Cancer incidence among priests: 45?years of follow-up in four Nordic countries

Previously published studies on the risk of cancer among male priests have been based on cancer mortality with the exception of one case–control study. The aim of this study was to present estimates of cancer incidence among Nordic male priests. The study cohort for our analyses consisted of 6.5 million men aged 30–64 years old who had participated in any computerised population census in four Nordic countries in 1990 or earlier. Follow-up was done by drawing linkages with the national population and cancer registries. 13,491 priests were identified by their job title codes. We estimated the standardised incidence ratio (SIR) and 95% confidence intervals (95% CI) for the priests using the male population as a reference. Priests had a lower cancer incidence than the general population (overall SIR 0.85, 95% CI: 0.82–0.88). The majority of smoking- and alcohol-related cancers were associated with decreased SIR estimates. Increased risks were observed for skin melanoma (SIR 1.34, 95% CI: 1.11–1.62), acute myeloid leukemia (SIR 1.75, 95% CI: 1.20–2.47) and thyroid cancer (SIR 1.86, 95% CI: 1.22–2.73). This is the first cohort study regarding the incidence of cancer among priests. The lower incidence of smoking and alcohol-related cancers among Nordic male priests can be explained by their lower exposure to cigarettes and alcohol when compared to the general population. A greater risk of melanoma is typical of highly-educated people, but it is unclear why priests should have an increased risk of acute myeloid leukemia or thyroid cancer.     

Trends in cervical cancer incidence and mortality in Poland: is there an impact of the introduction of the organised screening?

Aside from existing opportunistic screening, an organised screening programme (OSP) for cervical cancer (CC) was implemented in 2006/2007 in Poland. We applied joinpoint regression and age-period-cohort model to look for the impact of the OSP on CC incidence/mortality trends. Decline of age-standardised incidence rates (ASIRs) in the screening-age group (25–59 years) accelerated from ?2.2% (95% CI ?2.7 to ?1.7%) between 1993 and 2008 to ?6.1% (95% CI ?7.7 to ?4.4%) annually after 2008. In women aged 60+ years, ASIRs declined from 1986 until 2005 [annual percent change (APC) = ?2.6%, 95% CI ?2.9 to ?2.4%] and stabilised thereafter. Decline of age-standardised mortality rates (ASMRs) in the screening-age group accelerated from ?1.3% (95% CI ?1.5 to ?1.1%) between 1980 and 2005 to ?4.7% (95% CI ?5.6 to ?3.8%) annually after 2005. In women aged 60+ ASMR declined between 1991 and 2004 (APC = ?2.9%, 95% CI ?3.5 to ?2.3%) and stabilised thereafter. Relative risks of CC diagnosis and death were 0.63 (95% CI 0.62–0.65) and 0.61 (95% CI 0.59–0.63), respectively, for the most recent period compared to the reference around 1982. Implementation of the OSP possibly accelerated downward trends in the burden of CC in Polish women under the age of 60, but recent stabilisation of trends in older women requires actions.     

Recent increases in tuberculosis notifications in England and Wales--real or artefact?

BACKGROUND: In light of recent increases in tuberculosis notifications in England and Wales, this study examines data on the occurrence of tuberculosis from other sources to see if the increase seen in notifications is corroborated. METHODS: Tuberculosis notifications for 1988-2000 were compared with laboratory reports of Mycobacterium tuberculosis complex isolates (1994-2000), national survey data for 1988, 1993 and 1998, and enhanced tuberculosis surveillance data for 1999 and 2000. RESULTS: Data from all three sources reveal a similar overall trend, with the increase most marked in 1999 and 2000 and a steady increase in the number of cases reported from London. The largest increase is seen in the 15-34 year age group. National survey and enhanced surveillance data show a continuing increase in the proportion of tuberculosis patients born abroad, and in number of patients from most non-White ethnic groups. All sources show an increased number of patients with extra-pulmonary disease. CONCLUSION: A similar level in the overall increase in cases, and their distribution by geographic region, age, sex and site of disease, observed using data from all three sources, suggests that much of the increase is likely to be real. Data from additional continuous years of enhanced surveillance will permit more accurate assessment of trends in population subgroups.     

What's new in tuberculosis vaccines?

Over the past 10 years, tuberculosis (TB) vaccine development has resurged as an active area of investigation. The renewed interest has been stimulated by the recognition that, although BCG is delivered to approximately 90% of all neonates globally through the Expanded Programme on Immunization, Mycobacterium tuberculosis continues to cause over 8 million new cases of TB and over 2 million deaths annually. Over one hundred TB vaccine candidates have been developed, using different approaches to inducing protective immunity. Candidate vaccines are typically screened in small animal models of primary TB disease for their ability to protect against a virulent strain of M. tuberculosis. The most promising are now beginning to enter human safety trials, marking real progress in this field for the first time in 80 years.     

