Measuring the health and health behaviours of adolescents through cross-national survey research: recent developments in the Health Behaviour in School-aged Children (HBSC) study

Cross-national surveys have the potential to make a significant contribution to the study of adolescent health. The Health Behaviour in School-aged Children (HBSC) study was among the first international studies established in three countries in 1983 and growing to more than 40 countries for the seventh wave of fieldwork in 2005/06. The original aim of the study has remained largely the same since its inception, to increase understanding of adolescent health behaviours, health and well being in their social context and to collect high quality comparable data to achieve this. The challenges to producing valid and reliable data from cross-national, school-based research were recognised from the outset and reflected in the methodological development of the study. The paper sets out how these challenges were addressed, examining key aspects of the methodology, including study design, questionnaire content, data collection and file preparation. These methods are still in place, but HBSC has had to recognise the social and political change of recent years. The challenges that were recognised 20 years ago are magnified today, with the study embracing a variety of cultures across Europe and North America. As demand for HBSC data has grown from the scientific and policy communities, greater attention has been paid to scrutiny of the data produced, matched by a sharper focus on continuous improvement in data quality. Key developments of recent years are summarised in the paper, focusing on study organisation, review of the international Research Protocol, strengthening support for sampling, greater attention to translation and improvements in data processing and documentation. It is concluded that the HBSC study has evolved over the last 20 years and continues to do so, recognising the importance of data quality, but also the constraints of cross-national survey research. Looking to the future, some outstanding issues for consideration are touched upon, including the opportunities and challenges for expanding our knowledge on the possibilities for gathering cross-national and cross-cultural data, with the HBSC study being used to build capacity in understanding the health needs of young people in other regions of the world.     

Factors associated with early menarche: results from the French Health Behaviour in School-aged Children (HBSC) study

Background  

Puberty is a transition period making physiological development a challenge adolescents have to face. Early pubertal development could be associated with higher risks of poor health. Our objective was to examine risk behaviours, physical and psychological determinants associated with early menarche (<11 years).     

Researching health inequalities in adolescents: the development of the Health Behaviour in School-Aged Children (HBSC) family affluence scale

Socioeconomic inequalities in adolescent health have been little studied until recently, partly due to the lack of appropriate and agreed upon measures for this age group. The difficulties of measuring adolescent socioeconomic status (SES) are both conceptual and methodological. Conceptually, it is unclear whether parental SES should be used as a proxy, and if so, which aspect of SES is most relevant. Methodologically, parental SES information is difficult to obtain from adolescents resulting in high levels of missing data. These issues led to the development of a new measure, the Family Affluence Scale (FAS), in the context of an international study on adolescent health, the Health Behaviour in School-Aged Children (HBSC) Study. The paper reviews the evolution of the measure over the past 10 years and its utility in examining and explaining health related inequalities at national and cross-national levels in over 30 countries in Europe and North America. We present an overview of HBSC papers published to date that examine FAS-related socioeconomic inequalities in health and health behaviour, using data from the HBSC study. Findings suggest consistent inequalities in self-reported health, psychosomatic symptoms, physical activity and aspects of eating habits at both the individual and country level. FAS has recently been adopted, and in some cases adapted, by other research and policy related studies and this work is also reviewed. Finally, ongoing FAS validation work is described together with ideas for future development of the measure.     

Socioeconomical status, health behaviors and health status of French adolescents: Health Behavior in School-aged Children (HBSC) survey

BACKGROUND: The impact of living conditions on health is not well known, but health inequalities observed in adults seem partly determined by behaviours and health status at an earlier stage, and more particularly during adolescence. So, our aim was to study adolescents' health and their health behaviours function to family socioeconomic status. METHODS: We analysed French data from the international survey "Health Behavior in School-aged Children" carried out in a representative sample of adolescents aged 13 and 15 years in 1998. A self-administered questionnaire was completed by the adolescents who answered questions concerning their health, health behaviours, and their families' socio-economic status. RESULTS: Adolescents from blue-collar families were more numerous to report to be in "fairly good health" or "not very good health" (OR = 1.40, CI 95% = 1.12-1.74) and to be overweight or obese (OR = 1.85, CI 95% = 1.25-2.24) than those from executive families. They were also more numerous to have bad health behaviours than those from executive families. CONCLUSION: This study has established that, in adolescents, differences in health, health behaviours, types of consumption and physical activities depended on the families' socio-economic status.     

