The European Journal of Public Health - Advance Access

Physical and psychosocial working conditions as explanations for occupational class inequalities in self-rated health

Kaikkonen, R., Rahkonen, O., Lallukka, T., Lahelma, E. — 2009-07-01

Background: Socio-economic health inequalities are well documented, but efforts to explain health inequalities are less. However, previous studies suggest that working conditions provide potential explanations for inequalities in health. Methods: Cross-sectional questionnaire survey data, collected from municipal employees of the City of Helsinki, aged 40–60 years (n = 8960, response rate 67%) in 2000–02, were examined using binomial regression analysis. Socio-economic position was measured by six occupational social classes ranging from top managers to manual workers, and the outcome was self-rated health (SRH). Key physical and psychosocial working conditions and work arrangements were included as explanatory factors for inequalities in health. Results: Occupational class inequalities in SRH were clear among women [prevalence ratio (PR) 1.89, 95% confidence interval (CI) 1.54–2.32] and men (PR 1.78, 95% CI 1.40–2.25). Heavy physical workload explained a half of the health inequalities among women and almost one-third among men. Physical and chemical exposures at work explained one-fifth of the health inequalities among women and a half among men. Job control explained 24% of the men's and 40% of women's inequalities, whereas job demands widened the inequalities by 13–14%. The effects of shift work and working hours were negligible. In the fully adjusted model, 60% of the women's and 32% of the men's inequalities in SRH were explained. Conclusion: Physical working conditions explained a large part and job control, a somewhat smaller part of socio-economic inequalities in SRH. Improving physical working conditions and increasing job control provide potential routes to reduced inequalities in health among employees.

Greater gains from smoke-free legislation for non-smoking bar staff in Belfast

Bannon, F., Devlin, A., McElwee, G., Gavin, A. — 2009-06-30

Background: In April 2007, smoke-free legislation was enacted in workplaces throughout N. Ireland. The effects of this legislation on bar workers’ health and their exposure to second-hand smoke at home, work and social environment, and their attitudes to the legislation before and after its implementation remain to be documented. Methods: A self-completed questionnaire of bar staff in 35 Belfast bars, before (March 2007, n = 110) and after the legislation (July 2007, n = 110). Results: Smokers (excluding ‘social smokers’) made up 41.6% of respondents. After the introduction of the smoke-free legislation, the reductions in the proportion of bar workers reporting various respiratory symptoms ranged from 1.3% to 18.6% for smokers and from 21.9% to 33.2% for non-smokers. Likewise, the reductions for various sensory symptoms ranged from 7.3% to 17.7% for smokers and from 29.6% to 46.8% for non-smokers. Reduction in wheeze, cough and throat symptoms after the legislation were much greater for non-smokers than smokers. The proportion of bar staff who reported satisfaction with the legislation remained unchanged across the surveys. Decreases in perceived exposure to second-hand smoke occurred at work, home and in social settings. After the legislation's enactment, a majority of bar workers felt the workplace was healthier (98%). Conclusion: These first findings show reduced reported symptoms among bar workers, both smokers and non-smokers, after the introduction of smoke-free legislation in N. Ireland, though greater among non-smokers. There was also a reported fall in the hours of second-hand smoke exposure in the home for this group of workers which has a high prevalence of smokers.

Correlates of intensive alcohol and drug use in men who have sex with men in Catalonia, Spain

Folch, C., Esteve, A., Zaragoza, K., Munoz, R., Casabona, J. — 2009-06-29

Background: The objectives of the study were to determine the prevalence of alcohol and drug use before or during sex among men who have sex with men (MSM) in Catalonia during 2006, and to identify factors associated with variables of intensive alcohol and drug use. Methods: Cross-sectional study using self-administered questionnaires. Men were recruited in saunas, sex shops, bars and a public park and by mail to all the members of the Catalonia Gay Federation. Results: 19.6% of men said they were frequent users of alcohol, some type of drug (21.7%), or that they were multidrug users (18%) in the last 12 months. The multivariate analysis showed an association between having suffered discrimination and frequent alcohol and multidrug use. Being human immunodeficiency virus (HIV)-positive was associated with frequent use of drugs and multidrug use. Associations between substance use and sexual risk behaviour also emerged. Conclusion: The high percentage of MSM who use alcohol and drugs before and during sex and association between these substances and sexual risk behaviours reveals the need to intensify interventions to reduce their levels of use and/or to reduce the associated damage and risks. These programs must try to cover MSM-specific psychosocial aspects and include prevention for HIV-positive men.

The contribution of qualitative research to the development of tailor-made community-based interventions in primary care: a review

Jansen, Y. J. F. M., Foets, M. M. E., Bont, A. A. d. — 2009-06-26

Background: In recent years, a trend in the use of tailor-made approaches and pragmatic trial methodology for evaluating effectiveness has been visible in programs ranging from large-scale national health prevention campaigns to community-based initiatives. Qualitative research is used more often for tailoring interventions towards communities and/or local care practices. This article systematically reviews the contribution of qualitative research in developing tailor-made community-based interventions in primary care evaluated by means of the pragmatic trial methodology. Methods: A systematic search of Pubmed/Medline and Embase revealed 33 articles. Using a literature mapping process, the articles were arranged according to the development phases identified in the MRC framework for the development of complex interventions to improve health. Results: The review showed qualitative research is mainly used to provide insight into the contextual circumstances of the interventions’ implementation, delivery and evaluation. To a lesser extent, qualitative research findings are used for tailoring and improving the design of the interventions for a better fit with daily primary care practice. Moreover, most qualitative findings are used for tailoring the interventions’ contextual circumstances so that the interventions are performed in practice as planned, rather than adjusted to local circumstances. Conclusions: Pragmatic trials seem to be oxymoronic. Although the pragmatic trial methodology establishes the effectiveness of interventions under natural, non-experimental conditions, no pragmatic fit is allowed. Qualitative research's contribution to the development of tailor-made community-based interventions lies in providing ongoing evaluations of the dilemmas faced in pragmatic trials and allowing for the development of true tailor-made interventions.

Changes in alcohol consumption and drinking patterns during 11 years of follow-up among ageing men: the FinDrink study

2009-06-26

Background: Alcohol consumption is often reported to decrease with ageing. We investigated alcohol consumption and drinking patterns in an ageing population-based male sample during an 11-year follow-up period. Methods: This study with baseline and two follow-up examinations (at 4 and 11 years) included 1516 randomly selected participants, aged 42, 48, 54 and 60 years from Eastern Finland. Alcohol consumption and drinking patterns during the year preceding the examination were assessed. Data were analysed using Generalized Estimating Equations and Mixed Models. Results: Over the 11-year study period, the amount of alcohol consumed weekly increased among the 42-year-olds (P < 0.001) and remained constant among the older cohorts. The risk of frequent drinking (alcohol consumption at least twice weekly) increased among all cohorts (OR = 2.04, 95% CI = 1.50–2.79 for 42-year-olds; OR = 1.71, 95% CI = 1.13–2.58 for 48-year-olds; OR = 1.67, 95% CI = 1.16–2.39 for 54-year-olds and OR = 1.67, 95% CI = 1.21–2.29 for 60-year-olds). There was also an increasing probability of heavy consumption (more than 14 weekly drinks) among the 42-year-olds (OR = 1.47, 95% CI = 1.09–2.00). The risk of binging (six-plus drinks at one occasion) decreased among the older participants (OR = 0.65, 95% CI = 0.47–0.89 for 54-year-olds, and OR = 0.56, 95% CI = 0.39–0.81 for 60-year-olds). Conclusion: Finnish men born in 1926–1946 do not seem to decrease drinking while ageing. In contrast those born in 1944–1946 increase drinking until their 60’s. This should be taken into consideration in planning health services for aged men in the near future.

