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Background High-risk human papillomavirus (HR-HPV) is a known cause of cervical cancer (CC). Latvia has a high incidence of CC compared with the average incidence in the European Union. This study aims to fill the data gap on the HR-HPV burden in Latvia, providing information on its prevalence and associated factors. Methods The cross-sectional study was conducted from February 2021 to April 2022. Participants 25–70 years old visiting a general practitioner (general population) or those referred to a colposcopy clinic with changes in their cervical cytology (colposcopy population) collected vaginal self-sample and completed a paper-based questionnaire. Samples were analyzed with Cobas 6800 System (Roche) for HPV16, HPV18 and other HR-HPV (HPV31/33/35/39/45/51/52/56/58/59/66/68). Descriptive statistics for categorical variables were performed. The Chi-square test was used to determine for the statistical significance of differences in the proportions of the dependent variable between subgroups of the independent variable. Univariate and multivariate binary logistic regression were used to identify factors associated with positive HR-HPV status. Results were considered statistically significant at P  < 0.05. Results A total of 1274 participants provided a valid sample. The prevalence of any HR-HPV infection was 66.8% in the colposcopy group and 11.0% in the general population. Factors associated with positive HR-HPV status were marital status single/divorced/widowed (vs. married/cohabiting) [adjusted OR (aOR) 2.6; P  = 0.003], higher number of lifetime sex partners [aOR 5.1 (P  < 0.001) and 4.0 (P  = 0.001)] for six or more and three to five partners in the general population; in the colposcopy group, the statistical significance remained only for Latvian ethnicity (vs. other) (aOR 1.8; P  = 0.008) and current smoking (vs. never) (aOR 1.9; P  = 0.01). Conclusion We documented a comparison to European Union HR-HPV infection burden in Latvia. Any HR-HPV positivity was significantly associated with sexual and other health behavior. [ABSTRACT FROM AUTHOR]

Background Atopic diseases are among the most common chronic conditions in childhood. Causes of allergies are manifold. The aim of this paper is to evaluate risk factors for atopic diseases and unremitting wheeze and to examine if there is an association between measles, mumps and rubella (MMR) vaccination and atopic dermatitis, asthma and unremitting wheeze in Bavarian pre-schoolers. Methods Parents filled out a questionnaire on children's health and environmental and socioeconomic factors. The questionnaire was administered within the Health Monitoring Units in a cross-sectional study in Bavaria, Germany (2014/2015). Data on vaccinations were obtained via the School Entrance Examination, a mandatory examination for pre-school children in Bavaria. Rates of influential factors of atopic diseases and wheeze, MMR and DTP (diphtheria, pertussis and tetanus) vaccination were calculated for all children stratified by health outcomes. To examine if there is an association between MMR vaccination and health outcomes, a multiple logistic regression analysis was performed. Results Data were available for 3237 individuals. Symptoms and diseases were more frequent in boys. Higher parental education was associated with a higher prevalence of atopic dermatitis. There were no significant associations between any of the health outcome groups and MMR vaccination in the multiple logistic regression models with adjustment for potential confounders. Conclusions The present study is in line with the current state of research that MMR vaccination is not associated with atopic diseases. [ABSTRACT FROM AUTHOR]

Background: The strengthening of primary care (PC) has been encouraged as a strategy to achieve more efficient and equitable health systems. However, the Great Recession may have reduced access to PC. This paper analyses the change in access to PC and its patterning in 28 European countries between 2007 and 2012. Methods: We used data from the 2007 and 2012 waves of the EU-SILC questionnaire (n = 687 170). The dependent variable was the self-reported access to PC ('easy' vs. 'difficult'). We modelled the access to PC as a function of the year and individual socioeconomic and country-level health system variables, using a mixed effects logistic regression, adjusting for sex, age, civil status, country of birth, chronic condition and self-reported health. Additionally, we interacted the year with socioeconomic and country-level variables. Results: The probability of reporting difficult access to PC services was 4% lower in 2012, in comparison with 2007 (OR = 0.96, P < 0.01). People with the lowest educational level (OR = 1.63, P < 0.01), high difficulty to make ends meet (OR = 1.94, P < 0.01) and with material deprivation (OR = 1.25, P < 0.01) experienced a significantly higher likelihood of difficult access. The better access in 2012 was significantly higher in people living in countries with higher health expenditures, a greater number of generalist medical practitioners, and with stronger gatekeeping. Conclusion: Access to PC improved between 2007 and 2012, and this improvement was greater for people living in countries with a higher investment in health and PC. However, the poor access amongst low-SE status people was stable over the period. [ABSTRACT FROM AUTHOR]

