Background: Women not offered screening mammography reported higher levels of negative psychosocial aspects than women offered screening. This was demonstrated in a questionnaire survey where 1000 women were included: 500 women living in areas where the public authorities had never offered screening mammography and 500 women living in areas where women had been invited to screening mammography for >10 years. After this baseline survey, nationwide screening mammography was implemented. The aim of this follow-up study was to resurvey the 1000 women and to investigate if the identified difference in reported psychosocial aspects had disappeared or been reduced because of the nationwide screening implementation. Methods: The 1000 women included in the previous survey were posted part I of the questionnaire Consequences of Screening in Breast Cancer (COS-BC1) in August 2011, nearly 5 years after they received the COS-BC1 the first time. Results: A total of 677 women returned the questionnaire. There was no statistically significant difference between the two groups in reported psychosocial aspects. Women new to screening reported less negative psychosocial aspects compared with the previous survey. Conclusion: An implementation of a screening mammography programme provides reassurance for those women invited to the screening. This reassurance is in contrast to the unbalanced proportion between the intended benefits and the unintended harms of the screening programme.
Background: We aim to describe levels of awareness and uptake of colorectal, breast, cervical and prostate cancer screening tests and to analyze the association to socio-demographic and health-related variables. Methods: Population-based cross-sectional study conducted using a home-based personal interview survey on a nationwide representative sample (n = 7938) of population aged ≥18 years (Oncobarometro Survey). Awareness was assessed by asking participants: Now I am going to mention several medical tests for cancer detection, please tell me if you already know about them or if this is the first time you have heard of them? The tests mentioned were faecal occult blood test (FOBT), mammography, Pap smear and prostate-specific antigen (PSA). Cancer screening uptake was assessed by asking participants whether they had received tests within the previous 2 years. Results: Awareness rates of 38.55% for FOBT, 95.03% for mammography, 70.84% for Pap smears and 54.72% for PSA were found. Uptake mammography was 74.46%, Pap smears 65.57%, PSA 35.19% and FOBT 9.40%. Factors such as immigration status, lower educational level or income and not suffering from chronic conditions are negative predictors for uptake. Conclusions: Awareness and uptake results showed acceptable figures for mammography, moderate for Pap smears and unacceptably low for FOBT. Inequalities exist in uptake of cancer screening. It is necessary to develop public health educational programmes, especially for the vulnerable populations, aiming to inform and motivate them to use screening services on a regular basis. Our data suggest that although PSA is not recommended, this opportunistic screening is frequently used in Spain.
Background: All-cause and cause-specific mortality have long been known to be associated with various indicators of socio-economic status, and social gradients have been shown also for cancer survival. In recent decades, several studies have reported increasing social differentials in mortality rates. This study aims to investigate the development with respect to cancer survival, which has not been done before. Methods: Discrete-time hazard regression models for cancer deaths among women and men diagnosed with cancer 1970–2007 at age 30–89 were estimated, using register data encompassing the entire Norwegian population. The analysis was based on >200 000 cancer deaths during over 2 million person-years of exposure among >440 000 individuals diagnosed with cancer. Results: There has been an increasing advantage for women of all educational categories when compared with those with only compulsory schooling. No such widening of the educational gap has appeared with respect to cancer survival among men. Conclusions: Increasing educational differentials in health at the time of diagnosis, health behaviour and cancer treatment seem plausible, and would to some extent accord with the increasing social gaps in all-cause or cause-specific mortality rates that have been reported in other studies. Also, it is not impossible that such trends in the educational gradients in health and treatment are stronger for women than for men, though such sex differences have not been indicated in mortality studies. There is no obvious explanation for the complete absence of change in the education effects among men.
