- - Background: Two areas of uncertainty about routine statistics for mortality after hospital admission for myocardial infarction (MI) or stroke are i) whether most deaths occur in the admission episode itself rather than after discharge, and ii) whether most deaths are certified on death certificates as, respectively, MI or stroke. Methods: Use of linked hospital and mortality statistics to analyse the time, place and certified cause of death in people aged 35–74 after admission for MI or stroke. Results: Of 7,964 deaths within a year of admission for MI, 5,686 (71.4%) occurred within 30 days of admission. Of these, 4,856 (85.4%) occurred during the initial hospital admission. Of 7,070 deaths within a year of admission for stroke, 4,905 (69.4%) were within 30 days, and 4,509 (91.9%) of these occurred during the initial admission. As expected, deaths at longer intervals than 30 days occurred mainly after discharge. Of deaths within 30 days of MI and stroke, 85.2% and 80.0%, respectively, were certified with MI or stroke as the underlying cause of death. Conclusion: In-hospital death rates alone, calculated without record linkage to death certificates, would have identified most deaths that occurred within 30 days of admission. Nonetheless, linkage added to completeness of ascertainment even within this time period. Data without linkage are unreliable in identifying deaths at longer time intervals. Routine mortality statistics for MI and stroke, as the underlying cause, reliably included most deaths that occurred within 30 days of admission for each respective disease.
]]> Goldacre, M. J.2004-11-0310.1093/eurpub/14.4.338 - - Oxford University Press - -
- - Background: The incidence of and mortality from ruptured abdominal aortic aneurysm (AAA) is increasing. There is uncertainty regarding the indicators which could be used to identify groups at high risk. This issue has been addressed in a systematic review of population-based screening studies. Methods: MEDLINE and EMBASE were searched, reference lists scanned and manual searches made of eight journals. The search was restricted to four languages (English, German, French and Italian). Population-based studies investigating risk factors associated with screening-detected AAA were included. The following risk factors were considered: sex, smoking, hypertension, diabetes, a history myocardial infarction, and peripheral vascular disease. Results: Fourteen cross-sectional studies met our inclusion criteria. Most studies screened people aged 60 years or older. The prevalence of AAA ranged from 4.1% to 14.2% in men and from 0.35% to 6.2% in women. Male sex showed a strong association with AAA (OR 5.69), whereas smoking (OR 2.41), a history of myocardial infarction (OR 2.28) or peripheral vascular disease (OR 2.50) showed moderate associations. Hypertension was only weakly associated with AAA (OR 1.33) and no association was evident with diabetes (OR 1.02). Conclusions: The efficacy of screening men aged 60 years or older and women of the same age who smoke or have a history of peripheral or coronary artery disease should be evaluated in randomized controlled trials.
]]> Cornuz, J.2004-11-0310.1093/eurpub/14.4.343 - - Oxford University Press - -
- - Background: A substantial number of myocardial infarctions (MI) occur at working age. It is, however, insufficiently well known how many of these patients return to work after their MI. Methods: Sources of information were the Hospital Discharge Register, the Causes of Death Register and the registers for social security benefits. Availability for the labour market was used as the return to work criterion. Altogether 10,244 persons (8,733 men, 1,511 women) aged 35–59 years had their first MI or coronary death during 1991–1994 in Finland. Persons who survived for 28 days and were not on pension at the time of MI were included in a two-year follow-up. Results: Twenty-nine per cent of patients were already pensioned at the time of their first MI. Of the patients not pensioned at the time of their MI, 4,929 were alive two years after the event. Of them, 38% of men and 40% of women received disability pension, 3% of both genders were on sick leave and 1% of both genders were on unemployment pension. The remainder, 58% of men and 56% of women, did not receive any of these benefits, thus, being available to the labour force. Conclusions: Nearly one-third of persons having their first MI at working age were already out of the labour force at the time of their MI. Of those who were not pensioned and who survived the event, slightly more than half were available to the labour market two years later.
]]> Hamalainen, H.2004-11-0310.1093/eurpub/14.4.350 - - Oxford University Press - -
- - Background: Studies have demonstrated that when parents shoulder considerable financial responsibilities, adverse health outcomes may occur. The present study assesses the association between economic stress and self-rated health in a sample of Swedish parents, and especially how this relation is affected by foreign origin and employment status. Methods: A questionnaire was sent to a random sample of 5,600 individuals between the ages of 21 and 81 in Malmö, Sweden. The total response rate was 69%. Among the respondents, 824 were parents having at least one child living at home. The main exposures were such sociodemographic variables as country of origin and employment status, and economic stress. The outcome variable was self-rated health. Results: Of the parents in the study, the 34.7% coded as exposed to economic stress showed a significantly increased odds ratio for poor self-rated health (OR=3.12, 95% CI: 2.01–4.84) adjusted for age and sex. After controlling for foreign origin and unemployment, the odds ratio remained statistically significant regarding exposure to economic stress (OR=1.94; 1.16–3.23). In the multivariate model, foreign origin and unemployment were also strongly associated with poor self-rated health (OR=1.78, 95% CI: 1.12–2.88; OR=1.67, 95% CI: 1.01–2.75, respectively). The adjusted population-attributable risk for poor self-rated health was estimated to be 27.4% for economic stress, 26.6% for foreign origin, and 16.7% for unemployment. Conclusions: Parental economic stress was associated with low self-rated health to a statistically significant degree, even when accounting for employment status and foreign origin. It, therefore, deserves to be seriously considered as an potential public health risk factor among Swedish families.
]]> Olivius, G.2004-11-0310.1093/eurpub/14.4.354 - - Oxford University Press - -
- - Background: Risk factors in young adulthood may persist into later life and eventually lead to cardiovascular (CV) disease. The purpose of this study was to describe the prevalence of hypertension and other established CV risk factors in older adolescents. Methods: Study nurses examined 120 girls and 80 boys with a mean age of 17.4 (SD, 0.8; range 15.8–19.6 years). After 5 minutes of sitting rest, resting blood pressure (BP) of the participants was measured in triplicate by sphygmomanometry. Body height and weight were measured and body mass index (BMI) was calculated. Serum lipids, smoking and drinking status were assessed. Hypertension was diagnosed according to the criteria specified in the 1996 update of the Task Force on BP treatment in Children and Adolescents (Pediatrics 1996;98:649–58). Results: Almost 25% of the subjects currently smoked with a median daily consumption of 6 (Interquartile 4–9) and 11 (6–16) cigarettes in girls and boys, respectively. Fourty-nine (41%) girls used oral contraceptives. Systolic (118 versus 109 mm Hg, p<0.001) and diastolic BPs (70.5 versus 68.0 mm Hg, p=0.033) were significantly higher in boys than in girls. Two (2%) girls and four (5%) boys had systolic hypertension; diastolic hypertension was found in six (5%) girls and one (1%) boy. Twelve (10%) girls and six (8%) boys were overweight (>25.0 kg/m2). Twenty (17%) girls and seven (9%) boys had hypercholesterolemia (total serum cholesterol ≥5.2 mmol/L). Overall, 50 (42%) girls and 31 (39%) boys had at least one CV risk factor, 12 (10%) girls and four (5%) boys had two risk factors, and three (3%) girls and one (1%) boy had more than two risk factors. Conclusions: In 17-year-olds living in an affluent society the prevalence of CV risk factors was high. These findings underscore the importance of health education and prevention at this age.
