Showing papers in "European Journal of Public Health in 2016"
TL;DR: The high number of policy, regulatory and educational reforms, such as on nurse prescribing, demonstrate an evolving trend internationally toward expanding nurses' scope-of-practice in primary care, and would facilitate recognition procedures in increasingly connected labour markets.
Abstract: Background: Primary care is in short supply in many countries. Task shifting from physicians to nurses is one strategy to improve access, but international research is scarce. We analysed the extent of task shifting in primary care and policy reforms in 39 countries. Methods: Cross-country comparative research, based on an international expert survey, plus literature scoping review. A total of 93 country experts participated, covering Europe, USA, Canada, Australia and New Zealand (response rate: 85.3%). Experts were selected according to pre-defined criteria. Survey responses were triangulated with the literature and analysed using policy, thematic and descriptive methods to assess developments in country-specific contexts. Results: Task shifting, where nurses take up advanced roles from physicians, was implemented in two-thirds of countries ( N = 27, 69%), yet its extent varied. Three clusters emerged: 11 countries with extensive (Australia, Canada, England, Northern Ireland, Scotland, Wales, Finland, Ireland, Netherlands, New Zealand and USA), 16 countries with limited and 12 countries with no task shifting. The high number of policy, regulatory and educational reforms, such as on nurse prescribing, demonstrate an evolving trend internationally toward expanding nurses’ scope-of-practice in primary care. Conclusions : Many countries have implemented task-shifting reforms to maximise workforce capacity. Reforms have focused on removing regulatory and to a lower extent, financial barriers, yet were often lengthy and controversial. Countries early on in the process are primarily reforming their education. From an international and particularly European Union perspective, developing standardised definitions, minimum educational and practice requirements would facilitate recognition procedures in increasingly connected labour markets.
232 citations
TL;DR: EHR system, when properly implemented, can improve the quality of healthcare, increasing time efficiency and guideline adherence and reducing medication errors and ADEs and strategies for EHR implementation should be recommended and promoted.
Abstract: Objective: To assess the impact of electronic health record (EHR) on healthcare quality, we hence carried out a systematic review and meta-analysis of published studies on this topic. Methods: PubMed, Web of Knowledge, Scopus and Cochrane Library databases were searched to identify studies that investigated the association between the EHR implementation and process or outcome indicators. Two reviewers screened identified citations and extracted data according to the PRISMA guidelines. Meta-analysis was performed using the random effects model for each indicator. Heterogeneity was quantified using the Cochran Q test and I2 statistics, and publication bias was assessed using the Egger’s test. Results: Of the 23 398 citations identified, 47 articles were included in the analysis. Meta-analysis showed an association between EHR use and a reduced documentation time with a difference in mean of −22.4% [95% confidence interval (CI) = −38.8 to −6.0%; P < 0.007]. EHR resulted also associated with a higher guideline adherence with a risk ratio (RR) of 1.33 (95% CI = 1.01 to 1.76; P = 0.049) and a lower number of medication errors with an overall RR of 0.46 (95% CI = 0.38 to 0.55; P < 0.001), and adverse drug effects (ADEs) with an overall RR of 0.66 (95% CI = 0.44 to 0.99; P = 0.045). No association with mortality was evident ( P = 0.936). High heterogeneity among the studies was evident. Publication bias was not evident. Conclusions: EHR system, when properly implemented, can improve the quality of healthcare, increasing time efficiency and guideline adherence and reducing medication errors and ADEs. Strategies for EHR implementation should be therefore recommended and promoted.
209 citations
TL;DR: Barriers and facilitators of CRC screening participation are frequently reported, and understanding these factors is the first step to possibly modify specific factors to increase CRC screening Participation rate.
Abstract: Background: Colorectal cancer (CRC) is one of the most common cancers in men and women. CRC screening programmes have been implemented in various countries. However, the participation rate remains disappointingly low. For a screening method to be beneficial, high participation rates are essential. Therefore, understanding the factors that are associated with CRC screening and follow-up adherence is necessary. In this systematic review, factors studied in literature were identified that are associated with CRC screening adherence. Methods : A systematic search in PUBMED, EMBASE and COCHRANE was performed to identify barriers and facilitators for CRC screening adherence. Study characteristics were summarized and analysed. Results: Seventy-seven papers met the inclusion criteria to be applicable for review. Female gender, younger participants, low level of education, lower income, ethnic minorities and not having a spouse were the most frequently reported barriers. Health provider characteristics, such as health insurance and a usual source of care were also frequently reported barriers in CRC screening adherence. Disparities were found in weight, employment status and self-perceived health status. Conclusion : Barriers and facilitators of CRC screening participation are frequently reported. Understanding these factors is the first step to possibly modify specific factors to increase CRC screening participation rate.
163 citations
TL;DR: Several factors linked to breast cancer risk and outcome, such as lower screening attendance for women with lower socioeconomic status, are suitable targets for policy intervention aimed at reducing socioeconomic-related inequalities in health outcomes.
Abstract: Background: Breast cancer is the leading cause of female cancer in Europe and is estimated to affect more than one in 10 women Higher socioeconomic status has been linked to higher incidence but lower case fatality, while the impact on mortality is ambiguous Methods: We performed a systematic literature review and meta-analysis on studies on association between socioeconomic status and breast cancer outcomes in Europe, with a focus on effects of confounding factors Summary relative risks (SRRs) were calculated Results: The systematic review included 25 articles of which 8 studied incidence, 10 case fatality and 8 mortality The meta-analysis showed a significantly increased incidence (SRR 125, 117–132), a significantly decreased case fatality (SRR 072, 063–081) and a significantly increased mortality (SRR 116, 110–123) for women with higher socioeconomic status The association for incidence became insignificant when reproductive factors were included Case fatality remained significant after controlling for tumour characteristics, treatment factors, comorbidity and lifestyle factors Mortality remained significant after controlling for reproductive factors Conclusion: Women with higher socioeconomic status show significantly higher breast cancer incidence, which may be explained by reproductive factors, mammography screening, hormone replacement therapy and lifestyle factors Lower case fatality for women with higher socioeconomic status may be partly explained by differences in tumour characteristics, treatment factors, comorbidity and lifestyle factors Several factors linked to breast cancer risk and outcome, such as lower screening attendance for women with lower socioeconomic status, are suitable targets for policy intervention aimed at reducing socioeconomic-related inequalities in health outcomes
160 citations
TL;DR: There is scientific evidence that employees, both men and women, who report specific occupational exposures, such as low decision latitude, job strain or noise, have an increased incidence of ischaemic heart disease.