Trends and determinants of mortality in women of reproductive age in rural Guinea-Bissau,West Africa – a cohort study

Background

There are few studies reporting mortality of women of reproductive age (WRA) in developing countries. The trend and patterns of their mortality may be important for documenting the health status of the population in general.

Methods

We used a prospective open cohort of women aged 12 to 49 years living in the Bandim Health Project’s rural Health and Demographic Surveillance System (HDSS) in 5 regions of Guinea-Bissau from 1996 to 2007. Information on in- and out-migration and deaths were collected through the HDSS routine procedures. We assessed the trends in mortality and the associated determinants using Cox regression models.

Results

We followed 27,185 WRA for 141,693 person-years-at-risk (PYO) among whom 9,093 moved out and 1,006 died. Overall standardized mortality rate was 759 per 100,000 PYO. WRA mortality did not decline, but three periods could be distinguished: a stable mortality between 1996–2000 followed by 14% increase in mortality [Hazard rate ratio (HRR)?=?1.14; 95% confidence interval (CI): 0.98-1.32; p?=?0.08] between 2001–2003, and then in the last period from 2004–2007 a 25% decline (HRR?=?0.75; 95% CI: 0.64-0.87; p?<?0.001) in relation to the first period. Compared with the years 1990–1996 mortality increased in the first two periods until 2003; only in the last period did mortality reach the same level as in 1990–1996 (HRR?=?0.96; 95% CI: 0.82-1.13; p?=?0.62). The level of mortality differed between regions. In the adjusted analysis the eastern regions Bafata (HRR?=?1.79; 95% CI: 1.38-2.32; p?<?0.001) and Gabu (HRR?=?1.70; 95% CI: 1.28-2.26; p?<?0.001) had significantly higher mortality, but the hazard rate did not differ by ethnic group. As expected the rate increased with increasing age.

Conclusions

Over the twelve-year period mortality of WRA did not decline. A stable mortality in the beginning was followed by an increase and then a return to the previous levels. Further monitoring of mortality is needed to identify the risk factors for the striking regional differences. Advantage should be taken of the HDSS to monitor progress towards the MDGs and beyond.

     

Trends in Health Insurance Status of US Children and their Parents, 1998–2008

In the United States (US), a parent’s health insurance status affects their children’s access to health care making it critically important to examine trends in coverage for both children and parents. To gain a better understanding of these health insurance trends, we assessed the coverage status for both children and their parents over an 11-year time period (1998–2008). We conducted secondary analysis of data from the nationally-representative Medical Expenditure Panel Survey. We examined frequency distributions for full-year child/parent insurance coverage status by family income, conducted Chi-square tests of association to assess significant differences over time, and explored factors associated with full-year insurance coverage status in 1998 and in 2008 using logistic regression. When considering all income groups together, the group with both child and parent insured decreased from 72.4 % in 1998 to 67.2 % in 2008. When stratified by income, the percentage of families with an insured child, but an uninsured parent increased for low-income families from 12.4 to 25.1 % and from 3.8 to 7.1 % for middle-income families when comparing 1998–2008. In regression analyses, family income remained the strongest characteristic associated with a lack of full-year health insurance. As future policy reforms take shape, it will be important to look beyond children’s coverage patterns to assess whether gains have been made in overall family coverage.     

Is the decline of the increasing incidence of non-Hodgkin lymphoma in Sweden and other countries a result of cancer preventive measures?

Is the decline of the increasing incidence of non-Hodgkin lymphoma (NHL) in Sweden and other countries a result of cancer preventive measures? The yearly age-standardized incidence of NHL increased significantly in Sweden during 1971-1990, for men an average of 3.2% and for women 3.1%. The corresponding figures for 1991-2000 were -0.8% and -0.2%, respectively. A decline of the increasing incidence has also been seen in other countries, such as the United States, Finland, and Denmark. Immunosuppression is one established risk factor for NHL, possibly with interaction with Epstein-Barr virus. Phenoxyacetic acids and chlorophenols, both pesticides, have been associated with NHL. Use of these chemicals was banned in Sweden in 1977 and 1978, respectively. Also, persistent organic pollutants such as polychlorinated biphenyls, hexachlorobenzene, chlordanes, and dioxins have been shown to increase the risk. Exposure of the whole population occurs predominantly through the food chain. Exposure to such chemicals was highest in the 1960s and 1970s. Because of regulation in the 1970s, exposure has declined substantially in the population. The change in incidence of NHL in Sweden and other countries may serve as a good example of how prohibition and limitation of exposure may be reflected in cancer statistics some decades later.     

