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Background Disability does not simply affect the health status of the individual who directly experiences that condition, but it has important consequences on the health and well-being of the other family members as well. Focusing on Italy, an extremely interesting test-bed due to its strong familialist welfare regime, we show significant spillover effects of children's disability on parental health and well-being. Methods We use data from a nationally representative household survey on almost 13 000 mothers and fathers and adopt a multivariate regression setting providing evidence that the disability of a child is negatively associated with parents' health and life satisfaction. Results Parents of a disabled child report lower levels of general and mental health, as well as lower levels of well-being compared with parents with a healthy child. Strong heterogeneity by gender and socio-economic characteristics is observed, with mothers being more affected by the disability status of the child than fathers. The estimated coefficients suggest that education remains an important protective factor even for parents of a disabled child. Conclusion This study claims and documents that child disability is an overlooked source of health disadvantage for parents. Such disadvantage is especially relevant for mothers and lower-educated parents, evidence that suggests the importance of taking an intersectional approach to study health disparities. [ABSTRACT FROM AUTHOR]

Background: The worksite is a promising setting for health promotion. This review summarizes the evidence of effect of intervention studies in European countries promoting a healthy diet solely and in combination with increasing physical activity at the workplace. Methods: A systematic review of published literature was carried out. Inclusion criteria were: studies conducted in European countries; papers published from 1 January 1990 to 1 October 2010; worksite-based interventions promoting a healthy diet solely or in combination with physical activity; primary prevention; measurement of anthropometrical or behavioural change and adults (≥18 years old). Levels of evidence for intervention effectiveness on behavioural determinants, nutrition and physical activity behaviours and body composition and the quality of the included interventions were assessed. Results: Seventeen studies solely focusing on promotion of a healthy diet were identified. Eight were educational, one used worksite environmental change strategies, and eight used a combination of both (multi-component). None of the interventions were rated as ‘strong’; seven met the criteria for ‘moderate’ quality. The reviewed studies show moderately evidence for effects on diet. Thirteen studies focusing both on nutrition and physical activity (nine educational and four multi-component studies) were identified. Ten were rated as having ‘weak’ and three as having ‘moderate’ methodological quality, providing inconclusive evidence for effects. Conclusion: Limited to moderate evidence was found for positive effects of nutrition interventions implemented at the workplace. Effects of workplace health promotion interventions may be improved if stronger adherence to established quality criteria for such interventions is realized. [ABSTRACT FROM PUBLISHER]

Background: Environmental nuisances, including ambient air pollution, are thought to contribute to social inequalities in health. There are two major mechanisms, which may act independently or synergistically, through which air pollution may play this role. Disadvantaged groups are recognized as being more often exposed to air pollution (differential exposure) and may also be more susceptible to the resultant health effects (differential susceptibility). Method: European research articles were obtained through a literature search in the Medline database using keywords 'Socioeconomic Factors, Air Pollution, Health' and synonymous expressions. Results: Some studies found that poorer people were more exposed to air pollution whereas the reverse was observed in other papers. A general pattern, however, is that, irrespective of exposure, subjects of low socio-economic status experience greater health effects of air pollution. So far as we are aware, no European study has explored this relationship among children. Conclusion: The housing market biases land use decisions and may explain why some subgroups suffer from both a low socio-economic status and high exposure to air pollution. Some data may be based on inaccurate exposure assessment. Cumulative exposures should be taken into account to explore health problems more accurately. The issue of exposure and health inequalities in relation to ambient air quality is complex and calls for global appraisal. There is no single pattern. Policies aimed at reducing the root causes of these inequalities could be based on urban multipolarity and diversity, two attributes that require long-term urban planning. [ABSTRACT FROM AUTHOR]

Background: Kenya recently transitioned from a paper to an electronic system for recording and reporting of tuberculosis (TB) data. Methods: During September-October 2013, the data quality of the new system was evaluated through an audit of data in pa per source documents and in the national electronicsystem, and an analysis of all 99 281 cases reported in 2012. Results: While the new electronic system overall is robust, this assessment demonstrated limitations in the concordance and completeness of data reaching the national level. Conclusions: Additional oversight and training in data entry are needed to strengthen TB surveillance data quality in Kenya. [ABSTRACT FROM AUTHOR]

Older patients, suffering from numerous diseases and taking multiple medications are the rule rather than the exception in primary care. A manifold of medical conditions are often associated with poor outcomes, and their multiple medications raise additional risks of polypharmacy. Such patients account for most healthcare expenditures. Effective approaches are needed to manage such complex patients in primary care. The paper will discuss different models of care as well as major health care challenges in the management of multimorbidity in primary care with focus on interactions (disease-disease, treatment-treatment, and treatment-disease) extrapolated from (disease specific) guidelines and the feasibility to apply these guidelines for and with patients who have multimorbidity. [ABSTRACT FROM AUTHOR]

Backgound: In Romania Roma women are vulnerable to pregnancy-related events, unwanted pregnancies, stillbirth, abortion and cervical cancer. This paper aims to analysis the use of reproductive health services, family planning, prenatal care and screening for cervical cancer by Roma women. Methods: A secondary analysis was performed on the data of the Reproductive Health Survey in Romania 2016, of a subsample of 314 Roma women, aged 15-44 years. Results: 2/3 of Roma women had their first pregnancy in adolescence, 66.9% between 15-19 and 8.4% under 15 years of age. 65.4% Roma adolescent girls had their first child at 15-19 years, and 2.8% at ages under 15 years. During pregnancy, 24.1% of Roma women do not use prenatal care services, three times more than the women from the reference population (7.1%) (p < 0.01). 73% of Roma women have never benefited from cervical cancer screening compared to 42.7% in the general fertile female population. 46, 7% of Roma women use any type of contraceptive method and 38.1% modern methods, a closed prevalence of contraception in the general population of fertile women (48.4% of any method and 38.7% modern methods) Conclusions: Roma women have their first pregnancy in adolescence. There are inequalities in the use of preventive services for prenatal care and cervical cancer screening of the Roma female population compared to the reference female population in Romania. Public health policies should include specific active measures for Roma women to improve their access to preventive services. In order to prevent unwanted pregnancies, public health policies in Romania should include family planning measures addressed towards all women, but using methods culturally adapted to the Roma population. Key messages: • There are inequalities in sexual reproductive health services use of Roma minories women I Romania. • Services and active preventive mesures should be adressed to Roma populationtion. [ABSTRACT FROM AUTHOR]