Underappreciated role of binge drinking in the risk of lung cancer

2009-06-25

Children's physical activity, TV watching and obesity in Cyprus: the CYKIDS study

Lazarou, C., Soteriades, E. S. — 2009-06-25

Background: Even though there is a severe obesity problem in Cyprus, information about the contribution of predisposing lifestyle factors is limited. Our aim was to investigate the relationship between physical activity (PA), sedentary behaviour and various obesity indices [i.e. body mass index (BMI), waist circumference (WC), percentage of body fat (BF%) and ‘total & abdominal obesity’ (TAO)]. Methods: A national cross-sectional study of 1140 children (mean age = 10.7 ± 0.98 years) selected by multistage sampling in Cyprus was conducted during 2004–05. Children completed a 32-item, semi-quantitative PA questionnaire, which assessed organized and free-time PA and sedentary behaviours. Weight, height and WC were collected from a random sub-sample of 622 children and obesity was defined by IOTF criteria. Body fat percentage was calculated, and TAO status was computed based on obesity status and WC [i.e. (i) both BMI/WC, (ii) either BMI/WC abnormal and (iii) both BMI/WC abnormal]. Linear and logistic regression analyses with obesity indices as dependent variables were applied after adjusting for several potential confounders. Results: Only variables describing sedentary behaviours were retained in the final regression models in both boys and girls. Girls who spent ≥4 h/day on TV and DVD watching were almost three times more likely to be overweight or obese [OR = 2.84 (95% CI 1.08–7.47)], three times more likely to have WC ≥75th percentile [OR = 3.25 (95% CI 1.06–9.98)] and 3.5 times more likely to have ≥30% body fat [OR = 3.63 (95% CI 1.01–12.98)], while in boys, even though the same variable was retained in almost all final models, it did not reach statistical significance. Conclusion: Sedentary behaviours such as TV watching may be more important predictors of children's various obesity indices than PA behaviours. Interventions targeting sedentary behaviours, such as TV watching, may help in the prevention and treatment of obesity among Cypriot children.

Deaths in German police custody

Heide, S., Kleiber, M., Hanke, S., Stiller, D. — 2009-06-25

Background: According to the ministries of the interior of all German federal states, a total of 128 persons died in police custody between 1993 and 2003. Methods: An inquiry to the forensic university institutes and regional court doctors showed that, within this period, post mortems were conducted in 75 of these cases. We were able to include 60 of these 75 cases in our evaluation and deficiency analysis, which were carried out under assessment of the post mortem records and partly by making use of the subsequent medical expert reports and the results of criminal investigation. Results: The most frequent cause of death was acute alcoholic intoxication, followed by cerebrocranial traumata, internal diseases and fatal poisonings with medical or illegal drugs. In 23 cases, the person taken into custody had been seen by a physician in order to determine the person's fitness for detention in custody. Of these 23 cases, 15 (65.2%) revealed deficiencies in various areas of medical activity. Police officers had made mistakes in 33 of the 60 cases (55.0%), mainly because they failed to seek medical assistance or did not monitor the person with sufficient frequency. Our retrospective study however showed that in 16 cases (26.6%) death was very probably not preventable even if the person had received all necessary care. Conclusions: Our study gives recommendations on how to improve various measures to increase the quality of medical attention given to persons taken into police custody.

The effect of television news items on intimate partner violence murders

Vives-Cases, C., Torrubiano-Dominguez, J., Alvarez-Dardet, C. — 2009-06-23

Background: This study has been carried out in order to explore the effect of the growing appearance of IPV in television news items on deaths by this cause. Methods: Ecological study based on 340 deaths by intimate partner violence (IPV) and 3733 television news items covering this topic on Spanish television channels (2003 and 2007). Logistic regression analysis was carried out. Dependent variable: the difference between the number of IPV deaths in the 7 days following a news item broadcast and the number of IPV deaths in the 7 days before a media item. This outcome variable was conceptualised as a binary variable: increase vs. no increase. Independent variables: days with IPV news items—in general, concerning deaths, measures or other IPV crimes. Adjusted variables: day of the week, month, year and public holidays. Results: A small copycat effect was observed in the IPV murder rate (RR = 1.32, CI_95% = 1.07 – 1.62) for IPV-related news item days compared with days without such news. This effect continued when information about deaths was broadcast (RR = 1.28, CI_95% = 1.01 – 1.62). News items concerning measures (RR = 0.90, CI_95% = 0.82 – 0.98) or other IPV crimes (0.84, CI_95% = 0.82 – 0.98) were related to a lower possibility of an increase in deaths compared with days with death-related news. Conclusion: Given the results observed in the case of IPV-related news, there is an evident need to develop a journalistic style guide in order to determine what type of information is recommended due to the potential positive or negative effects.

'How are you?': what do you mean?

Lang, T., Delpierre, C. — 2009-06-23

Is health recognized in the EU's policy process? An analysis of the European Commission's impact assessments

Stahl, T. P. — 2009-06-23

Background: The European Commission has an Impact Assessment (IA) procedure that aims to inform decision-makers of the all important impacts that decisions may have. This article studies how health is considered in the IA procedure and how it is reflected in the reports: what aspects, whose and simply in what context health is mentioned in the IA reports. Methods: Half of the Commissions IAs from 2006 were studied. The analysis was text based and informed by content analysis. In total, 48 reports by 17 DGs were analysed. Results: Five DGs (29%) and 10 reports (21%) made no reference to human health, public health or health systems. Five DGs were clearly considering health impacts more often than others; DG EMPL, SANCO, AGRI, ELARG and ENV. Health systems/services were most often and human health next most common referred to (39% and 29% of all, respectively). Health impacts were usually referred to in the sections on the definition of problems and the analysis of impacts. Seldom were they reported on in the sections on policy options, comparing options, or in the monitoring and evaluation sections. Conclusion: The results partly support concerns about the potential neglect of health impacts. The results also suggest that health is not considered an important factor when discussing alternative policy choices, and neither does it seem to be an important objective. There is a clear need for further exploration on ways in which health could be more appropriately considered when impacts of other policies are considered by the various DGs.

Pneumonia mortality in a UK general practice population cohort

2009-06-23

Background: Pneumonia is a common diagnosis in general practice in the United Kingdom and yet there is little known about the short- and long-term prognosis of people with a diagnosis of pneumonia in general practice. We investigated the short- and long-term survival of people with pneumonia diagnosed in general practice as compared to the general population for all ages. Methods: This was a general population-based cohort study. Data was obtained from a comprehensive general practice database called The Health Improvement Network (THIN) database which has computerized medical records from 300 general practice surgeries in the United Kingdom. We used Cox regression for our analyses. Results: For pneumonia cases the 30-day mortality was 18.5% and the 3-year mortality was 30.8%. The equivalent figures for the general population controls were 0.4% and 10.3% respectively. The adjusted hazard ratio (HR) for all-cause mortality (for total follow-up time) in pneumonia cases vs. general population was 4.64 (95% CI 4.35–4.95). For the first 30 days the risk of mortality in cases was 46 times more (adj. HR 45.90, 95% CI 36.80–55.20). Even in the period of follow-up 91 days after diagnosis cases were almost 20% more likely to die compared to general population (adj. HR 1.19, 95% CI 1.08–1.31). Conclusion: People in general practice who have a diagnosis of pneumonia have a markedly increased mortality in the short-term but some increase in mortality persists during longer-term follow-up.

Educational inequalities in self-rated health within the Arab minority in Israel: explanatory factors

Daoud, N., Soskolne, V., Manor, O. — 2009-06-23

Background: Studies on factors explaining the socioeconomic inequalities in health within ethnic minorities are scarce. This study examines the contribution of material conditions, and psychosocial, community, cultural and behavioural factors to explaining educational disparities in self-rated health (SRH) within the Arab minority in Israel. Methods: In 2005, a national random sample of 902 persons aged 30–70 was selected in a multistage sampling procedure for interviewing. We used multistage logistic regression modelling to examine the percent of attenuations in odds ratios (OR) of extreme categories for education (low vs. high) in the associations with SRH after inclusion of explanatory variables. Results: Education was significantly associated with SRH [odds ratio (OR) = 3.86, 95% confidence interval (CI) = 2.30–6.47]. The separate inclusion of material conditions reduced the OR of poor SRH by 43%. Psychosocial, community or behavioural variables reduced it by 17%, 26% and 11%, respectively. Combining each group of factors with material conditions led to small additional reductions in OR. Integrating all explanatory variables reduced OR by 54%, with the association becoming non-significant. Cultural variables were not associated with SRH and were therefore not included in the multivariate analysis. Conclusions: Material conditions are a major factor in explaining the educational disparities in SRH among Arabs in Israel. Most of the impact of psychosocial and health behaviours, together with part of the community effects, operated through material conditions. Reduction of educational inequalities in SRH requires provision of educational attainment opportunities accompanied by employment opportunities assuring equivalent material gains. Further examination of factors explaining health inequalities among other minorities is warranted.

