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Search Results: 1 - 10 of 88 matches for " Karien Stronks "
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The development of a strategy for tackling health inequalities in the Netherlands
Johan P Mackenbach, Karien Stronks
International Journal for Equity in Health , 2004, DOI: 10.1186/1475-9276-3-11
Abstract: A 6-year research and development program was conducted which covered a number of different policy options and consisted of 12 intervention studies. The study results were discussed with experts and policy makers. A government advisory committee developed a comprehensive strategy that intends to reduce socioeconomic inequalities in disability-free life expectancy by 25% in 2020. The strategy covers 4 different entry-points for reducing socioeconomic inequalities in health, contains 26 specific recommendations, and includes 11 quantitative policy targets. Further research and development efforts are also recommended.Although the Dutch approach has been influenced by similar efforts in other European countries, particularly the United Kingdom and Sweden, it is unique in terms of its emphasis on building a systematic evidence-base for interventions and policies to reduce health inequalities. Both researchers and policy-makers were involved in the process, and there are clear indications that some of the recommendations are being adopted by health policy-makers and health care practice, although more so at the local than at the national level.Before 1980, socioeconomic inequalities in health were a non-issue in public health (research) in the Netherlands. This changed in the early 1980's as a result of the publication of the Black Report in England [1], and a report on inequalities in health between neighborhoods in the city of Amsterdam [2]. Gradually, interest in health inequalities rose, first among researchers and then among policy-makers. Interest among policy-makers was further strengthened by the "Health For All by the year 2000" targets of the World Health Organization that the Dutch government officially endorsed in 1985 [3]. In 1986, the Ministry of Health published its Health 2000 report which was the first government document to include a paragraph on socioeconomic inequalities in health [4]. This was followed in 1987 by a conference organized by the prestig
Acculturation does not necessarily lead to increased physical activity during leisure time: a cross-sectional study among Turkish young people in the Netherlands
Karen Hosper, Niek S Klazinga, Karien Stronks
BMC Public Health , 2007, DOI: 10.1186/1471-2458-7-230
Abstract: Cross-sectional data were obtained from the LASER-study (2003–2004) on health related behaviours in first and second generation Turkish young people living in the Netherlands. For this study we included 485 Turkish participants aged 15–30 years, who participated in a structured interview during a home visit. Acculturation was indicated by level of 'cultural orientation towards the Dutch culture' and 'social contacts with ethnic Dutch' with persons being low oriented towards the Dutch culture and having few social contacts with ethnic Dutch as reference group. The measured barriers were 'having children', 'occupational physical activity' and 'living in a less attractive neighbourhood'. Logistic regression analyses were used to assess the associations between acculturation and physical activity during leisure time, stratified by these contextual barriers.Greater cultural and social integration was associated with increased physical activity during leisure time. Odds ratio's were 1.85 (CI: 1.19–2.85) for 'cultural orientation' and 1.77 (CI: 1.15–2.71) for 'social contacts with ethnic Dutch'. However, these associations were not present or less strong among people who had children, or who were living in a less attractive neighbourhood or who engaged in occupational physical activity.Physical activity during leisure time increased with greater acculturation, however, this relationship was found only among participants without children, living in a attractive neighbourhood and having no occupational activity. Interventions aimed at migrant populations should not only focus on the least integrated. Instead, effectiveness might be enhanced when interventions are sensitive to the contextual barriers that might inhibit physical activity behaviours during leisure time.Physical inactivity is currently acknowledged to be a serious public health burden in the industrialized world [1,2]. A large body of evidence shows that regular physical activity reduces the risk of death from s
Which factors engage women in deprived neighbourhoods to participate in exercise referral schemes?