Abstract: Background: There is need for an updated systematic review of associations between occupational exposures and ischaemic heart disease (IHD), using the GRADE system. Methods: Inclusion criteria: (i) publication in English in peer-reviewed journal between 1985 and 2014, (ii) quantified relationship between occupational exposure (psychosocial, organizational, physical and other ergonomic job factors) and IHD outcome, (iii) cohort studies with at least 1000 participants or comparable case-control studies with at least 50 + 50 participants, (iv) assessments of exposure and outcome at baseline as well as at follow-up and (v) gender and age analysis. Relevance and quality were assessed using predefined criteria. Level of evidence was then assessed using the GRADE system. Consistency of findings was examined for a number of confounders. Possible publication bias was discussed. Results: Ninety-six articles of high or medium high scientific quality were finally included. There was moderately strong evidence (grade 3 out of 4) for a relationship between job strain and small decision latitude on one hand and IHD incidence on the other hand. Limited evidence (grade 2) was found for iso-strain, pressing work, effort-reward imbalance, low support, lack of justice, lack of skill discretion, insecure employment, night work, long working week and noise in relation to IHD. No difference between men and women with regard to the effect of adverse job conditions on IHD incidence. Conclusions: There is scientific evidence that employees, both men and women, who report specific occupational exposures, such as low decision latitude, job strain or noise, have an increased incidence of IHD.
141 citations
TL;DR: It is suggested that increased TV watching is associated with increased risk of childhood obesity, and restricting TV time and other sedentary behaviour of children may be an important public health strategy to prevent childhood obesity.
Abstract: Background: Over the last few decades, there has been a worldwide epidemic of childhood obesity. An important step in successful prevention in paediatrics is the identification of modifiable risk factors of childhood obesity. Many studies have evaluated the associations between television (TV) watching and childhood obesity but yielded inconsistent results. Methods: To help elucidate the role of TV watching, PubMed and Embase databases were searched for published studies on associations between TV watching and childhood obesity. Random-effects models and dose–response meta-analyses were used to pool study results. Results: Fourteen cross-sectional studies with 24 reports containing 106 169 subjects were included in the meta-analysis. Subgroup analyses were conducted by the available characteristics of studies and participants. The multivariable-adjusted overall OR of the childhood obesity for the highest vs. the lowest time of TV watching was 1.47 [95% confidence interval (95% CI): 1.33–1.62]. A linear dose–response relationship was also found for TV watching and childhood obesity ( P < 0.001), and the risk increased by 13% for each 1 h/day increment in TV watching. Subgroup analysis showed a basically consistent result with the overall analysis. The association is observed in both boys and girls (for boys, OR 1.30, 95% CI 1.16–1.45; for girls, OR 1.26, 95% CI 1.11–1.41). Conclusions: our meta-analysis suggested that increased TV watching is associated with increased risk of childhood obesity. And restricting TV time and other sedentary behaviour of children may be an important public health strategy to prevent childhood obesity.
104 citations
TL;DR: Evidence is provided of a likely misestimation of social disparities in HD, in both men and women, due to self-report bias in alcohol consumption surveys, which contributes to a better knowledge of the social dimensions of HD and to the targeting of alcohol policies.
Abstract: BACKGROUND: Self-report bias in surveys of alcohol consumption is widely documented; however, less is known about the distribution of such bias by socioeconomic status (SES) and about the possible impact on social disparities. This study aims to assess social disparities in hazardous drinking (HD) and to analyze how correcting alcohol consumption data for self-report bias may affect estimates of disparities. METHODS: National survey data from 13 countries, Canada, England, Finland, France, Germany, Hungary, Ireland, Japan, Korea, New Zealand, Spain, Switzerland and USA, are used to examine social disparities in HD by SES and education level. Defining HD as drinking above 3 drinks/day for men and 2 for women, social disparities were assessed by calculating country-level concentration indexes. Aggregate consumption data were used to correct survey-based estimates for self-report bias. RESULTS: Survey data show that more-educated women are more likely than less-educated women to engage in HD, while the opposite is observed in men in most countries. Large discrepancies in alcohol consumption between survey-based and aggregate estimates were found. Correcting for self-report bias increased estimates of social disparities in women, and decreased them in men, to the point that gradients were reversed in several countries (from higher rates in low education/SES men to an opposite pattern). CONCLUSION: This study provides evidence of a likely misestimation of social disparities in HD, in both men and women, due to self-report bias in alcohol consumption surveys. This study contributes to a better knowledge of the social dimensions of HD and to the targeting of alcohol policies.
103 citations
TL;DR: Making only selected vaccinations compulsory can have detrimental effects on the vaccination programme by decreasing the uptake of voluntary vaccinations, as the prevalence of vaccine hesitancy within a society will influence the damage of partial compulsory vaccination.
Abstract: Background: During outbreaks of vaccine-preventable diseases, compulsory vaccination is sometimes discussed as a last resort to counter vaccine refusal. Besides ethical arguments, however, empirical evidence on the consequences of making selected vaccinations compulsory is lacking. Such evidence is needed to make informed public health decisions. This study therefore assesses the effect of partial compulsory vaccination on the uptake of other voluntary vaccines. Method: A total of 297 ( N ) participants took part in an online experiment that simulated two sequential vaccination decisions using an incentivized behavioural vaccination game. The game framework bases on epidemiological, psychological and game-theoretical models of vaccination. Participants were randomized to the compulsory vaccination intervention ( n = 144) or voluntary vaccination control group ( n = 153), which determined the decision architecture of the first of two decisions. The critical second decision was voluntary for all participants. We also assessed the level of anger, vaccination attitude and perceived severity of the two diseases. Results: Compulsory vaccination increased the level of anger among individuals with a rather negative vaccination attitude, whereas voluntary vaccination did not. This led to a decrease in vaccination uptake by 39% in the second voluntary vaccination (reactance). Conclusion: Making only selected vaccinations compulsory can have detrimental effects on the vaccination programme by decreasing the uptake of voluntary vaccinations. As this effect occurred especially for vaccine hesitant participants, the prevalence of vaccine hesitancy within a society will influence the damage of partial compulsory vaccination.
