Barriers and benefits of a healthy diet in spain: comparison with other European member states

OBJECTIVE: Our purpose was to identify the main barriers and benefits perceived by the European citizens in regard to following a healthy diet and to assess the differences in expected benefits and difficulties between Spain and the remaining countries of the European Union. DESIGN: A cross-sectional study in which quota-controlled, nationally representative samples of approximately 1000 adults from each country completed a questionnaire. SETTING: The survey was carried out between October 1995 and February 1996 in the 15 member states of the European Union. SUBJECTS: Participants (aged 15 y and older) were selected and interviewed in their homes about their attitudes towards healthy diets. They were asked to select two options from a list of 22 potential barriers to achieve a healthy diet and the benefits derived from a healthy diet. The associations of the perceived benefits of barriers with the sociodemographic variables within Spain and the rest of the European Union were compared with the Pearson chi-squared test and the chi-squared linear trend test. Two multivariate logistic regression models were also fitted to assess the characteristics independently related to the selection of 'Resistance to change' among the main barriers and to the selection of 'Prevent disease/stay healthy' as the main perceived benefits. RESULTS: The barrier most frequently mentioned in Spain was 'Irregular work hours' (29.7%) in contrast with the rest of the European Union where 'Giving up foods that I like' was the barrier most often chosen (26.2%). In the multivariate logistic regression model studying resistance to change, Spaniards were less resistant to change than the rest of the European Union. The benefit more frequently mentioned across Europe was 'Prevent disease/stay healthy'. In the multivariate logistic regression model women, older individuals, and people with a higher educational level were more likely to choose this benefit. CONCLUSIONS: It is apparent that there are many barriers to achieve healthy eating, mostly lack of time. For this reason a higher availability of food in line with the nutrition guidelines could be helpful. The population could have a better knowledge of the benefits derived from a healthy diet.     

Surveillance of outbreaks of waterborne infectious disease: categorizing levels of evidence.

Public health surveillance requires the monitoring of waterborne disease, but sensitive and specific detection of relevant incidents is difficult. The Communicable Disease Surveillance Centre receives information from various sources about clusters of cases of illness in England and Wales. The reporter may suspect that water consumption or recreational water exposure is the route of infection, or subsequent investigation may raise the hypothesis that water is associated with illness. It is difficult to prove beyond reasonable doubt that such a hypothesis is correct. Water samples from the time of exposure are seldom available, some organisms are difficult to detect and almost everyone has some exposure to water. Therefore, we have developed a method of categorizing the degree of evidence used to implicate water. The categories take into account the epidemiology, microbiology and water quality information. Thus outbreaks are classified as being associated with water either ''strongly'', ''probably'' or ''possibly''. This system allows a broad database for monitoring possible effects of water and is not confined to the few outbreaks which have been intensively investigated or have positive environmental microbiology. Thus, for reported incidents, the sensitivity of classifying it as water associated should be high but this may be at the expense of specificity, especially with the ''possible'' association.     

An evaluation of waterborne disease surveillance in the European Union

Surveillance systems to inform controls for waterborne disease (WBD) are important for the protection of public health. Member States of the European Union (EU) will soon be required to implement Directives and the Protocol on Water and Health for controlling WBD. The investigation reported here considers the consistency of surveillance systems across the EU. Eleven EU member states participated in a survey to determine the nature and range of practices used for monitoring WBD. Some WBD are notifiable in most countries surveyed, others are notifiable only in one country. Non-notifiable WBD are routinely monitored in five countries. Surveillance schemes are inconsistent, and the variable mandatory reporting among the Member States allows many WBD cases to remain unidentified. Nine replying countries had no legal definition for WBD outbreak. No country requires the reporting of anti-diarrhea medication sales for detecting outbreaks.     

