non-Western Ethnic Background Research Articles

Socioeconomic and ethnical disparity in coronary heart disease outcomes in Denmark and the effect of cardiac rehabilitation-A nationwide registry study.

Cardiovascular patients with low socioeconomic status and non-western ethnic background have worse prognostic outcomes. The aim of this nationwide study was first to address whether short-term effects of hospital-based outpatient cardiac rehabilitation (CR) are similar across educational level and ethnic background, and secondly to study whether known disparity in long-term prognosis in patients with cardiovascular disese is diminished by CR participation. All patients with myocardial infarction and/or coronary revascularization from August 2015 until March 2018 in the Danish national patient registry or the Danish cardiac rehabilitation database (DHRD) were included. We used descriptive statistics to address disparity in achievement of quality indicators in CR, and Cox proportional hazard regression to examine the association between the disparity measures and MACE (cardiovascular hospitalization and all-cause mortality) with adjustment for age, gender, index-diagnose and co-morbidity. We identified 34,511 patients of whom 19,383 had participated in CR and 9,882 provided information on CR outcomes from the DHRD. We demonstrated a socioeconomic gradient in improvements in VO2peak, and non-western patients were less often screened for depression or receive dietary consulting. We found a strong socioeconomic gradient in MACE irrespective of CR participation, medication, and risk factor control (adjusted HR 0.65 (95% CI 0.56-0.77) for high versus low education). Non-western origin was associated with higher risk of MACE (adjusted HR 1.2 (1.1-1.4)). We found only minor socioeconomic and ethnic differences in achievement of CR quality indicators but strong differences in CHD prognosis indication that conventional risk factor control and medical treatment following CR do not diminish the socioeconomic and ethnical disparity in CHD prognosis.

Confidential enquiry into maternal deaths in the Netherlands, 2006–2018

To calculate the maternal mortality ratio (MMR) for 2006-2018 in the Netherlands and compare this with 1993-2005, and to describe women's characteristics, causes of death and improvable factors. We performed a nationwide, cohort study of all maternal deaths between January 1, 2006 and December 31, 2018 reported to the Audit Committee Maternal Mortality and Morbidity. Main outcome measures were the national MMR and causes of death. Overall MMR was 6.2 per 100 000live births, a decrease from 12.1 in 1993-2005 (risk ratio [RR] 0.5). Women with a non-western ethnic background had an increased MMR compared with Dutch women (MMR 6.5 vs. 5.0, RR 1.3). The MMR was increased among women with a background from Surinam/Dutch Antilles (MMR 14.7, RR 2.9). Half of all women had an uncomplicated medical history (79/161, 49.1%). Of 171 pregnancy-related deaths within 1 year postpartum, 102 (60%) had a direct and 69 (40%) an indirect cause of death. Leading causes within 42days postpartum were cardiac disease (n=21, 14.9%), hypertensive disorders (n=20, 14.2%) and thrombosis (n=19, 13.5%). Up to 1 year postpartum, the most common cause of death was cardiac disease (n=32, 18.7%). Improvable care factors were identified in 76 (47.5%) of all deaths. Maternal mortality halved in 2006-2018 compared with 1993-2005. Cardiac disease became the main cause. In almost half of all deaths, improvable factors were identified and women with a background from Surinam/Dutch Antilles had a threefold increased risk of death compared with Dutch women without a background of migration.

Factors Associated With Early Elementary Child Health-Related Quality of Life: The Generation R Study.

