Background: Preterm birth is a rising health problem in Europe generally, and in Austria specifically. Decision makers require objective information on the effects and costs of measures to prevent preterm birth. Methods: We undertook a budget impact analysis from a public payer perspective and for a 1-year and 5-year time horizon for five prevention approaches to reduce preterm birth. These were cervix screening + progesterone application, progesterone injection, smoking cessation, fish oil supplementation and infection screening. We analysed affordability in terms of programme costs and potential cost savings. Results: Programme costs range from below 50 000 (cervix screening in high-risk pregnancy) to 500 000 (universal infection screening). The lowest health effects have been shown for smoking cessation programmes (–10 preterm births per year), whereas infection screening demonstrated the largest effect (–230 preterm births per year). In the base-case analysis, all programmes are potentially cost saving (–500 000 to –13 million per year). In the sensitivity analyses, preterm birth costs, target group size and (partly) unit costs of programme components have an influence on potential cost savings. However, except for two programmes, the results are robust concerning an overall economic net benefit of the programmes analysed compared with no programme. The study is mainly limited by the quality of some cost data and choice of the reference scenario. Conclusion: When considering potential cost savings, the five prevention programmes analysed seem affordable, with cervix screening and infection screening likely being the most promising in Austria.
Background: Behaviour and related health outcomes of migrants have been suggested to shift towards the practices of the indigenous population of the host country. To investigate this, we studied generational differences in sexual behaviour between first- and second-generation migrants (FGMs and SGMs) in The Netherlands. Methods: In 2003–05, persons aged 16–70 years with origins in Surinam, the Antilles and Aruba were interviewed on their sexual behaviour in The Netherlands and their country of origin. The relationship of generation, age at migration and sexual behaviour was studied by multinomial logistic regression analyses. Results: Generational differences were observed regarding concurrent partnerships, anal sex and history of sexually transmitted infection. Compared with FGMs who migrated at an age >25 years, those who migrated between 10 and 25 years of age were more likely to report concurrency [odds ratio (OR): 1.52, 95% confidence interval (CI): 1.14–2.04], whereas SGMs were less likely to report concurrency (OR: 0.65, 95% CI: 0.43–0.98). FGMs who migrated before the age of 10 were more likely to have had anal sex (OR: 1.90, 95% CI: 1.34–2.71) or a sexually transmitted infection diagnosis (OR: 1.80, 95% CI: 1.20–2.71) than those who had migrated at >25 years of age. Conclusion: Our study shows that not only SGMs but also FGMs who migrated at an early age tend to differ from the sexual patterns of FGMs who migrated at an older age. Generational differences in sexual behaviour could be explained by acculturation and increased identity with the values of the host country.
Background: The burden of cardiovascular diseases (CVDs) is much more pronounced in Eastern Europe, a spatial gradient within Europe still exists. However, former studies showed a significantly lower CVD mortality of German repatriates from the Former Soviet Union compared with the German population. Methods: All-cause, CVD and ischemic heart disease (IHD) standardized mortality ratio (SMR), IHD standardized incidence ratio and annual age-standardized mortality and acute myocardial infarction (AMI) incidence rates were calculated in a retrospective cohort. Time trends were investigated by loess regression. Results: A total of 6378 German repatriates were observed from 1990 to 2010, accumulating 92 149 person-years. We observed a lower all-cause mortality [SMR = 0.86 (0.75, 0.98)] in females and CVD mortality [International Statistical Classification of Diseases and Related Health Problems, version 10 (ICD) 10: I00–I99; SMR = 0.82 (0.65, 1.03)] and IHD mortality (I20–I25) [SMR = 0.84 (0.60, 1.15)] in males. In contrast, AMI incidence was significantly higher in male repatriates [standardized incidence ratio = 1.30 (1.02, 1.65)]. Whereas in the general population, mortality rates of CVD, IHD and AMI incidence have continuously decreased over time, the pattern in the repatriates was not as clear. In male repatriates, mortality rates seemed to be lower after immigration and remained rather constant. Incidence rates possibly exceed Germans rates by now. Conclusions: A possible historical repatriates’ IHD advantage shown in former studies has disappeared. The increasing AMI incidence in (male) repatriates might demonstrate the delaying onset of the impact of changes in the CVD risk profile due to migration. Health politics and the health system should be sensitized and take care of the development of IHD mortality and AMI incidence among the repatriates.