]]> Nawrot, T. S.2004-11-0310.1093/eurpub/14.4.361 - - Oxford University Press - -
- - Background: The objective of this study is to determine parents' awareness of their children's headaches and to evaluate some of the factors that affect this awareness. Methods: The subjects of the study are 2601 children who were diagnosed with headache. Data on the children and the parents was collected using a detailed data form. The diagnosis of headache in children was made on the basis of the criteria of the International Headache Society (IHS). If the parents of a child diagnosed with headache reported that their child had headache, the parent was evaluated to be aware of his/her child's headache. In the statistical analyses, chi-square and binary logistic regression were used. Results: Almost 74% of parents were aware of their children's headache. It was found that migraine type headache, female gender, being the first child of the family, travel sickness of children, the presence of headache history in one of the family members; the number of family members and mother's age are factors that affect the awareness level of parents. It was also revealed that parents who do not work outside are more aware of their children's headache and that educational and financial status do not have any effect on the degree of awareness. Conclusions: In a city like Mersin, which is economically well developed when compared with the rest of the country, one quarter of the parents are not aware of their children's headache.
]]> Sasmaz, T.2004-11-0310.1093/eurpub/14.4.366 - - Oxford University Press - -
- - Background: With an incidence of 15, abortion is a common reproductive event in France. This study describes conditions of access to health care for abortions based on women's reports, taking into account the woman's background and the influence of the first professional contacted. Methods: A representative sample of 2,863 women, aged 18 to 44, was interviewed by telephone between September 2000 and January 2001. Of these women, 480 had an abortion in the last 10 years. Main results: The choice of first professional depended on women's background, as we found differences according to age, educational level or past induced abortion. This choice affected subsequent access conditions, in terms of time delay or complexity of patterns of care to access abortion services. Women who first contacted a private gynaecologist, which is the most frequent situation in France, had more direct and shorter patterns of care. Conversely, general practitioners were associated with longer and more indirect patterns of care, especially when women were less well educated. Conclusion: This study reveals the heterogeneous nature of patterns of access to an abortion in France. It also raises questions concerning the training of general practitioners, who seem to be less well prepared to take charge of a request for an abortion than other professionals. Efforts must be made to better inform women and these professionals about the process required for abortions.
]]> Moreau, C.2004-11-0310.1093/eurpub/14.4.369 - - Oxford University Press - -
- - Background: The aim of the study was to compare elderly persons' self-reported use of physician services and associated sociodemographic factors and self-rated health in two Nordic countries with different health care systems, Finland and Norway. Methods: Population based, cross-sectional surveys conducted in Norway (1995–97) and in Finland (1997) were employed. In the Norwegian data a total of 7,919 individuals, and in the Finnish data 1, 500 individuals, aged 65–74 years old were included in the samples. The outcome variables were having visited a general practitioner, a specialist or both during the past 12 months. Associations between utilization of physician's services and sociodemographic factors and self-rated health were analysed by multiple logistic regression. Results: Approximately the same proportion of elderly in Norway and Finland reported having visited a physician during the previous 12 months. Finnish elderly more often visited a specialist compared to Norwegians. Self-rated health was strongly associated with visits to a specialist in both countries and to a GP in Norway. In Finland visits to a GP were only weakly connected with self-rated health. The use of specialist services increased with increasing education in both countries and in Finland the association was steeper than in Norway. Marital status was not consistently associated with visiting a physician. Conclusions: Higher rates of specialist care among the elderly in Finland may indicate a more efficient gate-keeping role among Norwegian general practitioners or inducement caused by two overlapping service sectors. Inconsistent associations between utilization and health variables may be due to cultural differences.
]]> Suominen-Taipale, A. L.2004-11-0310.1093/eurpub/14.4.375 - - Oxford University Press - -
- - Background: Infants of North African immigrants are reported to have higher birthweights than their Belgian counterparts. It is unclear what mechanism contributes to this difference. Methods: Analyses were based on a hospital-based cohort of 1,162 women. Results: Infants of North African immigrants were less likely to be born preterm, compared to infants of Belgian women. After adjusting for sociodemographic and maternal factors, the estimated difference in mean birthweight was 74 g (p=0.05). When limited to term births, this difference was 28 g (p=0.42). Conclusion: The difference in mean birthweight between North African and Belgian infants was explained by differences in preterm birth and other risk factors.
]]> Vahratian, A.2004-11-0310.1093/eurpub/14.4.381 - - Oxford University Press - -
- - Background: Smoking is a major public health risk and information regarding high-risk groups is needed to plan, implement and evaluate interventions aimed at lowering the number of smokers. Methods: During the years 1999–2001 data was collected regarding the smoking behaviour of the Israeli population in three national surveys. All three surveys included ages 25–64 and two included also ages 21–25 and over 64. Results: Smoking was associated with age, sex, ethnicity, education and religiosity after adjusting for the various demographic characteristics of the survey population. The prevalence of smoking among Arab and immigrant men from the former Soviet Union is higher than among Jewish men. Among women the opposite association exists. The older, religious and more educated reported smoking less frequently. In the Jewish population respondents, defining themselves as secular, reported higher rates of smoking. Only in women was marital status associated with smoking. A few specific high-risk groups for smoking can be identified such as young, less educated men, Arab men, single Jewish women and young immigrant men and women. Conclusions: The three ethnic groups residing in Israel differ in the prevalence of smoking; each has a distinct pattern of smoking, positioning them at different stages within the conceptual framework of the larger smoking pandemic. Ethnicity, religiosity, age and education are associated with smoking in both sexes. This calls for specific tailored interventions aimed at younger men with less education, Arab men, and young immigrants.
]]> Baron-Epel, O.2004-11-0310.1093/eurpub/14.4.384 - - Oxford University Press - -
- - Background: The aim of this study was to analyse the pattern of sociodemographic variations in the prevalence of obesity in Estonia, Finland and Lithuania. In addition, the association between obesity and selected health behaviours was examined. Methods: Cross-sectional surveys were conducted among representative national samples of adult populations in 1994, 1996 and 1998. The number of participants aged 20–64 was 3759 in Estonia, 9488 in Finland and 5635 in Lithuania. The data were obtained from mailed questionnaires (covering sociodemographic characteristics, health behaviour indicators, and self-reported height and weight). Obesity was defined as BMI ≥ 30 kg/m2. Results: The prevalence of obesity among men and women was 10% and 15% in Estonia, 11% and 10% in Finland, and 10% and 18% in Lithuania respectively. The prevalence of obesity increased only among Estonian men. Obesity was more prevalent among those aged over 50 in all three countries. It was also more prevalent among the less educated women in all countries and among the less educated men in Finland. Obesity was less prevalent among daily smokers among Estonian men and women and Lithuanian men. Physically inactive Estonian women and Finnish men and women were more likely to be obese. Conclusions: A significant association was found between low educational level and obesity in women in all the countries, but this association was found for men only in Finland. In Finland obesity was also more consistently associated with indicators of unhealthy behaviour than in Estonia and Lithuania. Thus, even though the social gradient of obesity was broadly similar in all the countries studied, differences emerged with regard to the behavioural correlates of obesity.
