Front-of-pack nutrition labelling: testing effectiveness of different nutrition labelling formats front-of-pack in four European countries

In two studies, the impact of eight front-of-pack nutrition labelling formats that differed in complexity was investigated across four European countries. In total 1630 men and women (18-55 yrs) were recruited from Internet panels in the United Kingdom, Germany, Italy and the Netherlands for study 1 and 776 in Italy and the United Kingdom for study 2. Participants evaluated several products (healthier and less healthy variants of the same product category) with a front-of-pack nutrition labelling format. The first study evaluated different labelling formats on consumer friendliness (comprehension, liking and credibility) and the second study measured the effect of the different labelling formats on decision-making (usage intention and process time). The results indicated minor differences in consumer friendliness and usage intention between simpler (such as Healthier Choice Tick, Smileys and Stars) and more complex front-of-pack nutrition labelling formats (such as Multiple Traffic Light, Wheel of Health and GDA scores). Endorsement by national and international health organisations strongly increased the labelling formats' credibility. Participants needed significantly less time to evaluate simpler front-of-pack labelling compared to the more complex labelling format. Thus simpler front-of-pack labelling formats seem more appropriate in a shopping environment where quick decisions are made.     

A comparison of the alcohol-attributable mortality in four European countries

Background: Deaths due to alcohol consumption are an important component of all-cause mortality, particularly premature mortality. However, there are considerable regional variations, the reasons for which are unclear. Methods: Estimates were made as reliably as possibly using vital statistics and best estimates of risk of the alcohol-attributable mortality, by age, sex and cause for four European countries (England and Wales, Germany, Denmark and Italy). Twenty-seven alcohol-related conditions were considered including the possible cardio-protective effects of alcohol. Results: It was estimated that there are approximately 2% fewer deaths annually in England and Wales than would be expected in a non-drinking population and 0.3% fewer deaths among East German females. In West Germany, Denmark, Italy and among East German males there are more deaths caused by alcohol than are prevented (between 0.7 and 2.6% of all deaths). The highest age-specific proportion of alcohol-attributable deaths is found in East Germany where around 30% of deaths among males aged 25–44 years are due to drinking. Among young men in all four countries the largest contributor to alcohol-related deaths is road traffic accidents involving alcohol. Conclusions: Possible explanations for the variation in alcohol-attributable deaths between countries include different underlying heart disease rates, different patterns of alcohol consumption and beverage preferences, and different use of mortality classification. Differences in the reported alcohol consumption levels explain little of the variation in alcohol-attributable deaths. Estimating alcohol-attributable mortality by age and sex across countries may be a useful indicator for developing alcohol strategies and exploring ways of preventing premature mortality.     

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.     

Beverage and water intake of healthy adults in some European countries

Abstract

Introduction: Nutritional surveys frequently collect some data of consumption of beverages; however, information from different sources and different methodologies raises issues of comparability. The main objective of this review was to examine the available techniques used for assessing beverage intake in European epidemiological studies and to describe the most frequent method applied to assess it. Materials and methods: Information of beverage intake available from European surveys and nutritional epidemiological investigations was obtained from gray literature. Results: Twelve articles were included and relevant data were extracted. The studies were carried out on healthy adults by different types of assessments. The most frequent tool used was a 7-d dietary record. Only Germany used a specific beverage assessment tool (Beverage Dietary History). Conclusion: From the limited data available and the diversity of the methodology used, the results show that consumption of beverages is different between countries. Current epidemiological studies in Europe focusing on beverage intake are scarce. Further research is needed to clarify the amount of beverage intake in European population.     

Health-related quality of life in rural children living in four European countries: the GABRIEL study

Objective

Measuring children’s health-related quality of life (HRQOL) is of growing importance given increasing chronic diseases. By integrating HRQOL questions into the European GABRIEL study, we assessed differences in HRQOL between rural farm and non-farm children from Germany, Austria, Switzerland and Poland to relate it to common childhood health problems and to compare it to a representative, mostly urban German population sample (KIGGS).

Methods

The parents of 10,400 school-aged children answered comprehensive questionnaires including health-related questions and the KINDL-R questions assessing HRQOL.

