Background Ethnic differences in colon cancer (CC) care were shown in the United States, but results are not directly applicable to European countries due to fundamental healthcare system differences. This is the first study addressing ethnic differences in treatment and survival for CC in the Netherlands. Methods Data of 101,882 patients diagnosed with CC in 1996–2011 were selected from the Netherlands Cancer Registry and linked to databases from Statistics Netherlands. Ethnic differences in lymph node (LN) evaluation, anastomotic leakage and adjuvant chemotherapy were analysed using stepwise logistic regression models. Stepwise Cox regression was used to examine the influence of ethnic differences in adjuvant chemotherapy on 5-year all-cause and colorectal cancer-specific survival. Results Adequate LN evaluation was significantly more likely for patients from ‘other Western’ countries than for the Dutch (OR 1.09; 95% CI 1.01–1.16). ‘Other Western’ patients had a significantly higher risk of anastomotic leakage after resection (OR 1.24; 95% CI 1.05–1.47). Patients of Moroccan origin were significantly less likely to receive adjuvant chemotherapy (OR 0.27; 95% CI 0.13–0.59). Ethnic differences were not fully explained by differences in socioeconomic and hospital-related characteristics. The higher 5-year all-cause mortality of Moroccan patients (HR 1.64; 95% CI 1.03–2.61) was statistically explained by differences in adjuvant chemotherapy receipt. Conclusion These results suggest the presence of ethnic inequalities in CC care in the Netherlands. We recommend further analysis of the role of comorbidity, communication in patient-provider interaction and patients’ health literacy when looking at ethnic differences in treatment for CC.
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We focus in the current study on associations between personality, multicultural attitudes, and perceived ethnic outgroup distance in the Netherlands. Data were collected among four different ethnic groups (from low to high in terms of ethnic hierarchy): Turkish/Moroccan-Dutch, Antillean/Surinamese-Dutch, Mixed Western immigrants, and Dutch majority group members. We found support for a mediation model in which in all groups multicultural attitudes mediate the relation between personality traits, education level, and age as antecedents, and outgroup distance as outcome; age was the only antecedent that also had a direct effect on outcome. Education was positively related to multiculturalism in the groups high in the hierarchy and unrelated in the groups low in the hierarchy. The association between multicultural attitudes and outgroup distance was negative and stronger for the groups higher in the ethnic hierarchy; hierarchy was unrelated to outgroup distance. Groups higher in the hierarchy scored lower on multicultural attitudes. It was concluded that multicultural attitudes and outgroup distance are important for understanding intergroup dynamics in ethnically diverse societies.
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Objective: To examine the prevalence of sarcopenia and its association with protein intake in men and women in a multi-ethnic population. Design: We used cross-sectional data from the HELIUS (Healthy Life in an Urban Setting) study, which includes nearly 25,000 participants (aged 18–70 years) of Dutch, South-Asian Surinamese, African Surinamese, Turkish, Moroccan, and Ghanaian ethnic origin. For the current study, we included 5161 individuals aged 55 years and older. Sarcopenia was defined according to the EWGSOP2. In a subsample (N = 1371), protein intake was measured using ethnic-specific Food Frequency Questionnaires. Descriptive analyses were performed to study sarcopenia prevalence across ethnic groups in men and women, and logistic regression analyses were used to study associations between protein intake and sarcopenia. Results: Sarcopenia prevalence was found to be sex- and ethnic-specific, varying from 29.8% in Turkish to 61.3% in South-Asian Surinamese men and ranging from 2.4% in Turkish up to 30.5% in South-Asian Surinamese women. Higher protein intake was associated with a 4% lower odds of sarcopenia in the subsample (OR = 0.96, 95%-CI: 0.92–0.99) and across ethnic groups, being only significant in the South-Asian Surinamese group. Conclusion: Ethnic differences in the prevalence of sarcopenia and its association with protein intake suggest the need to target specific ethnic groups for prevention or treatment of sarcopenia.
