The European Journal of Public Health - recent issues

Health inequalities in European welfare states

Lahelma, E., Lundberg, O. — Mon, 21 Sep 2009 07:35:31 PDT

Human ecology and public health

Tarkowski, S. — Mon, 21 Sep 2009 07:35:31 PDT

Privatization processes in health care in Europe--a move in the right direction, a 'trendy' option, or a step back?

Albreht, T. — Mon, 21 Sep 2009 07:35:31 PDT

The role of the private sector in health financing and service delivery

Fidler, A. H. — Mon, 21 Sep 2009 07:35:31 PDT

Causality, social selectivity or artefacts? Why socioeconomic inequalities in health are not smallest in the Nordic countries

Huijts, T., Eikemo, T. A. — Mon, 21 Sep 2009 07:35:31 PDT

Too early to stop immigrant vaccination programmes

Petrignani, M. W. F., Kroneman, A., van Hunen, R., Vennema, H., Koopmans, M. — Mon, 21 Sep 2009 07:35:31 PDT

Association between political ideology and health in Europe

Subramanian, S. V., Huijts, T., Perkins, J. M. — Mon, 21 Sep 2009 07:35:31 PDT

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.

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

Kaikkonen, R., Rahkonen, O., Lallukka, T., Lahelma, E. — Mon, 21 Sep 2009 07:35:31 PDT

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.

Is bullying equally harmful for rich and poor children?: a study of bullying and depression from age 15 to 27

Due, P., Damsgaard, M. T., Lund, R., Holstein, B. E. — Mon, 21 Sep 2009 07:35:31 PDT

Background: Exposure to bullying in childhood and adolescence is harmful to health, well-being and social competence of the victim. However, little is known about the long-term consequences of bullying victimization. In this paper, we use a longitudinal study from age 15 to 27 to examine whether childhood socioeconomic position (CSP) modifies the association between exposure to bullying in childhood and symptoms of depression in young adulthood. Methods: Nationally representative baseline sample in 1990 (n = 847), followed up 2002 (n = 614). We used multivariate analyses of variance to examine the influence of bullying on symptoms of depression at age 27. Results: Analyses showed that exposure to bullying, low CSP and female gender significantly increased the risk of depression in young adulthood. There was a statistically significant interaction between bullying and CSP, so that bullying increased the risk of depression for people from low CSP, while there was only a weak association between bullying victimization and depressive symptoms for people from more affluent childhood socioeconomic backgrounds. The same pattern was found for analyses stratified by sex. Conclusion: Our study suggests that the effects of bullying may have more serious long-term implications on health for children from less affluent backgrounds. Our study points at bullying exposure as another pathway through which social adversity in childhood influences social inequalities in adult health. Political efforts are needed to improve norms and legislations about how to treat children and more specific interventions should take place in schools to reduce the exposure to bullying.

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

Mon, 21 Sep 2009 07:35:31 PDT

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.

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

Daoud, N., Soskolne, V., Manor, O. — Mon, 21 Sep 2009 07:35:31 PDT

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.

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

Rafnsson, S. B., Bhopal, R. S. — Mon, 21 Sep 2009 07:35:31 PDT

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.

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

Sipila, P., Martikainen, P. — Mon, 21 Sep 2009 07:35:31 PDT

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.

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

Mon, 21 Sep 2009 07:35:32 PDT

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.

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

Becares, L., Stafford, M., Nazroo, J. — Mon, 21 Sep 2009 07:35:32 PDT

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.

Diabetes prevalence and risk factors among ethnic minorities

Mon, 21 Sep 2009 07:35:32 PDT

Background: Ethnic minorities living in Western societies may have a higher prevalence of diabetes. We investigated whether the prevalence of diabetes among Turkish and Moroccan migrants differs from the indigenous urban population in the Netherlands, and whether these differences can be explained by differences in risk factors. Methods: In 2004 a general health survey, stratified by ethnicity and age, was carried out among the population of Amsterdam. The current study included 375 Turkish, 314 Moroccan and 417 Dutch individuals aged 18–70 years. Participants underwent a physical examination and a health interview. Diabetes was based on self-report, the use of anti-diabetic medicine, blood glucose levels and HbA1c. Results: The prevalence of diabetes in the Amsterdam population was significantly higher in Turkish (5.6%) and Moroccan (8.0%), compared to Dutch individuals (3.1%). These differences, which were much larger after adjustment for age, were only partly explained by the lower socioeconomic status and higher frequency of obesity among ethnic minorities. The difference between Dutch and Moroccan individuals remained significant even after adjustments for multiple risk factors. The typical age of onset of diabetes in both Turks and Moroccans is respectively one and two decades younger than in the indigenous population. Conclusion: Diabetes is more prevalent among Turkish and Moroccan migrants as compared to the indigenous population. Only part of this difference can be explained by differences in demographic and lifestyle risk factors.