Results

Austrian children reported highest KINDL-R scores (mean: 80.9; 95 % CI [80.4, 81.4]) and Polish children the lowest (74.5; [73.9, 75.0]). Farm children reported higher KINDL-R scores than non-farm children (p = 0.002). Significantly lower scores were observed in children with allergic diseases (p < 0.001), with sleeping difficulties (p < 0.001) and in overweight children (p = 0.04). The German GABRIEL sample reported higher mean scores (age 7–10 years: 80.1, [79.9, 80.4]; age 11–13 years: 77.1, [74.9, 79.2]) compared to the urban KIGGS study (age 7–10 years: 79.0, [78.7–79.3]; age 11–13 years: 75.1 [74.6–75.6]). Socio-demographic or health-related factors could not explain differences in HRQOL between countries.

Conclusions

Future increases in chronic diseases may negatively impact children’s HRQOL.     

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.     

Public ideas and values concerning the commercialization of organ donation in four European countries

Against the background of the increasing academic and political debate on financial incentives for organ donation, we conducted a qualitative investigation on the conditions under which European citizens would actually consider or refuse financial incentives for organ donation. Our paper combines an analysis of data that were collected in eight Focus Group discussions on transplantation medicine with lay people and patients from four European countries (Cyprus, Germany, the Netherlands, and Sweden) with a critical re-assessment of the dichotomy between gift and commodity in the recent political and academic discourse. We find that the distinction between living and post mortem donation on the one hand, and between different models of financial incentives on the other, plays a crucial role for the participants' values and ideas about organ donation. We discuss the significance of our results with particular respect to the central role of reciprocity and draw conclusions for the bioethical and biopolitical debate.     

Variations in general practitioners' views of asthma management in four European countries.

The aim was to identify differences and similarities in views regarding asthma management among general practitioners in four European countries (Germany, Netherlands, Norway and Sweden), and to explore reasons for suboptimal performance. The results are to be used for the development and tailoring of educational interventions. Semistructured interviews with 20 GPs in each country were conducted and analysed using a phenomenographic approach. The domains of (i) general view of asthma, (ii) the doctor-patient relationship in managing asthma, and (iii) overall management of asthma (treatment goals and evaluation of results) were approached during the interviews. There were different ways of experiencing phenomena related to asthma management both within and between the four countries. Three general views on asthma were found where different perspectives were emphasised: a medical, a 'global' (including community health, social and environmental aspects) and a patient's perspective. Within the medical perspective, only a few German doctors emphasised a psychological aetiology of asthma. The views on the doctor-patient relationship described as 'authoritarian', 'teaching' or 'empowering' occurred similarly in all countries. The majority of the doctors showed confidence in the effectiveness of the pharmaceutical treatment of asthma, some doctors were concerned about limitations, but only in Germany a few doctors were explicitly critical of the values of conventional pharmaceutical treatment. The main treatment goals were either conceived as getting the patient symptom-free (Netherlands, Norway, and Germany) or to control the inflammatory process (Sweden). Several German and some Norwegian doctors expressed the view that patients had to accept the disease and learn how to manage it, while a few German doctors aimed at alternative treatments of asthma. The existence of qualitatively different ways of experiencing asthma management, both in and between countries, calls for consideration when trying to implement general evidence-based treatment guidelines. A variation of approaches in continuing medical education for GPs is needed to address such existing beliefs and conceptions that could sometimes be opposed to the content of educational messages.     

Cancer mortality patterns among Turkish immigrants in four European countries and in Turkey

The aim of this study on cancer mortality among Turkish immigrants, for the first time, traditional comparisons in migrant health research have been extended simultaneously in two ways. First, comparisons were made to cancer mortality from the immigrants’ country of origin and second, cancer mortality among Turkish immigrants across four host countries (Belgium, Denmark, France and the Netherlands) was compared. Population-based cancer mortality data from these countries were included. Age-standardized mortality rates were computed for the local-born and Turkish population of each country. Relative differences in cancer mortality were examined by fitting country-specific Poisson regression models. Globocan data on cancer mortality in Turkey from 2008 were used in order to compare mortality rates of Turkish immigrants with those from their country of origin. Turkish immigrants had lower all-cancer mortality than the local-born populations of their host countries, and mortality levels comparable to all-cancer mortality rates in Turkey. In the Netherlands and France breast cancer mortality was consistently lower in Turkish immigrants women than among local-born women. Lung cancer mortality was slightly lower in Turkish immigrants in the Netherlands and France but varied considerably between migrants in these two host countries. Stomach cancer mortality was significantly higher in Turkish immigrants when compared to local-born French and Dutch. Our findings indicate that exposures both in the country of origin and in the host country can have an effect on the cancer mortality of immigrants. Despite limitations affecting any cross-country comparison of mortality, the innovative multi-comparison approach is a promising way to gain further insights into determinants of trends in cancer mortality of immigrants.     