Background: Smoking during pregnancy has been declining in the past decades in high-income countries, including Sweden. Paradoxically, increasing trends associated with duration of residence have been reported among immigrants. We aimed to clarify how these two contrasting trends have shaped smoking patterns among immigrants. Methods: We conducted a population-based study of 1 598 433 pregnancies in Sweden in the period 1992–2008. We used multinomial logistic regression to estimate the odds of mild and heavy smoking relative to no smoking associated with year of delivery, years since migration, maternal region of birth and their interaction, after controlling for potential confounders. Results: The prevalence of smoking decreased for the Swedish-born and for immigrants during the study period. Among immigrants, duration of residence was independently associated with increases in smoking and varied according to maternal region of birth (P-value for interaction <0.001). The odds ratio associated with a 10-year increase in duration of residence was weakest for mild smoking among former Yugoslav women (adjusted odds ratio; 95% confidence interval: 1.10; 1.04–1.17) and those from other Nordic countries (1.22; 1.17–1.26) and strongest for heavy smoking among East African (4.46; 3.23–6.16) and sub-Saharan African (3.56; 2.68–4.72) women. The association between duration of residence and smoking was attenuated after stratifying by cohorts of arrival among European but not among non-European immigrants. Conclusions: Declines in smoking during pregnancy among immigrants from various regions of the world were differentially affected by opposite increasing trends throughout their residence in Sweden.
Background: Manganese (Mn) is an essential element and a potential toxicant for developing organism. Deficiency and excess of it were both deleterious to fetal growth in experimental animals. However, literature on relationship between Mn status and birth outcome in humans is sparse. Methods: Mn concentrations were measured in mother whole blood (MWB) and umbilical cord blood (UCB) in 125 pairs of mother–infant; birth size was examined and relationship between them was analysed. Potentially environmental factors influencing Mn loads in maternal and fetal organisms were investigated through epidemiological method. Results: Mn level in UCB was significantly higher than that in MWB (mean value: 54.98 vs. 78.75 µg/L), and a significant positive correlation was shown between them. There was a quadratic curvilinear (inverted U-shaped curve) relationship between MWB Mn and birth size, and between UCB Mn and birth size. Both univariate analysis and multiple linear regression analysis showed that exposure to harmful occupational factors during gestation remarkably increased maternal and fetal Mn levels. Living close to major transportation routes (<500 m) also increased the MWB Mn levels. Conclusion: Our results suggested that lower or higher Mn level in maternal and umbilical blood may induce adverse effect on birth size in humans. In addition, increased levels of Mn in MWB or UCB may be associated with exposure to some environmental hazard factors.
Background: The social disparity in perinatal mortality may vary by the age of the offspring. We studied offspring mortality from pregnancy week 16 until 1 year after birth by maternal educational level. Methods: We included all births in Norwegian women during the years 1999–2004 (n = 297 663). The Medical Birth Registry of Norway was linked to the Norwegian Education Registry to obtain individual information on maternal education at the time of delivery. Information on infant mortality was obtained by linkage to the Norwegian Central Person Registry. Results: In pregnancy weeks 37 through 43 and in the first week after birth, there was little difference in offspring mortality by maternal education. Before pregnancy week 37, the excess offspring mortality associated with compulsory school only was >60% using university/college education as the reference. During the 2nd through 12th month after birth, the excess mortality was 132% in offspring of mothers with compulsory school only. Conclusion: The social disparity in offspring mortality was lowest in pregnancies at term and in the first week after birth. In this period, all women living in Norway and their infants use the public health care service extensively. Our results may suggest that health care that is equally available to all citizens, reduces social disparities in mortality.
