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Background In Europe, a substantial percentage of the 22 million inhabitants with histories of migration from non-European countries utilize healthcare in their countries of origin. That could reflect avoidance of healthcare in the country of residence, but this has not been studied previously. Methods We linked Dutch healthcare reimbursement data to the multi-ethnic population-based data from the HELIUS study conducted in Amsterdam. In multivariable logistic regression and negative binomial generalized estimating equation (GEE) analyses, we examined associations between healthcare use in country of origin and in country of residence by people with Turkish and with Moroccan backgrounds (N = 2920 and N = 3031, respectively) in the period 2010–15. Results Participants with Turkish and Moroccan backgrounds who utilized healthcare one or multiple times in the country of origin (n = 1335 and n = 558, respectively) were found to be more likely, in comparison with non-users (n = 1585, n = 2473), to be frequent attenders of services by general practitioners, medical specialists and/or allied health professionals in the Netherlands [odds ratios between 1.21 (95% CI 0.91–1.60) and 3.15 (95% CI 2.38–4.16)]. GEE analyses showed similar results. Conclusion People with Turkish or Moroccan backgrounds living in the Netherlands who use healthcare in their countries of origin are more likely than non-users to be higher users of healthcare in the Netherlands. We thus found no indications for avoidance of healthcare in the country of residence. [ABSTRACT FROM AUTHOR]

Avoiding activities posing bodily threat is adaptive. However, spreading of avoidance to safe activities may cause functional disability in people with chronic pain. We investigated whether costly pain-related avoidance would generalize from one activity to another on the basis of real-life categorical knowledge in 40 pain-free people (30 female; mean age = 25 years; university students and public of Maastricht, The Netherlands). In a computer task, participants moved a joystick to complete activities from two categories (gardening and cleaning). During activities from the avoidance category, pain could be avoided at the cost of task efficiency by deviating from a short, pain-associated joystick movement. Activities from the safe category were never painful. Subsequently, we tested generalization of avoidance to novel pain-free activities from both categories. Participants generalized avoidance to novel activities from the avoidance category despite the novel activities not being paired with pain and despite avoidance costs, suggesting that costly (pain-related) avoidance generalizes from one activity to another on the basis of category knowledge and can thus be wide reaching, creating detrimental consequences.

• The falls efficacy scale – international avoidance behavior (FES-IAB) builds upon the internationally used and validated FES-I. • The FES-IAB assesses activity avoidance due to concerns about falling. • The FES-IAB shows good reliability and construct validity. • The short FES-IAB is a good alternative when a shorter questionnaire is required. Background and Objectives: The Falls Efficacy Scale-International (FES-I) and its shorter version (Short FES-I) are widely used measures of concerns about falling (CaF) and have consistently demonstrated good psychometric properties. The FES-I Avoidance Behavior (FES-IAB) and Short FES-IAB were developed to gain insight into activity avoidance due to CaF and add a question to each item of the FES-I and Short FES-I. The objective was to assess the psychometric properties of the FES-IAB and Short FES-IAB in community-dwelling older people. Methods: A community-dwelling sample of the Dutch population (n = 744) aged 60 and over completed the FES-IAB twice with one month in between (with a follow-up response rate of 92.2%). Results: Confirmatory factor analysis confirmed the unidimensionality of the FES-IAB, with high factor loadings and very good fit. The scale correlated strongly with the FES-I, and moderately with ADL disability and 1-item questions of activity avoidance and CaF. The FES-IAB discriminated well between groups based on age, sex, fall history. Internal consistency and test-retest reliability were high (Cronbach's alpha: 0.92, intraclass correlation coefficient: 0.85). FES-IAB scores were positively skewed; 343 people (46.1%) had the lowest possible score of 16. The psychometric properties of the Short FES-IAB were comparable. No problems were identified with the feasibility of the FES-IAB and Short FES-IAB. Discussion: Overall, the FES-IAB and Short FES-IAB demonstrated good psychometric properties in assessing activity avoidance due to CaF in community-dwelling older people. These instruments may help researchers and clinicians to investigate the behavioral consequences of CaF. [ABSTRACT FROM AUTHOR]