Demand and supply for psychological help in general practice in different European countries: access to primary mental health care in six European countries

BACKGROUND: The general practitioner is usually the first health care contact for mental problems. The position of a general practitioner may vary between health care systems, depending on the referral system (gatekeepers versus directly accessible specialists), presence of fixed lists and the payment system. This may influence patients' expectations and requests for help and GPs' performance. In this paper the effects of working in different health care systems on demand and supply for psychological help were examined. METHODS: Data were collected in six European countries with different health care system characteristics (Belgium, Germany, The Netherlands, Spain, Switzerland and the UK). For 15 consecutive contacts with 190 GPs in the six countries, each patient completed questionnaires concerning reason for visit and expectations (before) and evaluation (after consultation). General practitioners completed registration forms on each consultation, indicating familiarity with the patient and diagnosis. General practitioners completed a general questionnaire about their personal and professional characteristics as well. RESULTS: Practices in different countries differed considerably in the proportion of psychological reasons for the visit by the patient and psychological diagnoses by the GP. Agreement between patients' self-rated problems and GPs' diagnoses also varied. Patients in different countries evaluated their GPs' psychological performance differently as well, but evaluation was not correlated with agreement between request for help and diagosis. In gatekeeping countries, patients had more psycho-social requests, GPs made more psychological diagnoses and agreement between both was relatively high. Evaluation, however, was more positive in non-gatekeeping countries. Individual characteristics of doctors and patients explained only a relatively small part of variance. CONCLUSIONS: Health care system characteristics do affect GPs' performance in psycho-social care.     

Comparative cost-effectiveness analysis of oral triptan therapy for migraine in four European countries

Aim

To assess the differences in the cost-effectiveness of oral triptan therapy for migraines among European countries.

Methods

A cost-effectiveness analysis of triptan therapy for migraine was conducted from a health-care payer perspective in four European countries (France, Italy, Spain and the UK). The study included those orally administered triptans available in all of these countries (almotriptan, brand-name sumatriptan, generic sumatriptan, zolmitriptan), and it was performed using a decision-tree model that incorporated costs of the drugs and probabilities associated with the possible events and outcomes. Average cost-effectiveness ratios were calculated in two different scenarios.

Results

The average cost-effectiveness ratio showed wide variations across the different countries, these differences being up to 131 % (almotriptan), 77 % (brand-name sumatriptan), 153 % (generic sumatriptan) and 77 % (zolmitriptan). Generic sumatriptan was the most cost-effective drug analysed in the studied countries.

Conclusions

Caution must be taken when trying to transfer conclusions of pharmacoeconomics studies on migraines even in neighbouring countries. This cross-country variability is a concern for decision-makers and also for the elaboration of international recommendations and clinical practice guidelines.     

The impact of structural factors on the injury rate in different European countries

BACKGROUND: A previous study pointed to there being two kinds of injuries--those with a mainly social genesis and those with a mainly environmental genesis. The aim of this study was to analyse how socioeconomic factors--such as level of economic development, alcohol consumption and unemployment and more cultural factors--such as education and religion--relate to kinds of injury. METHODS: Motor vehicle traffic accidents were chosen to represent injuries with a predominantly environmental genesis and suicides those with a mainly social genesis. Qualitative comparative analysis (QCA) complemented by Pearson correlation was employed. The data come from 12 European countries. RESULTS: Four groups of countries emerged from the analysis. Group 1 was high on both kinds of injuries and was also high on all the independent variables considered. Group 2 was low on social injuries and high on environmental injuries; it had a low level of economic development, high alcohol consumption and a high proportion of Roman Catholics. Group 3 was high on social injuries and low on environmental injuries; it had a high level of economic development, low alcohol consumption and few Roman Catholics. Group 4 was low on both kinds of injuries; the independent variables formed a similar pattern to those of group 3. CONCLUSION: The pattern for traffic fatalities differs from that of suicides. There is also patterning with regard to structural factors; economic level, education and religion seem to be more important with regard to injury rate differentials than alcohol consumption or unemployment.     