Indicators of socioeconomic status for adolescents: the WHO Health Behaviour in School-aged Children Survey

Many indicators of socioeconomic status used for adults are inappropriate for use in research on adolescents. In a school-based survey of 4079 Scottish schoolchildren using a self-completion questionnaire, over 20% of 11-15 year olds were unable to provide a substantive response on father's occupation. In contrast, indicators derived to construct a family affluence scale, which included car ownership, telephone ownership and the child having their own unshared bedroom, resulted in a 98% response rate; and 92% of children responded to a question on their weekly spending money. The intercorrelations between the conventional indicator of father's occupation and each family affluence and spending money were examined, and their associations with a range of health indicators and health behaviour measures compared. Father's occupational status and family affluence were moderately correlated and showed broadly similar patterns of association with the selected health measures although there were also some distinct differences. Child's spending money was only weakly correlated with father's occupation and showed rather different patterns of association with health measures. A case is made for the use of multiple indicators of socioeconomic status in adolescent health surveys, and it is argued that that the family affluence scale provides a useful and easily applied additional indicator to father's occupation or an alternative measure of socioeconomic background where occupational data are unavailable.     

School differences in adolescent health and wellbeing: Findings from the Canadian Health Behaviour in School-aged Children Study

The goal of this study was to assess the relationship between student- and school-level factors and student health and wellbeing outcomes, and to estimate the variability present at each of the student and school levels for each of three selected health-related outcomes.     

Changes in HIV/AIDS education, knowledge and attitudes among Scottish 15-16 year olds, 1990-1994: findings from the WHO: Health Behaviour in School-aged Children Study (HBSC).

There is concern about the high prevalence of adolescent sexual health problems, such as sexually transmitted diseases (STDs) and unwanted pregnancies, that currently exist in the UK. If young people are to reduce their risk from HIV/AIDS and other STDs it is imperative, in the first instance, they know what the risks are and how they can avoid them. However, effective school-based sex education can only be delivered if there are accurate data on young people's current levels of knowledge and existing sex education needs. This paper details findings from the WHO: Health Behaviours of School-aged Children Study on the changes that have occurred between 1990 and 1994 in Scottish school-children's knowledge, attitudes and perceived educational needs in relation to HIV/AIDS. There have been significant changes in knowledge and attitudes that may affect their sexual behaviour, e.g. in their attitudes to condom use, risk of HIV/AIDS and other STDs, and also other sexual health problems, such as the risk of unwanted pregnancies and abortions. Finally, areas that require future research and recommendations for future sexual health education interventions are highlighted.     

Universal Health Coverage in Italy: lights and shades of the Italian National Health Service which celebrated its 40th anniversary

The Italian National Health Service (I-NHS) was established in 1978 to guarantee universal access to healthcare. Prominent in international reports, the I-NHS has reached a satisfactory level of efficiency and excellent standards of care in many regions, in forty years. Along the years, I-NHS has developed a structural public-private partnership in health services delivery that in some regions contributes to the achievement of very high standards of healthcare quality. However, the I-NHS is currently facing some major challenges: (a) Italy is experiencing a remarkable aging of its population with increasing health needs; (b) the recent and constant cuts to public expenditures are reducing the budget for welfare. It is of utmost importance to ensure that on-going efforts to contain health system costs do not subsume health care quality. In addition, monitoring of the essential levels of care (Livelli Essenziali di Assistenza, LEA) highlights significant differences in healthcare delivery among Italian regions that, in turns, contribute to the burdensome migration of patients to best-performing regions. Therefore, a more consolidated and ambitious approach to quality monitoring and healthcare improvement at a system level is needed to guarantee its sustainability in the future.     

