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Background and study aims: There is widespread consensus on the need for better indicators of the effectiveness of healthcare. We carried out an analysis of the validity of amenable mortality as an indicator of the effectiveness of healthcare, focusing on the potential use in routine surveillance systems of between-country variations in rates of mortality. We assessed whether the introduction of specific healthcare innovations coincided with declines in mortality from potentially amenable causes in seven European countries. In this paper, we summarise the main results of this study and illustrate them for four conditions. Data and methods: We identified 14 conditions for which considerable declines in mortality have been observed and for which there is reasonable evidence in the literature of the effectiveness of healthcare interventions to lower mortality. We determined the time at which these interventions were introduced and assessed whether the innovations coincided with favourable changes in the mortality trends from these conditions, measured using Poisson linear spline regression. All the evidence was then presented to a Delphi panel. Main results: The timing of innovation and favourable change in mortality trends coincided for only a few conditions. Other reasons for mortality decline are likely to include diffusion and improved quality of interventions and in incidence of diseases and their risk factors, but there is insufficient evidence to differentiate these at present. For most conditions, a Delphi panel could not reach consensus on the role of current mortality levels as measures of effectiveness of healthcare. Discussion and conclusions: Improvements in healthcare probably lowered mortality from many of the conditions that we studied but occurred in a much more diffuse way than we assumed in the study design. Quantification of the contribution of healthcare to mortality requires adequate data on timing of innovation and trends in diffusion and quality and in incidence of disease, none of which are currently available. Given these gaps in knowledge, between-country differences in levels of mortality from amenable conditions should not be used for routine surveillance of healthcare performance. The timing and pace of mortality decline from amenable conditions may provide better indicators of healthcare performance. [ABSTRACT FROM AUTHOR]

Objectives To measure changes in prevalence and predictors of home smoking bans (HSBs) among smokers in four European countries after the implementation of national smoke-free legislation. Design Two waves of the International Tobacco Control Policy Evaluation Project Europe Surveys, which is a prospective panel study. Pre- and post-legislation data were used from Ireland, France, Germany and the Netherlands. Two pre-legislation waves from the UK were used as control. Participants 4634 respondents from the intervention countries and 1080 from the control country completed both baseline and follow-up and were included in the present analyses. Methods Multiple logistic regression models to identify predictors of having or of adopting a total HSB, and Generalised Estimating Equation models to compare patterns of change after implementation of smoke-free legislation to a control country without such legislation. Results Most smokers had at least partial smoking restrictions in their home, but the proportions varied significantly between countries. After implementation of national smoke-free legislation, the proportion of smokers with a total HSB increased significantly in all four countries. Among continuing smokers, the number of cigarettes smoked per day either remained stable or decreased significantly. Multiple logistic regression models indicated that having a young child in the household and supporting smoking bans in bars were important correlates of having a pre-legislation HSB. Prospective predictors of imposing a HSB between survey waves were planning to quit smoking, supporting a total smoking ban in bars and the birth of a child. Generalised Estimating Equation models indicated that the change in total HSB in the intervention countries was greater than that in the control country. Conclusions The findings suggest that smoke-free legislation does not lead to more smoking in smokers' homes. On the contrary, our findings demonstrate that smoke-free legislation may stimulate smokers to establish total smoking bans in their homes. [ABSTRACT FROM AUTHOR]

Background: Multiple sclerosis (MS) is a chronic disabling, demyelinating disease of the central nervous system and is often associated with psychiatric comorbidities. Some studies suggest increased prevalence of bipolar disorder (BD) in MS. Objective: To conduct a systematic review and meta-analysis assessing the prevalence of BD in adults with MS. Methods: We registered this review with PROSPERO and searched electronic databases (Ovid MEDLINE, Central, Embase, PsycINFO and Scopus) for eligible studies from earliest inception to October 2020. Prevalence data of BD in adult patients with MS were extracted. Meta-analysis was conducted using random-effects model. Findings: Of the 802 articles that were screened, 23 studies enrolling a total of 68 796 patients were included in the systematic review and meta-analysis. The pooled prevalence rate of BD in patients with MS was 2.95% (95% CI 2.12% to 4.09%) with higher prevalence in the Americas versus Europe. The lifetime prevalence of BD was 8.4% in patients with MS. Subgroup analysis showed a higher prevalence of BD in MS in females (7.03%) than in males (5.64%), which did not reach statistical significance (p=0.53). Conclusions: This meta-analysis suggests a high lifetime prevalence of BD in patients with MS. Patients with MS should be routinely screened for BD. Further assessment of bipolar comorbidity in MS through prospective studies may help in developing effective management strategies and may improve treatment outcomes in patients with MS. [ABSTRACT FROM AUTHOR]