Influenza vaccination coverage and reasons to refrain among high-risk persons in four European countries

This paper examines influenza vaccine coverage using a population base of an average of 2300 persons in each of four European countries (Germany, Spain, Poland and Sweden). The reasons for non-vaccination of those in the high-risk groups were explored by questionnaire. The vaccine coverage rate (VCR) for elderly ranged from 18% in Poland to 67% in Spain. The VCR for high-risk population under 65 was 10% in Poland, 13% in Sweden, 27% in Germany and 30% in Spain. The most important reasons mentioned for not being vaccinated were: perceived sufficient resistance to flu (33-42%) in all countries; financial barriers in Poland (25%), and not to qualify for the vaccination (30%) and forgetfulness (20%) in Germany. Receiving a personal invitation for the vaccination, results in higher coverage rates in all four countries. We think that future interventions could be directed towards: an information campaign with special attention to the high-risk groups due to disease; promotion of personal invitations; and, for Poland, solving financial barriers to vaccination.     

Liberalized abortion in four countries

Liberalized abortion laws have become effective in 4 Western countries during 1975. Details of the more liberal abortion statutes in France, Cyprus, Austria, and Sweden are presented.     

Work stress and quality of life in persons with disabilities from four European countries: the case of spinal cord injury

Background

Evidence on the adverse effects of work stress on quality of life (QoL) is largely derived from general populations, while respective information is lacking for people with disabilities. We investigated associations between work stress and QoL and the potentially moderating role of socioeconomic circumstances in employed persons with spinal cord injury (SCI).

Methods

Cross-sectional data from 386 employed men and women with SCI (≥18 work h/week) from the Netherlands, Switzerland, Denmark, and Norway were analyzed. Work stress was assessed with the ‘effort–reward imbalance’ (ERI) model and the control component of the ‘demand/control’ model. QoL was operationalized with five WHOQoL BREF items. Socioeconomic circumstances were measured by years of formal education and perception of financial hardship. We applied ordinal and linear regressions to predict QoL and introduced interaction terms to assess a potential moderation of socioeconomic circumstances.

Results

Multivariate analyses showed consistent associations between increased ERI and decreased overall QoL (coefficient ?1.55, p < 0.001), domain-specific life satisfaction (health ?1.32, p < 0.001; activities of daily living ?1.28, p < 0.001; relationships ?0.84, p = 0.004; living conditions ?1.05, p < 0.001), and the QoL sum score (?2.40, p < 0.001). Low job control was linked to decreased general QoL (0.13, p = 0.015), satisfaction with relationships (0.15, p = 0.004), and QoL sum score (0.15, p = 0.029). None of the tested interaction terms were significant.

Conclusion

ERI was consistently related to all indicators of QoL, while associations with job control were less consistent. Our results do not support the notion that unfavorable socioeconomic circumstances moderate the association between work stress and QoL among persons with SCI.     

Cost-effectiveness of adherence therapy versus health education for people with schizophrenia: randomised controlled trial in four European countries

Background

Non-adherence to anti-psychotics is common, expensive and affects recovery. We therefore examine the cost-effectiveness of adherence therapy for people with schizophrenia by multi-centre randomised trial in Amsterdam, London, Leipzig and Verona.

Methods

Participants received 8 sessions of adherence therapy or health education. We measured lost productivity and use of health/social care, criminal justice system and informal care at baseline and one year to estimate and compare mean total costs from health/social care and societal perspectives. Outcomes were the Short Form 36 (SF-36) mental component score (MCS) and quality-adjusted life years (QALYs) gained (SF-36 and EuroQoL 5 dimension (EQ5D)). Cost-effectiveness was examined for all cost and outcome combinations using cost-effectiveness acceptability curves (CEACs).

Results

409 participants were recruited. There were no cost or outcome differences between adherence therapy and health education. The probability of adherence therapy being cost-effective compared to health education was between 0.3 and 0.6 for the six cost-outcome combinations at the willingness to pay thresholds we examined.

Conclusions

Adherence therapy appears equivalent to health education. It is unclear whether it would have performed differently against a treatment as usual control, whether such an intervention can impact on quality of life in the short-term, or whether it is likely to be cost-effective in some sites but not others.

Trial registration

Trial registration: Current Controlled TrialsISRCTN01816159