http://repub.eur.nl/res/aut/10254/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/25555/ 2011-04-01T00:00:00Z Background: There are concerns about ethnic disparity in outcome of obstetric health care in high-income countries. Our aim was to assess these differences in a large cohort of women having experienced severe acute maternal morbidity (SAMM) during pregnancy, delivery and puerperium. Methods: All women experiencing SAMM were prospectively collected in a nationwide population-based design from August 2004 to August 2006. Women delivering in the same period served as reference cohort. Population-based risks were calculated by ethnicity and by type of morbidity. Additionally, non-Western and Western women having experienced SAMM were compared in multivariable logistic regression analysis. Results: All 98 Dutch maternity units participated. There were 371 021 deliveries during the study period. A total of 2506 women with SAMM were included, 21.1% of whom were non-Western immigrants. Non-Western immigrants showed a 1.3-fold [95% confidence interval (CI) 1.2-1.5] increased risk to develop SAMM. Large differences were observed among different ethnic minority groups, ranging from a non-increased risk for Moroccan and Turkish women to a 3.5-fold (95% CI 2.8-4.3) increased risk for sub-Saharan African women. Low socio-economic status, unemployment, single household, high parity and prior caesarean were independent explanatory factors for SAMM, although they did not fully explain the differences. Immigration-related characteristics differed by ethnic background. Conclusions: Non-Western immigrants have an increased risk of developing SAMM as compared to Western women. Risks varied largely by ethnic origin. Immigration-related characteristics might partly explain the increased risk. The results suggest that there are opportunities for quality improvement by targeting specific disadvantaged groups. http://repub.eur.nl/res/pub/10364/ 2004-01-01T00:00:00Z The number of native Dutch and Turkish workers receiving a permanent disability pension in the Netherlands is still rising. To assess ethnic differences in disability risk between Dutch and Turkish scaffolders, a retrospective study was conducted within a large scaffolding company. Medical files for the period 1981-2000 were used to gather information on ethnicity, age at entering service, age at becoming disabled, years of employment, the year to receive a disability pension, the disability diagnosis, and the percentage rating of the disability pension. In the past 20 yr, 131 Turkish and 125 Dutch scaffolders have become disabled. Musculoskeletal disorders were the primary reason for the diagnosis. No differences in diagnoses were observed, except for a small difference in cardiovascular disease. Turkish scaffolders started their work at an older age, received the disability pension at an older age, and had a longer duration of employment. Turkish scaffolders faced disability 2.48 (95% confidence interval 1.94-3.18) times more often than their Dutch colleagues, adjusted for age. Explanations for the differences in disability risk between Dutch and Turkish scaffolders are sought in the older age at start of employment, lower mobility in the labour market, and less access to medical and social care. In future, employers, general practitioners, occupational health physicians and social security workers, as stakeholders in reintegration, should sufficiently attune their activities concerning care and cure for Turkish construction workers on long-term sick leave or during reintegration into other work. http://repub.eur.nl/res/pub/18176/ 1997-06-25T00:00:00Z Concern for occupational health and safety has a long tradition in Westem countries. In these countries, well-established disciplines are able to recognize and control inherent risks of industrial processes. The occupational health care system is well-developed and occupational health services play an important role in safeguarding workers' health. There is an abundant body of scientific literature on almost evelY aspect of occupational health in affluent nations. In stark contrast, there is very little information available on work-related health hazards in occupations in low-income countries, while the largest part of the worldwide workforce is to be found in these low-income countries. Moreover, anecdotal evidence suggests that working conditions in developing countries may substantially differ from those in affluent nations, usually for the worse. Infonnation on the distribution of health hazards and the prevalence of work-related diseases in low-income countries is extremely scarce or even absent for many areas. In low-income countries, enforcement of labor laws is almost nonexistent, occupational health services are not available and resources for identifYing and cvaluating working conditions and consequent health effects are severely limited. This thesis is about the health and safety of workers inlow-income countries and opportunities to improve their working conditions. The origin of the thesis is the author's personal experiencc in one specific program directed at improving the occupational health and safety in tamleries in Kanpur, India, and his more general experience in international public health.