Solidarity and the Role of the State in Italian Health Care

The article deals with the issue of solidarity in health care,with particular reference to the Italian context. It presents thedifficulties of the Italian NHS and assesses the current proposalto counter the crisis of the Welfare State by giving upinstitutional arrangements, in order to favour the so-called`social private'. Moreover, it addresses the question ofprioritisation and targeting in the context of health care,arguing for the insufficiency of the standard approach of neutralliberalism, and showing how the concept of solidarity might helpto develop a different account. Lastly, it discusses the case oforgan transplantion in Italy, as an example ofsolidarity-inspired health care policy.     

Self-efficacy and medicine use for headache among adolescents in Italy: results from the Italian HBSC 2010 study

This article aims first to investigate gender patterns in medicine use, and corresponding headache complaints, in Italian adolescents; second, to examine the association between self-efficacy and medicine use for headache. This study used data from 23,941 15-year-old students participating in the 2009/2010 Health Behaviour in School-aged Children (HBSC) Survey. Self-complete questionnaires devised by the HBSC international group were administered in classrooms. Logistic regression models (controlling demographics: age, gender, and FAS) were used to investigate the association between medicine use for the associated health complaint, and perceived self-efficacy. Overall, prevalence of students reporting medicine use for headache (at least once a month) was 40.1%. Medicine use was significantly more common among girls than among boys for that somatic symptom. The use of medicines was significantly associated with the frequency of the corresponding health complaint. Self-efficacy was associated with a lower use of medicine for headache just for the group with low frequency of headache. In conclusion, self-efficacy may reduce the tendency to use medicines when adolescents report infrequent headaches.     

长期护理机构老年痴呆患者精神行为症状的症状簇及其照护困扰

  目的  探讨长期照护机构中老年痴呆患者挑战性行为现状及影响因素。  方法  于2017年9 — 11月,便利选取广州市3所长期照护机构340例老年痴呆患者,采用自编一般人口学资料问卷,中文版挑战性行为量表（CBS）进行问卷调查。  结果  99.1 %（357例）的老年痴呆患者存在挑战性行为及管理难度。其中有5种挑战性行为不仅发生频率高,且管理难度大：“缺乏自我照顾能力”发生率为81.8 %,管理难度（6.55 ± 5.216）分、“言行重复”发生率为51.5 %,管理难度（3.55 ± 4.817）分、“缺乏积极性”发生率为43.2 %,管理难度（2.99 ± 4.452）分、“大声叫喊”发生率为43.5 %,管理难度（2.93 ± 4.617）分、“烦躁不安”发生率为42.1 %,管理难度（2.62 ± 4.141）分。生活自理能力较差（OR = 2.869,5.094,P < 0.05）、不接受精神科治疗（OR = 2.252,P < 0.05）、伴随疾病数量≥3种（OR = 2.195,P < 0.05）是老年痴呆患者挑战性行为管理困难的危险因素。  结论  长期照护机构老年痴呆患者普遍存在挑战性行为及管理难度,其管理难度受患者的生活自理能力、精神科治疗状况、伴随疾病种类影响。     

The Exeter Family Study of Childhood Health (EFSOCH): study protocol and methodology

The Exeter Family Study of Childhood Health is a prospective study, set up to test the fetal insulin hypothesis, and to identify genetic polymorphisms that play a role in determining birthweight and early postnatal growth. We recruited 1017 families from a postcode-defined area in central Exeter. Specific inclusion criteria were established to obtain a homogeneous, non-diabetic, UK Caucasian cohort. Detailed anthropometric measurements were taken from both parents at 28 weeks' gestation, and from their children at birth, 12 weeks, 1 year and 2 years of age. Insulin and other biochemical analysis were measured in fasting parental samples and an umbilical cord blood sample taken at delivery. Parental and offspring DNA were extracted to allow molecular genetic analysis of candidate genes implicated in fetal growth. This comprehensive data set is available on a disease-free cohort, and detailed preparatory work has ensured high levels of quality control. The study would welcome collaboration within strict confidentiality rules.     