98 citations
TL;DR: People with mental health disorder have still elevated mortality, but the mortality declined faster for general population than for psychiatric patients, and was similar for other cardiovascular deaths excluding cerebrovascular deaths.
Abstract: Introduction: People with severe mental illness have increased risk for premature mortality and thus a shorter life expectancy. Relative death rates are used to show the excess mortality among patients with mental health disorder but cannot be used for the comparisons by country, region and time. Methods: A population-based register study including all Swedish patients in adult psychiatry admitted to hospital with a main diagnosis of schizophrenia, bipolar or unipolar mood disorder in 1987–2010 (614 035 person-years). Mortality rates adjusted for age, sex and period were calculated using direct standardization methods with the 2010 Swedish population as standard. Data on all residents aged 15 years or older were used as the comparison group. Results: Patients with severe mental health disorders had a 3-fold mortality compared to general population. All-cause mortality decreased by 9% for people with bipolar mood disorder and by 26–27% for people with schizophrenia or unipolar mood disorder, while the decline in the general population was 30%. Also mortality from diseases of the circulatory system declined less for people with severe mental disorder (−35% to − 42%) than for general population (−49%). The pattern was similar for other cardiovascular deaths excluding cerebrovascular deaths for which the rate declined among people with schizophrenia (−30%) and unipolar mood disorder (−41%), unlike for people with bipolar mood disorder (−3%). Conclusions: People with mental health disorder have still elevated mortality. The mortality declined faster for general population than for psychiatric patients. More detailed analysis is needed to reveal causes-of-death with largest possibilities for improvement.
87 citations
TL;DR: This study underscores the rationale of promoting mental well-being as a public mental health strategy to prevent mental illness in wealthy European nations by examining whether flourishing mental health predicts first-incidence and recurrent mental disorders 3 years later.
Abstract: Background: High levels of mental well-being might protect against the onset of mental disorders but longitudinal evidence is scarce. This study examines whether flourishing mental health predicts first-incidence and recurrent mental disorders 3 years later. Methods: Data were used from 4482 representative adults participating in the second (2010–12) and third wave (2013–15) of the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2). Mental well-being was assessed with the Mental Health Continuum-Short Form (MHC-SF) at the second wave. The classification criteria of this instrument were used to classify participants as having flourishing mental health: high levels of both hedonic well-being (life-satisfaction, happiness) and eudaimonic well-being (social contribution, purpose in life, personal growth). DSM-IV mood, anxiety and substance use disorders were measured with the Composite International Diagnostic Interview (CIDI) 3.0 at all waves. Odds ratios of (first and recurrent) incident disorders were estimated, using logistic regression analyses adjusting for potential confounders. Results: Flourishing reduced the risk of incident mood disorders by 28% and of anxiety disorders by 53%, but did not significantly predicted substance use disorders. A similar pattern of associations was found for either high hedonic or high eudaimonic well-being. Significant results were found for substance use disorders when life-events and social support were removed as covariates. Conclusion: This study underscores the rationale of promoting mental well-being as a public mental health strategy to prevent mental illness. In wealthy European nations it seems fruitful to measure and pursuit a flourishing life rather than merely high levels of hedonic well-being.
82 citations
TL;DR: Income inequalities in obesity and overweight widened significantly between age 5 and 11 and a similar set of risk factors protected against upward and promoted downward movements across weight categories.
Abstract: Background: There is limited evidence on which risk factors attenuate income inequalities in child overweight and obesity; whether and why these inequalities widen as children age. Method: Eleven thousand nine hundred and sixty five singletons had complete data at age 5 and 9384 at age 11 from the Millennium Cohort Study (UK). Overweight (age 5 : 15%; age 11 : 20%) and obesity (age 5 : 5%; age 11 : 6%) were defined using the International Obesity Taskforce body mass index cut-points. To measure socioeconomic inequalities, we used quintiles of family income and as risk factors, we considered markers of maternal health behaviours and of children’s physical activity, sedentary behaviours and diet. Binary and multinomial logistic regression models were used. Results: The unadjusted analyses revealed stark income inequalities in the risk of obesity at age 5 and 11. At age 5, children in the bottom income quintile had 2.0 (95% CI: 1.4–2.8) increased relative risk of being obese whilst at age 11 they had 3.0 (95% CI: 2.0–4.5) increased risk compared to children in the top income quintile. Similar income inequalities in the risk of overweight emerged by age 11. Physical activity and diet were particularly important in explaining inequalities. Income inequalities in obesity and overweight widened significantly between age 5 and 11 and a similar set of risk factors protected against upward and promoted downward movements across weight categories. Conclusions: To reduce income inequalities in overweight and obesity and their widening across childhood the results support the need of early interventions which take account of multiple risk factors.
TL;DR: Over a 6-year period, living alone was related to a half year reduction in survival among elderly people in Sweden and was associated with elevated mortality, especially among men and an increased risk of institutionalization.
