The European Journal of Public Health - recent issues

Health technology assessment and public health: a time for convergence

Battista, R. N., Lafortune, L. — 2009-05-21

Preferences, quality of life and public health

Leidl, R. — 2009-05-21

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

Westerling, R. — 2009-05-21

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

Birt, C. A., Foldspang, A. — 2009-05-21

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

Rezza, G. — 2009-05-21

Influenza virus resistance to oseltamivir: what are the implications?

Fleming, D. M., Elliot, A. J., Meijer, A., Paget, W. J. — 2009-05-21

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

2009-05-21

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

2009-05-21

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

2009-05-21

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. — 2009-05-21

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. — 2009-05-21

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. — 2009-05-21

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. — 2009-05-21

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. — 2009-05-21

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

2009-05-21

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

2009-05-21

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

2009-05-21

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. — 2009-05-21

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. — 2009-05-21

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

2009-05-21

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. — 2009-05-21

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. — 2009-05-21

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. — 2009-05-21

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

2009-05-21

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. — 2009-05-21

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. — 2009-05-21

A new Helsinki Declaration--but what about public health research?

Allebeck, P. — 2009-03-23

The practising public health researcher

Reijneveld, S. A. — 2009-03-23

The relevance for Europe of the report of the Commission on the Social Determinants of Health

Needle, C. — 2009-03-23

Report of the WHO commission on social determinants of health: a French perspective

Lang, T., Kaminski, M., Leclerc, A. — 2009-03-23

A vision of hope for US domestic and international health policy

Novotny, T. E. — 2009-03-23

Should health be seen as the central goal and means?

Vallgarda, S. — 2009-03-23

Chronic diseases in Europe's migrant and ethnic minorities: challenges, solutions and a vision

Bhopal, R. — 2009-03-23

The pattern of chronic disease varies hugely internationally, and this is now reflected in Europe's multi-ethnic populations. This is creating challenges for epidemiology, public health and clinical care. Human rights legislation and health policies are mandating equity of service i.e. equal needs being met equally well. Indicators of race and ethnicity demonstrate important variations in health and health care, but the data are sparse, especially in Southern and Eastern Europe, and for some ethnic groups across the continent. Ethnic coding of routine health databases is required. The task will best succeed as a national one, with European level coordination and guidance on concepts. Pending this achievement, data linkage techniques can help fill the information gap. One of many ongoing debates that need resolution across Europe is on the preferred indicator of ethnicity, related terminology and mode of measurement. Original research also needs expansion, especially in relation to cohort studies and trials and boosted samples of ethnic minority groups in large scale European health surveys. Such work may require European legislation of the kind that has been effective in the United States (NIH Revitalisation Act 1993). A dialogue between policy makers, funders, researchers and practitioners is needed urgently as a precursor to engaging the public.

Socio-economic and gender differences in nutritional content of foods advertised in popular UK weekly magazines

Adams, J., White, M. — 2009-03-23

Background: Advertising in magazines contributes to nutritional knowledge and social norms and may play a role in food choice and adiposity. In contrast to food advertising on television, that in magazines has received little research attention. We describe the type and nutritional content of foods advertised in popular UK weekly magazines and explore variations in these according to the socio-economic and gender profile of readers. Method: Four consecutive issues of 30 popular UK weekly magazines were obtained. Food advertisements were categorized into one of eight food groups. Manufacturer's data on the nutritional content of advertised foods was used to determine the nutritional content of advertised foods. Socio-economic and gender profile of magazines was determined from national readership statistics. Results: Four hundred forty three advertisements for food products were identified. The most common categories of foods advertised were meals, combination foods, soups and sauces (26%) and foods containing fat/sugar (23%). Advertised foods had a lower percentage of energy from carbohydrate (43%), lower fibre density (2 g/MJ), but higher percentage of energy from sugars (24%) and higher sodium density (0.5 g/MJ) than a diet recommended to avoid diet-related disease. There were variations in the type of foods advertised according to the socio-economic profile of readers and in the nutritional content of advertised foods according to the socio-economic and gender profile of readers. Conclusions: Food advertising reflects, and may reinforce, socio-economic and gender variations in food choice and adiposity. Producers of more healthy food may need help from policy makers and health promoters to effectively market their products.

Type of employment relationship and mortality: prospective study among Finnish employees in 1984-2000

Natti, J., Kinnunen, U., Makikangas, A., Mauno, S. — 2009-03-23

Background: The study investigated the relationship between the type of employment (permanent/temporary) contract and mortality. Factors through which temporary employment was expected to be associated with increased mortality were the degree of satisfaction with the uncertainty related to temporary work situation (Study 1) and the voluntary/involuntary basis for temporary work (Study 2). Methods: In Study 1 the data consisted of representative survey on Finnish employees in 1984 (n = 4502), which was merged with register-based follow-up data in Statistics Finland covering years 1985–2000. In Study 2 the data consisted of representative survey on Finnish employees in 1990 (n = 3502) with register-based follow-up data covering years 1991–2000. The relative risk of death was examined by conducting Cox proportional hazards analyses for the permanent and the two temporary employment groups, respectively. Results: In Study 1 temporary employees feeling the insecure situation unsatisfactory had a 1.95-fold higher risk of mortality than permanent employees (95% CI 1.13–3.35) after adjusted for background, health- and work-related factors. In Study 2 employees in the position of having a temporary job on the involuntarily basis had a 2.59-fold higher risk of mortality than permanent employees (95% CI 1.16–5.80). Conclusions: The present study confirmed that temporary employees are not a homogeneous group, which holds true even for mortality. Those temporary employees, who either felt the insecure situation unsatisfactory or who worked in temporary work involuntarily, had higher risk of mortality than permanent employees.

Contribution of a shelter-based survey for screening respiratory diseases in the homeless

2009-03-23

Background: The homeless are at very high risk for both respiratory diseases and poor access to health care delivery systems. The aim of this study was to assess the contribution of a shelter-based survey to identify respiratory diseases in the homeless population in Marseilles, in order to further develop preventive interventions. Methods: A prevalence survey of respiratory diseases was conducted in two homeless shelters in Marseilles, in February 2005. A multidisciplinary team including infectious diseases specialists, lung specialists, residents, nurses, physiotherapists and X-ray technicians visited the two shelters. Interview, physical examination, sputum sampling for Mycobacterium tuberculosis detection, nasal swabs for virus detection and chest X-rays were performed in shelters. Chest X-rays were subsequently analysed by a pneumonologist and subjects found to have radiological abnormalities were hospitalized for further investigations. Results: Of the 221 homeless persons enrolled, 110/221 (50%) had at least one respiratory manifestations. Chest X-rays were abnormal in 14 persons. Active tuberculosis was diagnosed in two, influenza in two, respiratory syncytial virus infection in two, acute pneumonia in one, asthma in two, lung cancer in one, acute bronchitis in 23, chronic bronchitis in 42, and exacerbation of chronic obstructive pulmonary disease in 22 persons, respectively. Conclusion: Our shelter-based survey, including clinical evaluation and chest radiographic screening, shows that this approach can be useful to control and prevent respiratory diseases among the homeless. However, further studies are necessary to determine the magnitude of influenza in the homeless, the impact of influenza immunization and optimal frequency of interventions in shelters.