Objectives: To identify changes in social inequalities for mammograms uptake in Belgium over the period 1997–2008 using multiple indices, and to assess the contribution of the national breast cancer screening programme in these changes. Methods: Data were obtained from four waves of the Belgian Health Interview Survey. The socio-economic position was defined by the educational level. Inequalities were measured both with pairwise measures comparing extreme educational groups (prevalence difference and prevalence ratio), and with indices measuring the total inequality impact at population level: the Population Attributable Fraction (PAF), the Relative Index of Inequality (RII) and the Slope Index of Inequality (SII). Results: All indices show a substantial decrease in inequalities in mammographic uptake between 1997 and 2008. For the indices of total impact (PAF, RII, SII), the change occurred between the first two waves (1997 and 2001) and stabilized afterwards, while for pairwise indices the evolution continued over the whole period. Conclusion: Using multiple indices of inequality is necessary for a more complete understanding of the changes: total impact inequality indices should always complement simple pairwise measures. The inequalities in mammograms uptake, as measured with total impact indices, only decreased before the start of the national screening programme.
Background: Understanding the patterns of cervical cytology use in preventive care may provide useful information for an efficient transition from opportunistic screening to organized programmes. We aimed to identify the determinants of non-use and underuse of cervical cytology in Portuguese women. Methods: As part of the fourth National Health Survey (2005/2006), 2191 women aged between 25 and 64 years were evaluated. The previous use of cervical cytology was classified as never or ever, and, among the latter, those having performed the latest cytology testing >5 years before were considered to underuse cervical cytology. We assessed the determinants of non-use and underuse through age- and education-adjusted odds ratios (ORs) and corresponding 95% confidence intervals (95% CIs). Results: Overall, 23.5% of women had never used cervical cytology and 10.7% reported underuse. This prevalence increased with age and decreased with education and income. Compared with the national mean, the lowest risk of non-use and underuse was observed in Norte (non-use: OR = 0.31, 95% CI: 0.23–0.42; underuse: OR = 0.60, 95% CI: 0.40–0.91) and the highest in Alentejo (non-use: OR = 2.33, 95% CI: 1.78–3.06; underuse: OR = 2.37, 95% CI: 1.43–3.93). Women without a private health insurance (OR = 2.65, 95% CI: 1.29–5.47), who had no doctor appointments in the preceding 3 months (OR = 2.06, 95% CI: 1.22–3.48) and those who had never performed a mammography (OR = 17.78, 95% CI: 9.09–34.78) were more likely to have never performed a cervical cytology. Conclusion: This study shows inequalities in the use of cervical cancer screening in Portugal and provides useful information for a better allocation of resources for cancer screening.
Background: This study was undertaken to examine whether there is an association between parity and age at first birth and risk of kidney cancer. Methods: The study cohort consisted of 1 292 462 women who had a first and singleton childbirth between 1 January 1978 and 31 December 1987. We tracked each woman from the time of her first childbirth to 31 December 2009, and their vital status was ascertained by linking records with the computerized mortality database. Cox proportional hazard regression models were used to estimate the hazard ratios (HRs) of death from kidney cancer associated with parity and age at first birth. Results: There were 95 kidney cancer deaths during 34 980 246 person-years of follow-up. The mortality rate of kidney cancer was 0.27 cases per 100 000 person-years. The adjusted HR was 1.88 [95% confidence interval (CI) 1.10–3.19] for women who gave birth between 24 and 26 years of age and 2.52 (95% CI 1.44–4.40) for women who gave birth after 26 years of age, when compared with women who gave birth when <23 years of age. A trend of increasing risk of kidney cancer was seen with increasing age at first birth. The adjusted HR was 0.88 (95% CI 0.49–1.59) for women who had two children and 0.89 (95% CI 0.47–1.67) for women with three or more births, when compared with women who had given birth to only one child. Conclusion: This study is the first to suggest that early age at first birth may confer a protective effect on the risk of kidney cancer.