Income inequality and male homicide rates: Sao Paulo, Brazil, 1996-2007

Lotufo, P. A., Bensenor, I. M. — 2009-06-17

In Sao Paulo, Brazil, homicides to men aged 15–44 years increased with an annual percentage change (APC) of 4.7% from 1996 to 2001, and then decreased from 2001 to 2007 with an APC of –14.6%. Analyzing the intra-urban distribution according to family income, the increase in the homicide rate was restricted to men living in the poorest neighbourhoods. In contrast, the decline in homicide rates was observed to men living in all districts. The reasons for this ‘up and down’ trend are not clear.

Association between political ideology and health in Europe

Subramanian, S. V., Huijts, T., Perkins, J. M. — 2009-06-17

Studies have largely examined the association between political ideology and health at the aggregate/ecological level. Using individual-level data from 29 European countries, we investigated whether self-reports of political ideology and health are associated. In adjusted models, we found an inverse association between political ideology and self-rated poor health; for a unit increase in the political ideology scale (towards right) the odds ratio (OR) for reporting poor health decreased (OR 0.95, 95% confidence interval 0.94–0.96). Although political ideology per se is unlikely to have a causal link to health, it could be a marker for health-promoting latent attitudes, values and beliefs.

Socio-economic factors and active commuting to school in urban Spanish adolescents: the AVENA study

2009-06-17

Background: This study aimed: (i) to describe the patterns of commuting to school in urban Spanish adolescents; and (ii) to examine the associations between active commuting to school (ACS) and socio-economic factors.

Methods: From the AVENA Study, 2183 adolescents (1142 females) aged 13–18.5 years were gathered. Mode and time of transportation to school were self-reported by the adolescents. Parental education level (primary, secondary or university degree), parental professional level (managerial, skilled worker or unskilled worker/unemployed) and the type of school (public or private) were self-reported by the parents. The relationships between ACS and socio-economic factors were analysed by binary logistic regression.

Results: Nearly <65% of the adolescents reported ACS and 83% of them spent <15 min travelling to school. In male adolescents, maternal primary education level showed an odds ratio (OR) of 1.55 (95% confidence interval, 1.12–2.15), with respect to mothers with a university degree. In female adolescents, mothers with a primary education level showed an OR of 0.68 (0.50–0.92), with respect to mothers with a university degree. Low maternal professional level showed an OR of 1.70 (1.29–2.24), with respect to high maternal professional levels. Students attending public schools showed an OR of 3.47 (2.46–4.90), with respect to students from private schools.

Conclusion: Most of the adolescents actively commuted to school, yet the time spent commuting was low. Socio-economic level seems to be inversely related to the ACS in adolescents. Type of school and maternal educational level were the main predictors of ACS.

The aftershock of deindustrialization--trends in mortality in Scotland and other parts of post-industrial Europe

Walsh, D., Taulbut, M., Hanlon, P. — 2009-06-15

Background: Post-industrial decline is frequently cited as one of the major underlying reasons behind the poor health profile of Scotland and, especially, West Central Scotland (WCS). This begs the question: to what extent is poor health a common outcome in other post-industrial regions and how does Scotland's experience compare to these other comparable regions? Methods: Regions were identified by means of an expert-based consultation, backed up by analysis of regional industrial employment loss over the past 30 years. Mortality rates and related statistics were calculated from data obtained from national and regional statistical agencies. Results: Twenty candidate regions (in: Belgium; France; Germany; Netherlands; UK; Poland; Czech Republic) were identified, of which ten were selected for in-depth analyses. WCS mortality rates are generally higher and—crucially—appear to be improving at a slower rate than in the other post-industrial regions. This relatively poor rate of improvement is largely driven by mortality among the younger working age (especially male) and middle-aged female populations. Conclusion: WCS mortality trends compare badly with other, similar, post-industrial regions of Europe, including regions in Eastern Europe which tend to be characterized by higher levels of poverty. This finding challenges any simplistic explanation of WCS's poor health being caused by post-industrial decline alone, and begs the question as to what other factors may be at work.

What makes you work while you are sick? Evidence from a survey of workers

Bockerman, P., Laukkanen, E. — 2009-06-12

Background: Sickness absenteeism has been a focus of the EU Labour Force Surveys since the early 1970s. In contrast, sickness presenteeism is a newcomer. Based on surveys, this concept emerged in the empirical literature as late as the 1990s. Knowledge of the determinants of sickness presenteeism is still relatively sparse. Methods: The article examines the prevalence of sickness presenteeism in comparison with sickness absenteeism, using survey data covering 725 Finnish union members in 2008. We estimate logit models. The predictor variables capture working-time arrangements and the rules at the workplace. We include control variables such as the sector of the economy and educational attainment. Results: Controlling for worker characteristics, we find that sickness presenteeism is much more sensitive to working-time arrangements than sickness absenteeism is. Permanent full-time work, mismatch between desired and actual working hours, shift or period work and overlong working weeks increase sickness presenteeism. We also find an interesting trade-off between sickness categories: regular overtime decreases sickness absenteeism, but increases sickness presenteeism. Conclusions: Two work-related sickness categories, absenteeism and presenteeism, are counterparts. However, the explanations for their prevalence point to different factors.

'Ethnic Cleansing Bleaches the Atrociites of Genocide'--correction

Richter, E. D., Stanton, G. — 2009-06-09

National cardiovascular prevention should be based on absolute disease risks, not levels of risk factors

Powles, J., Shroufi, A., Mathers, C., Zatonski, W., Vecchia, C. L., Ezzati, M. — 2009-06-08

Background: It has been shown that the prevention of multicausal diseases such as heart attack (at an individual level) should be guided by absolute risks rather than by the level of risk factors. Here, we show that an analogous argument should form the basis of population-level prevention. Methods: Estimates of age- and sex-specific means and standard deviations for systolic blood pressures and blood cholesterol concentrations and for deaths assigned to all vascular causes in 2002 were obtained from the World Health Organization for 25 current member states of the European Union, for the ages 30–69 years. Predicted effects of 5 mmHg reductions in mean systolic blood pressures and 0.5 mmol l^–1 reductions in mean total blood cholesterol concentrations on deaths and years of life lost (YLL) per 100 000 person-years from vascular diseases were modelled using proportional risk coefficients from meta-analyses of cohort studies and randomized controlled trials. Results: Potential absolute benefits were strongly positively associated with current levels of absolute mortality risk: in the case of systolic blood pressure, predicted vascular deaths averted in the highest risk populations (Romania, Bulgaria) were over five times higher than in the lowest risk populations (Spain, France). Potential benefits were only weakly related to existing levels of the risk factor of interest. Conclusions: High-risk populations should give the highest priority to achieving favourable shifts in all modifiable risk factors. Irrespective of the level of any particular risk factor, the rewards will be greatest in these populations.

Language-group mortality differentials in Finland in 1988-2004: assessment of the contribution of cause of death, sex and age

Sipila, P., Martikainen, P. — 2009-06-05

Background: The higher mortality among Finnish-speaking than Swedish-speaking Finns is well established and has been shown to be very persistent. However, the most recent comprehensive documentation on the language-group differential extends only to the mid-1980s. We study recent trends in sex- and age-specific language-group mortality from 1988 to 2004, focusing on the relative contribution of the main causes of death and differences in sociodemographic structure. Methods: The register data are based on an 11% sample of Finns aged ≥30 years at the end of 1987—which further includes an oversample of deaths covering 80% of all deaths in the period 1988–2004. Results: Finnish-speaking men had 19% and women 11% higher age-adjusted mortality rates than the Swedish speakers. Further adjustments for sociodemographic composition explained 47% and 36%, respectively, of these differences. Age group-specific analyses showed the steepest differences in the young and middle-aged groups (30–49 years) in both men and women. The cause-specific differences were most pronounced in alcohol-related diseases, suicide and other external causes, for which a slight increase in differentials was also observed. Conclusion: The relative difference in mortality between the two main language groups in Finland persists, with a slight narrowing of the gap among women. Moreover, the largest differences and indications of diverging trends were found among the youngest age groups. The causes of death in which the difference is greatest highlight the importance of health-related behaviour and cultural differences in lifestyle.