Abstract: Background: Living alone is common among elderly people in Western countries, and studies on its relationship with institutionalization and all-cause mortality have shown inconsistent results. We investigated that the impact of living alone on institutionalization and mortality in a population-based cohort of elderly people. Methods: Data originate from the Swedish National study on Aging and Care-Kungsholmen. Participants aged ≥66 years and living at home ( n = 2404) at baseline underwent interviews and clinical examination. Data on living arrangements were collected in interviews. All participants were followed for 6 years; survival status and admission into institutions were tracked continuously through administrative registers from 2001 to 2007. Data were analysed using Cox proportional hazard models, competing risk regressions and Laplace regressions with adjustment for potential confounders. Results: Of the 2404 participants, 1464 (60.9%) lived alone at baseline. During the follow-up, 711 (29.6%) participants died, and 185 (15.0%) were institutionalized. In the multi-adjusted Cox model, the hazard ratio (HR) of mortality in those living alone was 1.35 (95% confidence interval [CI] 1.18 to 1.54), especially among men (HR = 1.44, 95% CI 1.18 to 1.76). Living alone shortened survival by 0.6 years and was associated with the risk of institutionalization (HR = 1.74, 95% CI 1.10 to 2.77) after taking death into account as a competing risk. Conclusions: Living alone is associated with elevated mortality, especially among men and an increased risk of institutionalization. Over a 6-year period, living alone was related to a half year reduction in survival among elderly people in Sweden.
TL;DR: There is a great deal of relevant literature offering explanations for “excess” mortality, and it would be of interest to explore similarities and differences between upstream influences, health behaviours and linked outcomes in Scotland and in eastern European countries.
Abstract: Background This systematic scoping review was commissioned by NHS Health Scotland as one of a number of projects to investigate reasons behind ‘excess’ mortality in Scotland compared to other parts of the UK. It aimed to identify explanations for (1) the high mortality in Scotland, or parts of Scotland relative to comparable populations (2) excess mortality between otherwise comparable populations. Methods Ten electronic databases were searched in November 2014, plus searches of relevant websites and a structured internet search. Potentially relevant records were screened by one reviewer with a random 10% double screened. Data was extracted into the categories: Countries compared; Study design; Outcomes reported; Hypotheses proposed (if any). Results 27,723 articles were screened and 837 included (1) Half of the 305 included studies mentioned deprivation or deprivation-related artefacts as an explanation for excess mortality in Glasgow or Scotland. The next largest category (29%) related to health behaviours. Other significant explanations related to political attack, effects of policies, health services supply and demand, deindustrialisation, different culture of substance misuse, possible mechanisms, migration, lower social capital, poor housing, life course effects, artefacts of measurement and the external physical environment. (2) In the international literature (n = 532), the largest category related to health behaviours (37%), with deprivation featuring in 32%. Other significant explanations related to health services supply and demand, income inequalities, artefacts of measurement, political attack or effects, social capital, different culture of substance misuse, and genetic differences. Conclusions There is a great deal of relevant literature offering explanations for “excess” mortality. Further research that includes validity assessment of these studies would be necessary to understand the reasons more fully and to ascertain which are the most robust. Key messages: Further research might focus on the links between “downstream” (e.g. health behaviours), “midstream” and “upstream” levels of explanations for excess mortality both in Scotland and internationally It would be of interest to explore similarities and differences between upstream influences, health behaviours and linked outcomes in Scotland and in eastern European countries © The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
TL;DR: The results demonstrate the need for urgent actions targeting homeless families, in terms of reducing housing instability and providing adequate care, especially for children, and highlight the importance of families among the homeless population in Paris region.
Abstract: Background: The objectives were to estimate the size of homeless family population in Paris region, to describe their living conditions and health and to analyse the impact of homelessness on children’s growth and development, which was never investigated in France. Methods: A cross-sectional survey was conducted on a random sample of homeless sheltered families in 2013. Families were interviewed in 17 languages and a nurse took anthropometric measures, blood samples and collected health data from child health reports. Results: The population size was estimated at 10 280 families. Half were single-parent female families and 94% were born outside France. Most families had experienced housing instability and 94% were living below the poverty line (828 euros/month). Malnutrition was a major problem: the prevalence of food insecurity was high (77% of parents and 69% of children), as well as anaemia (50% of mothers and 38% of children), overweight (38% of mothers and 22% of children) and obesity (32% of mothers and 4% of children). High rates of depressive disorders were found in 30% of homeless mothers and 20% of children had signs of possible mental health disorders. Discussion: These first results highlight the important number of families among the homeless population in Paris region. Families differed from other homeless people regarding social characteristics such as birthplace, single-parent status and residential instability that are likely to influence schooling, social ties, health and access to care. These results demonstrate the need for urgent actions targeting homeless families, in terms of reducing housing instability and providing adequate care, especially for children.
TL;DR: The results indicate an association of overweight/obesity with PIU and suggest the importance of formulating preventive public health policies that target physical health, education and sedentary online lifestyle early in adolescence with special attention to boys.
Abstract: Background: Overweight of children and adolescents continues to be an important and alarming global public health problem. As the adolescent’s time spent online has increased, problematic internet use (PIU) potentially leads to negative health consequences. This study aimed to examine the relation between PIU and overweight/obesity among adolescents in seven European countries and assess the effect of demographic and lifestyle factors recorded in the European Network for Adolescent Addictive Behaviour (EU NET ADB) survey ([www.eunetadb.eu][1]). Methods: A cross-sectional school-based survey of 14- to 17-year-old adolescents was conducted in seven European countries: Germany, Greece, Iceland, the Netherlands, Poland, Romania and Spain. Anonymous self-completed questionnaires included sociodemographic data, internet usage characteristics, school achievement, parental control and the Internet Addiction Test. Associations between overweight/obesity and potential risk factors were investigated by logistic regression analysis, allowing for the complex sample design. Results: The study sample consisted of 10 287 adolescents aged 14–17 years. 12.4% were overweight/obese, and 14.1% presented with dysfunctional internet behavior. Greece had the highest percentage of overweight/obese adolescents (19.8%) and the Netherlands the lowest (6.8%). Male sex [odds ratio (OR) = 2.89, 95%CI: 2.46–3.38], heavier use of social networking sites (OR = 1.26, 95%CI: 1.09–1.46) and residence in Greece (OR = 2.32, 95%CI: 1.79–2.99) or Germany (OR = 1.48, 95%CI: 1.12–1.96) were independently associated with higher risk of overweight/obesity. A greater number of siblings (OR = 0.79, 95%CI: 0.64–0.97), higher school grades (OR = 0.74, 95%CI: 0.63–0.88), higher parental education (OR = 0.89, 95%CI: 0.82–0.97) and residence in the Netherlands (OR = 0.49, 95%CI: 0.31–0.77) independently predicted lower risk of overweight/obesity. Conclusions: The results indicate an association of overweight/obesity with PIU and suggest the importance of formulating preventive public health policies that target physical health, education and sedentary online lifestyle early in adolescence with special attention to boys.
