Biomedical subjects

H van de Mheen

Publications and source records attributed to H van de Mheen.

At least 19 recordsLinked to original sources

PubMed2006

Substance use among emergency room patients: Is self-report preferable to biochemical markers?

AIM OF STUDY: To explore the validity of self-reported substance use among emergency room populations and the processes of sample selection bias, to establish their influence on the prevalence rates found. METHODS: Self-reported alcohol and illicit drug use of patients in the emergency room is compared with results from an alcohol breath analyser and urine toxicology. RESULTS: Variations in reported substance use occur when comparing self-report measures with alcohol breath analyser results and urine toxicology. Self-reported alcohol use was found among 7.5% of the patients compared with 4.7% based on alcohol breath analysers. Illicit drug use was reported by 9.0% of the patients whereas urine toxicology resulted in 30% patients positive for illicit drug use. Patients that voluntarily participate in the study differ from those that do not participate. Patients who refuse an alcohol breath analyser report slightly more alcohol use prior to the injury (difference not significant), and patients who provide a urine sample report more illicit drug use prior to the injury compared to those that refuse. DISCUSSION: Differences in prevalence rates can be explained partly by the measurements used and partly by sample selection bias. Self-reported alcohol use and self-reported illicit drug use are preferable to the "gold standard" when used among emergency room patients, because both measures provide more accurate information on the actual use. Sample selection bias also influences the prevalence rates.

Adolescent↗

PubMed2006

A local and regional Alcohol and Drugs Monitor in the Netherlands: a tale of three cities.

Local and regional policymakers, care providers and prevention workers involved in addiction and addiction care need timely and reliable information. As few data on substance use are available at a local or regional level, an integrated local or regional monitoring system for alcohol and drugs (MAD) was developed. The MAD consists of four modules: a local social and information map, analyses of registration data of (addiction) care organisations, a local/regional survey among the general population and a community-based drug monitoring system aimed at collecting data on hard drug users. Both quantitative and qualitative research methods are used. This paper presents an overview of the MAD results with respect to alcohol and illicit drug use. Both quantitative and qualitative results show a substantial variation between regions, even in a country as small as the Netherlands. The study shows that a monitoring system can be an important source of information for local addiction policy, care and prevention.

Adolescent↗

PubMed2006

Monitoring of alcohol and drugs under scrutiny: output and shortcomings.

A major focus of Dutch addiction policy is to improve the monitoring of substance use and addiction - which surveys and registrations are important for the monitoring of alcohol and drugs problems, and what information is generated or needs to be generated by these monitors? Three methods were used: an inventorisation of existing monitoring projects, a survey among experts in the field of alcohol and drugs to study the information needs, and a study on the output and shortcomings of the existing monitors. Sixty monitors and 13 'umbrella' monitors were found. Experts formulated the needs of 11 topics which were matched with the output of the monitors. Coverage of the nature and extent of use in general is good. Shortcomings apply to the use and accessibility of the monitors, as well as to their completeness, standardisation and content. Especially questions with respect to problem use, treatment demand/need of help and user careers cannot be answered sufficiently with the existing information.

Humans↗

PubMed2000

Socioeconomic differences in self-assessed health in a chronically ill population: the role of different health aspects.

We investigated the role that different health aspects play in the explanation of socioeconomic differences in self-assessed health. Socioeconomic differences in self-assessed health were investigated in relation to chronic disease, functional limitations, psychosomatic symptoms, and perceived discomfort/distress. In multiple logistic regression analyses, for three cutoff points of self-assessed health, significant socioeconomic differences in self-assessed health could be observed after adjusting for age and gender. After separate adjustment for each of the four health aspects, the analyses showed that for a health assessment as less-than-good and less-than-fair, psychosomatic symptoms were the most powerful explanatory factor. Perceived discomfort/distress proved to be the most powerful factor for a poor health assessment. We found that socioeconomic differences in self-assessed health could, to a large extent (72-80%), be explained through socioeconomic differences in the prevalence of the four types of health problems included in the study. For all cutoff points, objective health aspects accounted for a relatively small part of the socioeconomic variability in self-assessed health. More subjective aspects of health accounted for more of the variability.