Large-scale epidemiological data on cardiovascular diseases and diabetes in migrant and ethnic minority groups in Europe

Rafnsson, S. B., Bhopal, R. S. — 2009-06-04

Background: Data on differences by ethnicity in cardiovascular diseases (CVDs) and diabetes, reflecting the influence of diverse cultural, social and religious factors, are important to providing clues to disease aetiology and directing public health interventions and health care resources. Methods: Through a network of European public health researchers and searches of bibliographic databases and internet sites, we determined the availability and characteristics of ethnically relevant data on mortality and morbidity from coronary heart disease (CHD), stroke and diabetes, in current European Union countries; data from the four countries comprising the UK were assessed separately. Results: In total, 25 countries had one or more relevant data sets (72 in total); however, two-thirds (n = 47) of the data sources came from only eight Nordic and Western European countries. For several countries, no data could be identified. Ethnically relevant, national death registers were available in 24 countries. Country of birth was the most common indicator of ethnicity. Data on CHD, stroke and diabetes morbidity among migrant and ethnic minority populations are currently scarce; both between and within countries, there are important differences in how ethnicity as well as disease outcomes are defined and measured which limits data comparability. Conclusion: Reliable routine data are key to evidence-based public health policies at both national and EU level. EU countries have a relatively weak base for assessing needs and planning health care interventions for its migrant and ethnic minority populations. The lack of ethnically relevant data on CVD and diabetes across the EU needs to be addressed urgently.

Cost-effectiveness of varenicline compared with nicotine patches for smoking cessation--results from four European countries

2009-06-02

Background: The aim of this study was to evaluate and compare the cost-effectiveness of varenicline with nicotine replacement therapy (NRT) for smoking cessation in four European countries (Belgium, France, Sweden and the UK). Methods: Markov simulations, using the Benefits of Smoking Cessation on Outcomes (BENESCO) model, were performed. We simulated the incidence of four smoking-related morbidities: lung cancer, chronic obstructive pulmonary disease, coronary heart disease and stroke. The model computes quality-adjusted life-years gained and incremental cost-effectiveness ratios. Incremental cost-utility ratios were calculated, adopting a lifetime perspective. Efficacy data were obtained from a randomized open-label trial: Week 52 continuous abstinence rates were 26.1% for varenicline and 20.3% for NRT. Results: The analyses imply that for countries analysed, smoking cessation using varenicline versus NRT was associated with reduced smoking-related morbidity and mortality. The number of morbidities avoided, per 1000 smokers attempting to quit, ranged from 9.7 in Belgium to 6.5 in the UK. The number of quality-adjusted life-years gained, per 1000 smokers, was 23 (Belgium); 19.5 (France); 29.9 (Sweden); and 23.7 (UK). In all base-case simulations (except France), varenicline dominated (more effective and cost saving) NRT regarding costs per quality-adjusted life-year gained; for France the incremental cost-effectiveness ratio was 2803. Conclusion: This cost-effectiveness analysis demonstrated that since varenicline treatment was more effective, the result was increased healthcare cost savings in Belgium, Sweden and the UK. Our results suggest that funding varenicline as a smoking cessation aid is justifiable from a healthcare resource allocation perspective.

The role of drunken older siblings and drunken peers in the alcohol-violence nexus

Kuntsche, E., Gossrau-Breen, D., Gmel, G. — 2009-05-29

Background: It is common knowledge that alcohol use and violence in adolescence is interrelated. However, less is known about variables which modify the link between alcohol use and violent behaviours in adolescence. The present study investigates how the interaction of intraindividual [adolescent risky single occasion drinking (RSOD)], intrafamilial (risky drinking of older siblings) and extrafamilial (risky drinking among peers) alcohol-related risk factors contributes to adolescents’ violence and delinquency. Methods: Multiple linear regression analyses including two- and three-way interactions were conducted based on a national representative sample of 3711 8–10th graders in Switzerland (mean age 15.0, SD = 0.95) who had older siblings. Results: All three alcohol-related risk factors and the three-way interaction contributed significantly to the frequency of violence and delinquency. Adolescents who frequently engage in RSOD and have both drunken peers and drunken older siblings had the highest levels of violence and delinquency. Moreover, their association between own drinking and violence increased the steepest. Conclusion: The present study confirmed the occurrence of cumulative risk processes and demonstrated that excessive alcohol consumption among older siblings and peers represents a crucial contextual factor for the link between adolescents’ risky drinking and violence and delinquency. For prevention, the findings suggest that a focus on peers alone may not be effective if the familial background is not taken into consideration.

Fear of racism, employment and expected organizational racism: their association with health

Becares, L., Stafford, M., Nazroo, J. — 2009-05-29

Background: Racism has been argued to be a focal element of larger societal inequalities which generate ethnic health disparities. Despite suggestions that socio-demographic characteristics of the victim may influence the impact of racism on health, little is known in the United Kingdom about how self-reported experiences of racism vary by socio-demographic characteristics, whether racism contributes to ethnic differences in health and whether there is a differential association between racism and health for certain socio-demographic groups. Methods: Multilevel logistic regression models were conducted using data from the 2005 Citizenship Survey to identify the demographic characteristics associated with reporting experienced racism; explore the association between health, racism and its contribution to ethnic inequalities in health; and explore the moderating role that gender, age, ethnicity and socio-economic position (SEP) have in the relationship between racism and health. Results: Females were significantly more likely to report fear of racial and religious attacks, but reported lower odds of experiencing employment and expected organizational discrimination. A trend was observed for decreasing employment discrimination as SEP decreased. A reverse association was found for SEP and expected organizational discrimination, where people in the lowest employment categories reported lower odds of experiencing discrimination. Conclusion: This study highlights variations in the types of racial discrimination most commonly reported across different socio-demographic characteristics. Despite substantial differences in the experience of racial discrimination, the detrimental impact of racism on health was the same across socio-demographic groups.

Evaluating risk for cardiovascular diseases--vain or value? How do different cardiovascular risk scores act in real life

Ketola, E., Laatikainen, T., Vartiainen, E. — 2009-05-29

Background: Screening tools to identify persons with high cardiovascular risk exist, but less is known about their validity in different population groups. The aim of this article is to compare the sensitivity and specificity of three different cardiovascular disease risk scores and their ability to detect high-risk individuals in daily practice. Methods: The sensitivity and specificity of risk charts based on Framingham Risk Function, SCORE and cardiovascular disease (CVD) Risk Score were analysed using a large population risk factor survey database in Finland. For different cardiovascular disease end-points in 10-year follow-up true positive, false positive, true negative and false negative cases were identified using different risk charts. Subjects over 40 years (n = 25 059) of the FINRISK Study were used in analyses. Results: Risk scores differed depending on gender, age and cardiovascular outcome. Among men the sensitivity of CVD Risk Score and Framingham Risk Function at risk of ≥10% for each end point was higher than of SCORE or Framingham Risk Function at risk of 20%. The specificity of Framingham Risk Function at risk of 20% was higher than the specificity of other risk charts. Among women in all endpoints the sensitivity was highest in CVD Risk Score and lowest in Framingham Risk Function at risk of ≥20%. Specificity for all different endpoints was highest in SCORE and Framingham Risk Function at risk of 20%. Conclusions: Sensitivity and specificity varied markedly in between three cardiovascular risk evaluation tools. Practitioners should be aware of their limitations especially when estimating risk among women and younger patients.

Prevalence of family violence in adults and children: estimates using the capture-recapture method

Oosterlee, A., Vink, R. M., Smit, F. — 2009-05-29

Background: Reliable prevalence estimates of family violence in adults and children are difficult to obtain. Most are based on surveys or registration counts, whose research designs and methods are often questionable, making the results difficult to compare. This article presents an alternative approach. Methods: The capture–recapture method (CRC), which makes it possible to estimate unknown numbers in a partly hidden population, was applied to data from eight collaborating organizations in Haarlem, The Netherlands. Results: Uniform data registration took place over a 7-month period. The 1-year prevalence rate for adult victims of family violence was estimated to be 2.0% of the adult population (95% CI: 1.3–3.1). For victims of child abuse, it was 1.5–2.5%, and for child witnesses of spouse-abuse, it was 1.2–2.1%, though small numbers made these results more uncertain. Only ~20% of all victims in the study were known to one or more of the participating organizations. Our results accorded quite well with results obtained by general health surveys in the Netherlands. Conclusions: CRC appears to be a valid and feasible research method for estimating the prevalence of family violence and child abuse. It can be used to complement other methods, especially in young children, in whom valid results are otherwise difficult to obtain.

Television exposure is related to fear of avian flu, an Ecological Study across 23 member states of the European Union

Van den Bulck, J., Custers, K. — 2009-05-28

Background: A pandemic outbreak of H5N1 avian influenza is believed to coincide with large-scale panic. Even without an outbreak fear of infection may be widespread. Mass media coverage of the risks of a pandemic may lead to higher levels of fear. Methods: An ecological study looked at data from 23 member states of the European Union and controlled for population size, level of education, age distribution and income and wealth. Results: When the findings for Cyprus were excluded each additional hour of average TV viewing was associated with a 15.6% increase in the proportion of people worrying about the virus. TV viewing explained 52% of the variance. Conclusion: Fear of a pandemic precedes any real pandemic and may have to be dealt with separately. Exposure to television is highly associated with worrying about the virus. This relationship merits further study.

