1
|
Brakenridge CJ, Koster A, de Galan BE, Carver A, Dumuid D, Dzakpasu FQS, Eussen SJPM, Savelberg HHCM, Bosma H, Owen N, Schaper NC, Healy GN, Dunstan DW. Associations of 24 h time-use compositions of sitting, standing, physical activity and sleeping with optimal cardiometabolic risk and glycaemic control: The Maastricht Study. Diabetologia 2024:10.1007/s00125-024-06145-0. [PMID: 38656371 DOI: 10.1007/s00125-024-06145-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/28/2024] [Indexed: 04/26/2024]
Abstract
AIMS/HYPOTHESIS The associations of sitting, standing, physical activity and sleep with cardiometabolic health and glycaemic control markers are interrelated. We aimed to identify 24 h time-use compositions associated with optimal metabolic and glycaemic control and determine whether these varied by diabetes status. METHODS Thigh-worn activPAL data from 2388 participants aged 40-75 years (48.7% female; mean age 60.1 [SD = 8.1] years; n=684 with type 2 diabetes) in The Maastricht Study were examined. Compositional isometric log ratios were generated from mean 24 h time use (sitting, standing, light-intensity physical activity [LPA], moderate-to-vigorous physical activity [MVPA] and sleeping) and regressed with outcomes of waist circumference, fasting plasma glucose (FPG), 2 h plasma glucose, HbA1c, the Matsuda index expressed as z scores, and with a clustered cardiometabolic risk score. Overall analyses were adjusted for demographics, smoking, dietary intake and diabetes status, and interaction by diabetes status was examined separately. The estimated difference when substituting 30 min of one behaviour with another was determined with isotemporal substitution. To identify optimal time use, all combinations of 24 h compositions possible within the study footprint (1st-99th percentile of each behaviour) were investigated to determine those cross-sectionally associated with the most-optimal outcome (top 5%) for each outcome measure. RESULTS Compositions lower in sitting time and with greater standing time, physical activity and sleeping had the most beneficial associations with outcomes. Associations were stronger in participants with type 2 diabetes (p<0.05 for interactions), with larger estimated benefits for waist circumference, FPG and HbA1c when sitting was replaced by LPA or MVPA in those with type 2 diabetes vs the overall sample. The mean (range) optimal compositions of 24 h time use, considering all outcomes, were 6 h (range 5 h 40 min-7 h 10 min) for sitting, 5 h 10 min (4 h 10 min-6 h 10 min) for standing, 2 h 10 min (2 h-2 h 20 min) for LPA, 2 h 10 min (1 h 40 min-2 h 20 min) for MVPA and 8 h 20 min (7 h 30 min-9 h) for sleeping. CONCLUSIONS/INTERPRETATION Shorter sitting time and more time spent standing, undergoing physical activity and sleeping are associated with preferable cardiometabolic health. The substitutions of behavioural time use were significantly stronger in their associations with glycaemic control in those with type 2 diabetes compared with those with normoglycaemic metabolism, especially when sitting time was balanced with greater physical activity.
Collapse
Affiliation(s)
- Christian J Brakenridge
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
- Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia.
- Active Life Lab, South-Eastern Finland University of Applied Sciences, Mikkeli, Finland.
- Centre for Urban Transitions, Swinburne University of Technology, Melbourne, VIC, Australia.
| | - Annemarie Koster
- Department of Social Medicine, Maastricht University, Maastricht, the Netherlands
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Bastiaan E de Galan
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Alison Carver
- National Centre for Healthy Ageing, The School of Translational Medicine, Monash University, Melbourne, VIC, Australia
| | - Dorothea Dumuid
- Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, SA, Australia
| | - Francis Q S Dzakpasu
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Simone J P M Eussen
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
- Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
| | - Hans H C M Savelberg
- Department of Nutrition and Movement Science, Maastricht University, Maastricht, the Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Hans Bosma
- Department of Social Medicine, Maastricht University, Maastricht, the Netherlands
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Neville Owen
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Centre for Urban Transitions, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Nicolaas C Schaper
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Genevieve N Healy
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - David W Dunstan
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, Australia
| |
Collapse
|
2
|
Chan JA, Bosma H, Lakerveld J, Schram MT, van Greevenbroek M, Koster A. Social cohesion and associations with sedentary time, physical activity and dietary quality in the Maastricht study. Prev Med 2024:107970. [PMID: 38653391 DOI: 10.1016/j.ypmed.2024.107970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 04/04/2024] [Accepted: 04/20/2024] [Indexed: 04/25/2024]
Abstract
INTRO We aim to investigate the relationship between social cohesion and sedentary behavior (SB), total physical activity (PA), moderate-to-vigorous PA (MVPA), and dietary quality. Additionally, we assess whether these associations are independent of neighborhood walkability and the food environment. METHODS A total of 7641 participants from The Maastricht Study in the Netherlands between the ages of 40 and 75 years were analyzed. Neighborhood social cohesion was obtained by participant questionnaire completed at baseline and measured by the Dutch Livability meter. Home addresses were linked to geographic information system (GIS) data from the Geoscience and Health Cohort Consortium (GECCO) to create neighborhood exposures of walkability and food environment. A thigh worn accelerometer collected data to measure sedentary time, total daily PA, and MVPA. Dietary quality was measured with a food frequency questionnaire. Multivariate linear regression analyses were adjusted for age, sex, socioeconomic position, neighborhood walkability, and food environment. RESULTS Those living in the highest quartile area of perceived social cohesion had statistically significant lower levels of SB (Q4 B: -13.04; 95% CI = -20.23, -5.85), higher total PA (Q4 B: 4.39; 95% CI = 1.69, 7.10), and higher MVPA (Q4 B: 2.57; 95% CI = 0.83, 4.31) and better diet quality (Q4 B: 1.12; 95% CI = 0.24, 2.01) compared to the lowest quartile independent of walkability and food environment. Similar results were found using the Livability meter. CONCLUSION We discovered neighborhood social cohesion as an important obesogenic determinant that should be considered in policymaking to encourage higher levels of PA and higher diet quality.
Collapse
Affiliation(s)
- Jeffrey Alexander Chan
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands; Department of Social Medicine, Maastricht University, Maastricht, the Netherlands; Department of Physical Medicine and Rehabilitation, Northern California VA Healthcare System, Martinez, CA, USA.
| | - Hans Bosma
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands; Department of Social Medicine, Maastricht University, Maastricht, the Netherlands
| | - Jeroen Lakerveld
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Miranda T Schram
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands; Department of Internal Medicine, Maastricht University, Maastricht, the Netherlands; Heart and Vascular Centre, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Marleen van Greevenbroek
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands; Department of Internal Medicine, Maastricht University, Maastricht, the Netherlands
| | - Annemarie Koster
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands; Department of Social Medicine, Maastricht University, Maastricht, the Netherlands
| |
Collapse
|
3
|
Chung GKK, Liu X, Massar K, Schelleman-Offermans K, Bosma H, Chan YH, Chan SM, Chen JK, Wong H, Chung RYN. Socioeconomic inequalities in psychosocial well-being among adolescents under the COVID-19 pandemic: a cross-regional comparative analysis in Hong Kong, mainland China, and the Netherlands. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02649-7. [PMID: 38573376 DOI: 10.1007/s00127-024-02649-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 03/03/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Despite evidence on socioeconomic inequalities in psychosocial well-being of adolescents under the COVID-19 pandemic, the explanatory factors and their potential variations across contexts remained understudied. Hence, this cross-regional study compared the extent of inequalities and the mediating pathways across Hong Kong, Mainland China, and the Netherlands. METHODS Between July 2021 and January 2022, 25 secondary schools from diverse socioeconomic background were purposively sampled from Hong Kong, Zhejiang (Mainland China), and Limburg (the Netherlands). 3595 junior students completed an online survey during class about their socioeconomic position, psychosocial factors, and well-being. Socioeconomic inequalities were assessed by multiple linear regressions using the Slope Index of Inequality (SII), whereas the mediating pathways through learning difficulty, overall worry about COVID-19, impact on family' financial status, resilience, trust in government regarding pandemic management, and adaptation to social distancing were examined by mediation analyses moderated by regions. RESULTS The adverse psychosocial impact of COVID-19 was stronger in the Netherlands and Hong Kong compared with Mainland China. The greatest extent of socioeconomic inequalities in the change in psychosocial well-being was observed among students in the Netherlands (SII = 0.59 [95% CI = 0.38-0.80]), followed by Hong Kong (SII = 0.37 [0.21-0.52]) and Mainland China (SII = 0.12 [0.00-0.23]). Learning difficulty and resilience were the major mediators in Mainland China and Hong Kong, but to a lesser extent in the Netherlands. CONCLUSION Socioeconomic inequalities in psychosocial well-being were evident among adolescents under the pandemic, with learning difficulty and resilience of students as the key mediators. Differences in the social contexts should be considered to better understand the variations in inequalities and mediating pathways across regions.
Collapse
Affiliation(s)
- Gary Ka-Ki Chung
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, China
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Xiaoting Liu
- School of Public Affairs, Zhejiang University, Hangzhou, China
| | - Karlijn Massar
- Department of Work and Social Psychology, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands
| | - Karen Schelleman-Offermans
- Department of Work and Social Psychology, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands
| | - Hans Bosma
- Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands
| | - Yat-Hang Chan
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, China
| | - Siu-Ming Chan
- CityU Department of Social and Behavioural Sciences, The City University of Hong Kong, Hong Kong, China
| | - Ji-Kang Chen
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong, China
| | - Hung Wong
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, China
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong, China
| | - Roger Yat-Nork Chung
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, China.
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
- CUHK Centre for Bioethics, The Chinese University of Hong Kong, Hong Kong, China.
| |
Collapse
|
4
|
Meisters R, Albers J, Sezer B, de Galan BE, Eussen SJPM, Stehouwer CDA, Schram MT, van Greevenbroek MMJ, Wesselius A, Koster A, Bosma H. Socioeconomic inequalities in health-related functioning among people with type 2 Diabetes: longitudinal analyses in the Maastricht Study. BMC Public Health 2024; 24:73. [PMID: 38172697 PMCID: PMC10763122 DOI: 10.1186/s12889-023-17553-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a common chronic disease that disproportionally affects disadvantaged groups. People with a low socioeconomic position (SEP) have increased risk of T2DM and people with a low SEP and T2DM have higher HbA1c-levels compared to people with T2DM and high SEP. The aim of this study is to analyze longitudinal socioeconomic differences in health-related functioning in people with T2DM. METHODS Longitudinal data from 1,537 participants of The Maastricht Study with T2DM were used (32.6% female, mean (SD) age 62.9 (7.7) years). SEP was determined by baseline measures of education, occupation and income. Health-related functioning (physical, mental and social) was measured with the Short-Form Health Survey and the Impact on Participation and Autonomy survey (all scored from 0 to 100). Associations of SEP and health-related functioning were studied annually over a 10-year period (median (IQR) 7.0 (5.0) years, baseline 2010-2018) using linear mixed methods adjusting for demographics, HbA1c-levels and lifestyle factors. RESULTS Participants with a low SEP had significantly worse health-related functioning compared to those with a high SEP. For example, participants with low income had lower scores for physical (-4.49[CI -5.77;-3.21]), mental (-2.61[-3.78,-1.44]) and social functioning (-9.76[-12.30;-7.23]) compared to participants with high income on a scale from 0 to 100. In addition, participants with a low education significantly declined more over time in mental (score for interaction education with time - 0.23[-0.37;-0.09]) and social functioning (-0.44[-0.77;-0.11]) compared to participants with high education. Participants with low and intermediate incomes significantly declined more over time in physical functioning (-0.17 [-0.34, -0.01 and - 0.18 [-0.36, 0.00]) compared to participants with high income. CONCLUSIONS Among people with T2DM, those with a lower SEP had worse health-related functioning in general than people with a higher SEP. Additionally, people with T2DM and low education developed poorer mental and social functioning over time compared to people with T2DM and high education. People with T2DM and low or intermediate income declined more in physical functioning over time than those with high incomes. In addition to HbA1c-levels and lifestyle patterns, more attention is needed for socioeconomic differences in health-related functioning for people living with T2DM.
Collapse
Affiliation(s)
- Rachelle Meisters
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, the Netherlands.
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands.
| | - Jeroen Albers
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, the Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Bengisu Sezer
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, the Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Bastiaan E de Galan
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Simone J P M Eussen
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
- Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Miranda T Schram
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- MHeNS School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Heart and Vascular Center, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | | | - Anke Wesselius
- Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands
| | - Annemarie Koster
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, the Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Hans Bosma
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, the Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| |
Collapse
|
5
|
Albert Torchyan A, Houkes I, Bosma H. Income inequality and socioeconomic differences in bullying perpetration among adolescents in post-communist countries of Europe: Findings from the HBSC study. Prev Med Rep 2024; 37:102540. [PMID: 38152835 PMCID: PMC10750175 DOI: 10.1016/j.pmedr.2023.102540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 11/20/2023] [Accepted: 12/05/2023] [Indexed: 12/29/2023] Open
Abstract
Background Adolescent bullying is a major public health concern in post-Communist countries of Europe (PCCE). We studied the impact of income inequality on the prevalence of and socioeconomic differences in bullying perpetration. Methods Nationally representative samples of adolescents aged 11-15 years from 14 PCCE participating in the Health Behavior in School-aged Children survey during 2017-18 years were included. Multilevel logistic regression models were fitted. Results Overall, 71,119 adolescents participated in the survey. About 27.7 % of country differences in bullying perpetration were attributable to high income inequality. Adolescents with low and high family socioeconomic status (SES) had a 10-15 % greater risk (P < 0.05) of bullying perpetration compared to middle-SES adolescents. In cross-level interaction, the risk of bullying perpetration was the highest among high-SES adolescents from countries with wider income inequality (P-interaction = 0.003). The odds ratios of bullying perpetration comparing high- vs. low-SES adolescents ranged from 0.67 in the least unequal to 1.59 in the most unequal countries. Conclusions Our findings suggest that high income inequality might contribute to school bullying among adolescents in PCCE, particularly those from high-SES families. The necessary political and economic interventions should focus on improving the country socioeconomic environment in PCCE. Moving towards less neoliberal policies and creating a strong welfare state that promotes the population's economic and social well-being and reduces income inequality might be a necessary component of macro-level strategies aimed at preventing bullying among adolescents. Targeted public health interventions might be required for high-SES adolescents in countries with wide income inequality.