Background During the Coronavirus Disease 2019 (COVID-19) pandemic, immunization programmes struggled to reach all population groups equally. While migrant groups face multiple barriers to health systems, including vaccination, little is known about their vaccine uptake. Methods We conducted a cross-sectional telephone survey on adults with and without migration history in Germany to investigate barriers and drivers to COVID-19 vaccination (11 April 2021 to 18 December 2021). Interviews were conducted in six languages. We used logistic regression models and a mediation model to analyze the association between migration history and vaccine uptake. Furthermore, we determined the effect of psychological determinants (5C model) on vaccine uptake. Results The survey comprised 2039 individuals, including 1015 with migration history. Of these, 448 were interviews conducted in languages other than German. Individuals with migration history had a significantly lower vaccine uptake but, while still unvaccinated, had a higher intention to get vaccinated (P  = 0.015) compared with those without migration history. The association between migration history and vaccine uptake was no longer significant when other factors were included in the regression model (odds ratio = 0.9; 95% confidence interval: 0.57–1.47). Socio-economic index, language skills and discrimination experience fully mediated this association. Among the psychological determinants, 'higher confidence' and 'higher collective responsibility' increased the chance of individuals with migration history to be vaccinated. Conclusion Migration history alone cannot explain vaccine uptake; socio-economic index, language skills and discrimination experiences need to be considered. To achieve vaccine equity, future public health policy should aim to reduce relevant barriers through tailored interventions. [ABSTRACT FROM AUTHOR]

Background Recently, the World Health Organization (WHO) released an updated global guideline on physical activity and sedentary behavior, including recommendations for sub-populations living with chronic conditions or disabilities. We aimed to examine the prevalence of meeting the WHO recommendations among these sub-populations in the USA. Methods We conducted a cross-sectional study using data from the 2017 to 2018 cycle of the National Health and Nutrition Examination Survey (NHANES). Results We revealed variations in physical activity levels among individuals with chronic conditions and disability. US adults with diabetes, hypertension or disability had a lower prevalence of recommended physical activity levels than the general population. In addition, certain demographic groups such as being female, older and having lower socioeconomic status were associated with a lower likelihood of meeting the WHO recommendations on physical activity. Conclusions Our findings underscore the importance of promoting physical activity levels among US adults, especially those with older age, low socioeconomic status, hypertension and disability. [ABSTRACT FROM AUTHOR]

Background Misinformation hampers vaccine uptake. The European Union (EU) employed a coordinated effort to curb misinformation during the Covid-19 pandemic. In this context, we investigated relationships between sources of information, vaccine safety/effectiveness, satisfaction with government vaccination strategy, and vaccination intent. Methods We used cross-sectional survey data (May 2021) from Flash Eurobarometer 494, a population-adjusted dataset comprised of a representative sample of those ≥15 years from 27 EU nations. We employed a latent class analysis to create clusters of information sources as the independent variable and beliefs in vaccine safety/efficacy, satisfaction with government vaccination strategy, and vaccine intent as four outcome variables. We first estimated the association between source clusters and each of the first three outcomes separately. Then, using these three as intermediate variables, we employed structural equation modeling to estimate the relationship between sources and vaccine intent. We adjusted for individual and country-level variables. Results Among 23 012 respondents, four clusters of information sources emerged: (1) national authorities/health professionals (n  = 9602; 42%), (2) mostly health professionals (6184; 27%), (3) mixed (n  = 1705; 17%) and (4) social media/family/friends (n  = 5524; 24%). Using cluster (3) as the referent, we found decreasing odds of beliefs in vaccine safety/effectiveness, satisfaction and vaccine intent across clusters (1), (2) and (4), respectively. Demographics played a role. Conclusion In the context of the Covid pandemic, these results provide the first EU-wide estimates of the association between sources of information about vaccine safety/effectiveness, satisfaction and vaccine intent. The coordinated approach promulgated by the EU to minimize misinformation provides a model for managing future pandemics. [ABSTRACT FROM AUTHOR]