Socio-occupational status and congenital anomalies

2009-03-23

Background: The aim of this study is to investigate the association between socio-occupational status and the frequency of major congenital anomalies in offspring. Methods: The study population comprised 81 435 live singletons born to mothers enrolled in the Danish National Birth Cohort between 1996 and 2002. A total of 3352 cases of major congenital anomalies (EUROCAT criteria) were identified by linkage to the National Hospital Discharge Register. Malformations were recorded at birth or in the first year of life. Information about maternal and paternal socio-occupational status was collected prospectively using telephone interviews in the second trimester of pregnancy and was categorized as high, middle or low. Associations were measured as relative prevalence ratios using the highest socio-occupational status within the couple as the reference group. Results: The prevalence of all recorded major congenital anomalies was similar, about 4%, in all the socio-occupational categories. Low social status of the couple did, however, correlate with a higher prevalence of congenital anomalies of the ‘respiratory system’. No association was substantially attenuated when we adjusted for maternal and paternal age, smoking status, maternal alcohol habits, folic acid intake and body mass index. When malformations of the heart and the cardiovascular system were grouped together, they were more frequent in families where both parents presented a low socio-occupational status. Conclusion: We detected an association between low socio-occupational status and congenital anomalies of the respiratory system, the heart and the circulatory system. These malformations are good candidates for a large study on occupational, environmental and social determinants.

Inequalities in maintenance of health and performance between young adult women and men in higher education

Love, J., Dellve, L., Eklof, M., Hagberg, M. — 2009-03-23

Background: Because of ageing populations, most high-income countries are facing an imminent scarcity of labour. Maintenance of health and performance in young adults therefore becomes a crucial prerequisite for sustainable societies. One major obstruction to this accomplishment is the striking health inequalities between young women and young men. Previously these inequalities have mainly been studied in a cross-sectional way, focusing on ill-health. In this study, we compared the prevalence of maintained health and performance between young adult women and men and the predictors for this outcome. Methods: The cohort consisted of 1266 participants from a homogenous sample of university students in Sweden. A combined assessment of self-rated ‘very good’ health and un-impaired performance took place at three time points (i.e. maintained health and performance). Potential predictors covered stable conditions in health-related behaviours, conditions at work/school and work-home interference. Results: Young women had less maintained health and performance than young men. No major differences in predictors were found. However, there was a tendency for psychosocial factors to be the most important predictors, especially in women. Conclusions: That young women had less maintained health and performance in a homogenous sample beyond well-known differentiating factors suggests explanations other than observable structural differences between the sexes. This was also indicated by the importance attached to perceived demands, and work-home interference, especially in women. The combination of less scheduled, and more unscheduled, schoolwork (i.e. time-flexibility) negatively affected the maintenance of health and performance in our study population, suggesting a focus for future studies.

Assessing changes in mortality inequalities in Israel using a period-specific measure of socio-economic position, 1983-92 and 1995-2004

Jaffe, D. H., Manor, O. — 2009-03-23

Changes in mortality inequalities among middle-aged individuals were examined using a household amenities variable with analogous interpretation and distribution over time. Data were taken from the census-based Israel Longitudinal Mortality Studies I (1983–92, n = 91 656) and II (1995–2004, n = 120 973). Mortality differentials in socio-economic gradients for high household amenities showed relative increases over time in overall and cardiovascular disease mortality for resident men (44% and 42%, respectively) and women (45% and 82%, respectively). Temporal influences on measures of socio-economic position did not affect our findings of a widening in socio-economic inequalities in mortality.

Intimate partner violence against women, health effects and health care seeking in rural Vietnam

Vung, N. D., Ostergren, P.-O., Krantz, G. — 2009-03-23

Background: Health effects and health care seeking were investigated among women in rural Vietnam exposed to physical and/or sexual violence from their partner in the past year. The study was conducted within the framework of the demographic surveillance site in Bavi District, Ha Tay Province in northern Vietnam. Methods: Face-to-face interviews based on a questionnaire developed by the WHO for use in violence research were conducted with 883 randomly selected women. Past-year violence and health effects were investigated in bi and multivariate analyses. Results: The prevalence of past-year physical and/or sexual violence was 9.2% (n = 81). Women exposed to violence ran a considerably elevated risk of memory loss (OR 3.7; 1.8–7.5), pain or discomfort (OR 3.8; 2.3–6.3), sadness or depression (OR 4.5; 2.7–7.5) and having suicidal thoughts (OR 2.8; 1.04–7.3) compared with those with no violence experience in the past year, when adjusted for socio-demographic factors. Almost 50% (n = 40) of the women exposed to violence reported injuries and, of those, 58% had to seek health care. Conclusions: Physical and/or sexual violence are common occurrences in Vietnam, associated with pain, injuries and mental health problems in exposed women. These results point to the need for a reliable health surveillance system, along with health care and support activities for victimised women, and policy initiatives to prevent this violence.

First description of a dengue fever outbreak in the interior of French Guiana, February 2006

2009-03-23

Background: A dengue fever outbreak occurred in the interior of French Guiana from November 2005 onwards. An investigation, with epidemiological, entomological and public health inputs, was initiated. Its objectives were to confirm the outbreak, to describe the emergence of dengue fever in the High Maroni area and to initiate a specific public health response. Methods: The investigation was conducted in Maripasoula in February 2006, the biggest community in that part of the country. Definition criteria were used for suspected, probable and confirmed cases of dengue fever. An entomological evaluation for larvae and adult mosquitoes was carried out. Some personal and collective vector control measures were set up by the vector control team. Results: This survey identified 127 suspected dengue fever cases, whereas the epidemiological surveillance system detected only six probable and confirmed cases from the same place and for the same period. The proportion of dengue fever was higher in those people who had not travelled (23.5%) than within the population that had travelled (15.3%) in the three previous months (P = 0.01). Larvae of Stegomyia aegypti were found throughout the town, and adults were captured in 90.9% of the houses. Conclusion: This is the first time that a dengue fever outbreak has been described beyond the coastal region of this French overseas Department.