Collapse
Affiliation(s)
- Armen Albert Torchyan
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
- Department of Family and Community Medicine, College of Medicine and King Khalid University Hospital, King Saud University, P.O. Box, 7805, Riyadh 11472, Saudi Arabia
| | - Inge Houkes
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Hans Bosma
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| |
Collapse
|
6
|
Ren Z, Bosma H, Wesselius A, Eussen SJ, Kooi ME, van der Kallen CJ, Koster A, van Greevenbroek MM, Dagnelie P, Stehouwer CD, Brouwers MC. Traditional lifestyle factors partly mediate the association of socioeconomic position with intrahepatic lipid content: The Maastricht study. JHEP Rep 2023; 5:100855. [PMID: 37771365 PMCID: PMC10522893 DOI: 10.1016/j.jhepr.2023.100855] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/02/2023] [Accepted: 07/07/2023] [Indexed: 09/30/2023] Open
Abstract
Background & Aims Recent studies have unveiled an association between socioeconomic position (SEP) and intrahepatic lipid (IHL) content. The aim of this study was to examine to what extent traditional lifestyle factors mediate the relationship between SEP and IHL content, independent of aetiology, and non-alcoholic fatty liver disease (NAFLD). Methods We used cross-sectional data derived from The Maastricht Study (N = 4,001; mean age: 60 years, 49% women, 32% low education level, 21% diabetes, 21% NAFLD). Education, income, and occupation were used as indicators of SEP. Physical activity (accelerometer), intake of total energy, alcohol, saturated fat, protein, vitamin E, dietary fibre, and fructose from sugar-sweetened beverages (SSBs) and fruit juice (food frequency questionnaires) were potential mediators. IHL content was quantified by magnetic resonance imaging. Age, sex, and type 2 diabetes were covariates. Multiple parallel mediation analyses (bootstraps = 10,000) were performed. Results Individuals with a low education level had a 1.056-fold higher IHL content (95% CI: 1.03-1.08) and a 44% greater NAFLD risk (OR:1.44; 95% CI:1.18-1.77) compared with those with higher education levels. Approximately 8.9% of educational disparity in risk of IHL content was attributable to moderate-to-vigorous physical activity; 6.3% to fructose intake from SSBs; 5.5% to dietary fibre; and -23% to alcohol. Approximately 8.7% of educational disparity in risk of NAFLD was attributable to moderate-to-vigorous physical activity; and 7.7% to fructose intake from SSBs. However, the indirect effect of these mediators was small (0.998 for IHL content and 1.045 for NAFLD) in comparison to the total effect. Similar results were found when income and occupation were used as SEP indicators. Conclusions Societal measures may alleviate the burden of NAFLD and further studies that identify mediators other than traditional lifestyle factors are warranted to define the relationship underlying SEP and IHL content. Impact and implications Individuals with a low or medium level of education, income, or occupational status had more fat accumulation in their livers than individuals with a higher education, income, or occupational status. This difference may be attributed to the influence of unhealthy lifestyle factors, such as reduced physical activity and a higher intake of sugar-sweetened beverages among individuals with lower socioeconomic position. Nevertheless, other yet unknown factors may also play a role.
Collapse
Affiliation(s)
- Zhewen Ren
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- Laboratory for Metabolism and Vascular Medicine, Maastricht University, Maastricht, The Netherlands
| | - Hans Bosma
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Anke Wesselius
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism Maastricht University, Maastricht, The Netherlands
| | - Simone J.P.M. Eussen
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism Maastricht University, Maastricht, The Netherlands
| | - M. Eline Kooi
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Carla J.H. van der Kallen
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Annemarie Koster
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Marleen M.J. van Greevenbroek
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- Laboratory for Metabolism and Vascular Medicine, Maastricht University, Maastricht, The Netherlands
| | - Pieter Dagnelie
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Coen D.A. Stehouwer
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Martijn C.G.J. Brouwers
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
7
|
Chan JA, Bosma H, Drosinou C, Timmermans EJ, Savelberg H, Schaper N, Schram MT, Stehouwer CDA, Lakerveld J, Koster A. Association of perceived and objective neighborhood walkability with accelerometer-measured physical activity and sedentary time in the Maastricht Study. Scand J Med Sci Sports 2023; 33:2313-2322. [PMID: 37489093 DOI: 10.1111/sms.14455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND We investigated the association of neighborhood walkability with accelerometer-measured physical activity (PA) and sedentary behavior (SB) and examined whether objective and subjective measures of walkability resulted in similar findings. METHODS PA and SB from the first 7689 Maastricht Study participants ages 40-75 from 2010 to 2017 were measured using accelerometers for 7 days. Mean daily step count, light-intensity PA, moderate- to vigorous- intensity PA (MVPA), and SB were calculated. Objective walkability was measured by the 7-component Dutch Walkability Index within 500 m Euclidean buffers around residential addresses of participants. Subjective walkability was obtained from the Abbreviated Neighborhood Environment Walkability Scale. Linear regression models analyzed the associations of walkability with PA and SB, controlling for potential confounders. RESULTS Objective walkability was negatively associated with light intensity PA in the most walkable quartile (b = -14.58, 95% CI = -20.94, -8.23). Compared to participants living in the least walkable neighborhoods, those in the most walkable quartile had statistically significantly higher SB levels (b = 11.64, 95% CI = 4.95, 18.32). For subjective walkability, mean daily step count was significantly higher in the most walkable quartile (b = 509.60, 95% CI = 243.38, 775.81). Higher subjective walkability was positively associated with MVPA (b = 4.40, 95% CI = 2.56, 6.23). CONCLUSION Living in a neighborhood with higher objective walkability was associated with lower levels of PA and higher SB levels while higher subjective walkability was associated with higher levels of PA. These results show discordant findings and thus, the effect of walkability on participant PA and SB within our sample is to be determined.
Collapse
Grants
- Cardiovascular Center (CVC, Maastricht, the Netherlands)
- Cardiovascular Research Institute Maastricht (CARIM, Maastricht, the Netherlands)
- Dutch Ministry of Economic Affairs (grant 31O.041)
- European Regional Development Fund
- Health Foundation Limburg (Maastricht, the Netherlands)
- Janssen-Cilag B.V. (Tilburg, the Netherlands)
- Novo Nordisk Farma B.V. (Alphen aan den Rijn, the Netherlands)
- Pearl String Initiative Diabetes (Amsterdam, the Netherlands)
- Province of Limburg
- Sanofi-Aventis Netherlands, B.V. (Gouda, the Netherlands)
- School for Nutrition, Toxicology and Metabolism (NUTRIM, Maastricht, the Netherlands)
- School for Public Health and Primary Care (CAPHRI, Maastricht, the Netherlands)
- Stichting Annadal (Maastricht, the Netherlands)
- Stichting De Weijerhorst (Maastricht, the Netherlands)
Collapse
Affiliation(s)
- Jeffrey Alexander Chan
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
- Department of Physical Medicine and Rehabilitation, Northern California VA Healthcare System, Martinez, California, USA
| | - Hans Bosma
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
| | - Connie Drosinou
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
| | - Erik J Timmermans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Hans Savelberg
- School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Nicolaas Schaper
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University, Maastricht, The Netherlands
| | - Miranda T Schram
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University, Maastricht, The Netherlands
- Heart and Vascular Centre, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Coen D A Stehouwer
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University, Maastricht, The Netherlands
| | - Jeroen Lakerveld
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Annemarie Koster
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
8
|
Heger I, van Boxtel M, Deckers K, Bosma H, Verhey F, Köhler S. Socioeconomic position, modifiable dementia risk and cognitive decline: results of 12-year Maastricht Aging Study. Int Psychogeriatr 2023:1-13. [PMID: 37905417 DOI: 10.1017/s1041610223000819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
OBJECTIVES This study investigated whether the association between modifiable dementia risk and rate of cognitive decline differs across socioeconomic status (SES) strata. DESIGN, SETTING AND PARTICIPANTS Data were used from Maastricht Aging Study, a prospective cohort study with a 12-year follow-up. The baseline sample consisted of 1023 adults over 40 years old. MEASUREMENTS The "LIfestyle for BRAin health" (LIBRA) index was used to assess modifiable dementia risk. Cognitive performance was assessed at baseline, 6 and 12 years, and measured in the domains of information processing speed, executive functioning and verbal memory function. An SES score was calculated from equivalent income and educational level (tertiles). Linear mixed models were used to study the association between LIBRA, SES and their interaction on the rate of cognitive decline. RESULTS Participants in the lowest SES tertile displayed more decline in information processing speed (vs. middle SES: X2 = 7.08, P = 0.029; vs. high SES: X2 = 9.49, P = 0.009) and verbal memory (vs. middle SES: X2 = 9.28, P < 0.001; vs. high SES: X2 = 16.68, P < 0.001) over 6 years compared to their middle- and high-SES counterparts. Higher (unhealthier) LIBRA scores were associated with more decline in information processing speed (X2 = 12.66, P = 0.002) over 12 years and verbal memory (X2 = 4.63, P = 0.032) over 6 years. No consistent effect modification by SES on the association between LIBRA and cognition was found. CONCLUSIONS Results suggest that lifestyle is an important determinant of cognitive decline across SES groups. Yet, people with low SES had a more unfavorable modifiable risk score suggesting more potential for lifestyle-based interventions.
Collapse
Affiliation(s)
- Irene Heger
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Martin van Boxtel
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Kay Deckers
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Hans Bosma
- Care and Public Health Research Institute (CAPHRI), Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Frans Verhey
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Sebastian Köhler
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
9
|
Albers JD, Meertens RM, Savelberg HHCM, Köhler S, Wesselius A, Schram MT, Stehouwer CDA, de Galan BE, van Greevenbroek MMJ, van der Kallen CJH, Eussen SJPM, Bosma H, Schaper NC, Koster A. Both short and long sleep durations are associated with type 2 diabetes, independent from traditional lifestyle risk factors-The Maastricht Study. Sleep Health 2023; 9:733-741. [PMID: 37573207 DOI: 10.1016/j.sleh.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 05/17/2023] [Accepted: 06/27/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVES This study examined the cross-sectional association between sleep duration, prediabetes, and type 2 diabetes, and its independence from the traditional lifestyle risk factors diet, physical activity, smoking behavior, and alcohol consumption. METHODS Cross-sectional data from 5561 people aged 40-75 years recruited into The Maastricht Study between 2010 and 2018 were used (1:1 female:male and mean age: 60.1 years [standard deviation: 8.6]). Sleep duration was operationalized as in-bed time, algorithmically derived from activPAL3 accelerometer data (median 7 nights, IQR 1). Glucose metabolism status was determined with an oral glucose tolerance test. Multinomial logistic regression was used to assess the association of sleep duration as restricted cubic spline with prediabetes and type 2 diabetes. We adjusted for sex, age, educational level, the use of sleep medication or antidepressants, and the following lifestyle risk factors: diet quality, physical activity, smoking behavior, and alcohol consumption. RESULTS A U-shaped association between sleep duration and type 2 diabetes was found. Compared to those with a sleep duration of 8 hours, participants with a sleep duration of 5 and 12 hours had higher odds of type 2 diabetes (OR: 2.9 [95% CI 1.9 to 4.4] and OR 3.2 [2.0 to 5.2], respectively). This association remained after further adjustment for the lifestyle risk factors (OR: 2.6 [1.7 to 4.1] and OR 1.8 [1.1 to 3.1]). No such association was observed between sleep duration and prediabetes. CONCLUSIONS Both short and long sleep durations are associated positively and independently of lifestyle and cardiovascular risk factors with type 2 diabetes, but not with prediabetes.
Collapse
Affiliation(s)
- Jeroen D Albers
- Department of Social Medicine, Maastricht University, Maastricht, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands.
| | - Ree M Meertens
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands; School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands; Department of Health Promotion, Maastricht University, Maastricht, the Netherlands
| | - Hans H C M Savelberg
- School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands; Department of Human Movement Sciences, Maastricht University, Maastricht, the Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands
| | - Anke Wesselius
- School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands; Department of Genetics & Cell Biology, Complex Genetics, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Miranda T Schram
- School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands; Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands; Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - Bastiaan E de Galan
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands; Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marleen M J van Greevenbroek
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - Carla J H van der Kallen
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - Simone J P M Eussen
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands; Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
| | - Hans Bosma
- Department of Social Medicine, Maastricht University, Maastricht, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Nicolaas C Schaper
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands; Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - Annemarie Koster
- Department of Social Medicine, Maastricht University, Maastricht, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| |
Collapse
|
10
|
Sezer B, Koster A, Albers J, Meisters R, Schram M, Eussen S, Dukers N, de Rijk A, Stehouwer C, Bosma H. Socioeconomic Position and Type 2 Diabetes: The Mediating Role of Psychosocial Work Environment- the Maastricht Study. Int J Public Health 2023; 68:1606036. [PMID: 37744416 PMCID: PMC10511755 DOI: 10.3389/ijph.2023.1606036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/28/2023] [Indexed: 09/26/2023] Open
Abstract
Objective: We examined the association between low socioeconomic position (SEP) and Type 2 Diabetes Mellitus (T2DM), and the mediating role of psychosocial work environment by using counterfactual mediation analysis. Methods: Data from 8,090 participants of The Maastricht Study were analysed. SEP indicators (education, income, occupation), self-reported psychosocial work stressors, (pre)diabetes by oral glucose tolerance test were measured at baseline. Incident T2DM was self-reported per annum up to 9 years. Cox regression and causal mediation analyses were performed. Results: 2.8% (N = 172) of the participants without T2DM at baseline reported incident T2DM. People with lower SEP more often had prevalent T2DM (e.g., education OR = 2.49, 95% CI: 2.16-2.87) and incident T2DM (e.g., education HR = 2.21, 95% CI: 1.53-3.20) than higher SEP. Low job control was associated with prevalent T2DM (OR = 1.44 95% CI: 1.25-1.67). Job control partially explained the association between income and prevalent T2DM (7.23%). Job demand suppressed the associations of education and occupation with prevalent T2DM. The mediation models with incident T2DM and social support were not significant. Conclusion: Socioeconomic inequalities in T2DM were present, but only a small part of it was explained by the psychosocial work environment.
Collapse
Affiliation(s)
- Bengisu Sezer
- Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- Institute of Care and Public Health Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Annemarie Koster
- Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- Institute of Care and Public Health Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Jeroen Albers
- Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- Institute of Care and Public Health Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Rachelle Meisters
- Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- Institute of Care and Public Health Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Miranda Schram
- Department of Internal Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- Heart and Vascular Center, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Simone Eussen
- Institute of Care and Public Health Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- Department of Epidemiology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Nicole Dukers
- Institute of Care and Public Health Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- South Limburg Medical Health Service (GGD South Limburg), Heerlen, Netherlands
| | - Angelique de Rijk
- Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- Institute of Care and Public Health Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Coen Stehouwer
- Department of Internal Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Hans Bosma
- Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- Institute of Care and Public Health Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| |
Collapse
|
11
|
Chan JA, Koster A, Eussen SJPM, Pinho MGM, Lakerveld J, Stehouwer CDA, Dagnelie PC, van der Kallen CJ, van Greevenbroek MMJ, Wesselius A, Bosma H. The association between the food environment and adherence to healthy diet quality: the Maastricht Study. Public Health Nutr 2023; 26:1775-1783. [PMID: 37340803 PMCID: PMC10478064 DOI: 10.1017/s1368980023001180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/19/2023] [Accepted: 06/05/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVE The purpose of this study is to determine if healthier neighbourhood food environments are associated with healthier diet quality. DESIGN This was a cross-sectional study using linear regression models to analyse data from the Maastricht Study. Diet quality was assessed using data collected with a FFQ to calculate the Dutch Healthy Diet (DHD). A buffer zone encompassing a 1000 m radius was created around each participant home address. The Food Environment Healthiness Index (FEHI) was calculated using a Kernel density analysis within the buffers of available food outlets. The association between the FEHI and the DHD score was analysed and adjusted for socio-economic variables. SETTING The region of Maastricht including the surrounding food retailers in the Netherlands. PARTICIPANTS 7367 subjects aged 40-75 years in the south of the Netherlands. RESULTS No relationship was identified between either the FEHI (B = 0·62; 95 % CI = -2·54, 3·78) or individual food outlets, such as fast food (B = -0·07; 95 % CI = -0·20, 0·07) and diet quality. Similar null findings using the FEHI were identified at the 500 m (B = 0·95; 95 % CI = -0·85, 2·75) and 1500 m (B = 1·57; 95 % CI = -3·30, 6·44) buffer. There was also no association between the food environment and individual items of the DHD including fruits, vegetables and sugar-sweetened beverages. CONCLUSION The food environment in the Maastricht area appeared marginally unhealthy, but the differences in the food environment were not related to the quality of food that participants reported as intake.