Adolescent↗

PubMed2000

Education and nutrient intake in Dutch elderly people. The Rotterdam Study.

OBJECTIVE: Unfavourable dietary habits might explain a part of the increased cardiovascular morbidity and mortality among the lower socioeconomic groups. The aim of the study was to describe differences in dietary intake in older subjects by socioeconomic status, as indicated by educational level. DESIGN: A cross-sectional analysis of socioeconomic status in relation to dietary intake. SETTING: The Rotterdam Study. SUBJECTS: 2213 men and 3193 women, aged 55 y and over living between 1990 and 1993 in a district of Rotterdam, The Netherlands. METHODS: Dietary data were assessed with a semiquantitative food frequency questionnaire, containing 170 food items in 13 food groups. RESULTS: In general, the dietary differences between socioeconomic groups were small. Lower educated subjects had a higher intake of almost all macronutrients compared with higher educated subjects. The total energy intake of men/women with the lowest educational level differed from those with the highest education in the following respect: 9.60/7.54 vs 8.94/7.17 MJ/day. Furthermore, fat composition was more adverse in the lower educated strata; in lower educated subjects, relatively more energy was derived from saturated fat (14.5/14.6 vs 13.8/13.8 energy%), the ratio of polyunsaturated saturated fat was lower (for men: 0.50 vs 0. 55) and the intake of cholesterol higher (271/220 vs 240/204 mg/day). These differences could be explained by a higher intake of visible fat (46/37 vs 44/34 g/day) and more meat consumption (130/100 vs 116/86 g/day). In addition, the composition of these products differed: the higher educated used relatively more lean meat and low-fat milk products. Furthermore, the intake of fibre was lower among the lower educated (1.88/2.17 vs 2.03/2.29 g/MJ). Among lower educated groups there were more abstainers (15.5/31.5 vs 12.3/26.9%) and the type of alcoholic beverages also differed between the groups. Intake of antioxidant vitamins from food alone did not differ between educational groups. CONCLUSIONS: In Dutch elderly people, there are socioeconomic differences in dietary intake. Although these differences are small, these findings support the role of diet in the explanation of socioeconomic inequalities in cardiovascular health. SPONSORSHIP: Erasmus Centre for Research on Aging, Erasmus University Rotterdam. European Journal of Clinical Nutrition (2000) 54, 159-165

Aged↗

PubMed2000

Drinking patterns and health outcomes: occasional versus regular drinking.

AIMS: To compare the health of drinkers with different drinking patterns and particularly drinkers with comparable average intakes and different drinking frequency. SETTING: General population survey conduced in Eindhoven, the Netherlands (n = 18,973). MEASUREMENTS: Chronic conditions, perceived general health, and health complaints were the outcome measures. Drinking categories were constructed by taking into account the frequency and amount of alcohol consumption (up to six glasses per sitting). FINDINGS: Drinking 3-5 days per week/3-5 glasses per occasion and drinking 6-7 days/1-2 glasses were associated with lower likelihood for reporting health complaints and for perceiving one's health as less than good compared to those drinking 1-2 days/1-2 glasses (reference group). Drinking 1-2 days/6 glasses was associated with being more likely to report chronic conditions, compared to the reference group. Those drinking 1-2 days/6 glasses were significantly more likely to report > 3 health complaints than those drinking 6-7 days/1-2 glasses. Although no differences were observed for any of the other comparison groups, at high levels of consumption (18-35 units/week), occasional drinkers (3-5 days/6 glasses) seemed to have better health outcomes compared to their counterparts (6-7 days/3-5 glasses). CONCLUSION: In addition to average alcohol intake, drinking pattern is also related to health.

Adolescent↗

PubMed2000

Adverse working conditions and alcohol use in men and women.