Background Flooding can cause long-term, significant impacts on mental health in affected populations. We explored help-seeking behaviour of households affected by flooding. Methods A cross-sectional analysis was conducted on National Study of Flooding and Health data on households flooded in England in winter 2013/14. Participants (Year 1: n  = 2006; Year 2: n  = 988; Year 3: n  = 819) were asked if they sought help from health services and other sources. Logistic regression was conducted to calculate odds ratios (ORs) of help-seeking in flooded and disrupted participants compared to unaffected, adjusted for a priori confounders. Results The odds of seeking help from any source 1 year after flooding were greater for flooded participants [adjusted OR (aOR): 1.71, 95% confidence interval (CI): 1.19–1.45] and those disrupted by flooding (aOR: 1.92, 95% CI: 1.37–2.68) compared to unaffected participants. This continued in the second year (flooded: aOR 6.24, 95% CI: 3.18–13.34; disrupted: aOR: 2.22, 95% CI: 1.14–4.68), and help-seeking remained greater in flooded than unaffected participants in the third year. Flooded and disrupted participants were particularly likely to seek help from informal sources. Help-seeking was more prevalent amongst participants with mental health outcomes, but a notable proportion of individuals with any mental health outcome did not seek help (Year 1: 15.0%; Year 2: 33.3%; Year 3: 40.3%). Conclusions Flooding is associated with increased demand for formal and informal support, persisting for at least 3 years, and an unmet need for help amongst affected individuals. Our findings should be considered in flood response planning to reduce the long-term adverse health impacts of flooding. [ABSTRACT FROM AUTHOR]

Background The COVID-19 pandemic has had wide effects on child health globally. Increased prevalence of childhood obesity has been observed by a number of countries during the pandemic. The absence of a formal societal lockdown during the pandemic, made Sweden stand out compared to other countries. This study aims to examine changes in BMI among preschool children in Sweden before and during COVID-19 pandemic. Methods Retrospective population-based cross-sectional study, with longitudinal follow-up for a portion of the children. The study included 25 049 children from three Swedish regions, with growth measures at 3- (n  = 16 237), 4- (n  = 14 437) and 5-years of age (n  = 11 711). Care Need Index was used as a socioeconomic parameter at health centre level. Results There was an increase in BMI in children aged three (P  = 0.028) and four (P <0.001) during the COVID-19 pandemic. Obesity in 3-year-old girls increased from 2.8% to 3.9%. Four-year-olds increased in obesity, and overweight (girls) and the prevalence of underweight decreased in boys. No change in BMI was observed in 5-year-olds. Children in areas of low socioeconomic status had higher risk of obesity. Conclusions Overweight and obesity increased among 3- and 4-year-old children in Sweden, findings that were accentuated in children attending child health centres in areas with lower socioeconomic status. The COVID-19 pandemic is likely to have affected health behaviours negatively in Swedish preschool children. Our results expose the need for extended efforts directed to prevent childhood obesity, especially targeting lower socioeconomic areas. [ABSTRACT FROM AUTHOR]

Background Over the past decade, the financial crisis has affected harshly the household income of Greek people. This study aimed to investigate whether the effect of the financial crisis on food spending has affected the dietary habits in the family environment. Methods Under a cross-sectional study conducted during 2014–2016, 1145 children and their parents completed questionnaires examining socio-economic and dietary characteristics. The MedDietScore and the KIDMED Score were used to assess parental and childhood adherence to the Mediterranean diet, respectively. Results The parents who reported that the financial crisis has affected food spending used to consume weekly fewer fruits (3.26 ± 0.94 vs. 3.41 ± 0.90, P  = 0.016), carbohydrate foods (3.16 ± 0.57 vs. 2.99 ± 0.55, P  < 0.001) and legumes (3.28 ± 0.76 vs. 3.14 ± 0.67, P  = 0.001) and more nutrient-poor/energy-dense foods (2.55 ± 0.98 vs. 2.20 ± 0.82, P  < 0.001) compared with non-affected parents. Their children showed a decreased weekly consumption of vegetables (2.82 ± 0.90 vs. 2.97 ± 0.98, P  = 0.019) and increased weekly consumption of nutrient-poor/energy-dense foods (2.38 ± 0.97 vs. 2.19 ± 0.80, P  < 0.001). The affected parents had a lower MedDietScore than non-affected parents (25.76 ± 8.10 vs. 27.03 ± 8.11, P  = 0.034). No difference was revealed on the KIDMED Score (P  = 0.294). Conclusions The constrained food spending due to financial crisis has an independent and inverse impact on parent's diet quality while keeping unaffected preadolescent's diet quality. This finding highlights the role of parents as a protective 'wall' against the deterioration of their children's diet quality. The modification on the prices of healthy food and the provision of food aid particularly in economically disadvantaged households is underlined. [ABSTRACT FROM AUTHOR]