Background: The objective of this paper is to explore the connection between self-reported health and religiosity among Israeli Jews, using several self-reported health measures. Methods: Data were collected by two health surveys covering 1999 individuals in 1993 and 2505 individuals in 2000, representing the population of Jewish Israelis aged 45-75 years residing in urban communities in those years. Self-reported health was measured by (i) reported chronic conditions, (ii) the SF-36 instrument, and (iii) a visual analogue scale of health-related quality of life. Religiosity was measured by a self-reported five-category scale. Results: Controlling for a large array of socio-demographic characteristics, while no religiosity gradient was found in reported chronic morbidity, religious persons generally report worse health than secular persons on the other measures. The gap is larger in the SF-36's role-performance scales, and among women and Israelis from Asian-African origin. Discussion: The mixed results are consistent with the ambiguity of the religiosity effect on health reported in recent surveys. However, trying to reconcile between longer life expectancy of religious persons found in earlier Israeli and other research and poorer reported health found above, the paper emphasizes the possible differences in the perception of 'normal' life and roles, and argues that the SF-36 health measures might suffer from a religiosity-related reporting heterogeneity, distorting their association with mortality in the population. [ABSTRACT FROM AUTHOR]

Introduction Big data is defined as the amount of data that once organized and analysed, can make a value, make decisions, make predictions and discover patterns in order to reduce costs, avoid risks and optimize services. Machine Learning (ML) is a field of artificial intelligence and is characterized as a method of machine learning, which uses algorithms that learn from data analysis, allowing computers to find patterns, draw conclusions and make predictions. These tools can be used in different areas of human knowledge, particularly in the health sector which are generated daily a huge amount of information, allowing the creation of algorithms that learn and gain understanding to assist in various clinical practices. Objectives The purpose of this paper is to analyse the benefits of Big Data and Machine Learning in providing overall health care. Methodology We conducted a review of the scientific literature published in the electronic databases PubMed/MEDLINE and Google Scholar, according to specific criteria, using keywords: Big Data", "Machine Learning". Results In the field of oncology (skin cancer, breast, lung, leukaemia) ML and Big Data have contributed to early diagnosis of different pathologies and their evolution, as well as optimizing therapies. In ophthalmology (diabetic retinopathy and congenital cataract) has shown high efficacy in rapid diagnosis and appropriate treatment crucial to prevent the progress of the disease. The tested algorithms achieved very favourable results in cases of Parkinson's and cardiovascular diseases. In the pharmaceutical industry these computer and digital tools have contributed to the optimization of clinical trials, genome sequencing of tumours to then identify and develop specific drugs to fight it. Conclusion Advances of MIL and Big data are notorious and development opportunities are immense and can come to revolutionize tasks such as diagnosis, treatment and health care in general. [ABSTRACT FROM AUTHOR]

An introduction to the journal is presented which discusses topics related to the Sustainable Development Goals (SDG) set by the United Nations (UN) and featured within the issue, including the SDG framework for action, the health-related SDG in Europe, and the political aspects of the SDG.

Since 2014, imported cases of malaria have been notified by SINAVE, the Portuguese nationwide electronic surveillance system that replaced paper-based notification. Nevertheless, the disease is still believed to be under-reported. Completeness of notification of malaria cases in 2016 was estimated using a two-source capture-recapture method, with SINAVE and the Diagnostic-Related Group cases. Completeness of SINAVE and the diagnosis-related group sources was computed in 32.9% and 72.3%, respectively. The results confirm that malaria is under-reported and highlight the need for more effective notification strategies, especially given the risk of resurgence of locally acquired cases. [ABSTRACT FROM AUTHOR]

Many initiatives have been taken in European countries that are designed to reduce inequalities in health. However, the effects of only a very few of these initiatives have been assessed. The main aim of a Dutch research and development programme was to systematically investigate and evaluate interventions aimed at reducing inequalities in health. In this paper, we report on this investigation, and draw lessons from the methodology used to evaluate such interventions. Approach: The programme included 12 evaluation studies, focusing on the wider determinants of inequalities in health (n = 2), behavioural determinants (n = 4), working conditions (n = 3) and health care (n = 3). Results: An experimental design was applied in two evaluation studies. The studies provided evidence of a positive effect. A quasi-experimental design appeared to be the only attainable option in seven studies. Five of these provided sufficient evidence for a positive effect, but two interventions appeared not to be successful. In three studies, no experimental or quasi-experimental design could be applied. Conclusions: The programme showed that it is possible to apply experimental or quasi-experimental studies to complex public health interventions. The Programme Committee steering the programme considered that the evidence generated by the experimental and quasi-experimental studies justified the implementation of the interventions on a wider scale, accompanied by further evaluation studies. Further development of the methodology of public health interventions is necessary. These include non-experimental designs such as international comparisons and time trend studies, especially in order to be able to evaluate broader policy measures. [ABSTRACT FROM AUTHOR]

