Female Genital Mutilation in Iraqi Kurdistan: Description and Associated Factors

The high prevalence of female genital mutilation has been a concern in Iraqi Kurdistan. This study was undertaken to estimate its prevalence and describe factors associated with its occurrence. A cross-sectional survey was undertaken from March to April 2011 of females aged up to 20 years using interviews and clinical examination. The survey included 1,508 participants with mean age of 13.5 years (SD 5.6). Overall female genital mutilation prevalence was 23%, and the mean age at which it had been performed was 4.6 years (SD 2.4). Type I (partial or total removal of the clitoris) comprised 76% of those who had had female genital mutilation; in 79% of cases the decision to perform it was made by the mother; and in 54% of cases it was performed by traditional birth attendants/midwives. Women aged 16 years and over were more likely to have had female genital mutilation compared to children aged below 6 years (OR 11.9, p < .001). Children of uneducated mothers were eight times as likely to have had genital mutilation compared to children of mothers with over nine years of education (OR 8.0, p < .001). Among women aged 17 years and younger, 34% of those who were married had been circumcised versus 17% of those who were not married (p < .001). Participants residing in the northeast of Kurdistan region were more likely to have been circumcised. The study results show that female genital mutilation is a frequent practice in Iraqi Kurdistan. Attention and intervention is needed to address this aspect of the well-being of girls and women.     

Female Genital Mutilation: perceptions of healthcare professionals and the perspective of the migrant families

Background  

Female Genital Mutilation (FGM) is a traditional practice which is harmful to health and is profoundly rooted in many Sub-Saharan African countries. It is estimated that between 100 and 140 million women around the world have been victims of some form of FGM and that each year 3 million girls are at risk of being submitted to these practices. As a consequence of the migratory phenomena, the problems associated with FGM have extended to the Western countries receiving the immigrants. The practice of FGM has repercussions on the physical, psychic, sexual and reproductive health of women, severely deteriorating their current and future quality of life. Primary healthcare professionals are in a privileged position to detect and prevent these situations of risk which will be increasingly more present in Spain.     

Female Genital Mutilation/Cutting in Mali and Mauritania: Understanding Trends and Evaluating Policies

Despite international commitments to end female genital mutilation/cutting (FGM/C), very little is known about the effectiveness of national policies in contributing to the abandonment of this harmful practice. To help address this gap in knowledge, we apply a quasi-experimental research design to study two west African countries, Mali and Mauritania. These countries have marked similarities with respect to practices of FGM/C, but differing legal contexts. A law banning FGM/C was introduced in Mauritania in 2005; in Mali, there is no legal ban on FGM/C. We use nationally representative survey data to reconstruct trends in FGM/C prevalence in both countries, from 1997 to 2011, and then use a difference-in-difference method to evaluate the impact of the 2005 law in Mauritania. FGM/C prevalence in Mauritania began to decline slowly for girls born in the early 2000s, with the decline accelerating for girls born after 2005. However, a similar trend is observable in Mali, where no equivalent law has been passed. Additional statistical analysis confirms that the 2005 law did not have a significant impact on reducing FGM/C prevalence in Mauritania. These findings suggest that legal change alone is insufficient for behavioral change with regard to FGM/C. This study demonstrates how it is possible to evaluate national policies using readily available survey data in resource-poor settings.     

Cardiovascular diseases during and after World War II: a comparison of the Federal Republic of Germany with other European countries

The Statistische Bundesamt (Federal Office for Statistics) has released information which shows a steep increase of atherosclerosis and coronary sclerotic deaths since 1949–1950 throughout West Germany. This upturn is observed to a different extent among all age groups and with a lesser effect among normally menstruating women. During the years 1950 to 1970, the epidemic proportions could hardly be overlooked. Since 1970, the increase has been more gradual, and since 1975 coronary deaths have plateaued. A reduction in the prevalence of coronary disease deaths could possibly have occurred for men ages 40–45. Also, the number of fatal strokes has decreased in the FRG for the last 3 reporting years. Clinical and pathoanatomical investigations in Germany prove that coronary heart disease deaths between 1945 and 1948 were rare—a paucity of global statistics precludes adequate comparison with other countries. These data are supported by the study of the pathoanatomical protocols showing very few cases of accluding coronary sclerosis. Comparative pathoanatomical studies conducted for the years 1939–1953 in Basel and Marburg and ranked according to progression disclosed no significant differences in atherosclerotic disorders. Yet, autopsy reports of the University of Marburg for the years 1945–1948 indicate an increased prevalence of premature fatty streaks and edema. This probably could be due to higher numbers of critically injured and chronically ill soldiers.In another Swiss study, a substantial increase of coronary atherosclerosis was found among active duty soldiers in 1939–1945 and 50 accident deaths examined at the Zürich Institute of Pathology in 1964. This process can be related to the nutritional situation of the 60s as opposed to the war years. The less dramatic reduction of calorie intake in neutral Switzerland should be considered when compared with European countries at war. Thromboembolism in the FRG was considerably lower during the lean postwar years than during the prewar years and the years following 1948.Perhaps the only benefit resulting from the World War II years was that they contributed to our understanding of the roles of nutrition, smoking, obesity and physical activity in the pathogenesis of arteriosclerosis.     

