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Abstract Background In many countries, the prevalence of non-communicable diseases risk factors is commonly assessed through self-reported information from health interview surveys. It has been shown, however, that self-reported instead of objective data lead to an underestimation of the prevalence of obesity, hypertension and hypercholesterolemia. This study aimed to assess the agreement between self-reported and measured height, weight, hypertension and hypercholesterolemia and to identify an adequate approach for valid measurement error correction. Methods Nine thousand four hundred thirty-nine participants of the 2018 Belgian health interview survey (BHIS) older than 18 years, of which 1184 participated in the 2018 Belgian health examination survey (BELHES), were included in the analysis. Regression calibration was compared with multiple imputation by chained equations based on parametric and non-parametric techniques. Results This study confirmed the underestimation of risk factor prevalence based on self-reported data. With both regression calibration and multiple imputation, adjusted estimation of these variables in the BHIS allowed to generate national prevalence estimates that were closer to their BELHES clinical counterparts. For overweight, obesity and hypertension, all methods provided smaller standard errors than those obtained with clinical data. However, for hypercholesterolemia, for which the regression model’s accuracy was poor, multiple imputation was the only approach which provided smaller standard errors than those based on clinical data. Conclusions The random-forest multiple imputation proves to be the method of choice to correct the bias related to self-reported data in the BHIS. This method is particularly useful to enable improved secondary analysis of self-reported data by using information included in the BELHES. Whenever feasible, combined information from HIS and objective measurements should be used in risk factor monitoring.

Background: In many countries, the prevalence of non-communicable diseases risk factors is commonly assessed through self-reported information from health interview surveys. It has been shown, however, that self-reported instead of objective data lead to an underestimation of the prevalence of obesity, hypertension and hypercholesterolemia. This study aimed to assess the agreement between self-reported and measured height, weight, hypertension and hypercholesterolemia and to identify an adequate approach for valid measurement error correction. Methods: Nine thousand four hundred thirty-nine participants of the 2018 Belgian health interview survey (BHIS) older than 18 years, of which 1184 participated in the 2018 Belgian health examination survey (BELHES), were included in the analysis. Regression calibration was compared with multiple imputation by chained equations based on parametric and non-parametric techniques. Results: This study confirmed the underestimation of risk factor prevalence based on self-reported data. With both regression calibration and multiple imputation, adjusted estimation of these variables in the BHIS allowed to generate national prevalence estimates that were closer to their BELHES clinical counterparts. For overweight, obesity and hypertension, all methods provided smaller standard errors than those obtained with clinical data. However, for hypercholesterolemia, for which the regression model's accuracy was poor, multiple imputation was the only approach which provided smaller standard errors than those based on clinical data. Conclusions: The random-forest multiple imputation proves to be the method of choice to correct the bias related to self-reported data in the BHIS. This method is particularly useful to enable improved secondary analysis of self-reported data by using information included in the BELHES. Whenever feasible, combined information from HIS and objective measurements should be used in risk factor monitoring. [ABSTRACT FROM AUTHOR]

Abstract Background Participation rates in health surveys, recognized as an important quality dimension, have been declining over the years, which may affect representativeness and confidence in results. The Portuguese national health examination survey INSEF (2015) achieved a participation rate of 43.9%, which is in line with participation rates from other similar health examination surveys. The objective of this article is to describe how local teams of survey personnel conducted the survey, describing strategies used to solve practical survey problems and to try to increase the participation rate. Methods After a literature search, informal interviews were conducted with 14 public health officials from local health examination teams, regional and central authorities. Forty-one of the local staff members (survey personnel) also filled in a short questionnaire anonymously. The interviews and self-administered questionnaires were analysed using mixed methods, informed by thematic analysis. Results The local teams believed that the detailed manual, described as a “cookbook for making a health examination survey”, made it possible to maintain high scientific standards while allowing for improvising solutions to problems in the local context. The quality of the manual, supported by a series of training workshops with the central research and support team, gave the teams the confidence and knowledge to implement local solutions. Motivation and cohesion within the local teams were among the goals of the training process. Local teams felt empowered by being given large responsibilities and worked hard to incite people to attend the examination through a close and persuasive approach. Local teams praised their INSA contacts for being available for assistance throughout the survey, and said they were inspired to try harder to reach participants to please their contacts for interpersonal reasons. Conclusions The theory of organizational improvisation or bricolage, which means using limited resources to solve problems, was useful to discuss and understand what took place during INSEF. A detailed manual covering standard procedures, continuous monitoring of the data collection and face-to-face workshops, including role-play, were vital to assure high scientific standards and high participation rates in this health examination survey. Close contacts between the central team and local focal points in all regions and all survey sites were key to accommodating unexpected challenges and innovative solutions.