[1]: http://www.eunetadb.eu
TL;DR: The fortification of commonly used foods with vitamin D and vitamin D supplementation seems to be an efficient way to increase the vitamin D intake and theitamin D status in the adult population in Finland.
Abstract: Background: Due to vitamin D intake below recommendation (10 µg/day) and low (<50 nmol/l) serum 25-hydroxycholecalciferol (25(OH)D) concentration in Finnish population, the fortification of liquid dairy products with 0.5 µg vitamin D/100 g and fat spreads with 10 µg/100 g started in Finland in December 2002. In 2010, the fortification recommendation was doubled. The aim of this study was to investigate whether the vitamin D intake and status have improved among Finnish adults as a consequence of these nutrition policy actions. A further aim was to study the impact of vitamin supplement use to the total vitamin D intake. Methods: A cross-sectional survey was conducted every 5 years. The National FINDIET Survey was conducted in Finland as part of the National FINRISK health monitoring study. Dietary data were collected by using a computer-assisted 48-h dietary recall. In 2002, dietary data comprised 2007, in 2007, 1575 and 2012, 1295 working aged (25–64 years) Finns. Results: The mean D-vitamin intake increased from 5 µg/day to 17 µg/day in men and from 3 µg/day to 18 µg/day in women from 2002 to 2012. The most important food sources of vitamin D were milk products, fat spreads and fish dishes. The share of milk products was 39% among younger men and 38% among younger women, and 29% among older men and 28% among older women. Fat spreads covered on average 28% of vitamin D intake, except for younger men for which it covered 23%. Fish dishes provided 28% of vitamin D intake for older men and women, and approximately 18% for younger ones. In January–April 2012, the average serum 25-hydroxycholecalciferol (25(OH)D) concentration for men was 63 nmol/l for men and for women 67 nmol/l for women. Conclusions: The fortification of commonly used foods with vitamin D and vitamin D supplementation seems to be an efficient way to increase the vitamin D intake and the vitamin D status in the adult population.
TL;DR: Maternal modelling of healthy active behaviours may have a greater influence on children compared to paternal modelling, whereas unhealthy sedentary behaviours seem to be modelled by both parents equally.
Abstract: Background: Parents play an important role in modelling healthy behaviours to their children. This study investigated associations between parent and child physical activity and screen time behaviours across specific domains, including moderating effects by parent and child gender. Method: The sample comprised 3300 school children and 2933 parents participating in the UP4FUN project (mean ages: child 11.2 ± 0.8 years, mother 40.0 ± 4.9 years, father 43.4 ± 5.8 years; 49% boys, 83% mothers). Data were collected in 2011 in Belgium, Greece, Hungary, Germany and Norway. Questionnaires assessed physical activity (sport, outdoor activities, walking and cycling for transport) and screen time (TV/DVD viewing, computer/games console use) in children and parents. Multilevel multivariate regression was applied to assess associations between parent and child physical activity and screen time. Results: Maternal, but not paternal, participation in sport, outdoor activities and walking for transport were associated with higher participation in these activities in children ( P < 0.001). In contrast, both maternal and paternal TV/DVD viewing and computer/games console use were related to higher engagement in these screen-based activities in children ( P < 0.01). Furthermore, maternal modelling of outdoor activities was significantly associated with outdoor activities in girls ( P < 0.001). In contrast, paternal modelling of TV/DVD viewing and computer/games console were significantly associated with these screen-based behaviours in boys ( P < 0.001). Conclusions: Maternal modelling of healthy active behaviours may have a greater influence on children compared to paternal modelling, whereas unhealthy sedentary behaviours seem to be modelled by both parents equally.
TL;DR: This review provides an overview of sick leave recommendations in Europe for influenza and synthesizes current literature on sickness presenteeism and influenza transmission in the workplace and concludes that the effectiveness of interventions to reduce workplace presenteism is largely unknown.
Abstract: Background: Knowledge about influenza transmission in the workplace and whether staying home from work when experiencing influenza-like illness can reduce the spread of influenza is crucial for the design of efficient public health initiatives. Aim: This review synthesizes current literature on sickness presenteeism and influenza transmission in the workplace and provides an overview of sick leave recommendations in Europe for influenza. Methods: A search was performed on Medline, Embase, PsychINFO, Cinahl, Web of Science, Scopus and SweMed to identify studies related to workplace contacts, -transmission, -interventions and compliance with recommendations to take sick leave. A web-based survey on national recommendations and policies for sick leave during influenza was issued to 31 European countries. Results: Twenty-two articles (9 surveys; 13 modelling articles) were eligible for this review. Results from social mixing studies suggest that 20–25% of weekly contacts are made in the workplace, while modelling studies suggest that on average 16% (range 9–33%) of influenza transmission occurs in the workplace. The effectiveness of interventions to reduce workplace presenteeism is largely unknown. Finally, estimates from studies reporting expected compliance with sick leave recommendations ranged from 71 to 95%. Overall, 18 countries participated in the survey of which nine (50%) had issued recommendations encouraging sick employees to stay at home during the 2009 A(H1N1) pandemic, while only one country had official recommendations for seasonal influenza. Conclusions: During the 2009 A(H1N1) pandemic, many European countries recommended ill employees to take sick leave. Further research is warranted to quantify the effect of reduced presenteeism during influenza illness.
TL;DR: The findings suggest that contexts with increasing average trust can be harmful for low trust individuals, which might reflect the negative impact that social capital can have in certain groups.
