Ischaemic heart disease in Turkish migrants with type 2 diabetes mellitus in The Netherlands: wait for the next generation?

OBJECTIVE: To study the prevalence of ischaemic heart disease in Turkish and Surinam-Asian migrants with type 2 diabetes mellitus in the Netherlands as compared with Europeans. METHODS: In a consecutive case-control study, 59 Turkish and 62 Surinam-Asian patients were compared with 185 Europeans referred to a diabetes clinic for treatment of type 2 diabetes in the period 1992 to 1998. Main outcome measures were ischaemic heart disease and its associated risk factors. RESULTS: The prevalence of ischaemic heart disease was lower (9%) in the Turks (p < 0.02), but higher (29%) in the Surinam-Asians compared with the Europeans (23%). The Turks (52 +/- 10 years) and Surinam-Asians (46 +/- 12 years) were younger than the Europeans (64 +/- 11 years, p < 0.001). Body mass index was 32 +/- 5 (p < 0.001) in the Turks, 27 +/- 5 in the Surinam-Asians (p < 0.05) and 29 +/- 5 in the Europeans. Turkish patients smoked less (23%, p < 0.05) and used less alcohol (4%, p < 0.05) than the Europeans. Proteinuria was found in 24% of the Turks (p < 0.05), 37% of the Surinam-Asians (NS) and 46% of the Europeans. In univariate analysis ischaemic heart disease was related to Turkish origin, OR 0.34 (0.14-0.83) p < 0.02, to Surinam-Asian origin, OR 1.84 (1.00-3.38) p = 0.05, and smoking, OR 1.78 (1.18-2.68) p < 0.01. Other variables were not related to ischaemic heart disease. Multivariate analysis in a model with ethnicity and smoking showed significant relations between ischaemic heart disease and Turkish ethnicity, OR 0.19 (0.06-0.65) p = 0.007, Surinam-Asian origin, OR 2.77 (1.45-5.28) p = 0.002, and smoking, OR 1.79 (1.20-2.66) p = 0.004. CONCLUSION: Type 2 diabetes mellitus in different ethnic groups results in a significant difference in incidence of ischaemic heart disease. The most remarkable finding is a low incidence of ischaemic heart disease in the Turkish patients with type 2 diabetes, independent of smoking. The high prevalence of ischaemic heart disease in young migrant Asians with diabetes is confirmed

Why are Health Persuasive Messages Not Always Effective?

In the framework of developing more effective persuasive messages in the domain of health, it is important to analyze what can go wrong: Why are persuasive messages not (always) effective? This chapter presents a theoretical analysis of this issue in two parts, using the Working Memory approach of Persuasion (WMaP) as the integrative theoretical framework. In the first part, the focus is on how persuasive messages fail to target the self-regulatory processes involved in persuasion. The core of the persuasive process is the meaning-giving of the persuasive information, which occurs in working memory on the basis of activated long-term memory contents. In the second part, the focus is on the purposeful inhibition of the persuasive process with defensive self-regulatory actions (DSAs). These also occur in working memory and manifest in different ways that undermine the development of lucid and emotional mental images around the persuasive information. DSAs are closely related to the recipient’s self, as shown by studies on self-affirmation and personalization. Using the WMaP, DSAs are studied now using a novel research paradigm in persuasion: induced eye movements that tax working memory.</p

A cross-sectional analysis of motivation and decision-making in referrals to lifestyle interventions by primary care general practitioners: a call for guidance

Aim: To explore 1) GPs´ motivation to refer to lifestyle interventions and to investigate the association between GPs’ own lifestyle-behaviors and their referral behavior, and 2) patient indicators in the decision-making process of the GPs’ referral to lifestyle interventions. Method: A cross-sectional study was conducted among 99 Dutch primary care GPs. Their motivation to refer was assessed by beliefs regarding lifestyle interventions. GPs’ referral behaviors were assessed - considering referral and self-reported actual referral - and their own lifestyle behaviors - physical activity, dieting, being overweight). Decision-making regarding referring patients to lifestyle interventions was assessed by imposed patient indicators, spontaneously suggested decisive patient indicators, and by case-based referring (vignettes). Results: A substantial group of GPs was not motivated for referral to lifestyle interventions. GPs’ refer behavior was significantly associated with their perceived subjective norm, behavioral control, and their own physical activity and diet. Most important patient indicators in referral to lifestyle interventions were somatic indicators, and patients’ motivation for lifestyle interventions. Conclusions: GPs motivation and referral behavior might be improved by providing them with tailored resources about evidence based lifestyle interventions, with support from allied health professionals, and with official guidelines for a more objective and systematic screening of patients