Investment decisions in influenza pandemic contingency planning: cost-effectiveness of stockpiling antiviral drugs

Lugner, A. K., Postma, M. J. — Mon, 21 Sep 2009 07:35:32 PDT

Background: The threat of an influenza pandemic has led to stockpiling of antiviral drugs in order to mitigate a plausible outbreak. If the stockpile would be used in relation to the recent pandemic alert, an investment decision about renewing the stock for a possible subsequent pandemic is essential. The decision should include cost-effectiveness considerations. Methods: We constructed a cost-effectiveness analysis in the Dutch context, explicitly including risk of an outbreak. Outcomes from a dynamic transmission model, comparing an intervention with a non-intervention scenario, were input in our health economic calculations. Results: Stockpiling was cost-effective from the health-care perspective if the actual risk is 37% for 30 years. If less than 60% of the population would take the antiviral drugs or the attack rate is about 50%, the investment would not be cost-effective from this perspective. Conclusion: Risk perception, realistic coverage among population and size of a pandemic are crucial parameters and highly decisive for the investment decision.

Pneumonia mortality in a UK general practice population cohort

Mon, 21 Sep 2009 07:35:32 PDT

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.

Assessment and proposal of a new combination of screening criteria for hepatitis C in France

Mon, 21 Sep 2009 07:35:32 PDT

Background: The current French hepatitis C virus infection screening programme is not yet reaching all populations at risk. In order to better identify individuals that would benefit from a screening test, we investigated an expanded combination of personal characteristics as potential screening criteria for this infection. Methods: We constructed two multiple-regression models predicting hepatitis C antibody seropositivity using the population sample from the 2004 French national hepatitis C antibody seroprevalence survey (SPS) (n = 14 416): one representing current screening guidelines and another constructed from personal characteristics collected for the SPS. Performance of the two predictive models was statistically compared and we internally validated the better performing model. Results: The expanded screening criteria model better discriminated seropositive and seronegative individuals [area under the ROC curve (AUC) 0.869 (95% CI 0.861–0.873)] than the current screening guidelines model [AUC 0.821 (95% CI 0.810–0.824)]. This performance difference was statistically significant (P < 0.00001). The expanded criteria model contains the variables age, sex, pre-1992 blood transfusion, intra-venous drug use, receipt of medical welfare for precarious individuals, previous surgeries, illicit nasal drug use, previous hepatitis C screening, tattoo, raised alanine aminotransferase level and birth in a hepatitis C high/moderate-prevalence country. Conclusion: Results indicate that an expanded combination of screening criteria better predicted hepatitis C antibody status and thus individuals needing screening than the current French-screening guidelines. The proposed combination of screening criteria could more effectively target hepatitis C risk-populations in France and could serve as the basis for a decision-making screening tool for the general population.

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

Mon, 21 Sep 2009 07:35:32 PDT

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.

Measuring burden of disease in Estonia to support public health policy

Lai, T., Habicht, J., Kiivet, R.-A. — Mon, 21 Sep 2009 07:35:32 PDT

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.

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

Oliveira, A., Ramos, E., Lopes, C., Barros, H. — Mon, 21 Sep 2009 07:35:32 PDT

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.

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

Mon, 21 Sep 2009 07:35:32 PDT

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.

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

Richter, E. D., Stanton, G. — Mon, 21 Sep 2009 07:35:32 PDT

Sandra Dawson, Zoe Slote Morris (editors). Future public health.

McCarthy, M. — Mon, 21 Sep 2009 07:35:32 PDT

Raj Bhopal. Concepts of Epidemiology: Integrating the Ideas, Theories, Principles and Methods of Epidemiology

Leyland, A. H — Mon, 21 Sep 2009 07:35:32 PDT

Getting busy doing the right things: a review of Public Health Branding * Evans WD and Hastings G (editors).

Lefebvre, R. C. — Mon, 21 Sep 2009 07:35:32 PDT

European Public Health Association * EUPHA takes first STEPS * 59th Session of the WHO Regional Committee for Europe

Paget, D. Z., Barnhoorn, F. — Mon, 21 Sep 2009 07:35:32 PDT

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

Lang, T., Delpierre, C. — Mon, 20 Jul 2009 04:52:56 PDT

Measuring patient experiences in Europe: what can we learn from the experiences in the USA and England?

Delnoij, D. M. J. — Mon, 20 Jul 2009 04:52:56 PDT

Neutrality and translation problems in measuring patient experience

Sally, D., Sizmur, S. — Mon, 20 Jul 2009 04:52:56 PDT

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

Linares, C., Diaz, J., Tobias, A. — Mon, 20 Jul 2009 04:52:56 PDT

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

Neuner, T., Hubner-Liebermann, B., Hajak, G., Hausner, H. — Mon, 20 Jul 2009 04:52:56 PDT

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

Mon, 20 Jul 2009 04:52:56 PDT

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.

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

Veerman, J. L., Van Beeck, E. F., Barendregt, J. J., Mackenbach, J. P. — Mon, 20 Jul 2009 04:52:56 PDT

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.

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. — Mon, 20 Jul 2009 04:52:56 PDT

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.