Years of life lost due to cancer in a cohort study in Japan

2009-03-23

Background: We estimated the burden of cancer using mortality and years of life lost according to life tables in a cohort study in Japan. Methods: A cohort of 13 270 subjects established in the late 1980s in Japan was followed annually for the vital status of all subjects until 2003. For subjects who died, the underlying cause of death was ascertained from the death certificate. Crude mortality rate from cancer per 100 000 person-years was calculated, and years of life lost (YLL) as well as the average years of life lost (AYLL) were computed using the 1995 life tables in Japan. Results: During the follow-up period, we recorded a total 839 cancer deaths (517 men and 322 women), representing 35.5% of deaths from all causes. Overall crude cancer mortality was 654.9 per 100 000 person-years in men and 312.6 in women. Total YLL due to cancer was 7035.3 years in men and 5627.0 years in women. Overall AYLL due to all cancers was 13.6 years less than life expectancy in men and 17.5 years in women. Conclusion: These results showed that cancer was the leading cause of death in this cohort; with stomach, liver and lung cancer the three most frequent cancers in both sexes. YLL and AYLL reflect the cost of dying from cancer in terms of years of life expectancy lost. The different mortality statistics used here may be useful in public health considerations of cancer burden.

The epidemiological patterns of honour killing of women in Pakistan

Nasrullah, M., Haqqi, S., Cummings, K. J. — 2009-03-23

Background: Honour killing (HK) is a problem of public health concern but published data on the phenomenon are limited and many cases likely go unrecognized. Our study focuses on the epidemiological patterns of HK of women in Pakistan, where domestic violence is common and HK occurs but is poorly described. Methods: Human Rights Commission of Pakistan (HRCP) systematically collected data on HK of women using newspaper reports from January 2004 till December 2007. We analysed the aggregated data on HK through December 2007 and estimated the rates of HK. Results: A total of 1957 HK events occurred from 2004 to 2007; complete data was not available for all variables. Adults (≥18 years) constituted 82% (803/978) of death toll with 88% (1257/1435) being married. Alleged extramarital relation was the major reason for the killing (92%; 1759/1902). Husbands (43%; 749/1739), brothers (24%; 421/1739) and ‘other’ close relatives (12%; 200/1739) were the perpetrators in known HK events. Among the weapons/methods used for killing, firearms (61%; 1071/1768), stabbing (4%; 65/1768), use of axe (12%; 220/1768), edged tool (8%;136/1768) and strangulation (9%; 167/1768) were the main means of execution. The mean annual rate of HK in females (age 15–64 years) was found to be 15.0 per million. Conclusions: Newspaper reports are good source of surveillance when information is limited. We found that adult married women constituted the majority of victims of HK. Ongoing surveillance would serve to better characterize HK in Pakistan and assess the effectiveness of preventive strategies.

The impact of smokefree legislation in Scotland: results from the Scottish ITC Scotland/UK longitudinal surveys

2009-03-23

Background: To evaluate how Scotland's smokefree law impacted self-reported secondhand smoke (SHS) exposure in hospitality venues, workplaces and in people's homes. In addition, we examine changes in support for the law, pub and restaurant patronage, smoking cessation indicators and whether any observed changes varied by socioeconomic status. Methods: A quasi-experimental longitudinal telephone survey of nationally representative samples of smokers and non-smokers interviewed before the Scottish law (February to March 2006) and 1 year later after the law (March 2007) in Scotland (n = 705 smokers and n = 417 non-smokers) and the rest of the UK (n = 1027 smokers and n = 447 non-smokers) where smoking in public places was not regulated at the time. Results: Dramatic declines in the observance of smoking in pubs, restaurants and workplaces were found in Scotland relative to the rest of the UK. The change in the percent of smokers reporting a smokefree home and number of cigarettes smoked inside the home in the evening was comparable in Scotland and the rest of the UK. Support for smokefree policies increased to a greater extent in Scotland than in the rest of the UK. Self-reported frequency of going to pubs and restaurants was generally comparable between Scotland and the rest of the UK; however, non-smokers in Scotland were more likely to frequent pubs more often. No differences in smoking cessation indicators were observed between countries. Conclusion: The Scottish smokefree law has been successful in decreasing secondhand smoke exposure while causing none of the hypothesized negative outcomes.

The effect of the Irish smoke-free workplace legislation on smoking among bar workers

Mullally, B. J., Greiner, B. A., Allwright, S., Paul, G., Perry, I. J. — 2009-03-23

Background: On 29 March 2004, the Republic of Ireland (ROI) became the first EU country to introduce a nationwide ban on workplace smoking. While the focus of this measure was to protect worker health by reducing exposure to second-hand smoke, other effects such as a greater reduction in smoking prevalence and consumption were likely among bar workers. Methods: A random sample of bar workers from Cork city were surveyed before (n = 129) and after (n = 107; 82.9% follow-up rate) implementation of the smoke-free legislation. Self report and combined self report and cotinine concentration were used to determine smoking status. For comparison a cross-sectional random telephone survey of the general population (ROI) was conducted before and 1 year after the smoke-free legislation. There were 1240 pre- and 1221 participants post-ban in the equivalent age and occupational subset of the general population. Results: There was a non-significant decline in smoking prevalence among bar workers 1 year post-ban (self report: –2.8% from 51.4% to 48.6%, P = 0.51; combined self report and cotinine: –4.7% from 56.1% to 51.4%, P = 0.13), but a significant decline in consumption of four cigarettes (95% CI 2.21–6.36) per day. Within the occupationally equivalent general population sub-sample there was a significant drop (3.5%, P = 0.06) in smoking prevalence but no significant change in consumption. Conclusions: Ireland's smoke-free workplace legislation was accompanied by a drop in smoking prevalence in both bar workers and the general population sub-sample.

Adolescents perceived effectiveness of the proposed European graphic tobacco warning labels

Vardavas, C. I., Connolly, G., Karamanolis, K., Kafatos, A. — 2009-03-23

Background: Graphical tobacco product labelling is a prominent source of health information and has an important position among tobacco control initiatives. However, little is known about its effectiveness among adolescents. With this above in mind, we aimed to research into how adolescents perceive the proposed EU graphic tobacco product warning labels as an effective means of preventing smoking initiation in comparison to the current EU text-only warning labels. Methods: Five hundred seventy four adolescents (13–18, 54% male) from Greece were privately interviewed, with the use of a digital questionnaire and randomly shown seven existing EU text-only and proposed EU graphic warning labels. Non-smoking respondents were asked to compare and rate the warnings effectiveness in regard to preventing them from smoking on a 1–5 Likert type scale. Results: Irrespective of the warning category shown, on all occasions, non-smoking adolescents rated the suggested EU graphic labels as more effective in preventing them from smoking in comparison to the existing EU text-only warnings. Controlling for gender, age, current smoking status and number of cigarettes smoked per month, younger adolescents were found to opt for graphic warnings more often, and also perceive graphic warning labels as a more effective means of preventing them from smoking, in comparison to their elder peers (P < 0.001). Conclusions: The proposed EU graphic warning labels may play an important role in preventing of smoking initiation during the crucial years of early adolescence when smoking experimentation and early addiction usually take place.