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Background to the problem Dutch society demonstrates a development which is apparent in many societies in the 21st century; it is becoming ethnically heterogeneous. This means that children who are secondlanguage speakers of Dutch are learning English, a core curriculum subject, through the medium of the Dutch language. Research questions What are the consequences of this for the individual learner and the class situation?Is a bi-lingual background a help or a hindrance when acquiring further language competences. Does the home situation facilitate or impede the learner? Additionally, how should the TEFL professional respond to this situation in terms of methodology, use of the Dutch language, subject matter and assessment? Method of approach A group of ethnic minority students at Fontys University of Professional Education was interviewed. The interviews were subjected to qualitative analysis. To ensure triangulation lecturers involved in teaching English at F.U.P.E. were asked to fill in a questionnaire on their teaching approach to Dutch second language English learners. Thier response was quantitatively and qualitatively analysed. Findings and conclusions The students encountered surprisingly few problems. Their bi-lingualism and home situation were not a constraint in their English language development. TEFL professionals should bear the heterogeneous classroom in mind when developing courses and lesson material. The introduction to English at primary school level and the assessment of DL2 learners require further research.
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Lasiocarpine and riddelliine are pyrrolizidine alkaloids (PAs) known to cause liver toxicity. The aim of this study was to predict the inter-species and inter-ethnic human differences in acute liver toxicity of lasiocarpine and riddelliine using physiologically based kinetic (PBK) modelling based reverse dosimetry of in vitro toxicity data. The concentration–response curves of in vitro cytotoxicity of lasiocarpine and riddelliine defined in pooled human hepatocytes were translated to in vivo dose–response curves by PBK models developed using kinetic data obtained from incubations with pooled tissue fractions from Chinese and Caucasian individuals, providing PBK models for the average Chinese and average Caucasian, respectively. From the predicted in vivo dose–response curves, the benchmark dose lower and upper confidence limits for 5% effect (BMDL5 and BMDU5) were derived and subsequently compared to those previously obtained in rat to evaluate inter-species differences. The inter-species differences amounted to 2.0-fold for lasiocarpine and 8.2-fold for riddelliine with humans being more sensitive than rats. The inter-ethnic human differences varied 2.0-fold for lasiocarpine and 5.0-fold for riddelliine with the average Caucasian being more sensitive than the average Chinese. In conclusion, the present study provides the proof-of-principle to predict inter-species and inter-ethnic differences in in vivo liver toxicity for PAs by an alternative testing strategy integrating in vitro cytotoxicity data with PBK modelling-based reverse dosimetry.
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The need for a shift toward healthier and more sustainable diets is evident and is supported by universalized standards for a “planetary health diet” as recommended in the recent EAT-Lancet report. At the same time, differences exist in tastes, preferences and food practices among diverse ethnic groups, which becomes progressively relevant in light of Europe’s increasingly multi-ethnic cities. There is a growing tension between current sustainable diets standards and how diverse ethnic resident groups relate to it within their ‘culturally appropriate’ foodways, raising questions around inclusion. What are dynamics of inclusiveness in migrant food practices? And what does this mean towards the transition to healthy and sustainable food? We study this question among Syrian migrants with different lengths of stay in the Netherlands.
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New approach methodologies predicting human cardiotoxicity are of interest to support or even replace in vivo-based drug safety testing. The present study presents an in vitro–in silico approach to predict the effect of inter-individual and inter-ethnic kinetic variations in the cardiotoxicity of R- and S-methadone in the Caucasian and the Chinese population. In vitro cardiotoxicity data, and metabolic data obtained from two approaches, using either individual human liver microsomes or recombinant cytochrome P450 enzymes (rCYPs), were integrated with physiologically based kinetic (PBK) models and Monte Carlo simulations to predict inter-individual and inter-ethnic variations in methadone-induced cardiotoxicity. Chemical specific adjustment factors were defined and used to derive dose–response curves for the sensitive individuals. Our simulations indicated that Chinese are more sensitive towards methadone-induced cardiotoxicity with Margin of Safety values being generally two-fold lower than those for Caucasians for both methadone enantiomers. Individual PBK models using microsomes and PBK models using rCYPs combined with Monte Carlo simulations predicted similar inter-individual and inter-ethnic variations in methadone-induced cardiotoxicity. The present study illustrates how inter-individual and inter-ethnic variations in cardiotoxicity can be predicted by combining in vitro toxicity and metabolic data, PBK modelling and Monte Carlo simulations. The novel methodology can be used to enhance cardiac safety evaluations and risk assessment of chemicals.