Background Research has suggested that exposure to loneliness can have a powerful detrimental impact on health, including mental health. Addressing socially determined health inequity requires understanding of the situation of marginalized or vulnerable groups. People with disability are increasingly being recognized as one such group. Little population-based research has addressed the association between loneliness and health among working age adults with and without disability. Methods Secondary analysis of data collected in waves 8 and 9 of Understanding Society , the UK's main annual household panel study. Results Rates of exposure to substantial loneliness were 25.4% (95%CI 23.5–27.3%) among adults with persistent disability (disability at W8 and W9), 15.4% (13.3–17.5%) among adults with disability onset (disability at W9 only), 12.3% (10.1–14.5%) among adults with disability offset (disability at W8 only), and 6.9% (6.5–7.3%) among adults with no disability. Exposure to loneliness was positively associated with the incidence (GHQ-12) and prevalence (SF-12 Mental) of mental health problems, but not the prevalence of physical health problems (SF-12 Physical). Disability status appeared to moderate the association between loneliness and health, with the difference between the persistent disability and no disability group increasing with exposure to greater levels of loneliness. Conclusion Loneliness may be an important determinant of the poorer mental health of working age adults with disability in the UK. Exposure rates are significantly higher than among the non-disabled population. The strength of association between exposure to loneliness and poorer mental health is greater for people with persistent disability than people with no disability. [ABSTRACT FROM AUTHOR]

Background Scholar photoprotection campaigns are among the most effective strategies for preventing skin cancer. Analysis of the target population constitutes a valuable starting point for the implementation of primary prevention strategies. Our aim is to study photoprotection habits, attitudes and knowledge among a Spanish school community. Methods Descriptive cross-sectional study targeting schoolchildren, parents and teachers at 20 schools in the area of the Costa del Sol Health Agency in southern Spain. Two population-specific, validated questionnaires were used: the CHRESI (for children aged 0–10 years) and CHACES Questionnaire(for adults and adolescents aged > 11 years). We collected demographic data, skin colour, skin phototype, sunburn episodes, sun exposure and photoprotection practices, attitudes and knowledge. Results 1728 questionnaires were analyzed (22% parents, 14.5% teachers, 44.8% adolescents and 18.6% children). The average ages were 8 years (children), 16 years (adolescents), 39 years (teachers) and 42 years (parents). Globally, the predominant features were: male sex (52%), Spanish nationality (92%) and phototypes II–III (61%). Children, followed by adolescents, reported the highest exposure to the sun, both in frequency and in duration. Adolescents had the higher rate of sunburn (75%), followed by parents/teachers (54.1%) and children (44.1%). Children and their parents were the most likely to adopt photoprotection measures, while adolescents presented more risky attitudes. Knowledge regarding photoprotection was acceptable (6.9/10). Conclusions This study highlights the need to improve photoprotection knowledge, habits and attitudes among our target population. Scholars, parents and teachers in our area should be addressed in campaigns to promote healthy sun exposure habits, thus reducing skin cancer-related morbidity and mortality in this region. [ABSTRACT FROM AUTHOR]

Background The extent to which patients are involved in their care can be influenced by hospital policies and interventions. Nevertheless, the implementation of patient participation and involvement (PPI) at the organisational (meso) level has rarely been assessed systematically. The aim of this study was to assess the occurrence of PPI practises in hospitals in Belgium, France, Germany and Luxembourg and to analyze if, and to what extent, the hospital vision and the presence of a patient committee influence the implementation of PPI practises. Methods A cross-sectional study was carried out using an online questionnaire in hospitals in the border regions of the four countries. The data were analyzed for differences between regions and the maturity of PPI development. Results Full responses were obtained from 64 hospitals. A wide range of practices were observed, the degree of maturity was mixed. A majority of hospitals promoted patient partnership in the hospital's philosophy of care statement. However, the implementation of specific interventions for PPI was not found uniformly and differences could be observed between the countries. Conclusions Hospitals in the region seem to be motivated to include patients more fully, however, implementation of PPI interventions seems incomplete and only partially integrated into the general functioning of the hospitals. The implementation of the concept seems to be more mature in the francophone part of the region perhaps due, in part, to a more favourable political context. [ABSTRACT FROM AUTHOR]