Evaluation of new medicines in Spain and comparison with other European countries

ObjectiveTo compare the use of health technology assessment (HTA) as a tool to support pricing and reimbursement (P&R) of new medicines in Spain with England, Sweden, France and Germany.MethodFor each country, the literature is used to identify the purpose and timing of the P&R decision, the HTA and decision-making procedures used to generate evidence, and the criteria used to make decisions.ResultsResults are presented as a summary of the HTA landscape for P&R of new medicines in each country. Comparisons are made between Spain and other countries regarding the procedure and implementation of HTA.ConclusionsBased on these assessments, we made recommendations for how HTA might develop in Spain with the aim of improving governance and efficiency. Spain has made considerable progress in recent years, but still falls short of international standards in terms of independence of the HTA agencies and decision-making committees from political influence and industrial policy, the setting of prices of medicines in relation to health gain, improve the transparency of the process and results of the evaluation, and promote the participation of stakeholders. In common with other countries, Spain needs to clarify the role of cost-effectiveness criteria. Further progress needs to be made to coordinate effort across the various agencies, strengthen technical staff, and ensure equitable access to medicines between regions.     

Non-malignant occupational respiratory diseases in Germany in comparison with those of other countries

Objective: To present recent data on the occurrence of non-malignant occupational airway diseases in Germany and to compare mainly affected occupations of obstructive airway diseases caused by allergens and irritants with available surveillance data from other countries. Methods: Sources of German data were statistics for the year 2003 of the Ministry of Labour and Social Affairs and of the federation of statutory accident insurance institutions for the industrial sector. Results: Confirmed cases of non-malignant occupational respiratory diseases in Germany are mainly benign asbestos-associated diseases (occupational disease no. 4103: 1,975 cases), silicosis/coal workers pneumoconiosis (occupational disease no. 4101: 1,158 cases), obstructive airway diseases due to allergens (occupational disease no. 4301: 935 cases), chronic obstructive bronchitis and/or emphysema in hard coal miners (occupational disease no. 4111: 414 cases), obstructive airway diseases due to irritants and toxic agents (occupational disease no. 4302: 181 cases), diseases caused by ionising radiation (171 cases), diseases due to isocyanates (occupational disease no. 1315: 55 cases), and 22 cases of other rare occupational lung and airway diseases. Miners, bakers, chemical workers, hairdressers and health care workers are mostly affected. Bakers were also frequently affected by occupational asthma in Finland, France, Sweden, the United Kingdom, the Piedmont region in Italy, South Africa, and New Zealand. Further, high frequencies of occupational asthma were reported for health care workers in France, Italy, New Jersey, Michigan, and South Africa. Conclusion: Despite completely different legal definitions and regulations, comparably high numbers of occupational obstructive diseases in western countries require better primary and secondary prevention in industries with high incidence, especially in bakeries, the health care sector, farming, and mining. Furthermore, there is a urgent need for harmonization of recognition and compensation systems for occupational diseases as well as of respective preventive strategies within the European Union.     

The Effects of Female Genital Mutilation on the Onset of Sexual Activity and Marriage in Guinea

Female genital mutilation (FGM) is almost universal in Guinea and practiced by all ethnic and religious groups and social classes, although the prevalence of the various types of FGM varies by socioeconomic group. A common explanation for FGM practices is that they contribute to the social control over female sexuality and enhance the marriageability of women. These claims were tested using the 1999 Guinea Demographic and Health Survey (DHS) (N = 6753). Event history techniques were used to examine the effect of type of FGM on the age at first sex and the age at first marriage and logistic regression for the effect of FGM on premarital sex. The results showed that the type of FGM had a significant zero-order effect on the age at first marriage and the prevalence of premarital sex, but not on the age at first sex. However, these effects became non-significant once controls for age, religion, ethnicity, education, residence, and wealth were added to the model. Variations in sexual behavior, therefore, were unrelated to type of FGM, but reflected differences in the social characteristics of the participants.     