OBJECTIVE: This study examined the association between adverse working conditions and abstinence and heavy drinking. METHODS: The study was a cross-sectional study within the framework of a general population survey conducted in Eindhoven, The Netherlands (N = 7533). Working conditions were classified into four domains: hazardous physical working conditions, demands at work, level of control over one's job, and support from coworkers and supervisors. Abstainers were compared with drinkers; within drinkers, heavy drinkers were compared with light-moderate drinkers, and those who reported binge drinking were compared with those who did not report binge drinking. RESULTS: Respondents who reported adverse working conditions were as likely to be abstainers as they were to be drinkers. Within drinkers, males and females who reported high hazardous physical working conditions were more likely to be heavy drinkers than to be light-moderate drinkers (light-moderate is not just an amount, but a combination of amount and frequency) and to report binge drinking (males only). Respondents who reported high demands were also more likely to be heavy drinkers than to be light-moderate drinkers. CONCLUSIONS: Stressful circumstances, such as adverse working conditions, were associated with high levels of alcohol intake among drinking men and women.

Aged↗

PubMed2000

Employment grade differences in cause specific mortality. A 25 year follow up of civil servants from the first Whitehall study.

STUDY OBJECTIVE: To test the hypothesis that the association between socioeconomic status and mortality rates cuts across the major causes of death for middle aged and elderly men. DESIGN: 25 year follow up of mortality in relation to employment grade. SETTING: The first Whitehall study. PARTICIPANTS: 18,001 male civil servants aged 40-69 years who attended the initial screening between 1967 and 1970 and were followed up for at least 25 years. MAIN OUTCOME MEASURE: Specific causes of death. RESULTS: After more than 25 years of follow up of civil servants, aged 40-69 years at entry to the study, employment grade differences still exist in total mortality and for nearly all specific causes of death. Main risk factors (cholesterol, smoking, systolic blood pressure, glucose intolerance and diabetes) could only explain one third of this gradient. Comparing the older retired group with the younger pre-retirement group, the differentials in mortality remained but were less pronounced. The largest decline was seen for chronic bronchitis, gastrointestinal diseases and genitourinary diseases. CONCLUSIONS: Differentials in mortality persist at older ages for almost all causes of death.

Administrative Personnel↗

PubMed2000

Smoking and the compression of morbidity.

OBJECTIVE: To examine whether eliminating smoking will lead to a reduction in the number of years lived with disability (that is, absolute compression of morbidity). DESIGN: Multistate life table calculations based on the longitudinal GLOBE study (the Netherlands) combined with the Longitudinal Study of Aging (LSOA, United States of America). SETTING: the Netherlands. SUBJECTS: Dutch nationals aged 30-74 years living in the city of Eindhoven and surrounding municipalities (GLOBE) and United States citizens age 70 and over (LSOA). MAIN OUTCOME MEASURES: Life expectancy with and without disability and total life expectancy at ages 30 and 70. RESULTS: A non-smoking population on balance spends fewer years with disability than a mixed smoking-non-smoking population. Although non-smokers have lower mortality risks and thus are exposed to disability over a longer period of time, their lower incidence of disability and higher recovery from disability yield a net reduction of the length of time spent with disability (at age 30: -0.9 years in men and -1.1 years in women) and increases the length of time lived without disability (2.5 and 1.9 years, for men and women, respectively). These outcomes indicate that elimination of smoking will extend life and the period of disability free life, and will compress disability into a shorter period. CONCLUSIONS: Eliminating smoking will not only extend life and result in an increase in the number of years lived without disability, but will also compress disability into a shorter period. This implies that the commonly found trade off between longer life and a longer period with disability does not apply. Interventions to discourage smoking should receive high priority.

Adult↗

PubMed2000

Prevalence, treatment, and control of hypertension by sociodemographic factors among the Dutch elderly.