Background: Few epidemiological investigations evaluated the role of smoking cessation on blood pressure (BP), and the results are not univocal. Therefore, the aim of this study was to assess the effect of smoking cessation on the risk to develop hypertension (HPT) and on BP values. Methods: This longitudinal study, with a follow-up period of 8 years, included the participants of the Olivetti Heart Study. Participants were 430 untreated normotensive non-diabetic men with normal renal function, examined twice in 1994–95 and in 2002–04. The sample included current smokers (S, n = 212), former smokers (ES, n = 145) and never smokers (NS, n = 73) at baseline. Results: Basal body mass index (BMI), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were significantly higher in ES than in S (ES vs. S; BMI: 27.0 ± 2.5 vs. 26.1 ± 2.9 kg/m2; P < 0.01; SBP/DBP: 121.2 ± 9.3/80.0 ± 5.8 vs. 19.1 ± 9.9/77.4 ± 6.7 mm Hg; P < 0.05; M ± SD). After 8 years of follow-up, BP changes () were significantly lower in ES than in S (SBP/DBP: 12.6 ± 13.4/7.9 ± 8.1 vs. 16.0 ± 14.9/10.3 ± 10.1 mm Hg; P < 0.05; M ± SD), also after adjustment for potential confounders. Moreover, at the last examination, the overall HPT prevalence was 33%, with lower values in ES than in S (25 vs. 38%, P = 0.01). After accounting for age, BP and BMI at baseline, and changes in smoking habit over the 8-year period, ES still had significant lower risk of HPT than S (odds ratio 0.30, 95% confidence interval 0.15–0.58; P < 0.01). Conclusions: In this sample of healthy men, smoking cessation was associated with lower BP increment and minor HPT risk, independently of potential confounders.
Background: We aimed to determine which socioeconomic status measures are associated with stroke risk in mid-aged women and assess the contribution of lifestyle, biological and psychosocial factors to observed associations. Methods: We included women born in 1946–51 from the Australian Longitudinal Study on Women’s Health, who were surveyed every 3 years. Using generalized estimating equation analysis, we determined the association between socioeconomic status and stroke at the subsequent survey, adjusting for time-varying covariates. For significant associations, we calculated the contribution of individual mediating factors in explaining these associations. Results: Among 11 468 women aged 47–52 years, 177 strokes occurred during a 12-year follow-up. Education (odds ratio lowest vs. highest 2.45, 95% confidence interval: 1.40–4.30) and homeownership, but not occupation or managing on income, were significantly associated with stroke. After full adjustment, the overall association between education and stroke was non-significant. Lifestyle (smoking, exercise, alcohol and body mass index), biological (hypertension, diabetes, heart disease and hysterectomy/oophorectomy) and psychosocial (depression and marital status) factors explained 38% of the association in the lowest versus highest education groups. Lifestyle and biological factors together accounted for 34%. Mediators accounted for 29% of the association between homeownership and stroke, with lifestyle and psychosocial factors responsible for most of this attenuation. However, a significant association remained in fully adjusted models (odds ratio non-homeowner vs. homeowner 1.63, 95% confidence interval: 1.12–2.38). Conclusions: Lower education level is associated with increased stroke risk in mid-aged women, and is partially mediated by known risk factors, particularly lifestyle and biological factors. Non-homeownership is associated with increased stroke risk, but the underlying mechanism is unclear.
Background: Exposure to cold weather increases blood pressure (BP) and may aggravate the symptoms and influence the prognosis of subjects with a diagnosis of hypertension. We tested the hypothesis that subjects with hypertension alone or in combination with another cardiovascular disease (CVD) experience cold-related cardiorespiratory symptoms more commonly than persons without hypertension. This information is relevant for proper treatment and could serve as an indicator for predicting wintertime morbidity and mortality. Methods: A self-administered questionnaire inquiring of cold-related symptoms was obtained from 6591 men and women aged 25–74 yrs of the FINRISK Study 2002 population. BP was measured in association with clinical examinations. Symptom prevalence was compared between subjects with diagnosed hypertensive disease with (n = 395) or without (n = 764) another CVD, untreated diagnosed hypertension (n = 1308), measured high BP (n = 1070) and a reference group (n = 2728) with normal BP. Results: Hypertension in combination with another CVD was associated with increased cold-related dyspnoea (men: adjusted odds ratio 3.94, 95% confidence interval 2.57–6.02)/women: 4.41, 2.84–6.86), cough (2.64, 1.62–4.32/4.26, 2.60–6.99), wheezing (2.51, 1.42–4.43/;3.73, 2.08–6.69), mucus excretion (1.90, 1.24–2.91/2.53, 1.54–4.16), chest pain (22.5, 9.81–51.7/17.7, 8.37–37.5) and arrhythmias (43.4, 8.91–211/8.99, 3.99–20.2), compared with the reference group. Both diagnosed treated hypertension and untreated hypertension and measured high BP resulted in increased cardiorespiratory symptoms during the cold season. Conclusion: Hypertension alone and together with another CVD is strongly associated with cold-related cardiorespiratory symptoms. As these symptoms may predict adverse health events, hypertensive patients need customized care and advice on how to cope with cold weather.