]]> Klumbiene, J.2004-11-0310.1093/eurpub/14.4.390 - - Oxford University Press - -
- - Objective: To estimate the prevalence of obesity among the personnel of a Greek warship and to highlight the potential relationship of the body-mass index (BMI). Methods: Data on behavioural and demographic characteristics, among 274 men of a Greek warship, aged between 19 and 38 years, were analysed. Results: 26.5% of participants were overweight and 4.7% obese. BMI was correlated with age, and cigarette pack-years, and inverse correlated with the aerobic exercise. No significant associations were found between BMI and alcohol consumption. Conclusion: A relatively high proportion of obesity was found in a Greek military population. Intervention and prevention measures should be targeted at the promotion of physical activity and the reduction of the smoking behaviour of personnel.
]]> Mazokopakis, E. E.2004-11-0310.1093/eurpub/14.4.395 - - Oxford University Press - -
- - Background: While several socio-demographic predictors of disability pension (DP) have been identified, less is known about the importance of the medical aspects. Methods: A representative sample of Norwegian long-term sickness absentees, 2043 women and 1585 men, with detailed diagnostic information based on the International Classification of Primary Care (ICPC) was followed up for 5 years. The date of granting DP was obtained from the Norwegian DP-register and used as the dependent variable in Cox multivariate regression analysis. Medical and socio-demographic factors were entered as explanatory variables. Results: Kaplan–Meier estimates of the 5 year risk of DP were 22.9% for the full sample, 22.5% for men and 23.3% for the women. Men on sick leave for mental health disorders had an increased disability risk. Except for pregnancy-related cases, which carried a very low risk for future DP, there was no significant difference between the main diagnostic groups among women. Previous sickness absence increased the disability risk but was significant only for total absence above 20 weeks in the 4 years preceding inclusion. Age was the strongest predictor of future DP. Increasing income decreased the risk, bur not linearly. Unemployment status in the year preceding inclusion increased disability risk for women, but not for men. Among cases with musculoskeletal disorders (54.5% of the sample), subgroups with different disability risks were identified in Cox' regression analysis, with a gender-specific pattern. Conclusion: In addition to previously known socio-demographic predictors, medical variables were important in identifying sickness absentees with an increased risk of DP.
]]> Gjesdal, S.2004-11-0310.1093/eurpub/14.4.398 - - Oxford University Press - -
- - Background: The aim of this study was to look for any possible contextual effect of deprivation at municipality level on the risk of being granted the medically based disability pension, controlled for compositional effects due to spatial concentration of people with a high risk of disability. Methods: The material consists of the residentiary part of a total Norwegian county population aged 20–54 years without disability pension at baseline, n=40,083. This study was performed as a 10-year follow-up study. The relative risk of being granted a disability pension was estimated by logistic regression analyses as odds ratios (OR) between people living in different municipalities according to a municipality deprivation index at three levels, adjusted for individual factors. Results: The OR of disability pension was 1.36 (1.22, 1.51) for people residing in intermediate deprived municipalities and 1.48 (1.31, 1.67) for people residing in the most deprived municipalities compared to the most affluent municipalities, adjusted for gender and age. After adjustment for individual risk factors the OR was 1.26 (1.12, 1.41) and 1.18 (1.04, 1.35) respectively. Analyses stratified by gender showed that the increased risk of receiving a disability pension for men in the most deprived municipalities was explained by individual factors alone. Conclusion: Relative municipality deprivation seems to account for an increase in the incidence of disability pension. This effect contributes to marginalization of people living in less affluent areas out of employment and thus to widening socioeconomic inequalities in the population.
]]> Krokstad, S.2004-11-0310.1093/eurpub/14.4.406 - - Oxford University Press - -
- - Objectives: To compare the magnitude of socio-economic differences in sickness absence rates between a Japanese cohort and a British cohort. To assess the effects of self-rated health and behavioural risk factors on sickness absence in the two cohorts, and whether they explain socio-economic differences in sickness absence within and between cohorts. Methods: An 8 year follow up study of sickness absence in 2504 Japanese male employees in a factory in Japan and 6290 British male employees in civil service departments in London. The rates of first occurrences of long-term (>7 calendar days) sickness absence were determined and compared between these cohorts. Socio-economic status was measured with hierarchical employment grades. Results: The first time sickness absence rates were about two times higher among British men as compared with Japanese men. The rate ratio of lower to higher employment grade was 1.2, 1.3 and 2.1 among Japanese white-collar, Japanese blue-collar and British white-collar employees respectively. Baseline self-rated health and smoking habit predicted sickness absence in both cohorts. After adjusting for these factors a significant difference between the Japanese and British cohorts, and between employment grades remained. Conclusions: The rate of long-term sickness absence was higher in the British cohort than the Japanese cohort.
]]> Morikawa, Y.2004-11-0310.1093/eurpub/14.4.413 - - Oxford University Press - -
- - Background: The aim of the study was to examine the effects of parental socioeconomic status, own socioeconomic status and social mobility upon the development of smoking from adolescence to adulthood. Methods: Subjects were the participants of the North Karelia Youth Project study from six schools in Eastern Finland. At the baseline in 1978 they were 13 year-olds (n=903) and in the last of the six surveys in 1993 they were 28-year-olds. The parents were studied in 1978 and 1980. The association between smoking and socioeconomic status was measured by education, occupation and income in adolescence and adulthood, and social mobility was measured by the difference between parental and own education. Results: In general, parental socioeconomic status was not significantly associated with the subjects' smoking in adolescence or adulthood. Own socioeconomic status measured at the age of 21 and 28 was strongly related to smoking. Those who were most educated in adulthood had smoked the least already from the age of 13. Social mobility was not significantly associated with smoking. Conclusion: The study stresses the importance of own socioeconomic status in relation to smoking, but parental socioeconomic status or social mobility does not have direct effects on smoking. Socioeconomic differences in smoking should be understood as an important determinant for health inequalities.