Cyberdrugs: a cross-sectional study of online pharmacies characteristics

Mon, 20 Jul 2009 04:52:56 PDT

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.

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

Mon, 20 Jul 2009 04:52:56 PDT

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.

Per capita alcohol consumption and sickness absence in Norway

Norstrom, T., Moan, I. S. — Mon, 20 Jul 2009 04:52:56 PDT

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.

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

Toriola, A. T., Kurl, S., Laukkanen, J. A., Kauhanen, J. — Mon, 20 Jul 2009 04:52:57 PDT

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.

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

Kuntsche, E., Gossrau-Breen, D., Gmel, G. — Mon, 20 Jul 2009 04:52:57 PDT

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.

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

Mon, 20 Jul 2009 04:52:57 PDT

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.

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. — Mon, 20 Jul 2009 04:52:57 PDT

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.

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

Ouwehand, C., de Ridder, D. T. D., Bensing, J. M. — Mon, 20 Jul 2009 04:52:57 PDT

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.

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

Mon, 20 Jul 2009 04:52:57 PDT

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.

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

van Leth, F., Kalisvaart, N. A., Erkens, C. G. M., Borgdoff, M. W. — Mon, 20 Jul 2009 04:52:57 PDT

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

Mon, 20 Jul 2009 04:52:57 PDT

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

Mon, 20 Jul 2009 04:52:57 PDT

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.

Migrants and hepatitis B: new strategies for secondary prevention needed

Hahne, S., Wormann, T., Kretzschmar, M. — Mon, 20 Jul 2009 04:52:57 PDT

President's column: EUPHA initiatives in public health innovation--new challenges and opportunities * EUPHA office column: Abstract overview--the 2nd joint European Conference on Public Health, Lodz, Poland, 25-28 November 2009 * International Scientific Committee * Health in times of global economic crisis: implications for the WHO European Region

Sakellarides, C., Paget, D. Z. — Mon, 20 Jul 2009 04:52:57 PDT

RETRACTION of: A survey of hepatitis B and C prevalence amongst the homeless community of Prague

Volf, V., Marx, D., Pliskova, L., Sumegh, L., Celko, A. — Mon, 20 Jul 2009 04:52:57 PDT

Health technology assessment and public health: a time for convergence

Battista, R. N., Lafortune, L. — Thu, 21 May 2009 08:37:02 PDT

Preferences, quality of life and public health

Leidl, R. — Thu, 21 May 2009 08:37:02 PDT

The harmonization of the medical speciality in Public Health in the EU countries--a challenge for the profession

Westerling, R. — Thu, 21 May 2009 08:37:02 PDT

Public health capacity building--not only the property of the medical profession

Birt, C. A., Foldspang, A. — Thu, 21 May 2009 08:37:02 PDT

Chikungunya and West Nile virus outbreaks: what is happening in north-eastern Italy?

Rezza, G. — Thu, 21 May 2009 08:37:02 PDT

Influenza virus resistance to oseltamivir: what are the implications?

Fleming, D. M., Elliot, A. J., Meijer, A., Paget, W. J. — Thu, 21 May 2009 08:37:02 PDT

Effect of Hepatitis A vaccination programs for migrant children on the incidence of Hepatitis A in the Netherlands

Thu, 21 May 2009 08:37:02 PDT

Background: Since 1998 Municipal Public Health Services (MPHSs) in the Netherlands carried out Hepatitis A (HAV) vaccination programs for Turkish and Moroccan children to reduce import and secondary HAV infections. The aim of this study was to assess the effects of the programs on HAV incidence. Methods: MPHSs were questioned about HAV vaccination programs for migrant children. Notification data of HAV over the period 1995–2006 were analysed. Results: Since 1998, 19 MPHSs (58%) organized vaccination programs for Turkish and Moroccan children. A large variation in the range of activities in HAV vaccination programs was observed. In the Netherlands, HAV incidence declined, from 6.5 per 100 000 inhabitants in 1995 to 1.3 in 2005. HAV incidence in children of Turkish and Moroccan decent declined from 70.3 per 100 000 in 2000 to 13.5 per 100 000 in 2005. Regions where MPHSs organized vaccination campaigns had the steepest decline in HAV incidence. Conclusion: The decline in HAV incidence in the Netherlands coincided with that observed for the rest of Europe. Therefore, also other causes than the enhanced vaccination programs could have contributed to this effect. At present, low priority is placed on continuing these HAV vaccination programs, as in areas without enhanced programs the incidence also declined to very low levels. Because HAV is still endemic in Morocco and Turkey, it remains important that all travellers to these countries are vaccinated against HAV, regardless of their country of origin.