Background: Migraine has been suggested to be associated with hypertension. The aim of the present 5-year prospective cohort study was to examine whether self-reported migraine in 1998 predicted hypertension in 2003 in a Finnish working-age population. Methods: This cohort study consisted of 13 454 randomly selected initially non-hypertensive working-age participants of the prospective postal survey of the Health and Social Support. A total of 13 426 responses of the initial participants were linked with the register data of the Social Insurance Institution on the special reimbursement medication for hypertension. The outcome variable, hypertension, was determined according to the survey data and the register data of the Social Insurance Institution. The statistical analysis was carried out using logistic regression. Results: In a multivariate model adjusted for gender, age, occupational training, living alone, metabolic equivalent of task, body mass index and alcohol consumption, self-reported migraine predicted hypertension (odds ratio 1.39; 95% confidence interval 1.19–1.64) for the self-reported and (odds ratio 1.42; 95% confidence interval 1.13–1.77) for the register data of the Social Insurance Institution. Conclusion: The findings may indicate a focus on hypertension screening for the working-age population with migraine.
Background: Although population-based screening has the potential to reduce inequalities in breast cancer survival, evidence on this topic is controversial. The objective of this study was to evaluate whether the full implementation of a mammography screening programme in Emilia-Romagna in Italy had an impact on variations in breast cancer survival by educational level. Methods: A cohort study was performed, including all women <70 years and residing in Emilia-Romagna who had infiltrating breast cancer registered in 1997–2000 (transitional screening period) or 2001–03 (consolidation screening period). Cancer cases were retrieved from the regional Breast Cancer Registry and followed up for 5 years. Educational level was determined from census data and allocated to cancer cases by individual record linkage. Age at diagnosis was classified into two groups (30–49, 50–69: screening target population). Results: A total of 9639 cases were analyzed. In the 1997–2000 period, low-educated women had significantly lower survival compared with high-educated women, both in the younger and in the older age-groups. After the full implementation of the screening programme, these differences decreased in both age-groups, until disappearing completely among women in the age-group invited to screening. Conclusions: Our findings suggest that a fee-free population-based organized mammography screening programme with active invitation of the whole target population could be effective in reducing differences in survival in the population targeted by the screening.
Background: In any country, part of the population is sceptical about the utility of vaccination. To develop successful vaccination programmes, it is important to study and understand the defining characteristics of vaccine sceptics. Research till now mainly focused either on the underlying motives of vaccine refusal, or on socio-demographic differences between vaccine sceptics and non-sceptics. It remained till now unexplored whether both groups differ in terms of basic psychological dispositions. Methods: We held a population survey in a representative sample of the population in Flanders, Belgium (N = 1050), in which we investigated whether respondents’ attitude to vaccination was associated with their basic disposition toward other community members or society in general, as measured by the Triandis and Gelfand social orientation scale. Results: We found that sceptics and non-sceptics have a different social orientation, even when several variables are controlled for. More specifically, vaccine sceptics scored significantly lower on both horizontal individualism and horizontal collectivism, indicating a lower disposition to see others as equals. Conclusion: These findings need confirmation in the context of different countries. Such insights can be valuable to optimize the design of effective communication strategies on vaccination programmes.