Background When patients receiving palliative care are transferred between care settings, adequate collaboration and information exchange between health care professionals is necessary to ensure continuity, efficiency and safety of care. Several studies identified deficits in communication and information exchange between care settings. Aim of this study was to get insight in the quality of collaboration and information exchange in palliative care from the perspectives of nurses. Methods We performed a cross-sectional regional survey study among nurses working in different care settings. Nurses were approached via professional networks and media. Respondents were asked questions about collaboration in palliative care in general and about their last deceased patient. Potential associations between quality scores for collaboration and information handovers and characteristics of respondents or patients were tested with Pearson's chi-square test. Results A total of 933 nurses filled in the questionnaire. Nurses working in nursing homes were least positive about inter-organizational collaboration. Forty-six per cent of all nurses had actively searched for such collaboration in the last year. For their last deceased patient, 10% of all nurses had not received the information handover in time, 33% missed information they needed. An adequate information handover was positively associated with timeliness and completeness of the information and the patient being well-informed, not with procedural characteristics. Conclusion Nurses report that collaboration between care settings and information exchange in palliative care is suboptimal. This study suggests that health care organizations should give more attention to shared professionalization towards inter-organizational collaboration among nurses in order to facilitate high-quality palliative care. [ABSTRACT FROM AUTHOR]

Background A physically active lifestyle decreases the progression of atherosclerosis and consequently reduces cardiovascular mortality. However, activity levels are hampered by aging. The association between aging and physical inactivity might be gender-specific or be modified by the presence of cardiovascular disease (CVD). In this study, we investigated if the association between aging and physical inactivity was different between men and women and between primary and secondary prevention patients. Methods We performed a cross-sectional analysis of three primary care samples including primary and/or secondary prevention patients (total n = 4726). Baseline data for sample 1 were collected in the years 2013–14, for sample 2 in 2009–10 and for sample 3 in 2009. Activity levels were measured by the patient reported Rapid Assessment of Physical Activity questionnaire. A multilevel regression analysis was used to explore the association between aging and physical inactivity, adjusted for confounders. We examined potential effect modification by gender and the presence of CVD on the association between aging and physical inactivity. Results Multilevel regression revealed that aging was consistently associated with physical inactivity in three out of three samples. This association was, however, not modified by gender or the presence of CVD. Conclusions Cardiovascular risk management interventions should aim at increasing or maintaining physical activity levels in aging primary care population. This study does not support the notion that extra emphasis should be put in targeting men or women, or people with or without the presence of CVD. [ABSTRACT FROM AUTHOR]

Background Most European countries are still facing a high burden of sexually transmitted infections (STIs) cases each year. Available literature has found associations between time preference, i.e. the relative weight given by individuals to future outcomes compared to present ones, and various health behaviours such as tobacco or alcohol consumption, vaccination or participation in cancer screening programmes. Our objective is to investigate the role of future preference in risky sexual behaviours. Methods We conducted a cross-sectional study using self-administered questionnaires in three HIV testing centres in Paris. We collected data on sexual behaviours, risk perceptions, risk attitude, future preference (Considerations of Future Consequences scale) and socioeconomic and demographic variables. Full data for variables used in regression analyses were available for 1090 respondents. We study factors associated with condom use at the first sexual encounter, with the frequency of condom use and with the number of sexual partners. Results In the full sample, future preference is positively correlated with both measures of condom use while it is negatively correlated with the number of sexual partners. Decomposing the analysis by risk group, our results indicate that future preference has more impact on sexual behaviours, especially condom use, among men who have sex with men compared to heterosexual men and, to a lesser extent, compared to heterosexual women. Conclusion If future time perspective is confirmed as a determinant of safer sexual behaviours, prevention campaigns could be shifted towards greater information on short-term consequences of STIs. [ABSTRACT FROM AUTHOR]

Background Moderately elevated blood total cholesterol (TC), blood glucose (BG) and blood pressure (BP) are rarely symptomatic and as such many individuals remain untreated. We studied the yield of an in-pharmacy screening for identifying undetected high TC and strategies to reach those with absence of prior measurement of TC, BG and BP. Methods A cross-sectional TC screening study with complementary TC measurements and self-administered questionnaire was conducted for 1 week in each of 2012 and 2014 in 148 and 149 BootsTM Norge AS community pharmacies nationwide in Norway. Results Non-medicated adults (n = 21 090) with mean age 54.5 ± 16.0 were included. The study population resembled the Norwegian population in regards to body mass index, educational level, smokers and physical inactivity level, but with an overrepresentation of middle-aged women. Of 20 743 with available data, 11% (n = 2337) were unaware of their high TC ≥7.0 mmol/L, and an additional 8% were unaware of TC ≥6.2 mmol/L. More than 40% of the study sample had not measured TC or BG before. In order for future screenings to reach those who are less likely to have previously measured TC and BG, our results suggest that young, low-educated, overweight men and women should be targeted for TC measurement, whereas normal weigh men in all ages should be targeted for BG measurement. Conclusions In total 19% in an in-pharmacy screening were unaware of their elevated TC of ≥6.2 mmol/L. We also identified characteristics that could be used reach those who are less likely to have measured TC and BG. [ABSTRACT FROM AUTHOR]