Long-term effectiveness and cost-effectiveness of screening for Hepatitis C virus infection

Thu, 21 May 2009 08:37:02 PDT

Background: Hepatitis C virus (HCV) infection is an emerging problem in public health. In most countries, the majority of HCV infected people are yet undiagnosed. Early detection and treatment may result in better health outcomes and save costs by preventing future advanced liver disease. The evidence for long-term effectiveness and cost-effectiveness of HCV screening was systematically reviewed. Methods: We performed a systematic literature search on long-term health-economic effects of HCV screening and included Health Technology Assessment (HTA) reports, systematic reviews, long-term clinical trials, full health economic and decision-analytic modelling studies with a sufficiently long time horizon and patient-relevant long-term outcomes such as life-years gained (LYG) or quality-adjusted life years (QALY) gained. Economic results were converted to 2005 Euros. Results: Seven studies were included. Target population, HCV prevalence, study perspective, discount rate, screening and antiviral treatment mode varied. The incremental effectiveness of HCV screening and early treatment compared to no screening and standard care varied from 0.0004 to 0.066 LYG, and from 0.0001 to 0.072 QALY. Incremental cost-effectiveness and cost-utility ratios of HCV screening vs. no screening were 3900–243 700 /LYG and 18 300–1 151 000 /QALY. HCV screening seems to be cost-effective in populations with high HCV prevalence, but not in low HCV prevalence populations. Conclusions: HCV screening and early treatment have the potential to improve average life-expectancy, but should focus on populations with elevated HCV prevalence to be cost-effective. Further research on the long-term health-economic impact of HCV screening when combined with appropriate monitoring strategies in different European health care systems is needed.

Potential impact and cost-effectiveness analysis of rotavirus vaccination of children in Israel

Thu, 21 May 2009 08:37:02 PDT

Background: Rotavirus is a common cause of acute gastroenteritis in children under 5 years of age. Two effective vaccines against rotavirus gastroenteritis were recently licensed in many countries throughout the world. The study aimed to investigate the cost effectiveness of vaccinating an Israeli birth cohort of 143 500 children. Methods: The cost-effectiveness analysis was determined using a decision analytical model, based on evidence-based estimates of the medical burden of rotavirus gastroenteritis in Israel. Results: According to our model, a routine rotavirus immunization program using Rotarix® and RotaTeq® would prevent 17 801 and 13 288 office visits and 645 and 535 hospitalizations every year, respectively. When direct healthcare costs and societal costs are taken into account, the incremental cost-effectiveness ratio per gained QALY for Rotarix® and RotaTeq® are $10 995 and $30 674, respectively. Conclusion: Rotavirus vaccination can be considered a cost-effective intervention in Israel, depending on the precise vaccine price.

Vulnerability to drug-related infections and co-infections among injecting drug users in Budapest, Hungary

Anna Gyarmathy, V., Neaigus, A., Ujhelyi, E. — Thu, 21 May 2009 08:37:02 PDT

Background: Drug-related infectious diseases are among the major health consequences of drug use, and any existing drug-related infection may predispose injecting drug users (IDUs) to other infections. Methods: We assessed among IDUs in Budapest, Hungary the prevalence of and vulnerability to selected drug-related infections and co-infections. The sample consisted of 186 participants recruited between October 2005 and December 2006. Results: We found 0% HIV, 37% HCV, 24% HAV, and 14% past HBV infection. Infections with Herpes 1 or 2, tuberculosis, Chlamydia, syphilis, and gonorrhoea were 79%, 12%, 7%, 4%, and 0%, respectively. Co-infection with HAV/HCV was 12%, HBV/HCV 9%, HAV/HBV 7%, and HAV/HBV/HCV 4%. Those over age 30, the ethnic Roma, and the homeless were more likely to have any hepatitis and a higher number of drug-related infections. Amphetamine injectors were more likely to have a higher number of drug-related infections and those who travelled within Hungary were more likely to have any STI. However, those who worked at least part time and those who were in treatment were less likely to have drug-related infections. Conclusions: These results highlight the need of interventions in Hungary to reach and focus on marginalized (Roma or homeless) IDUs and address not only injecting and sex risk, but also hygienic living and injecting conditions. Furthermore, structural interventions to increase social integration (working or being in treatment) may improve welfare and decrease drug use and infection risk tied to drug use/injection among disadvantaged, marginalized, mostly minority populations.

Individual and familial factors associated with teenage pregnancy: an interview study

Haldre, K., Rahu, K., Rahu, M., Karro, H. — Thu, 21 May 2009 08:37:02 PDT

Background: The determinants of teenage sexual health, including pregnancies, can be addressed from social, familial and individual level perspectives. The main objective of this study was to examine whether pregnancy among 18 years old and younger girls were associated with selected individual (age at coitarche, score of sexual health knowledge, dislike of school) and family (mother's education) and family functioning (alcohol abuse in the family, parents’ acceptance of sexual relationship) characteristics. Methods: An interview survey in two medical institutions in Estonia among 279 18 year old and younger girls, who: (i) used contraception, had been sexually active for at least 6 months and had not pregnancies—(148 girls); (ii) came for termination of pregnancy—abortion group; (iii) planned to deliver and came for prenatal care—delivery group. The last two groups were analysed together as the ‘pregnancy group’—131 girls. Multivariate analysis, by means of logistic regression models, was used to explore whether the associations were sustained after adjusting for other variables. Crude odds ratios (ORs), adjusted ORs and their 95% confidence intervals (CIs) were estimated, with girls having no pregnancies as the reference group. Results: Risk factors associated with teenage pregnancy were low score of sexual health knowledge (adjusted ORs 3.07; 95% CIs 1.73–5.46), dislike of school (adjusted ORs 1.96; 95% CIs 1.08–3.54), alcohol abuse by family members (adjusted ORs 2.03; 95% CIs 1.16–3.54). Conclusion: Sexual knowledge of teenagers, their attitude towards school, alcohol abuse in the family are factors associated with teenage pregnancies.

