large cities where perinatal mortality rates are 20-50% higher than elsewhere. Consequently in the Netherlands, there is heated debate on how to tackle these problems. Without the introduction of measures throughout the entire perinatal health care chain, pregnancy outcomes are difficult to improve. With the support of health care professionals, the City of Rotterdam and the Erasmus University Medical Centre have taken the initiative to develop an urban perinatal health programme called 'Ready for a Baby'. The main objective of this municipal 10-year programme is to improve perinatal health and to reduce perinatal mortality in all districts to at least the current national average of l0 per 1000. Key elements are the understanding of the mechanisms of the large health differences between women living in deprived and non-deprived urban areas. Risk guided care, orientation towards shared-care and improvement of collaborations between health care professionals shapes the interventions that are being developed. Major attention is given to the development of methods to improve risk-selection before and during pregnancy and methods to reach low-educated and immigrant groups.

Effectiveness of a health promotion programme for long-term unemployed subjects with health problems: a randomised controlled trial.

BACKGROUND: Employment status is an important determinant of health inequalities. Among unemployed people, poor health decreases the likelihood of re-employment. METHODS: A randomised controlled trial with 6 months' follow-up among unemployed people with health complaints receiving social security benefits from the city of Rotterdam, The Netherlands. In total, 456 people were assigned to the control group and 465 people to the intervention group. The intervention consisted of three sessions weekly over 12 weeks. One session a week was focused on education to enhance the ability to cope with (health) problems, and two weekly sessions consisted of physical activities. The primary outcome measures were perceived health, measured by the Short Form 36 Health Survey, and psychological measures mastery, self-esteem and pain-related fear of movement. Secondary outcome measures were work values, job search activities and re-employment. RESULTS: Enrolment in the intervention programme was 65%, and 72% completed the programme with over 70% attendance at all sessions. The intervention had a good reach among subjects with lower education, but had no effect on mental and physical health, mastery, self-esteem and pain-related fear of movement. Participation in the programme had no influence on work values, job search activities or re-employment. CONCLUSION: This intervention programme aimed at the promotion of physical and mental health in unemployed people with health complaints did not show beneficial effects. The lack of integration into regular vocational rehabilitation activities may have interfered with these findings. This particular health programme cannot be recommended for implementation.

[Perinatal outcomes in the four largest cities and in deprived neighbourhoods in The Netherlands]. / Perinatale uitkomsten in de vier grote steden en de prachtwijken in Nederland.

OBJECTIVE: To analyse the association between neighbourhood, ethnicity and adverse perinatal outcome in pregnant women from the 4 largest cities (Amsterdam, Rotterdam, The Hague and Utrecht; G4) and elsewhere in The Netherlands. DESIGN: Descriptive, retrospective. METHOD: The perinatal outcome of 877,816 single pregnancies during the years 2002-2006, derived from The Netherlands Perinatal Registry, was analysed for the ethnicity (Western or non-Western) and the neighbourhood (deprived or not) of the pregnant women in the G4 and elsewhere in The Netherlands. Adverse perinatal outcome was defined as perinatal mortality, congenital abnormalities, intra-uterine growth restriction, preterm birth, Apgar score after 5 minutes < 7 and/or admission to a neonatal intensive-care unit. RESULTS: The overall perinatal mortality rate was higher in the G4 than elsewhere in The Netherlands (11.1 per thousand versus 9.3 per thousand; p < 0.001; 95% confidence interval of the difference: 1.2-2.4 per thousand). The same was true for the sum of adverse perinatal outcomes (154.9 per thousand versus 138.9 per thousand). In the G4 the perinatal mortality among non-Western women was higher than among Western women (13.2 per thousand versus 9.5 per thousand). Residing in Dutch deprived neighbourhoods was associated with a higher perinatal mortality than outside deprived neighbourhoods (13.5 per thousand versus 9.3 per thousand). The relative risks of living in deprived neighbourhoods for adverse pregnancy outcomes are higher among Western than among non-Western women. CONCLUSION: Pregnant women in the G4 have an increased risk ofadverse perinatal outcomes. The risks of residing in a deprived neighbourhood are even higher, especially among Western women. The findings are important for new strategies to improve perinatal outcomes.

No clear effect of diabetes education on glycaemic control for Turkish type 2 diabetes patients: a controlled experiment in general practice.