Abstract Background Metabolic syndrome (MetS) is a public health problem in Europe, affecting all age groups. Several MetS definitions are available. The aim of this study was to compare four different MetS definitions in the Finnish adult population, to assess their agreement and to evaluate the impact of the choice of the definition on the prevalence of MetS. Methods Data from FinHealth 2017, a cross-sectional national population health survey, focusing on adults aged 25 years or older were used in the analysis (n=5687). Measured data on anthropometrics, blood pressure and biomarkers together with questionnaire data were used to classify the participants into the MetS categories according to the four definitions. The definitions chosen for the comparison were those by the World Health Organization (WHO) (1998), National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) (2004), International Diabetes Federation (IDF) (2005), and Joint Interim Statement (JIS) (2009). Results The four MetS definitions resulted in substantially different MetS prevalence: 17.7% by WHO, 33.3% by NCEP-ATP III, 41.5% by IDF, and 43.0% by JIS. Regardless of the definition used, the prevalence of MetS increased with age. The prevalence of the different components varied between the definitions, depending on the different cut-off points adopted. Out of all participants, only 13.6% were identified to have MetS according to all four definitions. Agreement between participants recognised by different MetS definitions, estimated through kappa coefficients, was almost perfect for IDF vs. JIS (0.97), strong for JIS vs. NCEP-ATP III (0.80), moderate for IDF vs. NCEP-ATP III (0.76) and weak for WHO vs. NCEP-ATP III (0.42), WHO vs. IDF (0.41) and WHO vs. JIS (0.40). Conclusions Differences between observed prevalence of MetS in Finnish men and women using different MetS definitions were large. For cross-country comparisons, as well as for trend analyses within a country, it is essential to use the same MetS definition to avoid discrepancies in classification due to differences in used definitions.

Aims: There are several advantages to pooling survey data from individual studies over time or across different countries. Our aim is to share our experiences on harmonizing data from 13 Finnish health examination surveys covering the years 1972–2017 and to describe the challenges related to harmonizing different variable types using two questionnaire variables – blood pressure measurement and total cholesterol assessment – as examples. Methods: Data from Finnish national population-based health surveys were harmonized as part of the research project 'Projections of the Burden of Disease and Disability in Finland – Health Policy Prospects', including variables from questionnaires, objective health measurements and results from the laboratory analysis of biological samples. The process presented in the Maelstrom Research guidelines for data harmonization was followed with minor adjustments. Results: The harmonization of data from objective measurements and biomarkers was reasonably straightforward, but questionnaire items proved more challenging. Some questions and response options had changed during the covered time period. This concerned, for example, questionnaire items on the availability and use of medication and diet. Conclusions: The long time period – 45 years – made harmonization more complicated. The survey questions or response options had changed for some topics due to changes in society. However, common core variables for topics that were especially relevant for the project, such as lifestyle factors and certain diseases or conditions, could be harmonized with sufficient comparability. For future surveys, the use of standardized survey methods and the proper documentation of data collection are recommended to facilitate harmonization. [ABSTRACT FROM AUTHOR]

Introduction: The incidence of colorectal cancer is increasing worldwide. However, the screening uptake is generally low. We analyzed the association between sociodemographic, economic, and access-to-healthcare factors and the use of exams that are the basis for colorectal cancer screening in Portugal. Methods: We conducted a cross-sectional study based on data from the 1st National Health Examination Survey. We used Poisson regression to estimate prevalence ratios and study factors associated with the use of fecal immunochemical tests (FIT) and colonoscopy in a Portuguese population aged 50–74 years (n = 2,489). Results: 45.7% of the individuals reported using FIT in the previous 2 years; 37.3% reported using colonoscopy in the previous 5 years. The use of FIT was associated with age group, health region, and having a family doctor. It was higher in older individuals (47.6% in the age group 70–74 years vs. 38.1% in the age group 50–54 years; adjusted prevalence ratio [aPR] = 1.32; 95% CI 1.05–1.65), and in individuals assigned to a family doctor (47.6 vs. 30.3%; aPR = 1.50; 95% CI 1.14–1.98). Colonoscopy was associated with age group, health region, higher education, economic capacity, and having a family doctor. It was higher in older individuals (45.3% in the age group 70–74 years vs. 25.6% in the age group 50–54 years; aPR = 1.85; 95% CI 1.42–2.40), individuals with a higher economic capacity (40.5 vs. 32.4%; aPR = 1.19; 95% CI 1.01–1.40), and individuals assigned to a family doctor (38.7 vs. 25.6%; aPR = 1.43; 95% CI 1.08–1.91). Discussion/Conclusion: In our analysis, the use of FIT and colonoscopy was influenced by sociodemographic, economic, and access-to-healthcare factors. This is relevant to guide interventions in this area. It is essential to ensure an equitable and uniform implementation of the screening program, with family doctors as an important part of the process.

Introduction: Health surveys constitute a relevant information source to access the population’s health status. Given that survey errors can significantly influence estimates and invalidate study findings, it is crucial that the fieldwork progress is closely monitored to ensure data quality. The objective of this study was to describe the fieldwork monitoring conducted during the first Portuguese National Health Examination Survey (INSEF) regarding protocol deviations and key performance indicators (KPI). Methods: Data derived from interviewer observation and from the statistical quality control of selected KPI were used to monitor the four components of the INSEF survey (recruitment, physical examination, blood collection and health questionnaire). Survey KPI included response rate, average time distribution for procedures, distribution of the last digit in a specific measure, proportion of haemolysed blood samples and missing values. Results: Interviewer observation identified deviations from the established protocols, which were promptly corrected. During fieldwork monitoring through KPI, upon implementation of corrective measures, the participation rate increased 2.5-fold, and a 4.4-fold decrease in non-adherence to standardized survey procedures was observed in the average time distribution for blood pressure measurement. The proportion of measurements with the terminal digit of 0 or 5 decreased to 19.6 and 16.5%, respectively, after the pilot study. The proportion of haemolysed samples was at baseline level, below 2.5%. Missing data issues were minimized by promptly communicating them to the interviewer, who could recontact the participant and fill in the missing information. Discussion/Conclusion: Although the majority of the deviations from the established protocol occurred during the first weeks of the fieldwork, our results emphasize the importance of continuous monitoring of survey KPI to ensure data quality throughout the survey.