Optimising lifestyle interventions: identification of health behaviour patterns by cluster analysis in a German 50+ survey

Schneider, S., Huy, C., Schuessler, M., Diehl, K., Schwarz, S. — Thu, 21 May 2009 08:37:02 PDT

Background: Many prevention and intervention measures are still targeting isolated behaviours such as tobacco use or physical inactivity. Cluster analysis enables the aggregation of single health behaviours in order to identify distinctive behaviour patterns. The purpose of this study was to group a sample of the over-50 population into clusters that exhibit specific health behaviour patterns regarding regular tobacco use, excessive alcohol consumption, unhealthy diet and physical inactivity. Methods: From the total population of the federal state of Baden-Wuerttemberg, Germany, 982 men and 1020 women aged 50–70 were randomly selected. Subjects were asked by trained interviewers in computer-assisted telephone interviews (CATI) about health behaviour and sociodemographic characteristics. Cluster analysis was conducted to identify distinct health behaviour patterns. Multinomial logistic regression was used to characterize clusters by specific social attributes. Results: Five homogeneous health behaviour clusters were identified: ‘No Risk Behaviours’ (25.3%), ‘Physically Inactives’ (21.1%), ‘Fruit and Vegetable Avoiders’ (18.2%), ‘Smokers with Risk Behaviours’ (12.7%) and ‘Drinkers with Risk Behaviours’ (22.7%). Whereas the first cluster is the ideal in terms of risk and prevention, the latter two groups include regular users of tobacco and excessive consumers of alcohol, who also engage in other risk behaviours like inactivity and maintaining an unhealthy diet. These two risk groups also exhibit specific sociodemographic attributes (male, living alone, social class affiliation). Conclusion: Unhealthy behaviours evidently occur in typical combinations. An awareness of this clustering enables prevention and intervention measures to be planned so that multiple behaviours can be modified simultaneously.

The differences in drinking patterns between Finnish-speaking majority and Swedish-speaking minority in Finland

Paljarvi, T., Suominen, S., Koskenvuo, M., Winter, T., Kauhanen, J. — Thu, 21 May 2009 08:37:02 PDT

Background: This study aims to examine whether the Swedish-speaking minority in Finland differ from the Finnish-speaking majority in respect to alcohol consumption and, whether such differences could be explained by aspects of social capital measured by both individual and area level variables. Methods: This cross-sectional dataset consisted of 17 352 Finnish speakers (baseline response rate 40%) and 2018 Swedish speakers (baseline response rate 37%), aged 25–59 years. Multilevel logistic regression models were used to analyse the differences in alcohol consumption between the language groups, and to adjust for several potential individual and area level confounders. Results: Finnish-speaking men and women reported more frequent drunkenness, suffered more frequent hangovers, and had alcohol-induced pass-outs significantly more often than men and women in the Swedish-speaking population. Demographic, social, or environmental factors did not explain the observed differences in drinking patterns between these groups. Active social participation, social engagement, and trust in others were significantly related to drinking patterns only among Finnish speakers, but not among Swedish speakers. Conclusions: Drinking patterns are likely to have a direct impact on the health differences between the two populations, especially in relation to alcohol-related acute harm. It seems unlikely that the effect of social capital on the health differences between the two populations would be mediated through drinking patterns.

Gender differences regarding the alcohol-tobacco relationship among Romanian adolescents--a longitudinal study

Lotrean, L. M., Kremers, S., Ionut, C., de Vries, H. — Thu, 21 May 2009 08:37:02 PDT

Background: The objective of this study was to assess cross-sectional and prospective relations between alcohol and tobacco use among Romanian adolescents, giving special attention to possible gender differences. Methods: The data were obtained from a two-wave 1-year longitudinal study carried out among 403 Romanian high school students aged 15–17 years (mean age 15.9; SD = 0.3). Questionnaires were used to assess smoking behaviour and alcohol use. Both behaviours were classified into two categories, that of adolescents who used the substance (at least once/month) and that of those who did not use the substance or used it less than monthly. Logistic regression was used to determine which substance was the best predictor of the subsequent use of the other substance. Results: Alcohol and cigarette use were found to be linked reciprocally and this interrelationship differed across genders. Among girls smoking predicted alcohol use better than the converse, while for the boys it was the other way around. Conclusion: It is important for future studies of adolescent substance use to systematically investigate the gender differences in the tobacco–alcohol relationship.

