Neighborhood social and physical environment and general practitioner assessed morbidity

The aim of our study was to investigate the association between health enhancing and threatening, and social and physical aspects of the neighbourhood environment and general practitioner (GP) assessed morbidity of the people living there, in order to find out whether the effects of environmental characteristics add up or modify each other. We combined GP electronic health records with environmental data on neighbourhoods in the Netherlands. Cross-classified logistic multilevel models show the importance of taking into account several environmental characteristics and confounders, as social capital effects on the prevalence of morbidity disappear when other area characteristics are taken into account. Stratification by area socio-economic status, shows that the association between environmental characteristics and the prevalence of morbidity is stronger for people living in low SES areas. In low SES areas, green space seems to alleviate effects of air pollution on the prevalence of high blood pressure and diabetes, while the effects of green space and social capital reinforce each other

The role of health literacy in explaining the association between educational attainment and the use of out-of-hours primary care services in chronically ill people: a survey study

Abstract Background Low socioeconomic status (SES) is persistently associated with poor health and suboptimal use of healthcare services, and more unplanned healthcare use. Suboptimal use of emergency and acute healthcare services may increase health inequalities, due to late diagnosis or lack of continuity of care. Given that health literacy has been associated with healthcare utilisation and with education attainment, we sought to explore whether health literacy is related to the use of out-of-hours (OOH) Primary Care Services (PCSs). Additionally, we aimed to study whether and to what extent health literacy accounts for some of the association between education and OOH PSC use. Methods A survey including measures of education attainment, health literacy (assessed by means of the Dutch version of the nine-dimension Health Literacy Questionnaire) and use of PCS was conducted among a sample of adults diagnosed with (any) somatic chronic condition in the Netherlands (response 76.3%, n = 1811). We conducted linear and logistic regression analyses to examine associations between education level and PCS use in the past year. We performed mediation analyses to assess whether the association between education and PCS use was (partly) explained by different aspects of health literacy. We adjusted the models for patient characteristics such as age and morbidity. Results Higher education attainment was associated with higher scores on the health literacy aspects Appraisal of health information, and Navigating the healthcare system. Additionally, appraisal and navigating the healthcare system partially accounted for educational differences in PCS use. Finally, higher appraisal of health information scores were associated with higher PCS utilisation. Conclusion Several aspects of health literacy were demonstrated to relate to PCS use, and partly accounted for educational differences herein. Accordingly, developing health literacy within individuals or communities may help to reduce inappropriate PCS use among people with low education

Social capital, collective efficacy and the provision of services and amenities by municipalities.

Differential provision of local services and amenities has been proposed as a mechanism behind the relationship between social capital and health. The aim of this study was to investigate whether social capital and collective efficacy are related to the provision of social support services and amenities in Dutch municipalities, against a background of decentralisation of long-term care to municipalities. We used data on neighbourhood social capital, collective efficacy (the extent to which people are willing to work for the common good), and the provision of services and amenities in 2012. We included the services municipalities provide to support informal caregivers (e.g. respite care), individual services and support (e.g. domiciliary help), and general and collective services and amenities (e.g. lending point for wheelchairs). Data for social capital were collected between May 2011 and September 2012. Social capital was measured by focusing on contacts between neighbours. A social capital measure was estimated for 414 municipalities with ecometric measurements. A measure of collective efficacy was constructed based on information about the experienced responsibility for the liveability of the neighbourhood by residents in 2012, average charity collection returns in municipalities in 2012, voter turnout at the municipal elections in 2010 and the percentage of blood donors in 2012. We conducted Poisson regression and negative binomial regression to test our hypotheses. We found no relationship between social capital and the provision of services and amenities in municipalities. We found an interaction effect (coefficient = 3.11, 95% CI = 0.72–5.51, P = 0.011) of social capital and collective efficacy on the provision of support services for informal caregivers in rural municipalities. To gain more insight in the relationship between social capital and health, it will be important to study the relationship between social capital and differential provision of services and amenities more extensively and in different contexts. (aut. ref.

Influence of municipal policy and individual characteristics on the use of informal and formal domestic help in the Netherlands.