Intention to change smoking in pregnant and postpartum women according to number of pregnancies

2009-03-23

Background: The status of a pregnant woman might add to the motivation to stop smoking. However, little is known about whether women who are pregnant for the first time (primigravidae) show a motivation to quit smoking that is different from women who are pregnant at least the second time (multigravidae). The goal of the current study was to compare smoking status, urge to smoke and intention to change smoking behaviour of primigravidae and multigravidae. We hypothesized that amongst primigravidae there are less current smokers, that the smokers consume less cigarettes per day, have less urge to smoke and that more stop smoking after delivery when compared with multigravidae. Methods: Among 642 women postpartum who had smoked before pregnancy smoking status, the Fagerström Test for Nicotine Dependence and intention to change smoking behaviour were assessed. The data were analysed with the Chi-square test, Mann–Whitney's U-test and the Sign-test. Results: Primigravidae smoked less cigarettes (P < 0.01) and showed less urge to smoke (P < 0.05) than multigravidae. They did not differ according to the intention to change smoking behaviour (P > 0.05). Conclusion: Experience of first pregnancy does not seem to automatically induce more smoking cessation compared to multigravidae. Prevention measures are needed for primigravida women and multigravida women to the same extent.

Screening for prostate cancer: a public campaign, evidence-based-medicine and conflicting interests

Braillon, A., Dubois, G., Zielinski, O. — 2009-03-23

Judith Green and Ronald Labonte. Critical perspectives in Public Health.

Petticrew, M. — 2009-03-23

Hann A. (editor). Health policy and politics

Petticrew, M. — 2009-03-23

Zuniga JM, Whiteside A, Ghaziani A, Bartlett JG (editors). A decade of HAART--the development and global impact of highly active antiretroviral therapy.

Kallings, L. O. — 2009-03-23

EUPHA office column: EUPHA's founding father retires * EUPHA--ASPHER 2009 conference * WHO regional office for Europe column: The impact of the financial crisis on health and health systems

Paget, D. Z. — 2009-03-23

Bacalhao under the Ponte 25 de Abril: impressions from Lisbon

Mackenbach, J. P. — 2009-01-21

Denialism: what is it and how should scientists respond?

Diethelm, P., McKee, M. — 2009-01-21

Testing at home--the screening of the future?

de Koning, H. J. — 2009-01-21

Quality of life as an outcome of fall prevention interventions among the aged: a systematic review

Vaapio, S. S., Salminen, M. J., Ojanlatva, A., Kivela, S.-L. — 2009-01-21

Background: Measuring quality of life (QOL) is an important part in assessing the effects of treatments and health services on patients’ well-being. This kind of an assessment should be included when assessing the effects of preventive programmes. The aim was to explore whether QOL has been used as an outcome measure in fall prevention trials and to provide a systematic review of randomized controlled trials (RCTs) that involve fall prevention interventions with an assessment of the effects on QOL among the aged. No previous systematic review about this topic among the aged was found. Methods: A search covering various medical databases was conducted to identify RCTs about the effects of fall prevention programmes on QOL. The 12 included studies were classified according to an appraisal of the population, the method of randomization, the intervention and control programmes, the QOL measures and the results. Methodological quality was assessed in relation to blinding at outcome assessment, length of follow-up and using intention to treat analysis. Results: Six studies out of 12 showed a positive effect on some dimensions of QOL (physical function, social function, vitality, mental health, environmental domain). The methods of interventions showing a positive effect varied. Conclusion: Only a few fall prevention studies reported a positive effect on QOL. Studies with larger sample sizes, longer follow-ups and multiple outcome measures are needed. QOL should be taken into account as an secondary outcome measure.

Integration of alcohol use disorders identification and management in the tuberculosis programme in Tomsk Oblast, Russia

2009-01-21

Alcohol use disorders (AUDs) among tuberculosis (TB) patients are associated with nonadherence and poor treatment outcomes. We developed a multidisciplinary model to manage AUDs among TB patients in Tomsk, Russia. First, we assessed current standards of care through stakeholder meetings and ethnographic work. The Alcohol Use Disorders Identification Test (AUDIT) was incorporated into routine assessment of all patients starting TB treatment. We established treatment algorithms based on AUDIT scores. We then hired specialists and addressed licensing requirements to provide on-site addictions care. Our experience offers a successful model in the management of co-occurring AUDs among patients with chronic medical problems.

Alcohol consumption and sickness absence: evidence from microdata

Johansson, E., Bockerman, P., Uutela, A. — 2009-01-21

Background: Aggregate time-series evidence has shown that overall per capita alcohol consumption is associated with sickness absence. This study re-examines the relationship between alcohol consumption and sickness absence by using individual-level microdata and methods that yield results which are less likely to be due to spurious correlations. Methods: Data on sickness absence and alcohol consumption for 18 Finnish regions over the period 1993–2005 was used. Sickness absence was measured as the number of sickness absence days during 1 year. Alcohol consumption was measured as the number of alcohol drinks consumed per week. The individual-level relationship between alcohol consumption and sickness absence was estimated by using Poisson regression models. Unobserved determinants of lifestyle behaviours associated with the region and survey year were controlled for. Personal characteristics as well as the clustering of observations by regions were also taken into account. Results: The estimates show that alcohol consumption is associated with sickness absence. The positive relationship between alcohol consumption and sickness absence is particularly pronounced for low-educated males. Conclusions: Aggregate time-series evidence for the relationship between alcohol consumption and sickness absence is confirmed by using individual-level microdata. The policy lesson is that it is important to take into account the effects of alcohol consumption on the prevalence of sickness absence (i.e. labour supply on an intensive margin) when one is considering the level of taxation of alcoholic beverages.

Price sensitivity and smoking smuggled cigarettes

Lee, J.-M., Chen, S.-H., Chen, H.-F., Jeng, H.-Y. J. — 2009-01-21

Background: This study analysed the socio-economic factors that influence a smoker's decision to consume smuggled cigarettes when faced with the rising costs of legal cigarettes. We hope our findings will help public health authorities create policies that simultaneously discourage consumption of smuggled cigarettes and lower overall smoking levels.

Methods: We conducted a national telephone survey from April to June 2004. We then applied Multiple Logistic Regression to the collected data to answer the following questions: do socio-economically disadvantaged smokers differ significantly in their characteristics? If so, which characteristics are most influential in the decision to purchase smuggled cigarettes?

Results: Smokers with a personal monthly income of less than New Taiwan dollar (NT$) 10 000 are 24% more likely to smoke smuggled cigarettes than are smokers who earn NT$10 000 or more. Smokers with the least amount of education are 21% more likely to smoke smuggled cigarettes than those with higher levels of education. Smokers with the most experience purchasing smuggled cigarettes are 31% more likely to do so than those with less experience. Finally, smokers who have a personal monthly income of less than NT$10 000 and the least amount of education are 54% more likely to smoke smuggled cigarettes than those with just one—or none—of these characteristics.