The article discusses a study to find whether work related stress increases the risk of common cancers. It states that work related stress is connected with many adverse health effects such as coronary heart disease and depression, it is suggested that it could also raise the risk of cancer. It mentions that the proof of this association is uncertain. Topics include selection criteria for studies; primary outcome; and bias, confounding, and other reasons for caution.

The article presents a study to determine whether measurement of C reactive protein (CRP) and procalcitonin help in the analysis of pneumonia in primary care. It states that presence of pneumonia was considered if the local radiologist reported lobar or bronchopneumonia. Results showed that CRP helped to eliminate pneumonia and procalcitonin had no clinically applicable added value. CRP and procalcitonin concentrations were measured with conventional venous blood tests is also mentioned.

The article discusses a study to evaluate the association between frequent use of sunbeds and the instance of melanoma in western Europe. The findings of this meta-analysis validate previous studies and affirm the increase in the risk of cutaneous melanoma due to the use of sunbeds from a young age. The article mentions that melanoma cases were majorly observed in all white populations irrespective of sun sensitivity.

Background: A growing number of studies indicate that sensationalist reporting of suicide is associated with increases in suicide rates, but in the light of some negative findings, the issue has remained controversial. The aim of this study was to evaluate the best current evidence on the association between celebrity suicide stories and subsequent suicides. Methods: Literature searches of six data sources (Medline, Psychlit, Communication Abstracts, Education Resources Information Center, Dissertation Abstracts and Australian Public Affairs Database (APAIS)) were conducted. Studies were included if they (1) adopted an ecological design, (2) focused on celebrity suicide, (3) had completed suicide as outcome variable, (4) analysed suicide rates across all suicide methods, (5) used data from after World War II and (6) satisfied basic quality criteria. Results: 10 studies with totally 98 suicides by celebrities met the criteria. The pooled estimate indicated a change in suicide rates (suicides per 100 000 population) of 0.26 (95% CI 0.09 to 0.43) in the month after a celebrity suicide. There was substantial heterogeneity between studies, which was explained by the type of celebrity (entertainment elite vs others) and the region of study, as indicated by mixed-effects meta-regression. The region-of-study--specific effect of reporting a suicide by an entertainment celebrity was 0.64 (95% CI 0.55 to 0.73) in North America, 0.58 (95% CI 0.47 to 0.68) in Asia, 0.36 (95% CI -0.10 to 0.61) in Australia and 0.68 (95% CI 0.51 to 0.85) in Europe. There was no indication of publication bias. Conclusions: Reports on celebrity suicide are associated with increases in suicides. Study region and celebrity type appear to have an impact on the effect size. [ABSTRACT FROM AUTHOR]

Background: Studying social disparities in health implies the ability to measure them accurately, to compare them between different areas or countries and to follow trends over time. This study proposes a method for constructing a French European deprivation index, which will be replicable in several European countries and is related to an individual deprivation indicator constructed from a European survey specifically designed to study deprivation. Methods and Results: Using individual data from the European Union Statistics on Income and Living Conditions survey, goods/services indicated by individuals as being fundamental needs, the lack of which reflect deprivation, were selected. From this definition, which is specific to a cultural context, an individual deprivation indicator was constructed by selecting fundamental needs associated both with objective and subjective poverty. Next, the authors selected among variables available both in the European Union Statistics on Income and Living Conditions survey and French national census those best reflecting individual experience of deprivation using multivariate logistic regression. An ecological measure of deprivation was provided for all the smallest French geographical units. Preliminary validation showed a higher association between the French European Deprivation Index (EDI) score and both income and education than the Townsend index, partly ensuring its ability to measure individual socioeconomic status. Conclusion: This index, which is specific to a particular cultural and social policy context, could be replicated in 25 other European countries, thereby allowing European comparisons. EDI could also be reproducible over time. EDI could prove to be a relevant tool in evidence-based policymaking for measuring and reducing social disparities in health issues and even outside the medical domain. [ABSTRACT FROM AUTHOR]