Abstract: Background: Generalized interpersonal trust (as an indicator of social capital) has been linked to health status at both the individual and ecological level. We sought to examine how changes in contextual and individual trust are associated with changes in self-rated health in the European Social Surveys 2002–12. Methods: A multilevel analysis using a variance components model was performed on 203 452 individuals nested within 145 country cohorts covering 35 countries. Conditional on sociodemographic covariates, we sought to examine the association between self-rated health and individual trust, country average trust and a cross-level interaction between the two. Results: Although individual trust perceptions were significantly correlated with self-rated health [OR = 0.95, 95% confidence interval (0.94–0.96)], country-level trust was not associated [OR = 1.12, 95% confidence interval (0.95–1.32)]. There was, however, a strong crosslevel interaction between contextual and individual trust ( P < 0.001), such that individuals with high interpersonal trust reported better health in contexts in which other individuals expressed high average interpersonal trust. Conversely, low trust individuals reported worse health in high trust contexts. Conclusion: Our findings suggest that contexts with increasing average trust can be harmful for low trust individuals, which might reflect the negative impact that social capital can have in certain groups. These findings suggest that contextual trust has a complex role in explaining health inequalities and individual self-rated health.
TL;DR: The main factors that possibly will improve the SWB of people across the globe are state of health, household's financial satisfaction and freedom of choice, according to Cohen's rules of thumb.
Abstract: Background: Maximising the happiness and life satisfaction [i.e. subjective well-being (SWB)] of citizens is a fundamental goal of international governmental organizations’ policies. In order to decide what policies should be pursued in order to improve SWB there is a need to identify what the key drivers of SWB are. However, to date most studies have been conducted in unrepresentative samples of largely ‘developed’ nations. Methods: Data from the latest World Value Survey (2010–14) and gathered 85 070 respondents from 59 countries (Age 1–99 years, Mean = 42, SD = 16.54; 52.29% females) were pooled for the analysis. A cross-sectional multilevel random effects model was performed where respondents were nested by country. Results: The average levels of SWB varied across countries and geographical regions. Among the lowest 10 SWB countries are nations from: Eastern Europe and Former Soviet Union and Middle East and North Africa. Factors driving SWB include state of health, financial satisfaction, freedom of choice, GDP per capita, income scale, importance of friends, leisure, being females, weekly religious attendance, unemployment and income inequality. Nevertheless, according to Cohen’s rules of thumb, most of these factors have ‘small’ effect sizes. Thus, the main factors that possibly will improve the SWB of people across the globe are: state of health, household’s financial satisfaction and freedom of choice. Conclusions: To maximize the well-being of the population, policy makers may focus on health status, household’s financial satisfaction and emancipative values. The levels of prosperity and political stability appear to positively improve the SWB of people.
TL;DR: In 2015, one million refugees came to Europe, and almost 4000 have died in the Mediterranean, this situation requires a timely and effective Public Mental Health answer.
Abstract: Mental health is central to health, and research has recognized the vulnerability of refugees, asylum seekers and internally displaced persons in relation to mental health.1 Escalating wars and continuous conflicts contributed to mass displacement of people during 2015. By the end of 2015 almost 60 million individuals were forcibly displaced. In 2015, one million refugees came to Europe, and almost 4000 have died in the Mediterranean. This situation requires a timely and effective Public Mental Health answer (Box 1).
Box 1
Definition
The 1951 United Nations Convention Relating to the Status of Refugees defines a refugee as a person who ‘owing to well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality and is unable or, owing to such fear, is unwilling to avail himself of the protection of that country; or who, not having a nationality and being outside the country of his former habitual residence as a result of such events, is unable or, owing to such fear, is unwilling to return to it’. An asylum seeker is a person seeking international protection whose claim has not been determined …
TL;DR: Because of the variations in the European community care contexts, the growing demand for community care as a cost-effective and quality solution to the care burden of aging populations will have country-specific impacts.
Abstract: Background: The European population is aging. The main drivers of public spending on health care for people of 65 years and older are hospital admission and admission to long-term care facilities. High quality community care can be a cost-effective and quality solution to respond to the impact of ageing populations on health-care systems. It is unclear how well countries are equipped to provide affordable and quality community care. The aim of this article is to describe and compare community care delivery with care-dependent older people in Europe. Methods: This study is conducted within the European Union-financed IBenC project [Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of community care (FP7)] in which six European countries are involved. To compare the community care delivery with care-dependent older people in these countries, we performed a systematic comparison of macro indicators using metadata complemented with data from multinational surveys. Results: Data on the following dimensions are described and compared: population of the country, governmental expenditures on health, sources of community health services funding, governmental vision and regulation on community care, community care organisations and care professionals, eligibility criteria for and equity in receiving care and the involvement of informal care. Conclusion : Because of the variations in the European community care contexts, the growing demand for community care as a cost-effective and quality solution to the care burden of aging populations will have country-specific impacts. When learning from other countries’ best practices, in addition to researchers, policy makers should take full account of local and national care contexts.
TL;DR: Excluding Sweden, current oral tobacco use was not commonly reported in the European countries surveyed and was similarly rare both in men and in women.
Abstract: Introduction: The purpose of this study is to report prevalence and determinants of use of smokeless tobacco in a representative sample of men and women from Sweden, where Swedish snus sales are legal, and from 17 other European countries, where sales of smokeless tobacco are restricted. Methods: In 2010, a face-to-face survey including information on current smokeless tobacco use was conducted in a representative sample of around 1000 individuals aged ≥15 years per country in Albania, Austria, Bulgaria, Czech Republic, Croatia, England, Finland, France, Greece, Hungary, Ireland, Italy, Latvia, Poland, Portugal, Romania, Spain and Sweden. Results: In Sweden, the overall prevalence of smokeless tobacco use was 12.3% (20.7% in men, 3.5% in women). The corresponding estimate for other European countries combined was 1.1% (1.2% in men, 1.1% in women). Compared with never smokers, former smokers in Sweden were significantly more likely to use smokeless tobacco (odds ratio, OR: 2.67), whereas no difference in use was observed in other countries (OR: 1.04). Use of smokeless tobacco was similar among current smokers in Sweden (OR: 1.96) and in other countries (OR: 2.40) when contrasted to never smokers. In Sweden there were no differences in the number of cigarettes/day between smokers who also use smokeless tobacco (13.3 cigarettes/day) and exclusive cigarette smokers (12.9 cigarettes/day; P = 0.785). Conclusions: Excluding Sweden, current oral tobacco use was not commonly reported in the European countries surveyed and was similarly rare both in men and in women. In Sweden, however, use of smokeless tobacco was about 10-fold higher than the rest of Europe and more prevalent in men than in women.
