The European Journal of Public Health - current issue

The old Edward Jenner and the new public health: the future of vaccines in Europe

Ricciardi, W. — 2008-07-21

Politics and health: a neglected area of research

Navarro, V. — 2008-07-21

Politics and health: policy design and implementation are even more neglected than political values?

Judge, K. — 2008-07-21

European Journal of Public Health--Comments on Ken Judge's article

Navarro, V. — 2008-07-21

Delivering a cardiovascular disease prevention programme in the United Kingdom: translating theory into practice

Lloyd-Williams, F., Capewell, S., Ireland, R., Birt, C. — 2008-07-21

Actual incidences of road casualties, and their injury severity, modelled from police and hospital data, France

Amoros, E., Martin, J.-L., Lafont, S., Laumon, B. — 2008-07-21

Background: Nation-wide road casualty figures usually come from police data. In France, as in many developed countries, the reporting of fatalities is almost complete but the reporting of non-fatal casualties is rather low. It is moreover strongly biased. Valid estimates are needed. Methods: Using the capture–recapture method on police data and on a road trauma registry covering a large county of 1.6 million inhabitants, we estimate police under-reporting correction factors that account for unregistered casualties. These correction factors are then applied to the nation-wide police data, with standardization on under-reporting bias factors. Results: In 2004, whereas the police report 108 727 non-fatally injured, the estimation yields 400 200. Over the 1996–2004 study period, the average annual estimated incidence is 871/100 000 for all injured (3.4 times the police incidence), 232/100 000 for hospitalized, 103/100 000 for seriously injured (2.2 times the police incidence) and 12.6/100 000 for casualties with long-term major impairment. The incidence of seriously injured (NISS 9+) is 11.3/100 000 for pedestrians, 9.5/100 000 for cyclists, 36.3/100 000 for motorized two-wheel users and 42.5/100 000 for car users. Conclusions: The estimated incidences are much higher than the police-based ones. This changes the scale of the road injuries issue. The risk of suffering a major impairment from a road crash is equal to the risk of being killed. Motorized two-wheel users experience a large burden of traffic casualties, much larger than that indicated by police data. The approach used can be reproduced in other countries, if an additional medical registration exists.

Influence of sociodemographic factors on the risk of unintentional childhood home injuries

Laursen, B., Nielsen, J. W. — 2008-07-21

Background: While social differences in childhood injuries are recognized, less is known about how social and demographic differences relate to injury mechanism. The purpose of the study was to reveal how sociodemographic factors affect the incidence of unintentional home injuries in Danish children for specific injury mechanisms and involved products. Methods: Information on injuries in 173 504 children treated at emergency departments was recorded for the period 1998–2003. The information was linked to data including parents’ education and income and family type, and the results were compared with those for a random sample of the population. Results: A total of 50 561 injuries were analysed. The risk was 1.5 (1.5–1.6) for children with mothers having only primary education compared to tertiary education, and 1.5 (1.4–1.6) for children in families with the lowest vs. the highest income. Risk differences were found for all injury mechanisms; however the risk for burns was 1.9 (1.6–2.3) times higher in the lowest-income group than in the highest-income group, the relative risk for poisoning was 1.7(1.4–2.1). For scalds from hot water, tea or coffee, the relative risk for the lowest-income group was 2.4(1.8–3.2). Living in a one- or two-parent family and size of the dwelling had little or no effect on risk. Conclusion: Childhood injury incidence depended on sociodemographic factors. The effect of the sociodemographic factors varied between injury mechanisms and products involved in the injury.

Surveillance for Rare Infectious Diseases: is one passive data source enough for Haemophilus influenzae?

2008-07-21

Background: The completeness of a compulsory reporting system of systemic Haemophilus influenzae infections in children in Germany is studied by means of cross-linking registry data from three sources and applying capture-recapture methods. Methods: Cases were collected for the years 2001–05 by three national data sources: a passive administration registry (SurvNet7commat;RKI), an active hospital surveillance system and an active laboratory surveillance system. The case definition required cultural detection of H. influenzae in blood or cerebrospinal fluid. Linkage was carried out by month and year of birth, sex, geographical region and date of disease onset. Capture-recapture models were used to estimate the incidence of invasive H. influenzae infections. Results: SurvNet7commat;RKI reported 113 H. influenzae and 38 H. influenzae type b (Hib) cases, compared to a total of 231 and 68 cases, respectively, reported by all three sources combined. Best-fitting 3-source capture-recapture estimations amounts to 258 (95% confidence interval: 247–276) H. influenzae and 71 (69–74) Hib cases. SurvNet7commat;RKI data depicted a similar decrease in annual H. influenzae cases as the capture-recapture estimates but failed to detect the underlying decrease in Hib cases which was observed in the capture-recapture estimates due to a considerable annual variability of ascertainment of serotyped cases in SurvNet7commat;RKI ranging from 14% to 69%. Conclusions: Because of small variability of ascertainment, the compulsory passive reporting system depicted trends in H. influenzae incidence, although less than half of the cases were ascertained. However, time trend in Hib cases could not be depicted, because of highly variable serotyping proportions.