Melanie Schmidt, Saida Absalah, Vera Nierkens, Karien Stronks
BMC Public Health , 2008, DOI: 10.1186/1471-2458-8-371
Abstract: A mixed method approach was utilized, combining a cross-sectional descriptive study and a qualitative component. In the quantitative part of the study, all female participants (n = 523) filled out a registration form containing questions about socio-demographic and psychosocial characteristics. Height and weight were also measured. In the qualitative part of the study, 38 of these 523 participants were interviewed.The majority of the participants had a migrant background, a low level of education, no paid job and a high body mass index. Although most participants were living sedentary lives, at intake they were quite motivated to start exercising. The ERS appealed to them because of its specific elements: facilitating role of the health professional, supportive environment, financial incentive, supervision and neighbourhood setting.This study supports the idea that ERS interventions appeal to women from lower socio-economic groups, including ethnic minorities. The ERS seems to meet their contextual, economic and cultural needs. Since the elements that enabled the women to start exercising are specific to this ERS, we should become aware of whether this population continues to exercise after the end of the scheme.Many studies have demonstrated the positive relationship between physical activity and health [1,2]. Despite these benefits, a large proportion of adults in European countries fail to achieve the minimum recommendation of 30 minutes of moderately intense physical activity every day [3]. People in lower socio-economic groups meet the current target less frequently than the rest of the population. Within this group, there is an even greater risk among people with a migrant background [4,5]. This is reflected in the results of various studies that show a decreased likelihood of being physically active among residents of deprived neighbourhoods [6,7] and a lower likelihood of using sport facilities for physical activity in deprived areas [8]. This means that maj
Factors affecting the disclosure of diabetes by ethnic minority patients: a qualitative study among Surinamese in the Netherlands
Mirjam JE Kohinor, Karien Stronks, Joke A Haafkens
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-399
Abstract: We conducted a qualitative study using semi-structured interviews with 32 Surinamese patients who were being treated for type 2 diabetes by general practitioners in Amsterdam, the Netherlands.Most patients disclosed their diabetes only to very close family members. The main factor inhibiting disclosure to people outside this group was the Surinamese cultural custom that talking about disease is taboo, as it may lead to shame, gossip, and social disgrace for the patient and their family. Nevertheless, some patients disclosed their diabetes to people outside their close family circles. Factors motivating this decision were mostly related to a need for facilities or support for diabetes self-management.Cultural customs inhibited Surinamese patients in disclosing their diabetes to people outside their very close family circles. This may influence their readiness to participate in community-based diabetes self-management programmes that involve other groups. What these findings highlight is that public health researchers and initiatives must identify and work with factors that influence the disclosure of diabetes if they are to develop community-based diabetes self-management interventions for ethnic minority populations.Type 2 diabetes is an increasingly common chronic condition all across the globe. Many ethnic minority populations living in the United States and Europe exhibit a greater risk of developing diabetes and diabetes-related morbidity and mortality than people of European origin [1-4]. Reducing ethnic disparities in diabetes-related morbidity and mortality has therefore become an important public health issue on both sides of the Atlantic. Careful diabetes self-management (such as monitoring blood glucose, using medication, following a diet, and exercising) is a key factor in preventing diabetes-related complications in all ethnic groups [2,5]. Diabetes self-management education is considered to be the cornerstone of diabetes care [6]. Studies in the US base
Blood pressure and body mass index in an ethnically diverse sample of adolescents in Paramaribo, Suriname
Charles Agyemang, Eline Oudeman, Wilco Zijlmans, Johannes Wendte, Karien Stronks
BMC Cardiovascular Disorders , 2009, DOI: 10.1186/1471-2261-9-19
Abstract: Cross-sectional study with anthropometric and blood pressure measurements. A random sample of 855 adolescents (167 Hindustanis, 169 Creoles, 128 Javanese, 91 Maroons and 300 mixed-ethnicities) were studied. Ethnicity was based on self-reported ethnic origin.Among boys, Maroons had a lower age- and height-adjusted systolic BP than Creoles, and a lower diastolic BP than other ethnic groups. However, after further adjustment for BMI, only diastolic BP in Maroons was significantly lower than in Javanese (67.1 versus 70.9 mmHg). Creole boys had a lower diastolic BP than Hindustani (67.3 versus 70.2 mmHg) and Javanese boys after adjustment for age, height and BMI. Among girls, there were no significant differences in systolic BP between the ethnic groups. Maroon girls, however, had a lower diastolic BP (65.6 mmHg) than