The study objective was to assess the prevalence, level of treatment, and control of hypertension in a general elderly population according to age and sociodemographic factors. We conducted a cross-sectional analysis of 7983 participants of the Rotterdam Study who were >/=55 years old and living in a district of Rotterdam. The prevalence of hypertension was based on blood pressure levels (>/=160/95 mm Hg) and the use of blood pressure-lowering medication for the indication of hypertension, type of treatment, and control of hypertension. Systolic blood pressure rises with age, whereas diastolic blood pressure declines. The prevalence of hypertension increases with age and was higher among women (39%) than among men (31%). About 80% of the hypertensives were aware of having hypertension, and 82% of the 80% were treated. For 70% of them, treatment was adequate with reference to conservative criteria. Hypertension was more prevalent among persons not living in a home for the elderly, for more-educated men, and for less-educated women. Persons without a partner and men living in a home for the elderly had a higher risk of being unaware of or of not being treated for existing hypertension. Treatment was more often successful among those living in a home for the elderly. The prevalence of hypertension was higher among older women and increased with age in both genders. A large proportion of hypertensive elderly persons were aware and were successfully treated for hypertension. The degree of awareness and control appeared to be affected by sociodemographic factors. More importantly, the majority of hypertensives did not have their hypertension well controlled. This group requires more attention by medical practitioners to reduce the burden of cardiovascular diseases in elderly persons.

Aged↗

PubMed1999

Socioeconomic status and aortic atherosclerosis in Dutch elderly people: the Rotterdam Study.

An inverse association has been reported between socioeconomic status (SES) and cardiovascular morbidity and mortality. Studies on subclinical manifestations of atherosclerotic disease are limited and have not been carried out among elderly persons. The authors investigated the relation between SES and aortic atherosclerosis among elderly people. As part of the Rotterdam Study, data on SES and atherosclerosis were collected for 4,451 persons aged 55-94 years. Atherosclerosis was estimated by radiographic assessment of calcified deposits in the abdominal aorta. Aortic atherosclerosis was more common among women in the lower educational and occupational strata. The lowest educational group and the lowest occupational group had increased risks of aortic atherosclerosis compared with the highest groups (odds ratios were 1.3 (95% confidence interval (CI) 1.0-1.6) and 1.3 (95% CI 1.0-1.8), respectively). The odds ratios for severe atherosclerosis among women in the lowest socioeconomic stratum compared with those in the highest stratum were 1.6 (95% CI 1.0-2.7) for education, 2.8 (95% CI 1.1-7.5) for occupation, and 1.7 (95% CI 0.9-3.3) for income. After exclusion of persons with a history of cardiovascular disease, the same trends still emerged. No relations were observed among men. These findings show that SES is related to aortic atherosclerosis in women. This suggests that SES affects the incidence of cardiovascular disease before its clinical manifestation.

Age Factors↗

PubMed1999

The influence of adult ill health on occupational class mobility and mobility out of and into employment in the The Netherlands.

In the debate about the explanation of socio-economic health inequalities one of the important issues is the relative importance of health selection. The aim of this study was to investigate to what extent occupational class mobility and mobility out of and into employment are health-related, and in addition, to estimate the contribution of health-related social mobility to socio-economic health differences in the working population. Data were taken from the Longitudinal Study on Socio-Economic Health Differences in the Netherlands, which started in 1991; follow-up data were collected in 1995. The analysis is based on 2533 persons aged 15-59 at baseline. The influence of health problems in 1991 (perceived general health, health complaints and chronic conditions) on changes in occupational class between 1991 and 1995 was negligible. Neither upward nor downward mobility was affected by health problems. However, health problems in 1991 were significantly associated with a higher risk of mobility out of employment and a lower risk of mobility into employment in 1995. For example, for mobility out of employment among persons that reported at least one chronic condition in 1991, the odds ratio was 1.46. Health-related mobility out of employment substantially influences the estimate of socio-economic health inequalities in the working population (measured by current occupation). For manual workers, as compared to non-manual workers, the odds ratio for a less-than-good perceived general health was underestimated by 34% in 1995. Selective mobility into employment overestimates socio-economic inequalities in health in the working population by 9%. Respondents that moved into and out of employment were healthier than those that remained economically inactive, but their health was worse than of those that remained employed (both manual and non-manual). Implications for health policy are that the prospects for people with health problems to stay in paid employment should be improved.