Low HIV-testing rates and awareness of HIV infection among high-risk heterosexual STI clinic attendees in The Netherlands

Van der Bij, A. K., Dukers, N. H. T. M., Coutinho, R. A., Fennema, H. S. A. — 2008-07-21

Objectives: Since 1999, HIV testing is routinely offered to all attendees of the sexually transmitted infections (STI) outpatient clinic in Amsterdam, the Netherlands. This study evaluates whether this more active HIV-testing policy increased uptake of HIV testing and awareness of an HIV-positive serostatus among heterosexual attendees. Methods: In addition to routine data collected at each STI consultation, data from half-yearly HIV surveys were used from 1994 to 2004. During each survey period, 1000 consecutive attendees are enrolled voluntary and anonymously for HIV testing and are interviewed on previous HIV testing and outcome. Trends in and predictors for uptake of HIV testing as offered during routine STI consultation were analysed by logistic regression. Trends in awareness of an HIV-positive serostatus as obtained from the anonymous HIV surveys were likewise analysed. Results: The percentage of heterosexual attendees opting for an HIV test during consultation increased from 13% in 1996 to 56% in 2004. However, the proportion of individuals aware of their HIV infection did not change over time and only a minority (19%) of the 108 attendees found HIV-positive in the anonymous surveys were aware of their HIV infection. Persons being or visiting a commercial sex worker, having a non-Dutch ethnicity, lacking health insurance and having an STI diagnosed were less likely to opt for an HIV test. Conclusions: Although heterosexual attendees increased their uptake of HIV testing during STI consultation over time, uptake of testing by attendees at risk for HIV infection, such as those infected with an STI, remained low. As a result, the percentage of persons aware of their HIV infection remained low, posing a risk for their individual health and for ongoing HIV transmission. Current testing strategies, therefore, misses the group that most needs testing. Based on these results, ‘opt-out’ HIV testing is now the standard procedure at the Amsterdam STI clinic.

The same factors influence job turnover and long spells of sick leave--a 3-year follow-up of Swedish nurses

Josephson, M., Lindberg, P., Voss, M., Alfredsson, L., Vingard, E. — 2008-07-21

Background: In many countries, a general shortage of nurses is a public health problem, and retention of nurses in active work is a challenge. The aim of this study was to ascertain whether the same individual factors, working conditions and health problems had led to increased probability of both leaving jobs and prolonged sickness absence in a cohort of Swedish nurses over a period of 3 years. Methods: A baseline questionnaire was answered by 2293 nurses, representing a response rate of 86%. Exposed and unexposed nurses were compared with regard to two outcomes. During the 3-year follow-up, exposed and unexposed nurses were compared with regard to two outcomes: resigning and having at least one sick leave spell that lasted 28 days or longer. Results: We found that 18% of the nurses left their employment, and 16% had sick leave spells ≥28 days. Work in geriatric care, being socially excluded by superiors and/or workmates, negative effects of organizational changes and poor self-rated general health were factors that increased the likelihood of both leaving jobs and long-term sick leave. Conclusions: The present results underline the importance of improving working conditions and supporting sustainable health in order to prevent high turnover and prolonged sick leave among nurses. Resigning and moving to another institution can be interpreted as a way to actively cope with an unhealthy work environment.

Alcohol-related adverse consequences: cross-cultural variations in attribution process among young adults

Kuendig, H., Plant, M. A., Plant, M. L., Miller, P., Kuntsche, S., Gmel, G. — 2008-07-21

Background: Social norms around what is culturally accepted in terms of alcohol consumption and drunken comportment appear important regarding the acceptance of alcohol-related adverse consequences; however, investigations often neglect to consider differences in terms of attribution. This study aims at assessing cross-cultural differences in the reporting of alcohol-related adverse consequences. It also considers differences across consequences that might explain which type of consequences (mainly acute or mainly chronic) are most affected by an attribution process. Methods: Conditional regression models were estimated based on data from eight European countries participating in the Gender, Alcohol and Culture—An International Study (GENACIS) project. Cases were matched to controls based on usual drinking patterns in order to control for average volume of alcohol and frequency of ‘risky single occasion drinking’ (RSOD). Results: Differences among the patterns of associations between countries and consequences were evident. The distinction between Nordic and other European countries was persistent. A higher variability of associations was observed for some consequences, namely the mainly acute instances. Finally, the Isle of Man and Switzerland showed specific trends with associations across consequences. Conclusion: Reporting of alcohol-related adverse consequences seemed strongly affected by cultural norms. The latter may be exemplified by viewing drinking as ‘time-out’ behaviour. Respondents in countries with a stereotypical history of being ‘dry’ or with a stereotyped ‘binge’ drinking culture were more likely to attribute consequences to their alcohol consumption than people in ‘wet’ countries. This was particularly true for consequences that related to episodic ‘time-out’ heavy drinking.