Background: International variation in homicide rates may be attributable to cultural differences in acceptance of moral justifications for killing. The aim of this study is to investigate the relationships between measures of attitudes towards the justification of killing and homicide rates in diverse international populations. Methods: Four studies assessed variations in acceptance of killing among adults and young people in nineteen nations and four areas in the USA. Study 1 (1996-1997) assessed adult attitudes in Brazil, Chile, Costa Rica, Spain, and Venezuela with personal interviews in major cities. Study 2 (1999-2001) assessed attitudes among high school students in Denmark, Finland, Malta, Mexico, Netherlands, Slovenia, Sweden, Taiwan, and the UK with paper surveys administered in classrooms. Study 3 (2001) used telephone interviews to measure the equivalent attitudes among the US samples nationally and from regions in Texas. Study 4 (2002-2003) used paper surveys in classrooms to measure attitudes among high school students in Armenia, Belarus, Georgia, and the Russian Federation. Results: The acceptance of killing varied significantly among genders and national/regional groups. The mean attitude scores in the four studies combined were significantly correlated with national/regional homicide rates and the amount of variance explained was similar to that for social inequality (GINI). Together the attitude scores and GINI explained 65% of the variance in homicide rates. Conclusion: This study provides evidence that variations in attitudes toward the justification of killing may be related to international differences in homicide rates. [ABSTRACT FROM AUTHOR]

Background: The tobacco industry has formed regional environmental tobacco smoke (ETS) consultants programs in order to generate controversy on the issue of secondhand smoke (SHS) in Europe, Asia and Latin America. Only those countries in which the industry foresaw SHS restrictions were included. This paper describes the European and Asian components of the tobacco industry's worldwide ETS consultants program. Methods: A systematic search was carried out of tobacco industry documents available on the Internet between October 2002 and February 2004. Results: Beginning in 1987, Philip Morris assembled an international ETS consultants program in collaboration with other tobacco companies based on their market shares in different regions of the world. The law firm Covington & Burling contacted and hired consultants with a wide range of expertise, usually affiliated with an academic institution, in order to avoid direct contact with the industry. The objective of the program was to influence policy makers, media and the public by providing, through their consultants, 'accurate' (pro-industry) information concerning smoking regulations in public places and workplaces, indoor air quality and ventilation standards, and scientific claims regarding SHS. Consultants also conducted research related to SHS and organized and attended regional and international symposiums related to SHS without acknowledging industry funding. Conclusions: Despite evidence that the issue of smoke-free environments was close to emerging within the general public throughout the world in the late 1980s, the tobacco industry used its well-organized network of consultants to avoid SHS regulations in most of the world. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The frameworks and methods used for analysis, monitoring and evaluation of communicable disease control vary greatly. Although a number of manuals exist instruments for a detailed analysis of wider health system context are lacking. This is surprising given that the success of vertical programmes is often determined by the constraints of health systems. The importance of the context and the health system in determining the successful implementation of national tuberculosis programmes is well recognized by the WHO, which recommends analysis of national tuberculosis programmes within the context of health care system, health reform and the economic status of the country. However, current approaches inadequately capture intelligence on the health systems variables impacting on programme efficacy, limiting the ability of policy makers to draw lessons for wider use. A recent WHO report highlights the major systemic constraints to DOTS implementation and recommends a comprehensive and multi-sectoral approach to tuberculosis control, This obviates the need for tools that take into account health systems issues as well as focusing on a particular vertical programme but no such comprehensive tool exists. This paper outlines the conceptual basis for a model and a toolkit for rapid assessment, monitoring, and evaluation of the context, the elements of the health system and vertical communicable disease programme. It describes the framework, the potential strengths and weaknesses, approach and piloting of the toolkit and its two elements: first for 'horizontal assessment' of the health system within which the programme is embedded and second for 'vertical assessment' of the infectious disease-specific programme. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including health indicators, medical projects for child health and dietary assessment in Europe.

The author examines whether Germany's new cannabis policy reform plans serve public health, as of October 2023. The goals of the new policy include the protection of cannabis consumers' health and safety, youth protection and the reduction of illicit cannabis markets as principal goals. Also cited is the two-step approach for cannabis policy reform in the revised proposal.

Editorial. Examines several papers on a BIOMED project about the various aspects of the single market for health care. Criticisms against the drafting of the Treaty of Rome which paid minimal attention to health care; Evolution of patient mobility in Europe; Discussion on several issues concerning the single market for health care.

This paper argues that there are ways of making research more amenable to the needs of policy makers and policy makers more sympathetic to the needs of researchers by investing in greater analysis of the links between research and policy. It shows how many in public health hold contradictory conceptual pictures of the research process, assuming a rational ratherthan enlightenment model of the policy process. By acknowledging the barriers to research affecting policy it becomes easier to build strategies around the dissemination of research so that it becomes more accessible to policy makers. Thus, researchers need to take into account the extent to which politics may affect how much notice policy makers take of research findings, they need to consider how far scientific uncertainty leads to distortion or inaction in policy making and they need to consider issues around timing and communication of research results, recognizing policy makers' short-term horizons and the need for clear presentation of scientific findings. The paper ends by arguing that those in public health need to pay far more attention to the policy environment, looking not just at policy content, but also at the processes of policy. By using a policy analysis framework it is possible to identify and overcome the barriers to research influencing policy. [ABSTRACT FROM PUBLISHER]

Background: Understanding parental barriers is crucial to promote active commuting to school since the parental perceptions influence how young people commute. This study examined parental barriers to active commuting to school among Spanish children and adolescents, and their association with their gender and the usual mode of commuting. Methods: Parents of children (n = 628) and parents of adolescents (n = 151) from Granada (Spain) completed a paper-based questionnaire about perceived parental barriers to active commuting to school and mode of commuting. Data were analyzed using the Chi-square test. Results: Among Spanish parents, the most common barriers reported by parents of children were traffic volume and dangerous intersections, whereas the most frequent barriers reported by parents of adolescents were distance to school and dangerous intersections. Compared to parents of children, a greater proportion of parents of adolescents reported distance to school and crime and smaller proportion reported traffic volume as barriers to active commuting to school. Among parents of children, crime was a more commonly reported as a barrier by parents of girls. Although some barriers reported by parents of passive commuters were similar for children and adolescents (such as distance to school and absence of a policeman at crosswalks), other barriers were specific to parents of children. Conclusions: The main parental barriers to active commuting in children were traffic volume and dangerous intersections whereas for adolescents were distance and dangerous intersections. Among Spanish parents, parental barriers to active commuting are influenced by children's age, gender and mode of commuting to school. [ABSTRACT FROM AUTHOR]

