A prospective population based study of childhood injuries: the Velestino town study

BACKGROUND: Unintentional injuries in childhood constitute a significant public health problem. Our purpose is to estimate the incidence of identifiable unintentional childhood injuries of any type and severity, and to document risk factors of non-transient nature. METHODS: We have undertaken a prospective population-based investigation in a Greek town with a population of 748 children (0-14 years old). All identifiable injuries have been monitored during a twelve-month period through information provided by the health care outlets or educational institutions as well as the police station and the regional hospital. RESULTS: The overall incidence was 28.2 per 100 person-years (95% confidence interval from 24.4 to 32.0), whereas the incidence of injuries with Hopkins Injury Severity Score equal to or higher than four was 6.3 with 95% confidence interval 4.5 to 8.1. The incidence of total injuries was higher among boys than among girls (p<0.01) and the gender difference was particularly evident among older children. Almost half of the injuries were due to falls and more than 20% were due to cutting. Children of younger and less educated parents have higher risk for injury and children from families with more injuries were more likely to be injured themselves. There was no evidence that somatometric characteristics were associated with injury risk. CONCLUSION: The incidence of unintentional childhood injuries is high and represents a considerable health burden. Family related variables are important risk factors for childhood injuries, whereas somatometric characteristics play a minimal role. Key points: Incidence and risk factors of all injuries in a population-based study among children. About 28 per 100 children got injured over a period of one year. There is evidence that younger paternal age and lower education may be associated with increased injury risk. Family related variables seem to be important risk factors for childhood injuries, whereas somatometric characteristics play minimal role.     

Job stress, absenteeism and coronary heart disease European cooperative study (the JACE study): Design of a multicentre prospective study

Background: The motives, objectives and design of a multicentreprospective study on job stress, absenteeism and coronary heartdisease in Europe (the JACE study) is presented in this paper.Some specific gaps in the reviewed literature are explicitlytapped into by the JACE study. Its objectives are i) to comparethe distributions of the Karasek job stress scales for the samebroad categories of occupations in different European countries(in males and females), ii) to study the predictive power ofthe job stress scales and the job strain model for one yearof sickness absence (in males and females) and iii) to studythe predictive power of the job stress scales and the job strainmodel for a three year incidence of coronary heart disease (Inmales only). Methods: In answering these questions, relationsare studied controlling for gender, age, level of education,company size, physical work risks and shift work, as well astraditional risk factors for CHD (i.e serum cholesterol, serumHDL cholesterol, smoking habits and blood pressure). The JACEstudy is a Biomed 1 concerted action. The JACE group consistsof eight participating centres from six countries, i.e. fromBelgium and Sweden (two centres), France, Italy, Spain, Swedenand The Netherlands (each one centre). The coordination of thegroup is in Brussels. The participating centres brought in over15, 000 European workers to test the hypotheses.     

总胆固醇与男性肺癌发病关系的前瞻性队列研究

目的 探讨基线TC与中国男性肺癌发病风险的关联及其强度。方法 自2006年5月,以开滦集团全体在职及离退休男性职工为调查对象,建立开滦集团男性动态队列并随访。基线调查时收集研究对象的社会人口学、个人疾病史、身体测量指标和TC等基线信息,并利用随访收集肺癌发病结局信息。参考《中国成人血脂异常防治指南》与研究人群TC分布特征,TC按照五分位数进行分组：<160、160～、180～、200～、≥240 mg/dl,以TC 160～mg/dl组为参比组,利用Cox比例风险模型分析基线TC与男性肺癌发病风险的关联性、限制性立方样条曲线分析其非线性关系。结果 截至2014年12月31日,109 884名男性进入队列,共计随访763 819.25人年,随访时间M=7.88年,收集肺癌新发病例808例。调整年龄、文化程度、收入、吸烟、饮酒、粉尘暴露史、FPG、BMI后,以160～mg/dl组为对照,TC偏低（<160 mg/dl）和TC升高（≥240 mg/dl）组男性肺癌发生风险分别升高34%（HR=1.34,95% CI：1.04～1.72）和45%（HR=1.45,95% CI：1.09～1.92）。剔除随访2年内肺癌新发病例及有高血脂病史者后,结果无显著变化。结论 TC与男性肺癌发生相关,TC过高或过低男性的肺癌发病风险均升高,保持适当的TC水平可能是预防和控制肺癌的有效措施之一。     

