Involving hard-to-reach ethnic minorities in low-budget health research: lessons from a health survey among Moluccans in the Netherlands

There is little evidence on which strategies are effective in recruiting minority groups in low-budget health surveys. We evaluated different recruitment strategies for their impact on response rates in a hard-to-reach minority population in the Netherlands. We conducted a health survey in 19 Moluccan districts (MDs). Each MD had its own set of recruitment strategies, such as information meetings, involving social or local media, involving community organizations, and door-to-door collection. The association between recruitment strategies and MD-specific response rates was assessed with logistic regression analysis. The overall response rate was 24 %, and varied from 9 to 58 %. Higher rates were obtained when the strategy included door-to-door collection (OR 1.57) and 'active' key informants (OR 1.68). No positive associations with response rates were observed of the other strategies. The overall low response rate in this study may be due to high levels of distrust, segmentation within the community and high respect for privacy among Moluccans. Our study shows that in such communities, response may be increased by a highly personal recruitment approach and a strong commitment and participation of community key-figure

All-cause mortality among three generations of Moluccans in the Netherlands

BACKGROUND: Mortality variations have been reported for ethnic minority groups compared with their host populations. It is uncertain how this mortality variations change over time as younger generations become older and mix with the host population. This study aimed to examine all-cause mortality among three generations of Moluccans in the Netherlands, and to compare Moluccans with a mixed and non-mixed ethnic background. METHODS: We used data from the death and municipality registry for the years 2000 through 2013, including all registered Dutch inhabitants. A list of Moluccan surnames was used to select the Moluccan population. Mortality differences were calculated by Poisson regression, controlling for sex, age and district socio-economic status. RESULTS: High all-cause mortality rates were observed in all generations of Moluccans although the extent of the differences between Moluccans and the Dutch were smaller in second (1.15, 1.07-1.23) and third generation (1.14, 1.00-1.29) compared with the first generation (1.55, 1.49-1.60). Higher all-cause mortality is also reflected in the higher mortality from most causes of death except neoplasms and external causes. Both mixed and non-mixed Moluccans showed high all-cause mortality among the first (child) and second generation compared with the Dutch. CONCLUSION: Our findings show a higher all-cause mortality in three generations of Moluccans compared with the Dutch. The results show that mortality inequalities may persist, though in an attenuated form, over generations among ethnic minorities

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

<div><p>Objective</p><p>Studies regularly show a higher incidence, prevalence and mortality of cardiovascular disease among immigrant groups from low-income countries. Despite residing in the Netherlands for over 60 years, the Moluccan-Dutch cardiovascular disease profile and health care use are still unknown. We aimed to compare (a) the clinical prevalence of cardiovascular diseases and (b) the use of health care services by cardiovascular disease patients of 5,532 Moluccan-Dutch to an age-sex matched control group of 55,320 native Dutch.</p><p>Methods</p><p>We performed a cross-sectional analysis of data of the Achmea health insurance company for the period of 1 January 2009 to 31 December 2010. We collected information on health care use, including diagnostic information. Linear and logistic regression models were used for comparison.</p><p>Results</p><p>Moluccans had a higher clinical prevalence of ischemic heart diseases (odds ratio 1.26; 95% confidence interval 1.03–1.56), but tended to have a lower prevalence of cerebrovascular accidents (0.79; 0.56–1.11) and cardiac failure (0.67; 0.44–1.03). The clinical prevalence of cardiovascular diseases together tended to be lower among Moluccans (0.90; 0.80–1.00). Consultation of medical specialists did not differ. Angiotensin II inhibitors (1.42; 1.09–1.84), antiplatelet agents (1.27; 1.01–1.59) and statins (1.27; 1.00–1.60) were prescribed more frequently to Moluccans, as were cardiovascular agents in general (1.27; 0.94–1.71).</p><p>Conclusion</p><p>The experience of Moluccans in the Netherlands suggests that, in the long run, cardiovascular risk and related health care use of ethnic minority groups may converge towards that of the majority population.</p></div

Pin1 levels are downregulated during ER stress in human neuroblastoma cells

Previously, we showed that pretangle neurons in Alzheimer's disease (AD) brain display unfolded protein stress in the endoplasmic reticulum (ER). Others showed that the peptidylprolyl isomerase Pin1 protects against tangle formation by facilitating tau dephosphorylation, corroborating with the lower expression of Pin1 observed in tangle-bearing neurons. In this study, we investigated Pin1 expression under ER stress conditions. We show that in human, but not mouse neuroblastoma cells, Pin1 is downregulated in response to ER stress, in accordance with the presence of an ER stress response element in the mouse, but not the human Pin1 gene. This study creates a starting point to investigate whether modulation of the ER stress response may prevent or delay tau pathology in AD

Characteristics of the study populations.

<p>^a SES, socio-economic status</p><p>^b SD, standard deviation.</p><p>Characteristics of the study populations.</p

Clinical prevalence’s of cardiovascular disease and hypertension: Moluccans compared to Dutch.

<p>^a OR, odds ratio, estimated by logistic regression, controlled for gender, age, urbanization and SES</p><p>^b CI, confidence interval</p><p>^c ATC, anatomical therapeutic classification</p><p>OR with a p-value ≤ 0.05 is presented in bold.</p><p>Clinical prevalence’s of cardiovascular disease and hypertension: Moluccans compared to Dutch.</p

Percentage of Moluccan cardiovascular patients receiving cardiovascular agents compared to Dutch patients.

<p>^a OR, odds ratio, estimated by logistic regression, controlled for gender, age, urbanization and SES</p><p>^b CI, confidence interval</p><p>OR with a p-value ≤ 0.05 is presented in bold.</p><p>Percentage of Moluccan cardiovascular patients receiving cardiovascular agents compared to Dutch patients.</p

Mean number of medical specialist visits among Moluccans compared to Dutch.

<p>^a SD, standard deviation</p><p>^b RR, relative ratio, estimated by linear regression, controlled for gender, age, urbanization and SES</p><p>^c CI, confidence interval</p><p>RR with a p-value ≤ 0.05 is presented in bold.</p><p>Mean number of medical specialist visits among Moluccans compared to Dutch.</p