Hindustani (69.1 mmHg), Javanese (71.2 mmHg) and Mixed-ethnic (68.3 mmHg) girls, but only after differences in BMI had been adjusted for. Javanese had a higher diastolic BP than Creoles (71.2 versus 66.8 mmHg) and Mixed-ethnicity girls. BMI was positively associated with BP in all the ethnic groups, except for diastolic BP in Maroon girls.The study findings indicate higher mean BP levels among Javanese and Hindustani adolescents compared with their African descent peers. These findings contrast the relatively low BP reported in Javanese and Hindustani adult populations in Suriname and underscore the need for public health measures early in life to prevent high BP and its sequelae in later life.The increasing prevalence of cardiovascular diseases (CVD) is putting a tremendous pressure on already overburdened resources in non-industrialised countries. [1] High blood pressure (BP) is a leading cause of CVD. [2] The rising prevalence of hypertension in non-industrialised countries reflects well on the high prevalence of CVD. [2]In children, BP tracking patterns confirm that persistent BP increase may be related to hypertension in adulthood. [3-5] Increased BP i
Depressive symptoms and smoking among young Turkish and Moroccan ethnic minority groups in the Netherlands: a cross-sectional study
Ceren Z Acartürk, Vera Nierkens, Charles Agyemang, Karien Stronks
Substance Abuse Treatment, Prevention, and Policy , 2011, DOI: 10.1186/1747-597x-6-5
Abstract: Multiple logistic regression analyses was used to analyze cross-sectional data from a sample of 364 Turkish and Moroccan migrants aged 15 to 24 years. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to measure the presence of clinically significant depressive symptoms. Smoking behavior was measured by a number of questions.Of the respondents, 22% were smokers and 33% had depressive symptoms. The prevalence of depressive symptoms was significantly higher in smokers (42.9%) than in nonsmokers (29.5%). Respondents with depressive symptoms had increased odds of smoking even after adjusting for socioeconomic and cultural factors (OR = 2.68, 95% CI = 1.45-4.97).Depressive symptoms were significantly associated with smoking behavior in young Turkish and Moroccan migrants. In addition to other acknowledged factors, depressive symptoms should also be considered in relation to the smoking behavior of this group. Intervention programs for smoking behavior should take depressive symptoms into account for young Turkish and Moroccan migrants.Smoking behavior is associated with mental health disorders, particularly depressive symptoms [1-4]. Smoking prevalence is higher among individuals with depressive symptoms than it is among those with no depressive symptoms [5]. Different causal pathways between depressive symptoms and smoking have been reported. Previous studies have found the use of nicotine to increase positive affect and/or decrease negative affect [6,7]. On the other hand, there is evidence showing that smoking triggers first-ever incidence of depression [8]. Some studies direct attention to a third independent factor: genetic predisposition to both smoking and depressive symptoms [9].An important target group for preventing smoking-related diseases is young adults, who are at risk of smoking and developing tobacco-related diseases [10,11]. Young adulthood has been seen as an important transition period from occasional smoking to regular smoking, a
Assessing Associations between Socio-Economic Environment and Self-Reported Health in Amsterdam Using Bespoke Environments
Eleonore M. Veldhuizen, Karien Stronks, Anton E. Kunst
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0068790
Abstract: Background The study of the relationship between residential environment and health at micro area level has a long time been hampered by a lack of micro-scale data. Nowadays data is registered at a much more detailed scale. In combination with Geographic Information System (GIS)-techniques this creates opportunities to look at the relationship at different scales, including very local ones. The study illustrates the use of a ‘bespoke environment’ approach to assess the relationship between health and socio-economic environment. Methods We created these environments by buffer-operations and used micro-scale data on 6-digit postcode level to describe these individually tailored areas around survey respondents in an accurate way. To capture the full extent of area effects we maximized variation in socio-economic characteristics between areas. The area effect was assessed using logistic regression analysis. Results Although the contribution of the socio-economic environment in the explanation of health was not strong it tended to be stronger at a very local level. A positive association was observed only when these factors were measured in buffers smaller than 200 meters. Stronger associations were observed when restricting the analysis to socioeconomically homogeneous buffers. Scale effects proved to be highly important but potential boundary effects seemed not to play an important role. Administrative areas and buffers of comparable sizes came up with comparable area effects. Conclusions This study shows that socio-economic area effects reveal only on a very micro-scale. It underlines the importance of the availability of micro-scale data. Through scaling, bespoke environments add a new dimension to study environment and health.