AimTo identify the factors associated with health-related quality of life (HRQOL) among early elementary age children (5–6 years) from a general population sample.MethodsWe analyzed data of 4,202 children from the Generation R Study, a population-based cohort study in the Netherlands. Children's physical and psychosocial HRQOL were measured using the Child Health Questionnaire Parent Form 28 (CHQ-PF28). Associations between socio-demographic characteristics (child age, sex, ethnic background, family situation, parental educational level, parental employment status, and net household income), health-related lifestyle behaviors (physical activity and screen time), health conditions (number of chronic conditions, emotional and behavioral problems, and family functioning) and children's physical and psychosocial HRQOL were assessed using multivariate regression analyses.ResultsMean child age was 6.0 years (SD: 0.43); 63.6% had a majority (Dutch) ethnic background. Children with a non-western ethnic background, and children of unemployed mothers had a lower physical HRQOL (all p < 0.05). Older children, boys, and children from single-parent or low educated families had a lower psychosocial HRQOL (all p < 0.05). Children from a low income household family, children having chronic conditions or emotional and behavioral problems, or from families with relatively high “pathological family functioning” reported both lower physical and psychosocial HRQOL (all p < 0.05).ConclusionIndicators of adverse socioeconomic and family circumstances and indicators of child health problems were associated with lower HRQOL. Public health initiatives to improve HRQOL of children should prioritize children from a low socioeconomic status or with less favorable health conditions from early age onwards.

Haploidentical Allogeneic Stem Cell Transplantation in Sickle Cell Disease: A Systematic Review and Meta-Analysis

▪BackgroundAllogeneic hematopoietic stem cell transplantation (SCT) is the only established curative treatment option for patients with sickle cell disease (SCD). Transplantations with an HLA-identical matched sibling donor (MSD) have resulted in excellent disease-free survival of >90% and overall survival (OS) of >95%. However, lack of HLA-identical siblings is a limiting factor. The chance of finding a potential matched unrelated donor is low for patients with a non-Western ethnic background (< 20%). Haploidentical related donors are a promising pool of donors potentially extending SCT as a curative treatment to a larger group of SCD patients with no other meaningful treatment options. Myeloablative conditioning regimens (MAC) are not recommended for adult SCD patients, as cumulative SCD-related organ damage renders these patients susceptible to increased toxicity and higher risk of transplant-related mortality. Using reduced-intensity conditioning (RIC) or non-myeloablative conditioning (NMC) in both adult and pediatric patients has resulted in decreased transplant-related toxicity and mortality. However, while successful in hematologic malignancies, NMC has been associated with significant risk of graft failure in hemoglobinopathies. In the present study, we aimed to systematically review (1) the outcomes of haploidentical SCT (Haplo-SCT), (2) the effects of conditioning intensity and modes of T-cell depletion on Haplo-SCT outcomes and (3) comparative outcomes between matched sibling donor SCT (MSD-SCT) and Haplo-SCT in selected studies.MethodsA comprehensive search was performed in MEDLINE/PubMed and Embase up to May 2021. Data was extracted by two reviewers independently and the Newcastle-Ottawa Quality Assessment Scale was used to assess the quality of the studies. Only studies reporting at least one of the outcomes: graft failure, OS, transplant-related mortality, and acute/chronic graft-versus-host disease (GvHD) were included. Fourteen studies met the inclusion criteria. To have an overview of the results of Haplo-SCT, we divided the included studies in four groups according to the conditioning intensity (MAC versus NMC/RIC) and the T-cell depletion method (in vivo (post-transplant cyclophosphamide (PTCy)) vs. in vitro).ResultsAll included studies were observational cohort studies. A subgroup meta-analysis of the results of Haplo-SCT showed relatively low overall pooled proportions of graft failure (7%, 95% CI: 2 - 20), acute (4%, 95% CI: 2 - 12) and chronic (11%, 95% CI: 7 - 16) GvHD. Overall survival was high (91%, 95% CI: 85 - 94). Graft failure in MAC-in vitro, MAC-in vivo, NMC/RIC-in vitro and NMC/RIC-in vivo groups was 4% (95% CI: 1 - 14), 0% (95% CI: 0 - 100), 25% (95% CI: 10 - 51) and 11% (95% CI: 3 - 36) respectively (Figure 1). OS was 100% and 93% for MAC and NMC/RIC groups with PTCy (in vivo T-cell depletion) respectively. In patients with in vitro T-cell depletion, OS was 87% and 81% in MAC and NMC/RIC groups respectively (Figure 2). Based on a comparative meta-analysis of the three studies that included both haploidentical and MSD transplantation, graft failure was significantly higher in the haploidentical group than in the MSD group (odds ratio 5.3, 95% CI: 1.0 - 27.6). Overall survival, transplant-related mortality and acute/chronic GvHD were not significantly different between the groups.ConclusionsThis systematic review shows that modifications in the intensity of the conditioning regimen and improved T-cell depletion approaches in Haplo-SCT in SCD have led to reduced transplantation-related toxicity while keeping graft failure rates low. Both in vitro and in vivo (PTCy) T-cell depletions result in very low transplantation-related mortality, though in vitro T-cell depletion is associated with a higher incidence of viral reactivations and other infectious complications.Haploidentical stem cell transplantation is becoming a viable alternative curative option for SCD, extending the availability of allogeneic SCT as a treatment option to many more transplant eligible SCD patients. Novel immunosuppression (immunoablation) and improvement in supportive care have allowed the use of RIC or NMC regimens, resulting in low risk of transplantation-related complications and improvement in engraftment rates. [Display omitted] DisclosuresBiemond: Global Blood Therapeutics: Honoraria, Research Funding, Speakers Bureau; Novartis: Honoraria, Research Funding, Speakers Bureau; CSL Behring: Honoraria; Sanquin: Research Funding; Novo Nordisk: Honoraria; Celgene: Honoraria. Nur: Celgene: Speakers Bureau; Roche: Speakers Bureau; Novartis: Research Funding, Speakers Bureau.