Background Discussions on raising pension eligibility age focus more on improvement in life expectancy (LE) and health expectancy measures than on socioeconomic differences in these measures. Therefore, this study assesses the level of socioeconomic differences in these two measures in Western-Europe. Methods Data from seven annual waves (1995-2001) of the European Community Household Panel were used. Health and socioeconomic information was collected using standardised questionnaires. Health was measured in terms of disability in daily activities. Socioeconomic status was determined as education level at baseline. Multi-state Markov modelling was applied to obtain age-specific transition rates between health states for every country, educational level and gender. The multi-state life table method was used to estimate LE and disability free life expectancy (DFLE) according to country, educational level and gender. Results When comparing high and low educational levels, differences in partial DFLE between the ages 50 and 65 years were 2.1 years for men and 1.9 years for women. At age 65 years, for LE the difference between high and low educated groups was 3 years for men and 1.9 years for women, and for DFLE the difference between high and low educated groups was 4.6 years for men and 4.4 years for women. Similar patterns were observed in all countries, although inequalities tended to be greater in the southern countries. Conclusions Educational inequalities, favouring the higher educated, exist on both sides of the retirement eligibility age. Higher educated persons live longer in good health before retirement and can expect to live longer afterwards. [ABSTRACT FROM AUTHOR]

Background Recent analyses explored associations of welfare state regimes with population health, with particular interest in differences between social protection-oriented versus more liberal regimes. Little is known about such associations with work-related health. The aims of this contribution are (1) to study variations of quality of work according to type of welfare regime and (2) to analyse differences in the size of effects of quality of work on workers' health according to type of welfare regime. Methods The authors use cross-sectional and longitudinal data from two studies ('Survey of Health, Ageing and Retirement in Europe' and the 'English Longitudinal Study on Ageing') with 9917 employed men and women (aged 50 to 64) in 12 European countries. Psychosocial quality of work is measured by low control and effort--reward imbalance at work. Depressive symptoms are introduced as a health indicator. Linear multilevel models and logistic regression analyses are performed to test the hypotheses. In addition to the welfare regime typology, the authors introduce labour policy and economy-related macro indicators. Results Between-country variations in quality of work are largely explained by macro indicators and welfare regimes, with poorer quality of work in countries with less emphasis on older workers' protection. Moreover, in the Liberal and Southern welfare regime, effects of quality of work on depressive symptoms are relatively strongest (adjusted ORs varying from 1.45 to 2.64). Conclusion Active labour policies and reliable social protection measures (eg, Scandinavian welfare regime) exert beneficial effects on the health and well-being of older workers. More emphasis on improving quality of work among this group is warranted. [ABSTRACT FROM AUTHOR]

Objective To study the association between exposure to transportation noise and blood pressure (BP) reduction during nighttime sleep. Methods 24-h ambulatory BP measurements at 15-min intervals were carried out on 149 persons living near four major European airports. Noise indicators included total and source-specific equivalent indoor noise, total number of noise events, annoyance scores for aircraft and road traffic nighttime noise. Long-term noise exposure was also determined. Multivariate linear regression analysis was applied. Results The pooled estimates show that the only noise indicator associated consistently with a decrease in BP dipping is road traffic noise. The effect shows that a 5 dB increase in measured road traffic noise during the study night is associated with 0.8% (-1.55, -0.05) less dipping in diastolic BP. Noise from aircraft was not associated with a decrease in dipping, except for a nonsignificant decrease noted in Athens, where the aircraft noise was higher. Noise from indoor sources did not affect BP dipping. Conclusions Road traffic noise exposure may be associated with a decrease in dipping. Noise from aircraft was not found to affect dipping in a consistent way across centres and indoor noise was not associated with dipping. [ABSTRACT FROM AUTHOR]