]]> Paavola, M.2004-11-0310.1093/eurpub/14.4.417 - - Oxford University Press - -
- - Background: In comparison to most other countries in Western Europe, Finland ranks high with regard to male excess mortality. This study examined the contribution of smoking and alcohol to the gender difference in mortality in Finland during 1991–93 among the population aged 15 or over. Methods: The study is based on data from linked registers. The number of alcohol-related deaths was assessed on the basis of information included in the death certificate, while the conventional method of population attributable fraction was applied to estimate the aggregated contribution of smoking. In combining the effects of alcohol and smoking, three alternative assumptions of their overlap were used. Results: Approximately 51–56% of the gender difference of 7.6 years in the life expectancy at age 15 was estimated to be attributable to alcohol or smoking, depending on the assumption about the overlap of the contribution of alcohol and smoking. Conclusions: The study confirms the important role of alcohol and smoking as a mechanism contributing to the difference in mortality between men and women in Finland.
]]> Martelin, T.2004-11-0310.1093/eurpub/14.4.422 - - Oxford University Press - -
- - Background: Cross-sectional studies provide empirical support for associations between advertising and adolescent smoking. The aim of this study was to investigate the relationship between Spanish adolescent smoking behaviour and prior awareness of cigarette advertisements on billboards, using a prospective design. Methods: 3,664 Spanish children aged 13 and 14 years filled in self-completion questionnaires at baseline, and 6, 12, and 18 months later (cohort study). Slides of three advertisements were projected at baseline. A multivariate logistic regression analysis was carried out to detect possible association between number of identified tobacco advertisements brands at baseline and smoking status along time, controlling ASE Model smoking determinants, smoking prevention interventions, age, gender and socio-economic status. Results: The more advertisements identified at baseline, the greater was the risk of being a smoker (p<0.0001). Final percentages of smokers were 15.8%, 16.3%, 19.3%, and 32.6%, respectively, for zero, one, two and three advertisements recognized. When confounders were controlled, the probability of being a smoker increased with the number of advertisements identified [OR 1.26 (95% CI: 1.09–1.46) after 6 months, OR 1.18 (95% CI: 1.03–1.35) after 12 months and 1.15 (95% CI: 1.02–1.30)] after 18 months. It is possible the association would have been even greater if there had not been a differential loss of smokers from the sample. Conclusion: Increased awareness of cigarette advertising was associated with a higher smoking incidence and an increased risk of Spanish children becoming smokers. It is, therefore, imperative that cigarette advertising should be banned as a matter of urgency.
]]> Lopez, M. L.2004-11-0310.1093/eurpub/14.4.428 - - Oxford
- - Background: Breast-feeding has shown to give a reduction in the risk of hospitalization due to respiratory tract infections and gastrointestinal conditions during the first two years of life. The association of breast-feeding with all admission causes and with fever of unknown origin (FUO) was analysed. Methods: A case-reference study in Cantabria (northern Spain) was carried out. Cases (n=336) were hospitalized children aged less than 24 months at University of Cantabria Hospital; the reference was a 1:1 matched (by time from delivery to admission) sample of children from mothers delivering at the same hospital. Information on breast-feeding, socioeconomic variables and employment were obtained. Odds ratios (ORs), their 95% confidence intervals (CIs), and mean length of breast-feeding were estimated after adjusment for confounding variables. Results: In the reference population, shorter duration of breast-feeding was associated with smoking, lower educational level, and less privileged social strata. The frequency of breast-feeding was higher in the reference than in the cases, 82.3% vs 75.6% (p=0.023). Significant negative trends were noted in univariate analyses between the length of breast-feeding and both all admission causes and FUO, although the statistical significance was lost after adjusting for confounding variables (educational level, social class, smoking, and use of incubator after delivery). The adjusted mean length of breast-feeding was shorter in hospitalized children ≤6 months old for both all admission causes (40.6 ± 5.4 vs 99.5 ± 5.4, p<0.001) and FUO (40.8 ± 12.4 vs 91.7 ± 12.4, p=0.006). Conclusion: Breast-feeding time is shorter in hospitalized children for both all admission causes and FUO.
]]> Pardo-Crespo, R.10.1093/eurpub/14.3.230 - - Oxford University Press - -
- - Background: Data on the impact of the many dietary and lifestyle factors on the prevalence of hypertension in Western societies are lacking. This study quantified the contributions of body weight, physical inactivity and dietary factors to the prevalence of hypertension in Finland, Italy, the Netherlands, United Kingdom (UK) and USA. Methods: Distributions of blood pressure (BP) and risk factors in Western populations were obtained from nationwide surveys. The effect of risk factors on BP was assessed by meta-regression analysis of randomized trials, published between 1966 and March 2001. Population attributable risk percentages (PAR%) for hypertension (i.e. systolic BP ≥140 mmHg) were computed for all risk factors in the five countries. Results: Being overweight made the largest contribution to hypertension, with PAR% between 11% (Italy) and 25% (USA). PAR% were 5–13% for physical inactivity, 9–17% for high sodium intake, 4–17% for low potassium intake and 4–8% for low magnesium intake. The impact of alcohol was small (2–3%) in all populations. PAR% varied among populations for inadequate intake of calcium (2–8%), magnesium (4–8%), coffee (0–9%) and fish fatty acids (3–16%). Conclusions: Diet and lifestyle have a substantial impact on hypertension in Western societies, with being overweight, physical inactivity, high sodium intake and low potassium intake being the main contributors. The relative significance of different risk factors varies among populations, which is important for preventative strategies.
]]> Geleijnse, J. M.10.1093/eurpub/14.3.235 - - Oxford University Press - -
- - Background: Treatment of persons at high risk for coronary heart disease (CHD) should include nutritional counselling, but little is known about the effects of different types of education. Methods: In a quasi-experimental study design the effects of a nutritional education programme (1st year: three group sessions by a dietitian; 2nd year: one group session; 3rd year: additional focus on saturated fat; reinforcement by written nutritional messages annually) (intervention group; n=103) are compared with the effects of a posted leaflet containing standard dietary guidelines (control group; n=163). Participants had hypercholesterolemia (6–8 mmol/l) and at least two other CHD risk factors. Results: After 3 years, no significant differences existed in established CHD risk factors between intervention and control groups (adjusted mean net differences: total cholesterol (0 mmol/l), diastolic blood pressure (–1.1 mm Hg; NS), and body weight (+0.3 kg, NS)). Regarding dietary intake, the intervention group had a lower intake of total (net difference –2.0% of energy, SEM 0.9) and saturated fat (–1.2% of energy, SEM 0.4) and a higher fish (+11 g/day, SEM 4) and vegetables consumption (+21 g/day, SEM 10) during the study period (p<0.05 for all). Conclusion: A nutritional education programme with group sessions changed dietary intake more effectively than a posted leaflet, but no additional positive effects were observed on established CHD risk factors after three years of follow-up.