Cardiac rehabilitation do not diminish the socioeconomic and ethnical disparity in patients with coronary heart disease

Abstract Aims Cardiac patients with low socioeconomic status and non-western ethnic background have worse outcomes. The aim of this nationwide study was to determine whether the immediate effect of CR differs between groups defined by socioeconomic status and ethnic background, and whether disparity in the prognosis of cardiac patients is diminished by CR participation. Methods We included all patients in Denmark with myocardial infarction and/or coronary revascularization from August 2015 until March 2018. Level of education, as a marker for socioeconomic status, was divided into four groups, and ethnicity into Danish, non-Western and Western. Participation in CR was identified through the Danish Cardiac Rehabilitation Database (DHRD) and the Danish National Patient Register. Primary outcome was achievement of CR quality indicators, including risk factor control and medication, from DHRD, and secondary outcome a composite endpoint of cardiovascular disease hospitalization and all-cause mortality (MACE). Results We identified 34,511 patients of whom 19,383 had participated in CR and 9,882 provided information on CR data from DHRD. Higher education was associated with greater improvement in VO2peak and non-western patients were less likely to be screened for depression or receive dietary consulting. No other significant disparity in CR quality indicators, was found across education and ethnicity. There was a strong socioeconomic gradient in MACE irrespective of CR participation, medication and risk factor control (adjusted HR 0.71 (0.58–0.86) for high versus low education). Similarly, non-western origin was associated with higher risk of MACE (adjusted HR 1.2 (1.1–1.4). Conclusion We found strong socioeconomic and ethnic disparity in prognosis of CHD patients which were unaffected by CR participation. The results indicate that CR, conventional risk factor control and medical treatment have limited impact on these disparities. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation Figure 1Figure 2

Psychosocial and peripartum determinants of postpartum depression: Findings from a prospective population-based cohort. The ABCD study

