Smoking initiation, continuation and prevalence in deprived urban areas compared to non-deprived urban areas in The Netherlands

Previous studies have shown that smoking prevalence is higher in deprived areas than in affluent areas. We aimed to determine whether smoking initiation or continuation contributes most to inequalities in current smoking, and in which population subgroups these area differences were largest. Therefore, we assessed the relationship between area deprivation and current smoking, initiation and continuation in urban areas, in subgroups defined by gender, generation and educational level. Cross-sectional data of 20,603 Dutch adults (18 years and over) living in 963 urban areas in The Netherlands were obtained from the annual national health survey (2003-2009). Three interrelated smoking outcomes were used: current smoking (smokers/total population), initiation (ever-smokers/total population) and continuation (smokers/ever-smokers). Area deprivation was dichotomised; deprived urban areas (as defined by the Dutch government) and non-deprived urban areas (reference group) were distinguished. Multilevel logistic regression models controlled for individual characteristics (including education and income) and tested for interaction with gender, generation and education. After controlling for individual characteristics, odds for smoking were not significantly higher in deprived areas (current smoking: OR = 1.04 [0.92-1.18], initiation: OR = 1.05 [0.93-1.18], continuation: OR = 1.03 [0.88-1.19]). For smoking initiation, significant differences between deprived areas and other areas remained in younger generations (OR = 1.19 [1.02-1.38]) and higher educated (OR = 1.23 [1.04-1.45]) respondents. For continuation and current smoking, after controlling for individual characteristics, no associations were found in any subgroups. In conclusion, area deprivation appears to be independently related to smoking initiation in, respectively, higher educated and younger generations. These results suggest that initiatives to reduce area-level inequalities in smoking should focus on preventing smoking initiation in deprived area

Thuiszorg in aandachtswijken: wat is de rol van materiële welvaart?

To examine if there is a higher uptake of home care among residents of deprived districts and to determine if this can be attributed to the lower levels of income and wealth of these residents. Retrospective, descriptive study. The study focused on residents aged 50 and above. We obtained data on uptake of home care in 2007 from national care registries, which were combined with fiscal registry data on income and wealth. Postcode data were used to distinguish between 40 'deprived' districts and all other Dutch districts. In the deprived districts more residents received home care than in other districts. This difference was greatest among residents aged 50 to 69 years. After correction for age, sex and country of origin, the difference was substantial (odds ratio (OR): 1.31). After correction for differences in income this difference was halved (OR: 1.17).The difference was further strongly reduced after correction for wealth (OR: 1.06). In deprived districts there was a higher uptake of domestic care (OR: 1.12) but the inverse was true for personal care (OR: 0.95). The latter was most marked in residents aged 80 and above (OR: 0.88). The higher uptake of home care among residents of deprived districts can be attributed to low levels of income and wealth. In the Netherlands, changes in home care arrangements at national and local level should take into account people with financial problems and the districts in which they liv

The impact of area-based initiatives on physical activity trends in deprived areas; a quasi-experimental evaluation of the Dutch District Approach

Numerous area-based initiatives (ABIs) have been implemented in deprived neighbourhoods across Europe. These large-scale initiatives aim to tackle the socio-economic and environmental problems in these areas that might influence physical activity (PA). There is little robust evidence of their impact on PA. This study aimed to assess the impact of a Dutch ABI called the District Approach on trends in leisure-time PA in deprived districts. Repeated cross-sectional data on 48401 adults across the Netherlands were obtained from the Integrated Survey on Household Living Conditions (POLS) 2004-2011. 1517 of these adults resided in deprived target districts and 46884 adults resided elsewhere in the Netherlands. In a quasi-experimental interrupted time-series design, multilevel logistic regression analyses were performed to assess trends in leisure-time walking, cycling, and sports before and during the intervention. Trends in deprived target districts were compared with trends in various control groups. The role of the intensity of environmental interventions was also assessed. Deprived target districts showed a significantly positive change in walking trend between the pre-intervention and intervention period. The trend change in the deprived target districts was significantly larger compared to the rest of the Netherlands, but not compared to other deprived districts. For cycling and sports, neither deprived districts nor control districts showed a significant trend change. For all leisure-time PA outcomes, trend changes were not related to the intensity of environmental interventions in the deprived target districts. Some evidence was found to suggest that ABIs like the District Approach have a positive impact on leisure-time PA in deprived districts, regardless of the intensity of environmental intervention