Changing patterns of mortality in 25 European countries and their economic and political correlates, 1955–1989

Objectives

We investigated trends in mortality in European countries by cause of death in the period 1955–1989, and studied the role of economic and political conditions.

Methods

We extracted data on age-standardised mortality by country (n = 25), sex, cause of death (n = 17) and calendar year from an internationally harmonised dataset. We analysed changes in dispersion of mortality as well as changes in the association of mortality with average income and levels of democracy.

Results

After 1960, dispersion in all-cause mortality in Europe as a whole increased due to diverging trends for many specific causes of death, particularly for cerebrovascular disease. This coincided with widening disparities in average income, and strengthening of the association between levels of democracy and mortality. Divergence in Central and Eastern Europe could largely be explained from stagnating trends in average income and an increasing mortality disadvantage related to its democratic deficit.

Conclusions

Although this was a politically stable period, mortality patterns were highly dynamic, and prefigured the more dramatic mortality trends after 1990. Economic and political stagnation probably explains the diverging trends in Central and Eastern Europe.     

The Global Fund and tuberculosis in Nicaragua: building sustainable capacity?

OBJECTIVE: The purpose of the study was to explore and provide feedback on local stakeholders' experiences with the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) as it related to capacity building for tuberculosis (TB) services in Nicaragua. METHODS: An ethnomethodological approach was used to capture the experiences of three different groups: service providers, service recipients, and decision-makers. Data collection involved reviewing secondary texts and records, participant observation, and in-depth interviews and focus groups in both rural and urban municipalities. RESULTS: Stakeholders felt that Nicaragua's Global Fund project improved TB control, built human resource capacity and strengthened community involvement in TB programming; however, they noted several contextual and structural threats to sustainable capacity development. The nature of the GFATM's performance-based evaluation de-emphasized qualitative assessment and, at times, created pressure to meet numeric targets at the risk of decreasing quality. Contextual challenges often determined or limited the potential sustainability of activities. Two examples (training volunteer health workers and establishing TB Clubs) from the broader study are offered here to highlight these challenges from health systems and community perspectives. CONCLUSIONS: Current approaches to GFATM evaluation and accountability may compromise its positive impacts on capacity building in Nicaragua. Greater consideration needs to be given to ensuring more comprehensive evaluation of project implementation.     

Can we defeat meningococcal disease in low and middle income countries?

The development of multivalent conjugate and protein-based meningococcal vaccines may make global control of meningococcal disease possible. However, achieving control of meningococcal disease in low and middle income countries will be challenging. In low income countries whose vaccination programmes receive financial support from the Global Alliance for Vaccination and Immunisation, the main challenge is lack of sufficient epidemiological information to allow rational decisions on vaccine introduction to be made and, in these countries, enhanced surveillance is needed. In middle income countries, financial challenges predominate. These could be met by demonstration of the cost effectiveness of new meningococcal vaccines and through the introduction of a tiered-pricing system.     

Cognitive determinants of healthcare evaluations – A comparison of Eastern and Western European countries

Knowing the public opinion of healthcare is essential when assessing healthcare system performance; but little research has focussed on the links between the public’s general attitude to the healthcare system and its perceptions and expectations of specific healthcare-related aspects. Using data from the fourth round of the European Social Survey 2008/09, we explore the cognitive determinants of global evaluations of the healthcare system in 12 Eastern and 16 Western European countries. We find that healthcare evaluations follow a coherent cognitive reasoning. They are associated with (i) perceptions of the performance of healthcare systems (i.e. efficiency, equality of treatment, health outcomes), (ii) expectations of the government’s role in providing healthcare, and (iii) reflections on demographic pressures (i.e. aging populations). Contrary to the general assumption that normative expectations are responsible for differences in healthcare evaluations between Eastern and Western Europe, our results suggest that regional differences are largely due to a more negative perception of the performance of healthcare systems within Eastern Europe. To enhance the public opinion of healthcare, policy makers should improve the efficiency of healthcare systems and take measures to assure equality in health treatment.     

Trends in adolescent suicide: misclassification bias?

OBJECTIVES: This study investigated the effect of misclassification of accidental deaths and undetermined deaths on age-, sex-, and race/ethnicity-specific adolescent suicide rates from 1979 through 1994. METHODS: Official mortality data were used to present suicide mortality trends. Two estimates of misclassified suicides in other death categories were applied to calculate "corrected" trends of adolescent suicide. RESULTS: The corrected trends showed a downward adjustment for Black adolescent males and young adolescents. This result does not, however, substantially alter the trend toward a recent increase in suicide in these groups. CONCLUSIONS: Despite misclassification, the true direction of trends in adolescent suicide is reflected in recent official data. However, suicide rates should continuously be tested for misclassification, mainly in populations with proportionately high accidental and undetermined death rates.