Public understanding of food risks in four European countries: a qualitative study

BACKGROUND: In the wake of the 'bovine spongiform encephalopathy (BSE) crisis' there was renewed interest in how those responsible for public health could take account of public views, both to 'democratize' policy making and to increase the likelihood of information about health risks resonating with public concerns. This study explored how members of the public in four European countries (Finland, Germany, Italy and the UK) understood food risks in general, and risks arising from BSE in particular. The aims were to identify the sources of knowledge used and trusted by the public and to explore how public views could be accessed for public health information policy. METHODS: Thirty-six focus group interviews were held using a common protocol across the four countries, including people from four life-cycle stages. RESULTS: The study demonstrated the utility of using focus groups as a relatively efficient method for accessing public views, and the feasibility of cross-national qualitative research on public views. We found that public views of food risks are neither irrational nor na?ve, but that they do need to be interpreted in the context of everyday food purchasing decisions, in which particular food risks are unlikely to have the same salience as they do for experts. CONCLUSIONS: Focus groups are a feasible method for accessing public knowledge on public health risks to inform information strategies.     

Sources of information about diet and health in a Mediterranean country: Comparison with other European member states

Background: A Pan-European survey was carried out to assessthe main sources of information about healthy diet in the Europeanpopulation and to assess whether these sources differ betweena Mediterranean country and other European populations. Methods:This study belongs to a Pan-European survey on Attitudes toFood, Nutrition and Health. A multistage sampling procedurewas used. Each subject was asked about the main sources of informationon healthy eating. The survey was completed between October1995 and February 1996 in the 15 member states of the EuropeanUnion. The questionnaire was completed by 14,331 persons, approximately1,000 from each member state. Data were quota controlled bysociodemographic factors and all results were weighted for thepurpose of maintaining national representativeness. The participantswere asked to indicate which sources they used more often outof a list with 22 options. They were allowed to select a maximumof two sources. Results: The source of information ‘televisionprogrammes or radio’ was more prevalent in the rest ofthe member states of the European Union (30.9%) than in Spain(25.7%). ‘Health professionals’ were mentioned withsimilar frequency as a source of information in Spain and inthe rest of the European Union. Conclusions: Our results confirmthat mass media play an important role in transferring messagesabout healthy eating to the general public. Increasing the circulationof newspapers in Spain, where a low level of newspapers readingexists, would probably improve the knowledge of the generalpublic.     

Surveillance of pneumococcal disease in Australian states and territories

Information on pneumococcal disease, including immunisation programs, and optimum future surveillance in each Australian State and Territory were discussed at the Pneumococcal Disease in Australia Workshop on 26-27 March 1999. Workshop participants further expanded on the surveillance aspects of the Workshop in this report. Most participants favoured notification by laboratories of pneumococcal isolates from sterile sites, to provide baseline surveillance data before immunisation programs are fully implemented. It was also thought that trends in antimicrobial resistance should be notified.     

Surveillance data for waterborne illness detection: an assessment following a massive waterborne outbreak of Cryptosporidium infection.

Following the 1993 Milwaukee cryptosporidiosis outbreak, we examined data from eight sources available during the time of the outbreak. Although there was a remarkable temporal correspondence of surveillance peaks, the most timely data involved use of systems in which personnel with existing close ties to public health programmes perceived the importance of providing information despite workload constraints associated with an outbreak. During the investigation, surveillance systems which could be easily linked with laboratory data, were flexible in adding new variables, and which demonstrated low baseline variability were most useful. Geographically fixed nursing home residents served as an ideal population with nonconfounded exposures. Use of surrogate measurements of morbidity can trigger worthwhile public health responses in advance of laboratory-confirmed diagnosis and help reduce total morbidity associated with an outbreak. This report describes the relative strengths and weaknesses of these surveillance methods for community-wide waterborne illness detection and their application in outbreak decision making.     