Background: Metabolic syndrome (MetS) is a public health problem in Europe, affecting all age groups. Several MetS definitions are available. The aim of this study was to compare four different MetS definitions in the Finnish adult population, to assess their agreement and to evaluate the impact of the choice of the definition on the prevalence of MetS. Methods: Data from FinHealth 2017, a cross-sectional national population health survey, focusing on adults aged 25 years or older were used in the analysis (n=5687). Measured data on anthropometrics, blood pressure and biomarkers together with questionnaire data were used to classify the participants into the MetS categories according to the four definitions. The definitions chosen for the comparison were those by the World Health Organization (WHO) (1998), National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) (2004), International Diabetes Federation (IDF) (2005), and Joint Interim Statement (JIS) (2009). Results: The four MetS definitions resulted in substantially different MetS prevalence: 17.7% by WHO, 33.3% by NCEP-ATP III, 41.5% by IDF, and 43.0% by JIS. Regardless of the definition used, the prevalence of MetS increased with age. The prevalence of the different components varied between the definitions, depending on the different cut-off points adopted. Out of all participants, only 13.6% were identified to have MetS according to all four definitions. Agreement between participants recognised by different MetS definitions, estimated through kappa coefficients, was almost perfect for IDF vs. JIS (0.97), strong for JIS vs. NCEP-ATP III (0.80), moderate for IDF vs. NCEP-ATP III (0.76) and weak for WHO vs. NCEP-ATP III (0.42), WHO vs. IDF (0.41) and WHO vs. JIS (0.40). Conclusions: Differences between observed prevalence of MetS in Finnish men and women using different MetS definitions were large. For cross-country comparisons, as well as for trend analyses within a country, it is essential to use the same MetS definition to avoid discrepancies in classification due to differences in used definitions. [ABSTRACT FROM AUTHOR]

Abstract Background Nationwide data on cardiovascular risk factors prevalence is lacking in Greece. This work presents the findings of the national health examination survey EMENO (2013–2016) regarding the prevalence of hypertension, hypercholesterolemia, diabetes, obesity and smoking. Methods A random sample of adults (≥18 years) was drawn by multistage stratified random sampling based on 2011 Census. All EMENO participants with ≥1 measurement of interest [blood pressure (BP), fasting glucose, HbA1c, total cholesterol (TC), Body Mass Index (BMI)] were included. Hypertension was defined as BP ≥ 140/90 mmHg and/or antihypertensive treatment; diabetes as fasting glucose≥126 mg/dL and/or HbA1c ≥ 6.5% or self-reported diabetes; hypercholesterolemia as TC ≥ 190 mg/dL. Sampling weights were applied to adjust for study design and post-stratification weights to match sample age and sex distribution to population one. Non-response was adjusted by inverse probability weighting. Results Of 6006 EMENO participants, 4822 were included (51.5% females, median age:47.9 years). The prevalence of hypertension was 39.2%, higher in men (42.4%) than in women (36.1%); of hypercholesterolemia 60.2%, similar in men (59.5%) and women (60.9%); of diabetes 11.6%, similar men (12.4%) and women (10.9%); of obesity 32.1%, higher in women (33.5% vs 30.2%), although in subjects aged 18–40 year it was higher in men; of current smoking 38.2%, higher in men (44.0%) than in women (32.7%). The prevalence of all risk factors increased substantially with age, except smoking, which followed an inverse U shape. Conclusions The burden of cardiovascular risk factors among Greek adults is alarming. There is considerable preventive potential and actions at health care and societal level are urgently needed.

Abstract Background In 2018 the first Belgian Health Examination Survey (BELHES) took place. The target group included all Belgian residents aged 18 years and older. The BELHES was organized as a second stage of the sixth Belgian Health Interview Survey (BHIS). This paper describes the study design, recruitment method and the methodological choices that were made in the BELHES. Methods After a pilot period during the first quarter of the BHIS fieldwork, eligible BHIS participants were invited to participate in the BELHES until a predefined number (n = 1100) was reached. To obtain the required sample size, 4918 eligible BHIS participants had to be contacted. Data were collected at the participant’s home by trained nurses. The data collection included: 1) a short set of questions through a face-to-face interview, 2) a clinical examination consisting of the measurement of height, weight, waist circumference, blood pressure and for people aged 50 years and older handgrip strength and 3) a collection of blood and urine samples. The BELHES followed as much as possible the guidelines provided in the framework of the European Health Examination Survey (EHES) initiative. Finally 1184 individuals participated in the BELHES, resulting in a participation rate of 24.1%. Results for all the core BELHES measurements were obtained for more than 90% of the participants. Conclusion It is feasible to organize a health examination survey as a second stage of the BHIS. The first successfully organized BELHES provides useful information to support Belgian health decision-makers and health professionals. As the BELHES followed EHES recommendations to a large extent, the results can be compared with those from similar surveys in other EU (European Union) member states.