Conclusion: Low-income, poorly-educated smokers are most likely to purchase smuggled cigarettes. To alter such behaviour, government must understand the motivations and opinions of this population and create marketing messages targeted specifically to their needs.

Potential population impact of changes in heroin treatment and smoking prevalence rates: using Population Impact Measures

Torun, P., Heller, R. F., Verma, A. — 2009-01-21

Background: The drug misuse and asthma are major health problems in urban settings. There are effective interventions to reduce cigarette smoking and also to treat heroin use; in the context of European System of Urban Health Indicators Project (EURO-URHIS), we explored the use of Population Impact Measures (PIMs) to describe the potential for increase in methadone use and reduction in cigarette smoking to reduce deaths -from heroin use- and asthma events in examples of urban populations. Methods: The two PIMs calculated here are the Number of Events Prevented in your Population (NEPP) and the Population Impact Number of Eliminating (or reducing the prevalence of) a Risk Factor (PIN-ER-t). Results: Increasing methadone treatment uptake from its current levels to 90% would prevent 21 (95% CI: 11–34) deaths in Manchester City, 218 (95% CI: 114–339) in Greater London and overall 1 243 (95% CI: 641–1953) in England in 1 year. In males 2 (95% CI: –22 to 28), 27 (95% CI: –296 to 363) and 170 (95% CI: –1757 to 2186) and in females 36 (95% CI: 6–70), 0 and 2312 (95% CI: 934–3783) fewer asthma cases per year would have been expected in Manchester City, Greater London and overall in England respectively, if the smoking prevalence is reduced from current levels to 20% in both sexes. Conclusions: PIMs provide estimates of absolute risk and benefit to a total population, of potential use to policy-makers since current practice and intervention goals are taken into account.

Capture-recapture estimates of the local prevalence of problem drug use in six French cities

Vaissade, L., Legleye, S. — 2009-01-21

Background: General population surveys do not provide reliable estimates of problem drug users, which are essential for drug use prevention and treatment policies. Indirect estimation methods, especially capture–recapture method, are preferred. Problem drug use receives now a growing interest on a European level. Very few studies using this method have been carried out in France especially on a multicentric level.

Method: Six three-sample capture–recapture analyses were carried out in urban areas of Lille, Lyon, Marseille, Metz, Rennes, Toulouse. Data were collected in 2006 from different sources including treatment data, harm reduction and social data and law enforcement data. Users of opiates, cocaine/crack, stimulants and/or hallucinogens aged 15–64 were identified. Log-linear models were fitted to the data in order to test different interactions between the data sources representing potential dependencies. The simplest model was selected on the basis of its Akaike Information Criterion (AIC) and log-likelihood ratio tests. Confidence intervals were estimated using the likelihood interval method.

Results: The total number of problem drug users was estimated to be 7900 (95% CI 6300–10 200) in Lille, 8400 (6300–11 800) in Lyon, 5600 (4200–7700) in Marseille, 2300 (1700–3200) in Metz, 1500 (1100–2300) in Rennes and 5400 (4300–6900) in Toulouse (estimates are rounded to nearest 100). These figures correspond to the following prevalence rates of the population aged 15–64 years: 10.8 per thousand (8.6–14.0) in Lille, 10.6 (8.0–15.0) in Lyon, 10.3 (7.7–14.2) in Marseille, 10.8 (8.0–15.0) in Metz, 7.6 (5.6–11.7) in Rennes, 10.1 (8.0–12.9) in Toulouse.

Conclusions: Although the confidence intervals are wide, the method provides valuable information on the extent of problem drug use.

Associations of multiple socio-economic circumstances with physical functioning among Finnish and British employees

2009-01-21

Background: To further increase our understanding of socio-economic health inequalities, we need studies considering multiple socio-economic circumstances and comparing different cultural contexts. This study compared the associations of past and present socio-economic circumstances with physical functioning between employees from Finland and Britain.

Methods: Cross-sectional survey data from the Helsinki Health Study (n = 5866) and the Whitehall II Study (n = 3052) were used. Participants were white-collar public sector employees aged 45–60 years. Physical functioning was measured with the SF-36 physical component summary. The socio-economic indicators were parental and own education, childhood and current economic difficulties, occupational class, income, housing tenure.

Results: Childhood and current economic difficulties were independently associated with physical functioning in both cohorts, although in London women childhood difficulties did not reach statistical significance. Own education was independently associated with physical functioning in Helsinki. Occupational class showed associations with physical functioning in both cohorts. These were mainly attenuated by education and income, but in London women there was a strong independent association. The association of income with physical functioning was attenuated by education (Helsinki) and occupational class (London). Parental education and housing tenure showed no consistent associations.

Conclusions: Past and present economic difficulties were independently associated with physical functioning. The conventional socio-economic indicators showed less consistent associations which were partly mediated through other indicators and modified by the national context. The associations that varied according to the indicators and between the cohorts highlight the importance of considering the multiplicity of socio-economic circumstances and comparing different cultural contexts in further studies.

BMI, lipid profile, physical fitness and smoking habits of young male adults and the association with parental education

Stea, T. H., Wandel, M., Mansoor, M. A., Uglem, S., Frolich, W. — 2009-01-21

Background: Few studies have focused on the potential relationship between parental educational level and cardiovascular risk factors among young male adults. The aim of this study was to investigate cardiovascular disease risk factors among young men and whether body mass index (BMI), serum lipids, physical fitness and smoking habits were related to paternal and maternal education.

Methods: In this cross-sectional study 750 18- to 26-year-old male recruits participated.

Results: Linear regression analyses showed that the paternal education was inversely associated with BMI (P = 0.035) and the concentration of total cholesterol (P = 0.003) and low-density lipoprotein (LDL) (P = 0.014). Running performance was inversely related to cigarette smoking (P = 0.022) and the concentration of triacylglycerol (P = 0.001). BMI was positively related to the concentration of LDL (P = 0.002), total cholesterol/high-density lipoprotein (HDL) ratio (P < 0.001) and inversely related to the concentration of HDL (P < 0.001), running performance (P < 0.001) and muscular strength (P = 0.011). Recruits with low BMI, both high and low fitness, had a significantly better lipid profile than recruits with high BMI and low fitness (P ≤ 0.016). A lower concentration of triacylglycerol (P ≤ 0.001) and a higher concentration of HDL (P = 0.034) were further shown among recruits with high BMI/high fit compared to recruits with high BMI/low fit.

Conclusions: High paternal educational level was associated with a lower BMI and a better lipid profile among young adult men. Furthermore, men with low BMI, both high and low fit, had a better lipid profile than those with high BMI/low fit. Men with high BMI/high fit had a better lipid profile that those with high BMI/low fit.