Background: Reduced physical activity is a known risk factor for many illnesses. Research in adolescent populations found increased physical activity levels improves objective health outcomes, but there is conflicting evidence regarding the relationship between physical activity levels and self-reported health status. Aims: To synthesise current evidence on the association between physical activity and self-reported health status in adolescents. Secondary objectives are to assess whether the relationship is dose dependant, and the appropriateness of WHO recommendations on adolescents' physical activity. Methods: The main databases were searched using keywords for the main outcome of interest (health status, health behaviour and self-perception) and exposure of interest (motor activity, physical activity and exercise), supplemented with manual searches, secondary citation and reference searches. Quality appraisal was carried out using the Strengthening the Reporting of Observational Studies in Epidemiology checklist. Results: Eleven studies entered this review. Nine studies reported a significant relationship between increased levels of physical activity and improved self-reported health status, however two did not. Two studies followed up participants and found that the relationship persisted over time. Two papers described a dose-response relationship. Improvements in self-perceived health can be observed even below the current recommended levels of physical activity. Conclusion: The review supports initiatives to encourage adolescents to engage in physical activity as it improves self-reported health status. Sub- optimal levels of physical activity can also be beneficial. Further research should use standardised measurement scales and objectively measured physical activity levels. The roles of gender, income and culture should be further investigated. [ABSTRACT FROM AUTHOR]

Background: Self-reported health status (SRHS) reflects an individual's perception of their social, biological and psychological health, and has been linked to increased mortality risk and increased use of health services. Having a psychological co-morbidity can reduce health outcomes and increase healthcare costs. This paper investigates the relationship between SRHS and signs of psychological distress (PD) in European urban settings. Methods: The study sample comprised 20 439 adult respondents to surveys conducted across 37 urban areas. Data on SRHS, signs of PD and potential confounders were analysed in a multivariable logistic regression. Results: After adjusting for potential confounders (gender, age, time lived in country and regularity of contact with family and friends), a significant association was found between PD and self-reported poor health for all urban areas, particularly in Western European countries (adjusted OR = 3.615, 95% CI: 3.333-3.920 P < 0.001). Time lived in country of residence, financial stability and regularity of contact with family and friends were negatively associated with signs of PD in the adjusted model. Conclusions: There is a statistically significant association between self-reported poor health and signs of PD. Although the relationship was present in all geographical locations, the confounders were protective factors for Western European countries. Since the two factors are linked, interventions that target one might reduce the impact on both. Further study into causality would be of use in predicting future healthcare costs, which could be reduced by integrating their management. [ABSTRACT FROM AUTHOR]

Introduction: EURO-URHIS 2 aimed to collect comparable health indicators across a large number of urban areas (UAs) across Europe and Vietnam using four data collection tools. This paper outlines the process for the selection of indicators to be collected from routinely available sources, and the piloting of the data collection tool. Methods: A long-list of indicators potentially collectable from routinely available sources was generated by the EURO-URHIS 2 consortium. Key contacts from each UA completed an e-mail survey reporting for each indicator whether it could be collected using the given definition, an alternative definition or not at all. Additionally participants listed the 20 leading causes of death for their UAs from the Eurostat 65. Results were compiled to inform indicator selection for the main data collection phase. Results: Responses were received for 25 of 28 eligible UAs. Of the 29 proposed indicators, 55.1% (n = 16) were accepted without change, 24.1% (n = 7) were re-allocated to other data collection tools and 17.2% (n = 5) were accepted after a modification of the EURO-URHIS 2 definition. Discussion: This scoping exercise and piloting phase for the 'existing data tool' for the project was useful and informative. It provided detailed information on what could be collected, and an opportunity to modify indicator definitions to maximize response rates. These results are only applicable to those UAs returning results and cannot be generalized. Detailed interrogation of definitions is essential to this sort of data collection, and the process described was designed with cross-national comparability in mind. [ABSTRACT FROM AUTHOR]

Background: This paper proposes that Population Impact Measures (PIMs), the Population Impact Number of Eliminating a Risk Factor over a time period (PIN-ER-t) and the number of events prevented in your population (NEPP), can assist in policy making as they include relevant information which describes the impact or benefits to the population of risk factors and interventions. In this study, we explore the utilization of the indicators from European System of Urban Health Indicators System to produce the two PIMs. Methods: We identified from the indicators list the health determinants, health status and health interventions which can be linked, and searched Medline for evidence of association. We then investigated whether the type of frequency measure available for the indicator match with the measure used in PIMs, and explored data availability for the City of Manchester (UK) as an urban area. Results: Of the 39 indicators relevant to socio-economic factors, health determinants and health status, it was possible to calculate the population impact of a risk factor, i.e. the PIN-ER-t, for only six associations, and the population impact of health interventions, i.e. NEPP, for only one out of the three listed indicators, as the relevant health conditions were not included. Conclusions: The results of this study suggest that if an indicator system is intended to play a part in the policy making process, then the method of presentation to policy-makers should be decided before setting up the system, as it is likely that some indicators which would be essential might not be available. [ABSTRACT FROM AUTHOR]