Antenatal HIV screening in Europe: a review of policies

BACKGROUND: The increased prevalence of HIV infection in women is leading to a rising number of children born to HIV-infected mothers. As therapeutic possibilities for HIV/AIDS increase, the detection of undiagnosed HIV infections in pregnant women, followed by adequate management, is of crucial interest. Therapeutic protocols are being updated and increasingly applied in most European countries, but there is no structured information on policies and strategies with regard to antenatal HIV screening as such. METHODS: In order to identify national policies with regard to antenatal HIV screening, a structured questionnaire was sent to key-informants within the ministries of health and national institutes for public health in each of the 25 EU Member States. RESULTS: Information was obtained from all EU Member States with the exception of Cyprus and Luxembourg. Eighteen countries issued a national policy with regard to antenatal HIV screening, 16 opted for a system in which HIV testing is offered to all women attending antenatal services while only two opted for selective screening. None of the 18 countries with a national policy supports a mandatory screening strategy. The voluntary testing strategies are of two types: opting in versus opting out. In almost all EU countries with antenatal HIV screening policies, screening conditions are defined. CONCLUSION: Policies are in place in most EU countries. Nevertheless, there is a need for more integrated European policies and region-specific recommendations on the performance of antenatal HIV screening as an opportunity for comprehensive HIV/AIDS service delivery. This would enable the different aspects of prevention to be linked and also address both the needs of pregnant women and mothers as well as that of their infants.     

Transferring community-based interventions to new settings: a case study in heart health cholesterol testing from urban USA to rural Australia

Health promoters wishing to successfully replicate community-basedheart health interventions from major research and demonstrationprograms, face numerous obstacles in the adoption process. Unfortunately,there is little specific literature to guide them through theprocess. A case study is presented to demonstrate that by closelyexamining differences between the resources and user settingsin terms of geography, socio-demography, policy, organizationalstructure and perceived goals, health promoters can identifyand avoid failure points. We examine the transfer and adaptionof a cholesterol intervention from Pawtucket Heart Health Programin urban USA to a rural setting in Australia and we recommenda series of five logical steps when considering such adoptions.Process data from the adapted intervention, North Coast CholesterolCheck campaign, indicates that it is as successful as its counterpartin the USA. The new intervention his itself become a model programin Australia. This success can be largely attributed to theconsiderable planning effort which made it possible to modifythe organizational structure to accept an innovative strategyand also to tailor the resource program for an ideal fit tothe new user setting.     

Associations between relative income and mortality in Norway: a register-based study

BACKGROUND: Current research on health inequalities suggests that not only an individual's absolute level of income but also his/her relative position in the income hierarchy could have health consequences. This study examines whether relative income was associated with individuals' mortality in Norway during the 1990s. METHODS: Data were formed by linkages of Norwegian administrative registers. This study analyses 1.68 million men and women (age group: 30-66 years) with disposable income (1993) in the range 60,000-210,000 Norwegian Kroner. Relative income was calculated as deviations in per cent from the median income in the surrounding residential area. The outcome variable was deaths in 1994-1999. Effects of relative income on mortality were estimated by multiple logistic regression analyses, separately in 13 narrow brackets of absolute income. Adjustments were made for sex, education, marital status, and other individual-level mortality predictors. RESULTS: Low relative income compared with the median in residential regions with populations above 20,000 inhabitants was associated with higher mortality among those with medium and lower absolute income. The excess risk increased progressively the lower the level of absolute income. Among those with higher absolute income, however, relative income was not associated with mortality. Moreover, when relative income was considered in relation to the median in small municipalities, almost no effect on mortality was observed. CONCLUSION: In Norway during the 1990s, having low relative income constituted an additional mortality risk among individuals with middle or lower absolute incomes and when relative income was calculated in relation to the average in medium-sized or larger regions.     