TL;DR: People with poor mental and physical health are at increased risk of job loss, which contributes to poor health amongst the unemployed and highlights the need for policy focus on the health and welfare of out of work individuals, including support preparing them for re-employment.
Abstract: Background: Many studies have investigated how unemployment influences health, less attention has been paid to the reverse causal direction; how health may influence the risk of becoming unemployed. We prospectively investigated a wide range of health measures and subsequent risk of unemployment during 14 years of follow-up. Methods: Self-reported health data from 36 249 participants in the Norwegian HUNT2 Study (1995–1997) was linked by a personal identification number to the National Insurance Database (1992–2008). Exact dates of unemployment were available. Cox’s proportional hazard models were used to estimate hazard ratios (HR) for the association of unemployment with several health measures. Adjustment variables were age, gender, education, marital status, occupation, lifestyle and previous unemployment. Results: Compared to reporting no conditions/symptoms, having ≥3 chronic somatic conditions (HR 1.78, 95% CI 1.46–2.17) or high symptom levels of anxiety and depression (HR 1.57, 95% CI 1.35–1.83) increased the risk of subsequent unemployment substantially. Poor self-rated health (HR 1.36, 95% CI 1.24–1.51), insomnia (HR 1.19, 95% CI 1.09–1.32), gastrointestinal symptoms (HR 1.17, 95% CI 1.08–1.26), high alcohol consumption (HR 1.17, 95% CI 0.95–1.44) and problematic use of alcohol measured by the CAGE questionnaire (HR 1.32, 95% CI 1.17–1.48) were also associated with increased risk of unemployment. Conclusion: People with poor mental and physical health are at increased risk of job loss. This contributes to poor health amongst the unemployed and highlights the need for policy focus on the health and welfare of out of work individuals, including support preparing them for re-employment.
TL;DR: Only among low educated participants, current smokers reported an unhealthier dietary pattern in comparison to never smokers, which can be used in the development of targeted health promotion strategies.
Abstract: Background : Unhealthy dietary patterns have been associated with other unhealthy lifestyle factors such as smoking and physical inactivity. Whether these associations are similar in high- and low-educated individuals is currently unknown. Methods : We used information of the EPIC-NL cohort, a prospective cohort of 39 393 men and women, aged 20–70 years at recruitment. A lifestyle questionnaire and a validated food frequency questionnaire were administered at recruitment (1993–97). Low adherence to a Mediterranean-style diet was used to determine an unhealthy dietary pattern. Lifestyle-related factors included body mass index, waist circumference, smoking status, physical activity level, dietary supplement use and daily breakfast consumption. Multivariate logistic regression analyses were performed for the total population and by strata of educational level. Results : In total 30% of the study population had an unhealthy dietary pattern: 39% in the lowest educated group and 20% in the highest educated group. Physical inactivity, a large waist circumference, no dietary supplement use and skipping breakfast were associated with an unhealthy dietary pattern in both low and high educated participants. Among low educated participants, current smokers had a greater odds of an unhealthy diet compared with never smokers: OR 1.42 (95% CI: 1.25; 1.61). This association was not observed in the high educated group. Conclusions : Most associations between lifestyle-related factors and unhealthy diet were consistent across educational levels, except for smoking. Only among low educated participants, current smokers reported an unhealthier dietary pattern in comparison to never smokers. These results can be used in the development of targeted health promotion strategies.
TL;DR: The effect of unemployment on mortality was not uniform across the population; men, those with a low education, low income, unmarried or in urban employment were more vulnerable.
Abstract: Background: Mass unemployment in Europe is endemic, especially among the young. Does it cause mortality? Methods: We analyzed long-term effects of unemployment occurring during the deep Swedish recession 1992–96. Mortality from all and selected causes was examined in the 6-year period after the recession among those employed in 1990 (3.4 million). Direct health selection was analyzed as risk of unemployment by prior medical history based on all hospitalizations 1981–91. Unemployment effects on mortality were estimated with and without adjustment for prior social characteristics and for prior medical history. Results: A prior circulatory disease history did not predict unemployment; a history of alcohol-related disease or suicide attempts did, in men and women. Unemployment predicted excess male, but not female, mortality from circulatory disease, both ischemic heart disease and stroke, and from all causes combined, after full adjustment. Adjustment for prior social characteristics reduced estimates considerably; additional adjustment for prior medical history did not. Mortality from external and alcohol-related causes was raised in men and women experiencing unemployment, after adjustment for social characteristics and medical history. For the youngest birth cohorts fully adjusted alcohol mortality HRs were substantial (male HR = 4.44; female HR = 5.73). The effect of unemployment on mortality was not uniform across the population; men, those with a low education, low income, unmarried or in urban employment were more vulnerable. Conclusions: Direct selection by medical history explains a modest fraction of any increased mortality risk following unemployment. Mass unemployment imposes long-term mortality risk on a sizeable segment of the population.
TL;DR: While important changes occurred in screening recommendations and in social circumstances of the targeted population, CCS rates remained fairly stable in Switzerland between 1992 and 2012, at the same time, inequalities in CCS persisted over that period.