Female Genital Mutilation/Cutting in the United States: Updated Estimates of Women and Girls at Risk, 2012

Objectives

In 1996, the U.S. Congress passed legislation making female genital mutilation/cutting (FGM/C) illegal in the United States. CDC published the first estimates of the number of women and girls at risk for FGM/C in 1997. Since 2012, various constituencies have again raised concerns about the practice in the United States. We updated an earlier estimate of the number of women and girls in the United States who were at risk for FGM/C or its consequences.

Methods

We estimated the number of women and girls who were at risk for undergoing FGM/C or its consequences in 2012 by applying country-specific prevalence of FGM/C to the estimated number of women and girls living in the United States who were born in that country or who lived with a parent born in that country.

Results

Approximately 513,000 women and girls in the United States were at risk for FGM/C or its consequences in 2012, which was more than three times higher than the earlier estimate, based on 1990 data. The increase in the number of women and girls younger than 18 years of age at risk for FGM/C was more than four times that of previous estimates.

Conclusion

The estimated increase was wholly a result of rapid growth in the number of immigrants from FGM/C-practicing countries living in the United States and not from increases in FGM/C prevalence in those countries. Scientifically valid information regarding whether women or their daughters have actually undergone FGM/C and related information that can contribute to efforts to prevent the practice in the United States and provide needed health services to women who have undergone FGM/C are needed.In 1997, Public Health Reports published the first U.S. estimates of the number of women and girls in the United States in 1990 (hereafter referred to as the 1990 estimates) who were at risk for female genital mutilation/cutting (FGM/C).¹ That study was conducted at the request of the U.S. Congress, which passed legislation making FGM/C illegal in the United States. Since 2012, various constituencies have again raised concerns about the practice of FGM/C in the United States.^2–6 New estimates are needed because of substantial growth in the immigrant population of the United States in recent decades and the need to support additional policies to reduce the occurrence of FGM/C.We updated the 1990 estimates of the number of women and girls in the United States who were at risk for FGM/C. We report only the number of women and girls at risk for FGM/C and do not estimate the number of women and girls who have actually undergone the procedure.     

对欧美国家医疗器械管理模式的探讨与分析

通过介绍美国医疗器械监管机构即美国食品药品管理局(FDA)和欧盟在医疗器械领域的三个指令即《有源植入性医疗器械指令》(AIMDD)、《医疗器械指令》(MDD)和体外诊断器械指令(IVDD)具体的监管方法,与中国医疗器械监管体系进行比较和分析,提出一些建议和启示。     

Smoking among nurses in Turkey: comparison with other countries

The purpose of this study was to obtain baseline information on smoking among nurses. An attempt was made to contact, in person, all 301 nurses working for the university hospital in Sivas, Turkey, and when contacted they were asked to complete an anonymous questionnaire. Each unit of the hospital was visited three times, and 239 (79%) nurses were reached who all completed the questionnaire. Of the 239 respondents, 107 (45%) were current smokers, reflecting a substantially higher prevalence compared to that among the adult female population. The quit ratio was 22.5%. Of 127 ever-smoker nurses who responded to the related item, 90% started smoking during or after nursing education. This pattern of smoking initiation was different from the pattern in developed countries where nurses had already started smoking before beginning that training. Nurses with a high school education had a significantly higher prevalence of ever-smoking. Most respondents frequently or sometimes saw doctors smoking in rooms for nurses and in rooms for doctors in inpatient services. In-depth qualitative studies are needed to determine the reasons for the different smoking-initiation pattern.     

Lead in drinking water of Vienna in comparison to other European countries and accordance with recent guidelines

Due to the decrease of lead intake via inhalation route, the oral route, particularly from drinking water in cities with lead installations, gains relative importance. In two surveys a total of 288 objects were investigated and 1768 samples were analysed. The first series with 51 objects using a field experimental approach systematically investigated the effects of daytime, floor and flushing. Because only objects built before 1945 and suspected of lead plumbing were chosen, the first series approaches worst case conditions. The second series investigating 237 randomly chosen objects stratified according to time of consumption should allow inferences about the present situation in Viennese households. Each sampling procedure comprised one sample without flushing and three further samples with flushing of 1 l, 3 l and 10 l, respectively. Statistically significant decreases occurred between these flushing conditions. The sampling data of the upper floors showed significantly higher lead contents compared to the lower floors, which indicates that house installations are the main causes of lead contamination in Viennese drinking water. In comparison to other European countries the percentage of samples exceeding the guideline levels (50 micrograms/l as current value and 10 micrograms/l as target value) was lower.     