Socioeconomic determinants of children's environmental tobacco smoke exposure and family's home smoking policy

Bolte, G., Fromme, H., for the GME Study Group — 2009-01-21

Background: Few studies have analysed the impact of different socioeconomic indicators on the prevalence of children's environmental tobacco smoke (ETS) exposure at several indoor environments and on family's home smoking policy. Methods: Data on 12 422 pre-school children (48% female) from two cross-sectional surveys conducted during 2004–06 in Germany were analysed. Exposure assessment was based on parental report. Independent effects of socioeconomic indicators were determined by mutually adjustment in logistic regression analyses. Results: Low parental education, unemployment, low household equivalent income, non-German nationality, single-parent family and family size were independently associated with children's ETS exposure at home and in cars. The strongest associations were observed for low parental education [at home: adjusted odds ratio (OR) 3.94; 95% confidence interval (CI) 3.46–4.49; in cars: 5.00; 3.84–6.50]. Indicators of material living conditions (relative poverty: 0.48; 0.39–0.57, parental unemployment: 0.55; 0.46–0.65), as well as single-parent family, non-German nationality and family size, but not parental education, were independently associated with ETS exposure at hospitality venues. Smoking households with low parental education, unemployment, poverty, single-parent family and non-German nationality were less likely to have the rule of exclusively smoking on the balcony or terrace. Low parental education and unemployment were negatively associated with no smoking in presence of the child in households with smoking inside the flat. Conclusion: Several dimensions of socioeconomic position have to be considered in explanations of social inequalities in children's ETS exposure and family's home smoking policy as well as in development of targeted interventions.

Health and ill health of asylum seekers in Switzerland: an epidemiological study

Bischoff, A., Schneider, M., Denhaerynck, K., Battegay, E. — 2009-01-21

Background: Although the focus of health care for people seeking asylum in Western European countries is usually on communicable diseases, there is little data about the general health care need of this population. In this study, we investigated the actual burden of disease among asylum seekers. Methods: Data were collected from a Swiss Health Maintenance Organisation (HMO; a type of managed care organization in which physicians act as gate keepers) that was set up specifically to provide health care for asylum seekers. The data included socio-demographic characteristics, international classification of diseases (ICD-10) diagnoses and number of clinic visits. Descriptive statistics were used to assess the types of health problems and the number of clinic visits. Logistic regression analysis was used to determine whether age, gender or country or region of origin was predictive in terms of incidence of disease as diagnosed by using ICD classifications. Results: The total number of asylum seekers (mean age 22 years; 38% women) enrolled in the HMO from 2000 through 2003 was 979. Half of this group came from the former country of Yugoslavia. The remainder came primarily from sub-Saharan Africa, Turkey, Iraq and Sri Lanka. The most common health problems encountered in the population included musculoskeletal diseases, respiratory diseases, depression and post-traumatic stress disorder. The prevalence of all disease clusters was significantly associated with age. One-fifth of the population did not request health care at all during the time they were enrolled in the HMO. It is not known whether those who did not visit the medical clinic did not require health care or just chose not to request clinic services. Conclusions: The most frequent health problems encountered in the study population were chronic medical conditions, not communicable acute diseases. Although health care services provided to asylum seekers usually focus on episodic acute care, what this group actually needs is continuity of care.

Declining maternal smoking prevalence did not change low birthweight prevalence in Massachusetts from 1989 to 2004

Kabir, Z., Connolly, G. N., Clancy, L., Cohen, B. B., Koh, H. K. — 2009-01-21

Background: Maternal smoking is associated with low birthweight (LBW). LBW prevalence is increasing in the US. However, it is unclear whether a fall in maternal smoking has any impact on the LBW prevalence in Massachusetts, a state with a comprehensive tobacco control program since 1993. Methods: Temporal patterns in prenatal maternal smoking and in LBW prevalence were quantified between 1989 and 2004, using Massachusetts Community Health Information Profile database. Yearly population-attributable-risk (PAR %) of singleton LBW live-births among pregnant smoking mothers were estimated based on a summary relative risk. The expected number of LBW babies attributable to reductions in maternal smoking in 2004 relative to 1989 was compared to the actual number of LBW babies in 2004. Results: Of 88 929 and 74 554 singleton live-births, 4297 and 4004 LBW births occurred in 1989 and 2004, respectively. Between 1989 and 2004, maternal smoking prevalence significantly declined yearly by ≥6% (from 19.9% to 6.8%) but overall LBW prevalence increased yearly by <1% (from 4.8% to 5.4%), with a significant yearly increase (<1%) in moderately LBW (1500–2499 g) prevalence. Yearly PAR % declined from 20.3% (n = 872) to 8.0% (n = 320), with an expected total of 3745 [4297 – (872 – 320)] LBW babies in 2004 relative to 1989. However, actual LBW babies numbered 4004 in 2004. The 259 above predicted (4004 – 3745) LBW babies born in 2004 being attributed to factors other than prenatal maternal smoking. Conclusions: Massachusetts experienced a decline in prenatal maternal smoking prevalence, but an increase in moderately LBW prevalence has offset the potential gains apparently achieved due to reductions in maternal smoking prevalence.

The influence of public or private paediatric health care on vaccination coverages in children in Catalonia (Spain)

Borras, E., Dominguez, A., Oviedo, M., Batalla, J., Salleras, L. — 2009-01-21

Background: Maintaining high vaccination coverages is necessary in order to control vaccine-preventable diseases. We studied vaccination coverages in a representative sample of 630 children aged <3 years in Catalonia in order to determine the relationship between vaccination coverages and socioeconomic factors. Methods: Sampling was carried out in a representative sample of the health regions in Catalonia stratified according to habitat. A sample of 630 parents of children aged <3 years born in October 2001 were interviewed by telephone. Information collected included sociodemographic data, type of health care provider (public or private) and information on vaccination coverage for the basic plus booster immunization series (BBI) which consisted of: four DTP, four OPV, one MMR and the doses of Hib and MenC necessary according to age of administration of the first dose. Results: A total of 87.62% of the children were vaccinated with the BBI series, and no statistically significant differences in coverage between public (87.93%) and private (88.30%) paediatric providers, or between social classes (high: 87.58%, low: 88.81%) were found. Vaccination coverage was associated with attending a day-care centre (OR: 1.89; 95% CI: 1.12–3.21) and maternal university education (OR: 1.84; 95% CI: 1.01–3.33). Conclusion: Vaccination coverages are high and are similar between types of provider, probably due to preventive policies which have made a concerted effort to ensure universal vaccination.

Self-rated health during adolescence: stability and predictors of change (Young-HUNT study, Norway)

Breidablik, H.-J., Meland, E., Lydersen, S. — 2009-01-21

Background: Self-rated health (SRH) is an important single-item variable used in many health surveys. It is a predictor for later mortality, morbidity and health service attendance. Therefore, it is important to study how SRH is influenced during adolescence. The present study examined the stability of SRH over a 4-year period in adolescence, and the factors predicting change in it.