Abstract Background The disability-adjusted life years (DALYs) summarize the burden of years of life lost (YLL) due to premature mortality and years lost due to disability (YLD). Our aim was to estimate the burden of ischemic heart disease (IHD) and chronic obstructive pulmonary disease (COPD) in Finland in 2012, and to examine, how much the YLD are affected by the use of different data sources. Methods The YLL were calculated using mortality data for the Finnish 25–74-year-old population in 2012. The YLD were calculated using data from the FINRISK 2012 survey (3041 males, 3383 females aged 25–74 years) and then directly adjusted to the corresponding population. Different administrative registers on 1) hospital inpatient episodes and specialist outpatient visits, 2) entitlement to specially reimbursed medicines, and 3) purchases of prescribed medicines were used for estimation of the YLD in addition to self-reported data. The DALYs were calculated without age-weighting. Results The YLL for IHD were 37.5 for males and 9.1 for females per 1000 population among 25–74-year-old people in Finland in 2012. The YLD for IHD varied markedly depending on which data sources were used. All data sources combined, the YLD per 1000 were 5.3 for males and 2.5 for females resulting in estimated 42.8 and 11.6 DALYs per 1000 due to IHD among males and females, respectively. For COPD, the YLL were 4.7 for males and 2.0 for females per 1000. Also for COPD, the YLD varied markedly depending on data sources used. The YLD per 1000 based on all data sources combined were 2.0 for males and 1.6 for females. As a result, estimated 6.7 and 3.6 DALYs per 1000 were due to COPD among males and females, respectively. Conclusions Especially for COPD, all mild disease cases could probably not be identified from the included registers. Thereby, including survey data improved the coverage of the data. The YLD of IHD and COPD varied markedly between the data sources used in the calculations. However, as YLL constituted a major part of DALYs for these diseases, the variation in YLD did not lead to substantial variation in DALYs.

Background: Nationwide data on cardiovascular risk factors prevalence is lacking in Greece. This work presents the findings of the national health examination survey EMENO (2013-2016) regarding the prevalence of hypertension, hypercholesterolemia, diabetes, obesity and smoking.Methods: A random sample of adults (≥18 years) was drawn by multistage stratified random sampling based on 2011 Census. All EMENO participants with ≥1 measurement of interest [blood pressure (BP), fasting glucose, HbA1c, total cholesterol (TC), Body Mass Index (BMI)] were included. Hypertension was defined as BP ≥ 140/90 mmHg and/or antihypertensive treatment; diabetes as fasting glucose≥126 mg/dL and/or HbA1c ≥ 6.5% or self-reported diabetes; hypercholesterolemia as TC ≥ 190 mg/dL. Sampling weights were applied to adjust for study design and post-stratification weights to match sample age and sex distribution to population one. Non-response was adjusted by inverse probability weighting.Results: Of 6006 EMENO participants, 4822 were included (51.5% females, median age:47.9 years). The prevalence of hypertension was 39.2%, higher in men (42.4%) than in women (36.1%); of hypercholesterolemia 60.2%, similar in men (59.5%) and women (60.9%); of diabetes 11.6%, similar men (12.4%) and women (10.9%); of obesity 32.1%, higher in women (33.5% vs 30.2%), although in subjects aged 18-40 year it was higher in men; of current smoking 38.2%, higher in men (44.0%) than in women (32.7%). The prevalence of all risk factors increased substantially with age, except smoking, which followed an inverse U shape.Conclusions: The burden of cardiovascular risk factors among Greek adults is alarming. There is considerable preventive potential and actions at health care and societal level are urgently needed. [ABSTRACT FROM AUTHOR]

Background In Health Examination Surveys interview information is complemented with objective information, providing more accurate indicators than self-reported data. We report the study design, planning and implementation of the first Portuguese Health Examination Survey (INSEF). Methods INSEF was a cross-sectional population-based study representative at regional and national level. Individuals aged between 25 and 74 years old, residing in Portugal were selected from the national health users' registry through multi-stage stratified probabilistic sampling. Sample size was set at 4200 individuals. Data was collected in primary care units and included blood pressure, height, weight, hip and waist measurements, blood collection for lipid profile, HbA1c and blood count and a general health questionnaire. European HES procedures were followed. Results A total of 4911 individuals agreed to participate (43.9% participation rate). Participation rate varied by region, sex and age group, being lower in Lisbon and Tagus Valley (32.8%), for men (41.8%) and for those aged 25–34 years old (36%). Conclusions INSEF has set up an experienced national and regional structure for HES implementation. Nationally representative quality epidemiological data is now available for public health monitoring, planning and research. [ABSTRACT FROM AUTHOR]

Oral health is a determinant for quality of life and preventive behaviours such as regular tooth brushing can reduce the risk of a wide spectrum of oral diseases. Adopting preventive behaviours increases the likelihood of being healthy and can be conditioned by demographic and socio-economic factors.Objective: This study aims to describe preventive oral hygiene behaviours in the Portuguese population and assess their association with sociodemographic and socioeconomic factors.Material and Methods: A cross-sectional epidemiologic study was developed using data from the first Portuguese National Health Examination Survey. The target population comprised Portuguese community-dwelling residents aged between 25 and 74 years old. The percentage of individuals who brushed their teeth at least twice a day, provided that once was before sleeping, was considered the indicator showing a preventive behaviour, as this is recommended by the General Directorate of Health in Portugal. Poisson regression was used to identify factors independently associated with this behaviour.Results: Sixty-five per cent of the participants reported tooth brushing as recommended. The prevalence of adoption of this preventive behaviour was higher among those living in urban areas and those who have higher educational level. Results show an association between being male and having low educational level with lesser adoption of preventive oral health behaviours.Conclusion: These findings suggest a need for integrated approaches, from measures tackling social inequalities to actions focused on improving health literacy. It is also important to expand dental healthcare services and improve effective coverage to increase access for rural population. [ABSTRACT FROM AUTHOR]