Background Food insecurity is a major concern in homeless population, however nutritional consequences remain poorly documented, especially for children. The objective of this study was to assess the prevalence of anaemia and to investigate the relation between both food insecurity and dietary intake to moderate-to-severe anaemia (MSA) in homeless sheltered children. Methods In 2013, a cross-sectional survey was conducted on a random sample of 801 sheltered homeless families in the Paris region. Haemoglobin concentration was measured in 630 mother/child dyads and questionnaires administrated to mothers collected socio-demographic, socioeconomic, health and dietary data. Factors associated with MSA were analysed in two stratified child age groups; 0.5–5 and 6–12 years old. Results Anaemia was detected in 39.9% of the children and 50.6% of the mothers, and MSA in 22.3% and 25.6%, respectively. In both age groups, MSA was positively associated with maternal MSA. In the 0.5–5 years group, it was also positively associated with child food insecurity, no cooking facilities and household monthly income. In the 6–12 years group, it was positively associated with household food insecurity and children’s age. Conclusion A higher food insecurity score was associated with greater prevalence of moderate-to-severe anaemia in children. Considering the high prevalence of anaemia among homeless mothers and their children, these findings highlight the need for reducing food insecurity in shelters so as to prevent anaemia in this vulnerable population. [ABSTRACT FROM AUTHOR]

Background: In Spain, migrants are disproportionately affected by HIV and experience high rates of late diagnosis. We investigated barriers to health care access among migrants living with HIV (MLWH) in Spain. Methods: Cross sectional electronic survey of 765 adult HIV-positive migrants recruited within 18 health care settings between July 2013 and July 2015. We collected epidemiological, demographic, behavioral and clinical data. We estimated the prevalence and risk factors of self-reported barriers to health care using multivariable logistic regression. Results: Of those surveyed, 672 (88%) had information on health care access barriers: 23% were women, 63% from Latin America and Caribbean, 14% from Sub-Saharan Africa and 15% had an irregular immigration status. Men were more likely to report barriers than women (24% vs. 14%, P = 0.009). The main barriers were: lengthy waiting times for an appointment (9%) or in the clinic (7%) and lack of a health card (7%). Having an irregular immigration status was a risk factor for experiencing barriers for both men (OR: (4.0 [95%CI: 2.2-7.2]) and women (OR: 10.5 [95%CI: 3.1-34.8]). Men who experienced racial stigma (OR: 3.1 [95%CI: 1.9-5.1]) or food insecurity (OR: 2.1 [95%CI: 1.2-3.4]) were more likely to report barriers. Women who delayed treatment due to medication costs (6.3 [95%CI: 1.3-30.8]) or had a university degree (OR: 5.8 [95%CI: 1.3-25.1]) were more likely to report barriers. Conclusion: Health care barriers were present in one in five5 MLWH, were more common in men and were associated to legal entitlement to access care, perceived stigma and financial constraints. [ABSTRACT FROM AUTHOR]

Background: In 2012 the National Screening Program for all women between 25 and 64 years of age was launched in Romania. Public awareness is an important factor in the success of a screening program. For this reason, we intended to assess the perception and the level of awareness of Romanian women regarding the Pap test in the prevention of cervical cancer. Methods: A cross-sectional study was conducted among 454 women from rural and urban areas. For our study, we used a questionnaire covering general characteristics, awareness, knowledge and practices regarding cervical cancer and Pap smear. Results: 431 participants (95%) had heard of cervical cancer and Pap smear but only 71.8% knew the exact role of it. Bivariate analysis showed that knowledge about the importance of the Pap smear, early detection and treatment of early-stage cervical cancer was reduced among women with low socio-economic status, mainly living in rural area. The most frequent reasons for avoiding Pap smear screening were: lack of money, embarrassment or fear of gynaecological consultation and pain, the feeling that they don't need it, misconceptions about cervical cancer, fatalistic attitude, perceived low susceptibility to cervical cancer. Conclusions: Because the uptake and the success of cervical cancer screening are determined by women's knowledge and awareness of Pap smear, it is critical to improve these perceptions in the near future especially in rural area characterized by a low socio-economic status. [ABSTRACT FROM AUTHOR]