Background Sustaining public health programmes in the long-term is key to ensuring full manifestation of their intended benefits. Although an increasing interest in sustainability is apparent within the global literature, empirical studies from within the European setting are few. The factors that influence sustainability are generally conceptualized at three levels: programme level, the immediate context and the wider environment. To-date attention has focused primarily on the former two. Using a community-based child injury prevention programme in England as an exemplar, this paper explores the concept of sustainability within the wider policy environment, and considers the impact of this on local programmes. Methods A content review of global and UK national public health policies (1981-2014) relevant to child safety was undertaken. Interviews were held with senior representatives of global and UK agencies involved in developing child safety policy. Results Forty-nine policies were reviewed. The term 'sustain', or its derivatives, featured in 36 (73%) of these. Its' use however, related primarily to conservation of resources rather than continued programme operation. Potential mechanisms for supporting programme sustainability featured within some documents; however, the approach to sustainability was inconsistent between policies and over time. Policy stakeholders identified programme sustainability as relevant to their core business, but its' conceptualization varied according to individual interpretation. Conclusions Programme sustainability is poorly addressed within global and UK-based public health policy. Strengthening a national and international policy focus on sustainability and incorporating sustainability into public health planning frameworks may create a more supportive environment for local programmes. [ABSTRACT FROM AUTHOR]

Background: Financial difficulties in childhood may be associated with immediate and long-term consequences for mental health. The aim of the current paper is to investigate the association between childhood financial difficulties and adult depression, and assess the relative contribution of financial difficulties in childhood to symptoms of adult depression across different age groups. Methods: Using three age cohorts (25-40, 41-59, 60-75) from 19 countries in the European Social Survey Round 7 (N=18 401), multi-level and country-wise OLS regression analyses were used to investigate the association between financial difficulties in childhood and adult depression, while adjusting for age, education, gender, highest education in family, level of family conflict, number of social meetings and marital status. Results: Financial difficulties in childhood was found to be influential predictors of depression scores for 25-40 year olds in 10 out of 19 countries in fully adjusted models. In older participants, depression scores were mostly influenced by frequency of social meetings and marital status. There was great variation in the pattern of influential risk factors across countries, and the predicted effect childhood financial difficulties had on adult depression scores. Conclusion: Childhood financial difficulties as predictors of depression appear to, by themselves, exert the strongest influence in younger adults. There was, however, large variation between countries in the magnitude of associated risk, and in the pattern of risk factors contributing to adult depression, which underscores the need to account for country-level factors when aiming to gain knowledge about mental health. [ABSTRACT FROM AUTHOR]

Background: A range of non-communicable diseases (NCDs) has been found to follow a social pattern whereby socioeconomic status predicts either a higher or lower risk of disease. Comprehensive evidence on the socioeconomic distribution of NCDs across Europe, however, has been limited. Methods: Using cross-sectional 2014 European Social Survey data from 20 countries, this paper examines socioeconomic inequalities in 14 self-reported NCDs separately for women and men: heart/circulatory problems, high blood pressure, back pain, arm/ hand pain, foot/leg pain, allergies, breathing problems, stomach/digestion problems, skin conditions, diabetes, severe headaches, cancer, obesity and depression. Using education to measure socioeconomic status, age-controlled adjusted risk ratios were calculated and separately compared a lower and medium education group with a high education group. Results: At the pooled European level, a social gradient in health was observed for 10 NCDs: depression, diabetes, obesity, heart/circulation problems, hand/arm pain, high blood pressure, breathing problems, severe headaches, foot/leg pain and cancer. An inverse social gradient was observed for allergies. Social gradients were observed among both genders, but a greater number of inequalities were observed among women. Country-specific analyses show that inequalities in NCDs are present everywhere across Europe and that inequalities exist to different extents for each of the conditions. Conclusion: This study provides the most up-to-date overview of socioeconomic inequalities for a large number of NCDs across 20 European countries for both women and men. Future investigations should further consider the diseases, and their associated determinants, for which socioeconomic differences are the greatest. [ABSTRACT FROM AUTHOR]

Background: Health inequalities persist between and within European countries. Such inequalities are usually explained by health behaviours and according to the conditions in which people work and live. However, little is known about the relative contribution of these factors to health inequalities in European countries. This paper aims to investigate the independent and joint contribution of a comprehensive set of behavioural, occupational and living conditions factors in explaining social inequalities in self-rated health (SRH). Method: Data from 21 countries was obtained from the 2014 European Social Survey and examined for respondents aged 25-75. Adjusted rate differences (ARD) and adjusted rate risks (ARR), generated from binary logistic regression models, were used to measure health inequalities in SRH and the contribution of behavioural, occupational and living conditions factors. Result: Absolute and relative inequalities in SRH were found in all countries and the magnitude of socio-economic inequalities varied considerably between countries. While factors were found to differentially contribute to the explanation of educational inequalities in different European countries, occupational and living conditions factors emerged as the leading causes of inequalities across most of the countries, contributing both independently and jointly with behavioural factors. Conclusion: The observed shared effects of different factors to health inequalities points to the interdependent nature of occupational, behavioural and living conditions factors. Tackling health inequalities should be a concentred effort that goes beyond interventions focused on single factors. [ABSTRACT FROM AUTHOR]

Background: Norway has achieved a noteworthy reduction in smoking prevalence over the past forty years. In 2015, 13% of Norwegians aged 13-74 smoked daily and a further 9% smoked occasionally. One of the objectives of the Norwegian 2013-16 national strategy for tobacco control is to achieve a reduction in the daily smoking prevalence to<10% by 2016. This paper aims to estimate how long it will take for Norway to achieve the 10% smoking prevalence. Methods: A dynamic forecasting model using smoking prevalence data from national survey data on the prevalence of current, former and never smokers in the Norwegian population from 1985 to 2012 was used to estimate future smoking prevalence in the Norwegian population based on a continuation of current patterns in smoking cessation and initiation rates. Results: The result suggests that Norway's smoking prevalence among men and women will continue to decline if current trends of smoking initiation and cessation continue. Our model predicts, based on figures for 1985-2012, that the prevalence of current daily and occasional smoking among men and women will not fall below the 10% mark until 2029 for men and 2026 for women, if current trends continue. Conclusion: Smoking is likely to remain an important public health issue in Norway for many years. New strategies are needed to accelerate the decline in smoking in Norway. [ABSTRACT FROM AUTHOR]