Background: Non-communicable diseases are increasing in sub-Saharan Africa and are estimated to account for 32% of adult deaths in The Gambia. Worldwide, prevalence of hypertension is highest in the African region (46%) and a very high proportion is undiagnosed. This study examined diagnosed and undiagnosed hypertension in The Gambian adult population.Methods: Data were collected in 2010 from a nationally representative random sample of 4111 adults aged 25-64 years, using the World Health Organization STEPwise cross-sectional survey methods. Analyses were restricted to non-pregnant participants with three valid blood pressure measurements (n = 3573). We conducted gender-stratified univariate and multivariate regression analyses to identify the strongest sociodemographic, behavioural and biological risk factors associated with hypertension.Results: Almost one-third of adults were hypertensive; a high proportion were undiagnosed, particularly among men (86% of men vs 71% of women with hypertension, P < 0.001). Rural and semi-urban residents and overweight/obese persons had increased odds of hypertension. Compared with urban residents, participants from one of the most rural regions had higher odds of hypertension among both men [adjusted odds ratio (AOR) 3.2; 95% CI: 1.6-6.4] and women (AOR 2.5; 95% CI: 1.3-4.6). Other factors strongly associated with hypertension in multivariate analyses were age, smoking, physical inactivity and ethnicity.Conclusions: Rural and semi-urban residence were strongly associated with hypertension, contrary to what has been found in similar studies in sub-Saharan Africa. Intervention to reduce the burden of hypertension in The Gambia could be further targeted towards rural areas. [ABSTRACT FROM AUTHOR]

Objectives: To examine cross-sectional and longitudinal associations between physical exercise and cognitive function across different age groups in a nationwide population-based sample of adults aged 18-79 years in Germany.Design: Cross-sectional/prospective.Methods: Cognitive function was assessed in the mental health module of the German Health Interview and Examination Survey for Adults (DEGS1-MH, 2009-2012, n=3535), using a comprehensive neuropsychological test battery. Cognitive domain scores for executive function and memory were derived from confirmatory factor analysis. Regular physical exercise in the last three months was assessed by self-report and defined as no exercise, <2 and ≥2h (hours) of exercise per week. A subgroup of DEGS1-MH participants who previously participated in the German National Health Interview and Examination Survey 1998 (GNHIES98, 1997-1999, n=1624) enabled longitudinal analyses with a mean follow-up of 12.4 years.Results: Compared to no exercise, more weekly physical exercise was associated with better executive function in cross-sectional (<2h: β=0.12; ≥2h: β=0.17; all p<0.001) and longitudinal analyses (<2h: β=0.14, p<0.001; ≥2h: β=0.15, p=0.001) using linear regression models adjusted for age, sex, education, smoking, alcohol consumption, fruit and vegetable consumption and obesity. Slightly weaker associations were found for memory in cross-sectional (<2h: β=0.08, p=0.009; ≥2h: β=0.08, p=0.026) and longitudinal analysis (<2h: β=0.09, p=0.036; ≥2h: β=0.08, p=0.114). There was no evidence of interaction between physical exercise and age.Conclusions: Higher levels of physical exercise were associated with better executive function and memory in cross-sectional and longitudinal analyses with no evidence for differential effects by age. [ABSTRACT FROM AUTHOR]

Our aim was to provide up-to-date cardiorespiratory fitness reference data for adults of all ages and to investigate associations between cardiores-piratory fitness and leisure time physical activity as well as sitting time. In the Danish Health Examination Survey 2007-2008, cardiorespiratory fitness was estimated in 16 025 individuals aged 18-91 years from validated cycle ergometer exercise tests. Level of leisure time physical activity (sedentary, light, moderate, and vigorous) and daily sitting time in hours was obtained from a self-administered questionnaire. Men had 20-33% higher cardiorespiratory fitness than women, depending on age, and cardiorespiratory fitness decreased by 0.26 and 0.23 mL/min/kg per year in men and women, respectively. Cardiorespiratory fitness was higher among participants who reported a high level of physical activity in leisure time compared with participants who were sedentary. Among sedentary or lightly physically active participants, inverse associations between total daily sitting time and cardiorespiratory fitness were found, while there was no association between sitting time and cardiorespiratory fitness among moderately or vigorously physically active participants. These data on cardiorespiratory fitness can serve as useful reference material. Although reluctant to conclude on causality, sitting time might impact cardiorespiratory fitness among individuals with low levels of leisure time physical activity. [ABSTRACT FROM AUTHOR]

Aims: Health examination surveys (HES) provide important information about population health and health-related factors, but declining participation rates threaten the representativeness of collected data. It is hard to conduct national HESs at examination clinics near to every sampled individual. Thus, it is interesting to look into the possible association between the distance from home to the examination clinic and non-participation, and whether there is a certain distance after which the participation activity decreases considerably. Methods: Data from two national HESs conducted in Finland in 2011 and 2012 were used and a logistic regression model was fitted to investigate how distance was related to non-participation. Results: We found out that non-participation modestly increased with distance to the examination clinic. An additional analysis indicated that the option of having an examination at home may decrease the effect of distance to participation. Conclusions: Long distances from home to the examination clinic are one reason for low participation activity. Possible bias caused by these differences in participation could be decreased by providing the option of a home examination. [ABSTRACT FROM AUTHOR]