BackgroundPostpartum depression is prevalent and concerns a serious health problem for women and their families. The current large-scale birth cohort study investigated: (1) the associations of various potential determinants of postpartum depression using a multidimensional approach, and (2) the individual contribution of obstetric and perinatal determinants and pregnancy-specific anxiety to the risk of postpartum depression. MethodsThis study was based on a large-scale birth cohort study in Amsterdam, the Netherlands (ABCD-study). In 5109 women depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (cut-off ≥16 indicating high risk of postpartum depression). Determinants were assessed using self-report or perinatal registries. ResultsIn the final multivariable model, other-Western and non-Western ethnic background, increased antepartum depressive symptoms, increased antepartum anxiety, increased pregnancy-specific anxiety, being unemployed, poor sleep quality, unwanted pregnancy, abuse, multiparity, and congenital abnormality were all independently related to an increased risk of postpartum depression. The strongest risk factors for postpartum depression were antepartum depressive symptoms (adjusted odds ratio (AOR) = 3.86, 95% confidence interval (CI) 3.02–4.92), having a baby with a congenital abnormality (AOR = 2.33, 95% CI 1.46–3.73), and abuse (AOR = 1.95, 95% CI 1.02–3.73). The final model accounted for 24.5% of the variance. LimitationsOur dataset did not provide information on social support or maternal and family history of depression. Next to these determinants, future research should include biological factors. ConclusionsThe determinants identified provide opportunities for the development of multidimensional early screening and early intervention strategies for women with an increased risk of postpartum depression.

Vitamin D Knowledge, Attitudes, and Behaviors in Young Danish Women with a Non-Western Ethnic Minority Background-A Questionnaire Survey.

The prevalence of vitamin D deficiency in women with a non-Western ethnic minority background in Nordic countries is high. The aim of this study was to assess vitamin D knowledge, attitudes, and behaviors in women with a non-Western ethic minority background living in Denmark. A validated vitamin D knowledge, attitudes, and behaviors’ questionnaire was translated into Danish, piloted, and distributed via relevant Facebook groups. The responses were analyzed using parametric and non-parametric tests for descriptive and bivariate analyses. In total, 254 women who considered themselves having a non-Western ethnic minority background responded to the questionnaire. The median age (IQR) was 25 (23–33) years old; 32% had a professional bachelor’s, 28% had high school, and 22% had a master’s or higher university education. Participants scored higher on vitamin D general knowledge (scores above 80 on the scale 0–100) compared to vitamin D nutrition knowledge or vitamin D attitudes and behaviors (scores around 60 on the scale 0–100). In conclusion, the vitamin D knowledge among study participants—i.e., young well-educated non-Western ethnic minority women in Denmark—was pretty good. The further examination of vitamin D knowledge, attitudes, and behaviors should explore specifics related to nationality and religion and focus on less-educated non-Western ethnic minority women in Denmark and other Nordic countries.

Vitamin D related knowledge, attitudes and behaviors among ethnic minority women

Abstract Background Vitamin D (VD) deficiency may increase the risk of developing nutritional rickets, metabolic, autoimmune, infectious, cardiovascular and mental disorders. VD status in reproductive age is of special importance, as it may determine health outcomes not only for women but also for their offspring. Danish health authorities recommend VD supplementation for groups at risk of VD deficiency. In Nordic countries, persistent high prevalence of VD deficiency among non-Western ethnic minority women suggests that health information may not reach the population in need. Aim to assess VD related knowledge, attitudes and behaviors among non-Western ethnic minority women living in Denmark in 2019. Methods A validated VD knowledge, attitudes and behaviors questionnaire was translated into Danish, piloted and distributed via relevant Facebook groups using online SurveyXact platform. The responses were analyzed with SPSS statistical package, using both parametric and non-parametric tests for bivariate analyses. Results 254 women who considered themselves having a non-Western ethnic minority background answered the questionnaire. Median age (IQR) was 26 (23-33) year old; 81 (39%) had professional, 71 (28%) high school and 56 (22%) university education. Age was associated with VD nutrition knowledge (p = 0.048) and VD behaviors (p = 0.026): older women had better knowledge about VD rich nutrition and reported more VD friendly behavior. Education was associated with both VD general (p = 0.034) and VD nutrition (p = 0.034) knowledge. Women with university education had better knowledge about VD generally, and women with professional education had better knowledge about VD rich nutrition. Conclusions Aged and education were associated with VD related knowledge and behaviors in young women with non-Western ethnic minority women. Further examining of VD related knowledge and behaviors focusing among less populations is warranted. Key messages Education was associated with both vitamin D general (p = 0.034) and vitamin D nutrition (p = 0.034) knowledge. Aged and education were associated with vitamin D related knowledge and behaviors in young women with non-Western ethnic minority women.