Smoking prevalence and tobacco exposure among adolescents in Cyprus

Karekla, M., Symeou, A., Tsangari, H., Kapsou, M., Constantinou, M. — 2009-05-27

Background: Smoking has been internationally recognized as an epidemic contributing to major health problems. Smoking contributes to most of the preventable deaths worldwide. Although Cyprus is considered among developed countries with high smoking prevalence (estimates of 25–35% of the population), not much has been done for the systematic scientific study of this problem, especially in adolescence. The present study aimed to investigate smoking prevalence and related factors among Cypriot adolescents. Methods: Participants were selected through stratified random sampling. The final sample included two subpopulations: middle (n = 1085) and high (n = 767) school students. Results: Six percent of middle school students reported being regular smokers. This climbed to 24% among high school students. Smoking prevalence increases with age, and appears higher in boys than in girls. Smoking is quite common in the participant's families, particularly among fathers. Cigarette and smoke exposure in the home was high, as only a fifth of the students reported smoking never being allowed in the home. Exposure to actors smoking on television was the norm (62–67%) with low reported exposure to anti-smoking messages. Having friends who smoke, exposure to others smoking and low educational aspirations were significant predictors of smoking for both groups. Additional predictors, which were different for middle and high school students, were identified. Conclusion: Further research to investigate the nature of these effects is required and to provide further insight into the psychosocial parameters affecting smoking. These results can guide possible prevention and intervention programs for adolescents, and suggest the importance of following a systemic approach.

Health status of 'Ruhr-City' in 2025 - predicted disease burden for the metropolitan Ruhr area in North Rhine-Westphalia

2009-05-21

Background: Demographic change is a driving force of disease burden. The German population is aging and simultaneously shrinking, due to a rising life expectancy and a declining fertility rate. North Rhine-Westphalia (NRW) is the most populous federal state of Germany including the Ruhr metropolitan area. The NRW population is expected to shrink by 2.5% until 2025, the population of the Ruhr area by 9.5%. At the same time, the population forecast predicts a growth of 30% in the age group ≥55 years for NRW. Methods: The ‘burden of disease’ approach of the World Health Organisation (WHO) summarizes the health status of populations. This approach was used to predict the regional disease burden in 2025 by calculating disability adjusted life years (DALY) as the sum of life years lost due to premature death and years lived with disability due to selected diseases. Our projection included selected tumours, myocardial infarction (MI) and dementia. Results: For the Ruhr area, increases in DALYs are expected for all causes studied, i.e. selected tumours (20%), MI (17%) and dementia (36%). The increase in the Ruhr area was estimated to be proportionally lower than in NRW in total, but the disease burden per inhabitant is higher. Conclusion: The population shrinking is no cure for ‘Ruhr City’. The projection of disease burden shows that health status will decrease due to the demographic change. DALY estimates show the potential health gains, which can be won by implementing measures to reduce premature deaths and to prevent new cases.

Migrants and hepatitis B: new strategies for secondary prevention needed

Hahne, S., Wormann, T., Kretzschmar, M. — 2009-05-19

Could recommendations about aspirin prophylaxis enhance colorectal cancer screening programmes?

Morgan, G., Elwood, P. — 2009-05-18

Promoting stair climbing in Barcelona: similarities and differences with interventions in English-speaking populations

Puig-Ribera, A., Eves, F. F. — 2009-05-12

This study evaluated the ability of three different messages to encourage stair climbing on the Barcelona underground. Two weeks of baseline were followed by three banner intervention periods with three different messages, each for a 2 week period. Follow-up data was gathered two weeks after removing the messages. Stair climbing increased overall [odds ratio (OR) = 1.45; 95% confidence intervals (CIs) = 1.25–1.68], with no statistical differences between the messages. During follow-up, stair climbing remained elevated (OR = 1.22; 95% CIs = 1.01–1.48). These preliminary data suggest stair climbing interventions, effective in the UK, may prove successful in Catalonia and Spain. Baseline differences, however, outline the magnitude of the task.

Results of a cervical cancer screening programme from an area of Barcelona (Spain) with a large immigrant population

2009-05-12

Background: To assess the participation rate and results of cytological assessment in the context of cervical cancer screening activities in an area of Barcelona (Spain) with a large immigrant population. Methods: Descriptive retrospective study of cytologies performed between 2001 and 2006 in women ≥14 years of age living in 2 out of 10 districts of Barcelona (n = 129 327) and participating in cervical cancer screening activities within a sexual and reproductive health care programme. Results: Between 2001 and 2006, overall participation among women aged 20- to 64-years old was 50.7%, with higher participation among women aged 20–34 years than among those aged 50–64 years (63.8 and 36.0%, respectively; P < 0.01). The median frequency was 0.5 cytologies/year. The rate of pathological results increased from 11.4 in 2001 to 29.0 in 2006 (P < 0.001). This increase was higher among younger women and was mainly due to an increase in the rate of atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesions (L-SIL). Conclusions: These results show a low rate of participation in the public cervical cancer screening programme and an increase in the number of pathological results during the study period. These results provide useful information at a time when significant changes in the prevention of cervical cancer are being planned.

Is depression associated with health risk-related behaviour clusters in adults?

Verger, P., Lions, C., Ventelou, B. — 2009-04-29

Background: Depressive disorders have been linked to health risk-related behaviours (HRBs) considered separately. Our objective was to study whether depression is associated with the co-occurrence of HRBs in adults. Methods: A sample of 17 355 subjects aged ≥18 years, derived from the 2002–03 cross-sectional Decennial Health Survey; probable depression was assessed with the CES-D scale. A cluster analysis of various HRBs (tobacco use, alcohol use, binge drinking, physical inactivity, certain eating habits) was used to study their co-occurrence. Multiple regressions adjusted on demographic and socio-economic characteristics, Body Mass Index and chronic illnesses were performed to study associations between probable depression and the HRBs clusters obtained. Results: Five clusters were observed evidencing a gradient of cumulative exposure to HRBs: ‘healthy lifestyles (Cluster 1), ‘non-daily-consumers-fruit-and-green-vegetables’ (Cluster 2), ‘regular alcohol users’ (Cluster 3), ‘daily smokers’ (Cluster 4) and ‘cumulate risk takers’ (Cluster 5). Compared with Cluster 1, positive associations were found between probable depression and Clusters 2, 4 and 5: OR 1.49 (95% CI 1.26–1.76) for Cluster 2; OR 1.81 (95% CI 1.54–2.12) for Cluster 4; OR 2.05 (95% CI 1.68–2.51) for Cluster 5. For Cluster 3, no association was found: OR 1.01 (95% CI 0.84–1.21). Conclusions: HRBs tend to co-occur in the general population, more frequently in case of probable depression. Further research is necessary to disentangle the direction of the links between depression and HRB clusters. Nonetheless, these results question the classic design of education campaigns considering HRBs separately. Moreover, screening for depression should be systematic during prevention consultations and various HRBs should be monitored when treating depressive patients.

Relationships between work satisfaction, emotional exhaustion and mental health among Swiss primary care physicians

Bovier, P. A., Arigoni, F., Schneider, M., Gallacchi, M. B. — 2009-04-29

Background: Work-related satisfaction is an important determinant of quality of care. However, its relationship with doctors’ mental health is poorly understood. It could have an independent beneficial effect on mental health (direct association) or simply reduce the impact of work stress on mental health (moderating or ‘buffering’ role). Methods: One thousand seven hundred and thirty-two Swiss primary care physicians (824 board-certified generalists, 436 general internists, 162 paediatricians, 147 internal medicine specialists and 163 physicians without specialty qualification) completed a mailed questionnaire. Previously, validated instruments were used to measure mental health (SF-12), emotional exhaustion [Maslach Burnout Inventory (MBI)] and work-related satisfaction. Linear regression models with mental health as dependant variable were used to study the relationships between these variables. Differences in mental health scores were standardized to represent a one standard deviation (SD) difference in the other scales [standardized beta coefficients (SBC)]. Results: In multivariate analyses, higher levels of mental health were found in respondents with higher work-related satisfaction with current income and social prestige (SBC 1.04) and professional relations (SBC 0.57), and in respondents with lower emotional exhaustion (SBC –4.98) and higher personal accomplishment scores (SBC 1.72). Interaction terms between these dimensions of work-related satisfaction and emotional exhaustion were significant, supporting a ‘buffering’ role of these dimensions. Conclusion: Work-satisfaction with current income, social prestige and professional relations are important correlates of mental health among primary care physicians, as well as emotional exhaustion. Higher levels of these dimensions of work-related satisfaction seems to mitigate the relationship between emotional exhaustion and physicians’ mental health.