Background: Health examination surveys (HESs), carried out in Europe since the 1950's, provide valuable information about the general population's health for health monitoring, policy making, and research. Survey participation rates, important for representativeness, have been falling. International comparisons are hampered by differing exclusion criteria and definitions for non-response.Method: Information was collected about seven national HESs in Europe conducted in 2007-2012. These surveys can be classified into household and individual-based surveys, depending on the sampling frames used. Participation rates of randomly selected adult samples were calculated for four survey modules using standardised definitions and compared by sex, age-group, geographical areas within countries, and over time, where possible.Results: All surveys covered residents not just citizens; three countries excluded those in institutions. In two surveys, physical examinations and blood sample collection were conducted at the participants' home; the others occurred at examination clinics. Recruitment processes varied considerably between surveys. Monetary incentives were used in four surveys. Initial participation rates aged 35-64 were 45% in the Netherlands (phase II), 54% in Germany (new and previous participants combined), 55% in Italy, and 65% in Finland. In Ireland, England and Scotland, household participation rates were 66%, 66% and 63% respectively. Participation rates were generally higher in women and increased with age. Almost all participants attending an examination centre agreed to all modules but surveys conducted in the participants' home had falling responses to each stage. Participation rates in most primate cities were substantially lower than the national average. Age-standardized response rates to blood pressure measurement among those aged 35-64 in Finland, Germany and England fell by 0.7-1.5 percentage points p.a. between 1998-2002 and 2010-2012. Longer trends in some countries show a more marked fall.Conclusions: The coverage of the general population in these seven national HESs was good, based on the sampling frames used and the sample sizes. Pre-notification and reminders were used effectively in those with highest participation rates. Participation rates varied by age, sex, geographical area, and survey design. They have fallen in most countries; the Netherlands data shows that they can be maintained at higher levels but at much higher cost. [ABSTRACT FROM AUTHOR]

Background: A recent weakening and even decoupling of the association of body mass index (BMI) and systolic blood pressure (SBP) in population data was reported, i. a. for Western Europe. Methods: The association of BMI and SBP in recent cross-sectional population data from Germany was investigated in participants aged 18-79 years with BMI 17.5-40 kg/m2 from national health examination surveys 1998 (n = 6,931) and 2008-2011 (n = 6,861) in Germany. The association was analyzed both in the overall samples and in participants without antihypertensive medication. Results: From 1998 to 2008-11, age- and sex-standardized mean SBP decreased from 129.0 (CI 128.2-129.7) to 124.1 (123.5-124.6) mmHg in all participants and from 126.0 (125.4-126.7) to 122.3 (121.7-122.8) mmHg among persons not on antihypertensive medication. The proportion of persons treated with antihypertensives augmented from 19.2 % (17.7-20.8) to 25.3 % (24.0-26.6). Mean BMI remained constant at around 27 kg/m2 with a slight increase in obesity prevalence. BMI was positively associated with SBP both in 1998 and 2008-11, yet the association tended to level out with increasing BMI suggesting a non-linear association. The strength of the BMI-SBP-association decreased over time in all and untreated men. In women, the association weakened in the overall sample, but remained similarly strong in untreated women. The unadjusted linear regression models were used to estimate the increase in SBP within 5-unit BMI increases. E. g. for men in 1998, SBP was higher by 7.0 mmHg for a BMI increase from 20 to 25 kg/m2 and by 3.6 mmHg for BMI 30 to 35 kg/m2. The corresponding values for 2008-11 were 3.8 mmHg and 1.7 mmHg. Conclusions: The cross-sectional association of BMI and SBP decreased between 1998 and 2008-11 in Germany, however it did not disappear and it is in part explained by improvements in the diagnosis and treatment of high blood pressure. [ABSTRACT FROM AUTHOR]

Aims: In the 1980s, participation rates in health interview and health examination surveys were around 80% while now they are around 50–60%. There is also evidence that non-participation is selective. Low participation rates and selective non-participation may cause bias to our survey results based on participants alone. We aim to increase knowledge on cultural differences in acceptance and feasibility of different recruitment methods. Methods: The European Health Examination Survey Pilot Project, conducted in 2009–2012, included pilot surveys in 12 countries among people aged 25–64 years. Information about recruitment methods and participation rates in these surveys was collected. Results: Participation rates ranged from 16% to 57% for men and from 31% to 74% for women, where in most surveys women had higher participation rates than men. A variety of recruitment and promotion methods were used to obtain as high participation rates as possible. Combinations of phone calls, invitation letter and home visits were used to recruit invitees. Obtaining valid phone numbers for survey invitees was difficult in several countries. Incentives, websites and promotion in local media were used to promote the surveys. Conclusions: The European Health Examination Survey Pilot surveys showed that obtaining a participation rate above 50% for a representative population sample is possible but it requires hard work and a well-planned recruitment strategy. Recruitment methods used in one country may not be possible to use in another country due to cultural norms and national regulations. [ABSTRACT FROM PUBLISHER]

Data missing not at random (MNAR) are a major challenge in survey sampling. We propose an approach based on registry data to deal with non-ignorable missingness in health examination surveys. The approach relies on follow-up data available from administrative registers several years after the survey. For illustration, we use data on smoking prevalence in Finnish National FINRISK study conducted in 1972-97. The data consist of measured survey information including missingness indicators, register-based background information and register-based time-to disease survival data. The parameters of missingness mechanism are estimable with these data although the original survey data are MNAR. The underlying data generation process is modelled by a Bayesian model. The results indicate that the estimated smoking prevalence rates in Finland may be significantly affected by missing data. [ABSTRACT FROM AUTHOR]