Striking trends in the incidence of health problems in the Netherlands (2002-05). Findings from a new strategy for surveillance in general practice

Thu, 21 May 2009 08:37:02 PDT

Background: This study aimed to detect striking trends based on a new strategy for monitoring public health. Methods: We used data over 4 years from electronic medical records of a large, nationally representative network of general practices. Episodes were either directly recorded by general practitioners (GPs) or were constructed using a new record linkage method (EPICON). The episodes were used to estimate raw morbidity rates for all codes of the International Classification of Primary Care (ICPC). Multilevel Poisson regression models were used to analyse the trend over time for 15 health problems that showed an obvious change over time. Based on these models, we calculated adjusted incidence rates corrected for clustering, sex and age. Results: During 2002–05, both men and women increasingly consulted the GP because of concern about a drug reaction, a change in faeces/bowel movements and urination problems. Men showed an increase in consultations for prostate problems and venereal diseases. The incidence of chronic internal knee derangement decreased for both sexes. Women consulted their GP less frequently about sterilization and fear of being pregnant. Conclusion: The strategy developed proved to be useful to detect trends across a short period of time. Changes in the health care market, such as the increasing availability of over-the-counter drugs and various large advertising campaigns for medications may explain some of the findings. The increasing incidence of health problems in the urogenital area deserves attention as it could reflect increases in the incidence of sexually transmitted diseases (STDs) and urinary tract infections.

Physicians' knowledge, attitudes and professional use of RCTs and meta-analyses: A cross-sectional survey

Thu, 21 May 2009 08:37:02 PDT

Background: Familiarity with Randomized Control Trials (RCTs) and meta-analyses is essential to practice Evidence Based Medicine (EBM). The aims of this study were to describe knowledge, attitudes and professional behavior of physicians towards methods to evaluate the efficacy of health interventions, particularly meta-analysis and to find out their possible associated factors. Methods: A cross-sectional survey was carried out on a random sample of Italian physicians through a self-administered questionnaire. Results: A response rate of 70.1% was achieved (654 questionnaires). Despite satisfactory knowledge and substantial positive attitudes, Italian physicians have not integrated the use of RCTs and meta-analyses into their practice to a large extent, because they infrequently read and use RCTs and meta-analyses to make decisions in clinical practice. There is a high correlation between knowledge, attitudes and professional use of RCTs and meta-analyses. Moreover, the results of our multivariate analysis show that the probability of an appropriate professional use, that is higher for doctors who know the English language, have internet access and dedicate a proper amount of time to continuing medical education, increases significantly with a previous exposure to meta-analysis during graduate/post-graduate training (OR 2.25, 95% CI 1.44–3.52), and with the attendance of post-graduate courses about EBM (OR 1.75, 95% CI 1.09–2.82). Finally, Italian physicians demonstrate a high level of interest in further training. Conclusions: The association between the EBM educational background of doctors and the appropriate professional use of RCTs and meta-analyses suggest that EBM training may promote a more evidence-based practice among physicians.

Test-retest reliability of the PRIME-MD: limitations in diagnosing mental disorders in primary care

Thu, 21 May 2009 08:37:03 PDT

Background: The primary care evaluation of mental disorders (PRIME-MD) can be seen as characteristic for successive refinements of criteria and structured interview techniques for diagnosing psychiatric disorders in primary care. It is one of the most widely used instruments, but there is no evidence to support its test–retest reliability. Methods: With 1-week intervals between interviews, a test–retest study of the PRIME-MD was conducted in a general practice population of 100 distressed patients (20- to 60-years old) who were on sick leave. Results: Almost everyone (89%) received one or more diagnoses at both measurements, and there was fair total agreement ( = 0.27). The best agreement was found for more severe threshold disorders [major depressive disorder ( = 0.58), dysthymia ( = 0.57), and generalized anxiety disorder ( = 0.59)], while we found indefinite results for the sub-threshold disorders [anxiety disorder not otherwise specified (NOS) ( =.30), minor depressive disorder ( = –0.03), and somatoform disorder NOS ( = 0.11)]. Conclusion: The PRIME-MD is one of the few instruments in primary care that actually diagnoses specific mental disorders according to the DSM criteria. However, there was a failure to adequately classify sub-threshold disorders. Mental disorders, as seen in primary care, encompass important specific symptoms and clinical syndromes that vary in duration and severity over time, but they also encompass an admixture of somatic and psychological symptoms that do not match current diagnostic systems. This most likely resulted in methodological uncertainty about the level of agreement. Diagnostic criteria in psychiatry need to be operationalized for use in primary care and require further evaluation.