Background: The responsibility for care and social support in the Netherlands has been decentralized to the municipalities, on the assumption that they are able to organise care and social support more effectively and efficiently. Municipalities are responsible for offering citizens the social support they need. They have policy discretion to decide how and to what extent they encourage and support the use of informal help. This article explored whether the local policy focus on informal or formal help influences the actual take-up of domestic help. Methods: Data on 567 physically disabled people who use informal or formal help in the household were linked to local policy data in 167 municipalities. We performed multilevel multinomial regression analyses. Since we expected that local policy will have more influence on people with slight or moderate disabilities, cohabitees and people aged under 75, cross-level interaction terms were included between characteristics of local policy and of individuals. Results: The findings reveal differences between municipalities in their policy on support and differences in the use of formal or informal support between municipalities. Conclusions: We found no relationship between local emphasis on informal help and the use of informal help. Possible explanations: some people have a small social network, people using informal help did not apply for municipality support or even do not know the possibility exists. (aut. ref.

Werk en Inkomen: kerngegevens en trends. Rapportage 2013.

Mensen met een chronische ziekte of beperking hebben minder te besteden dan de algemene bevolking en maken daarbij nog extra kosten vanwege hun ziekte of beperking. Een kwart van hen moet spaargeld aanspreken om rond te komen of komt zelfs rood te staan. Dit ondanks de diverse inkomensondersteunende maatregelen die er voor deze groep bestaan. Vanaf 2014 zullen de meeste huidige tegemoetkomingsregelingen vervangen worden door één regeling die de gemeenten gaan uitvoeren. Mensen met een chronische ziekte of beperking hebben gemiddeld een lager inkomen dan de algemene bevolking. Daarnaast hebben zij extra uitgaven vanwege hun gezondheid. Een kwart van hen moest in 2012 spaargeld aanspreken om rond te komen of maakte hiervoor zelfs schulden. En één op de vijf gaf aan niet voldoende geld te hebben om ‘mee te doen’, ondanks de diverse inkomensondersteunende maatregelen die er voor deze groep bestaan. Dit blijkt uit de rapportage Werk en Inkomen van de Monitor zorg- en leefsituatie van mensen met een chronische ziekte of beperking van het NIVEL (Nederlands instituut voor onderzoek van de gezondheidszorg). Inkomen Gemiddeld bedroeg het – zelf gerapporteerde – besteedbaar inkomen van mensen met een chronische ziekte of beperking in 2011 1427 euro per maand (berekend voor een eenpersoonshuishouden). Onder jongere mensen met een chronische ziekte of beperking en onder lager opgeleiden lag het besteedbare inkomen lager. Onder ouderen en hoger opgeleiden hoger. Uitgaven Bijna alle mensen met een chronische ziekte of beperking (94%) hadden in 2011 eigen uitgaven vanwege de gezondheid, bovenop de door hen betaalde premie voor de zorgverzekering. Gemiddeld genomen ging het dan om een bedrag van ruim 1000 euro. Vooral mensen met ernstige beperkingen hebben hoge extra uitgaven, gemiddeld zo’n 150 euro per maand. Een flink deel hiervan geven zij uit aan hulpmiddelen of aanpassingen. Van alle mensen met een chronische ziekte of beperking had ruim de helft in 2011 eigen uitgaven aan hulpmiddelen of aanpassingen, gemiddeld ruim 600 euro. Eigen uitgaven aan brillen, lenzen, steunzolen en loophulpmiddelen kwamen het meest voor. Minder vaak voorkomend maar dan wel fors hoger, waren de eigen uitgaven aan aanpassingen aan de woning of auto, aangepast meubilair, een scootmobiel of aangepaste fiets en aan hoortoestellen. Compensatie Op dit moment bestaan er verschillende regelingen waardoor mensen met een chronische ziekte of beperking een tegemoetkoming kunnen krijgen in de hogere kosten die zij hebben vanwege hun ziekte of beperking, zoals de Compensatie Eigen Risico, de Wet tegemoetkoming chronisch zieken en gehandicapten (Wtcg) en de fiscale regeling voor de aftrek van specifieke zorgkosten. In 2011 ontving bijna twee derde (64%) van de mensen met een chronische ziekte of lichamelijke beperking naar eigen zeggen een bedrag als Compensatie Eigen Risico, de helft ontving een algemene tegemoetkoming vanuit de Wtcg en ruim een derde (38%) maakte gebruik van de aftrekregeling voor specifieke zorgkosten. 2014 Vanaf 2014 zullen deze regelingen vervangen worden door één regeling, die door de gemeenten zal worden uitgevoerd. Behalve besparing, hoopt het kabinet dat hierdoor meer maatwerk kan worden geleverd, zodat het geld terecht komt bij wie dat echt nodig heeft. NIVEL-programmaleider Mieke Rijken: “Het is heel belangrijk dat we precies nagaan welke gevolgen deze veranderingen hebben voor mensen met een chronische ziekte of beperking. Gemeenten krijgen een grote vrijheid in de uitvoering van de nieuwe regeling. Dat is nodig om maatwerk te kunnen leveren, maar kan tegelijkertijd tot onwenselijke verschillen leiden. Door ook de komende jaren onze peilingen voort te zetten, kunnen we nagaan of de nieuwe decentrale regeling aan zijn doelstelling beantwoordt.” Onderzoek De gegevens voor dit onderzoek werden verzameld bij het Nationaal Panel Chronisch zieken en Gehandicapten (NPCG), dat bestaat uit circa 3500 mensen met (medisch vastgestelde) chronische ziekten en/of matige tot ernstige lichamelijke beperkingen. De panelleden doen tenminste twee keer per jaar mee aan een enquête. De ‘Monitor zorg- en leefsituatie van mensen met een chronische ziekte of beperking’, waarvan dit onderzoek deel uitmaakt, wordt uitgevoerd door het NIVEL met subsidie van het ministerie van Volksgezondheid, Welzijn en Sport en het ministerie van Sociale Zaken en Werkgelegenheid