Health, alcohol and EU law: understanding the impact of European single market law on alcohol policies

Baumberg, B., Anderson, P. — 2008-07-21

Background: many professionals in the alcohol field see the role of the the European Court of Justice (ECJ) as negative for health. This review examines ECJ and European Free Trade Association (EFTA) case law in the context of two broader debates: firstly the extension of European Union (EU) law into alcohol policy (the ‘juridification’ of alcohol policy), and secondly the extent to which alcohol policy is an example of the dominance of ‘negative integration’ (the removal of trade-distorting policy) over ‘positive integration’ (the creation of European alcohol policies). Methods: a comprehensive review of all ECJ/EFTA Court cases on alcohol, with interpretation aided by a secondary review on alcohol and EU law and the broader health and trade field. Results: from looking at taxation, minimum pricing, advertising and monopoly policies, the extension of the scope of the these courts over alcohol policy is unquestionable. However, the ECJ and EFTA Court have been prepared to prioritise health over trade concerns when considering alcohol policies, providing certain conditions have been met. Conclusion: while a partial juridification of alcohol policy has led to the negative integration of alcohol policies, this effect is not as strong as sometimes thought; EU law is more health friendly than it is perceived to be, and its impact on levels of alcohol-related harm appears low. Nevertheless, lessons emerge for policymakers concerned about the legality of alcohol policies under EU law. More generally, those concerned with alcohol and health should pay close attention to developments in EU law given their importance for public health policy on alcohol.

Home warmth and health status of COPD patients

Osman, L. M., Ayres, J. G., Garden, C., Reglitz, K., Lyon, J., Douglas, J. G. — 2008-07-21

Background: Home Energy Efficiency guidelines recommend domestic indoor temperatures of 21°C for at least 9 h per day in living areas. Is health status of patients with Chronic Obstructive Pulmonary Disease (COPD) associated with maintaining this level of warmth in their homes? Methods: In a cross-sectional observational study of patients, living in their own homes, living room (LR) and bedroom (BR) temperatures were measured at 30 min intervals over 1 week using electronic dataloggers. Health status was measured with the St George's Respiratory Questionnaire (SGRQ) and EuroQol: EQ VAS. Outdoor temperatures were provided by Met Office. Results: One hundred and forty eight patients consented to temperature monitoring. Patients’ mean age was 69 (SD 8.5) years, 67 (45%) male, mean percentage of predicted Forced Expiratory Volume in one second (FEV₁) 41.7 (SD 17.4). Fifty-eight (39%) were current smokers. Independent of age, lung function, smoking and outdoor temperatures, poorer respiratory health status was significantly associated (P = 0.01) with fewer days with 9 h of warmth at 21°C in the LR. A sub analysis showed that patients who smoked experienced more health effects than non-smokers (P < 0.01). Conclusion: Maintaining the warmth guideline of 21°C in living areas for at least 9 h per day was associated with better health status for COPD patients. Patients who were continuing smokers were more vulnerable to reduction in warmth.

Predictive items of functional decline and 2-year mortality in nonagenarians--the NonaSantfeliu study

Ferrer, A., Formiga, F., Ruiz, D., Mascaro, J., Olmedo, C., Pujol, R. — 2008-07-21

Background: Few studies have prospectively evaluated predictors of mortality or decline in functional capacity in nonagenarians. The aim of this study is to determine predictors of death or functional decline in basic activities of daily living in nonagenarians after 2 years of follow-up.

Methods: One hundred and seventy-six nonagenarians were prospectively evaluated. Functional status was determined by the Lawton–Brody index (LI) and the Barthel Index (BI), and cognition by the Spanish version of the Mental State Examination. The Charlson score was used to measure co-morbidity. Nutritional status was evaluated by the short version of the Mini Nutritional Assessment questionnaire. Results: The sample comprised 135 women (76.3%) and 41 men. Mean age was 93 ± 3.2 years. Mortality after 2 years was 36.3%. Forty-six (41%) of the 112 survivors presented BI losses >19%. One hundred and ten subjects (63%) presented the combined negative outcome item (death or functional decline). A multiple stepwise logistic regression analysis identified two variables associated with a fall of >19% on the BI or death: a low LI (odds ratio 0.785, 95% CI 0.656–0.940) and a low score at baseline on the Spanish version of the Mental State Examination (odds ratio 0.950, 95% CI 0.914–0.987).