Survival prediction in nursing home residents using the Minimum Data Set subscales: ADL Self-Performance Hierarchy, Cognitive Performance and the Changes in Health, End-stage disease and Symptoms and Signs scales

Lee, J. S. W., Chau, P. P. H., Hui, E., Chan, F., Woo, J. — Thu, 21 May 2009 08:37:03 PDT

Background: With the intention to aid planning for elderly focused public health and residential care needs in rapidly aging societies, a simple model using only age, gender and three Minimum Data Set (MDS) subscales (MDS-ADL Self-Performance Hierarchy, MDS-Cognitive Performance and the MDS-Changes in Health, End-stage disease and Symptoms and Signs scales) was used to estimate long-term survival of older people moving into nursing homes. Methods: A total of 1820 nursing home residents were assessed by the MDS 2.0 and their mortality status 5 years later was used to develop a survival prediction model. Result: In December 2006, 54.2% of subjects were dead. Older age at nursing home admission (HR = 1.036 per 1-year increment, 95% CI 1.028–1.045), men (HR = 1.895, 95% CI 1.651–2.175), higher impairment level according to the MDS-ADL (HR = 1.135 per 1-unit increment, 95% CI 1.099–1.173) and MDS-CPS (HR = 1.077 per 1-unit increment, 95% CI 1.033–1.123), and more frail on the MDS-CHESS (HR = 1.150 per 1-unit increment, 95% CI 1.042–1.268), were all independent predictors of shorter survival after nursing home admission in multivariate analysis. Survival function was derived from the fitted Cox regression model. Survival time of nursing home residents with different combinations of risk factors were estimated through the survival function. Conclusion: The MDS-ADL, MDS-CPS and MDS-CHESS scales, in addition to age and gender, provide prognostic information in terms of survival time after institutionalization. The model may be useful for health care and residential care planning in an ageing community.

Age and closeness of death as determinants of health and social care utilization: a case-control study

Forma, L., Rissanen, P., Aaltonen, M., Raitanen, J., Jylha, M. — Thu, 21 May 2009 08:37:03 PDT

Background: We used case-control design to compare utilization of health and social services between older decedents and survivors, and to identify the respective impact of age and closeness of death on the utilization of services. Methods: Data were derived from multiple national registers. The sample consisted of 56 001 persons, who died during years 1998–2000 at the age of ≥70, and their pairs matched on age, gender and municipality of residence, who were alive at least 2 years after their counterpart's death. Data include use of hospitals, long-term care and home care. Decedents’ utilization within 2 years before death and survivors’ utilization in the same period of time was assessed in three age groups (70–79, 80–89 and ≥90 years) and by gender. Results: Decedents used hospital and long-term care more than their surviving counterparts, but the time patterns were different. In hospital care the differences between decedents and survivors rose in the last months of the study period, whereas in long-term care there were clear differences during the whole 2-year period. The differences were smaller in the oldest age group than in younger age groups. Conclusion: Closeness of death is an important predictor of health and social service use in old age, but its influence varies between age groups. Not only the changing age structure, but also the higher average age at death affects the future need for services.

Changes in BMI and blood pressure after a school based intervention: The CHILDREN study

Thu, 21 May 2009 08:37:03 PDT

Background: Identification of the behavioural, normative and control beliefs influencing children's behaviour is an important prerequisite in designing effective interventions. The current study aims to evaluate the effectiveness of an intervention program, based on the Theory of Planned Behaviour (TPB), on obesity indices and blood pressure (BP) in Ioannina, Greece. Methods: Participants were 646 fifth grade pupils (360 girls and 286 boys). The intervention group (IG) consisted of 321 children in 13 randomly selected schools while the rest (n = 325 children) served as the control group (CG). Based on the outcome of the TPB questionnaire, the intervention focused on overcoming the barriers in accessing physical activity areas, increasing the availability of fruits and vegetables and increasing parental support. General linear mixed model and mediating variable analysis were used to evaluate the differences between the two groups and to test whether changes in certain dietary, physical activity and anthropometrical indices mediated the effect of the intervention on BP.

Results: IG had higher consumption of fruits and lower consumption of fats/oils and sweets/beverages compared with the CG. Intervention's effect on BMI could be explained by the changes in fruit and fats/oils intake whereas the reduction of systolic and diastolic BP could be explained by the reduction of BMI. Conclusions: The findings indicate favourable changes in BP and obesity indices after the implementation of a 1-year school-based intervention program based on the TPB. These results highlight the importance of developing a social and physical environment that promotes balanced eating behaviours and extra-curricular access to physical activity venues.

Impact of health reforms on child health services in Europe: the case of Bulgaria

Rechel, B., Spencer, N., Blackburn, C., Holland, R., Rechel, B. — Thu, 21 May 2009 08:37:03 PDT

Background: In the last two decades, all countries in Europe have embarked on substantial health reforms, introducing new models of financing and provision of health services. Using Bulgaria as a case study, this article examines the impact of the reforms on child health services. Methods: This is the first of a series of papers drawing on a broader research on inequalities in access to child health services, using Bulgaria as a case study. Multiple methods and data sources were used, including a review of the literature and existing epidemiological data, 50 qualitative in-depth interviews and an analysis of regulatory documents. This article presents the findings of the documentary analysis. Results: Primary health services for children are now provided by general practitioners. Children are exempted from health insurance contributions and user fees and are formally entitled to free health care. During the first years of the reform general practitioners still had insufficient training in child health. Restrictions on the number of referrals to paediatricians and discontinuation of community services at a time when general practice was not well established, undermined access to quality care. Conclusion: While many of these issues have been subsequently addressed, the reform process was far from linear. Challenges remain in ensuring access to quality child health services to the rural population and marginalized groups, such as the Roma minority and children with disabilities. Throughout Europe, health reforms need to be based on solid evidence of what works best for improving quality of and access to child health services.