A prospective analysis of the effect of neighbourhood and individual social capital on changes in self-rated health of people with chronic illness.

Background: Social capital in the living environment, both on the individual and neighbourhood level, is positively associated with people's self-rated health; however, prospective and longitudinal studies are rare, making causal conclusions difficult. To shed more light on the direction of the relationship between social capital and self-rated health, we investigated main and interaction effects of individual and neighbourhood social capital at baseline on changes in self-rated health of people with a somatic chronic disease. Methods: Individual social capital, self-rated health and other individual level variables were assessed among a nationwide sample of 1048 non-institutionalized people with a somatic chronic disease residing in 259 neighbourhoods in the Netherlands. The assessment of neighbourhood social capital was based on data from a nationwide survey among the general Dutch population. The association of social capital with changes in self-rated health was assessed by multilevel regression analysis. Results: Both individual social capital and neighbourhood social capital at baseline were significantly associated with changes in self-rated health over the time period of 2005 to 2008 while controlling for several disease characteristics, other individual level and neighbourhood level characteristics. No significant interactions were found between social capital on the individual and on the neighbourhood level. Conclusions: Higher levels of individual and neighbourhood social capital independently and positively affect changes in self-rated health of people with chronic illness. Although most of the variation in health is explained at the individual level, one's social environment should be considered as a possible relevant influence on the health of the chronically ill. (aut.ref.

A prospective analysis of the effect of neighbourhood and individual social capital on changes in self-rated health of people with chronic illness

Background: Social capital in the living environment, both on the individual and neighbourhood level, is positively associated with people’s self-rated health; however, prospective and longitudinal studies are rare, making causal conclusions difficult. To shed more light on the direction of the relationship between social capital and self-rated health, we investigated main and interaction effects of individual and neighbourhood social capital at baseline on changes in self-rated health of people with a somatic chronic disease. Methods: Individual social capital, self-rated health and other individual level variables were assessed among a nationwide sample of 1048 non-institutionalized people with a somatic chronic disease residing in 259 neighbourhoods in the Netherlands. The assessment of neighbourhood social capital was based on data from a nationwide survey among the general Dutch population. The association of social capital with changes in self-rated health was assessed by multilevel regression analysis. Results: Both individual social capital and neighbourhood social capital at baseline were significantly associated with changes in self-rated health over the time period of 2005 to 2008 while controlling for several disease characteristics, other individual level and neighbourhood level characteristics. No significant interactions were found between social capital on the individual and on the neighbourhood level. Conclusions: Higher levels of individual and neighbourhood social capital independently and positively affect changes in self-rated health of people with chronic illness. Although most of the variation in health is explained at the individual level, one’s social environment should be considered as a possible relevant influence on the health of the chronically ill