]]> Bemelmans, W. J.E.10.1093/eurpub/14.3.240 - - Oxford University Press - -
- - Background: To examine the postulated relationship between Ambulatory Care Sensitive Conditions (ACSC) and Primary Health Care (PHC) in the US context for the European context, in order to develop an ACSC list as markers of PHC effectiveness and to specify which PHC activities are primarily responsible for reducing hospitalization rates. Methods: To apply the criteria proposed by Solberg and Weissman to obtain a list of codes of ACSC and to consider the PHC intervention according to a panel of experts. Five selection criteria: i) existence of prior studies; ii) hospitalization rate at least 1/10,000 or ‘risky health problem’; iii) clarity in definition and coding; iv) potentially avoidable hospitalization through PHC; v) hospitalization necessary when health problem occurs. Fulfilment of all criteria was required for developing the final ACSC list. A sample of 248,050 discharges corresponding to 2,248,976 inhabitants of Catalonia in 1996 provided hospitalization rate data. A Delphi survey was performed with a group of 44 experts reviewing 113 ICD diagnostic codes (International Classification of Diseases, 9th Revision, Clinical Modification), previously considered to be ACSC. Results: The five criteria selected 61 ICD as a core list of ACSC codes and 90 ICD for an expanded list. Conclusions: A core list of ACSC as markers of PHC effectiveness identifies health conditions amenable to specific aspects of PHC and minimizes the limitations attributable to variations in hospital admission policies. An expanded list should be useful to evaluate global PHC performance and to analyse market responsibility for ACSC by PHC and Specialist Care.
]]> Caminal, J.10.1093/eurpub/14.3.246 - - Oxford University Press - -
- - Background: Cholecystectomy use varies moderately across regions and countries. The purpose of this study was to evaluate the appropriateness of the use of cholecystectomy in patients with nonmalignant diseases in different hospitals using explicit criteria developed by an expert panel. Methods: Patients on waiting lists to undergo a cholecystectomy for nonmalignant diseases in six public hospitals in Spain were included in this prospective observational study over a 1-year period. Appropriateness criteria were first developed by a panel of experts using the RAND appropriateness method. The appropriateness of the indication was judged by applying explicit criteria developed previously. Complications were recorded 3 months after surgery. Results: After evaluation of 960 patients, 7 (0.7%) were considered to have undergone inappropriate procedures and 76 (7.9%) were judged to be uncertain. Differences were found in the rate of appropriateness among some centres (inappropriateness rate ranging from to 0 to 2.6%). No differences were found among the appropriateness categories for length of stay or complications, mortality, or readmission up to the third month after discharge. Conclusions: This study identified a low percentage of inappropriately performed cholecystectomies in our area. Even so, appropriateness differences among hospitals were found.
]]> Quintana, J. M.10.1093/eurpub/14.3.252 - - Oxford University Press - -
- - Background: In Italy patients are supposed to choose their primary care physician (PCP), but many prefer to attend specialists or hospitals. To understand the patients' decision processes regarding selection of PCP, their attitudes, perceptions and related behaviours on the role of PCPs in Italy were investigated. Methods: A random sample of parents received a questionnaire concerning information on demographic and socio-economic characteristics, health status, utilization of health services, attitudes and behaviours towards PCPs. Results: A total of 387 (48.4%) subjects participated in the study. Of the sample subjects, 70% had attended a PCP in the previous year, 45% a specialist, and 40% a hospital. Reasons for not attending a PCP were absence of health problems (52.5%), preference for specialists (18.8%), and self-care (17.5%). For almost all responders (88.8%) the first medical person they attended regarding health problems was the PCP, mainly because of confidence in professional skills (45.1%), satisfaction regarding the interpersonal relationship (25.8%), easy access to visit (14%), and medical prescriptions (14%). Patients were significantly more willing to visit a PCP if they were of lower education level and had visited a PCP in the previous year; those who preferred a PCP to present severe health problems were significantly more likely to be young, not affected by a chronic disease, and had attended a PCP in the previous year. Conclusions: The majority of patients perceived the role of PCPs as ‘gate-keepers’ and further research is needed to explore how PCPs' attitudes and behaviour can enhance patients' trust in primary health care.
]]> Pileggi, C.10.1093/eurpub/14.3.258 - - Oxford University Press - -
- - Background: to estimate the coverage of HIV testing during pregnancy in Catalonia, to identify factors associated with testing during pregnancy and to assess the recording of screening in medical records and the women's awareness about being tested. Methods: A survey was carried out in 2000 among pregnant women attending hospital, with face-to-face interview 24–48 hours post-delivery, and review of the medical records. Results: Out of 2,132 participants, 76% were from public and 24% from private hospitals. Medical records showed that 88.3% of the participants had a HIV test (94% in public, 71% in private hospitals), while for 3.7% and 18.5% in private and public, respectively, this information was not documented. Overall, 67% of women reported having been tested for HIV during that pregnancy, and unawareness of having been tested was detected in 10.7%. Educational level and prenatal care are determinants for being tested. Conclusion: Catalonia has a good coverage of HIV testing among childbearing women, although it is lower in private hospitals. Frequently prenatal HIV testing is not documented in medical records and women are unaware of it. Improving the prenatal care and tailoring these programmes to specific populations, like migrants or marginalized groups, will result in a better understanding of HIV prevention and in an increase in HIV testing before delivery.
]]> Perez, K.10.1093/eurpub/14.3.261 - - Oxford University Press - -
- - The frameworks and methods used for analysis, monitoring and evaluation of communicable disease control vary greatly. Although a number of manuals exist instruments for a detailed analysis of wider health system context are lacking. This is surprising given that the success of vertical programmes is often determined by the constraints of health systems. The importance of the context and the health system in determining the successful implementation of national tuberculosis programmes is well recognized by the WHO, which recommends analysis of national tuberculosis programmes within the context of health care system, health reform and the economic status of the country. However, current approaches inadequately capture intelligence on the health systems variables impacting on programme efficacy, limiting the ability of policy makers to draw lessons for wider use. A recent WHO report highlights the major systemic constraints to DOTS implementation and recommends a comprehensive and multi-sectoral approach to tuberculosis control. This obviates the need for tools that take into account health systems issues as well as focusing on a particular vertical programme but no such comprehensive tool exists. This paper outlines the conceptual basis for a model and a toolkit for rapid assessment, monitoring, and evaluation of the context, the elements of the health system and vertical communicable disease programme. It describes the framework, the potential strengths and weaknesses, approach and piloting of the toolkit and its two elements: first for ‘horizontal assessment’ of the health system within which the programme is embedded and second for ‘vertical assessment’ of the infectious disease-specific programme.