Abstract: Background: Incidence and mortality of cervical cancer declined thanks to Pap smear screening. However cervical cancer screening (CCS) inequalities are documented, including in high income countries. This population-based study aims to assess the importance and 20-year trends of CCS inequalities in Switzerland, where healthcare costs and medical coverage are among the highest in the world. Methods: We analyzed data from five waves of the population-based Swiss Health Interview Survey (SHIS) covering the period 1992–2012. Multivariable Poisson regression were used to estimate weighted prevalence ratios (PR) of CCS and 95% Confidence Intervals (CI) adjusting for socio-economic, socio-demographic characteristics, family status, health status, and use of healthcare. Results: The study included 32’651 women aged between 20 and 70 years old. Between 1992 and 2012, rates of CCS over the past 3 years fluctuated between 71.7 and 79.6% (adjusted P < 0.001). Lower CCS was observed among women with low education, low income, those having limited emotional support, who were non-Swiss, single, older, living in non-metropolitan area or in the French-speaking region, overweight. Over the analyzed period, differences in CCS across age groups diminished while rates among women who visited a GP over the previous year, versus those who did not, increased. Conclusions : While important changes occurred in screening recommendations and in social circumstances of the targeted population, CCS rates remained fairly stable in Switzerland between 1992 and 2012. At the same time, inequalities in CCS persisted over that period.
TL;DR: The A Global Charter for the Public’s Health (GCPH) is developed as the main output of the WFPHA's collaboration plan with the WHO to adapt today's public health to its global context in the light of and in conjunction with the Sustainable Development Goals (SDGs).
Abstract: ### Growth, development, equity and stability
Political leaders increasingly perceive health as being crucial to achieving growth, development, equity and stability throughout the world. Health is now understood as a product of complex and dynamic relations generated by numerous determinants at different levels of governance. Governments need to take into account the impact of social, environmental and behavioural health determinants, including economic constraints, living conditions, demographic changes and unhealthy lifestyles in many of the World Health Organization (WHO) Member States. This understanding and increasing globalization means it is very timely to review the role of (global) public health in this changing societal and political environment.
### Globalization
The positive and negative impacts of globalization need to be better understood by public health professionals and more widely acknowledged by policy makers. Globalization is marked by increased interconnectedness and interdependence of peoples and countries, based on the opening of borders to increasingly fast flows of goods, services, finance, people and ideas across international borders and the changes in institutional and policy regimes at the international and national levels that facilitate or promote such flows. It is recognized that globalization has both positive and negative impacts on health development. Increasingly trade agreements provide frameworks for intergovernmental relationships; however, possible impacts on human health are not routinely assessed prior to signing.
### The proposal for a Global Charter for the Public’s Health
In this context, the World Federation of Public Health Associations (WFPHA) has developed the A Global Charter for the Public’s Health (GCPH) as the main output of its collaboration plan with the WHO to adapt today’s public health to its global context in the light of and in conjunction with the Sustainable Development Goals (SDGs). GCPH brings together the best of all the existing models and provides a comprehensive, clear and flexible framework that can be applied globally and within individual countries, whether low, middle or high income.
The WFPHA has …
TL;DR: The WAI without the list of diseases is a good alternative to the complete WAI to identify non-sicklisted workers at risk of future LTSA durations ≥2, ≥4 and ≥6 weeks.
Abstract: Background: The Work Ability Index (WAI) identifies non-sicklisted workers at risk of future long-term sickness absence (LTSA). The WAI is a complicated instrument and inconvenient for use in large-scale surveys. We investigated whether shortened versions of the WAI identify non-sicklisted workers at risk of LTSA. Methods: Prospective study including two samples of non-sicklisted workers participating in occupational health checks between 2010 and 2012. A heterogeneous development sample ( N = 2899) was used to estimate logistic regression coefficients for the complete WAI, a shortened WAI version without the list of diseases, and single-item Work Ability Score (WAS). These three instruments were calibrated for predictions of different (≥2, ≥4 and ≥6 weeks) LTSA durations in a validation sample of non-sicklisted workers ( N = 3049) employed at a steel mill, differentiating between manual ( N = 1710) and non-manual ( N = 1339) workers. The discriminative ability was investigated by receiver operating characteristic analysis. Results: All three instruments under-predicted the LTSA risks in both manual and non-manual workers. The complete WAI discriminated between individuals at high and low risk of LTSA ≥2, ≥4 and ≥6 weeks in manual and non-manual workers. Risk predictions and discrimination by the shortened WAI without the list of diseases were as good as the complete WAI. The WAS showed poorer discrimination in manual and non-manual workers. Conclusions: The WAI without the list of diseases is a good alternative to the complete WAI to identify non-sicklisted workers at risk of future LTSA durations ≥2, ≥4 and ≥6 weeks.
TL;DR: This work can serve as a basis to construct the first multi-country reproductive monitoring system and indicators related to the testicular dysgenesis syndrome, precocious puberty incidence and reproductive hormone levels are highlighted as prior indicators in the context of EDC exposure.
Abstract: Background: Worrying trends regarding human reproductive endpoints (e.g. semen quality, reproductive cancers) have been reported and there is growing circumstantial evidence for a possible causal link between these trends and exposure to endocrine disrupting chemicals (EDCs). However, there is a striking lack of human data to fill the current knowledge gaps. To answer the crucial questions raised on human reproductive health, there is an urgent need for a reproductive surveillance system to be shared across countries. Methods: A multidisciplinary network named HUman Reproductive health and Global ENvironment Network (HURGENT) was created aiming at designing a European monitoring system for reproductive health indicators. Collaborative work allowed setting up the available knowledge to design such a system. Furthermore we conducted an overview of 23 potential indicators, based upon a weight of evidence (WoE) approach according to their potential relation with EDC exposure. Results: The framework and purposes of the surveillance system are settled as well as the approach to select suitable reproductive indicators. The indicators found with the highest scores according to the WoE approach are prostate and breast cancer incidence, sex ratio, endometriosis and uterine fibroid incidence, indicators related to the testicular dysgenesis syndrome, precocious puberty incidence and reproductive hormone levels. Conclusion: Not only sentinel health endpoints, but also diseases with high burdens in public health are highlighted as prior indicators in the context of EDC exposure. Our work can serve as a basis to construct, as soon as possible, the first multi-country reproductive monitoring system.