Methods: Analyses were based on 4-year longitudinal data from the Young-HUNT studies in Norway among adolescents aged 13–19 years. A total of 2800 students (81%) participated in the follow-up study, and 2399 of these were eligible for data analysis. Cross-tables for SRH at the start of the study (between 1995 and 1997) and 4 years later were used to estimate the stability over the period. Proportional odds logistic regression analyses of SRH during 2000–01 were carried out, controlling for initial SRH, independent variables at the start of the study and changes in the same independent variables over 4 years as covariates.

Results: In 59% of the respondents, SRH remained unchanged through the 4-year observation period during adolescence. Fewer than 4% changed their ratings of SRH by two steps or more on a four-level scale. The self-assessed general well-being, health behaviour variables, being disabled in any way, and body dissatisfaction at the start of the study and the change of these predictors influenced SRH significantly during the 4-year observation. Being diagnosed with a medical condition, or specific mental or somatic health symptoms was of less importance for later SRH. Adolescents with more health service contacts at the start of the study, or who increase their attendance rate during the 4 years, report deterioration of SRH.

Conclusion: SRH is a relatively stable construct during adolescence, and deteriorates consistently with a lack of general well-being, disability, healthcare attendance and health-compromising behaviour.

Aspects of alienation and symptom load among adolescents

Rayce, S. L. B., Holstein, B. E., Kreiner, S. — 2009-01-21

Background: The purpose was to examine the association between aspects of alienation and symptom load among adolescents. Furthermore an integrated purpose was to construct and validate an index of alienation. Methods: Cross-sectional data from 5205 school children aged 11–15 years from a random sample of schools in Denmark were used. Data stems from the Danish contribution to the cross-national study Health and Behaviour in School-aged Children (HBSC). Alienation was measured with a new index fulfilling four criteria: (i) theoretical foundation, (ii) inter-correlation between items, (iii) correlation between each of the index's items and the outcomes and (iv) no differential item functioning. The final index included three indicators of alienation: helplessness, feeling left out of things and lack of confidentiality with parents. Symptom load was measured by HBSC Symptom Checklist and divided into physical and psychological symptoms respectively. High symptom load was defined as experiencing at least one symptom on a daily basis. Results: The odds-ratio (OR) for high symptom load increased with the degree of alienation. For students with all three indicators of alienation, the OR for high physical symptom load was 2.49 (1.05–5.87). The OR for high psychological symptom load for the corresponding degree of alienation was 6.50 (3.11–13.56). Conclusion: The index of alienation fulfilled psychometric criteria for scalability. Furthermore the analyses showed a graded and significant association between alienation and high symptom load. This suggests alienation to be taken into account in future health interventions among adolescents. In school settings this may be done using principles of empowerment.

Disparities between persons with and without disabilities in their participation rates in mass screening

Park, J.-H., Lee, J.-S., Lee, J.-Y., Gwack, J., Park, J.-H., Kim, Y.-I., Kim, Y. — 2009-01-21

Objectives: The purpose of this study was to determine the number of persons with and without disabilities who participated in the National Health Insurance (NHI) chronic disease mass screening programs in South Korea. Methods: The data were obtained from mass screening claims submitted to the NHI and National Disability Registry. Factors affecting the participation rate included demographic variables, socioeconomic status, residential region, and disability type and severity. A multiple logistic regression analysis was used to evaluate the relationship between participation rates and disability type and severity adjusted for confounding factors. Results: The analysis revealed that persons with a disability were less likely to participate in mass screening programs than those without a disability (35.8% vs. 40.2%). Multiple logistic regression analysis indicated that persons with severe disabilities had lower participation rates than those without disabilities [adjusted odds ratio (aOR): 0.64, 95% confidence interval (CI): 0.63–0.64]. In particular, persons with severe disabilities such as limb, brain, visual and internal organ impairment, were less likely to participate in the mass screening programs. However, persons with mild disability had higher participation rates than those without disabilities (1.03, 1.02–1.03). Conclusions: Although the prevalence rates of chronic diseases are higher among persons with disabilities, various types of impairments such as limb, brain, visual and internal organ impairment, hinder participation in mass screening programs for chronic diseases. The reasons for this disparity must be investigated and health policies must be altered to make preventative treatments more accessible to persons with disabilities.

Obesity in adults in Turkey: age and regional effects

Iseri, A., Arslan, N. — 2009-01-21

Background: In this study, the body mass index (BMI) of Turkish population is calculated using a sample of 4205 persons consisting of 2263 male and 1942 female individuals in 2007. The study contains data from all seven geographical regions (Aegean, Black Sea, Central Anatolia, Eastern Anatolia, Marmara, Mediterranean and Southeast Anatolia) of Turkey and from all age groups from 20 to 85 years. Method: In this study, height and weight data were measured and used for calculating the BMI of Turkish population accounting for age and regional effects. Results: This study's analysis found that age, region and gender are significant determinants on obesity of Turkish population. Also, Turkish population has higher obesity prevalence than most of the European countries. Overall, it was found that 56% of Turkish Population is overweight while 41% is in the normal range. Conclusions: This is the first study related to obesity in Turkey covering all seven regions and all age groups. Analyzing the differences of obesity prevalence between genders, geographical regions and age groups will be beneficial for better understanding the reasons behind obesity in Turkey.

Waist circumference home measurement--a device to find out patients in cardiovascular risk

Korhonen, P. E., Jaatinen, P. T., Aarnio, P. T., Kantola, I. M., Saaresranta, T. — 2009-01-21

Background: New strategies are needed to prevent the global epidemic of diabetes and subsequent rise in cardiovascular diseases. We describe a community-based, two-stage screening strategy using home waist circumference measurement and a risk factor questionnaire as a primary screening tool. Methods: We mailed a tape for measurement of waist and a risk factor questionnaire to every inhabitant aged 45–70 years living in the rural town of Harjavalta in Finland. Thereafter we performed an oral glucose tolerance test, anthropometric variables and blood pressure of subjects having at least one risk factor for type 2 diabetes or cardiovascular disease. People with previously known diabetes or vascular disease were excluded. Results: Seventy-three percent (2085/2856) of the invited inhabitants participated, and 84% of the respondents had at least one pre-specified risk factor. Waist circumference ≥80 cm in women and ≥94 cm in men (n = 1168), positive metabolic syndrome criteria of the International Diabetes Federation (n = 681) or the Finnish Diabetes Risk Score questionnaire ≥12 points (n = 697) identified 95, 92 and 63% of the new cases of type 2 diabetes and 84, 75 or 62% of pre-diabetes, respectively. Conclusion: The International Diabetes Federation criteria for elevated waist circumference are very sensitive but lack specificity in diagnosing glucose disorders. The criteria for metabolic syndrome and the Finnish Diabetes Risk Score questionnaire are more efficient tools for the selection of patients for further risk stratification in general practise.

