The objective of the present study is to compare the QL of a wide range of chronic disease patients. Secondary analysis of eight existing data sets, including over 15,000 patients, was performed. The studies were conducted between 1993 and 1996 and included population-based samples, referred samples, consecutive samples, and/or consecutive samples. The SF-36 or SF-24 were employed as generic QL instruments. Patients who were older, female, had a low level of education, were not living with a partner, and had at least one comorbid condition, in general, reported the poorest level of QL. On the basis of rank ordering across the QL dimensions, three broad categories could be distinguished. Urogenital conditions, hearing impairments, psychiatric disorders, and dermatologic conditions were found to result in relatively favorable functioning. A group of disease clusters assuming an intermediate position encompassed cardiovascular conditions, cancer, endocrinologic conditions, visual impairments, and chronic respiratory diseases. Gastrointestinal conditions, cerebrovascular/neurologic conditions, renal diseases, and musculoskeletal conditions led to the most adverse sequelae. This categorization reflects the combined result of the diseases and comorbid conditions. If these results are replicated and validated in future studies, they can be considered in addition to information on the prevalence of the diseases, potential benefits of care, and current disease-specific expenditures. This combined information will help to better plan and allocate resources for research, training, and health care.

The analysis of patterns of utilisation proved to supply useful information concerning the relationship between ethnicity and use of health care services in addition to figures concerning single service use only.

In recent years, many researchers tried to explain the social selection in use of mental health care services. A modest role is attributed to the orientation toward help-seeking. This article studies this orientation. Our research-population consisted of 10,171 Dutch persons, aged 18 and older. Analysis showed that most people are prone to seek help for one or more emotional problems. People who are more prone to seek help are younger, have had more education and have a higher family income. They have more often acquaintances working in mental health care. People who are more prone to seek help do not see chance as the locus of control of health. These people are less dependent on their GP for common disorders and are more open about mental health matters. The results of discriminant analysis are not satisfactory, but when we try to distinguish the groups of people who are and who are not willing to seek help, we see that the best discriminating factor is their help-seeking attitude for common disorders. People who have high expectations from the GP for common disorders, clearly do have a preference to seek help for the emotional problems. The groups of people who are more willing to seek help from the GP compared to mental health professionals cannot be distinguished by these expectations. Here the level of education discriminates fairly well: people who are more prone to seek help from a GP have a lower educational level. Future research should be focussed on the testing of a theoretical model that explains the orientation toward help-seeking for emotional problems and selection in help-seeking with longitudinal data.

BackgroundStudies on differences between immigrant and non-immigrant groups in health care utilization vary with respect to the extent and direction of differences in use. Therefore, our study aimed to provide a systematic overview of the existing research on differences in primary care utilization between immigrant groups and the majority population.MethodsFor this review PubMed, PsycInfo, Cinahl, Sociofile, Web of Science and Current Contents were consulted. Study selection and quality assessment was performed using a predefined protocol by 2 reviewers independently of each other. Only original, quantitative, peer-reviewed papers were taken into account. To account for this hierarchical structure, logistic multilevel analyses were performed to examine the extent to which differences are found across countries and immigrant groups. Differences in primary care use were related to study characteristics, strength of the primary care system and methodological quality.ResultsA total of 37 studies from 7 countries met all inclusion criteria. Remarkably, studies performed within the US more often reported a significant lower use among immigrant groups as compared to the majority population than the other countries. As studies scored higher on methodological quality, the likelihood of reporting significant differences increased. Adjustment for health status and use of culture-/language-adjusted procedures during the data collection were negatively related to reporting significant differences in the studies.ConclusionOur review underlined the need for careful design in studies of differences in health care use between immigrant groups and the majority population. The results from studies concerning differences between immigrant and the majority population in primary health care use performed within the US might be interpreted as a reflection of a weaker primary care system in the US compared to Europe and Canada.

Background: Immigrant elderly are a rapidly growing group in Dutch society; little is known about their health care use. This study assesses whether ethnic disparities in health care use exist and how they can be explained. Applying an established health care access model as explanatory factors, we tested health and socio-economic status, and in view of our research population we added an acculturation variable, elaborated into several sub-domains.

The lower prevalence of hypertension among Moroccan men may contribute to the low cardiovascular disease (CVD) mortality reported among this group in the Netherlands. The differential risks in CVD mortality between Moroccan men and women may partly result from the lower hypertension awareness and treatment rates in Moroccan women. Strategies aimed at improving the detection and treatment of hypertension among Moroccan women may improve the sex disparity in cardiovascular mortality between Moroccan men and women in the Netherlands.

SummaryTo review the prevalence regarding overweight and obesity among children and adolescents from migrant and native origin within Europe, a systematic review (1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)) was performed, using Embase, PubMed and citation snowballing. Literature research resulted in 19 manuscripts, reporting studies in six countries, mostly situated in Western and Central Europe.From this review, it appears that, in most of the European countries for which data are available, especially non-European migrant children are at higher risk for overweight and obesity than their native counterparts. The prevalence of overweight in migrant children ranged from 8.9% to 37.5% and from 8.8% to 27.3% in native children. The prevalence of obesity in migrant children ranged from 1.2% to 15.4% and from 0.6% to 11.6% in native children. Some limitations of the review are discussed, especially the problematic classification of migrant and native children.Apparently, migrant children display an even more sedentary way of life or adverse dietary patterns, as compared with native children. To what degree these differences can be explained by socioeconomic and cultural factors remains to be investigated. As overweight and obese children are at risk for many chronic health problems, further research is urgently needed in order to develop preventive interventions.

Pragmatic trials seem to be oxymoronic. Although the pragmatic trial methodology establishes the effectiveness of interventions under natural, non-experimental conditions, no pragmatic fit is allowed. Qualitative research's contribution to the development of tailor-made community-based interventions lies in providing ongoing evaluations of the dilemmas faced in pragmatic trials and allowing for the development of true tailor-made interventions.