]]> Atun, R.A.10.1093/eurpub/14.3.267 - - Oxford University Press - -
- - Background: The seventh pandemic of cholera affected South America in 1991 after a century of absence. Favoured by local conditions, the epidemic of cholera in Ecuador had a rapid impact. The epidemic of cholera evolved with temporal and geographical variations. Methods: The temporal and geographical variations of cholera in Ecuador between 1991 and 1996 have been analysed. The Ecuadorian epidemiological surveillance system is a semi-active one based on obligatory weekly declarations. A geographical representation of annual impact rate has been made. Using a smoothing technique by crossvalidation, time curves were identified and spatial diffusion was studied by cartography. Results: In 1991 and 1992, cholera in Ecuador evolved in an epidemic mode with two explosive epidemic peaks. Cholera then entered a phase of regression. The disease spread from two main epicentres, one in the South (El Oro, Guayas, Los Rios) and the other in the North (Esmeraldas and Imbabura). These focal outbreaks spread to neighbouring provinces during the peak outbreaks between 1991 and 1993. Conclusion: This study demonstrated that the epidemic spread from the affected provinces in the South and the North of the country.
]]> Chevallier, E.10.1093/eurpub/14.3.274 - - Oxford University Press -
- - Background: The authors investigated correlates of depression in a general population sample of adolescents (15–19 years) and young adults (20–24 years). Methods: As part of the Finnish Health Care Survey a random sample of 509 adolescents (281 females, 228 males) and 433 young adults (224 females, 209 males) was interviewed in 1996. DSM-III-R major depressive episode (MDE) was assessed by the University of Michigan Composite International Diagnostic Interview Short Form (UM-CIDI SF). Results: In multivariable regression analysis, current smoking (odds ratio (OR) 5.54; 95% confidence interval (CI) 1.44, 21.3) and chronic illness (OR 3.77; 95% CI: 1.04, 13.7) associated with MDE among adolescents. Among young adults, drunkenness at least twice a month (OR 4.48; 95% CI: 1.44, 14.0) or once a month (OR 2.79; 95% CI: 1.14, 6.83), not being married nor cohabiting (OR 3.50; 95% CI: 1.35, 9.08) and infrequent physical exercise (OR 4.01; 95% CI: 1.18, 14.0) were related to MDE. Female MDE associated with not being married nor cohabiting (OR 3.56; 95% CI: 1.23, 10.1) and living in southern Finland (OR 2.30; 95% CI: 1.06, 5.02). Drunkenness at least twice a month was related to MDE among males (OR 4.54; 95% CI: 1.27, 16.3). Conclusions: Attention should be paid to compromised health and health-related behaviour associating with MDE in youth. Specifically, the association between smoking and major depression in early adolescence should be borne in mind, and drinking habits or frequency of drunkenness should be carefully noted.
]]> Haarasilta, L. M.10.1093/eurpub/14.3.280 - - Oxford University Press - -
- - Background: The dehumanizing aspects of conflict and war are increasingly recognized as serious health and human rights concerns. This paper examines the impact on civilians of the 29 March 2002 Israeli Army invasion and subsequent curfews lasting up to 45 consecutive days, of five West Bank towns. Methods: Using focus groups, a 10-item scale was devised to measure the effects of the invasion's impact on the social and health-related quality of life. The scale is an aggregate of three constructs measuring housing, financial, and health-related issues. A survey composed of demographic questions and the 10-item social/health scale was administered to a stratified random sample of inhabitants of the five towns. Results: the invasion caused extensive destruction, food and cash shortages, internal displacement of civilians, psychological distress, and serious interruptions of basic services, including crucial health services. Overall, Jenin experienced the most deleterious effects. Using the subscales, Jenin experienced the highest overall housing damage, Bethlehem the most financial difficulties, and Ramallah the most health-related hardships. Conclusions: civilians inevitably suffer during conflict and war from destruction of the community infrastructure and from personal stress due to disruption of services and the non-fulfilment of basic human needs. In contradistinction to standard damage assessments that focus on collective physical damage, this scale provides richer information on the needs of civilians in conflict-torn areas, and can assist aid workers in the efficient deployment of resources.
]]> Giacaman, R.10.1093/eurpub/14.3.286 - - Oxford University Press - -
- - Background: As a basis for preventive strategies to reduce subway suicides, an investigation was undertaken to determine if there was a distinct pattern of subway suicidal behaviour. Methods: Data were taken from the Municipal Munich Subway System case registry (southern Germany) for all suicidal incidents on the track: purposely inflicted; date, time and location of incident, sex of victim, outcome. The analysis covered a 20 year observation period between 1980 and 1999, for which the Munich Municipal Office for Statistics also provided data of all deaths due to suicides within the city area of Munich. Suicide mortality was classified by the International Classification of Diseases, Ninth revision (codes E950–E959). Results: A total of 306 incidents were documented with an annual mean of 16.5 cases. Case fatality was 66% (n=202). It was highest in winter and in higher aged groups. No significant time trend for incidences was observed. Median age of suicide attempters was 38 years. Most incidences (24.2%) were recorded for persons aged 20–29 years. The male: female ratio was 1.15 : 1. The peak time of day for incidences in women was during the late morning hours while significantly more men committed subway suicides during evening hours (p=0.001). No consistent seasonal variation was observed. Conclusions: In comparison to average suicide attempters, subjects committing subway suicides are markedly younger and they follow to a lesser extent established seasonal or circadian time patterns. More women are involved in subway suicides than would be expected. However, similarities to reports on behavioural patterns of subway suicides in other communities are striking.
]]> Ladwig, K.-H.10.1093/eurpub/14.3.291 - - Oxford University Press -
- - Background: Regular inhalation of tobacco smoke, whether it be voluntary or not, may have profound negative effects on the body. Also intervertebral discs may be affected. The objective of the present study was to test the hypothesis that nurses' aides who were exposed to environmental tobacco smoke (ETS) at home during childhood have an increased risk of long-term sick leave. Methods: The sample comprised 5563 Norwegian nurses' aides, not on sick leave when they completed a mailed questionnaire in 1999. Of these, 4744 (85.3%) completed a second questionnaire 15 months later. The outcome measure was the incidence proportion of long-term sick leave during the 12 months prior to the follow-up. Results: Respondents who reported at baseline that they had been exposed to ETS at home during childhood had increased risk of sick leave exceeding 14 days attributed to neck pain (odds ratio (OR) = 1.34; 95% confidence interval (CI): 1.04–1.73), high back pain (OR=1.49; CI: 1.07–2.06), low back pain (OR=1.21; CI: 0.97–1.50), and any illness (OR=1.23; CI: 1.07–1.42), after adjustments for demographic and familial characteristics, former smoking, current smoking, physical leisure-time activities, work factors, prior neck injury, and affective symptoms. They also had increased risk of sick leave exceeding 8 weeks (OR=1.29; CI: 1.08–1.55). Conclusion: The study supports the hypothesis that nurses' aides who were exposed to ETS at home during childhood have an increased risk of long-term sickness absence.