Sociodemographic factors, current asthma and lung function in an urban child population.

BackgroundWe aimed to assess which sociodemographic factors are associated with current asthma and indicators of lung function in 10‐year‐old children.MethodsWe analysed data of 5237 children (Mean age: 9.7, SD: 0.3) from the Generation R Study (2012‐2016), a population‐based cohort study in the Netherlands. Indicators of sociodemographic factors included parental educational level, net household income, financial difficulties, parental employment status and child ethnic background. Current asthma (yes/no) was defined as ever doctor‐diagnosed‐asthma combined with wheezing symptoms or asthma‐medication use in the past 12 months. Lung function was measured by spirometry and included forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC, and forced expiratory flow after exhaling 75% of FVC (FEF75). Within‐study sex‐, height‐ and age‐adjusted lung function measurements’ z‐scores were converted.ResultsAfter adjustment for all sociodemographic factors, an independent association was observed between ethnic background with current asthma and lung function. Compared with children with a Dutch background, children with a nonwestern ethnic background had a higher odds of having current asthma (OR: 1.61, 95% CI: 1.02, 2.53), lower FVC z‐score (−0.25, 95% CI: −0.35, −0.14), higher FEV1/FVC z‐score (0.26, 95% CI: 0.14, 0.37) and higher FEF75% z‐score (0.15, 95% CI: 0.04, 0.25).ConclusionsAmong 10‐year‐old children, ethnic background was associated with current asthma and lung function after adjusting for a wide range of sociodemographic factors. No associations were found between socioeconomic status indicators and current asthma. Explanations for these associations such as language barriers, suboptimal care or pathophysiological differences require further investigation.

Estimating Reductions in Ethnic Inequalities in Child Adiposity from Hypothetical Diet, Screen Time, and Sports Participation Interventions.

Childhood obesity is a global epidemic, and its prevalence differs by ethnicity. The objective of this study was to estimate the change in ethnic inequalities in child adiposity at age 10 resulting from interventions on diet at age 8 and screen time and sports participation at age 9. We conducted a population-based cohort study, the Generation R Study, from 9,749 births in Rotterdam (2002-2006), of which 9,506 children remained in the analysis. We measured ethnicity, diet, screen time, and sports participation through questionnaires; we measured weight, body mass index (BMI), fat mass index, and fat-free mass index directly. We used sequential G-estimation to estimate the reduction in inequality that would result from the interventions. We observed that sociodemographic characteristics, diet, screen time, sports participation, and all adiposity measurements were more favorable in children from Western versus non-Western ethnic backgrounds: weight = -1.2 kg (95% confidence interval [CI] = -1.7, -0.8), BMI = -1.0 kg/m (CI = -1.2, -0.9), and fat mass index = -0.8 kg/m (CI = -0.9, -0.7). We estimated that extreme intervention (maximum diet score of 10, no screen time, and >4 hours/week of sports) reduced ethnic inequalities by 21% (CI = 8%, 35%) for weight, 9% (CI = 4%, 14%) for BMI, and 9% (CI = 6%, 13%) for fat mass index. A diet score ≥5 points, screen time ≤2 hours/day, and sports participation >2 hours/week reduced ethnic inequalities by 17% (CI = 6%, 28%) for weight, 7% (CI = 3%, 11%) for BMI, and 7% (CI = 4%, 10%) for fat mass index. Our results are consistent with the hypothesis that interventions integrating diet, screen time, and sports participation have a moderate impact on reducing ethnic inequalities in child adiposity.