Objectives: To describe the pattern and determinants of working during pregnancy in rural China. Methods: A cross-sectional survey was carried out in 2009 in three provinces (Anhui, Chongqing and Shaanxi) in rural China among 3966 mothers who had recently given birth. Multilevel logistic regression was used to examine the determinants of work behaviour during pregnancy. Results: Overall, 39% of the women stopped working during early pregnancy, 32% worked the same throughout pregnancy and the rest decreased their work or stopped later in pregnancy. Women from Anhui (53%) and Chongqing (54%) provinces were more likely to stop work in early pregnancy than women from Shaanxi province (20%). Older women [odds ratio (OR) 0.74, 95% confidence interval (CI) 0.56–0.99], those having two or more children (OR 0.55, 95% CI 0.43–0.69) and non-farmers (OR 0.50, 95% CI 0.65–0.99) were less likely to stop working on the first trimester, but those with higher education (high school OR 1.43, 95% CI 1.05–1.94) were more likely to stop working. Stopping work early was not related to household income and adequacy of prenatal care. Women with two or more children, non-farmers and those from Shaanxi province were more likely to continue to work to the same extent during pregnancy. But those with higher household income and middle and high school were less likely to work the same. Conclusions: Women’s working patterns during pregnancy in rural China were polarized: many women stopped working already in early pregnancy, but others continued to work as before. The key determinant of the working patterns was the province of residence.
Background and objectives: The socioeconomic position of women who have an induced abortion has been explored extensively, but without taking contextual factors into account. The objective was to describe socioeconomic inequalities in the rate of induced abortion in Spain in 2001, jointly evaluating the effects of both regional and individual socioeconomic characteristics. Methods: A cross-sectional study using a multilevel approach was carried out among women who were resident in Spain in 2001, considering the hierarchical structure of relevant factors. Analyses were carried out at the individual and regional level. We fit Poisson regression models to calculate adjusted relative risks (aRR) of induced abortion and 95% confidence intervals (CIs). Results: The estimated abortion rate was 6.26 per 1000 women aged 20–49 years. Induced abortion was more frequent among younger women (aRR = 1.55 for women aged 20–24 years, compared with those aged 25–34 years) and those with less than primary education (aRR = 2.25 compared with women with university studies). Women residing in regions with lower public spending on non-university education (aRR = 0.83, 95% CI: 0.70–0.98) and a higher percentage of non-European Union immigrants (aRR = 1.06, 95% CI: 1.02–1.10) were also more likely to have had an induced abortion. Conclusions: Socioeconomic inequalities in the practice of induced abortion in Spain exist not only at the individual level but also at the regional level. The prevention of unintended pregnancy should be approached using a global political strategy aimed at changing contextual and individual factors that contribute to unintended pregnancy.
Objectives: In addition to individual-level characteristics also contextual factors may contribute to the large regional variation seen in disability retirement. We examined the associations of municipality-level characteristics and disability retirement due to all causes, musculoskeletal diseases, mental disorders and other diseases. Methods: A register-based study was conducted with a 20% random sample of the Finnish population aged 25–62 years. Municipalities were separately divided into quintiles by their proportion of manual workers, unemployed and industrial employees. Multilevel Poisson regression analysis was applied to examine associations between the three municipality characteristics and disability retirement during a 5-year follow-up. Results: All three municipality-level indicators were associated with disability retirement, but the association between the proportion of industrial workers and disability retirement disappeared after adjustment for age, gender, marital status, socioeconomic position, unemployment and industrial employee status at the individual level. The associations were particularly strong for disability retirement due to musculoskeletal diseases: in the municipalities with the highest proportion of manual workers, the risk for disability retirement due to musculoskeletal diseases was 2.5 times higher than in the municipalities with least manual workers. After adjustment for the individual-level factors, the risk was 1.5 times higher. Cross-level interactions showed that the risk of disability retirement increased with the increasing proportion of unemployment in the municipality only among those who had not experienced unemployment themselves. Conclusions: Municipality-level characteristics made an independent contribution to the probability of disability retirement in particular due to musculoskeletal diseases. Also, area-level characteristics should be considered when targeting disability retirement.