Collapse
Affiliation(s)
- Jeffrey Alexander Chan
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
- Department of Physical Medicine and Rehabilitation, Northern California VA Healthcare System, Martinez, CA, USA
| | - Annemarie Koster
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
| | - Simone JPM Eussen
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Maria Gabriela M Pinho
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jeroen Lakerveld
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Coen DA Stehouwer
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University, Maastricht, The Netherlands
| | - Pieter C Dagnelie
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University, Maastricht, The Netherlands
| | - Carla J van der Kallen
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University, Maastricht, The Netherlands
| | - Marleen MJ van Greevenbroek
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University, Maastricht, The Netherlands
| | - Anke Wesselius
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
- School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Hans Bosma
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
12
|
Meisters R, Putrik P, Westra D, Bosma H, Ruwaard D, Jansen M. Two sides of the same coin? Absolute income and perceived income inadequacy as social determinants of health. Int J Equity Health 2023; 22:128. [PMID: 37408001 DOI: 10.1186/s12939-023-01945-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 06/27/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Absolute income is commonly used in studies of health inequalities, however it does not reflect spending patterns, debts, or expectations. These aspects are reflected in measures concerning perceived income inadequacy. While health inequities by absolute income or perceived income inadequacy are well established, few studies have explored the interplay of absolute income and perceived income inadequacy in relation to health. METHODS Multiple data sources were linked into a nationally representative dataset (n = 445,748) of Dutch adults (18 +). The association between absolute income, perceived income inadequacy and health (self-reported health, chronic disease and psychological distress) was tested using logistic and Poisson regressions, controlling for various potential confounders (demographics, education) and mastery. Interactions were tested to check the association between perceived income inadequacy and health for different absolute income groups. RESULTS Perceived income inadequacy was reported at every absolute income group (with 42% of individuals in the lowest income group and 5% of individuals in the highest income group). Both absolute income and perceived income inadequacy were independently associated with health. The adjusted relative risk (RR) for lowest absolute income group is 1.11 (1.08-1.1.14) and 1.28 (1.24-1.32) for chronic disease and self-reported health respectively, and the Odds Ratio (OR) for psychological distress is 1.28 (1.16-1.42). For perceived income inadequacy the RR's were 1.41 (1.37-1.46) and 1.49 (1.44-1.54) and the OR for psychological distress is 3.14 (2.81-3.51). Mastery appeared to be an important mediator for the relationship between perceived income inadequacy, poor self-rated health and psychological distress. CONCLUSIONS Absolute income and perceived income inadequacy reflect conceptually different aspects of income and are independently associated with health outcomes. Perceived income inadequacy may be accounted for in health inequality studies, alongside measures of absolute income. In policy-making, targeting perceived income inadequacy might have potential to reduce health inequalities.
Collapse
Affiliation(s)
- Rachelle Meisters
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, the Netherlands.
| | - Polina Putrik
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, the Netherlands
- GGD Zuid Limburg, Academic Collaborative Centre for Public Health Limburg, Heerlen, the Netherlands
| | - Daan Westra
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, the Netherlands
| | - Hans Bosma
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, the Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, the Netherlands
| | - Maria Jansen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, the Netherlands
- GGD Zuid Limburg, Academic Collaborative Centre for Public Health Limburg, Heerlen, the Netherlands
| |
Collapse
|
13
|
Torchyan AA, Houkes I, Bosma H. Income Inequality and Socioeconomic Disparities in Alcohol Use Among Eastern European Adolescents: A Multilevel Analysis. J Adolesc Health 2023:S1054-139X(23)00167-2. [PMID: 37125987 DOI: 10.1016/j.jadohealth.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/23/2023] [Accepted: 03/01/2023] [Indexed: 05/02/2023]
Abstract
PURPOSE In this study, we tested the "golden youth" hypothesis, which suggests that in Eastern Europe, affluent adolescents are at an increased risk of alcohol use. Also, we hypothesized that the relationship between high socioeconomic position (SEP) and more alcohol use is stronger in countries with wider income inequality. METHODS In total, 50,421 adolescents aged 13-15 years were included from 16 Eastern European countries participating in the 2013-2014 Health Behaviour in School-aged Children survey. Multilevel logistic regression analyses were performed. RESULTS Affluent adolescents had greater odds of weekly alcohol use (OR = 1.32, 95% CI = 1.23-1.41) and binge drinking (OR = 1.24, 95% CI = 1.16-1.32) than their peers from low-SEP families. However, no significant difference was observed between middle- and low-SEP adolescents. In countries with wider income inequality, the relationship between high family-SEP and weekly alcohol use (p interaction = .006), as well as high family-SEP and binge drinking (p interaction = .007), was stronger compared to countries with lower income inequality. DISCUSSION Possibly, influenced by the lifestyle choices of their parents, and using alcohol as a status symbol to establish and maintain friendly relationships with peers, Eastern European adolescents from affluent families, particularly in the most unequal settings, are at increased risk of alcohol use, confirming the golden youth hypothesis. Insecure self-image and perceived threat to their high status might be explanatory factors. More research is needed to identify the precise individual and family characteristics responsible for increased alcohol use among wealthy adolescents, especially in Eastern European countries with high income inequality.
Collapse
Affiliation(s)
- Armen Albert Torchyan
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maryland, Maastricht, the Netherlands; Department of Family and Community Medicine, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.
| | - Inge Houkes
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maryland, Maastricht, the Netherlands
| | - Hans Bosma
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maryland, Maastricht, the Netherlands
| |
Collapse
|
14
|
Dzakpasu FQS, Koster A, Owen N, Galan BED, Carver A, Brakenridge CJ, Boonen A, Bosma H, Dagnelie PC, Eussen SJPM, Sethi P, Stehouwer CDA, Schaper NC, Dunstan DW. Device-measured sitting time and musculoskeletal pain in adults with normal glucose metabolism, prediabetes and type 2 diabetes-The Maastricht Study. PLoS One 2023; 18:e0285276. [PMID: 37141228 PMCID: PMC10159126 DOI: 10.1371/journal.pone.0285276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 04/18/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Detrimental associations of sedentary behaviour (time spent sitting) with musculoskeletal pain (MSP) conditions have been observed. However, findings on those with, or at risk of, type 2 diabetes (T2D) have not been reported. We examined the linear and non-linear associations of device-measured daily sitting time with MSP outcomes according to glucose metabolism status (GMS). METHODS Cross-sectional data from 2827 participants aged 40-75 years in the Maastricht Study (1728 with normal glucose metabolism (NGM); 441 with prediabetes; 658 with T2D), for whom valid data were available on activPAL-derived daily sitting time, MSP [neck, shoulder, low back, and knee pain], and GMS. Associations were examined by logistic regression analyses, adjusted serially for relevant confounders, including moderate-to-vigorous intensity physical activity (MVPA) and body mass index (BMI). Restricted cubic splines were used to further examine non-linear relationships. RESULTS The fully adjusted model (including BMI, MVPA, and history of cardiovascular disease) showed daily sitting time to be significantly associated with knee pain in the overall sample (OR = 1.07, 95%CI: 1.01-1.12) and in those with T2D (OR = 1.11, 95%CI: 1.00-1.22); this was not statistically significant in those with prediabetes (OR = 1.04, 95%CI: 0.91-1.18) or NGM (OR = 1.05, 95%CI: 0.98-1.13). There were no statistically significant associations between daily sitting time and neck, shoulder, or low back pain in any of the models. Furthermore, the non-linear relationships were statistically non-significant. CONCLUSION Among middle-aged and older adults with T2D, daily sitting time was significantly associated with higher odds of knee pain, but not with neck, shoulder, or low back pain. No significant association was observed in those without T2D for neck, shoulder, low back, or knee pain. Future studies, preferably those utilising prospective designs, could examine additional attributes of daily sitting (e.g., sitting bouts and domain-specific sitting time) and the potential relationships of knee pain with mobility limitations.
Collapse
Affiliation(s)
- Francis Q S Dzakpasu
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
- Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Annemarie Koster
- Department of Social Medicine, Maastricht University, Maastricht, the Netherlands
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Neville Owen
- Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Centre for Urban Transitions, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Bastiaan E de Galan
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Alison Carver
- National Centre for Healthy Ageing, Peninsula Clinical School, Monash University, Frankston, Victoria, Australia
| | - Christian J Brakenridge
- Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Active Life Lab, South-Eastern Finland University of Applied Sciences, Mikkeli, Finland
| | - Annelies Boonen
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Hans Bosma
- Department of Social Medicine, Maastricht University, Maastricht, the Netherlands
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Pieter C Dagnelie
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Simone J P M Eussen
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
- Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
| | - Parneet Sethi
- Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Coen D A Stehouwer
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Nicolaas C Schaper
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - David W Dunstan
- Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| |
Collapse
|
15
|
Hazelzet E, Houkes I, Bosma H, de Rijk A. How a steeper organisational hierarchy prevents change-adoption and implementation of a sustainable employability intervention for employees in low-skilled jobs: a qualitative study. BMC Public Health 2022; 22:2373. [PMID: 36528559 PMCID: PMC9759045 DOI: 10.1186/s12889-022-14754-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Adoption and implementation are prerequisites for the effectiveness of organisational interventions, but successful implementation is not self-evident. This article provides insights into the implementation of the organisational intervention 'Healthy Human Resources' (HHR). HHR is developed with Intervention Mapping and aims at improving sustainable employability (SE) of employees in low-skilled jobs. METHODS Qualitative data on adoption and implementation were collected by interviews with three employees and seven middle managers in five Dutch organisations and by extensive notes of observations and conversations in a logbook. Data triangulation was applied and all data were transcribed and analysed thematically using the qualitative analysis guide of Leuven (QUAGOL). RESULTS All organisations adopted HHR, but three failed during the transition from adoption to implementation, and two implemented HHR only partially. The steepness of the organisational hierarchy emerged as an overarching barrier: steeper hierarchical organisations faced more difficulties with implementing HHR than flatter ones. This was reflected in middle managers' lack of decision-making authority and being overruled by senior management. Middle managers felt incapable of remedying the lack of employees' voice. Subsequently, 'us-versus-them' thinking patterns emerged. These power imbalances and 'us-versus-them' thinking reinforced each other, further strengthening the hierarchical steepness. Both processes could be the result of wider socio-political forces. CONCLUSIONS This study improved the understanding of the difficulties to adopt and implement such organisational intervention to contribute to the sustainable employability of employees in low-skilled jobs. Practical implications are given for future implementation of organisational interventions.
Collapse
Affiliation(s)
- Emmelie Hazelzet
- grid.5012.60000 0001 0481 6099Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Inge Houkes
- grid.5012.60000 0001 0481 6099Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Hans Bosma
- grid.5012.60000 0001 0481 6099Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Angelique de Rijk
- grid.5012.60000 0001 0481 6099Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, 6200 MD Maastricht, The Netherlands
| |
Collapse
|
16
|
Toczek L, Bosma H, Peter R. Early retirement intentions: the impact of employment biographies, work stress and health among a baby-boomer generation. Eur J Ageing 2022; 19:1479-1491. [PMID: 36692777 PMCID: PMC9729676 DOI: 10.1007/s10433-022-00731-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2022] [Indexed: 01/26/2023] Open
Abstract
In recent years, early retirement decisions have become more frequent in the European Union despite political efforts to prevent early retirement. This is a growing problem for the social security system. The study focuses on a life course approach using employment biographies and investigates the influence of work stress and health on early retirement intentions. Data of employees who were born in either 1959 or 1965 of the German cohort study on work, age, health and work participation are analysed (n = 3338). By linking survey and register data from 1993 to 2011, a sequence analysis is conducted to identify employment biographies. To analyse the relationship between the employment biographies and intended early retirement, a longitudinal path analysis is computed and includes work stress, measured through effort-reward imbalance, and self-rated health. The statistical analyses identify three adverse employment biographies, i.e. part-time work, episodes of unemployment or marginal employment. In addition, two favourable employment biographies are determined, characterised by full-time work and few episodes of unemployment. The results of the path analysis show that employment biographies with high work-related stress have early retirement intentions. Among adverse employment biographies, indirect effects of poor health on the association between work stress and early retirement intentions are found. Unexpectedly, among full-time workers, work stress is also associated with early retirement intentions with an additional mediation through health. The findings of this study highlight the importance of the life course perspective when analysing retirement decisions. In addition to health-promoting interventions in the labour market, effects of psychosocial factors should be focussed on in order to reduce early exits from the labour market. Supplementary Information The online version contains supplementary material available at 10.1007/s10433-022-00731-0.
Collapse
Affiliation(s)
- Lisa Toczek
- Department of Medical Sociology, Institute of the History, Philosophy and Ethics of Medicine, Faculty of Medicine, Ulm University, Parkstrasse 11, 89073 Ulm, Germany
| | - Hans Bosma
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Richard Peter
- Department of Medical Sociology, Institute of the History, Philosophy and Ethics of Medicine, Faculty of Medicine, Ulm University, Parkstrasse 11, 89073 Ulm, Germany
| |
Collapse
|
17
|
Meisters R, Westra D, Putrik P, Bosma H, Ruwaard D, Jansen M. Regional differences in healthcare costs further explained: The contribution of health, lifestyle, loneliness and mastery. TSG Tijdschr Gezondheidswet 2022; 100:189-196. [PMCID: PMC9628485 DOI: 10.1007/s12508-022-00369-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/27/2022] [Indexed: 11/07/2022]
Abstract
Healthcare costs in the Netherlands are rising and vary considerably among regions. Explaining regional differences in healthcare costs can help policymakers in targeting appropriate interventions in order to restrain costs. Factors usually taken into account when analyzing regional differences in healthcare costs are demographic structure and socioeconomic status (SES). However, health, lifestyle, loneliness and mastery have also been linked to healthcare costs. Therefore, this study analyzes the contribution of health, lifestyle factors (BMI, alcohol consumption, smoking and physical activity), loneliness, and mastery to regional differences in healthcare costs. Analyses are performed in a linked dataset (n = 334,721) from the Dutch Public Health Services, Statistics Netherlands, the National Institute for Public Health and the Environment (year 2016), and the healthcare claims database Vektis (year 2017) with Poisson and zero-inflated binomial regressions. Regional differences in general practitioner consult costs remain significant even after taking into account health, lifestyle, loneliness, and mastery. Regional differences in costs for mental, pharmaceutical, and specialized care are less pronounced and can be explained to a large extent. For total healthcare costs, regional differences are mostly explained through the factors included in this study. Hence, addressing lifestyle factors, loneliness and mastery can help policymakers in restraining healthcare costs. In this study, the region of Zuid-Limburg represents the reference region. Use compare regions for health and healthcare costs (Regiovergelijker gezondheid en zorgkosten) in order to select all other Dutch regions as reference region.
Collapse
Affiliation(s)
- Rachelle Meisters
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| | - Daan Westra
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| | - Polina Putrik
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
- Academische Werkplaats voor Publieke Gezondheid Limburg, GGD Zuid Limburg, Heerlen, The Netherlands
| | - Hans Bosma
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| | - Maria Jansen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
- Academische Werkplaats voor Publieke Gezondheid Limburg, GGD Zuid Limburg, Heerlen, The Netherlands
| |
Collapse
|
18
|
Clemmensen KKB, Koster A, Nielen YTH, Dagnelie PC, Stehouwer CDA, Bosma H, Wesselius A, Færch K, Eussen SJPM. Role of Weekday Variation on Glucose, Insulin, and Triglyceride: A Cross-Sectional Analysis From the Maastricht Study. J Clin Endocrinol Metab 2022; 107:e3145-e3151. [PMID: 35575196 PMCID: PMC9797041 DOI: 10.1210/clinem/dgac286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Indexed: 01/05/2023]
Abstract
CONTEXT The timing of sleep, physical activity, and dietary intake show variation over the week, with different timings in the weekend compared to the weekdays, which may potentially lead to impaired glucose and lipid regulation on Mondays compared to other weekdays. OBJECTIVE The aim of the study was to investigate differences in glucose metabolism and fasting triglyceride concentrations on Mondays compared to the rest of the week. DESIGN, SETTING AND PARTICIPANTS This cross-sectional study is based on data from the Maastricht Study, including 6067 participants without known diabetes and 1568 previously diagnosed with type 2 diabetes. MAIN OUTCOME MEASURES Confounder-adjusted linear regression analysis was applied to study the associations of day of the week of examination with glucose and insulin responses to an oral glucose tolerance test and fasting triglyceride concentrations. RESULTS In fully confounder-adjusted models, mean (95% CI) concentrations of fasting glucose, insulin, and triglycerides were slightly higher on Mondays compared with the other weekdays [glucose: 1% (0-2); insulin: 9% (1-18); triglycerides: 5% (2-8)]. Interaction analyses revealed that the association of weekday with insulin was only pronounced in men [18% (3-35)], but not in women [1% (-8-10)], whereas the associations with glucose and triglycerides were only apparent for individuals with known type 2 diabetes [glucose: 4% (0-7); triglycerides: 14% (6-23)] compared to the background population [glucose: 0% (0-1); triglycerides: 3% (0-6)]. DISCUSSION Being examined on a Monday was associated with higher fasting insulin concentrations among men but not women.