Statistical modelling needed to find the effects from a community-based elderly safety promotion program

Johansson, P. M., de Leon, A. P., Sadigh, S., Tillgren, P. E., Rehnberg, C. — 2009-01-21

Background: Multiple control areas and time-series analyses have been recommended for effect evaluations of community-based health promotion. Large fluctuations, maybe due to chance, among the areas and over the years might obscure the intervention effect. Methods: A quasi-experimental time-series analysis with several control areas was performed as an effect evaluation of a community-based elderly safety promotion program. The program was implemented during 1995–99 in a community in the Stockholm Metropolitan area (population +65 years: 5500; number of first hip fractures in 1995: 60). Four control areas were selected based on similar hip fracture-related characteristics as the intervention community, complemented with two larger control areas. The time series covered 6 years pre-intervention (1990–95) and 6 years post-intervention (1996–2001). The study population was divided into two age groups and gender, resulting in 28 panels. The first hip fracture incidence was obtained from the Swedish national in-patient register. Results: The time series revealed no discernible pattern, and conventional analyses showed no conclusive results. A multivariate analysis, examining the time trends by employing the intra-annual and intra-panel variance, revealed the underlying trends in hip fracture rates. Comparisons between predicted numbers of hip fractures in the intervention and control areas was enabled, which resulted in 14 less hip fractures in the intervention community than expected from the control communities. If one extreme value was altered, the result changed considerably. Conclusion: Effect evaluations of community-based health promotion programs using time-series from small communities might give faulty results, if statistical modelling is not employed.

Epidemiology and cost of treatment of genital warts in Spain

2009-01-21

Background: Genital warts (GW) are common and increasing in young people. Ninety percent of GW are due to Human Papillomavirus (HPV) types 6 and 11. The objective of this study was to assess the epidemiology and management costs associated with GW in Spain.

Methods: A 1-year (2005) retrospective observational study was performed among a sample of gynaecologists, dermatologists and urologists in six autonomous regions in Spain. Men and women with newly diagnosed, recurrent or resistant GW were included. We estimated the incidence (new and recurrent cases) and prevalence (also including resistant cases) of GW. Healthcare resource use were collected and combined with unit costs to assess the mean cost of GW management per patient. These figures were extrapolated to the 14- to 64-year-old Spanish population to estimate the total cost of GW management from the Third Party Payer (TPP) and societal perspectives.

Results: The overall annual incidence of GW was estimated at 160.4 cases per 100 000. Overall prevalence was calculated as 182.1 cases per 100 000, corresponding to 56 446 GW cases annually (14- to 64-year-old population). The mean management cost was 833 and 1056 per patient from the TPP and societal perspective, respectively. The overall annual cost was estimated at 47 million and 59.6 million, from the TPP and societal perspective, respectively.

Conclusion: This study provides a first overview of the burden of GW in Spain. A quadrivalent HPV vaccine that prevents HPV 6, 11, 16, 18 related diseases will have the potential to significantly decrease the socio-economic burden associated with GW in Spain.

Exposure to bullying at school and depression in adulthood: A study of Danish men born in 1953

2009-01-21

Background: Bullying among children is associated with high symptom load and depression. There is little knowledge about long-term consequences of bullying. The aim of the present study is to examine the association between recall of bullying at school and depression in midlife controlling for adult social class and parents’ mental health. Methods: The analyses were based on the 2004 survey among men from the Metropolit 1953 Danish Male Birth Cohort (n = 6094). Information on depression was retrieved by the Major Depression Inventory (MDI) (prevalent depression) and by a measure of first doctor diagnosed depression between the ages 31–51 years (DD). Information on bullying was based on a recall measure of bullying in school categorized into three dimensions: occurrence; intensity; and duration. Results: Compared to subjects who had never been bullied, those exposed to bullying in school were at a significantly increased risk of having been diagnosed with depression between the ages 31–51 years. Long duration and high intensity of bullying were risk factors for both MDI and DD. Inclusion of the possible confounders (SES, parental mental illness) attenuated the associations somewhat, but the associations remained statistically significant. Conclusion: The present comparisons of the long-term incidence of depression among middle-aged men who experienced high and low levels of bullying at school might indicate that being bullied at school is a contributing factor in the development of depression. Prospective longitudinal studies are needed to confirm the effect of bullying in school on adult depression.

Homicide in post-Soviet Belarus: urban-rural trends

Stickley, A., Leinsalu, M., Razvodovsky, Y. E. — 2009-01-21

Background: To investigate the occurrence of homicide in urban and rural regions of Belarus in the post-Soviet period. Methods: All-age male and female homicide mortality and population data were obtained for the years 1990, 1995, 2000 and 2005 for urban and rural regions of Belarus. These data were recalculated into three age categories and directly standardised. To assess relative changes in rural–urban homicide rates across time Poisson regression models were used to calculate rate ratios. Results: Between 1990 and 1995 homicide rates rose sharply in urban and rural regions although the rise was greater in the former. Although there was little change in homicide rates in 2000, a notable divergence had occurred by 2005. While homicide rates rose slightly in rural areas, a large fall occurred in the rates of both men and women in urban areas. This resulted in significantly higher rural homicide rate ratios at the end of the study period. With some variations age-specific homicide rates followed this overall general pattern resulting in significantly higher homicide rate ratios in all rural groups aged 15 and above in 2005. Conclusion: It is probable that a combination of factors such as high levels of poverty, the effects of alcohol consumption, as well as the poor provision of emergency medical services underlie both the high levels of lethal violence and the growing rural–urban divergence in homicide rates in contemporary Belarus. Urgent action is now needed to address the deteriorating social and economic conditions underpinning violence, especially in rural regions.

Ian Dowbiggin, The sterilization movement and global fertility in the twentieth century.

Hogberg, U. — 2009-01-21

Coker R, Atun R, McKee M (editors). Health Systems and the Challenge of Communicable Diseases; Experiences from Europe and Latin America.

Rosdahl, N. — 2009-01-21

EUPHA president column: The Lisbon 2008 Conference and EUPHA's Presidency * EUPHA office news--our collaboration with the Open Society Institute * The second joint European Conference on Public Health 26-28 November 2009, Lodz, Poland * Mental health care in Europe: diversity and progress, and need for further action

Sakellarides, C., Paget, D. Z., Muijen, M. — 2009-01-21

Erratum in the 2008 Abstract Supplement: In the 2008 abstract supplement of the EUPHA conference on innovation and health in Lisbon, 5-8 November 2008, we unfortunately failed to publish one abstract. Please find the abstract below.

2009-01-21

Thank you

Mackenbach, J., Allebeck, P., McKee, M., Ricciardi, W. — 2009-01-21