Core and Peripheral Voters: Predictors of Turnout Across Three Types of Elections

Citizens who abstain from voting in consecutive elections and inequality in turnout in democratic elections constitute a challenge to the legitimacy of democracy. Applying the law of dispersion, which stipulates higher levels of turnout and higher levels of equality in turnout are positively related, we study turnout patterns across different types of elections in Denmark, a high-turnout European context. Across three different elections with turnout rates from 56.3% to 85.9%, we use a rich, nationwide panel dataset of 2.1 million citizens with validated turnout and high-quality sociodemographic variables. A total of 9% of the citizens are abstainers in the three consecutive elections, and these are disproportionately male, of non-Western ethnic background, with little education, and with low income. The law of dispersion finds support as inequalities in turnout increase when turnout decreases and vice versa. Furthermore, municipalities with lower turnout have higher inequalities in participation than high-turnout municipalities in local elections.

Ethnic Inequalities in COPD Outcomes: a Register-Based Study in Copenhagen, Denmark.

The aim of this study was to investigate the differences in age at diagnosis and survival time after diagnosis between Chronic Obstructive Pulmonary Disease (COPD) patients with native Danish and other ethnic backgrounds. Individuals diagnosed with COPD in a hospital setting in Copenhagen in the period 2003-2007 were identified from annual hospital contact records. The cohort was restricted to COPD patients older than 35years old at diagnosis. Follow-up was available until the end of 2010. ANOVA was conducted to test if mean age at diagnosis differed between the patient groups with different ethnicity. Kaplan-Meier estimator was used to estimate survival time after diagnosis. Cox proportional hazards models were conducted to calculate hazards of death according to ethnicity. A total of 2845 COPD patients were included; 131 (4.6%) were with non-Western ethnic minority backgrounds. Patients with non-Western ethnic backgrounds were diagnosed at a younger age and had a better survival probability compared to ethnic Danish patients; hazard ratio HR (95% CI) for death during follow-up in non-Western vs. ethnic Danish patients was 0.33 (0.18-0.62). Our study showed marked differences in age at diagnosis and survival time after diagnosis between the COPD patients with different ethnic backgrounds residing in Copenhagen. Further studies are needed to find out the reasons for younger age of COPD diagnosis in non-Western minorities and for shorter survival time after diagnosis in ethnic Danish COPD patients.

Risk and Marginalization in the Norwegian Welfare Society: a National Cohort Study of Child Welfare Involvement

This study provided a comprehensive investigation of sociodemographic background characteristics of Norwegian families involved in child welfare services (CWS) during either of the two periods 1993–1999 or 2001–2007 and examined how the strong client growth over this period was accompanied by changes in client characteristics. Child welfare clients in two distinct age groups were considered: 0–5 and 13–18 years. Data were drawn from Norwegian longitudinal population registers, and records of CWS involvement for the period 1993–2007. Each birth cohort was evaluated for differences in sociodemographic background through the use of bivariate cross-tab analyses. The unique contribution of each background factor to the odds of CWS involvement was estimated through logistic regression. Separate regression models were constructed for child welfare involvement during pre-school years (0–5) and adolescence (13–18). The results indicated distinct sociodemographic differences between child welfare clients and the general child population throughout the sample and revealed that CWS involvement risk increased with single parent status, number of children born of the mother, low parental educational level, non-Western ethnic background, household income below the poverty line, low maternal age at first birth and age. The findings also indicated a distinct decrease in the statistical influence of most parental risk factors with increasing age and increasing, although relatively moderate differences between CWS clients and the general population from the first to the second period - above all in parental education and ethnic origin.