Background Reduced hand-grip strength predicts disability, morbidity and mortality, but whether it is shaped by socio-economic experiences is yet unknown. The authors examined the association of education, occupation, income and wealth with grip strength in older Europeans. Methods Data came from the Survey of Health, Ageing and Retirement in Europe comprising 27 351 participants ages 50+ in 11 countries. Grip strength was objectively measured using a handheld dynamometer. Estimates were obtained based on multivariate linear regression controlling for a wide set of confounders, demographics, health and disability measures, and behavioural risk factors. Results In the total sample, education, occupational class, income and wealth predicted grip strength among men, whereas only education and wealth predicted grip strength among women. While education and income effects were inconsistent in most countries, wealth consistently predicted grip strength in each country. A one-point increase in the log of wealth was associated with 0.38 kg (95% CI 0.31 to 0.45) higher grip strength in men and 0.18 kg (95% CI 0.15 to 0.21) higher grip strength in women. While education, income and occupation effects disappeared after adjustment for health measures, log of wealth effects remained significant in both men (0.22, 95% CI 0.15 to 0.29) and women (0.08, 95% CI 0.05 to 0.11). Wealth effects were particularly evident in the two lowest quintiles. Conclusion Old-age socio-economic and financial circumstances as measured by wealth are associated with grip strength, particularly among the least wealthy, while circumstances defined earlier in life as measured by education, income and occupation do not consistently predict grip strength. [ABSTRACT FROM AUTHOR]

Objective Unemployed individuals have poorer mental health than the employed, but the direction of this association is not clear. Our objective was to examine the links between major depression and unemployment in a European cohort of general practice attenders. Design Prospective cohort. Setting General practices in UK, Estonia, The Netherlands, Portugal, Slovenia, Spain and Chile. Participants Consecutive general practice attendees aged 18 to 75 years recruited April 2003-September 2004 (n=9793), followed up at 6, 12 and, in a subset (n=3259), 24 months. Main outcome measure The Depression Section of the Composite International Diagnostic Interview was completed at baseline, 6, 12 and 24 months. Employment status was self-reported at baseline, 6 and 24 months. Methods Random effect regression models or robust standard errors were used to account for clustering at General Practice level. Multinomial logistic regression models investigated whether unemployment (at baseline or 6 months) predicted onset of depression at 12 months. Logistic regression models investigated whether major depression (at baseline or 6 months) predicted onset of unemployment at 6 or 24 months. All models were adjusted for age, gender, level of education and country of origin. Gender interactions were examined. Results 3969 participants were employed or unemployed and seeking work at baseline and at 6 months. 6% (n=221) had major depression at 12 months. Participants who were employed baseline but unemployed at 6 months compared to those employed at both time points had adjusted RRR of 1.63 (95% CI 1.02 to 2.60) for presence of depressive symptoms and 1.50 (95% CI 0.83 to 2.72) for major depression at 12 months. Gender differences were not significant. 12% (n=465) were unemployed at 6 months. The adjusted OR of being unemployed at 6 months, for participants with major depression at baseline and 6 months was 1.63 (95% CI 1.01 to 2.64). The OR of unemployment at 24 months associated with major depression at baseline or 6 months in men was 3.52 (95% CI 0.97 to 12.75) adjusted for lifetime depression and was further attenuated on adjustment for prior employment. In women the equivalent OR was 0.98 (95% CI 0.54 to 1.79). Discussion There is some evidence that both causation and health selection result in raised levels of depressive symptoms in the unemployed. General practitioners should carefully monitor recently unemployed adults for onset of depressive symptoms and possible subsequent major depression. Adults with depression may have raised risks of subsequent unemployment and so should be supported at work. [ABSTRACT FROM PUBLISHER]