Background: Combining existing data on background characteristics with data from immunization registers might give insight into determinants of vaccine uptake, which can help to improve communication strategies and invitation policy of National Immunisation Programmes. Methods: The study population consisted of children born in 2005 as registered in the Dutch national immunization register Præventis. A hierarchical logistic regression model was used to quantify associations between individual vaccination status and proxy variables for ethnic background (individual level), socio-economic status (postcode level) and religious objection to vaccination (municipal level). Results: Most children whose both parents were not born in The Netherlands had a somewhat lower full vaccine uptake, for example, children whose both parents were born in Turkey [odds ratio = 0.7 (0.6–0.8)] or in Morocco [odds ratio = 0.8 (0.7–0.9)]. The partial uptake was also relatively high (3.7–8.0%) compared with children whose both parents were born in The Netherlands (3.1%). Municipalities with higher religious objection to vaccination and postcode areas with lower socio-economic status were also associated with a lower full uptake. Conclusions: Despite the high vaccination coverage in The Netherlands, we were able to identify determinants of vaccine uptake by combining existing data sets. This might be an example for other countries. The impact of ethnic background and socio-economic status is not as well known in The Netherlands as the effect of religious objection to vaccination, and deserves more attention. Groups that have a relatively high partial uptake deserve special attention because they do not reject vaccination in general.
Background: Studies suggest that road traffic noise increases risks of sleep disturbances, anxiety and depressive symptoms, but few have focused on psychotropic drug use. We examined whether exposure to night-time road traffic noise in Marseilles (France) is associated with an increased risk of purchasing anxiolytic or hypnotic medications. Methods: Cohort of 190 617 inhabitants of Marseilles (aged 18–64 years) covered by the National Health Insurance Fund. We used the CadnaA noise propagation prediction model to calculate a potential road noise exposure indicator at dwellings for the night-period: Ln. Association between the number of purchases of anxiolytics–hypnotics in 2008–9 and the Ln was analysed with a zero-inflated negative binomial (ZINB) model adjusted for characteristics of individuals (sociodemographic, consultations with general practitioners, presence of chronic psychiatric disorder), prescribers (demographic, specialty, workload) and neighbourhoods (medical density, complaints filed for environmental noise). Analyses were stratified by the deprivation level of the census block of residence to control for the confounding effects of neighbourhood socio-economic status. Results: The ZINB model showed a small but significant increase in the risk of purchasing higher numbers of anxiolytics–hypnotics for Ln greater than 55 dB(A) only in the low deprivation stratum. Conclusion: We found some evidence that potential exposure to night-time road traffic noise might affect individual use of anxiolytics–hypnotics. Further research based on strictly individual approaches is warranted to assess exposure to road traffic noise more precisely and reliably than allowed by noise propagation prediction models.
Background: Research suggests that patients presenting to hospital with self-cutting differ from those with intentional overdose in demographic and clinical characteristics. However, large-scale national studies comparing self-cutting patients with those using other self-harm methods are lacking. We aimed to compare hospital-treated self-cutting and intentional overdose, to examine the role of gender in moderating these differences, and examine the characteristics and outcomes of those patients presenting with combined self-cutting and overdose. Methods: Between 2003 and 2010, the Irish National Registry of Deliberate Self-Harm recorded 42,585 self-harm presentations to Irish hospital emergency departments meeting the study inclusion criteria. Data were obtained on demographic and clinical characteristics by independent data registration officers. Results: Compared with overdose only, involvement of self-cutting (with or without overdose) was significantly more common in males than females, with an overrepresentation of males aged <35 years. Independent of gender, involvement of self-cutting (with or without overdose) was significantly associated with younger age, city residence, repetition within 30 days and repetition within a year (females only). Factors associated with self-cutting as the sole method were no fixed abode/living in an institution, presenting outside 9 a.m. to 5 p.m., not consuming alcohol and repetition between 31 days and 1 year (males only). Conclusion: The demographic and clinical differences between self-harm patients underline the presence of different subgroups with implications for service provision and prevention of repeated self-harm. Given the relationship between self-cutting and subsequent repetition, service providers need to ensure that adequate follow-up arrangements and supports are in place for the patient.