Collapse
Affiliation(s)
| | - Annemarie Koster
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
- School for Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Yannick T H Nielen
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Pieter C Dagnelie
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Coen D A Stehouwer
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Hans Bosma
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
- School for Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Anke Wesselius
- Department of Complex Genetics and Epidemiology, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Kristine Færch
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Simone J P M Eussen
- Correspondence: Simone JPM Eussen, PhD, Department of Epidemiology, School for Cardiovascular Diseases (CARIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands. E-mail:
| |
Collapse
|
19
|
Torchyan AA, Bosma H, Houkes I. The role of poor mental health in substance use across socioeconomic strata of Armenian adolescents: a counterfactual mediation analysis. Journal of Substance Use 2022. [DOI: 10.1080/14659891.2022.2084787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Armen Albert Torchyan
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Family and Community Medicine, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Hans Bosma
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Inge Houkes
- Department of Family and Community Medicine, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
20
|
Torchyan AA, Bosma H, Houkes I. Pathways to socioeconomic health differences in Armenian adolescents: The role of bullying perpetration. PLoS One 2022; 17:e0269451. [PMID: 35657823 PMCID: PMC9165766 DOI: 10.1371/journal.pone.0269451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 05/20/2022] [Indexed: 11/19/2022] Open
Abstract
Bullying perpetration might be an alternative way of hierarchy formation among adolescents. It can potentially compensate for the negative health influences of low socioeconomic status (SES), rewarding this unwanted behavior. This study aimed to investigate the role of bullying perpetration in the relationship between SES and health among Armenian adolescents. A nationally representative sample of 3679 adolescents aged 11–15 years (mean = 13.1, standard deviation = 1.6) participated in the Health Behavior in School-aged Children 2013/14 survey in Armenia. Complex samples multiple logistic regression were used to estimate the associations between two SES measures (family socioeconomic position [SEP] and material well-being) and three health outcomes (perceived health status, psychosocial well-being, and psychosomatic symptoms). Bullying perpetration was not associated with less than good health or low psychosocial well-being (P > 0.05) but increased the odds of reporting high psychosomatic symptoms (P < 0.05). Perpetration did not change the SES-health gradient substantially. However, in stratified analyses, socioeconomic inequalities in health were consistently weaker among perpetrators. The largest observed difference was in the relationship between low family SEP and less than good health (OR = 3.60, 95% CI = 2.77–4.67 vs. OR = 1.80, 95% CI = 1.06–3.04), whereas the smallest difference was in the relationship between low family SEP and high psychosomatic symptoms (OR = 1.27, 95% CI = 1.03–1.56 vs. OR = 1.04, 95% CI = 0.61–1.77). Our findings suggest that bullying perpetration, as an alternative hierarchy, may be looked at as a compensatory but vicious strategy in the face of the negative health influences of low SES in Armenian adolescents. For high-SES adolescents, on the other hand, social, emotional, or psychological problems might contribute to bullying perpetration. Consequently, bullying prevention activities in Armenia should focus on both low and high-SES adolescents, considering SES-specific pathways and mechanisms.
Collapse
Affiliation(s)
- Armen A. Torchyan
- Department of Family and Community Medicine, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
- Faculty of Health, Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- * E-mail:
| | - Hans Bosma
- Faculty of Health, Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Inge Houkes
- Faculty of Health, Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
21
|
Sabahelzain MM, Moukhyer M, van den Borne B, Bosma H. Vaccine Hesitancy among Parents and Its Association with the Uptake of Measles Vaccine in Urban Settings in Khartoum State, Sudan. Vaccines (Basel) 2022; 10:vaccines10020205. [PMID: 35214664 PMCID: PMC8875338 DOI: 10.3390/vaccines10020205] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/20/2022] [Accepted: 01/26/2022] [Indexed: 12/10/2022] Open
Abstract
Vaccine uptake is one of the indicators that has been used to guide immunization programs. This study aimed to evaluate whether measles vaccine uptake is predicted by measles vaccine hesitancy. A community-based cross-sectional study was conducted in urban districts in Khartoum state in February 2019. Measles vaccine uptake among children was measured as either fully vaccinated or partially/not vaccinated. The Parent Attitudes about Childhood Vaccines (PACV) scale was used to measure measles vaccine hesitancy. Multivariate logistic regression was run to identify the predictors of measles vaccination uptake, controlling for sociodemographic variables, and the adjusted odds ratios (aORs) with 95% CI were calculated. The receiver operator characteristic (ROC) curve was created, and the area under the curve (AUC) for the PACV was computed. Data were collected from 495 participants. We found that measles vaccine hesitancy (PACV scores) predicts the uptake of measles vaccine after controlling for other potential social confounders, such as the mother’s age and the number of children (aOR 1.055; 95% CI 1.028–1.028). Additionally, the ROC for the PACV yielded an area under the curve (AUC 0.686 (95% CI 0.620–0.751; p < 0.001)). Our findings show that measles vaccine hesitancy in Sudan directly influences the uptake of the measles vaccine. Addressing the determinants of vaccine hesitancy through communication strategies will improve vaccine uptake.
Collapse
Affiliation(s)
- Majdi M. Sabahelzain
- Department of Public Health, School of Health Sciences, Ahfad University for Women, Omdurman P.O. Box 167, Sudan
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands;
- Correspondence:
| | - Mohamed Moukhyer
- Department of Research and Development, Faculty of Applied Medical Sciences, Jazan University, Jizan 45142, Saudi Arabia;
- Department of Emergency Medical Services, Faculty of Applied Medical Sciences, Jazan University, Jizan 45142, Saudi Arabia
- Public Health Programmes, School of Medicine, University of Limerick, V94 PX58 Limerick, Ireland
| | - Bart van den Borne
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands;
| | - Hans Bosma
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands;
| |
Collapse
|
22
|
Toczek L, Bosma H, Peter R. The Gender Pay Gap: Income Inequality Over Life Course - A Multilevel Analysis. Front Sociol 2021; 6:815376. [PMID: 35004942 PMCID: PMC8733696 DOI: 10.3389/fsoc.2021.815376] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/08/2021] [Indexed: 06/14/2023]
Abstract
The gender pay gap has been observed for decades, and still exists. Due to a life course perspective, gender differences in income are analyzed over a period of 24 years. Therefore, this study aims to investigate income trajectories and the differences regarding men and women. Moreover, the study examines how human capital determinants, occupational positions and factors that accumulate disadvantages over time contribute to the explanation of the GPG in Germany. Therefore, this study aims to contribute to a better understanding of the GPG over the life course. The data are based on the German cohort study lidA (living at work), which links survey data individually with employment register data. Based on social security data, the income of men and women over time are analyzed using a multilevel analysis. The results show that the GPG exists in Germany over the life course: men have a higher daily average income per year than women. In addition, the income developments of men rise more sharply than those of women over time. Moreover, even after controlling for factors potentially explaining the GPG like education, work experience, occupational status or unemployment episodes the GPG persists. Concluding, further research is required that covers additional factors like individual behavior or information about the labor market structure for a better understanding of the GPG.
Collapse
Affiliation(s)
- Lisa Toczek
- Department of Medical Sociology, Institute of the History, Philosophy and Ethics of Medicine, Faculty of Medicine, University of Ulm, Ulm, Germany
| | - Hans Bosma
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Richard Peter
- Department of Medical Sociology, Institute of the History, Philosophy and Ethics of Medicine, Faculty of Medicine, University of Ulm, Ulm, Germany
| |
Collapse
|
23
|
Sabahelzain MM, Moukhyer M, Bosma H, van den Borne B. Determinants of Measles Vaccine Hesitancy among Sudanese Parents in Khartoum State, Sudan: A Cross-Sectional Study. Vaccines (Basel) 2021; 10:vaccines10010006. [PMID: 35062667 PMCID: PMC8780692 DOI: 10.3390/vaccines10010006] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/07/2021] [Accepted: 12/20/2021] [Indexed: 11/20/2022] Open
Abstract
Determinants of vaccine hesitancy are not yet well understood. This study aims to assess measles vaccine hesitancy and characterize its determinants among Sudanese parents in Omdurman in Khartoum State. A community-based cross-sectional quantitative study was conducted in Khartoum State in February 2019. The Parent Attitudes about Childhood Vaccination (PACV) was used to measure measles vaccine hesitancy. Questions about the sociodemographic characteristics of the family, the perception of the parents about the measles vaccine, and the parental exposure to information were asked. Proportions of vaccine hesitancy and coefficients of linear regression were computed. Five hundred parents were recruited for the study. We found that a significant proportion of participants (about 1 in 5 parents) had hesitations regarding the measles vaccine. Significant predictors of measles vaccine hesitancy were parental exposure to anti-vaccination information or materials (β = −0.478, p-value < 0.001), the parents’ perception of the effectiveness of measles vaccines (β = 0.093, p-value = 0.020), the age of the mother (β = 0.112, p-value = 0.017), the birth rank of the child (β = −0.116, p-value = 0.015), and the total number of the children in the family (β = 0.098, p-value = 0.013). Vaccination access issues were the common justification for parental vaccination hesitancy. Our findings indicate that investment in vaccine communication as well as addressing access issues might be an effective intervention for improving measles vaccine acceptance and, ultimately, measles vaccine coverage.
Collapse
Affiliation(s)
- Majdi M. Sabahelzain
- Department of Public Health, School of Health Sciences, Ahfad University for Women, Omdurman P.O. Box 167, Sudan
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, 6211 LK Maastricht, The Netherlands;
- Correspondence:
| | - Mohamed Moukhyer
- Education Development and Quality Unit, College of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia;
- Public Health Programmes, School of Medicine, University of Limerick, V94 T9PX Limerick, Ireland
| | - Hans Bosma
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, 6211 LK Maastricht, The Netherlands;
| | - Bart van den Borne
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, 6211 LK Maastricht, The Netherlands;
| |
Collapse
|
24
|
Torchyan A, Bosma H, Houkes I. Socioeconomic inequalities in health among Armenian adolescents: the role of bullying perpetration. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Bullying perpetration might be an alternative way of hierarchy formation among adolescents. It can potentially suppress the socioeconomic inequalities in health or might compensate for the negative health influences of low socioeconomic status (SES), rewarding this unwanted behavior.
Methods
A nationally representative sample of 3679 adolescents aged 11-15 years participated in the Health Behavior in School-aged Children 2013/14 survey in Armenia. Complex samples multiple logistic regression were used to estimate the associations between two SES measures (family socioeconomic position [SEP], material well-being) and three health outcomes (perceived health status, psychosocial well-being, psychosomatic symptoms).
Results
Bullying perpetration was not associated with less than good health or low psychosocial well-being (P > 0.05) but increased the odds of reporting high psychosomatic symptoms (P < 0.05). Perpetration did not change the SES-health gradient substantially. However, in stratified analyses, socioeconomic inequalities in health were consistently weaker among perpetrators. The largest observed difference was in the relationship between low family (SEP) and less than good health (OR = 3.60, 95% CI = 2.77-4.67 vs. OR = 1.80, 95% CI = 1.06 - 3.04), whereas the smallest difference was in the relationship between low family SEP and high psychosomatic symptoms (OR = 1.27, 95% CI = 1.03-1.56 vs. OR = 1.04, 95% CI = 0.61-1.77).
Conclusions
Our findings suggest that bullying perpetration, as an alternative hierarchy, may be looked at as a compensatory but vicious strategy in the face of the negative health influences of low SES in Armenian adolescents. For high-SES adolescents, on the other hand, social, emotional, or psychological problems might contribute to bullying perpetration.
Key messages
Less vicious alternatives to bullying perpetration should be encouraged, especially for Armenian adolescents from low-SES families. Targeted health interventions might be necessary for bulling perpetrators from high-SES families.
Collapse
Affiliation(s)
- A Torchyan
- Department of Family and Community Medicine, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
- Department of Social Medicine, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - H Bosma
- Department of Social Medicine, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - I Houkes
- Department of Social Medicine, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| |
Collapse
|
25
|
Gianfredi V, Beran M, Koster A, Eussen SJ, Odone A, Signorelli C, Schaper NC, Köhler S, Bosma H, Dagnelie PC, Stehouwer CDA, Wesselius A, Amerio A, Brinkhues S, Dukers-Muijrers N, Schram MT. Association between social network characteristics and prevalent and incident depression: The Maastricht Study. J Affect Disord 2021; 293:338-346. [PMID: 34229287 DOI: 10.1016/j.jad.2021.06.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/09/2021] [Accepted: 06/19/2021] [Indexed: 11/30/2022]
Abstract
AIMS Social network characteristics may provide a novel non-pharmaceutical target for the prevention of depression. We investigated the temporal association of a broad range of structural and functional social network characteristics with incident depressive symptoms over 5 years of follow-up. METHODS We used data from The Maastricht Study, a population-based prospective cohort study (n=2,465, mean age 59.8±8.1 years, 49.1% women, 11,585 person-years of follow-up). Social network characteristics were assessed through a name generator questionnaire. Clinically relevant depressive symptoms (9-item Patient Health Questionnaire score≥10) were assessed at baseline and annually. We used multivariable logistic and Cox regression analyses, adjusted for sociodemographic, lifestyle and cardiovascular risk factors. RESULTS In cross-sectional analyses less emotional support for discomfort and with important decisions, and less informational support were associated with prevalent depressive symptoms (OR[95%CI] 1.19 [1.01-1.40]; 1.22 [1.05-1.43], and 1.20 [1.04-1.39], respectively). Every fewer 10% of family members was associated with prevalent depressive symptoms (1.11 [1.01-1.23]). In longitudinal analyses, less emotional support on important decisions was also associated with higher risk of incident depressive symptoms (HR[95%CI] 1.13 [1.03-1.25]). In addition, every fewer 10% of the network that was a family member was associated with a higher hazard of incident depressive symptoms (1.07 [1.01-1.13]). CONCLUSIONS This study shows that less emotional support and fewer family members in the network were associated with higher risk of both prevalent and incident depression. The importance of emotional support and the role that family plays should be considered in treatment and prevention of depression.