Measuring burden of disease in Estonia to support public health policy

Lai, T., Habicht, J., Kiivet, R.-A. — 2009-04-28

Background: Many countries have an overview on mortality and morbidity but few have performed contextualized national burden of disease studies. The objective of the present study is to provide a first set of national and sub-national burden of disease estimates for Estonia. Further, we present the causes and age-gender distribution of the burden. We conclude with the description of result uptake and impact of the study in Estonian public health policy arena. Methods: A burden of disease estimation procedure modified for best fit to country situation was used. That included disease classification reflecting Estonian disease profile, national disease severity assessments, mortality and morbidity prevalence data. Calculations were performed on national and sub-national levels. Results: Estonian population lost 446 361 (327/1000 persons) disability adjusted life-years in 2002. Premature mortality caused majority of the burden and cardiovascular diseases, external causes (e.g. suicide and injuries) and cancers were main sources of burden. Working age population (16–64 years) shouldered 60% of the burden. Sub-national levels of burden range from 114 to 725 disability adjusted life-years per 1000 persons and are correlated to regional socioeconomic development. Conclusion: Cardiovascular disease and injuries, premature mortality, working age population, male and people from economically less developed regions should be the priority targets for public health interventions. Estonian main public health strategies now address burden of disease concerns highlighted by our study.

Who can afford to look to the future ? The relationship between socio-economic status and proactive coping

Ouwehand, C., Ridder, D. T. D. d., Bensing, J. M. — 2009-04-23

Background: The aim of this article was to examine, whether middle-aged and older adults spontaneously engage in proactive coping to prevent future problems associated with ageing and whether differences in proactive coping were associated with socio-economic status (SES). Methods: As part of the cross-sectional Second Dutch National Survey of General Practice (DNSGP–2, 2001), a representative sample of 3189 adults aged 50–70 years filled in a questionnaire measuring proactive coping. In addition, data were collected regarding the three main components of SES, namely educational level, income and occupational status, as well as participants’ health status. Results: We found that higher SES, especially with respect to income and education, was positively associated with proactive coping. This relationship was not moderated, but was partially mediated by physical health problems. Conclusion: People with higher income and higher educational level used more proactive coping strategies in their daily life to offset potential problems associated with ageing. Physical health status partially explained the SES-differences in proactive coping. It seems that people with lower SES undertake less future-oriented activities as a result of the fact that present health problems require attention and drain resources.

Mental well-being and subjective health of 11- to 15-year-old boys and girls in Scotland, 1994-2006

Levin, K. A., Currie, C., Muldoon, J. — 2009-04-21

Background: Promoting young people's mental well-being and reducing socioeconomic inequalities are priority areas for WHO and the Scottish Government. This article describes changes in the subjective health and mental well-being of adolescents living in Scotland between 1994 and 2006, and investigates socioeconomic inequalities in mental well-being and subjective health over time. Methods: Data from the 1994, 1998, 2002 and 2006 Health Behaviour in School-aged Children surveys were analysed using Multilevel Binomial modelling. Results: Boys and younger adolescents scored more favourably on measures of confidence, happiness, helplessness and feeling left out than girls and older adolescents. Multiple health complaints (MHC) were also more prevalent among girls than boys. Significant increases over time were observed for all mental well-being measures among girls and for all but confidence among boys. Similarly, there was a significant decrease in odds of MHC over time for both boys and girls. There were no socioeconomic inequalities in any of the five outcomes in 1998. However by 2006, socioeconomic inequalities in young people's happiness, confidence and MHC emerged, while inequalities in girls’ helplessness also approached significance. Between 1998 and 2006 significant increases in socioeconomic inequalities in happiness and MHC were observed and increases in feeling left out also approached significance. Conclusions: Adolescent mental well-being and subjective health in Scotland is improving. However, gender differences persist and socioeconomic inequalities are emerging for some measures, suggesting that a longer term monitoring of mental well-being and subjective health in Scotland is required.

Assisted suicide on TV--the public 'License to Kill'?

Neuner, T., Hubner-Liebermann, B., Hajak, G., Hausner, H. — 2009-04-19

Suicides in public places: findings from one English county

Owens, C., Lloyd-Tomlins, S., Emmens, T., Aitken, P. — 2009-04-19

Little is known about where suicides take place. We collected data from coroners’ files on all suicides and undetermined deaths in one large English county from 2000 to 2004. The data show that >30% of suicides occurred in public places. A quarter of these involved jumping from a height and nearly a quarter involved car exhaust poisoning. Several sites were associated with multiple methods of suicide. Identifying and managing high-risk locations should be an important part of an overall suicide prevention strategy and is best tackled at local level.

Personality and health as predictors of income decrease in old age: Findings from the longitudinal SMILE study

2009-04-19

Background: There is much evidence for the influence of low socio-economic status on poor health. It is, however, also important to study the ways in which people attain and retain their socio-economic status and the factors that predict changes in socio-economic status, such as a decrease in income. Such mobility also occurs in older populations, in which financial and health-related changes are very common, especially after retirement. Methods: Three years of follow-up data from 1443 Dutch men and women aged 55 years and older who participated in the Study on Medical Information and Lifestyles Eindhoven (SMILE) were gathered. Logistic regression analyses were used to study the independent effects of physical and mental dysfunction and severity of chronic diseases and adverse personality factors on decrease in income. Results: Social anxiety (OR = 1.62, 95% CI: 1.09–2.40), physical dysfunction (OR = 1.71, 95% CI: 1.07–2.74) and severe diseases (OR = 1.37, 95% CI: 1.05–1.78) were significant predictors of decrease in income. These contributions were independent of each other, and remained robust after controlling for other confounding factors, such as gender, age and educational level and change in employment status. Mental dysfunction and other personality characteristics, such as hostility and mastery, did not contribute to decrease in income. Conclusion: Social anxiety and poor physical health are relevant factors associated with decrease in income in old age. The findings suggest that these factors are important in retaining one's socio-economic status. Future longitudinal research is necessary to further disentangle the mechanisms and pathways related to socio-economic health inequalities along the life-course.

Uptake of faecal occult blood test colorectal cancer screening by different ethnic groups in the Netherlands

2009-04-16

We investigated the participation rates in CRC screening with a FOBT among various ethnic groups in the Netherlands. Individuals (n = 10 054) were invited by mail and grouped by country of birth. Overall participation rate was 49%. Participation among ethnic minority groups was significantly lower than among ethnic Dutch [adjusted OR for participation: Middle- or Central-East 0.25 (0.18–0.34), African 0.48 (0.34–0.67), Surinamese and Antillean 0.51 (0.43–0.61), South- or South-East Asian 0.56 (0.46–0.69) and ‘other Western’ 0.78 (0.63–0.96)]. Further studies are needed to explore whether ethnic minority groups are not reached or that low uptake is determined by other causes.

Caring, employment and health among adults of working age: evidence from Britain and Belgium

Farfan-Portet, M.-I., Popham, F., Mitchell, R., Swine, C., Lorant, V. — 2009-04-16

Background: For those of working age, results are inconclusive when exploring the health impact of providing care. Moreover, population data is lacking and the impact of welfare policies on the caregivers’ health has not been yet analysed. Methods: Associations between general health and care giving, adjusting for differences in employment and socio-economic position, were explored for working age adults using logistic regression models. Data came from the 2001 British census (n = 1 361 222, 5% sample) and from the 2001 Belgian census (n = 4 368 637). The final model was stratified by employment status, given the significant interaction between caregiving and employment status. Results: In both countries, when compared with those providing no care, men and women providing ≥20 h of care per week had an increased risk of poor health. This increased risk was attenuated after adjustment for socio-economic position and particularly after adjustment for differences in employment status. However after stratifying by employment status, a dose response relationship between time spent caring and poor health was observed for the employed and unemployed, but not for the economically inactive. Conclusions: Despite contrasting welfare systems, employment status plays an important role in the association between caring and health in both countries. For the economically active, providing more care increases the risk of poor health. Whilst formal employment may be good for general health, having to informally care whilst in formal employment may have a detrimental health impact.