Adolescent↗

PubMed1999

Socioeconomic differences in stroke among Dutch elderly women: the Rotterdam Study.

BACKGROUND AND PURPOSE: We sought to assess the association between socioeconomic status and the risk of stroke among elderly women. Methods--The association between socioeconomic status and stroke emerged in cross-sectional and longitudinal data on 4274 female participants of the Rotterdam Study, a prospective, population-based, follow-up study in the Netherlands among older subjects. RESULTS: A history of stroke was more common among women in lower socioeconomic strata. The same trend was observed for the relationship between the lowest socioeconomic groups and the incidence of stroke. Risk factors for stroke were not related to socioeconomic status in a consistent manner. Smoking, history of cardiovascular diseases, and overweight were more common in lower socioeconomic groups. However, socioeconomic differences in hypertension, antihypertensive drug use, prevalence of atrial fibrillation, and prevalence of left ventricular hypertrophy were not observed. The complex of established risk factors could only partly explain the association between socioeconomic status and stroke. CONCLUSIONS: There is a strong association among elderly women between socioeconomic status and stroke. The association could only partly be explained by known risk factors. Our findings indicate that not only the actual risk profile but also risk factors earlier in life may be of importance.

Aged↗

PubMed1999

Education and the incidence of dementia in a large population-based study: the Rotterdam Study.

We assessed the risk of dementia by educational level in a prospective population-based study. In the Rotterdam Study, 6,827 nondemented participants with known education level were followed for an average of 2.1 years. During this period, 137 new cases of dementia occurred. Low education was associated with higher dementia risk in women but not in men, suggesting that the association is modified by sex. Our data indicate that cross-sectional studies may overrate the association between education and risk of dementia.

Age Distribution↗

PubMed1999

The U-shaped curve: various health measures and alcohol drinking patterns.

OBJECTIVE: To determine whether the well-known U-shaped relationship between average alcohol intake and mortality also holds for other health measures and for aspects of drinking other than weekly average alcohol intake, such as frequency of heavy-drinking episodes. METHOD: This study was carried out within the framework of a general population survey conducted in Eindhoven, The Netherlands (N = 18,973). Apart from mortality, the following health measures were considered: self-assessed health (based on perceived general health and the Nottingham Health Profile questionnaire), a list of chronic conditions and a list of health complaints. Respondents were categorized as abstainers, light (1-14 units/week), moderate (15-28 units/week) and excessive drinkers (> or =29 units/week). Information on the frequency with which heavy-drinking episodes occurred was also available. RESULTS: Light or moderate drinkers had not only lower mortality but other health burdens were lower than for either abstainers or heavier drinkers. Frequent heavy-drinking episodes were observed to be directly related to increased mortality rates, although not significantly. A trend was observed for drinkers reporting seldom heavy-drinking episodes (once or twice in the previous 6 months) to report less health burdens and to have lower mortality rates than those reporting no heavy drinking episodes. CONCLUSIONS: A U-shaped pattern was observed for mortality as well as for several other health measures. Frequent heavy-drinking episodes were related to an increased likelihood of mortality (not significant but suggesting a J-shaped pattern) and were not related to other health measures.

Adolescent↗

PubMed1998

Educational differences in leisure-time physical inactivity: a descriptive and explanatory study.