Collapse
Affiliation(s)
- Vincenza Gianfredi
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Magdalena Beran
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands; Department of Internal Medicine, Maastricht University, Maastricht, the Netherlands
| | - Annemarie Koster
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands; Department of Social Medicine, Maastricht University, Maastricht, the Netherlands
| | - Simone Jpm Eussen
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands; Department of Epidemiology; Maastricht University, Maastricht, the Netherlands
| | - Anna Odone
- Department Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Carlo Signorelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Nicolaas C Schaper
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands; Department of Internal Medicine, Maastricht University, Maastricht, the Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands; MHeNS School for Mental Health and Neuroscience, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Hans Bosma
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands; Department of Social Medicine, Maastricht University, Maastricht, the Netherlands
| | - Pieter C Dagnelie
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands; Department of Epidemiology; Maastricht University, Maastricht, the Netherlands
| | - Coen DA Stehouwer
- Department of Internal Medicine, Maastricht University, Maastricht, the Netherlands; Department of Social Medicine, Maastricht University, Maastricht, the Netherlands
| | - Anke Wesselius
- NUTRIM School for Nutrition and Translational Research in Metabolism, University of Maastricht, Department of Complex Genetics, Maastricht University, Maastricht, the Netherlands
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Mood Disorders Program, Tufts Medical Center, Boston, MA, USA
| | - Stephanie Brinkhues
- Department of Sexual Health, Infectious Diseases, and Environmental Health, Heerlen, South Limburg Public Health Service, the Netherlands
| | - Nicole Dukers-Muijrers
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands; NUTRIM School for Nutrition and Translational Research in Metabolism, University of Maastricht, Department of Complex Genetics, Maastricht University, Maastricht, the Netherlands; Department of Sexual Health, Infectious Diseases, and Environmental Health, Heerlen, South Limburg Public Health Service, the Netherlands; Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Miranda T Schram
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands; Department of Internal Medicine, Maastricht University, Maastricht, the Netherlands; MHeNS School for Mental Health and Neuroscience, Maastricht University Medical Center+, Maastricht, the Netherlands; Heart and Vascular Center, Maastricht University Medical Center+, Maastricht, the Netherlands.
| |
Collapse
|
26
|
Baumgartner-Dupuits M, Sep SJS, Verbunt J, Bosma H, van Eijk J. Peer Support to Enhance Social and Emotional Self-Management Following Acquired Brain Injury Rehabilitation: Design of a Pre-post Study With Process Evaluation. Front Neurol 2021; 12:647773. [PMID: 34393968 PMCID: PMC8360636 DOI: 10.3389/fneur.2021.647773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 06/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Specialized rehabilitation following acquired brain injury provides intensive multidisciplinary treatment to individuals with complex disabilities for optimizing recovery and supporting a safe transition to the community. Post-specialist rehabilitation, patients and caregivers have reported a need for support. We present the design of an implementation study to evaluate a new self-management support service for individuals with acquired brain injury and their caregivers. Methods: This is a pre–post intervention study with a mixed-method design. The study population comprises individuals aged ≥18 years with acquired brain injury living independently following specialized rehabilitation in the Southern part of the Netherlands. All participants receive a post-rehabilitation support service. The support service consists of several house visits by a peer support volunteer in the first weeks after specialized rehabilitation treatment. The peer support volunteers are trained according to an adapted version of the previously developed Self-Management Support (SMS) program. The SMS program is directed at improving social and emotional self-management. Patient outcomes are assessed by questionnaire pre-, directly post-, and 6 months post-intervention. The primary patient outcome measure is self-efficacy. Secondary outcomes are perceived autonomy, quality of life, and psychological well-being. A process evaluation will be performed to gain insight into barriers and facilitators for the implementation of peer-led SMS by combining both quantitative, questionnaire data and qualitative data derived from focus groups with peer supporters and patients. In a workshop with relevant stakeholders, possibilities for dissemination and sustainability will be explored. Discussion: This paper describes the design of a practice-based study on feasibility, barriers, and facilitators to the implementation of a home-based, peer-led self-management support intervention for patients with acquired brain injury. We will quantitatively and qualitatively evaluate the change in relevant patient outcomes pre- and post-intervention and the barriers and facilitators related to the implementation of the intervention. Following a positive evaluation, the final stage of the study aims to facilitate deployment and utilization of the intervention.
Collapse
Affiliation(s)
- Milou Baumgartner-Dupuits
- Care and Public Health Research Institute (Caphri), Faculty of Health, Medicine and Life Sciences, University Maastricht, Maastricht, Netherlands.,Department of Rehabilitation Medicine, Faculty of Health, Medicine and Life Sciences, University Maastricht, Maastricht, Netherlands.,Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, University Maastricht, Maastricht, Netherlands.,Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, Netherlands
| | - Simone J S Sep
- Care and Public Health Research Institute (Caphri), Faculty of Health, Medicine and Life Sciences, University Maastricht, Maastricht, Netherlands.,Department of Rehabilitation Medicine, Faculty of Health, Medicine and Life Sciences, University Maastricht, Maastricht, Netherlands.,Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, Netherlands
| | - Jeanine Verbunt
- Care and Public Health Research Institute (Caphri), Faculty of Health, Medicine and Life Sciences, University Maastricht, Maastricht, Netherlands.,Department of Rehabilitation Medicine, Faculty of Health, Medicine and Life Sciences, University Maastricht, Maastricht, Netherlands.,Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, Netherlands
| | - Hans Bosma
- Care and Public Health Research Institute (Caphri), Faculty of Health, Medicine and Life Sciences, University Maastricht, Maastricht, Netherlands.,Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, University Maastricht, Maastricht, Netherlands
| | - Jacques van Eijk
- Care and Public Health Research Institute (Caphri), Faculty of Health, Medicine and Life Sciences, University Maastricht, Maastricht, Netherlands.,Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, University Maastricht, Maastricht, Netherlands
| |
Collapse
|
27
|
Hazelzet E, Houkes I, Bosma H, de Rijk A. Using intervention mapping to develop 'Healthy HR' aimed at improving sustainable employability of low-educated employees. BMC Public Health 2021; 21:1259. [PMID: 34187445 PMCID: PMC8240435 DOI: 10.1186/s12889-021-11278-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 06/13/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The perspectives of low-educated employees are often neglected when designing sustainable employability (SE) interventions. As a result, the interventions offered by the employer do often not align with the needs of low-educated employees. This particular group should therefore be actively involved in the process of developing and implementing SE interventions in their work organizations. The current paper describes the development process of a web-based intervention for HR managers and direct supervisors aimed at improving the SE of low-educated employees. This intervention is specifically designed to involve low-educated employees. METHODS The first four steps of the Intervention Mapping (IM) approach were used to systematically develop the intervention with the active involvement of stakeholders. Step 1 comprised a needs assessment including a literature review, empirical evidence, scoping search and several focus group interviews with employees and with representatives of employers. Step 2 formulated the intervention objective. During step 3, suitable theoretical methods were selected and translated to practical applications. Step 4 involved the development of a web-based intervention by integrating all information from the preceding steps. RESULTS The needs assessment indicated that the employees' active involvement and employees-employer genuine dialogue should be essential characteristics of an SE intervention for low-educated employees. The online toolkit 'Healthy HR' (HHR) was developed, which contains eight steps. Each step consists of one or more tasks helping the employer and employees with developing and implementing SE interventions themselves. One or more dialogue-based tools support each task. The leading principle providing structure within HHR was Adapted Intervention Mapping. CONCLUSION Principles of IM appeared to be useful to develop the intervention HHR systematically. This development process resulted in a practical online toolkit that supports employers in the development and implementation of local SE interventions tailored to the needs of low-educated employees. These employees should be actively involved in the process through a dialogue-based approach. By using IM principles, HHR is expected to increase the effectiveness in bettering the health and well-being of low-educated employees.
Collapse
Affiliation(s)
- Emmelie Hazelzet
- Department of Social Medicine, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD, Maastricht, the Netherlands.
| | - Inge Houkes
- Department of Social Medicine, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD, Maastricht, the Netherlands
| | - Hans Bosma
- Department of Social Medicine, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD, Maastricht, the Netherlands
| | - Angelique de Rijk
- Department of Social Medicine, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD, Maastricht, the Netherlands
| |
Collapse
|
28
|
Oosterhoff M, Jolani S, De Bruijn-Geraets D, van Giessen A, Bosma H, van Schayck OC, Joore MA. BMI trajectories after primary school-based lifestyle intervention: Unravelling an uncertain future. A mixed methods study. Prev Med Rep 2021; 21:101314. [PMID: 33537184 PMCID: PMC7841358 DOI: 10.1016/j.pmedr.2021.101314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 12/13/2020] [Accepted: 12/20/2020] [Indexed: 11/03/2022] Open
Abstract
This mixed methods study aimed to examine plausible body mass index (BMI) trajectories after exposure to a primary school-based lifestyle intervention to aid in estimating the long-term intervention benefits. BMI trajectories for children at control schools (mean 7.6 years of age) were modelled until 20 years of age through extrapolating trial evidence (N = 1647). A reference scenario assumed that the observed 2-year effects of the 'Healthy Primary Schools of the Future' (HPSF) and 'Physical Activity Schools' (PAS) were fully maintained over time. This was modelled by applying the observed 2-year BMI effects until 20 years of age. Expert opinions on likely trends in effect maintenance after the 2-year intervention period were elicited qualitatively and quantitatively, and were used for developing alternative scenarios. Expert elicitation revealed three scenarios: (a) a constant exposure-effect and an uncontrolled environment with effect decay scenario, (b) a household multiplier and an uncontrolled environment with effect decay scenario, and (c) a household multiplier and maintainer scenario. The relative effect of HPSF at 20 years of age was -0.21 kg/m2 under the reference scenario, and varied from -0.04 kg/m2 (a) to -0.06 kg/m2 (b), and -0.50 kg/m2 (c). For PAS, the relative effect was -0.17 kg/m2 under the reference scenario, and varied from -0.04 kg/m2 (a, b), to -0.21 kg/m2 (c). The mixed methods approach proved to be useful in modelling plausible BMI trajectories and specifying uncertainty on effect maintenance. Further observations until adulthood could reduce the uncertainty around future benefits. This trial was retrospectively registered at Clinicaltrials.gov (NCT02800616).
Collapse
Affiliation(s)
- Marije Oosterhoff
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA) Maastricht University Medical Centre MUMC+, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Shahab Jolani
- Department of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Daisy De Bruijn-Geraets
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA) Maastricht University Medical Centre MUMC+, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Anoukh van Giessen
- Center for Prevention and Health Services, National Institute of Public Health and the Environment, Bilthoven, the Netherlands
| | - Hans Bosma
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Onno C.P. van Schayck
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Manuela A. Joore
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA) Maastricht University Medical Centre MUMC+, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| |
Collapse
|
29
|
Meisters R, Westra D, Putrik P, Bosma H, Ruwaard D, Jansen M. Does Loneliness Have a Cost? A Population-Wide Study of the Association Between Loneliness and Healthcare Expenditure. Int J Public Health 2021; 66:581286. [PMID: 34335136 PMCID: PMC8284859 DOI: 10.3389/ijph.2021.581286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/21/2020] [Accepted: 01/05/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Loneliness has been associated with unhealthy behavior, poorer health, and increased morbidity. However, the costs of loneliness are poorly understood. Methods: Multiple sources were combined into a dataset containing a nationally representative sample (n = 341,376) of Dutch adults (18+). The association between loneliness and total, general practitioner (GP), specialized, pharmaceutical, and mental healthcare expenditure was tested using Poisson and Zero-inflated negative binomial models, controlling for numerous potential confounders (i.e., demographic, socioeconomic, lifestyle-related factors, self-perceived health, and psychological distress), for four age groups. Results: Controlling for demographic, socioeconomic, and lifestyle-related factors, loneliness was indirectly (via poorer health) associated with higher expenditure in all categories. In fully adjusted models, it showed a direct association with higher expenditure for GP and mental healthcare (0.5 and 11.1%, respectively). The association with mental healthcare expenditure was stronger in younger than in older adults (for ages 19–40, the contribution of loneliness represented 61.8% of the overall association). Conclusion: Loneliness contributes to health expenditure both directly and indirectly, particularly in younger age groups. This implies a strong financial imperative to address this issue.
Collapse
Affiliation(s)
- Rachelle Meisters
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, Netherlands
| | - Daan Westra
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, Netherlands
| | - Polina Putrik
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, Netherlands.,Academic Collaborative Centre for Public Health Limburg, South Limburg Medical Health Service (GGD South Limburg), Heerlen, Netherlands
| | - Hans Bosma
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, Netherlands
| | - Maria Jansen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, Netherlands.,Academic Collaborative Centre for Public Health Limburg, South Limburg Medical Health Service (GGD South Limburg), Heerlen, Netherlands
| |
Collapse
|
30
|
Silverman-Retana O, Brinkhues S, Hulman A, Stehouwer CDA, Dukers-Muijrers NHTM, Simmons RK, Bosma H, Eussen S, Koster A, Dagnelie P, Savelberg HHCM, Schaper NC, van Dongen MCJM, Witte DR, Schram MT. Spousal concordance in pathophysiological markers and risk factors for type 2 diabetes: a cross-sectional analysis of The Maastricht Study. BMJ Open Diabetes Res Care 2021; 9:9/1/e001879. [PMID: 33597186 PMCID: PMC7893653 DOI: 10.1136/bmjdrc-2020-001879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/11/2020] [Accepted: 01/10/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION We compared the degree of spousal concordance in a set of detailed pathophysiological markers and risk factors for type 2 diabetes to understand where in the causal cascade spousal similarities are most relevant. RESEARCH DESIGN AND METHODS This is a cross-sectional analysis of couples who participated in The Maastricht Study (n=172). We used quantile regression models to assess spousal concordance in risk factors for type 2 diabetes, including four adiposity measures, two dimensions of physical activity, sedentary time and two diet indicators. We additionally assessed beta cell function and insulin sensitivity and glucose metabolism status with fasting and 2-hour plasma glucose and hemoglobin A1c. RESULTS The strongest spousal concordance (beta estimates) was observed for the Dutch Healthy Diet Index (DHDI) in men. A one-unit increase in wives' DHDI was associated with a 0.53 (95% CI 0.22 to 0.67) unit difference in men's DHDI. In women, the strongest concordance was for the time spent in high-intensity physical activity (HPA); thus, a one-unit increase in husbands' time spent in HPA was associated with a 0.36 (95% CI 0.17 to 0.64) unit difference in women's time spent in HPA. The weakest spousal concordance was observed in beta cell function indices. CONCLUSIONS Spousal concordance was strongest in behavioral risk factors. Concordance weakened when moving downstream in the causal cascade leading to type 2 diabetes. Public health prevention strategies to mitigate diabetes risk may benefit from targeting spousal similarities in health-related behaviors and diabetes risk factors to design innovative and potentially more effective couple-based interventions.
Collapse
Affiliation(s)
- Omar Silverman-Retana
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Stephanie Brinkhues
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Knowledge and Innovation, Public Health Service South Limburg, Heerlen, The Netherlands
| | - Adam Hulman
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Coen D A Stehouwer
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Nicole H T M Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, Heerlen, The Netherlands
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | | | - Hans Bosma
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
| | - Simone Eussen
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Annemarie Koster
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
| | - Pieter Dagnelie
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Hans H C M Savelberg
- Department of Nutrition and Movement Sciences, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Nicolaas C Schaper
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Martien C J M van Dongen
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Daniel R Witte
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Miranda T Schram
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
31
|
Brandts L, van Tilburg TG, Bosma H, Huisman M, van den Brandt PA. Loneliness in Later Life and Reaching Longevity: Findings From the Longitudinal Aging Study Amsterdam. J Gerontol B Psychol Sci Soc Sci 2021; 76:415-424. [PMID: 32880641 PMCID: PMC7813181 DOI: 10.1093/geronb/gbaa145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Indexed: 11/14/2022] Open
Abstract
Objectives There is an increasing research interest in factors that characterize those who reach exceptionally old ages. Although loneliness is often associated with an increased risk for premature mortality, its relationship with reaching longevity is still unclear. We aimed to quantify the association between (social/emotional) loneliness and the likelihood of reaching the age of 90 years in men and women separately. Methods For these analyses, data from the Longitudinal Aging Study Amsterdam (LASA) were used. Loneliness, social loneliness, and emotional loneliness were assessed at baseline using the 11-item De Jong-Gierveld scale in 1992–1993 (at age 64–85 years). Follow-up for vital status information until the age of 90 years was 99.5% completed. Multivariable-adjusted Cox regression analyses with a fixed follow-up time were based on 1,032 men and 1,078 women to calculate risk ratios (RR) of reaching 90 years. Results No significant associations were observed between loneliness and reaching 90 years in both men (RR, 0.90; 95% confidence interval [CI], 0.70–1.14) and women (RR, 0.98; 95% CI, 0.83–1.14). Social loneliness was significantly associated with a reduced chance of reaching 90 years in women (RR, 0.82; 95% CI, 0.67–0.99). Discussion The current analyses did not show support for the existence of a meaningful effect of loneliness on reaching longevity in both sexes. When investigating specific dimensions of loneliness, we observed that reporting social loneliness was associated with reaching 90 years in women. This indicates that, for women, a large and diverse personal network at an older age could increase the probability of reaching longevity. However, replication of our findings in other cohorts is needed.