]]> Eriksen, W.10.1093/eurpub/14.3.296 - - Oxford University Press - -
- - Background: The age at which the individual begins smoking may influence the health of smokers at an older age. Cultural and social factors effect the age of smoking initiation. Methods: A cross-sectional national survey of a random sample of 6,021 Israeli residents over the age of 21 were interviewed by telephone. The sample consisted of 4248 Jews, 858 Arabs and 915 immigrants, 856 of them were from the former Soviet Union. Results: Compared to the Jewish population the Jews who immigrated from the former Soviet Union began smoking at an earlier age and the Arabs started smoking at an older age. The young respondents in all ethnic groups reported starting to smoke at a younger age compared to the older respondents, and there was a decrease in smoking initiation at an older age. Father smoking during childhood predicted earlier age of smoking initiation but not mother or sibling smoking, significantly among Jews and immigrants and non-significantly among Arabs. Conclusions: Age of smoking initiation is dependent on the ethnic background in which the smokers grow up, however, the influence of the father smoking seems to be similar in all population groups. It seems that a higher percentage of young adults started smoking at an early age and there is a decrease in smoking initiation at older ages in all ethnic groups.
]]> Baron-Epel, O.10.1093/eurpub/14.3.301 - - Oxford University Press
- - Background: Studies indicate that shortage of cessation counsellors may be a major barrier for tobacco prevention among physicians. Telephone helplines (quitlines) may be an option. The effectiveness of the Swedish quitline and factors related to abstinence from smoking 12 months after the first contact were assessed. Method: Subjects included 694 smokers calling a reactive (no contact initiated by the counsellors) and 900 smokers calling a proactive (four or five contacts initiated by the counsellors after the first call) quitline for smoking cessation. The subjects were followed up 12 months after the first call using a mailed questionnaire assessing current abstinence, stages of change and factors potentially related to abstinence rates. Results: The questionnaire was returned by 70% of the subjects. Women receiving the proactive treatment reported 34% abstinence rates compared with 27% for those receiving the reactive treatment (p=0.03). For men the abstinence rates were 27% and 28%, respectively (p=0.80). Factors significantly related to abstinence in the adjusted analysis included no nicotine use at base-line, the adjusted odds ratio with 95% confidence interval being 6.4 (2.1–19.4), additional support from a health care professional 3.5 (1.0–12.3), additional social support 3.1 (1.6–6.1), stress or depressive mood 2.7 (1.6–4.7), nicotine replacement therapy for five weeks or more 2.1 (1.1–4.0), and exposure to second-hand smoke 1.9 (1.1–3.3). The use of oral tobacco did not significantly increase current abstinence. Conclusion: Quitlines are effective as an adjunct to the health care system. For women a proactive treatment may be more effective than a reactive treatment.
]]> Helgason, A. R.10.1093/eurpub/14.3.306 - - Oxford University Press
- - Background: The more diseases one suffers from, the higher the number of health care services attended. This study aims to examine the role this association plays in socio-economic differences in multiple health care utilization. Methods: The study population derived from the Netherlands Health Interview Surveys (1990–1998) and was 25 years or older (N=53,339). Socio-economic position was indicated by educational level. Comorbidity was defined as the concurrence of multiple health conditions in the same person. Multiple health care utilization was measured by the number of different health care services contacted in the preceding year. Logistic multiple regression was used, adjusted for age, gender and year of interview. Results: The lower the socioeconomic status, the more often people used multiple health care services (OR 1.46) and the higher the prevalence of comorbidity (OR 2.47). Conclusions: Lower socioeconomic groups use more health care services, partly because they suffer from more illnesses.
]]> Droomers, M.10.1093/eurpub/14.3.311 - - Oxford University Press -
- - Background: This study compares associations between types of employment and health indicators in the Second (ES1995) and the Third European Survey on Working Conditions (ES2000) by gender, adjusting for individual and country-level confounders. Methods: Two cross-sectional surveys of a representative sample of the European Union (EU) total active population (n=15,146 workers in ES1995 and n=21,703 workers in ES2000). Based on their comparability in both surveys four health indicators were considered: job dissatisfaction, stress, fatigue and backache. Results: Non-permanent employment reported high percentages of job dissatisfaction but low levels of stress. Small employers were more likely to report fatigue and stress but less likely to report job dissatisfaction. Sole traders were more likely to report fatigue and backache. Workers in full-time employment almost always reported worse levels of health indicators than part-time. Two exceptions for part-time were found: temporary employment regarding job dissatisfaction, and in ES2000, sole traders with regard to job dissatisfaction, fatigue and backache. By and large, results by gender were similar in both surveys, although the magnitude of associations decreased in ES2000. Associations remained unchanged after adjustment. Conclusion: This study has compared for the first time the associations between various types of employment and four health indicators for the EU in ES1995 and ES2000, by gender. Overall, a slight increase in all health indicators was observed in the ES2000 compared to ES1995, and results were very consistent between both surveys. Similar findings in both surveys suggest that causal interpretation may be enhanced.
]]> Benach, J.10.1093/eurpub/14.3.314 - - Oxford University Press - -
- - Background: The purpose of this study was to examine the associations of four key areas of resistance resources (GRR), i.e. childhood living conditions, work and family life, and social relationships, with sense of coherence (SOC) among Finnish men and women. A particular interest was devoted to interactions between sex and GRR. Methods: The data derived from a representative personal interview survey collected by Statistics Finland in 1994 (N=8650, response rate 73%). This study included ages 25–64 (N=6506, 49% women). The associations of age, educational attainment, childhood living conditions, work and family, and social relationships with SOC were analysed using ordinary regression analysis. Results: Among both men and women, psycho-emotional resources rather than socio-economic circumstances were associated with SOC. These resources included the quality of the relationship with partner, social support, quality of work, and childhood living conditions. Although sex differences were small, the association of living without a partner with low SOC was stronger among men than women. Conclusion: SOC is strongly associated with the psycho-emotional resistance resources. In the Finnish context, the SOC scale was largely sex neutral.
]]> Volanen, S.-M.10.1093/eurpub/14.3.322 - - Oxford University Press
- - Socio-economic differences in health appear to be universal but the precise pathways that link socio-economic status and health remain unclear. Differential exposure to specific risk and protective factors are often cited as, at least, partial explanations of socio-economic differences in health. However, risk factors are culturally specific and risk factor-specific models of socioeconomic differences in health may be inadequate: as soon as prevailing risk factors change, so too must associated explanations of socio-economic differences in health. An alternative, risk factor-independent, model of socio-economic differences in health proposes that fundamental pathways to health and disease exist and that risk and protective factors act by feeding into these pathways. We propose that biological ageing is one such fundamental pathway to health, disease and, thus, socio-economic differences in health. Biological ageing is the progressive decline in physiological ability to meet demands, that occurs over time. It is due to the accumulation of damage at the cellular level and the rate of biological ageing is determined by both environmental and genetic factors. There is increasing evidence that many known disease risk and protective factors influence the rate of cellular damage accumulation and hence biological ageing and that the pathogenesis of some important diseases is related to biological ageing. We discuss these issues and hypothesize that socio-economic differences in health are partly a result of poor people ageing faster than rich people due to the unhealthy environments to which they are exposed.