Does binge drinking increase the risk of lung cancer: results from the Findrink study

Toriola, A. T., Kurl, S., Laukkanen, J. A., Kauhanen, J. — 2009-04-15

Background: There are controversies on the role of alcohol in lung cancer but no studies have examined the role of alcohol consumption patterns. We examined the association between binge drinking and lung cancer. Methods: Prospective population based study of 2267 middle aged men from Finland without a history of lung cancer at baseline. Results: There were 65 cases of lung cancer during an average follow-up of 16.7 years. The relative risk (RR) of lung cancer for binge drinkers was 1.89 (95% CI 1.10–3.20) after adjusting for age, examination year, family history of cancer, smoking, socio-economic status (SES), leisure-time physical activity and body mass index (BMI). No increased risk was observed among non-smoking binge drinkers, RR 1.48 (95% CI 0.89–2.47). Binge drinking smokers had increased risks of lung cancer in all categories of daily smoking compared with non-binge drinking smokers. The RR were 2.70 (95% CI 1.61–4.53), 2.35 (95% CI 1.38–3.96) and 2.24 (95% CI 1.29–3.80) for those who smoked 1–19, 20–29 and ≥30/day, respectively. Conclusion: Binge drinking is not associated with an increased risk of lung cancer among non-smokers but among smokers, it is associated with an increased risk irrespective of the number of cigarettes smoked daily. Even though the number of lung cancer cases among non-smokers was relatively small, the fact that the increased risk was limited to only smokers means that residual confounding by smoking may play a role. Larger studies are needed to clarify this association.

Per capita alcohol consumption and sickness absence in Norway

Norstrom, T., Moan, I. S. — 2009-04-15

Background: There is only one previous study addressing the relationship between population drinking and sickness absence. That study, based on Swedish time-series data, showed a statistically significant relationship between per capita alcohol consumption and the male sickness absence rate. Estimates suggested that a 1-l increase in consumption was associated with a 13% increase in sickness absence among men. In the present study, we aim at replicating and expanding the Swedish study on the basis of data for Norway. Methods: The outcome measure comprised annual data for Norway on registered sickness absence for manual employees covering the period 1957–2001. The unemployment rate was included as a control, as this factor may be correlated with alcohol as well as sickness absence. Alcohol consumption was gauged by sales of alcohol (total and beverage specific by beer, spirits and wine) per inhabitant 15 years and above. The data were analysed using the Box–Jenkins method for time-series analysis. Results: The results suggested that a 1-l increase in total consumption was associated with a 13% increase in sickness absence among men (P < 0.05). This corresponds to an elasticity coefficient equal to 0.62. The alcohol effect was not significant for women. Unemployment was negatively associated with the outcome for men as well as for women (P < 0.05). In the beverage-specific analyses, spirits were statistically significant for men (P < 0.05), but not beer and wine. Conclusion: The present findings strengthen the conclusion from the Swedish study, that sickness absence may be added to the list of indicators of alcohol-related harm.

By how much would limiting TV food advertising reduce childhood obesity?

Veerman, J. L., Van Beeck, E. F., Barendregt, J. J., Mackenbach, J. P. — 2009-04-14

Background: There is evidence suggesting that food advertising causes childhood obesity. The strength of this effect is unclear. To inform decisions on whether to restrict advertising opportunities, we estimate how much of the childhood obesity prevalence is attributable to food advertising on television (TV). Methods: We constructed a mathematical simulation model to estimate the potential effects of reducing the exposure of 6- to 12-year-old US children to TV advertising for food on the prevalence of overweight and obesity. Model input was based on body measurements from NHANES 2003–04, the CDC-2000 cut-offs for weight categories, and literature that relates advertising to consumption levels and consumption to body mass. In an additional analysis we use a Delphi study to obtain experts’ estimates of the effect of advertising on consumption. Results: Based on literature findings, the model predicts that reducing the exposure to zero would decrease the average BMI by 0.38 kg/m^–2 and lower the prevalence of obesity from 17.8 to 15.2% (95% uncertainty interval 14.8–15.6) for boys and from 15.9% to 13.5% (13.1–13.8) for girls. When estimates are based on expert opinion, these values are 11.0% (7.7–14.0) and 9.9% (7.2–12.4), respectively. Conclusion: This study suggests that from one in seven up to one in three obese children in the USA might not have been obese in the absence of advertising for unhealthy food on TV. Limiting the exposure of children to marketing of energy-dense food could be part of a broader effort to make children's diets healthier.

Projection of the number of patients with tuberculosis in the Netherlands in 2030

Leth, F. v., Kalisvaart, N. A., Erkens, C. G. M., Borgdoff, M. W. — 2009-04-08

Background: The incidence of tuberculosis (TB) in The Netherlands has been declining for many years. For the purpose of planning future TB-control activities we estimated the number of TB patients in The Netherlands up to 2030. Methods: Statistical modelling for 5-year age groups up to 2030 distinguishing among Dutch TB patients infected by a Dutch source (survival model), non-Dutch patients (projection of the proportion of culture-positive patients among first generation immigrants) and Dutch patients infected by a non-Dutch source (fixed relation with the number of non-Dutch patients). Results: The number of TB patients is expected to decline to 877 in 2030. After 2010 declines may slow due to an increase in non-Dutch TB patients. This increase cancels out the decrease of Dutch TB patients infected by a Dutch source. In 2030, 85% of all TB patients are expected to be non-Dutch. In the four largest counties and the rest of The Netherlands, this will be 89 and 76%, respectively. Conclusion: The decrease in TB incidence observed over many years may stall from 2010 onwards because of an estimated increase in non-Dutch TB patients. Given their disproportionate burden, future TB-control activities should prioritize the health of first-generation immigrants. Enhanced TB control in the countries of origin and new diagnostic tests to identify those at high risk of developing active TB could help in reducing further the TB incidence in the Netherlands. Future TB-control efforts must be organized in a flexible way to be able to incorporate changing epidemiological situations.

Measuring risk of HIV and HCV among injecting drug users in the Russian Federation

2009-04-05

Background: The aim of the study was to measure risk of HIV and HCV infection among injecting drug users (IDUs) through force of infection (FOI) models in three cities of the Russian Federation and assess the value of behavioural data and FOI in predicting risk of infection as a method of second-generation surveillance. Methods: FOI models were fitted to prevalence data collected through an anonymous, cross-sectional community-recruited survey of IDUs with oral fluid sample collection for antibodies to HIV and HCV. Risk of infection was estimated from FOI estimates obtained by fitting a model to prevalence data by length of injecting career for each city and then overall. Risk behaviours were examined by injecting career length. Results: A total of 1473 IDUs were recruited. Prevalence of HIV was 8.1% (95% CI 6.7–9.6%) and HCV 63.4% (95% CI 60.9–65.9%). A higher FOI in new initiates to injecting (injecting career length <1 year) was found for both HIV and HCV compared with experienced IDUs (injecting career length <5 years). Increased risk of infection was not corroborated by injecting risk behaviours among new initiates into injecting (n = 38). Only 5.7% (n = 2) reported receptive sharing in the last 4 weeks, 57.9% (n = 22) sharing any injecting paraphernalia, 2.6% (n = 1) frontloading and 8.5% (n = 3) ever injecting with used needles/syringes. However, 29% of new initiates reported exchanging sex in the last 4 weeks (29%) compared with 11% long term IDUs. Conclusions: FOI models can play an important role in surveillance of HIV but caution is needed in the interpretation of behavioural data for predicting current or future risk of HIV.

Antibiotic prescribing in paediatric populations: a comparison between Viareggio, Italy and Funen, Denmark

2009-04-05

Background: High rates of antibiotic prescribing in paediatric populations represent a major issue because of the problem of antibiotic resistance. North European countries reported an appropriate use of antibiotics in general population; few studies on this issue have been conducted until now, especially in Italy. Therefore a comparison concerning paediatric antibiotic prescribing rates between an Italian administrative area in Tuscany (Viareggio) and the county of Funen (Denmark) was conducted. Methods: Reimbursement data from 2003 were gathered from the Tuscany Health Authority database and from the database containing pharmacy dispensing data from the Danish Medicines Agency. All data were converted to Defined Daily Doses (DDD) per 1000 inhabitants per day (DDD/TID). Data were broken down by age, identifying four age groups: 0–4, 5–9, 10–14, 15–19 years. Results: The overall prescription of antibiotics to paediatric patients from 0 to 19 years of age was higher in Viareggio (67 DDD/TID) than in Funen (35 DDD/TID). In Viareggio amoxicillin and amoxicillin plus enzyme inhibitors ranked in the first two places as the most frequently prescribed antibiotics in the whole population. Cephalosporins were also heavily used in Viareggio with cefaclor being the third most frequently prescribed antibiotic, especially in the 0–4 and 5- to 9-year-old age groups. In Funen, phenoxymethylpenicillin was the most commonly used antibiotic in all age groups, representing almost one-third of prescriptions, followed by amoxicillin. Conclusions: The paediatric antibiotic prescription rate is substantially higher in Viareggio compared with Funen. These data confirm possible overuse and misuse of antibiotics in the Italian paediatric population.