Collapse
Affiliation(s)
- Lloyd Brandts
- Department of Epidemiology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, the Netherlands
| | | | - Hans Bosma
- Department of Social Medicine, CAPHRI - School for Public Health and Primary Care, Maastricht, the Netherlands
| | - Martijn Huisman
- Department of Sociology, Vrije Universiteit, Amsterdam, the Netherlands.,Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, the Netherlands
| | - Piet A van den Brandt
- Department of Epidemiology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, the Netherlands.,Department of Epidemiology, CAPHRI - School for Public Health and Primary Care, Maastricht, the Netherlands
| |
Collapse
|
32
|
Sapkota T, Houkes I, Bosma H. Vicious cycle of chronic disease and poverty: a qualitative study in present day Nepal. Int Health 2021; 13:30-38. [PMID: 32352145 PMCID: PMC7807236 DOI: 10.1093/inthealth/ihaa016] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/06/2020] [Accepted: 03/14/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND In countries with out-of-pocket (OOP) payment systems for healthcare, the combination of chronic disease and poverty can have damaging socio-economic and health impacts for affected households. Using a life course perspective, this article aims to explore how Nepalese people struggle with, experience and adapt to chronic disease, poverty and their consequences, and how chronic diseases and poverty reinforce each other. METHODS In-depth semi-structured interviews were conducted with 21 chronically ill Nepalese people with one or more chronic diseases and/or their caretakers. Data were transcribed and analysed thematically. RESULTS The adaptation strategies for the consequences of the huge OOP costs make patients and their households financially disadvantaged. The impoverishment has major social impacts and often persists across generations. The situation forces people to choose between avoiding medical treatment or further impoverishing their families. CONCLUSIONS This study explored how chronically ill Nepalese people struggle with socio-economic and health consequences of OOP payments for their disease. The article sheds light on circumstances and adaptation strategies that obstruct every attempt to escape from the vicious cycle of the poverty trap. Hence poverty and health adversities accumulate across generations and contribute to greater health expenditures, worse health outcomes and severely compromised social life.
Collapse
Affiliation(s)
- Taranath Sapkota
- Department of Social Medicine, Maastricht University, CAPHRI, Maastricht, The Netherlands
| | - Inge Houkes
- Department of Social Medicine, Maastricht University, CAPHRI, Maastricht, The Netherlands
| | - Hans Bosma
- Department of Social Medicine, Maastricht University, CAPHRI, Maastricht, The Netherlands
| |
Collapse
|
33
|
Oosterhoff M, Over EAB, van Giessen A, Hoogenveen RT, Bosma H, van Schayck OCP, Joore MA. Lifetime cost-effectiveness and equity impacts of the Healthy Primary School of the Future initiative. BMC Public Health 2020; 20:1887. [PMID: 33297992 PMCID: PMC7724829 DOI: 10.1186/s12889-020-09744-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/21/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND This study estimated the lifetime cost-effectiveness and equity impacts associated with two lifestyle interventions in the Dutch primary school setting (targeting 4-12 year olds). METHODS The Healthy Primary School of the Future (HPSF; a healthy school lunch and structured physical activity) and the Physical Activity School (PAS; structured physical activity) were compared to the regular Dutch curriculum (N = 1676). An adolescence model, calculating weight development, and the RIVM Chronic Disease Model, calculating overweight-related chronic diseases, were linked to estimate the lifetime impact on chronic diseases, quality adjusted life years (QALYs), healthcare, and productivity costs. Cost-effectiveness was expressed as the additional costs/QALY gained and we used €20,000 as threshold. Scenario analyses accounted for alternative effect maintenance scenarios and equity analyses examined cost-effectiveness in different socioeconomic status (SES) groups. RESULTS HPSF resulted in a lifetime costs of €773 (societal perspective) and a lifetime QALY gain of 0.039 per child versus control schools. HPSF led to lower costs and more QALYs as compared to PAS. From a societal perspective, HPSF had a cost/QALY gained of €19,734 versus control schools, 50% probability of being cost-effective, and beneficial equity impact (0.02 QALYs gained/child for low versus high SES). The cost-effectiveness threshold was surpassed when intervention effects decayed over time. CONCLUSIONS HPSF may be a cost-effective and equitable strategy for combatting the lifetime burden of unhealthy lifestyles. The win-win situation will, however, only be realised if the intervention effect is sustained into adulthood for all SES groups. TRIAL REGISTRATION Clinicaltrials.gov ( NCT02800616 ). Registered 15 June 2016 - Retrospectively registered.
Collapse
Affiliation(s)
- Marije Oosterhoff
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center MUMC+/ Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 5800, 6202, AZ, Maastricht, The Netherlands.
| | - Eelco A B Over
- Centre for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment, Bilthoven, the Netherlands
| | - Anoukh van Giessen
- Centre for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment, Bilthoven, the Netherlands
| | - Rudolf T Hoogenveen
- Expertise Center for Methodology and Information Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Hans Bosma
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Onno C P van Schayck
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Manuela A Joore
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center MUMC+/ Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 5800, 6202, AZ, Maastricht, The Netherlands
| |
Collapse
|
34
|
Hazelzet E, Bosma H, de Rijk A, Houkes I. Does Dialogue Improve the Sustainable Employability of Low-Educated Employees? A Study Protocol for an Effect and Process Evaluation of "Healthy HR". Front Public Health 2020; 8:446. [PMID: 33014964 PMCID: PMC7505925 DOI: 10.3389/fpubh.2020.00446] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/20/2020] [Indexed: 11/21/2022] Open
Abstract
Background: There is a need to develop sustainable employability (SE) interventions that are better aligned to the needs of low-educated employees. This group needs to get a voice in intervention development and implementation. In this study, a dialogue-based approach is proposed consisting of an online step-by-step support toolkit for employers, "Healthy Human Resources" (HHR). When intervening, this toolkit enables and stimulates employers to have a continuous dialogue with their low-educated employees. By improving the employees' job control, HHR is aimed at cost-beneficially improving SE. This paper describes the protocol of the evaluation study to evaluate the effectiveness and implementation process of HHR on the SE of low-educated employees. Methods: The protocol of the evaluation study consists of: (1) an effect evaluation with a pretest-posttest design with a 1-year follow-up in five work organizations in the Netherlands deploying low-educated employees and with SE as the primary outcome and job control as the secondary outcome. The effect evaluation is expanded with a budget impact analysis; (2) a mixed-method process evaluation at 6 and 12 months after the start of HHR to evaluate the whole implementation process of HHR. This includes the experiences with HHR of various stakeholders, such as employees, human resource managers, and line managers. Discussion: The effect evaluation will give insight into the effects of HHR on the SE of low-educated employees. The process evaluation will provide insight into the underlying mechanisms of the (in) effectiveness of HHR. By improving dialogue, we hypothesize that HHR, through enhancing job control, will strengthen the SE of low-educated employees. Also for helping with tackling the socioeconomic health gap, if proven effective, the implementation of HHR on a wider scale can be recommended.
Collapse
Affiliation(s)
- Emmelie Hazelzet
- Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | | | | | | |
Collapse
|
35
|
Bosma H, Oosterhoff M, Vermeiren AP, Willeboordse M, Joore MA, van Schayck OCP. Can school-based, health behavioural interventions tackle health inequities in childhood? Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
To improve the health situation of children in primary school, many school-based interventions that are aimed at changing health behaviours, are being set up. Prior to knowing the (long-term) effectiveness of such intervention, we set out to examine whether there is room for such interventions to also tackle the health gap between children from high and low socioeconomic backgrounds.
Methods
Data from the Dutch quasi-experimental Health Primary School of the Future were used. All children from eight primary schools were included in the period 2015-2019. In the first cross-sectional phase, we studied whether there were socioeconomic differences in various health outcomes (e.g. body mass index) and whether these were smaller in children in the oldest groups (highest classes). In a two-year longitudinal approach, it was studied how socioeconomic differences in health outcomes developed in two years time and whether health behaviours could “explain” any socioeconomic differences in the outcomes. Linear and logistic regression analyses were used, including multilevel variants thereof, as well as mediation analyses.
Results
Both the cross-sectional and longitudinal analyses indicated substantial and consistent socioeconomic differences in various health outcomes. The socioeconomic differences in health appeared stronger in the oldest children (highest classes). Due to only small socioeconomic differences in health behaviours, such behaviours did not mediate the socioeconomic differences in the children's health outcomes.
Conclusions
The findings indicate substantial socioeconomic differences in health in primary school. That being longer at school did not attenuate the socioeconomic differences in health and that health behaviours did not mediate the socioeconomic differences in health suggests that there might not be much room for school-based, health behaviour interventions to easily tackle socioeconomic differences in health in childhood.
Key messages
We found substantial socioeconomic differences in child health in the Netherlands. But we found only little evidence that primary school-based, health behavioural interventions will easily tackle socioeconomic differences in child health.
Collapse
Affiliation(s)
- H Bosma
- Social Medicine, Maastricht University, Social Medicine, CAPHRI, Maastricht, Netherlands
| | - M Oosterhoff
- Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, Netherlands
| | - A P Vermeiren
- Social Medicine, Maastricht University, Social Medicine, CAPHRI, Maastricht, Netherlands
| | - M Willeboordse
- Family Medicine, Maastricht University, Maastricht, Netherlands
| | - M A Joore
- Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, Netherlands
| | | |
Collapse
|
36
|
Meisters R, Westra D, Putrik P, Bosma H, Ruwaard D, Jansen M. Costs of loneliness: the association between loneliness and healthcare expenditure. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Loneliness is a growing issue. It has been associated with a range of unhealthy behaviors, poorer health, and increased morbidity. However, the healthcare costs of loneliness are poorly understood as limited existing research on loneliness focused on older age populations, few expenditure categories, and controlled for just a few potential confounders. Our study aims to fill this evidence gap.
Methods
Multiple sources were combined into a dataset containing a nationally representative sample (n = 341,376) of Dutch adults (>18 y.o.). The association between loneliness and total, general practitioner (GP), specialized, pharmaceutical, and mental healthcare expenditure was tested using Poisson and Zero-inflated negative binomial models, controlling for numerous potential confounders (i.e. demographic, socioeconomic, lifestyle-related factors, self-perceived health, and psychological distress), for multiple age groups. Excess expenditure attributed to loneliness was extrapolated to the entire population.
Results
Controlling for demographic, socioeconomic, and lifestyle-related factors, loneliness was indirectly (via poorer health) associated with higher expenditure in all categories. In fully adjusted models, it showed a direct association with higher expenditure for GP and mental healthcare (0.5% and 11.1%, respectively). The association with mental healthcare expenditure was stronger in younger than in older adults (for ages 19-40, the contribution of loneliness represented 61.8% of the overall association).
Conclusions
Loneliness contributes to health expenditure both directly and indirectly, particularly in younger age groups. This implies a strong financial imperative to address this issue.
Key messages
Loneliness is associated with increased healthcare expenditure independent of demographic and socioeconomic factors. Excess healthcare expenditure related to loneliness are particularly apparent in mental healthcare and in younger age groups.
Collapse
Affiliation(s)
- R Meisters
- Health Services Research, CAPHRI, Maastricht University, Maastricht, Netherlands
| | - D Westra
- Health Services Research, CAPHRI, Maastricht University, Maastricht, Netherlands
| | - P Putrik
- Health Services Research, CAPHRI, Maastricht University, Maastricht, Netherlands
- Academic Collaborative Center for Public Health Limburg, GGD Zuid Limburg, Heerlen, Netherlands
| | - H Bosma
- Social Medicine, CAPHRI, Maastricht University, Maastricht, Netherlands
| | - D Ruwaard
- Health Services Research, CAPHRI, Maastricht University, Maastricht, Netherlands
| | - M Jansen
- Health Services Research, CAPHRI, Maastricht University, Maastricht, Netherlands
- Academic Collaborative Center for Public Health Limburg, GGD Zuid Limburg, Heerlen, Netherlands
| |
Collapse
|
37
|
Hazelzet E, Bosma H, de Rijk A, Houkes I. Does dialogue improve the sustainable employability of low-educated employees? A study protocol. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
There is a need to develop sustainable employability (SE) interventions that are better aligned to the needs of low-educated employees. This group needs to get a voice in intervention development and implementation. In this study, a dialogue-based approach is proposed consisting of an online step-by-step support toolkit for employers, 'Healthy Human Resources' (HHR). When intervening, this toolkit enables and stimulates employers to have a continuous dialogue with their low-educated employees. By improving the employees' job control, HHR is aimed at cost-beneficially improving SE. This paper describes the protocol of the evaluation study to evaluate the effectiveness and implementation process of HHR on the SE of low-educated employees.
Methods
The protocol of the evaluation study consists of: 1) an effect evaluation with a pretest-posttest design with a one-year follow-up in five work organizations deploying low-educated employees and with SE as the primary outcome and job control as the secondary outcome. The effect evaluation is expanded with a budget impact analysis; 2) a mixed-method process evaluation at six and twelve months after the start of HHR to evaluate the whole implementation process of HHR. This includes the experiences with HHR of various stakeholders, such as employees, human resource managers, and line managers.
Results
The upcoming effect evaluation, as described in this study protocol, will give insight into the effects of HHR on the SE of low-educated employees. The process evaluation, as described, will provide insight into the barriers and facilitators related to the (in) effectiveness of HHR.
Conclusions
By improving dialogue, we hypothesize that HHR, through enhancing job control, will strengthen the SE of low-educated employees. If HHR is proven effective, we also recommend the implementation of HHR on a wider scale, in order to tackle the socioeconomic health gap.
Key messages
This paper describes a protocol for the evaluation of a dialogue-based approach (Healthy HR) to improve the sustainable employability of low-educated employees. Healthy HR is expected to facilitate employers in the development of effective SE interventions in a true dialogue with their low-educated employees.
Collapse
Affiliation(s)
- E Hazelzet
- Social Medicine, Maastricht University, Maastricht, Netherlands
| | - H Bosma
- Social Medicine, Maastricht University, Maastricht, Netherlands
| | - A de Rijk
- Social Medicine, Maastricht University, Maastricht, Netherlands
| | - I Houkes
- Social Medicine, Maastricht University, Maastricht, Netherlands
| |
Collapse
|
38
|
Hazelzet E, Bosma H, Houkes I, de Rijk A. Development of an online intervention to improve sustainable employability of low-educated employees. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Although low-educated employees are more at risk of poor health, they participate less often in workplace interventions, and when they do participate, they tend to profit to a lesser extent than high-educated employees. When developing sustainable employability (SE) interventions, the perspectives of the low-educated employees are often lacking, leading to a mismatch between the intervention and the needs. This group should be included when developing SE interventions in work organizations. The paper describes the development of a web-based intervention for employers to improve the SE of their low-educated employees using the Intervention Mapping (IM) approach.
Methods
The development builds on the first four steps of IM. A needs assessment (step 1), based on empirical evidence from previous literature and focus groups with employees (N = 11) and with representatives of employers (N = 5), was used to formulate the intervention objective (step 2), followed by selecting relevant theoretical methods and translation to practical applications (step 3). Subsequently, a web-based intervention was developed (step 4).
Results
The needs assessment identified the importance of the active involvement of employees and of a true dialogue between employee and employer. An online toolkit, called 'Healthy HR' (HHR) was developed, with eight steps, each consisting of several tasks, for developing and implementing local SE interventions that are tailored to the organization by the employer and employees themselves. Every task comprises one or more supportive dialogue-based tools. Adapted Intervention Mapping was used as the guiding principle to structure the eight steps.
Conclusions
The systematic development resulted in an easy-to-use online toolkit for employers that supports developing SE interventions tailored to the needs of the low-educated employees and organization. Using IM principles is expected by both the researchers and the employers to improve the effectiveness of HHR.