意大利医疗保障体系建设及启示

目的:意大利医疗卫生保健体系被认为是世界上最先进的体系之一,在医疗卫生和改善国民健康状况方面取得了良好的绩效.在我国当前深化医药卫生体制改革的背景下,结合我国实际情况,分析意大利卫生保健体系的经验和对于我国的医改工作的启示.方法:从意大利医疗保健体系的总体绩效介绍入手,着重分析意大利医疗保健体系的组织结构、医疗服务运作模式和筹资分配方式等方面,系统介绍意大利卫生保健体系的一些特点和富有成效的措施.结果:意大利医疗保障体系在组织结构、服务提供、筹资模式和药品管理体系方面都有一些值得肯定的做法.结论:意大利医疗卫生保健体系良好绩效的取得,对于我国新医改政策背景下的医疗卫生保健体系建设具有很好的启示.     

User-friendly system (a smartphone app) for reporting violent incidents towards emergency nurses in the Emergency Department: an Italian multicenter study

Background:Nurses, particularly emergency nurses, are among the health workers most exposed to workplace violence. Although reporting systems are increasingly used, under-reporting remains high. Recent studies suggest that the use of easy registration systems could facilitate violence reporting.Objectives:To verify if a friendly reporting system based on a Mobile-app can facilitate the reporting of violent episodes and reduce under-reporting.Methods:Twenty emergency departments of five North and Central Italian regions participated in an interventional, multicentric, pre-post study to verify if a user-friendly reporting system based on a mobile app can facilitate the reporting of violent episodes and reduce under-reporting.Results:Three hundred and eighty-four out of 754 potentially eligible nurses answered the short questionnaire at time T₀, and 318 registered for the use of the app. One hundred and eighty-nine answered the questionnaire at time T₁. The t-Test for Paired Samples, although with a low mean difference, shows a significant difference in the change in the frequency of the reporting of violent episodes. The correlational tests showed no significant differences in the subgroups divided by demographic and professional characteristics. The usability of the app was considered very high.Conclusions:The simplification of the reporting system and the preliminary acquisition of data on the characteristics of the ED and each nurse, can save time and facilitate the reporting, but technology alone is not enough to solve the under-reporting.     

我国流行病学学会成立和发展的历程I．1978—1997年工作回顾

1987年国内成立了中华预防医学会后,原属预防医学范畴的专业学科均归属中华预防医学会领导,因此流行病学学会自1991年11月以后也被批准归属于中华预防医学会,其正式名称改为“中华预防医学会流行病学学会”,是中华预防医学会下属的二级学会之一。     

Genetic Screening for the Predisposition to Venous Thromboembolism: A Cost-Utility Analysis of Clinical Practice in the Italian Health Care System

ObjectivesIn the Italian health care system, genetic tests for factor V Leiden and factor II are routinely prescribed to assess the predisposition to venous thromboembolism (VTE) of women who request oral contraception. With specific reference to two subpopulations of women already at risk (i.e., familial history or previous event of VTE), the study aimed to assess whether current screening practices in Italy are cost-effective.MethodsTwo decisional models accrued costs and quality-adjusted life-years (QALY) annually from the perspective of the National Health Service. The two models were derived from a decision analysis exercise concerning testing practices and consequent prescribing behavior for oral contraception conducted with 250 Italian gynecologists. Health care costs were compiled on the basis of 10-year hospital discharge records and the activities of a thrombosis center. Whenever possible, input data were based on the Italian context; otherwise, the data were taken from the international literature.ResultsCurrent testing practices on women with a familial history of VTE generate an incremental cost-effectiveness ratio of €72,412/QALY, which is well above the acceptable threshold of cost-effectiveness of €40,000 to €50,000/QALY. In the case of women with a previous event of VTE, the most frequently used testing strategy is cost-ineffective and leads to an overall loss of QALY.ConclusionsThis study represents the first attempt to conduct a cost-utility analysis of genetic screening practices for the predisposition to VTE in the Italian setting. The results indicate that there is an urgent need to better monitor the indications for which tests for factor V Leiden and factor II are prescribed.