TG与高密度脂蛋白胆固醇对2型糖尿病发病影响的前瞻性队列研究

目的  评估TG、HDL-C及TG/HDL-C与2型糖尿病发病风险的关系。方法  以“金昌队列”基线调查中30 546名未患2型糖尿病者为研究对象,运用Cox比例风险回归模型、限制性立方样条法估计TG、HDL-C及TG/HDL-C对2型糖尿病发病风险及剂量-反应关系。采用受试者工作特征曲线评估其对2型糖尿病发病风险的预测能力,确定最佳预测指标及其临界值。结果  调整混杂因素后,在总人群中高TG、低HDL-C、高TG/HDL-C是2型糖尿病发病的危险因素,其发病风险比(hazard ratio, HR)分别为1.082(95% CI: 1.053~1.111, P < 0.001)、0.730(95% CI: 0.595~0.897, P=0.003)与1.061(95% CI: 1.038~1.085, P < 0.001),且均存在一定的剂量-反应关系。TG/HDL-C预测价值高于TG和HDL-C,其曲线下面积分别为0.652、0.646、0.600,最佳临界值为1.14、1.67 mmol/L、1.40 mmol/L。结论  高TG、低HDL-C及高TG/HDL-C是2型糖尿病发病的独立危险因素,TG/HDL-C对2型糖尿病发病的预测能力较强。     

Accelerated loss of FEV- in polyurethane production workers: a four-year prospective study

A four-year longitudinal study of ventilatory function in polyurethane-foam production workers exposed to toluene diisocyanate (TDI) revealed a dose-response relationship between average exposure to TDI and change in forced expiratory volume per second (FEV-1). Workers with mean exposure in excess of 0.0035 ppm showed a greater rate of decline of FEV-1 over the four-year period than that expected from aging. Factors other than TDI exposure (sex, smoking history, history of atopy) do not account for the loss. The current threshold limit value (TLV) for exposure to TDI in industry (0.02 ppm) does not protect workers from accelerated impairment of ventilatory capacity.     

Exploring the reasons for non-participation of women in a breast cancer screening campaign

Study objectives: to determine the reasons for non-participationin a programme of screening for breast cancer. Design: semi-structuredtelephone interview. Setting: a pilot programme of screeningby mammography, targeted at all women aged between 50 and 70years in two regions of Switzerland. Population: a sample of33 non-participants were interviewed. Main results: few non-participantstook advantage of the screening tests for female cancers. However,only one-quarter were determined never to have a mammography.The others did not participate because of organizational problems(one-quarter) or because they did not understand what a mammographyinvolved (half). Conclusions: there is considerable scope forincreasing the rate of participation. Efforts must be made toimprove the information directed at the socially less favoured(the objectives of the screening and the organizational arrangements).Family doctors are frequently consulted and are best placedto communicate this information. They should be encouraged toplay a much more active part in this respect.     

Predictors of disability pension in long-term sickness absence: results from a population-based and prospective study in Norway 1994-1999