Key messages
‘Healthy Human Resources’ (HHR), is an online dialogue-based toolkit that facilitates employers to develop tailored SE interventions by involving their low-educated employees via dialogue. The principles of intervention mapping (IM) are used at two levels: to develop HHR, and as the leading principle within HHR.
Collapse
Affiliation(s)
- E Hazelzet
- Social Medicine, Maastricht University, Maastricht, Netherlands
| | - H Bosma
- Social Medicine, Maastricht University, Maastricht, Netherlands
| | - I Houkes
- Social Medicine, Maastricht University, Maastricht, Netherlands
| | - A de Rijk
- Social Medicine, Maastricht University, Maastricht, Netherlands
| |
Collapse
|
39
|
Sabahelzain MM, Dubé E, Moukhyer M, Larson HJ, van den Borne B, Bosma H. Psychometric properties of the adapted measles vaccine hesitancy scale in Sudan. PLoS One 2020; 15:e0237171. [PMID: 32760162 PMCID: PMC7410231 DOI: 10.1371/journal.pone.0237171] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 07/21/2020] [Indexed: 11/19/2022] Open
Abstract
Background There is a need for reliable and validated tools to identify, classify, and quantify vaccine-hesitancy in low and middle-income countries, such as Sudan. We evaluated the psychometric properties of an adapted version of the measles vaccine hesitancy scale by assessing its reliability, convergent validity, and criterion validity in Sudan. The vaccine hesitancy scale (VHS) was originally developed by the WHO/SAGE Working Group of Vaccine Hesitancy. Methods A community-based survey among parents was conducted in February 2019 in Khartoum state. We conducted exploratory and confirmatory factor analysis to examine the structure of the adapted measles VHS (aMVHS). We computed Cronbach’s alphas, correlations with other vaccine hesitancy measurements including the Parental Attitude towards Childhood Vaccination (PACV) and the Vaccine Confidence Index (VCI), and performed a Mann-Whitney U test for assessing the reliability and the convergent and criterion validity, respectively. Moreover, to examine whether the aMVHS can predict the child’s vaccination status, the area under the curve (AUC) was estimated using receiver operator characteristic (ROC) curves. Results The questionnaire was completed by 500 parents. Most were women (87.2%) between the ages of 20 and 47 (M = 31.15, SD = 5.74). The factor analyses indicated that the aMVHS comprises of two factors (sub-scales): 'confidence' and 'complacency'. The aMVHS sub-scales correlated weakly to moderately with the PACV and VCI scales. The area under the curve was 0.499 at most (P >0.05) and the aMVHS score did hardly differ between actually vaccinated and non-vaccinated children. Conclusion Our findings underscore that the aMVHS and its confidence and complacency sub-scales are reliable and have a moderately good convergent validity. However, the aMVHS has a limitation in predicting the concurrent child's vaccination status. More work is needed to revise and amend this aMVHS, particularly by additionally including the 'convenience' construct and by further evaluating its validity in other contexts.
Collapse
Affiliation(s)
- Majdi M. Sabahelzain
- Department of Public Health, School of Health Sciences, Ahfad University for Women, Omdurman, Sudan
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
- * E-mail:
| | - Eve Dubé
- Institut National de Santé Publique du Québec (INSPQ), Québec City, Québec, Canada
| | - Mohamed Moukhyer
- Education Development and Quality Unit, College of Applied Medical Sciences, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Heidi J. Larson
- Vaccine Confidence Project, London School of Hygiene and Tropical Medicine, Keppel Street, London, United Kingdom
- Department of Health Metrics Sciences, University of Washington, Seattle, Washington, University of America
| | - Bart van den Borne
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Hans Bosma
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| |
Collapse
|
40
|
Consolazio D, Koster A, Sarti S, Schram MT, Stehouwer CDA, Timmermans EJ, Wesselius A, Bosma H. Neighbourhood property value and type 2 diabetes mellitus in the Maastricht study: A multilevel study. PLoS One 2020; 15:e0234324. [PMID: 32511267 PMCID: PMC7279598 DOI: 10.1371/journal.pone.0234324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 05/24/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Low individual socioeconomic status (SES) is known to be associated with a higher risk of type 2 diabetes mellitus (T2DM), but the extent to which the local context in which people live may influence T2DM rates remains unclear. This study examines whether living in a low property value neighbourhood is associated with higher rates of T2DM independently of individual SES. RESEARCH DESIGN AND METHODS Using cross-sectional data from the Maastricht Study (2010-2013) and geographical data from Statistics Netherlands, multilevel logistic regression was used to assess the association between neighbourhood property value and T2DM. Individual SES was based on education, occupation and income. Of the 2,056 participants (aged 40-75 years), 494 (24%) were diagnosed with T2DM. RESULTS Individual SES was strongly associated with T2DM, but a significant proportion of the variance in T2DM was found at the neighbourhood level (VPC = 9.2%; 95% CI = 5.0%-16%). Participants living in the poorest neighbourhoods had a 2.38 times higher odds ratio of T2DM compared to those living in the richest areas (95% CI = 1.58-3.58), independently of individual SES. CONCLUSIONS Neighbourhood property value showed a significant association with T2DM, suggesting the usefulness of area-based programmes aimed at improving neighbourhood characteristics in order to tackle inequalities in T2DM.
Collapse
Affiliation(s)
- David Consolazio
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Department of Sociology and Social Research, Università degli Studi di Milano-Bicocca, Milan, Italy
- * E-mail:
| | - Annemarie Koster
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Simone Sarti
- Department of Political and Social Science, Università degli Studi di Milano, Milan, Italy
| | - Miranda T. Schram
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Heart and Vascular Center, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Coen D. A. Stehouwer
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Erik J. Timmermans
- Department of Epidemiology and Biostatistics, Amsterdam UMC, VU University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Anke Wesselius
- Department of Complex Genetics, Maastricht University, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Hans Bosma
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
41
|
Rensma SP, Stehouwer CD, Van Boxtel MP, Houben AJ, Berendschot TT, Jansen JF, Schalkwijk CG, Verhey FR, Kroon AA, Henry RM, Backes WH, Dagnelie PC, van Dongen MC, Eussen SJ, Bosma H, Köhler S, Reesink KD, Schram MT, van Sloten TT. Associations of Arterial Stiffness With Cognitive Performance, and the Role of Microvascular Dysfunction. Hypertension 2020; 75:1607-1614. [DOI: 10.1161/hypertensionaha.119.14307] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The mechanisms underlying cognitive impairment are incompletely understood but may include arterial stiffness and microvascular dysfunction. In the population-based Maastricht Study, we investigated the association between arterial stiffness and cognitive performance, and whether any such association was mediated by microvascular dysfunction. We included cross-sectional data of 2544 participants (age, 59.7 years; 51.0% men; 26.0% type 2 diabetes mellitus). We used carotid-femoral pulse wave velocity and carotid distensibility coefficient as measures of aortic and carotid stiffness, respectively. We calculated a composite score of microvascular dysfunction based on magnetic resonance imaging features of cerebral small vessel disease, flicker light-induced retinal arteriolar and venular dilation response, albuminuria, and plasma biomarkers of microvascular dysfunction (sICAM-1 [soluble intercellular adhesion molecule-1], sVCAM-1 [soluble vascular adhesion molecule-1], sE-selectin [soluble E-selectin], and vWF [von Willebrand factor]). Cognitive domains assessed were memory, processing speed, and executive function. A cognitive function score was calculated as the average of these domains. Higher aortic stiffness (per m/s) was associated with lower cognitive function (β, −0.018 SD [95% CI, −0.036 to −0.000]) independent of age, sex, education, and cardiovascular risk factors, but higher carotid stiffness was not. Higher aortic stiffness (per m/s) was associated with a higher microvascular dysfunction score (β, 0.034 SD [95% CI, 0.014 to 0.053]), and a higher microvascular dysfunction score (per SD) was associated with lower cognitive function (β, −0.089 SD [95% CI, −0.124 to −0.053]). Microvascular dysfunction significantly explained 16.2% of the total effect of aortic stiffness on cognitive function. The present study showed that aortic stiffness, but not carotid stiffness, is independently associated with worse cognitive performance, and that this association is in part explained by microvascular dysfunction.
Collapse
Affiliation(s)
- Sytze P. Rensma
- From the CARIM School for Cardiovascular Diseases (S.P.R., C.D.A.S., A.J.H.M.H., C.G.S., A.A.K., R.M.A.H., P.C.D., S.J.P.M.E., K.D.R., M.T.S., T.T.v.S.)
- Department of Internal Medicine (S.P.R., C.D.A.S., A.J.H.M.H., C.G.S., A.A.K., R.M.A.H., P.C.D., M.T.S., T.T.v.S.)
| | - Coen D.A. Stehouwer
- From the CARIM School for Cardiovascular Diseases (S.P.R., C.D.A.S., A.J.H.M.H., C.G.S., A.A.K., R.M.A.H., P.C.D., S.J.P.M.E., K.D.R., M.T.S., T.T.v.S.)
- Department of Internal Medicine (S.P.R., C.D.A.S., A.J.H.M.H., C.G.S., A.A.K., R.M.A.H., P.C.D., M.T.S., T.T.v.S.)
| | - Martin P.J. Van Boxtel
- MheNs School for Mental Health and Neuroscience (M.P.J.V.B., J.F.A.J., F.R.J.V., W.H.B., S.K., M.T.S.)
- Department of Psychiatry and Neuropsychology (M.P.J.V.B., F.R.J.V.)
| | - Alfons J.H.M. Houben
- From the CARIM School for Cardiovascular Diseases (S.P.R., C.D.A.S., A.J.H.M.H., C.G.S., A.A.K., R.M.A.H., P.C.D., S.J.P.M.E., K.D.R., M.T.S., T.T.v.S.)
- Department of Internal Medicine (S.P.R., C.D.A.S., A.J.H.M.H., C.G.S., A.A.K., R.M.A.H., P.C.D., M.T.S., T.T.v.S.)
| | | | - Jaap F.A. Jansen
- MheNs School for Mental Health and Neuroscience (M.P.J.V.B., J.F.A.J., F.R.J.V., W.H.B., S.K., M.T.S.)
- Department of Radiology and Nuclear Medicine (J.F.A.J., W.H.B.)
- Department of Electrical Engineering, Eindhoven University of Technology, the Netherlands (J.F.A.J.)
| | - Casper G. Schalkwijk
- From the CARIM School for Cardiovascular Diseases (S.P.R., C.D.A.S., A.J.H.M.H., C.G.S., A.A.K., R.M.A.H., P.C.D., S.J.P.M.E., K.D.R., M.T.S., T.T.v.S.)
- Department of Internal Medicine (S.P.R., C.D.A.S., A.J.H.M.H., C.G.S., A.A.K., R.M.A.H., P.C.D., M.T.S., T.T.v.S.)
| | - Frans R.J. Verhey
- MheNs School for Mental Health and Neuroscience (M.P.J.V.B., J.F.A.J., F.R.J.V., W.H.B., S.K., M.T.S.)
- Department of Psychiatry and Neuropsychology (M.P.J.V.B., F.R.J.V.)
| | - Abraham A. Kroon
- From the CARIM School for Cardiovascular Diseases (S.P.R., C.D.A.S., A.J.H.M.H., C.G.S., A.A.K., R.M.A.H., P.C.D., S.J.P.M.E., K.D.R., M.T.S., T.T.v.S.)
- Department of Internal Medicine (S.P.R., C.D.A.S., A.J.H.M.H., C.G.S., A.A.K., R.M.A.H., P.C.D., M.T.S., T.T.v.S.)
| | - Ronald M.A. Henry
- From the CARIM School for Cardiovascular Diseases (S.P.R., C.D.A.S., A.J.H.M.H., C.G.S., A.A.K., R.M.A.H., P.C.D., S.J.P.M.E., K.D.R., M.T.S., T.T.v.S.)
- Department of Internal Medicine (S.P.R., C.D.A.S., A.J.H.M.H., C.G.S., A.A.K., R.M.A.H., P.C.D., M.T.S., T.T.v.S.)
| | - Walter H. Backes
- MheNs School for Mental Health and Neuroscience (M.P.J.V.B., J.F.A.J., F.R.J.V., W.H.B., S.K., M.T.S.)
- Department of Radiology and Nuclear Medicine (J.F.A.J., W.H.B.)
| | - Pieter C. Dagnelie
- From the CARIM School for Cardiovascular Diseases (S.P.R., C.D.A.S., A.J.H.M.H., C.G.S., A.A.K., R.M.A.H., P.C.D., S.J.P.M.E., K.D.R., M.T.S., T.T.v.S.)
- Department of Internal Medicine (S.P.R., C.D.A.S., A.J.H.M.H., C.G.S., A.A.K., R.M.A.H., P.C.D., M.T.S., T.T.v.S.)
- Department of Epidemiology (P.C.D., M.C.J.M.v.D., S.J.P.M.E.)
| | - Martin C.J.M. van Dongen
- Department of Epidemiology (P.C.D., M.C.J.M.v.D., S.J.P.M.E.)
- CAPHRI Care and Public Health Research Institute (M.C.J.M.v.D., H.B.)
| | - Simone J.P.M. Eussen
- From the CARIM School for Cardiovascular Diseases (S.P.R., C.D.A.S., A.J.H.M.H., C.G.S., A.A.K., R.M.A.H., P.C.D., S.J.P.M.E., K.D.R., M.T.S., T.T.v.S.)
- Department of Epidemiology (P.C.D., M.C.J.M.v.D., S.J.P.M.E.)
| | - Hans Bosma
- CAPHRI Care and Public Health Research Institute (M.C.J.M.v.D., H.B.)
- Department of Social Medicine (H.B.)
| | - Sebastian Köhler
- MheNs School for Mental Health and Neuroscience (M.P.J.V.B., J.F.A.J., F.R.J.V., W.H.B., S.K., M.T.S.)
| | - Koen D. Reesink
- From the CARIM School for Cardiovascular Diseases (S.P.R., C.D.A.S., A.J.H.M.H., C.G.S., A.A.K., R.M.A.H., P.C.D., S.J.P.M.E., K.D.R., M.T.S., T.T.v.S.)
- Department of Biomedical Engineering, Maastricht University Medical Centre, Maastricht, the Netherlands (K.D.R.)
| | - Miranda T. Schram
- From the CARIM School for Cardiovascular Diseases (S.P.R., C.D.A.S., A.J.H.M.H., C.G.S., A.A.K., R.M.A.H., P.C.D., S.J.P.M.E., K.D.R., M.T.S., T.T.v.S.)
- Department of Internal Medicine (S.P.R., C.D.A.S., A.J.H.M.H., C.G.S., A.A.K., R.M.A.H., P.C.D., M.T.S., T.T.v.S.)
- MheNs School for Mental Health and Neuroscience (M.P.J.V.B., J.F.A.J., F.R.J.V., W.H.B., S.K., M.T.S.)
| | - Thomas T. van Sloten
- From the CARIM School for Cardiovascular Diseases (S.P.R., C.D.A.S., A.J.H.M.H., C.G.S., A.A.K., R.M.A.H., P.C.D., S.J.P.M.E., K.D.R., M.T.S., T.T.v.S.)