Background: In the context of an European Centre for Disease Prevention and Control (ECDC) research project, our objective was to describe current recommendations regarding HIV testing and counselling targeting migrants and ethnic minorities in the European Union/European Economic Area/European Free Trade Association (EU/EEA/EFTA) Member States. Methods: An on-line survey was conducted among 31 EU/EEA/EFTA Member States. The survey inquired on the existence of specific HIV testing and counselling recommendations or policies for migrants and/or ethnic minorities and the year of their publication. Additionally, we performed a review of national recommendations, guidelines or any other policy documents retrieved from an Internet search through the different countries’ competent bodies. Results: Twenty-nine (94%) country representatives responded the survey, and 28 documents from 27 countries were identified. National guidelines on HIV testing are heterogeneous and tailored, according to the epidemiological situation. Twenty-two countries identify migrants and four countries identify ethnic minorities as particularly vulnerable to HIV. Sixteen countries explicitly recommend offering an HIV test to migrants/ethnic minorities. Guidelines especially target people originating from HIV endemic countries, and benefits of HIV early detection are highlighted. HIV testing is not mandatory in any country, but some countries overtly facilitate this practice. Conclusion: Benefits of HIV testing in migrants and ethnic minorities, at both individual and community levels are recognized by many countries. In spite of this, not all countries identify the need to test these groups.
Background: The Strengths and Difficulties Questionnaire (SDQ) is a valuable screening tool for identifying psychosocial problems. Its performance in a multi-ethnic society, common to many paediatric health care workers, has not been investigated. Because it is important that screening instruments are valid and reliable for all ethnic groups within one society, we examined differences in the SDQ’s psychometric properties in a multi-ethnic society. Methods: The SDQ parent (n = 8114) and teacher form (n = 9355) were completed as part of a preventive health check for children aged 5–6 years of Dutch and non-Dutch ethnic backgrounds. The Child Behaviour Checklist (CBCL)/Teacher Report Form (TRF) was administered to a subsample. Results: Factor analysis of the parent-rated SDQ showed different rating patterns for two of the five subscales for non-Dutch children as compared with Dutch children. Cronbach’s alpha for the total difficulties score varied by ethnic group (0.73–0.78 parent-rated SDQ, 0.80–0.83 teacher-rated SDQ), and coefficients were generally smaller for non-Dutch than for Dutch children (P < 0.05). Alpha coefficients for subscales varied between 0.31–0.85 for ethnic groups. Inter-rater correlations between parents and teachers for the total difficulties score varied between 0.20–0.41 between ethnic groups and were larger for Dutch than for non-Dutch children (P < 0.05). Concurrent validity was acceptable for most scales and most ethnic groups. Conclusion: The total difficulties score of the parent- and teacher-rated SDQ is valid and reliable for different ethnic groups within Dutch society. However, there are differences in reliability and validity of the subscales, which makes interpretation of the subscales difficult for certain ethnic groups.
Background: There is increasing evidence of the role that exposure to industrial chemicals plays in the development of childhood disease. The USA and the European Union (EU) have taken divergent policy approaches to managing this issue, and economic estimates of disease costs attributable to environmental exposures in children are available in the USA but not the EU. We undertook the first economic evaluation of the impacts of childhood environmental chemical exposures in the EU. Methods: We used a cost-of-illness approach to estimate health care system costs, and used environmentally attributable fraction modelling to estimate the proportion of childhood disease due to environmental exposures. We analysed data on exposures, disease prevalence and costs at a country level, and then aggregated costs across EU member states to estimate overall economic impacts within the EU. Results: We found the combined environmentally attributable costs of lead exposure, methylmercury exposure, developmental disabilities, asthma and cancer to be $70.9 billion in 2008 (range: $58.9–$90.6 billion). These costs amounted to ~0.480% of the gross domestic product of the EU in 2008. Conclusions: Childhood chemical exposures present a significant economic burden to the EU. Our study offers an important baseline of disease costs before the implementation of Registration, Evaluation and Authorization of Chemicals, which is important for studying the impacts of this policy regime.