Background: Research has shown that individual socio-economic circumstances throughout life affect health in older ages. However, little attention has been paid to the broad economic context affecting individual's life-chances. This paper examines whether economic downturns experienced during young and mid-adulthood have long-run effects on physical health. Methods: We exploit data on economic fluctuations in the period 1945-2010 in 11 European countries, linked to longitudinal data from three waves of the Survey of Health, Ageing and Retirement in Europe. We estimate a country fixed effect model assessing whether downturns experienced at 5-year intervals between ages 25 and 54 are associated with levels and onset of new limitations with Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) in older age (55-80). Results: Experiencing an economic downturn at ages 45-59 is associated with increased risk of having at least one disability limitation in later-life (odds ratio [OR] for ADL = 1.66, 95% CI [Confidence Interval] 1.24, 2.22; OR for IADL = 1.46, 95% CI 1.10, 1.94). Economic downturns at ages 40-44 and 45-49 also increase the risk of a new functional limitation in later-life (OR for IADL ages 40-44 = 1.20, 95% CI 1.03, 1.40; OR for IADL ages 45-49 = 1.44, CI 1.10-1.88). Economic downturns experienced around these ages are also associated with significantly greater risks of smoking and excessive alcohol consumption as well as lower incomes in older age. Conclusions: Exposure to an economic downturn at ages 40-49 is associated with poorer health in older ages, possibly by increasing risk of unhealthy behaviours and low incomes persisting into older age. [ABSTRACT FROM AUTHOR]

The article focuses on the guidelines in providing written informed consent to allow participants in making decision in their participation in research projects. It discusses the use of paper-based written consent form as traditional mean to document information as well as the advantages of new technologies in providing options to consent medium. Particular focus is also given to the approaches in presenting the scope and content such as the specific consent, broad consent and presumed consent.

Background The evaluation of participant experience is an essential part of monitoring the quality of breast cancer screening services. Satisfaction of services can lead to good adherence and hence affect health outcomes. Methods We performed a systematic review to assess how satisfied women were with organized breast cancer screening programs. A literature search in Medline, CINAHL, Embase and PsycINFO from 1965 to October 2019 was performed. Articles reporting a quantitative measure of satisfaction collected via questionnaires in programs using mammography as a screening test were selected. We narratively synthesized the data and used tabulated summaries. Results Out of 4310 individual citations, 3099 abstracts were reviewed by two independent researchers, and 126 articles were selected for full-text reading. Finally, 48 studies, published between 1990 and 2018, were included in analysis, reporting 54 surveys in the context of an organized screening program, 37 on satisfaction with screening mammography, 14 on satisfaction with further assessments and 3 with counseling. Most studies reported a high level of satisfaction for both mammography and further assessments. Despite commonly reported temporary pain, discomfort and anxiety, the willingness to be re-screened was very high. Effective information transfer, the staff's interpersonal skills and quick delivery of results correlated with high satisfaction. Only 7 out of 54 surveys used recognized satisfaction instruments or their modifications. Conclusions In general, satisfaction with breast cancer screening is high, but its evaluation is mainly performed using non-validated instruments. Emphasis should be put on effective communication, the staff´s interpersonal skills and quick delivery of results. [ABSTRACT FROM AUTHOR]

Investigates the potential imitation effect and the extent of preventive messages given in suicide reporting on Swiss print media. Development of a rating scheme; Differences between newspapers; Necessity of media guidelines for suicide reporting.

The European integration process and the application of the principle of free movement to new areas of social economic life are raising new questions. One of these questions is the potential mobility of patients within the European Union (EU). Under a commission from the Directorate General V of the European Commission, the authors conducted a study of this topic in 1991. The normative framework used in this study is again used here to analyse in depth the types of cross-border care available under social protection. In this paper the main results of this study are summarized and, where possible, updated. In the first part of the paper the historical development of the European cross-border care regulatory system is charted. A second part deals with the macro-analysis of patient flows. In the final part of the paper, some conclusions are drawn as to the desirable development of the EU policy with respect to cross-border care (de)regulation. [ABSTRACT FROM AUTHOR]

This paper presents the epidemiological and economic results pertaining to the first round of breast cancer screening programmes in France. Breast cancer screening is based within existing radiologic facilities in the private and public sector and on-going competition exists between organized and spontaneous screening. The mean screening attendance rate was 36.7%, the mean recall rate was 10.4%, the positive predictive value (PPV) for the screening test 5.8% and the biopsy rate 1.2%. There were 5.1 carcinomas detected per 1,000 women screened. Of these, 30.7% were smaller than 10 mm in diameter and 69.0% had no nodal involvement A retrospective resource-based cost analysis revealed a mean cost of US$63 per woman screened. This cost includes all direct programme costs excluding diagnostic testing and treatment costs. Organizational as opposed to technical aspects of screening accounted for 38% of this cost in the first round. These results reveal discrepancies in the quality, cost and estimated efficacy between 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 test and biopsy. In addition to the strict adherence to quality control and interpretation protocols, the shift of French women away from individual screening practices towards organized screening behaviour will be necessary to enable the French breast cancer screening programmes to reach their optimal efficacy. [ABSTRACT FROM AUTHOR]