BACKGROUND: In Turkish immigrant diabetics, problems with communication and cultural differences may hinder delivery of diabetes care. METHODS: In a prospective controlled study, the effect of an ethnic-specific diabetes education programme on glycaemic control and cardiovascular risk factors in Turkish type 2 diabetes patients was assessed, by comparing Turkish diabetics who were offered the education programme with Turkish diabetics offered routine care only (control group). From 16 general practices (31 GPs) in Rotterdam, 104 Turkish type 2 diabetes patients were recruited, 85 of whom could be assessed at one-year follow-up. Glycaemic control, lipid concentrations, blood pressure and body mass index were measured. RESULTS: Compared with the control group, mean HbA(1C) in the intervention group decreased by 0.3% (95% CI -0.8 to 0.2). A significant decrease in HbA(1C) was observed in women with HbA(1C) >7% at baseline (-0.9%; 95% CI -1.73 to -0.09) but not in the other subgroups studied. serum lipid concentrations, blood pressure and body mass index remained unchanged in the intervention group. CONCLUSION: Ethnic-specific diabetes education by Turkish female educators has no obvious beneficial effect on glycaemic control or cardiovascular risk profile. More focus on specific patient selection and gender equality between educators/patients may prove worthwhile.

Diabetes care in Dutch general practice: differences between Turkish immigrants and Dutch patients.

AIM: To compare the adherence to clinical guidelines by GPs as registered and glycaemic control in Turkish and Dutch type 2 diabetes patients. DESIGN: A retrospective cohort study. Search of general practice medical records for diabetes-related variables of Turkish and Dutch diabetes patients, stratified for age and gender. SETTING: Seventeen general practices (37 GPs) in the inner city of Rotterdam. SUBJECTS: 196 type 2 diabetes patients (106 Turkish and 90 Dutch), known with diabetes for at least 18 months, were followed for two years during the 1992-1997 period. MAIN OUTCOME MEASURES: 1) Level of care as registered in the medical records based on eight quantifiable criteria derived from the national guidelines for GPs; and 2) glycaemic control (fasting and non-fasting blood glucose levels). RESULTS: Turkish patients visited the GP for periodic control more often than Dutch patients. The other seven criteria were followed in an equal number of Turkish and Dutch patients. Turkish patients had a higher mean non-fasting plasma glucose level (12.9 mmol/l) than Dutch patients (10.8) (p=0.001) during the two-year follow-up. CONCLUSIONS: Although adherence to clinical guidelines as registered in Turkish and Dutch type 2 diabetes patients is comparable, Turkish patients have higher mean non-fasting plasma glucose level than their Dutch counterparts.

Interest in participation in a peer-led senior health education program.

A study was made of the characteristics of older adults showing an interest in participating in a health education course given by peers. Determining the degree of interest in health education is important for assessing the impact on the target-population and evaluating the dissemination strategy. In the course 'Successful Aging' groups of older adults came together to discuss health related issues. The course was given by senior health educators aged 55 years and over from the peer group. To determine interest in the course answer cards were sent with a letter of invitation to all independently living inhabitants aged between 55 an 79 in a Dutch community. The rate of expressed interest in the course was 5.8%. Interest was highest among females in the 55-64 age group, the unmarried and those with low wellbeing. Males in the age group 65-79, females aged 75-79, those with a lower socio-economic status and the inactive were comparatively less interested. Subscription to the course was distinguished from mere interest in the course. From those who expressed interest, more people of low socio-economic status, with a reduced level of wellbeing, many physical limitations and poor self-efficacy actually subscribed. It is concluded that the health education program will be continued and that special attention will be paid to groups that showed lower levels of uptake. Involving intermediates from these groups in the course development is recommended.

Effects of a peer-led senior health education program.

The effect of a health education course guided by peers aged 55 and over was evaluated. The aim of the course was to empower older adults to participate in society and to promote their wellbeing. Evaluation included determining the effect on attitude toward aging, self-efficacy, perception of the societal opinion regarding the place of the elderly in society (social influence), social participation, perceived social support, and wellbeing of the participants aged 55 to 79 years. A quasi-experimental approach was used. The effect on the experimental group of course participants was studied compared to a control group of older adults on the waiting list. The respondents filled out postal questionnaires at three time points (before starting the course (t0), immediately after termination (t1) and three months later (t2)). Using a multivariate analysis procedure, a significant interaction effect between time of measurement and group membership was found with respect to the outcome of social influence. At t1 an effect was absent, but at t2, the current idea that elderly occupy a marginal position in society, found less favour with the experimental group than the control group. Moreover perceived social support and subjective health improved significantly at t1 and t2 among the course members, when compared to the control group. No effect was found on attitude, self-efficacy, social participation and wellbeing in the short time span of a three months follow-up.