Background: The aim of this study is to assess if a Health Interview Survey (HIS) targeting the general population is an appropriate tool to collect valid data on domestic violence. Studying item non-response on the question on domestic violence and its association with socio-demographic and health characteristics compared with victims of domestic violence can contribute to this. Methods: Cross-sectional data from the Belgian HIS 2013 were analysed. A question whether the perpetrator of a violent event was a member of the respondents' household was embedded in a general topic on violence in the self-administered questionnaire. This study is limited to people aged 15+ that at least completed the first question of this topic. Socio-demographic characteristics of item nonrespondents and of victims of domestic violence were explored and the association with health status was assessed through ORs calculated via logistic regression. Results: The year prevalence of domestic violence is 1.1%. Although the question on domestic violence yields a high level of non-response (62%), this does not hinder the further completion of the questionnaire. When compared with victims of domestic violence, those not responding on the question on the perpetrator have better (mental) health. When compared with those not being victim of domestic violence, victims report poorer physical and mental health. Conclusion: An HIS can be an appropriate tool to assess domestic violence in the general population and its association with health. However, a solution should be found for the high item non-response on the question on the perpetrator of the violent event. [ABSTRACT FROM AUTHOR]

Background: Due to vitamin D intake below recommendation (10 mg/day) and low (<50nmol/l) serum 25- hydroxycholecalciferol (25(OH)D) concentration in Finnish population, the fortification of liquid dairy products with 0.5 mg vitamin D/100g and fat spreads with 10 mg/100g started in Finland in December 2002. In 2010, the fortification recommendation was doubled. The aim of this study was to investigate whether the vitamin D intake and status have improved among Finnish adults as a consequence of these nutrition policy actions. A further aim was to study the impact of vitamin supplement use to the total vitamin D intake. Methods: A cross-sectional survey was conducted every 5 years. The National FINDIET Survey was conducted in Finland as part of the National FINRISK health monitoring study. Dietary data were collected by using a computer-assisted 48-h dietary recall. In 2002, dietary data comprised 2007, in 2007, 1575 and 2012, 1295 working aged (25-64 years) Finns. Results: The mean D-vitamin intake increased from 5 mg/day to 17 mg/day in men and from 3 mg/day to 18 mg/day in women from 2002 to 2012. The most important food sources of vitamin D were milk products, fat spreads and fish dishes. The share of milk products was 39% among younger men and 38% among younger women, and 29% among older men and 28% among older women. Fat spreads covered on average 28% of vitamin D intake, except for younger men for which it covered 23%. Fish dishes provided 28% of vitamin D intake for older men and women, and approximately 18% for younger ones. In January-April 2012, the average serum 25-hydroxycholecalciferol (25(OH)D) concentration for men was 63 nmol/l for men and for women 67 nmol/l for women. Conclusions: The fortification of commonly used foods with vitamin D and vitamin D supplementation seems to be an efficient way to increase the vitamin D intake and the vitamin D status in the adult population. [ABSTRACT FROM AUTHOR]

Background: HIV testing is generally accepted as being the lynchpin of a prevention strategy to tackle the HIV epidemic among MSM. However, few studies have analysed in detail the factors that influence HIV test seeking behaviour. Methods: The objective of this article is to analyse the relationship between HIV test seeking behaviour and individual, social and demographic factors in a sample of MSM recruited though a multi-centre bio- behavioural cross-sectional study. A multi-level analysis was conducted to identify factors associated with HIV test seeking behaviour. Results: A total of 2400 men were included in the sample. Age, self-reported sexual orientation, residence, household composition, educational status and perceived homonegativity all seem to impact on test seeking behaviour. Conclusions: The results suggest the need for more targeted testing promotion strategies among MSM that take structural and environmental factors into consideration, as part of a comprehensive public health strategy to address the HIV epidemic. [ABSTRACT FROM AUTHOR]

Background: Patients' involvement in medical decision-making is crucial to provide good quality of care that is respectful of, and responsive to, patients' preferences, needs and values. Whether people want to be involved in medical decision-making is associated with individual patient characteristics, and health status. However, the observation of differences in whether people want to be involved does not in itself provide an explanation. Insight is necessary into mechanisms that explain people's involvement. This study aims to examine one mechanism, namely social norms. We make a distinction between subjective norms, that is doing what others think one ought to do, and descriptive norms, doing what others do. We focus on self-reported involvement in medical decision-making. Methods: A questionnaire was sent to members of the Dutch Health Care Consumer Panel in May 2015 (response 46%; N= 974). A regression model was used to estimate the relationship between socio-demographics, social norms and involvement in medical decision-making. Results: In line with our hypotheses, we observed that the more conservative social norms are, the less people are involved in medical decision-making. The effects for both types of norms were comparable. Conclusion: This study indicates that social norms play a role as a mechanism to explain involvement in medical decision-making. Our study offers a first insight into the possibility that the decision to be involved in medical decision-making is not as individual as it at first seems; someone's social context also plays a role. Strategies aimed at emphasizing patient involvement have to address this social context. [ABSTRACT FROM AUTHOR]