BACKGROUND: While several socio-demographic predictors of disability pension (DP) have been identified, less is known about the importance of the medical aspects. METHODS: A representative sample of Norwegian long-term sickness absentees, 2043 women and 1585 men, with detailed diagnostic information based on the International Classification of Primary Care (ICPC) was followed up for 5 years. The date of granting DP was obtained from the Norwegian DP-register and used as the dependent variable in Cox multivariate regression analysis. Medical and socio-demographic factors were entered as explanatory variables. RESULTS: Kaplan-Meier estimates of the 5 year risk of DP were 22.9% for the full sample, 22.5% for men and 23.3% for the women. Men on sick leave for mental health disorders had an increased disability risk. Except for pregnancy-related cases, which carried a very low risk for future DP, there was no significant difference between the main diagnostic groups among women. Previous sickness absence increased the disability risk but was significant only for total absence above 20 weeks in the 4 years preceding inclusion. Age was the strongest predictor of future DP. Increasing income decreased the risk, bur not linearly. Unemployment status in the year preceding inclusion increased disability risk for women, but not for men. Among cases with musculoskeletal disorders (54.5% of the sample), subgroups with different disability risks were identified in Cox' regression analysis, with a gender-specific pattern. CONCLUSION: In addition to previously known socio-demographic predictors, medical variables were important in identifying sickness absentees with an increased risk of DP.     

Health screening among the elderly: A comparison between a postal questionnaire and a personal interview

We analysed answers to 2 types of survey instrument used inpreventive health care for the elderly: face to face interviewand a postal questionnaire. The response rate was high as wasthe answer rate for each item. More people answered the questionnairethan attended the health clinic. Some of the questions requireda graded evaluation which was not defined in detail and thisreduced the reliability. Screening via a questionnaire seemsto be well accepted among the elderly and the method seems suitablefor revealing information about health and social problems,but the formulation of some of the questions must be clearerto avoid different interpretations.     

Use of prenatal screening tests in Finland

This study examines the availability of prenatal screening testssuch as ultrasound, amniocentesis, chorionic villus samplingand serum screening in Finnish maternity care and estimatespossible future trends. In Finland, municipalities are responsiblefor organizing maternity care in their area. Questionnaireswere sent to a random sample of 100 municipalities (responserate 99%) and to all Finnish public hospitals with obstetricor gynaecological departments (response rate 100%). Ultrasoundscreening examinations and amniocentesis and chorionic villussampling were put into use in Finland as soon as they were technicallyavailable. These screening techniques have diffused widely andare accessible throughout most of the country. There existssome variation with regard to the timing and number of ultrasoundexaminations and to which age group amniocentesis and chorionicvillus sampling are offered. A tendency to decentralize prenatalscreening test locations, in particular in the case of ultrasound,was found. Most professionals were comfortable with currentscreening systems and, if some change was wished for, it mostoften was a wish to increase screening activity. Regardlessof many controversial issues, prenatal screening has becomean established practice in Finland.     

Socioeconomic status and health behaviour patterns through adolescence: results from a prospective cohort study in Norway

BACKGROUND: In this paper, we investigate cross-sectional and prospective relationships between various socioeconomic indicators and different health behaviours among boys and girls at ages 13-21, and whether socioeconomic status (SES) is related to changes in health behaviour over time. METHODS: The study is based on a 10-year, two-generation prospective cohort study of health and lifestyle factors among a sample of Norwegian adolescents and their parents. Data presented here were collected at the ages of 13 (baseline), 15, 18 and 21. Parental and adolescent reports of socioeconomic factors were assessed along with a number of health-enhancing and health-compromising behaviours, both as single behaviours and as part of health behaviour indices. RESULTS: Relatively few significant relationships are observed between parental occupation and adolescents' reported health behaviour when the latter is analysed as single behaviours. A significant, but weak, social gradient in health-enhancing behaviour is observed when measuring health behaviour as composite indices rather than single forms of behaviour. This is apparent both when applying parental SES variables or adolescents' own educational aspirations as proxy measures of their socioeconomic status. CONCLUSION: Future investigations of the presence of a social gradient in adolescent health behaviour should focus on composite measures of health behaviour. Further research is needed on potential mediating mechanisms behind the SES-health behaviour relationships in youth.     