]]> Adams, J. M.10.1093/eurpub/14.3.331 - - Oxford University Press - -
- - Background: According to the data of the population census held in Estonia in 1989, the resident population consisted of 61.5% Estonians and 38.5% non-Estonians, the majority of them being Russians – 30.3%. The aim of this study was to investigate the prevalence of asthma, chronic bronchitis and respiratory symptoms among the adults in these ethnic groups. Methods: The study was a postal survey, similar in design to parallel studies currently in progress in Finland, Estonia and Sweden (FinEsS). Results: The prevalence of physician-diagnosed asthma was 2.0%, being similar in men and women and in both Estonians and non-Estonians. The prevalence of physician-diagnosed chronic bronchitis was 10.5%. Compared with the non-Estonian population, the prevalence was much lower among Estonians (7.9% vs. 13.5%, p<0.001). Such a difference in prevalence was observed in all age groups. The high prevalence of chronic bronchitis in non-Estonians could be related to more extensive smoking habits, smoking indoors and probably ETS exposure. The defined OR between non-Estonians vs. Estonians after correcting for the influence of smoking habits, area of domicile, age, gender, and socioeconomic group was 1.30. A similar pattern of differences between Estonians and non-Estonians was observed in respiratory symptoms. Conclusion: This study revealed that the prevalence of physician-diagnosed asthma in Estonians and non-Estonians was the same. Physician-diagnosed chronic bronchitis was more frequent in non-Estonians than in Estonians. A significant difference was determined in the prevalence of respiratory symptoms, especially among those common to chronic bronchitis. The differences remained significant after correction for possible confounders.
]]> Jannus-Pruljan, L.10.1093/eurpub/14.2.114 - - Oxford University Press - -
- - Background: In Italy, diabetes centres are considered to provide adequate care but little is known about their performance. Methods: Inpatient and outpatient administrative databases were used to select and study a cohort of 2,568 diabetic patients. Adherence to guidelines and effect of patient characteristics and diabetes centre on treatment was assessed. Mortality rate was calculated. Results: Patients averaged 9.3 outpatient visits per year. Each patient received a mean of 21.8 ambulatory services per year but only 2.21 Haemoglobin A1C tests, and only 0.56 procedures suggested by the guidelines. Diabetes management depended mainly on the care centre. A mortality rate of 6.9 per hundred person-years was observed. Conclusions: Hospital-affiliated centres do not ensure adequate diabetes management.
]]> Petrelli, A.10.1093/eurpub/14.2.120 - - Oxford University Press - -
- - Background: Elderly patients may be at risk of suboptimal care. Thus, the relationship between age and quality of care for patients hospitalized for heart failure was examined. Methods: A cross-sectional study based on retrospective chart review was performed among a random sample of patients hospitalized between 1996 and 1998 in the general internal medicine wards, with a principal diagnosis of congestive heart failure, and discharged alive. Explicit criteria of quality of care, grouped into three scores, were used: admission work-up (admission score); evaluation and treatment during the stay (evaluation and treatment score); and readiness for discharge (discharge score). The associations between age and quality of care scores were analysed using linear regression models. Results: Charts of 371 patients were reviewed. Mean age was 75.7 (±11.1) years and 52% were men. There was no relationship between age and admission or readiness for discharge scores. The evaluation and treatment score decreased with age: compared with patients less than 70 years old, the score was lower by –2.6% (95% CI: –7.1 to 1.9) for patients aged 70 to 79, by –8.7% (95% CI: –13.0 to –4.3) for patients aged 80 to 89, and by –19.0% (95% CI: –26.6 to –11.5) for patients aged 90 and over. After adjustment for possible confounders, this relationship was not significantly modified. Conclusions: In patients hospitalized for congestive heart failure, older age was not associated with lower quality of care scores except for evaluation and treatment. Whether this is detrimental to elderly patients remains to be evaluated.
]]> Kossovsky, M. P.10.1093/eurpub/14.2.123 - - Oxford University Press - -
- - Background: The objective of this study was to evaluate the hospital treatment costs of invasive breast cancer in relation to the mode of detection, i.e. by mammography screening, between screenings or without screening during a population-based mammography screening programme, which started in 1987 among 36,000 women aged 40 to 74 years in the city of Turku, Southwest Finland. Methods: The treatment costs and survival days of 556 women diagnosed with invasive breast cancer at the age of 40 to 74 years in 1987 to 1993 were followed up for five years from diagnosis or until death, whichever occurred first. Results: Screen-detected cancers had the lowest average costs. The mean treatment costs per patient were 1.4-fold for clinical cancers and 1.3-fold for interval cancers compared to screen-detected cancers (p<0.001). The corresponding ratios in the mean treatment costs per survival day were 3.5 for clinical cancers and 1.9 for interval cancers (p<0.001). The mean treatment costs per patient were 1.3-fold for the non-screened group (clinical cancers) compared to the screened group (screen-detected and interval cancers) (p<0.001). The corresponding ratio was 3, when the mean treatment costs per survival day were compared (p<0.001). The estimated savings resulting from early treatment were 26–30% measured as a proportion of the screening costs for 1987 to 1993. Conclusion: The treatment costs of screen-detected cancers are lower than those of cancers detected by other methods. The study shows the potential for reducing treatment costs through early detection of breast cancer by mammography screening.
]]> Kauhava, L.10.1093/eurpub/14.2.128 - - Oxford University Press - -
- - Background: The general practitioner is usually the first health care contact for mental problems. The position of a general practitioner may vary between health care systems, depending on the referral system (gatekeepers versus directly accessible specialists), presence of fixed lists and the payment system. This may influence patients' expectations and requests for help and GPs' performance. In this paper the effects of working in different health care systems on demand and supply for psychological help were examined. Methods: Data were collected in six European countries with different health care system characteristics (Belgium, Germany, the Netherlands, Spain, Switzerland and the UK). For 15 consecutive contacts with 190 GPs in the six countries, each patient completed questionnaires concerning reason for visit and expectations (before) and evaluation (after consultation). General practitioners completed registration forms on each consultation, indicating familiarity with the patient and diagnosis. General practitioners completed a general questionnaire about their personal and professional characteristics as well. Results: Practices in different countries differed considerably in the proportion of psychological reasons for the visit by the patient and psychological diagnoses by the GP. Agreement between patients' self-rated problems and GPs' diagnoses also varied. Patients in different countries evaluated their GPs' psychological performance differently as well, but evaluation was not correlated with agreement between request for help and diagosis. In gatekeeping countries, patients had more psycho-social requests, GPs made more psychological diagnoses and agreement between both was relatively high. Evaluation, however, was more positive in non-gatekeeping countries. Individual characteristics of doctors and patients explained only a relatively small part of variance. Conclusions: Health care system characteristics do affect GPs' performance in psycho-social care.
]]> Verhaak, P. F.M.10.1093/eurpub/14.2.134 - - Oxford University Press - -