To investigate at what age hydrocephalus is detected and to assess the role of head circumference measurements in detecting hydrocephalus, we performed a retrospective chart review in children with hydrocephalus treated in a tertiary paediatric hospital in the Netherlands. The study group contained 146 patients; 38 patients (31%) were referred because of abnormalities in head circumference. Eighty-nine per cent of the patients were detected in the first year of life. After this period, no patients were referred because of an abnormal head circumference. Therefore, head circumference measurements seem to have little value for detecting hydrocephalus after the first year of life.
Background: Denmark, like other Western countries, is recently burdened by increasingly high social spending on employment consequences caused by ill mental health. This might be the result of high work demands affecting persons with ill mental health. Therefore, this study assesses to what extent depressive symptoms and high work demands, individually and combined, have an effect on employment consequences. Methods: We conducted a population-based 7-year longitudinal follow-up study with baseline information from the year 2000 on socio-demographics, lifestyle, depressive symptoms and work demands. In total, 5785 employed persons, aged 40 and 50 years, were included. Information about employment status, sick leave and work disability was obtained from registers. Logistic regression models were used to measure separate and combined effects of depressive symptoms and work demands on job change, unemployment and sick leave during 2001–02 and work disability during 2003–07. Results: After adjustment for covariates, high physical work demands and depressive symptoms had a graded effect on subsequent unemployment, sick leave and permanent work disability. Persons with both depressive symptoms and high physical demands had the highest risks, especially for sick leave, but the combined effect did not exceed the product of single effects. Persons who perceived high amount of work changed job significantly more frequently. Conclusion: Persons with depressive symptoms might have an increased risk of negative employment consequences irrespective of the kind and amount of work demands. This might be an effect on the level of work ability in general as well as partly the result of health selection and co-morbidity.
Background: The prevalence of depression has been evaluated in populations of low- and middle-income (LMI) countries but the risk of depression has not been specified among persons with dementia. This cross-sectional analysis aimed to assess the prevalence and risk of depression among older people with dementia living in LMI countries. Methods: The study analysed data from a population-based survey conducted by 10/66 Dementia Research Group in 2004. Altogether, 17 031 participants from eight different countries aged 65 years and above were assessed. Logistic regression was used to calculate prevalence and odds ratio (OR) of depression on persons with dementia. Adjustments by age and education were included in the analysis. ORs of depression on different types of dementia were determined. Results: Depression was identified in 5.8% (4.4% of men, 6.6% of women) of all the 17 031 participants and in 12.4% (18.9% of men, 10.1% of women) of the 1612 persons with dementia. Persons with dementia had an increased risk of depression compared with persons without dementia, the age- and education-adjusted OR was 2.38 [95% confidence interval (CI0 1.99–2.84]); 3.86 (95% CI 2.83–5.26) for men and 1.88 (95% CI 1.51–2.35) for women. Compared with Alzheimer’s disease, Lewy body [OR 2.75 (95% CI 1.40–3.72)] and vascular dementia [OR 2.35, (95% CI 1.49–3.72)] were associated with a higher risk of depression. Conclusions: Persons with dementia were twice as likely to have depression as persons without dementia. Among persons with dementia, the prevalence of depression was higher for men than women, and the risk of depression varied by the type of dementia.
Aim: In this study, the prevalence and risk factors of Internet addiction in high school students was investigated. Material and Method: This cross-sectional study was performed in the Mersin Province in 2012. The study sample consisted of students attending high school in the central district of Mersin. The data were summarized by descriptive statistics and compared by a binary logistic regression. Results: Our study population included 1156 students, among whom 609 (52.7%) were male. The mean age of the students was 16.1 ± 0.9 years. Seventy-nine percent of the students had a computer at home, and 64.0% had a home Internet connection. In this study, 175 (15.1%) students were defined as Internet addicts. Whereas the addiction rate was 9.3% in girls, it was 20.4% in boys (P < 0.001). In this study, Internet addiction was found to have an independent relationship with gender, grade level, having a hobby, duration of daily computer use, depression and negative self-perception. Conclusion: According to our study results, the prevalence of Internet addiction was high among high school students. We recommend preventing Internet addiction among adolescents by building a healthy living environment around them, controlling the computer and Internet use, promoting book reading and providing treatment to those with a psychological problem.