Welfare state regimes,health and health inequalities in adolescence: a multilevel study in 32 countries

Comparative research on health and health inequalities has recently started to establish a welfare regime perspective. The objective of this study was to determine whether different welfare regimes are associated with health and health inequalities among adolescents. Data were collected from the ‘Health Behaviour in School‐aged Children’ study in 2006, including 11‐ to 15‐year‐old students from 32 countries (N = 141,091). Prevalence rates and multilevel logistic regression models were calculated for self‐rated health (SRH) and health complaints. The results show that between 4 per cent and 7 per cent of the variation in both health outcomes is attributable to differences between countries. Compared to the Scandinavian regime, the Southern regime had lower odds ratios for SRH, while for health complaints the Southern and Eastern regime showed high odds ratios. The association between subjective health and welfare regime was largely unaffected by adjusting for individual socioeconomic position. After adjustment for the welfare regime typology, the country‐level variations were reduced to 4.6 per cent for SRH and to 2.9 per cent for health complaints. Regarding cross‐level interaction effects between welfare regimes and socioeconomic position, no clear regime‐specific pattern was found. Consistent with research on adults this study shows that welfare regimes are important in explaining variations in adolescent health across countries.     

Effect of workup strategy on the cost-effectiveness of fecal occult blood screening for colorectal cancer

Physicians respond to a positive fecal occult blood test with a variety of workup strategies. To study the effect of the choice of strategy on the net costs and health benefits of colorectal cancer screening using this test, we used a decision analysis model to compare seven strategies that physicians might choose to examine a positive "screenee." Strategies using rigid or flexible sigmoidoscopy alone are not only insensitive, but also have high cost-effectiveness ratios. The strategy of air contrast barium enema alone had the lowest cost-effectiveness ratio. Rigid sigmoidoscopy combined with barium enema had a lower cost-effectiveness ratio than primary colonoscopy, but the strategy of primary colonoscopy could have an equal or better ratio depending on assumptions about test costs and the benefit of removing benign polyps. The primary colonoscopy strategy is both more effective and less costly than the combination of flexible sigmoidoscopy and barium enema. The optimal strategy will vary with local factors, and with the perspective of the decision-maker.     

Endoscopic biopsy is diagnostic in gastric antral vascular ectasia

Gastric antral vascular ectasia was endoscopically diagnosed in seven patients. Pathologic characteristics of this entity were defined retrospectively, by studying endoscopic pinch biopsy slides from these seven patients and antrectomy specimens from five patients. A scoring system was developed, and the seven patients were compared prospectively with various control groups. Abnormalities of mucosal vessels (fibrin thrombi and/or ectasia) consistently distinguished patients from control antrectomies, normal biopsies, acute gastritis biopsies and atrophic gastritis biopsies (P=0.02, all comparisons). Spindle cell proliferation into mucosa also was characteristic of gastric antral vascular ectasia, distinguishing this disease from normals, acute gastritis, and atrophic gastritis (P0.039, each comparison). The presence of abnormal mucosal vessels (fibrin thrombi and/or ectasia) and spindle cell proliferation was similar in patient antrectomies compared to patient endoscopic biopsies. Therefore, we conclude that endoscopic biopsies can reliably diagnose gastric antral vascular ectasia, a vascular disorder characterized by abnormal mucosal vessels and spindle cell proliferation.     

Effect of acupuncture in patients with angina pectoris

Twenty-one patients with stable effort angina pectoris were randomized in a crossover study to 4 weeks traditional Chinese acupuncture or placebo tablet treatment. The patients had at least five anginal attacks per week in spite of intensive treatment. Acupuncture was given three times per week at main points Neiguan (Pericardium 6), Tongli (Heart 5), Xinshu (Urinary Bladder 15), Pishu (Urinary Bladder 20) and Zusanli (Stomach 36). Previous antianginal treatment remained unchanged during the whole study. During the acupuncture period, the number of anginal attacks per week was reduced from 10.6 to 6.1 compared with placebo (P less than 0.01). Accordingly, the performance before onset of pain during exercise test increased from 82 W to 94 W (P less than 0.05). However, maximal performance did not increase after acupuncture. Intensity of pain at maximal workload decreased from 1.4 to 0.8 (scale 0-4, P less than 0.01). Further, ST-segment depressions at maximal comparable load decreased from 1.03 to 0.71 mm after acupuncture (P less than 0.01). A life quality questionnaire confirmed improved feeling of well-being. Thus, acupuncture showed an additional beneficial effect in patients with severe, intensively treated angina pectoris.     

Cytogenetic studies in patients with secondary leukemia/dysmyelopoietic syndrome after different treatment modalities

Cytogenetic studies of 68 patients who developed secondary leukemia (SL)/dysmyelopoietic syndrome (DMS) after extensive chemotherapy and/or radiation therapy as well as patients who developed SL/DMS without such treatment showed that those patients who received radiation alone or with chemotherapy had more extensive numerical and structural abnormalities than those who received only chemotherapy. In terms of the specific chromosomal abnormalities, there are no differences between the various treatment groups. Hypodiploidy is the most common form of aneuploidy in these patients, with the most common numerical abnormality being the loss of chromosome 7. The most common structural abnormalities involved chromosomes 3 and 5. When compared with patients with de novo leukemia and DMS, the chromosomal abnormalities in these patients are more complex and extensive. Serial studies revealed that cytogenetic abnormalities do not precede the development of hematologic changes by significant time periods.