Two fishing municipalities with a total population of 6,500 in Finnmark county were exposed to different hearth intervention programmes, both aiming at minimizing inequalities in health through empowerment and community involvement. One intervention (Nordkapp) was mainly focused on factors related to the working environment of fishermen and within the fishing industry, while the other (Bitsfjord) addressed the population as a whole in defining health problems, setting priorities and planning strategies and implementation. This paper describes the design and methods of intervention and evaluation and examines effects regarding knowledge about and discussions of the projects, acquisition of new information, attitudes and serf-reported behaviour changes after 2 years of intervention in a randomized sample of almost 2,000 individuals in the 2 communities. In Nordkapp, 27% of the men and 20% of the women knew about the project, with the highest level being among fishermen and the male employees in the fishing industry. The corresponding percentages for BStsfjord were 77 and 82%. Approximately 1 in 5 in Nordkapp and 2 in 5 in Bitsfjord had discussed the projects with somebody. In particular, in Bitsfjord knowledge about and discussion of the projects increased with the length of formal education, whereas acquisition of new information and self-reported behaviour change was highest among those with the lowest level of education in both communities. Approximately 40% of those aware reported behaviour change due to the interventions. These findings suggest that the projects have favoured the target groups of the intervention. [ABSTRACT FROM PUBLISHER]

This paper examines managed competition as a solution to the inefficiencies, bureaucracy and sclerosis of national health care systems. Managed competition promises to overcome the many dangers and limitations of using competition in medicine that have been previously identified. However, the inner logic of managed competition has several contradictions and flaws that undermine its own goals and may even make equitable, efficient health care more difficult to attain. The paper concludes with recommendations for attaining the same goals more effectively. [ABSTRACT FROM PUBLISHER]

Air pollution is severe in some areas of Central and Eastern Europe but the quality and representativeness of measurements are not consistent. Studies in the Czech Republic and Poland have shown an impact of air pollution on overall mortality, post-neonatal mortality and lung cancer. Estimates in this paper suggest that air pollution may cause up to 3% of all-cause, all-age mortality in the Czech Republic, which is some 9% of the mortality gap between this country and Western Europe. The impact in other countries of Central and Eastern Europe is probably smaller. [ABSTRACT FROM PUBLISHER]

The NHS reforms and creation of the UK internal market have led to changes in funding arrangements and incentives. Similar health care reforms are occurring across many developed countries, though at differing rates. These reforms have potentially serious implications for research funding and in particular, the service costs of health services research. Within the new NHS framework, the incentive to fund the service costs does not automatically fall on any agency and the main mechanism which should cover ‘excess’ service costs, the Service Increment For Teaching and Research (SIFTR), is in its present form inadequate, being unresponsive and non-comprehensive. This can and has led to partially funded research projects, an outcome which is not sustainable in the longer term. This paper discusses the emerging problem and argues that a dearer definition of research costs is required, so that both service and research costs are considered synonymously with the whole cost of the research to funders being identified and agreed at the outset. The service costs of research must most importantly now be considered to be an integral part of the research budget. This will help ensure that projects are adequately funded and can be carried out efficiently to promote high quality, cost-effective care in the NHS. An NHS Research & Development (R&D) Consultative Taskforce was set up to review the present situation and make recommendations for the way forward. We hope that our elucidation of the problem and our recommendations, aid or strengthen those of the Taskforce in this current debate. [ABSTRACT FROM PUBLISHER]

Recent evidence on the relationships between people's social support resources and their health shows the general importance of social support as an environmental factor promoting good personal and public health. The literature on social support is less equivocal in this sense than that on health-service use, where some evidence suggests that, even controlling for previous health status, use of the health services is not health promoting. However, it is not clear just what aspects of social support may be relevant to different measures of health status. The relationships between class inequality, social support and health-service use also require illumination. This paper uses longitudinal data from a study of socially disadvantaged households to explore these issues in relation to the health of women and young children. Analysis of these data shows that the social support resources of mothers generally decline over the first year following birth. Both quantitative and qualitative indicators of support are significant predictors of good health, though qualitative indicators (how support is experienced) have stronger relationships with health outcomes than quantitative indicators (the extent of social contact). The psychological well-being of mothers is more closely linked than either their physical health or that of their babies to their support resources. Support from mothers, friends and a research-provided midwife support intervention is particularly important. Health-service use and social support are not related to each other and, indeed, appear to function in opposite ways in relation to health outcomes; while health-service use is associated with poorer health (controlling for social deprivation, stress, and previous health status), the social support resources of mothers are associated with improved health outcomes. [ABSTRACT FROM PUBLISHER]

Although Spain has had the highest unemployment rate in the European Community for over a decade, very little is known about the impact of unemployment on the health of the Spanish population. This paper analyses the health consequences of unemployment in Barcelona, the capital of Catalonia, using a sample of 4,119 respondents to the Health Survey of Barcelona in 1986. It is concluded that ill health is not caused by unemployment per se, but is better explained by a combination of individual and socio-economic stressors. Furthermore, for more than purely economic reasons, the availability of an unemployment subsidy appears to be the most important factor in ameliorating the stresses of unemployment. [ABSTRACT FROM PUBLISHER]

Sexually active teenagers need a choice of accessible and acceptable services to provide contraceptive care and advice. This paper presents examples of good practice in providing care for young people in community settings in the UK but the same models of care could be adopted by other European countries. The published literature suggests that informal and drop-in services are needed, with the guarantee of confidentiality to the young person. A full range of contraceptive care and sexual health promotion should be available and staff should have expertise in dealing with young people. All local agencies should work together to increase knowledge and uptake of such services. Purchasers and providers of health care should agree a model of care which is related to local health needs. [ABSTRACT FROM PUBLISHER]