Psychosomatic health problems among adolescents in Sweden--are the time trends gender related?

Hagquist, C. — Thu, 21 May 2009 08:37:03 PDT

Background: Since the economic recession in Sweden in the 1990s alarming reports about deteriorating mental and psychosomatic health among young people have repeatedly been published but reliable survey data are rare. The purpose of the study is to describe the trends in psychosomatic health problems among adolescents, focusing on gender differences. Methods: The analysis is based on repeated cross-sectional data collected 1988–2005 among about 15 000 adolescents (15- to 16-years old) within a county in Sweden. The data were collected in schools using a questionnaire that was completed anonymously. A composite measure of psychosomatic health problems based on eight items was used. Results: Psychosomatic health complaints among boys increased mainly during the in-recession time period, while the health problems among girls increased only slightly during the crisis, but increased dramatically in the post-recession time period. Only among boys did the variance in psychosomatic health increase successively across years of investigation, implying that the psychosomatic health among boys on average did not change over time. Conclusions: In showing different trend patterns across genders, the present study nuances and qualifies previous reports on deteriorating mental and psychosomatic health among adolescents. Whether the gender-related trend patterns are due to differences in the relative influence of economic and social stress factors or if they reflect other factors such as changes in the educational systems should be addressed in future studies.

Inequalities in dental caries of 5-year-old children in Scotland, 1993-2003

Levin, K. A., Davies, C. A., Topping, G. V. A., Assaf, A. V., Pitts, N. B. — Thu, 21 May 2009 08:37:03 PDT

Background: Previous research suggests there are significant differences between socio-economic groups in prevalence and amount of decayed missing and filled primary teeth (d₃mft). The aim of this study was to describe the variation in obvious tooth decay experience amongst 5-year olds in Scotland and to look at the association between d₃mft and deprivation in Scotland. Methods: Data derived from 1993 to 2003 National Dental Inspection Programme were modelled using Bayesian multilevel zero-inflated Negative Binomial models, adjusting for age, sex and the deprivation. Results: Deprivation is positively and significantly associated with having d₃mft; the odds of a child in DepCat 7 (most deprived) having d₃mft in 1993 were 7.49 (5.03–11.15) that of a child in DepCat 1 (most affluent). Inequalities in the prevalence of d₃mft have reduced and in 2003 the odds of a child in DepCat 7 having d₃mft were 4.60 (3.47–6.14) that of a child in DepCat 1. However, socio-economic inequalities in the amount of d₃mft for those with d₃mft have seen no reduction and have in fact increased between 1993 and 2003, with this increase approaching significance. Conclusion: While socio-economic inequalities in prevalence of children with d₃mft have decreased in recent years, socio-economic inequalities in the amount of d₃mft for those with d₃mft persist. This suggests that improvements are only seen for those children with the potential for low d₃mft. High d₃mft persists among children from more deprived areas. The national target conceals this apparent inconsistency.

Differences in sickness absence in Sweden and Denmark: the cross national HAKNAK study

Thu, 21 May 2009 08:37:03 PDT

Aim: To investigate potential differences in sickness absence among public sector employees in Sweden and Denmark, and to what extent a difference was associated with age, gender, physical and psychosocial work environment exposures, lifestyle factors, self-rated health or work ability. Methods: In 2000, two cross-sectional samples of 8562 public sector employees in Sweden and Denmark were surveyed. The study outcome, self-reported number of sick-leave days the year preceding interview, was dichotomized into 7 days or less, and more than 7 days. Chi square test was used to analyse distribution of dependent and independent variables in the two sub-cohorts. Stratified logistic regression analysis was performed to identify causes for absence within the two sub-cohorts, and logistic regression analysis was performed to study differences in sickness absence levels between the two sub-cohorts. Results: More subjects from the Swedish study population reported more than 7 days of sickness absence. Factors associated with sickness absence were largely similar in the two countries. The difference in absence level between Sweden and Denmark was not associated with differences in age, gender, skill level, lifestyle, psychosocial or physical work environment, musculoskeletal symptoms or self-rated health, whereas work ability score decreased the difference in sickness absence level. Conclusion: The results could indicate an increased retention of employees with health problems in the Swedish labour market compared with the Danish labour market. A possible explanation for the differences in sickness absence ascertained in this study could be due to differences in the sickness insurance legislation.

Dean Baker, Mark J Nieuwenhuijsen (editors). Environmental epidemiology: study methods and application.

de Meer, G. — Thu, 21 May 2009 08:37:03 PDT

EUPHA President's Column * EUPHA--ASPHER 2009 Conference * Addressing social determinants of health inequities requires well-performing health systems

Sakellarides, C., Paget, D. Z., Ziglio, E. — Thu, 21 May 2009 08:37:03 PDT