The Effect on Mental Health of a Large Scale Psychosocial Intervention for Survivors of Mass Violence: A Quasi-Experimental Study in Rwanda
Willem F. Scholte,Femke Verduin,Astrid M. Kamperman,Theoneste Rutayisire,Aeilko H. Zwinderman,Karien Stronks
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0021819
Abstract: War has serious and prolonged mental health consequences. It is argued that post-emergency mental health interventions should not only focus on psychological factors but also address the social environment. No controlled trials of such interventions exist. We studied the effect on mental health of a large scale psychosocial intervention primarily aimed at social bonding in post-genocide Rwanda. The programme is implemented at population level without diagnostic criteria for participation. It is open to any person older than 15 years, and enables participation of over 1500 individuals per year. We postulated that the mental health of programme participants would improve significantly relative to non-participants.
Deficiencies in culturally competent asthma care for ethnic minority children: a qualitative assessment among care providers
Conny Seeleman, Karien Stronks, Wim van Aalderen, Marie-Louise Bot
BMC Pediatrics , 2012, DOI: 10.1186/1471-2431-12-47
Abstract: We conducted semi-structured interviews on care for ethnic minority children with asthma (aged 4-10 years) with paediatricians (n?=?13) and nurses (n?=?3) in three hospitals. Interviews were analysed qualitatively with a framework method, using a cultural competence model.Respondents mentioned patient non-adherence as the central problem in asthma care. They related non-adherence in children from ethnic minority backgrounds to social context factors, difficulties in understanding the chronic nature of asthma, and parents’ language barriers. Reactions reported by respondents to patients’ non-adherence included retrieving additional information, providing biomedical information, occasionally providing referrals for social context issues, and using informal interpreters.This study provides keys to improve the quality of specialist paediatric asthma care to ethnic minority children, mainly related to non-adherence. Care providers do not consciously recognise all the mechanisms that lead to deficiencies in culturally competent asthma care they provide to ethnic minority children (e.g. communicating mainly from a biomedical perspective and using mostly informal interpreters). Therefore, the learning objectives of cultural competence training should reflect issues that care providers are aware of as well as issues they are unaware of.Asthma outcomes are generally worse for children from ethnic minority backgrounds [1-3]. A recent study in the Netherlands showed that ethnic minority children have poorer asthma control and more complaints than their Dutch peers [4]. This reflects a significant, avoidable burden of illness, because asthma prevalence is as high as 5% to 10% among children in Western societies [5], and ethnic diversity has increased among young Western populations [6,7].Low adherence to preventive treatment with daily inhalation corticosteroids (ICSs) is an important barrier to achieving optimal asthma control [8,9]. Paediatric asthma care focuses on parents’ s
Cardiovascular disease, diabetes and established risk factors among populations of sub-Saharan African descent in Europe: a literature review
Charles Agyemang, Juliet Addo, Raj Bhopal, Ama de Graft Aikins, Karien Stronks
Globalization and Health , 2009, DOI: 10.1186/1744-8603-5-7
Abstract: This article provides a review of current understanding of the epidemiology of vascular disease, principally coronary heart disease (CHD), stroke and related risk factors among populations of Sub-Sahara African descent (henceforth, African descent) in comparison with the European populations in Europe.Compared with European populations, populations of African descent have an increased risk of stroke, whereas CHD is less common. They also have higher rates of hypertension and diabetes than European populations. Obesity is highly prevalent, but smoking rate is lower among African descent women. Older people of African descent have more favourable lipid profile and dietary habits than their European counterparts. Alcohol consumption is less common among populations of African descent. The rate of physical activity differs between European countries. Dutch African-Suriname men and women are less physically active than the White-Dutch whereas British African women are more physically active than women in the general population. Literature on psychosocial stress shows inconsistent results.Hypertension and diabetes are highly prevalent among African populations, which may explain their high rate of stroke in Europe. The relatively low rate of CHD may be explained by the low rates of other risk factors including a more favourable lipid profile and the low prevalence of smoking. The risk factors are changing, and on the whole, getting worse especially among African women. Cohort studies and clinical trials are therefore needed among these groups to determine the relative contribution of vascular risk factors, and to help guide the prevention efforts. There is a clear need for intervention studies among these populations in Europe.Globally, cardiovascular disease (CVD) is the leading cause of death [1]. This is particularly so in Europe, where CVD has continued to maintain its lead for several decades [1], and this is reflected in Europe's multi-ethnic populations [2]. The ex
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