Staff reports of psychosocial climate at school and adolescents' health, truancy and health education in Finland

2009-03-25

Background: Psychosocial climate at school reported by school personnel may be related to pupils’ reports of being heard at school, depression, physical and psychological symptoms, truancy and received health education. Methods: Cross-sectional study combining data from two independent surveys conducted between 2004 and 2005 in 136 public schools in Finland. The pupil sample comprised 11 583 boys and 12 706 girls from the eighth and ninth grades of lower secondary school and first and second grades of upper secondary school. A personnel survey (n = 1946) was used to measure psychosocial climate indexed by trust and opportunity for participation, support for innovation, orientation towards high-quality work and accepted and clear goals. Results: After adjustment for individual and school-level covariates, multilevel analyses revealed odds for pupils’ opinion of not being heard were higher in schools where personnel reported poor trust and opportunity for participation (OR = 1.33) and low support for innovation (OR = 1.37). Poor trust and opportunity for participation and unclear work goals among staff were associated with high truancy among pupils (ORs = 1.54 and 1.39). Poor trust and opportunity for participation among staff were also related to pupils’ depression [cumulative odds ratio (COR = 1.14)], and physical and psychological symptoms (COR = 1.17). Unclear goals among staff were associated with pupils’ opinions that health education was insufficient (OR = 1.40). Conclusions: school climate is associated with adolescents’ health, wellbeing and received health education.

The relationship between age at drinking onset and subsequent binge drinking among women

2009-03-25

Background: To examine the association between age at drinking onset and subsequent binge drinking, and to examine whether there are differences in this association between four countries.

Methods: The data consisted of 68 539 women aged 18–47 years randomly selected from the general population in Denmark, Iceland, Norway and Sweden. Frequency of binge drinking, defined as consuming >6 U of alcohol at the same occasion once or more per month, and age at drinking debut were assessed through a questionnaire survey.

Results: Overall, 12–26% reported binge drinking once or more per month in the four countries. Median age for starting drinking was 16 years in all four countries. Women who started drinking at 14 years or younger were significantly more likely to binge drink than women who started drinking at 19 years or older with adjusted odds ratios of 2.9 (95% confidence intervals 2.3–3.7), 2.8 (2.1–3.6) and 2.6 (1.9–3.4) for binge drinking in Denmark, Iceland and Sweden, respectively. Among Norwegian women the association was stronger with an adjusted odds ratio at 4.4 (3.5–5.6). The association in all four countries was more pronounced in women younger than 30 years than in older women. Conclusion: In the four Nordic countries, there is a strong relation between age at drinking onset and later binge drinking. The strong relationship found in countries with such different alcohol cultures is most likely generalizable to other Western countries.

Social vulnerability and unmet preventive care needs in outpatients of two French public hospitals

Pascal, J., Abbey-Huguenin, H., Leux, C., Lombrail, P., Lert, F. — 2009-03-23

Background: Outpatients attending consultations at public hospitals may have unmet needs for preventive medical care. This study aimed to identify and assess the association between these needs, social vulnerability and mode of healthcare use. Methods: In a multicentre epidemiological study, a group of socially vulnerable outpatients, was compared with a non-vulnerable group in a sample of 1316 outpatients selected in hospital consultations, using a validated tool for detection of social vulnerability. Before the patient was seen by medical staff, investigators collected data on social characteristics, healthcare use and preventive medical care received (interventions, advice). Results: More than 75% of outpatients stated that they were regularly followed by a physician, usually a general practitioner, but fewer vulnerable than non-vulnerable outpatients were followed (77% vs. 89%, P < 10^–3). For the majority of preventive interventions (vaccinations, screening for cardiovascular risk factors, gynaecological cancers), vulnerable outpatients presented a more marked shortage than non-vulnerable patients, but there was an overall shortage in both groups. When recommended preventive interventions had not been delivered, they had rarely been offered in either group. After adjustment for mode of healthcare use, the differences in preventive care received persisted to the disadvantage of vulnerable outpatients with regard to technical preventive interventions, but there was no difference between the two groups regarding advice received to reduce risk behaviours. Conclusion: Unmet needs for preventive care primarily resulted from social inequalities in secondary access to such care. It may be necessary to set up specific interventions targeting vulnerable patients within hospital consultations.

The gap between suicide characteristics in the print media and in the population

2009-03-19

Background: Programmes to educate media professionals about suicide are increasingly established, but information about which suicide cases are most likely to be reported in the mass media is sparse. Methods: We applied binomial tests to compare frequencies of social characteristics of all domestic suicides in the 13 largest Austrian print media in 2005 with frequencies of suicide characteristics in the population. Additionally, each reported suicide case was linked to its respective entry in the suicide database. We performed a logistic regression analysis, with presence of an article as outcome, and sex of the suicide case, age, religious affiliation, family status, conduction of an autopsy and location of the suicide as explaining variables. Time of the year and federal state where the suicide happened was controlled for. Results: Binomial tests showed that suicides involving murder or murder attempt were over-represented in the media. Reporting on mental disorders was under-represented. In the regression analysis, the likelihood of a report was negatively associated with the age of suicide cases. Foreign citizenship was a further predictor of a suicide report. The methods of drowning, jumping, shooting and rare methods were more likely to be reported than hanging, which is the most frequent suicide method in Austria. Conclusions: Suicide characteristics in the media are not representative of the population. The identified discrepancies provide a basis for tailor-made education of mass media professionals.

Self-reporting weight and height: misclassification effect on the risk estimates for acute myocardial infarction

Oliveira, A., Ramos, E., Lopes, C., Barros, H. — 2009-03-19

Background: The accuracy of self-reported weight and height to measure obesity has been evaluated, but no information is available on the possible error effects of self-reporting when estimating the association between body mass index (BMI) categories and the occurrence of acute myocardial infarction (AMI). We aim to evaluate if two different sources of information on height and weight (reported vs. measured) result in different risk estimates for non-fatal AMI events. Methods: A population-based case–control study was conducted with 732 cases of first AMI and 1914 community controls, recruited from the same catchment area of hospitals. As part of an interview, participants self-reported weight and height immediately before having it measured. Data were analysed separately by sex and age strata (≤45; >45 years). Results: Women under-reported their weight and over-reported their height, and the mean differences between measured and self-reported data were significantly larger in controls. Male controls also under-reported their weight, but cases over-reported it. After adjustment, in younger women the use of self-reported data underestimated the AMI risk according to BMI categories, but in older ones the self-reporting overestimated AMI risk, although with no statistical significance. In younger men, the association between AMI and self-reported obesity (BMI ≥ 30 kg/m²) was overestimated in ~50% (measured: OR = 2.05, 95% CI 1.08–3.87; self-reported: OR = 3.06, 95% CI 1.56–6.00). In older participants, a significant association was only found for overweight men when using self-reported data. Conclusions: Self-reporting of height and weight produced a differential misclassification and biased risks for AMI according to BMI, affecting not only the magnitude, but also the estimates direction.

Are the limit values proposed by the new European Directive 2008/50 for PM2.5 safe for health?

Linares, C., Diaz, J., Tobias, A. — 2009-03-11

Cyberdrugs: a cross-sectional study of online pharmacies characteristics

2009-01-16

As e-commerce and online pharmacies (OPs) arose, the potential impact of the Internet on the world of health shifted from merely the spread of information to a real opportunity to acquire health services directly. Aim of the study was to investigate the offer of prescription drugs in OPs, analysing their characteristics, using the content analysis method. The research performed using the Google search engine led to an analysis of 118 online pharmacies. Only 51 (43.2%) of them stated their precise location. Ninety-six (81.4%) online pharmacies did not require a medical prescription from the customer's physician. Online pharmacies rise complex issues in terms of patient–doctor relationship, consumer empowerment, drug quality, regulation and public health implications.

A new year, a new era: Romania and Bulgaria join the European Union

McKee, M., Balabanova, D., Steriu, A. — 2007-03-28

2006-10-13