Langdurig gebruik van tweedegeneratieantidepressiva en rijvaardigheid

De vraag of het gebruik van tweedegeneratieantidepressiva effect heeft op de rijvaardigheid van patiënten met een klinische depressie is nog niet beantwoord. De conclusies uit epidemiologisch onderzoek zijn niet eenduidig. Experimentele studies laten weinig invloed zien van tweedegeneratieantidepressiva op de rijvaardigheid, maar deze studies wijken vaak methodologisch af van de klinische praktijk. Dit artikel beschrijft de uitkomsten van een onderzoek naar de effecten van een langdurige behandeling (6–52 weken) met tweedegeneratieantidepressiva in een steekproef van klinisch depressieve patiënten. Patiënten die werden behandeld met een medicijn uit deze groep (n = 24) werden vergeleken met patiënten die chronisch behandeld werden met een benzodiazepine (n = 31), een onbehandelde patiëntengroep (n = 10) en een controlegroep van gezonde vrijwilligers (n = 24). De uitkomsten tonen aan dat de eerste groep significant beter presteerde op een gestandaardiseerde rijtest op de weg dan de andere twee patiëntengroepen, maar dat deze groep het nog steeds slechter deed dan de controlegroep. Een correlatieanalyse liet een verband zien tussen de ernst van de depressie en de prestatie op de rijtest. De conclusie is dan ook dat depressieve klachten een probleem vormen voor de rijveiligheid en dat een behandeling met een tweedegeneratieantidepressivum dit risico kan doen afnemen

Why residents of Dutch deprived neighbourhoods are less likely to be heavy drinkers: the role of individual and contextual characteristics

Earlier research has shown that residents of Dutch deprived neighbourhoods drink less alcohol than people in other areas. We aimed to assess the role of individual and neighbourhood characteristics in a cross-sectional, nationwide, multilevel study. Individual data of 30,117 Dutch adults, living in 1722 neighbourhoods across the Netherlands, were obtained from the 2004 to 2009 national health survey (POLS). Chronic heavy alcohol consumption was measured as ≥14 drinks/week for women and ≥21 for men, and episodic heavy drinking as ≥6 drinks/day at least once a week. Neighbourhood deprivation was dichotomous; deprived districts as selected by the Dutch government versus other areas. Multilevel logistic regression models of the association between deprivation and heavy drinking were corrected for age, gender, household composition, population density and potential predictors ethnicity, socioeconomic status (education, income), neighbourhood-level social cohesion and percentage Muslims. The prevalence of heavy drinking was lower in deprived neighbourhoods than in the rest of the Netherlands. This association was found for both chronic and episodic heavy drinking (OR=0.58 (0.47 to 0.72) and OR=0.57 (0.45 to 0.72), respectively). Adding ethnicity to the model reduced these associations by approximately one half. Socioeconomic composition did not contribute to the relationship. The proportion of Muslims explained a small part, while social cohesion explained even less of the association. Stronger associations were observed for women and older adults than for men and younger adults. The lower prevalence of heavy drinking occurring in deprived areas is largely explained by the ethnicity of neighbourhood resident

ROI-based RMANOVA results.

<p><b>Each panel depicts the color-coded RMANOVA F-values of the pairwise ROI functional connections for factors Drug (A), Time (B) and Drug x Time (C).</b> Repetitive values in the ROI connections matrix are replaced with black. Degrees of freedom for plotted F-values are 1 and 9 in all cases. Asterisks mark ROI connections with significant results at q(FDR) = 0.05.</p

ROI connection details.

<p>For each significant pairwise connection (Conn) the average connectivity values after Escitalopram (Escit) and Placebo (Plac) administration are shown, together with the paired-sample T-test statistics (degrees of freedom = 9), for both resting states RS1 and RS2. Abbreviations, see main text.</p

Scatterplots.

<p>Shown are the scatterplots of functional connectivity between PCC and RIPC (A), and between LIPC and RPHC (B) as a function of alertness ratings of the Bond and Lader VAS scale. Each data point represents one participant. A regression line (least squares fit) is drawn through the data points in each plot. Functional connectivity and VAS rating values are the average of the Escitalopram and Placebo conditions.</p