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Background: Shared decision-making (SDM) is often considered the ideal for decision-making in oncology. Views of specific groups such as ethnic minorities have seldom been considered in its development. Aim: In this study we seek to assess in oncology if there is a need for adaptation of the current SDM model to ethnic minorities and to formulate possible adjustments. Design: This study is embedded in empirical bioethics, an interdisciplinary approach integrating empirical data with ethical reasoning to formulate normative conclusions regarding a practice. For the empirical social scientific part, a cross-sectional qualitative study will be conducted; for the ethical reflection the Reflective Equilibrium will be used to develop a coherent view on the application of SDM among ethnic minorities in oncology. Method: Semi-structured interviews combined with visual methods (timelines and relational maps) will be held with healthcare professionals (HCPs), ethnic minority patients, and their relatives to identify values steering the behavior of these actors in SDM. In addition, focus groups (FGs) will be held with ethnic minority community members to identify value structures at the group level. Respondents will be recruited through organizations with access to ethnic minorities and collaborating hospitals. Data will be analyzed using a reflexive thematic analysis through the lens of Schwartz’s value theory. The results of the empirical phase will be included in the RE to formulate possible adjustments of the SDM model, if needed. Discussion: The integration of empirical data with ethical reflection is an innovative method in decision-making. This method enables a systematic and profound assessment of the need for adaptation of SDM and the formulation of theoretically and empirically based suggestions for adaptations of the model. Findings of this study may enrich the SDM model.
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from the repository of Utrecht University: "PURPOSE: Previously, a high prevalence of certain psychiatric disorders was shown among non-Western immigrants. This study explores whether this results in more prescriptions for psychotropic medication. METHODS: Data on dispensing of medication among adults living in the four largest Dutch cities in 2013 were linked to demographic data from Statistics Netherlands. Incident (i.e., following no dispensing in 2010-2012) and prevalent dispensing among immigrants was compared to that among native Dutch (N = 1,043,732) and analyzed using multivariable Poisson and logistic regression. RESULTS: High adjusted Odds Ratios (ORadj) of prevalent and high Incidence Rate Ratios (IRRadj) of incident dispensing of antipsychotics were found among Moroccan (N = 115,455) and Turkish individuals (N = 105,460), especially among young Moroccan males (ORadj = 3.22 [2.99-3.47]). Among Surinamese (N = 147,123) and Antillean individuals (N = 41,430), slightly higher rates of dispensed antipsychotics were found and the estimates decreased after adjustment. The estimates for antipsychotic dispensing among the Moroccan and Turkish increased, following adjustment for household composition. Rates for antidepressant dispensing among Turkish and Moroccan subjects were high (Moroccans: ORadj = 1.74 [1.70-1.78]). Among Surinamese and Antillean subjects, the rates for antidepressant dispensing were low and the ORadjlagged behind the IRRadj(Surinamese: 0.69 [0.67-0.71] vs. 1.06 [1.00-1.13]). Similar results were found for anxiolytics. For ADHD medication, lower dispensing rates were found among all migrant groups. CONCLUSIONS: The findings agree with earlier reports of more mental health problems among Moroccan and Turkish individuals. Surinamese/Antillean individuals did not use psychotropic drugs at excess and discontinued antidepressants and anxiolytics earlier. The data strongly suggest under-treatment for ADHD in all ethnic minority groups."
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Optimizing protein intake is a novel strategy to prevent age associated loss of muscle mass and strength in older adults. Such a strategy is still missing for older adults from ethnic minority populations. Protein intake in these populations is expected to be different in comparison to the majority of the population due to several socio-cultural factors. Therefore, the present study examined the dietary protein intake and underlying behavioral and environmental factors affecting protein intake among older adults from ethnic minorities in the Netherlands. We analyzed frequency questionnaire (FFQ) data from the Healthy Life in an Urban Setting (HELIUS) cohort using ANCOVA to describe dietary protein intake in older adults from ethnic minorities in the Netherlands (N = 1415, aged >55 years, African Surinamese, South Asian Surinamese, Moroccan, and Turkish). Additionally, we performed focus groups among older adults from the same ethnic minority populations (N = 69) to discover behavioral and environmental factors affecting protein intake; 40-60% of the subjects did not reach minimal dietary protein recommendations needed to maintain muscle mass (1.0 g/kg bodyweight per day (BW/day)), except for Turkish men (where it was 91%). The major sources of protein originated from animal products and were ethnic specific. Participants in the focus groups showed little knowledge and awareness about protein and its role in aging. The amount of dietary protein and irregular eating patterns seemed to be the major concern in these populations. Optimizing protein intake in these groups requires a culturally sensitive approach, which accounts for specific protein product types and sociocultural factors.
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