This paper examines the relationships between stress, social support, class, health and health-service use in a sample of mothers and children from a predominantly socially disadvantaged population. The initial sample size was 509; the sample was drawn from 4 cities, 2 in the south of England and 2 in the Midlands. Stress, measured using a standard life-events inventory, was found to be more common amongst the most disadvantaged women; the women who reported the most stress during pregnancy also reported the most stress 1 year after the birth. There were few direct relationships between stress and social support; those that did exist were in the direction of more life events being associated with less support. The occurrence of life events was strongly related to the mothers' psychological and physical health; there were also relationships with the babies' health, especially at 1 year. Events of particular importance were those relating to money, problems with partners and paid work. Women who reported life events were more likely to use the health services both for themselves and for their babies. A model is proposed for understanding the processes linking the material and cultural circumstances associated with class and health outcomes. In this model, social support and health-service use occupy contrasting roles as factors mediating these relationships. While health-service use is associated with an increased risk of adverse health outcomes, social support is health-promoting. [ABSTRACT FROM PUBLISHER]

The enterprise of health promotion in medicine involves a responsibility of distinguishing between the concepts of health and absence of disease and of reflecting on the notions of illness and sickness. In this paper the importance of human dialogue is stressed both as a means and end of the doctor-patient relationship and as the main means of genuine health promotion. The outcome of health work is proposed to depend mainly on the way the patients are encountered. Their efforts to make themselves seen as being sick should not on all occasions be diagnosed and treated. By means of a reflected, dialogic practice patients may be listened to and inspired to reconstruct their symbol-based relationship to the world of meaning. The conception of health primarily includes man's relationship to himself. Illness is looked upon as the subject's experience of illhealth, whereas disease is understood as a functional imbalance of bodily organs. There is a tacit meaning in being ill (and found sick) that can be realized and attended to best in close relationship with the patient. Physicians – preferably general practitioners – involved in health promotion should, it is concluded, both assist the patients to give up their sick role and continually elaborate their own professional competence to see and successfully encounter the manifold specifically human issues underlying their patients' presented symptoms. [ABSTRACT FROM PUBLISHER]

Health care reforms in the UK, USA and Sweden are leading health providers and purchasers to pay more attention to quality. This paper considers different approaches to proving and improving quality before and after 1990 in these three countries. The second part of the paper describes different frameworks for auditing health service quality, such as the ISO 9000 and US Malcum Baldridge award. It considers how purchasers can use these frameworks in purchasing services, and how providers can use the frameworks to assess and improve their own service quality. [ABSTRACT FROM PUBLISHER]

“Purchasing for health gain” a phrase used to describe a strategic role for purchasing bodies which were established in 1990 as part of the UK NHS reforms. Is it an empty phrase, serving to hide the reality of purchaser's main task of controlling expenditure? Will the operational difficulties encountered in the first two years of the reforms continue to stand in the way of a strategic role for public purchasing bodies? Is a strategic role impossible in an “managed market” for health care? This paper considers the concept of health gain and the difficulties encountered by NHS purchasers. It is argued that 1) the term “internal market” is inadequate to describe the different frameworks and combinations of features in different public health care systems with managed competition; 2) purchasing for health gain is more difficult in some types of “managed market” than in other types; 3) the way the UK market is developing may increase, rather than reduce the difficulties; 4) there is no evidence as yet that primary care purchasers cannot purchase for health gain if they are organized and rewarded for doing so; 4) performance assessment of purchasers and purchaser competition would reduce their costs and increase their effectiveness in purchasing to improve the health status of their populations; 5) value choices are integral to purchasing for health gain and new processes and institutions are needed to decide priorities and to introduce explicit rationing. The prospects, some solutions, and the implications for other countries introducing similar changes are discussed. [ABSTRACT FROM PUBLISHER]

The emergence of democracy has led the countries of central and eastern Europe to undertake a fundamental reappraisal of their public health services and training requirements. This paper describes the thinking behind the changes under way in Hungary. These involve a radical departure from the way public health medicine was taught. It was traditionally divided between departments of hygiene and social medicine. The hygiene departments had a very narrow focus, mainly on aspects of communicable disease epidemiology, food hygiene, occupational hygiene, environmental hygiene and toxicology. Social medicine was principally concerned with health service management, although more recently it has included some non-communicable disease epidemiology. A new postgraduate training programme in public health medicine will be developed in which non-communicable disease epidemiology will be strengthened and subjects such as health economics and health promotion will be incorporated. Training will take place in a multi-disciplinary setting and additional programmes for other professional groups will be developed and Integrated. [ABSTRACT FROM PUBLISHER]

The U.S. is experiencing a turbulent economic transition from a highly industrialized economy to an information/services economy. Manufacturing is increasingly automated or transferred to developing countries. There has been no developed national policy in this area and programs to address the transitions that must be made by displaced workers, particularly in the industrial sector, have been available to only a small proportion of those affected. This paper briefly describes federally funded, joint labor-management and union-based programs and focuses on the role of social support and the use of peer counselors in these programs to help workers use available resources effectively and make the transition to new jobs or new careers. Based on this experience, the paper also looks at future implications for the design of work in the future and the incorporation of lifelong learning in work settings. [ABSTRACT FROM PUBLISHER]

The purpose of this paper is to analyze the issue of the long working hours in Japan, and to discuss its effects on the working life of the individual. Although the average annual working hours dropped from 2,432 hours in 1960 to 2,111 hours in 1988, this is still 200–500 hours longer than the figure in western countries because of the low implementation rate of the five-day work week, the low usage rate of paid holiday, and increasing overtime hours. The following reasons have been given: a lower labor productivity per working hour than that in western countries; a stigma in the work place attached to taking a day-off; the loyalty of workers to the company; and cooperation between the management and the workers' unions. Two-thirds of workers complain of fatigue, and or death from overwork is becoming a social problem. Finally, in 1987, the government took a small step in revising the Law by changing the number of legal working hours. In addition, the labor unions have begun to try to reduce the working hours. It is expected that an improvement in the working life of the Japanese people will be seen in the 1990s. [ABSTRACT FROM PUBLISHER]

A list of the reviewers of the "European Journal of Public Health" as of February 2022 is presented including Denise Alexander of Ireland, Paolo Boffetta of Italy, and Pinar Soysal of Turkey.