Disparities in Cholesterol Screening: Falling Short of a National Health Objective

BACKGROUND: The objective of this study was to determine whether the Year 2000 national health objective for cholesterol screening was attained and to identify disparities in cholesterol screening across racial or ethnic and socioeconomic groups. METHODS: Using data from 149,692 persons interviewed by the 1999 Behavioral Risk Factor Surveillance System, we estimated the proportion of adults age > or =20 years who were screened for high blood cholesterol within the preceding 5 years. RESULTS: Overall, an estimated 70.8% of the U.S. population was screened for cholesterol, falling short of the Year 2000 objective of 75%. Screening prevalence was lowest at ages 20-44 years (58.2%), in contrast to ages 45-64 years (81.9%) and > or =65 years (87.1%). Screening prevalence was also low among Asian or Pacific Islanders (62.7%) and Hispanics (60.7%), particularly Hispanic men (55.3%). After multivariate adjustment, Asian Pacific Islanders were significantly less likely to be screened compared with white non-Hispanics (OR = 0.76, 95% CI 0.65, 0.89). The likelihood of screening decreased with decreasing income level (P < 0.05) and persons with health insurance were 1.6 times more likely to have been screened during the past 5 years than adults with no insurance (P < 0.05). CONCLUSIONS: Significant disparities in cholesterol screening exist across age, gender, racial or ethnic, and socioeconomic groups in the United States. As we look to attain the objectives of Healthy People 2010, state and local health officials and policy makers should be aware of these disparities in order to design and target effective cholesterol screening programs and cardiovascular disease prevention programs to those most in need.     

Compliance after 17 years of breast cancer screening: Factors associated with reattendance for periodic breast screening

The motives and reasons for regular attendance, irregular attendanceand drop-out were studied in women who were enrolled in a biennialbreast screening programme in 1975 and who were invited to eachsubsequent screening round until 1992. Three compliance groupswere compared: ‘attended all rounds’ (group A, n=79),‘missed 1 or 2 rounds’ (group B, n=73) and ‘missedmore than 2 rounds’ (group C, n=64). The groups did notdiffer with respect to background variables such as sociodemographiccharacteristics, actual health problems or preventive healthorientations, but significant differences were found in generalattitudes to breast screening and to the organizational aspectsof screening procedures. The results suggest that during thecourse of a screening programme, for a substantial group ofnot strongly motivated women, the recurring negative aspectsof mammography (pain and anxiety) are increasingly becominga burden. ‘Circumstantial factors’ like waitingfor one's turn, the distance to the screening centre and incidentaldissatisfaction with handling by screening staff, appear totrigger the decision to skip screening rounds or to drop outof the programme. From the perspective of maintaining a regularattendance throughout the programme this is an important group.Special efforts must be made to encourage these women to stayin the programme.     

Low-Density Lipoprotein Cholesterol and the Risk of Rheumatoid Arthritis: A Prospective Study in a Chinese Cohort

Objective: This study aimed to investigate whether low-density lipoprotein cholesterol (LDL-C) concentration was associated with the risk of rheumatoid arthritis (RA) in Chinese adults. Methods: The study included the 97,411 participants in the Kailuan Study without RA, with complete baseline LDL-C data, and who did not use lipid-lowering medications at baseline or during follow-up. We used Cox proportional hazards modeling to calculate the hazard ratio (HR) and 95% confidence interval (95% CI) of RA according to baseline LDL-C tertiles, adjusting for age, sex, body mass index, HDL-C, triglycerides, diabetes, hypertension, alcohol consumption, and smoking. We also calculated the HR and 95% CI of RA using updated LDL-C measurements prior to the end of follow-up, adjusting for covariates. Results: We identified 97 incident RA cases between 2006 and 2018. After adjusting for potential confounders, updated LDL-C concentration—rather than baseline LDL-C—was inversely associated with RA risk. The adjusted HR of RA was 0.64 (95% CI: 0.38, 1.09; p-trend = 0.10) comparing the two extreme baseline LDL-C tertiles, and 0.38 (95% CI: 0.22, 0.64; p-trend < 0.01) comparing the two extreme tertiles of the updated LDL-C concentrations. Conclusions: In this prospective study, high LDL-C concentrations, when measured closest to RA diagnosis or the end of follow-up, were associated with a low risk of RA. These findings highlight the changes in LDL-C prior to RA diagnosis, and the importance of including lipid analyses into studies of the pathogenesis of RA.     