Occupational exposure to inhalable wood dust in the member states of the European Union

The aim of this study was to estimate occupational exposure to inhalable wood dust by country, industry, the level of exposure and type of wood dust in 25 member states of the European Union (EU-25) for the purposes of hazard control, exposure surveillance and assessment of health risks. National labour force statistics, a country questionnaire (in 15 member states, EU-15), a company survey (in Finland, France, Germany and Spain), exposure measurements (from Denmark, Finland, France, Germany, The Netherlands and the United Kingdom) and expert judgements were used to generate preliminary estimates of exposure to different types of wood dust. The estimates were generated according to industrial class (six wood industries, four other sectors) and level of exposure (five classes). These estimates were reviewed and finalized by national experts from 15 member states. Crude estimates were generated also for 10 new member states (EU-10). The basic data and final estimates were included in the WOODEX database. In 2000-2003, about 3.6 million workers (2.0% of the employed EU-25 population) were occupationally exposed to inhalable wood dust. Of those, construction employed 1.2 million exposed workers (33%), mostly construction carpenters. The numbers of exposed workers were 700,000 (20%) in the furniture industry, 300,000 (9%) in the manufacture of builders' carpentry, 200,000 (5%) in sawmilling, 150,000 (4%) in forestry and <100,000 in other wood industries. In addition, there were 700,000 exposed workers (20%) in miscellaneous industries employing carpenters, joiners and other woodworkers. The numbers of exposed workers varied by country ranging from <3,000 in Luxembourg and Malta to 700,000 in Germany. The highest exposure levels were estimated to occur in the construction sector and furniture industry. Due to limited exposure data there was considerable uncertainty in the estimates concerning construction woodworkers. About 560,000 workers (16% of the exposed) may be exposed to a level exceeding 5 mg m(-3). Mixed exposure to more than one species of wood and dust from wooden boards was very common, but reliable data on exposure to different species of wood could not be retrieved. This kind of assessment procedure integrating measurement data, company data, country-specific data and expert judgement could also serve as one model for the assessment of other occupational exposures.     

Consumer perceptions of beef healthiness: results from a qualitative study in four European countries

Background  

Consumer perception of the healthiness of beef is an important determinant of beef consumption. However, little is known about how consumers perceive the healthiness of beef. The aim of this study is to shed light on the associations between beef and health.     

Experiences of Dutch students growing up with a family member with a chronic illness: A qualitative study

Students growing up with a family member with a chronic illness often delay or drop out of school when the combination of family care and their educational programme is too demanding. This study aims to describe the themes experienced by students growing up in this situation. A qualitative focus group design was used. The recruitment for this study was done through an online survey where students could indicate whether they also wanted to participate in a focus group. Twenty‐five Dutch students (age 18–25 years) who grew up with a family member with a chronic illness participated in one of the total of seven focus groups. A qualitative inductive analysis was used to identify codes and main themes. Students growing up with a family member with a chronic illness experience responsibility issues, loyalty conflicts, peer alienation, role reversal, negative influence on personal development, daily worries and confronting situations. They reported substantial impact in terms of their general well‐being, their family relationships and in their choices for their future. Students articulated that growing up in this situation has a serious and substantial impact on their lives. Further research is required in order to gain comprehensive insights into the requests of these students regarding personal and family support.     

Balancing needs as a family caregiver in Huntington's disease: a qualitative interview study

Family members in families with severe chronic disease play important roles in care‐giving. In families affected by Huntington's disease (HD), caregivers encounter practical and emotional challenges and distress. Enduring caregiver burdens may lead to problems and caregivers are in need of social support and health services to deal with challenges. We wanted to explore coping strategies and behaviour patterns used by family caregivers to care for themselves, while caring for a family member with HD. Participants were recruited from hospitals and community‐based healthcare. The sample represents experiences from care‐giving in all stages of the disease. We conducted semi‐structured interviews with 15 family caregivers in Norway. The transcribed material was analysed by use of systematic text condensation, a method for cross‐case thematic analysis of qualitative data. We found that family members used various coping strategies, adjusted to the stage and progression of HD. They tried to regulate information about the disease, balancing considerations for protection and disclosure, within and outside the family. The participants made efforts to maintain a balance between their own needs in everyday life and the need for care for affected family member(s). As the disease progressed, the balance was skewed, and the family caregivers' participation in social activities gradually decreased, resulting in experiences of isolation and frustration. In later stages of the disease, the need for care gradually overshadowed the caregivers' own activities, and they put their own life on hold. Health professionals and social workers should acknowledge that family caregivers balance their needs and considerations in coping with HD. They should, therefore, tailor healthcare services and social support to family caregivers' needs during the different stages of HD to improve caregivers' abilities to maintain some of their own activities, in balance with care‐giving.     

