Cardiovascular Health and Related Health Care Use of Moluccan-Dutch Immigrants

Objective

Studies regularly show a higher incidence, prevalence and mortality of cardiovascular disease among immigrant groups from low-income countries. Despite residing in the Netherlands for over 60 years, the Moluccan-Dutch cardiovascular disease profile and health care use are still unknown. We aimed to compare (a) the clinical prevalence of cardiovascular diseases and (b) the use of health care services by cardiovascular disease patients of 5,532 Moluccan-Dutch to an age-sex matched control group of 55,320 native Dutch.

Methods

We performed a cross-sectional analysis of data of the Achmea health insurance company for the period of 1 January 2009 to 31 December 2010. We collected information on health care use, including diagnostic information. Linear and logistic regression models were used for comparison.

Results

Moluccans had a higher clinical prevalence of ischemic heart diseases (odds ratio 1.26; 95% confidence interval 1.03–1.56), but tended to have a lower prevalence of cerebrovascular accidents (0.79; 0.56–1.11) and cardiac failure (0.67; 0.44–1.03). The clinical prevalence of cardiovascular diseases together tended to be lower among Moluccans (0.90; 0.80–1.00). Consultation of medical specialists did not differ. Angiotensin II inhibitors (1.42; 1.09–1.84), antiplatelet agents (1.27; 1.01–1.59) and statins (1.27; 1.00–1.60) were prescribed more frequently to Moluccans, as were cardiovascular agents in general (1.27; 0.94–1.71).

Conclusion

The experience of Moluccans in the Netherlands suggests that, in the long run, cardiovascular risk and related health care use of ethnic minority groups may converge towards that of the majority population.     

The Cultural Context of Health, Illness, and Medicine

The Cultural Context of Health, Illness, and Medicine. Martha O. Loustaunau and Elisa J. Sobo. Westport, CT: Begin & Garvey, 1997. 222 pp.     

Precipitation and Primary Health Care Visits for Gastrointestinal Illness in Gothenburg,Sweden

Background

The river Göta Älv is a source of freshwater for the City of Gothenburg, Sweden, and we recently identified a clear influence of upstream precipitation on concentrations of indicator bacteria in the river water, as well as an association with the daily number of phone calls to the nurse advice line related to acute gastrointestinal illnesses (AGI calls). This study aimed to examine visits to primary health-care centers owing to similar symptoms (AGI visits) in the same area, to explore associations with precipitation, and to compare variability in AGI visits and AGI calls.

Methods

We obtained data covering six years (2007–2012) of daily AGI visits and studied their association with prior precipitation (0–28 days) using a distributed lag nonlinear Poisson regression model, adjusting for seasonal patterns and covariates. In addition, we studied the effects of prolonged wet and dry weather on AGI visits. We analyzed lagged short-term relations between AGI visits and AGI calls, and we studied differences in their seasonal patterns using a binomial regression model.

Results

The study period saw a total of 17,030 AGI visits, and the number of daily visits decreased on days when precipitation occurred. However, prolonged wet weather was associated with an elevated number of AGI visits. Differences in seasonality patterns were observed between AGI visits and AGI calls, as visits were relatively less frequent during winter and relatively more frequent in August, and only weak short-term relations were found.

Conclusion

AGI visits and AGI calls seems to partly reflect different types of AGI illnesses, and the patients’ choice of medical contact (in-person visits versus phone calls) appears to depend on current weather conditions. An association between prolonged wet weather and increased AGI visits supports the hypothesis that the drinking water is related to an increased risk of AGI illnesses.     

Endangered Species: Health, Illness and Death among Madagascar's People of the Forest

Endangered Species: Health, Illness and Death among Madagascar's People of the Forest. Janice Harper. Ethnographic Studies in Medical Anthropology Series. Durham, NC: Carolina Academic Press, 2002. xvii. 273 pp.     

Optimal Cut-Off Points on the Health Anxiety Inventory,Illness Attitude Scales and Whiteley Index to Identify Severe Health Anxiety

Background

Health anxiety can be viewed as a dimensional phenomenon where severe health anxiety in form of DSM-IV hypochondriasis represents a cut-off where the health anxiety becomes clinically significant. Three of the most reliable and used self-report measures of health anxiety are the Health Anxiety Inventory (HAI), the Illness Attitude Scales (IAS) and the Whiteley Index (WI). Identifying the optimal cut-offs for classification of presence of a diagnosis of severe health anxiety on these measures has several advantages in clinical and research settings. The aim of this study was therefore to investigate the HAI, IAS and WI as proximal diagnostic instruments for severe health anxiety defined as DSM-IV hypochondriasis.

Methods

We investigated sensitivity, specificity and predictive value on the HAI, IAS and WI using a total of 347 adult participants of whom 158 had a diagnosis of severe health anxiety, 97 had obsessive-compulsive disorder and 92 were healthy non-clinical controls. Diagnostic assessments were conducted using the Anxiety Disorder Interview Schedule.

Results

Optimal cut-offs for identifying a diagnosis of severe health anxiety was 67 on the HAI, 47 on the IAS, and 5 on the WI. Sensitivity and specificity were high, ranging from 92.6 to 99.4%. Positive and negative predictive values ranged from 91.6 to 99.4% using unadjusted prevalence rates.

Conclusions

The HAI, IAS and WI have very good properties as diagnostic indicators of severe health anxiety and can be used as cost-efficient proximal estimates of the diagnosis.