Jalla! Jalla! and Import-Export: Two multicultural romantic comedies

Abstract Boy meets girl, the couple goes through a series of obstacles, they split, they reunite and there is a happy ending. This formula has reached international success in the genre of romantic comedy. Two immigrant Scandinavian writer-directors of non-western ethnic background, Josef Fares (Lebanese-Swedish) and Khalid Hussain (Pakistani-Norwegian), both employ this romantic comedy formula to engage their audiences with the multicultural issues second-generation Scandinavian ethnics face when falling in love with native Scandinavians. The Swedish film Jalla! Jalla! (Fares, 2000) and the Norwegian Import-eksport/Import-Export (Hussain, 2005), confront and expose stereotypes of immigrant identities in Scandinavia and explore the complexities of inter-ethnic romance. Both films also subversively reverse the hegemonic �insider/outsider� positions common to most Scandinavian film representations of the ethnic/racial outsider. In this article, I discuss how both director-writers approach multiculturalism, a relatively new phenomenon in Scandinavia, by adapting and personalizing the romantic comedy genre to reveal the unique experiences of immigrants in a way that audiences can understand. Additionally, I analyse ways in which the two films satirize the multiple stereotypes of immigrants and native Scandinavians to pose the question of what it means to be an immigrant or a Scandinavian, and sometimes both.

Intergenerational reduction in Helicobacter pylori prevalence is similar between different ethnic groups living in a Western city

ObjectiveHelicobacter pylori colonisation rates in childhood have declined in Western populations, but it is unknown whether this trend is similar in children of non-Western ethnic backgrounds, born in a Western...

Early lexical development and risk of verbal and nonverbal cognitive delay at school age

To characterise the relationship between preschool lexical delay and language comprehension and nonverbal intelligence at school age. The mothers of 2724 children completed the MacArthur Communicative Development Inventory when their child reached 1.5years and the Language Development Survey and the Parent Report of Children's Ability at 2.5years. When the children were 6years old, we assessed vocabulary comprehension and nonverbal intelligence using Dutch batteries for language and nonverbal intelligence. Demographic factors explained 9.9% of the variance in vocabulary comprehension and 8.7% of the variance in nonverbal intelligence at 6years. Male gender, low maternal education and non-Western ethnic background predicted vocabulary comprehension delay at 6years. Lexical development at 1.5 and 2.5years explained only 3.8% of the variance in language comprehension at the age of six. Late onset expressive vocabulary delay increased the risk of language comprehension and nonverbal intelligence delay at 6years (OR=2.31, 95% CI: 1.62-3.29 and OR=1.74, 95% CI: 1.17-2.58, respectively). Sociodemographic factors are important predictors of delays in language and nonverbal abilities as children enter school. In contrast, early expressive lexical delays, in particular before the age of two, have limited predictive power for language delays at the age of six.

The rights of the child and ethnic minority families in Sweden

The United Nations Convention on the Rights of the Child (UNCRC) was launched in 1989 and is ratified in most countries. The UNCRC is considered by child welfare authorities worldwide to be an essential document that aims to improve the rights of children. However, contemporary research indicates that the UNCRC is an obstacle to social work because it emphasizes the legal equality between children and adults. This finding prompts the question of how Western child protection agencies conduct child protection encounters with families with a non-Western ethnic background. The present article aims to examine if specific articles in the UNCRC can serve as a medium for improving social work with ethnic minority families within the child protection sector in Sweden. This article is based on a research project concerning youths with an ethnic minority background in out-of-home care. Relevant articles in the UNCRC are revealed to be potentially helpful to child protection programmes involving ethnic minority families because these articles emphasize considering the perspective of the child and strengthening parenting skills. However, child protection agencies must consider how the UNCRC can be used to teach parents or guardians to understand and acknowledge the perspective of the child without violating the values of the family.

Declining incidence of hepatitis A in Amsterdam (The Netherlands), 1996–2011: Second generation migrants still an important risk group for virus importation