Emerging electronic cigarette policies in European member states,Canada, and the United States

BackgroundIncreased electronic cigarette (ECIG) use has motivated new regulations to address the changing landscape of tobacco use and promote public health.MethodThis policy scan compares ECIG prevalence and regulations in the European Union (EU), Canada, and the United States (US) at the federal- and local-level to foster a policy dialogue around modern tobacco prevention and control regulations.ResultsAmong young adults, 40 % in the US, 29 % in Canada, and 28 % in the EU report ever using an ECIG. Results from the policy scan find significant variation in approach to regulating ECIGs. EU member states are subject to the most stringent requirements regarding nicotine concentration regulations, and several member states have also opted to ban flavors and/or require plain packaging or out of sight retail sales. Among EU and US states, taxation is a popular strategy, though taxing strategies vary widely. Regarding youth use, US states have led the way for increasing the legal age of sale to 21 at the federal level, and in Canada recent federal regulations are innovative in their approach to banning advertising that may appeal to youth.ConclusionStrategies to achieve public health goals related to ECIGs vary widely, with federalism playing an important role in policy innovation, offering opportunities to evaluate their effectiveness and inform future regulations.     

Good laboratory practice in the European Community. Role of the commission and the member states: external aspects

The paper recalls the history of the development of the OECD principles of good laboratory practice (GLP) and explains why the European Community has a role to play in the area of GLP. It presents briefly the current legal framework in the European Community (Directives 87/18/EEC and 88/320/EEC) and describes the role of the Commission and the member states in the practical implementation of the GLP principles within the European Community. Impacts of GLP on the relations of the European Community with third countries, both within the framework of the OECD and through bilateral trade agreements (mutual recognition agreements, MRA) based on article 133 of the treaty establishing the European Community, are then examined in greater detail.     

Assessing family history of heart disease in primary care consultations: a qualitative study

BACKGROUND: Current primary prevention guidelines recommend the assessment of family history of coronary heart disease (CHD) to identify at-risk individuals. OBJECTIVE: To examine how clinicians and patients understand and communicate family history in the context of CHD risk assessment in primary care. METHODS: A qualitative study. Patients completed a validated family history questionnaire. Consultations with clinicians were video recorded, and semi-structured interviews conducted with patients after consultation. The participants were 21 primary care patients and seven primary care clinicians (two practice nurses, five GPs). Four practices in South West England. RESULTS: Patients and clinicians usually agreed about the patient's level of risk and how to reduce it. Patients were mostly satisfied with their consultations and having their family history assessed. However, three issues were identified from the consultations which contributed to concerns and unanswered questions for patients. Problems arose when there were few modifiable risk factors to address. Firstly, patients' explanations of their family history were not explored in the consultation. Secondly, the relationship between the patient's family history and their other risk factors, such as smoking or cholesterol, was rarely discussed. Thirdly, clinicians did not explain the integration of family history into the patient's overall cardiovascular disease risk. CONCLUSIONS: Clinicians appeared to lack a rhetoric to discuss family history, in terms of capturing both genetic and environmental factors and its relation to other risk factors. This created uncertainties for patients and carries potential clinical and social implications. There is a need for better guidance for primary care clinicians about family history assessment.     

A three-state study of waterborne disease surveillance techniques.

For a two-year period, the states of Colorado, Vermont and Washington tested the effectiveness of ten surveillance methods for identifying waterborne disease. Nine were active surveillance methods, soliciting illness reports; one was passive, relying on voluntary disease reporting. One waterborne disease outbreak was identified through use of the nine active methods, while 14 were reported through the passive surveillance method. The presence of coliform bacteria during routine water testing was not related to illness in the community.