Health data and statistics are the foundation of health policy. Over the last 20 years, numerous government documents have been commissioned and published to inform obesity strategies in the UK. The Health Survey for England, an annual cross-sectional survey of a nationally representative random general population sample in England, collects information on health, lifestyle and socioeconomic factors, physical measurements and biological samples. Heights and weights measured by the Health Survey for England are believed to have played a major part in promoting, shaping and evaluating obesity strategies. A formal review of how these data have been used has not been conducted previously. This paper reviews government documents demonstrating the contribution of Health Survey for England examination data to every stage of the policy making process: quantifying the obesity problem in England (e.g. Chief Medical Officer's reports);, identifying inequalities in the burden of obesity ( Acheson report);, modelling potential future scenarios ( Foresight);, setting and monitoring specific, measurable, attainable targets (calorie reduction challenge in manufacturers' Responsibility Deal);, developing and informing strategies and clinical guidance; and, evaluating the success of obesity strategies ( Healthy Weights, Healthy Lives progress report)., Measurement data are needed and used by governments to produce evidence-based strategies to combat obesity. [ABSTRACT FROM AUTHOR]

Objective: To assess change in abdominal obesity in adolescents in England. Study design: Health Survey for England (HSE), annual cross-sectional surveys of nationally representative samples in England. Methods: This study included 1770 children aged 11-16 years in HSE 2005-2007 with valid waist circumference (WC) measurements. WC and body mass index (BMI) were expressed as standard deviation scores (z scores) against the growth references used for British children. Results: Mean WC z scores were substantially higher than mean BMI z scores for both sexes: WC 1.0 [95% confidence interval (CI) 0.93-1.1], BMI 0.54 (95% CI 0.44-0.63) for boys; WC 1.3 (95% CI 1.2-1.4), BMI 0.48 (95% CI 0.40-0.56) for girls (both P < 0.001). Mean WC z score was higher for girls than boys (P < 0.001). Between 1997 and 2005-2007, WC increased for both boys (P < 0.01) and girls (P < 0.001), but BMI did not (P > 0.05). Only children in the lowest WC decile had an increase in WC z score less than +1 standard deviation compared with the 1977-1987 baseline. BMI z score increased across the top nine deciles of the BMI distribution by 0.4 (2nd-4th deciles) to 0.9 (top decile). Conclusions: WC in adolescents has increased substantially, and probably more than BMI. The whole population has become fatter. [ABSTRACT FROM AUTHOR]

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Aims: To report the results of the first national Health Examination Survey (HES) on the prevalence of diabetes, its pharmacologic treatment and level of control, as well as pre-diabetes in Greece.Methods: Data were derived from the National Survey of Morbidity and Risk Factors (EMENO), in a randomly selected, representative sample of the adult Greek population. Sampling weights were applied to adjust for study design and post-stratification weights to match sample age/sex distribution to the population. Non-response was adjusted by inverse probability weighting. Weighted prevalence estimates are provided.Results: A total of 4393 persons with HbA1c and/or fasting plasma glucose measurements were included. Total diabetes prevalence was 11.9% (95% CI: 10.9-12.9), known diabetes 10.4% (9.5-11.4), and unknown 1.5% (1.1-1.9), with considerable increase in older age groups and no difference between genders. Pre-diabetes prevalence was 12.4% (11.4-13.6). The majority of persons with known diabetes were receiving metformin. Of those with known diabetes (and measured HbA1c), 70.9% were well controlled (HbA1c <7.0%).Conclusions: This first representative national HES showed high prevalence of diabetes in Greece, with low prevalence of unknown diabetes. Pre-diabetes prevalence is also substantial. These results will hopefully enable national authorities develop tailored and efficient strategies for disease prevention and management. [ABSTRACT FROM AUTHOR]

Introduction: The incidence of colorectal cancer is increasing worldwide. However, the screening uptake is generally low. We analyzed the association between sociodemographic, economic, and access-to-healthcare factors and the use of exams that are the basis for colorectal cancer screening in Portugal., Methods: We conducted a cross-sectional study based on data from the 1st National Health Examination Survey. We used Poisson regression to estimate prevalence ratios and study factors associated with the use of fecal immunochemical tests (FIT) and colonoscopy in a Portuguese population aged 50-74 years ( n = 2,489)., Results: 45.7% of the individuals reported using FIT in the previous 2 years; 37.3% reported using colonoscopy in the previous 5 years. The use of FIT was associated with age group, health region, and having a family doctor. It was higher in older individuals (47.6% in the age group 70-74 years vs. 38.1% in the age group 50-54 years; adjusted prevalence ratio [aPR] = 1.32; 95% CI 1.05-1.65), and in individuals assigned to a family doctor (47.6 vs. 30.3%; aPR = 1.50; 95% CI 1.14-1.98). Colonoscopy was associated with age group, health region, higher education, economic capacity, and having a family doctor. It was higher in older individuals (45.3% in the age group 70-74 years vs. 25.6% in the age group 50-54 years; aPR = 1.85; 95% CI 1.42-2.40), individuals with a higher economic capacity (40.5 vs. 32.4%; aPR = 1.19; 95% CI 1.01-1.40), and individuals assigned to a family doctor (38.7 vs. 25.6%; aPR = 1.43; 95% CI 1.08-1.91)., Discussion/conclusion: In our analysis, the use of FIT and colonoscopy was influenced by sociodemographic, economic, and access-to-healthcare factors. This is relevant to guide interventions in this area. It is essential to ensure an equitable and uniform implementation of the screening program, with family doctors as an important part of the process., Competing Interests: The authors have no conflict of interests to declare., (Copyright © 2021 by The Author(s). Published by S. Karger AG, Basel on behalf of NOVA National School of Public Health.)