BackgroundThe Netherlands is a very low endemic country for hepatitis A virus infections (HAV, notification rate of <1/100,000). Historically in Amsterdam, a large proportion of infections are imported from Turkey and Morocco in children returning from summer holiday. Annually since 1998, the public health service of Amsterdam has targeted these children for HAV vaccination before the summer. As the population of non-western immigrants and their descendents increases, we describe recent trends in HAV in ethnic groups in Amsterdam (1996–2011), identifying current risk groups and recommending targeted prevention through vaccination. MethodsWe studied all cases of (non-homosexually acquired) HAV infection notified in the Amsterdam region (1996–2011, n=819) by ethnic group and generation (first/second generation migrants: FGM and SGM respectively). Incidence rates were estimated as the average number of cases per 100,000/year. Using Poisson regression, we calculated incidence rate ratios (IRR) by ethnic group and generation adjusted for age and calendar year, and modeled seasonal variation using a smoothed time series. ResultsIncidence of HAV in Amsterdam dropped from 24.8/100,000 population in 1996 (178 cases) to 1.0/100,000 in 2011 (8 cases). Since 2005, 56% of cases are imported, the majority (62%) in second generation migrant (SGM) children of Moroccan, or other non-western ethnic backgrounds. The adjusted IRR in SGM relative to the ethnic Dutch population was 3.7 (95% CI: 2.3–6.1) in Moroccan SGM, 4.3 (95%CI: 2.6–7.2) in SGM of other non-western backgrounds and 1.9 (95%CI: 0.8–4.1) in Turkish SGM. ConclusionThough incidence of HAV in Amsterdam has declined substantially since 1996, it is still higher in SGM children of Moroccan & other non-western ethnic backgrounds. In line with WHO recommendations of June 2012, introduction of single-dose HAV vaccination, targeted at SGM children from HAV endemic countries, could be considered within the routine childhood vaccination schedule.

Midwives unable to overcome language barriers in prenatal care

Background: the present study aims to explore to what extent midwives experience barriers in providing information about prenatal screening for Down syndrome to women from diverse ethnic backgrounds, and to assess their competences to overcome these barriers. Methods: midwives from 24 Dutch midwifery practices in Rotterdam completed a structured webbased questionnaire (n=57). Data were obtained on perceived ethnic-related differences and barriers in providing information on prenatal screening, preparedness to provide cultural competent care, and the use of translated materials and professional translators. A group interview was conducted to further explore the results emerging from the questionnaire (n=23). Results: almost all midwives (95%) experienced barriers in informing women from non-Western ethnic backgrounds about prenatal screening. Midwives especially felt incompetent to provide information to pregnant women that hardly speak and understand Dutch. In total 58% of the midwives reported that they never used translated information materials and 88% never used professional interpreters in providing information on prenatal screening. The main reasons for this underutilization were unawareness of the availability of translated materials and unfamiliarity with the use of professional interpreters. Conclusions: although language barriers were reported to be the main difficulty in providing cultural competent care to patients from diverse ethnic backgrounds, only a minority of the midwives used translated materials or professional interpreters. In order to enable all pregnant women to make an informed decision whether or not to participate in prenatal screening, midwives’ competences to address language barriers should be increased.

Gender, Ethnicity, Religiosity, and Same-sex Sexual Attraction and the Acceptance of Same-sex Sexuality and Gender Non-conformity

This study explored the role of gender, ethnicity, religiosity, and sexual attraction in adolescents' acceptance of same-sex sexuality and gender non-conformity. Using an intersectionality perspective, we also tested whether the effects of gender, ethnicity, and religiosity on adolescents' attitudes would function differently in adolescents with and without same-sex attractions. Data for this study were collected by means of a paper questionnaire completed by 1,518 secondary school students (mean age = 14.56 years, SD = 1.05) in Amsterdam, the Netherlands. The sample was 48.1% female and 51.9% male. Approximately one third of adolescents in the sample were of a non-Western ethnic background (32.3%, n = 491) and 7.5% of the participants (n = 114) reported experiencing same-sex attractions. Results of our analyses showed that adolescents in our sample who were male, of non-Western ethnicity, and who were more religious (as indicated by frequency of religious service attendance), were less accepting of same-sex sexuality and gender non-conformity in comparison to female, Western and less religious peers. We also found a significant interaction effect between religiosity and sexual attractions, but only in relation to evaluation of same-sex attracted, gender nonconforming females. The negative effect of religiosity on acceptance of same-sex attracted, gender non-conforming females was stronger among those adolescents who reported same-sex attractions.