Water pollution in the USSR and other Eastern European countries

The condition of water bodies and measures taken to prevent their pollution in the USSR, Czechoslovakia, Poland, Bulgaria and Romania are the main subjects of this paper. For each of these countries information is given on population and area, physical features, rain-fall and rivers, the distribution of population and industry, water supply and sewerage, the condition of surface and ground waters, the authorities and legislation concerned with the protection of water resources, and research on pollution.     

Birth weight and perinatal mortality: a comparison of "optimal" birth weight in seven Western European countries

BACKGROUND: Previous studies have suggested that a population's entire birth weight distribution may be shifted towards higher or lower birth weights, and that optimal birth weight may be lower in populations with a lower average birth weight. We evaluated this hypothesis for seven western European countries. METHODS: We obtained data on all singleton births (N = 1,372,092) and extended perinatal deaths (stillbirths plus neonatal deaths; N = 7,900) occurring in Finland, Sweden, Norway, Denmark, Scotland, the Netherlands, and Flanders (Belgium) in 1993-1995. We assessed whether countries differed in the mode of their birth weight distribution and in the birth weight associated with the lowest perinatal mortality, and then correlated the two. RESULTS: Substantial international differences were found in the mode of the birth weight distribution, which ranged between 3384 gm in Flanders and 3628 gm in Finland. The position of the minimum of the perinatal mortality curve also differed considerably, ranging between 3755 gm in Flanders and 4305 gm in Norway. There was a strong relation between the two: for every 100 gm increase in modal birth weight, optimal birth weight was 170 gm higher (95% confidence interval = 104-236 gm). CONCLUSIONS: Our results confirm those of previous studies that compared two populations. To improve the identification of small babies at high risk of perinatal death, population-specific standards for birth weight should be developed and used.     

Treatment of patients with acute coronary syndromes in the Netherlands in 2000-2001; a comparison with other European countries and with the guidelines

OBJECTIVE: To determine whether the guidelines for the management of acute coronary syndrome (ACS) are being applied in daily clinical practice, and in what ways the management differs between the Netherlands and other member countries of the European Society of Cardiology (ESC). DESIGN: Prospective, observational study. METHOD: Patients with a confirmed diagnosis of ACS who were enrolled in 6 Dutch hospitals and in 97 hospitals in 24 other ESC member countries in the period from 4 September 2000 to 15 May 2001 were included. Data were collected on the acute treatment and secondary prevention in patients with ST-elevation and on the pharmacotherapy, risk stratification and secondary prevention in patients without ST-elevation. The findings were compared with the recommendations and guidelines of the ESC. RESULTS: A total of 223 patients with ST-elevation and 198 patients without ST-elevation were enrolled in the Netherlands, plus 4208 and 5169 patients, respectively, in the other European countries. The median age was 64-67 years and the percentage of males was 64-73. Of the patients with ST-elevation who arrived in the hospital within 12 hours after the onset of symptoms, 35% received neither thrombolysis nor primary percutaneus coronary intervention. In both the Netherlands and the rest of Europe, half of the ST-elevation patients received thrombolysis later than 40 minutes and primary percutaneous coronary intervention later than 90 minutes after arrival in the hospital. Risk stratification using troponin measurements was applied more often in the Netherlands. Of the high-risk patients without ST-elevation, over 50% in both the Netherlands and the rest of Europe underwent coronary angiography. Almost 70% and 80% of low-risk, non-ST-elevation patients underwent an exercise tolerance test or coronary angiography. In the Netherlands, clopidogrel, glycoprotein IIb/IIIa antagonists and statins were prescribed more often and ACE inhibitors less often. CONCLUSION: Guidelines for the management of ACS were followed to a moderate extent in both the Netherlands and the rest of Europe. The management differed in a number of ways between the Netherlands and the other countries.     

The burden of mortality from smoking: Comparing Sweden with other countries in the European Union

We describe the mortality currently attributable to smoking in the European Union (EU), and the change that would result if all EU countries had the smoking prevalence of Sweden. Almost 500,000 smoking-attributable deaths occur annually among men in the EU; about 200,000 would be avoided at Swedish smoking rates. In contrast, only 1100 deaths would be avoided if EU women smoked at Swedish rates. The low smoking-related mortality among Swedish men probably is due to their use of snus (Swedish smokeless tobacco).