Conclusion: Better cognitive status and higher capacity to perform instrumental activities of daily living (ADL) at baseline are the best predictors to identify which nonagenarians survived without major functional decline after a 2-year follow-up period.

Inside the virtual casino: a prospective longitudinal study of actual Internet casino gambling

LaBrie, R. A., Kaplan, S. A., LaPlante, D. A., Nelson, S. E., Shaffer, H. J. — 2008-07-21

Background: Participation in Internet gambling is growing rapidly, as is concern about its possible effects on the public's health. This article reports the results of the first prospective longitudinal study of actual Internet casino gambling behaviour. Methods: Data include 2 years of recorded Internet betting activity by a cohort of gamblers who subscribed to an Internet gambling service during February 2005. We examined computer records of each transaction and transformed them into measures of gambling involvement. The sample included 4222 gamblers who played casino games. Results: The median betting behaviour was to play casino games once every 2 weeks during a period of 9 months. Subscribers placed a median of 49 bets of 4 each playing day. Subscribers lost a median of 5.5% of total monies wagered. We determined a group of heavily involved bettors whose activity exceeded that of 95% of the sample; these players bet every fifth day during 17.5 months. On each playing day, these most involved bettors placed a median of 188 bets of 25. Their median percent of wagers lost, 2.5%, was smaller than that lost by the total sample. Conclusion: Our findings suggest that Internet casino betting behaviour results in modest costs for most players, while some, roughly 5%, have larger losses. The findings also show the need to consider time spent as a marker of disordered gambling. These findings provide the evidence to steer public health debates away from speculation and toward the creation of empirically-based strategies to protect the public health.

The health effects of education: a meta-analysis

Furnee, C. A., Groot, W., van den Brink, H. M. — 2008-07-21

Background: There is an abundance of empirical evidence, mainly from the epidemiological and social science literature, on the relation between education and health. Until now a meta-analysis of the relation between education and health was not available. This article presents a meta-analysis of studies that use self- reported health as an outcome variable to quantify the effect of education on health. Methods: Meta-analysis using a random and a fixed-effects model to quantify the marginal effect of education on self-reported health. Results: The results of the meta-analysis show that the quality adjusted life years weight (QALYweight) of a year of education is ~0.036. Some tentative calculations suggest that the cost-benefit ratio of investments in education on health is highly positive. Conclusion: For public policy this implies that a more integrated approach to education and health policies should be taken.

Do medical services personnel who deployed to the Iraq war have worse mental health than other deployed personnel?

2008-07-21

Aim: There is evidence of increased health care utilization by medical personnel (medics) compared to other trades in the UK Armed Forces. The aim of this study was to compare the burden of mental ill health in deployed medics with all other trades during the Iraq war. Methods: Participants’ main duty during deployment was identified from responses to a questionnaire and verified from Service databases. Psychological health outcomes included psychological distress, post-traumatic stress disorder, multiple physical symptoms, fatigue and heavy drinking. Results: A total of 479 out of 5824 participants had a medical role. Medics were more likely to report psychological distress (OR 1.30, 95% CI 1.00–1.70), multiple physical symptoms (OR 1.65, 95% CI 1.20–2.27) and, if men, fatigue (1.38, 95% CI 1.05–1.81) than other personnel. Female medics were less likely to report fatigue (0.57 95% CI 0.35–0.92). Neither post-traumatic stress disorder nor heavy drinking symptoms were associated with a medical role. Traumatic medical experiences, lower group cohesion and preparedness, and post-deployment experiences explained the positive associations with psychological ill health. Medics made greater use of medical facilities than other trades. Conclusions: There is a small excess of psychological ill health in medics, which can be explained by poorer group cohesion, traumatic medical and post-deployment experiences. The association of mental ill health with a medical role was not the consequence of a larger proportion of reservists in this group.

Olson RP. Mental health systems compared.

Thornicroft, G. — 2008-07-21

Beyrer C, Pizer HF (editors). Public health & human rights: evidence-based approaches.

Coughlin, S. S — 2008-07-21

Margaretha Jarvinen, Robin Room (editors). Youth drinking cultures. European experiences.

Holmila, M. — 2008-07-21

Sundin J, Willner S. Social change and health in Sweden: 250 years of politics and practice.

Vallgarda, S. — 2008-07-21

EUPHA president column: EUPHA-ASPHER collaboration will strengthen European public health * EUPHA office column: Lisbon 2008--a new record in submitted abstracts * Protecting Health from Climate Change: Next Steps in the WHO European Region

Keskimaki, I., Paget, D. Z., Menne, B., Racioppi, F. — 2008-07-21