Background: Poor health is more prevalent in the East of Europe as compared with the West. This variation is often attributed to Soviet communism. Few studies investigate this health discrepancy within young adults who were children during this period. We studied the health of young adults by examining variations between world regions in general health between generations (18–65+). The individual and contextual mechanisms that might influence their health were also investigated. Methods: World Health Survey data were analysed on young adults aged 18–34 (n = 91 823) and their elders aged 35+ (n = 132 362) from 59 countries. Main outcome was self-reported general health. Multi-level logistic regression was used to assess associations between general health and regions, while accounting for individual- and country-level socio-economic factors across age ranges. Results: The prevalence of poor health was much higher for young adults in the Former Soviet Union region than in Western Europe, with the Central European region being in-between.This pattern remained even after full adjustments, for the Former Soviet Union citizens [odds ratio 4.26 (95% confidence interval 1.77–10.24)] and for Central Europeans [odds ratio 1.73 (95% confidence interval 0.90–3.32)] as compared with Western Europe. Age-specific analyses showed East–West health differences usually being larger as age increases (up to 65+). This age pattern seemed reversed for the South–West divide. Conclusions: The East–West health gap seems more pronounced for the Former Soviet Union young adults, rather than Central Europeans. It appears as though young adults from Central Europe might have been somewhat insulated from the ill-health effects of communism.
Background: Alternative lifestyles are often associated with distinct practices with respect to nutrition, physical activity, smoking, alcohol use and usage of complementary medicine. Evidence concerning effects of these lifestyle-related practices on health status is still fragmentary. Objective: To describe maternal health characteristics related to alternative lifestyles, with emphasis on body-weight status, during pregnancy and maternity periods. Methods: We compared self-reported health-related features of mothers with alternative lifestyles and conventional lifestyles during pregnancy and maternity period in the KOALA Birth Cohort Study. This cohort comprises two recruitment groups of mother–infant pairs, one with a conventional (no selection based on lifestyle, n = 2333), the other with an alternative lifestyle (selected via organic food shops, anthroposophic clinicians and midwives, anthroposophic under-five clinics, Rudolf Steiner schools and relevant magazines, n = 485). Mothers in the alternative group more frequently chose organic foods, adhered to specific living rules, practised vegetarianism and identified themselves with anthroposophy. Results: Mothers in the alternative group showed lower BMI and lower prevalence of overweight and obesity than the conventional group, before pregnancy as well as 4–5 years after delivery. This difference was partly retained after adjusting for potential confounders. Furthermore, women in the alternative group had a lower prevalence of pregnancy-related hypertension, more often started breastfeeding and gave exclusive and prolonged breastfeeding for a longer period. Finally, they smoked less often, but more often drunk alcohol during pregnancy. Conclusion: The results suggest that an alternative lifestyle is associated with favourable body weight and with several differences in other health features.
Background: Health examination surveys (HESs), including both questionnaire and physical measurements, and in most cases also collection of biological samples, can provide objective health indicators. This information complements data from health interview surveys and administrative registers, and is important for evidence-based planning of health policies and prevention activities. HESs are valuable data sources for research. The first national HESs in Europe were conducted in the late 1950s and early 1960s. They have recently been carried out in an increasing number of countries, but there has been no joint standardization between the countries. Methods: The European Health Examination Survey Pilot Project was conducted in 2009–2012. The European Health Examination Survey Pilot Reference Centre was established and pilot surveys were conducted in 12 countries. Results: European standardized protocols for key measurements on main chronic disease risk factors (height, weight, waist circumference, blood pressure, blood lipids and fasting glucose or HbA1c) were prepared. European-level training and external quality assessment were organized. Although the level of earlier experience, infrastructures, economic status and cultural settings varied between the pilot countries, it was possible to standardize measurements of HESs across the populations. Obtaining high participation rates was challenging. Conclusion: HESs provide high-quality and representative population data to support policy decisions and research. For future national HESs, centralized coordination, training and external quality assessment are needed to ensure comparability of the results. Further studies on effects of different survey methods on comparability of the results and on recruitment and motivation of survey participants are needed.