The French breast cancer screening programme: Epidemiological and economic results of the first round of screening

This paper presents the epidemiological and economic resultspertaining to the first round of breast cancer screening programmesin France. Breast cancer screening is based within existingradiologic facilities in the private and public sector and on-goingcompetition exists between organized and spontaneous screening.The mean screening attendance rate was 36.7%, the mean recallrate was 10.4%, the positive predictive value (PPV) for thescreening test 5.8% and the biopsy rate 1.2%. There were 5.1carcinomas detected per 1,000 women screened. Of these, 30.7%were smaller than 10 mm in diameter and 69.0% had no nodal involvementA retrospective resource-based cost analysis revealed a meancost of US$63 per woman screened. This cost includes all directprogramme costs excluding diagnostic testing and treatment costs.Organizational as opposed to technical aspects of screeningaccounted for 38% of this cost in the first round. These resultsreveal discrepancies in the quality, cost and estimated efficacybetween the district programmes during the first screening round.Overall, epidemiological indicators reach European target values,with the exception of a low PPV for both the screening testand biopsy. In addition to the strict adherence to quality controland interpretation protocols, the shift of French women awayfrom individual screening practices towards organized screeningbehaviour will be necessary to enable the French breast cancerscreening programmes to reach their optimal efficacy.     

Economic evaluation of a mammography-based breast cancer screening programme in Spain

The aim of the study was to perform a cost-effectiveness analysisof a breast cancer (BC) mammography screening programme, comparedto a do-nothing alternative, In Spain. Screening consisted ofa biennial mammography performed on all women 50–65 yearsold. A marginal analysis including women 45–49 years oldwas also performed. With the aid of a decision tree model, thenumbers of BC cases diagnosed through screening, BC cases missedby screening and false-positive BC cases were calculated. Costswere calculated by feeding local data into Markovian modelsand the cost-effectiveness ratio calculation was performed ina computer spread sheet. A sensitivity analysis was also conducted.Results were presented in ECUs of 1993. The cost-effectivenessratio per avoided death is 115,500 ECUs and per saved life year7,300 ECUs. Including women 45–49 years old in the programmeraises this ratio to 229,000 and 9,400 ECUs respectively. Thesensitivity analysis showed the efficacy of mammography, complianceof the programme and screening costs to be the more sensitivevariables.     

总胆固醇与2型糖尿病关联性的前瞻性队列研究

目的  探讨总胆固醇与2型糖尿病(type 2 diabetes, T2DM)发病的关系。 方法  筛选20~90岁入队列时未患糖尿病并且体检次数≥2次者, 应用t检验或χ²检验比较有无发生T2DM两组人群基线特征, 按总胆固醇四分位数由低到高划分4组(2.10~mmol/L组、4.16~mmol/L组、4.76~mmol/L组和5.42~13.29 mmol/L组), 应用广义估计方程(generalized estimating equation, GEE)分析总胆固醇对2型糖尿病发病的影响。 结果  此队列共纳入12 928人, 共随访45 626人年, 平均随访时间为3.53年。随访期间, 新发T2DM患者447人, 发病密度为9.80‰, 随着总胆固醇水平增高, T2DM高发病密度呈上升趋势, 在多因素GEE分析中, 调整年龄、高密度脂蛋白、是否患高血压、是否肥胖后, 以2.10~mmol/L组为参照, 4.16~mmol/L组、4.76~mmol/L组和5.42~13.29 mmol/L组的相对危险度(relative risk, RR)值分别为1.24(95%CI:0.83~1.86)、1.75(95%CI:1.19~2.56)、3.60(95%CI:2.51~5.17)。 结论  总胆固醇与T2DM存在相关性, 随着总胆固醇水平的上升, 发生T2DM的危险性逐渐增大。