Improving healthy life years requires an effective understanding and management of the process of healthy ageing. Assessing the perceived health status and its determinants is a relevant step in this process. This study explored the potentialities of the Minimum European Health Module (MEHM) to cope with this critical issue. Investigation was conducted on 4798 Italian residents (49.7% women, aged 35-79 years), participating in the CUORE Project Health Examination Survey 2008-2012. The three MEHM questions-perceived health status, chronic morbidity and activity limitations-were examined also in association with living context, seasonality, marital status and level of education. A higher prevalence of health status negative perception was associated with older age (9% and 24% respectively in men and women aged 35-44 years; 46% and 61% respectively in men and women aged 75-79 years). In women, this negative perception was higher than in men in any age group, and reached 50% in the 65-69 age group, 10 years earlier than in men. For both sexes, the level of education had a strong impact on this negative perception (odds ratio 2.32 and 2.72 in men and women respectively), while "living alone" played a greater impact in women than in men. MEHM activity limitations subscale was as much as 30% higher for questionnaires answered during the hottest months. This study identified potential predictors of perceived health status in adults aged 35-79 years, which can be used to target interventions aimed at improving self-perceived health status.

Introduction: With the rapid ageing of the population in Europe, reliable estimates of the future development of the disease and disability burden as well as healthy life years in the older sections of the population are crucial. Meanwhile, the future prospects of the health and functional ability of the working-aged population are critical. The aims of the Projections of the burden of disease and disability in Finland - health policy prospects research project are to provide information about the long-term consequences of health-related behaviours of the population and to project the potential improvement of the burden of disease and disability based on realistic scenarios about the development of risk behaviours in the total population and its subgroups., Methods and Analysis: The analyses will be based on data from representative cross-sectional and longitudinal health examination surveys (HESs) conducted between 1972 to 2017 in Finland, and register data from several national administrative registers. Included HESs (FINRISK Surveys from 1972 to 2012, Mini-Finland Survey from 1978 to 1980, the Health 2000/2011 Surveys and the FinHealth 2017 Study) provide abundant information about biological and behavioural risk factors and the health and morbidity of the population. The modifiable risk factors used as predictors include hypertension, hyperlipidaemia, obesity, diabetes, physical inactivity, smoking, alcohol use and unfavourable diet. The main outcomes are ischaemic heart disease, cerebrovascular diseases, lung cancer, chronic obstructive pulmonary disease, Alzheimer's disease and diabetes. Within the project, novel projection techniques of data-driven Bayesian hierarchical models to provide robust and comparable estimates will be developed., Ethics and Dissemination: The prevailing legislation and regulations have been followed for all surveys. Surveys since 1997 have been approved by the respective Ethics Committees covering the scope of this project. A written informed consent was obtained from participants since 1997. The outputs of the project will include 8 to 10 scientific papers in peer-reviewed journals., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Surveillance of and monitoring trends for cardiovascular diseases and risk factors are relevant when we consider that these diseases and conditions are largely preventable. The aim of this paper is to assess time trends of cardiovascular diseases, lifestyles, risk factors and high risk conditions in different socioeconomic levels., Methods: Paired but independent population samples of men and women aged 35-74 years located in all 20 Italian regions were examined in 1998-2002 (n = 9612) and in 2008-2012 (n = 8141). Time trends of lifestyles, cardiovascular risk factors, prevalence of high-risk conditions and cardiovascular diseases are shown for two different socioeconomic levels, as assessed by educational level., Results: Over 10 years, in both genders and socioeconomic classes, the prevalence of smoking decreased (from 32% to 23% in men) as well as mean levels of blood pressure (systolic from 136 mmHg to 133 mmHg in men and from 132 mmHg to 127 mmHg in women), while the prevalence of dyslipidemia and obesity increased reaching 35% and 25% of the population respectively; the prevalence of myocardial infarction remained stable (1.6% in men; about 0.5% in women), that of stroke decreased in men (from 1.2% to 0.7%); the prevalence of diabetes did not change (12% in men; 8% in women). In the low educational class, cardiovascular risk factors and diseases remained unfavourable compared with the high educational class., Conclusions: The burden of cardiovascular diseases and their risk factors remain high and require continuous appropriate action at the community and individual levels, as suggested by the European Guidelines for Cardiovascular Prevention., (© The European Society of Cardiology 2015.)

Background: Information is needed at all stages of the policy making process. The Health Survey for England (HSE) is an annual cross-sectional health examination survey of the non-institutionalised general population in England. It was originally set up to inform national policy making and monitoring by the Department of Health. This paper examines how the nurse collected physical and biological measurement data from the HSE have been essential or useful for identification of a health issue amenable to policy intervention; initiation, development or implementation of a strategy; choice and monitoring of targets; or assessment and evaluation of policies., Methods: Specific examples of use of HSE data were identified through interviews with senior members of staff at the Department of Health and the Health and Social Care Information Centre. Policy documents mentioned by interviewees were retrieved for review, and reference lists of associated policy documents checked. Systematic searches of Chief Medical Officer Reports, Government 'Command Papers', and clinical guidance documents were also undertaken., Results: HSE examination data have been used at all stages of the policy making process. Data have been used to identify an issue amenable to policy-intervention (e.g. quantifying prevalence of undiagnosed chronic kidney disease), in strategy development (in models to inform chronic respiratory disease policy), for target setting and monitoring (the 1992 blood pressure target) and in evaluation of health policy (the effect of the smoking ban on second hand smoke exposure)., Conclusions: A health examination survey is a useful part of a national health information system.