In this study we aim to explain educational differences in leisure-time physical inactivity in terms of psychosocial and material factors. Cross-sectional data were obtained from the baseline of the Dutch GLOBE study in 1991, including 2598 men and women, aged 15-74 years. Physical inactivity during leisure time was defined as not participating in any activity, such as sports, gardening, walking or cycling. Psychosocial factors included in the study were coping resources, personality, and stressors. Material factors were financial situation, employment status, and living conditions. Logistic regression models were used to calculate educational differences in physical inactivity. Physical inactivity was more prevalent in lower educational groups. Psychosocial factors related to physical inactivity were locus of control, parochialism, neuroticism, emotional social support, active problem focussing, optimistic and palliative coping styles. Material factors associated with physical inactivity were income, employment status and financial problems. All correlates of physical inactivity were unequally distributed over educational groups, except optimistic and palliative coping. Personality and coping style were the main contributors to the observed educational differences in physical inactivity. That is to say, parochialism, locus of control, neuroticism and active problem focussing explained about half of elevated odds ratios of physical inactivity in the lower educational groups. The material factors, equivalent income and employment status explained about 40% of the elevated odds ratios. Psychosocial and material correlates together reduced the odds ratios of lower educational groups by on average 75%. These results have practical consequences for the design of more effective interventions to promote physical activity. In particular, personality and coping style of risk groups, such as lower educational groups, should be taken into consideration at the future development of these interventions, as well as inequalities in material restrictions related to engaging in physical activity. Supplementary interventions focussing on childhood conditions which, partly, influence both personality and physical inactivity may also contribute to a reduction of socio-economic differences in physical inactivity.

Adaptation, Psychological↗

PubMed1998

Does childhood socioeconomic status influence adult health through behavioural factors?

BACKGROUND: The purpose of this study is to assess to what extent the effect of childhood socioeconomic status on adult health could be explained by a higher prevalence of unhealthy behaviour among those with lower childhood socioeconomic status. METHODS: Data were obtained from the baseline of a prospective cohort study in the Netherlands (13 854 respondents, aged between 25 and 74). Childhood socioeconomic group was indicated by occupation of the father, and adult health was indicated by perceived general health, health complaints and mortality. Adult socioeconomic status was measured by current occupation. Behavioural factors were smoking, alcohol consumption, Body Mass Index and physical activity. Relations were analysed using logistic regression models. RESULTS: A clear association between childhood socioeconomic circumstances and adult health was shown, as well as an association between childhood socioeconomic circumstances and health-related behaviour, even after adjustment for current socioeconomic status. Physical activity shows the strongest relation with childhood socioeconomic circumstances. Behavioural factors explain the relation between childhood socioeconomic status and adult health for approximately 10%. CONCLUSIONS: Childhood socioeconomic circumstances have an independent effect on adult health and health-related behaviour: the risk of health problems and health damaging behaviour is higher in lower childhood socioeconomic groups. The independent effect of childhood circumstances on adult health operates for a small part through unhealthy behaviour.

Adolescent↗

PubMed1998

Role of childhood health in the explanation of socioeconomic inequalities in early adult health.

STUDY OBJECTIVE: To examine the contribution of childhood health to the explanation of socioeconomic inequalities in health in early adult life. DESIGN: Retrospective data were used, which were obtained from a postal survey in the baseline of a prospective cohort study (the Longitudinal Study on Socio-Economic Health Differences in the Netherlands). Adult socioeconomic status was indicated by educational level, while health was indicated by perceived general health. Childhood health was measured by self reported periods of severe disease in childhood. Relations were analysed using logistic regression models. The reduction in odds ratios of "less than good" perceived general health for different educational groups after adjustment for childhood health was used to estimate the contribution of childhood health. SETTING: The population of the city of Eindhoven and surroundings in the south east of the Netherlands in 1991. PARTICIPANTS: 2511 respondents, aged 25-34 years, men and women, of Dutch nationality, were included in the analysis. MAIN RESULTS: There was a clear association between childhood health and adult health, as well as an association between childhood health and adult socioeconomic status. Approximately 5% to 10% of the increased risk of the lower socioeconomic groups of having a "less than good" perceived general health can be explained by childhood health. CONCLUSIONS: Childhood health contributes to the explanation of socioeconomic inequalities in early adult health. Although this contribution is not very large, it cannot be ignored and has to be interpreted largely in terms of selection on health.

Adolescent↗