- Department of Internal Medicine (S.P.R., C.D.A.S., A.J.H.M.H., C.G.S., A.A.K., R.M.A.H., P.C.D., M.T.S., T.T.v.S.)
| |
Collapse
|
42
|
Warth J, Puth MT, Zier U, Beckmann N, Porz J, Tillmann J, Weckbecker K, Bosma H, Weltermann B, Münster E. Patient-physician communication about financial problems: A cross-sectional study among over-indebted individuals. PLoS One 2020; 15:e0232716. [PMID: 32369528 PMCID: PMC7199951 DOI: 10.1371/journal.pone.0232716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 04/20/2020] [Indexed: 11/19/2022] Open
Abstract
Background About every tenth household across Europe is unable to meet payment obligations and living expenses on an ongoing basis and is thus considered over-indebted. Previous research suggests that over-indebtedness reflects a potential cause and consequence of psychosomatic health problems and limited access to care. However, it is unclear whether those affected discuss their financial problems with general practitioners. Therefore, this study examined patient-physician communication about financial problems in general practice among over-indebted individuals. Methods We conducted a cross-sectional survey among clients of 70 debt advice agencies in North Rhine-Westphalia, Germany, in 2017. We assessed the prevalence of patient-physician communication about financial problems and its association with patient characteristics using descriptive statistics and logistic regression analysis. Of 699 individuals who returned the questionnaire (response rate:50.2%), we included 598 respondents enrolled in statutory health insurance with complete outcome data in the analyses. Results Conversations about financial problems with general practitioners were reported by 22.6% (n = 135) of respondents. Individuals with a high educational level were less likely to report such conversations than those with medium educational level (aOR 0.11; 95%CI 0.01–0.83) after adjustment for other sociodemographic characteristics, health status and measures of financial distress. Those without a migrant background(aOR 2.09; 95%CI 1.32–3.32), the chronically ill(aOR 1.90; 95%CI 1.16–3.13) and individuals who reported high financial distress(aOR 2.15; 95%CI 1.22–3.78) and cutting on necessities to pay for medications(aOR 1.86; 95%CI 1.12–3.09) were more likely to discuss financial problems than their counterparts. Conclusions Few over-indebted individuals discussed financial problems with their general practitioner. Patients’ health status, coping strategies and perception of financial distress might contribute to variations in disclosure of financial problems. Thus, enhancing communication and screening by routine assessment of financial problems in clinical practice can help to identify vulnerable patients and promote access to health care and social services and well-being for all.
Collapse
Affiliation(s)
- Jacqueline Warth
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
- * E-mail:
| | - Marie-Therese Puth
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
- Institute for Medical Biometry, Informatics and Epidemiology (IMBIE), University Hospital Bonn, Bonn, Germany
| | - Ulrike Zier
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
| | - Niklas Beckmann
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
| | - Johannes Porz
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
| | - Judith Tillmann
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
| | - Klaus Weckbecker
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
- Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Hans Bosma
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands
| | - Birgitta Weltermann
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
| | - Eva Münster
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
| |
Collapse
|
43
|
Oosterhoff M, van Schayck OCP, Bartelink NHM, Bosma H, Willeboordse M, Winkens B, Joore MA. The Short-Term Value of the "Healthy Primary School of the Future" Initiative: A Social Return on Investment Analysis. Front Public Health 2020; 8:401. [PMID: 32974255 PMCID: PMC7472552 DOI: 10.3389/fpubh.2020.00401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 07/07/2020] [Indexed: 12/05/2022] Open
Abstract
Background: This study examines the social return on investment (SROI) of the "Healthy Primary School of the Future" initiative after 2 years. Methods: Healthy Primary Schools of the Future (HPSF) provide a healthy lunch and daily structured physical activity sessions, whereas Physical Activity Schools (PAS) focus on physical activity only. We evaluated the 2-years investments and effects (N = 1,676 children) of both school environments (four schools) compared to control schools (four schools). Investments and outcomes were grouped within the healthcare, education, household & leisure, and labor & social security sector. Outcomes that could be expressed in monetary terms were used for the calculation of social return on investment. Results: HPSF and PAS created outcomes for the healthcare sector by favorable changes in health behaviors, body mass index [both significant], and medical resource use [not significant]. Outcomes for the education sector included a favorable impact on perceived social behaviors and school satisfaction, and absenteeism from school [latter not significant], and more engagement with the community was experienced. The per child investments, €859 (HPSF) and €1017 (PAS), generated a benefit of €8 (HPSF) and €49 (PAS) due to reduced school absenteeism and medical resource use. Conclusions: Within 2 years of intervention implementation, the HPSF initiative created outcomes in several sectors, but the benefits did not outweigh the investments. Follow-up assessments as well as modeling long-term outcomes are needed to assess the total value of the interventions. Until then, the SROI framework can inform strategies for obtaining stakeholder support and intervention implementation. Trial registration: The study was registered in the ClinicalTrials.gov database on 14 June 2016 (NCT02800616).
Collapse
Affiliation(s)
- Marije Oosterhoff
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Onno C P van Schayck
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Nina H M Bartelink
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Hans Bosma
- Department of Social Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Maartje Willeboordse
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Manuela A Joore
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| |
Collapse
|
44
|
Zhou TL, Kroon A, Henry R, Koster A, Dagnelie P, Bosma H, van Greevenbroek M, van der Kallen C, Schalkwijk C, Wesselius A, Reesink K, Köhler S, Schram M, Stehouwer C, van Sloten T. 3.7 Exercise Systolic Blood Pressure Response And Incident Depressive Symptoms – The Maastricht Study. Artery Res 2020. [DOI: 10.2991/artres.k.191224.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
45
|
Abstract
A uniform approach for costing school-based lifestyle interventions is currently lacking. The objective of this study was to develop a template for costing primary school-based lifestyle interventions and apply this to the costing of the "Healthy Primary School of the Future" (HPSF) and the "Physical Activity School" (PAS), which aim to improve physical activity and dietary behaviors. Cost-effectiveness studies were reviewed to identify the cost items. Societal costs were reflected by summing up the education, household and leisure, labor and social security, and health perspectives. Cost inputs for HPSF and PAS were obtained for the first year after implementation. In a scenario analysis, the costs were explored for a hypothetical steady state. From a societal perspective, the per child costs were €2.7/$3.3 (HPSF) and €- 0.3/$- 0.4 (PAS) per day during the first year after implementation, and €1.0/$1.2 and €- 1.3/$- 1.6 in a steady state, respectively (2016 prices). The highest costs were incurred by the education perspective (first year: €8.7/$10.6 (HPSF) and €4.0/$4.9 (PAS); steady state: €6.1/$7.4 (HPSF) and €2.1/$2.6 (PAS)), whereas most of the cost offsets were received by the household and leisure perspective (first year: €- 6.0/$- 7.3 (HPSF) and €- 4.4/$- 5.4 (PAS); steady state: €- 5.0/$- 6.1 (HPSF) and €- 3.4/$- 4.1 (PAS)). The template proved helpful for costing HPSF and PAS from various stakeholder perspectives. The costs for the education sector were fully (PAS) and almost fully (HPSF) compensated by the savings within the household sector. Whether the additional costs of HPSF over PAS represent value for money will depend on their relative effectiveness.
Collapse
Affiliation(s)
- Marije Oosterhoff
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre MUMC+/Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
| | - Hans Bosma
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 5800, 6202, AZ, Maastricht, The Netherlands
| | - Onno C P van Schayck
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Manuela A Joore
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre MUMC+/Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
46
|
Oosterhoff M, Joore MA, Bartelink NHM, Winkens B, Schayck OCP, Bosma H. Longitudinal analysis of health disparities in childhood. Arch Dis Child 2019; 104:781-788. [PMID: 30948361 DOI: 10.1136/archdischild-2018-316482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/06/2019] [Accepted: 03/08/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Combatting disparities in health outcomes among children is a major public health concern. This study focuses on two questions: (1) To what extent does socioeconomic status (SES) contribute to disparities in health outcomes? and (2) To what extent can social inequalities in health outcomes be explained by differences in children's health behaviours? DESIGN This study included 2-year follow-up data of 1259 children (4-12 years of age) who participated in the 'Healthy Primary School of the Future' project (ClinicalTrials.gov NCT02800616). SES was measured by maternal and paternal education and household income (adjusted for family size). Health outcomes were body mass index (BMI) z-score, health resource use, school absenteeism, health-related quality of life and psychosocial health, measured over 2 years of follow-up (2015-2017). Health behaviours included physical activity, and consumption of fruits, vegetables and sweetened beverages. Associations between SES and baseline health behaviours were examined, and mixed models for repeated measures were used to assess associations between SES and health outcomes over 2 years of follow-up. RESULTS A high socioeconomic background was significantly associated with better health outcomes (all outcomes). For example, children with a low SES had higher BMI z-scores (beta coefficient: 0.42, 95% CI 0.22 to 0.62) and higher consumption healthcare costs (ratio of mean costs: 2.21, 95% CI 1.57 to 3.10). Effects of SES changed very little after controlling for health behaviours. DISCUSSION Our findings strongly suggest that socioeconomic background has a pervasive impact on disparities in child health, but gives little support to the idea that social inequalities in child health can be tackled by means of lifestyle interventions.
Collapse
Affiliation(s)
- Marije Oosterhoff
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre (MUMC+)/Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Manuela A Joore
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre (MUMC+)/Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Nina H M Bartelink
- Department of Health Promotion, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Onno C P Schayck
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Hans Bosma
- Department of Social Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
47
|
Abstract
In the article, 'A Cost Analysis of School-Based Lifestyle Interventions', we calculated the societal costs of two school-based lifestyle interventions: 'the Healthy Primary School of the Future' and 'the Physical Activity School'.
Collapse
Affiliation(s)
- Marije Oosterhoff
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre MUMC+/Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
| | - Hans Bosma
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 5800, 6202, AZ, Maastricht, The Netherlands
| | - Onno C P van Schayck
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Manuela A Joore
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre MUMC+/Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
48
|
Sabahelzain MM, Moukhyer M, Dubé E, Hardan A, van den Borne B, Bosma H. Towards a further understanding of measles vaccine hesitancy in Khartoum state, Sudan: A qualitative study. PLoS One 2019; 14:e0213882. [PMID: 31220092 PMCID: PMC6586394 DOI: 10.1371/journal.pone.0213882] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 05/29/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Vaccine hesitancy is one of the contributors to low vaccination coverage in both developed and developing countries. Sudan is one of the countries that suffers from low measles vaccine coverage and from measles outbreaks. In order to facilitate the future development of interventions, this study aimed at exploring the opinions of Expanded Program on Immunization officers at ministries of health, WHO, UNICEF and vaccine care providers at Khartoum-based primary healthcare centers. METHODS Qualitative data were collected using semi-structured interviews during the period January-March 2018. Data (i.e. quotes) were matched to the categories and the sub-categories of a framework that was developed by the WHO-SAGE Working Group called ''Determinants of Vaccine Hesitancy Matrix''. FINDINGS The interviews were conducted with 14 participants. The majority of participants confirmed the existence of measles vaccine hesitancy in Khartoum state. They further identified various determinants that were grouped into three domains including contextual, groups and vaccination influences. The main contextual determinant as reported is the presence of people who can be qualified as "anti-vaccination". They mostly belong to particular religious and ethnic groups. Parents' beliefs about prevention and treatment from measles are the main determinants of the group influences. Attitude of the vaccine providers, measles vaccine schedule and its mode of delivery were the main vaccine related determinants. CONCLUSION Measles vaccine hesitancy in Sudan appears complex and highly specific to local circumstances. To better understand the magnitude and the context-specific causes of measles vaccine hesitancy and to develop adapted strategies to address them, there is clearly a further need to investigate measles vaccine hesitancy among parents.
Collapse
Affiliation(s)
- Majdi M. Sabahelzain
- Department of Public Health, School of Health Sciences, Ahfad University for Women, Omdurman, Sudan
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- * E-mail: ,
| | - Mohamed Moukhyer
- Education Development and Quality Unit, College of Applied Medical Sciences, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Eve Dubé
- Institut National de Santé Publique du Québec (INSPQ), Québec, Canada
| | | | - Bart van den Borne
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Hans Bosma
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
49
|
Hazelzet E, Picco E, Houkes I, Bosma H, de Rijk A. Effectiveness of Interventions to Promote Sustainable Employability: A Systematic Review. Int J Environ Res Public Health 2019; 16:ijerph16111985. [PMID: 31167462 PMCID: PMC6604015 DOI: 10.3390/ijerph16111985] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/27/2019] [Accepted: 05/28/2019] [Indexed: 12/04/2022]
Abstract
Background: Despite growing interest in sustainable employability (SE), studies on the effectiveness of interventions aimed at employees’ SE are scarce. In this review, SE is defined by four core components: health, productivity, valuable work, and long-term perspective. The aim of this review is to summarize the effectiveness of employer-initiated SE interventions and to analyze whether their content and outcome measures addressed these SE components. Methods: A systematic search was performed in six databases for the period January 1997 to June 2018. The methodological quality of each included study was assessed. A customized form was used to extract data and categorize interventions according to SE components. Results: The initial search identified 596 articles and 7 studies were included. Methodological quality ranged from moderate to weak. All interventions addressed the components ‘health’ and ‘valuable work’. Positive effects were found for ‘valuable work’ outcomes. Conclusions: The quality of evidence was moderate to weak. The ‘valuable work’ component appeared essential for the effectiveness of SE interventions. Higher-quality evaluation studies are needed, as are interventions that effectively integrate all SE core components in their content.
Collapse
Affiliation(s)
- Emmelie Hazelzet
- Department of Social Medicine, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands.
| | - Eleonora Picco
- Department of Psychology, University of Milano-Bicocca, 20126 Milano, Italy.
| | - Inge Houkes
- Department of Social Medicine, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands.
| | - Hans Bosma
- Department of Social Medicine, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands.
| | - Angelique de Rijk
- Department of Social Medicine, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands.
| |
Collapse
|
50
|
Qi Y, Koster A, van Boxtel M, Köhler S, Schram M, Schaper N, Stehouwer C, Bosma H. Adulthood Socioeconomic Position and Type 2 Diabetes Mellitus-A Comparison of Education, Occupation, Income, and Material Deprivation: The Maastricht Study. Int J Environ Res Public Health 2019; 16:E1435. [PMID: 31018480 PMCID: PMC6517950 DOI: 10.3390/ijerph16081435] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 04/10/2019] [Accepted: 04/20/2019] [Indexed: 01/24/2023]
Abstract
In an effort to better quantify the impact of adulthood socioeconomic circumstances on prediabetes and type 2 diabetes (T2DM), we set out to examine the relative importance of four adulthood socioeconomic indicators. Using cross-sectional data from The Maastricht Study on 2011 middle-aged older men and women, our findings indicate that low educational level (OR = 1.81, 95% CI = 1.24-2.64), low occupational level (OR = 1.42, 95% CI = 0.98-2.05), and material deprivation (OR = 1.78, 95% CI = 1.33-2.38) were independently associated with T2DM. Low income (OR = 1.28, 95% CI = 0.88-1.87) was the strongest, albeit not significant, SEP (socioeconomic position) correlate of prediabetes. This association confirms SEP as a multifaceted concept and indicates the need to measure SEP accordingly. In order to tackle the social gradient in prediabetes and T2DM, one should, therefore, address multiple SEP indicators and their possible pathways.
Collapse
Affiliation(s)
- Yuwei Qi
- Department of Social Medicine, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
- CAPHRI School for Public Health and Primary Care, Maastricht University, 6200 MD Maastricht, The Netherlands.
| | - Annemarie Koster
- Department of Social Medicine, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
- CAPHRI School for Public Health and Primary Care, Maastricht University, 6200 MD Maastricht, The Netherlands.
| | - Martin van Boxtel
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, 6200 MD Maastricht, The Netherlands.
| | - Sebastian Köhler
- School for Mental Health and Neuroscience (MHeNS), Maastricht University, 6229 ER Maastricht, The Netherlands.
| | - Miranda Schram
- Department of Medicine, Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands.
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, 6229 ER Maastricht, The Netherlands.
| | - Nicolaas Schaper
- CAPHRI School for Public Health and Primary Care, Maastricht University, 6200 MD Maastricht, The Netherlands.
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, 6229 ER Maastricht, The Netherlands.
- Department of Internal Medicine, Maastricht University Medical Centre, Randwycksingel 35, 6229 EG Maastricht, The Netherlands.
| | - Coen Stehouwer
- Department of Medicine, Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands.
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, 6229 ER Maastricht, The Netherlands.
| | - Hans Bosma
- Department of Social Medicine, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
- CAPHRI School for Public Health and Primary Care, Maastricht University, 6200 MD Maastricht, The Netherlands.
| |
Collapse
|