Background: With the goal of achieving greater unity and coherence, the Council of Europe developed a national palliative care (PC) policy framework--Recommendation (2003) 24. Although directed at member states, the policy spread to the wider World Health Organisation (WHO) European Region. This article aims to present the current situation relating to national PC health policies in European countries. Methods: A cross-sectional survey was conducted in 53 European countries of the WHO European Region. Relevant data reported (i) the existence of official documents concerning the provision of PC; (ii) the role of health departments and policymakers in the evaluation of PC provision and (iii) the availability of financial resources for PC provision. Results: In total, 46/53 (87%) EU and non-EU countries responded. PC legislation is established in 20 (71%) EU and nine (50%) non-EU countries. A total of 12 (43%) EU countries possess a PC plan or strategy in comparison with six (33%) non-EU countries. Individuals from Departments of Health and designated policymakers have established collaborative PC efforts. Quality systems have been initiated in 15 (54%) EU and four (22%) non-EU countries. Significant differences were not found in the reporting of payments for PC services between European regions. Conclusion: An improvement in national PC policy in both EU and non-EU countries was observed. Future priorities include potential initiatives to improve relationships with policymakers, establish quality control programmes and ensure financial support for PC. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to determine sex differences in the prevalence of cardiovascular health (CVH) metrics according to the CVH status. Methods: The cross-sectional, population-based study involved 2250 women and 1920 men aged >18 years that participated in the 2010 National Health Survey in the Republic of Srpska, Bosnia and Herzegovina. Prevalence of CVH behaviours (smoking, body mass index, physical activity, diet), CVH factors (cholesterol, fasting blood glucose and blood pressure, plus smoking) and ideal CVH were estimated according to the American Heart Association criteria for ideal, intermediate and poor levels. Association between sex and ideal CVH categories was analyzed with multivariable logistic regression analysis across three age stratums. Results: A higher prevalence of ideal CVH metrics was seen in women for smoking status, body mass index, healthy diet score and blood pressure, and in men for physical activity and total cholesterol. Women from all age groups had better CVH behaviours (odds ratio [OR] = 1.40 for the youngest; OR = 2.05 for middle-aged; and OR = 2.03 for older-aged women), while only women from the youngest age group had better CVH factors (OR = 5.09). In line with this, ideal overall CVH prevailed in younger and middle-aged women in comparison to men of the same ages (OR = 3.01 and OR = 2.25, respectively), while disappeared in older ones. Conclusions: Significant differences in the prevalence of CVH metrics between men and women in the Republic of Srpska should be considered in cardiovascular disease prevention. [ABSTRACT FROM AUTHOR]

Background: Positive affect contributes to the healthy life style, which, in turn, explains life satisfaction and psychological well-being among the elderly. Existent literature has reinforced that physical activity participation influences development of positive affect for the elderly. Because of the increased life constraints and physical problems, however, maintenance of positive affect might be challenging for elderly people. Methods: Data were drawn from a sample of the Survey of Health, Ageing and Retirement in Europe. A total sample of 3845 males and 3912 females aged between 65 and 103 years from 16 European countries was analyzed. Perception of life constraints, health problems, physical activity engagement and positive affect were measured by a structured questionnaire. Confirmatory factor analysis and a technique of structural equation modelling were employed using Amos 18 to examine the hypothesized relationships between study variables. Results: Perceived life constraints and physical problems significantly affected the acquisition of positive affect among the elderly. Physical activity was found to have a significant path coefficient towards the measure of positive attitude and emotion. Physical activity was also a significant mediator between physical problems and positive affect. Conclusions: This study extended our understanding of how the perception of life constraints and health problems influence the elderly's daily experience. Study finding reinforced the goodness of physical activity participation to enhance positive affect among the elderly. We should administer sustainable and evidence-based physical activity including interventions and infrastructure to improve positive affect and psychological well-bing among the elderly. [ABSTRACT FROM AUTHOR]

Background: The Mediterranean Diet (MeDi) is associated with a reduced risk of several non-communicable chronic diseases. High levels of nutrition knowledge are associated with greater MeDi adherence irrespective of education and other socio-economic factors. The present study investigates whether attending medical school changes students' adherence to the MeDi. Methods: A cross-sectional study was conducted in November-December 2014 using the 16-item KIDMED questionnaire, which inquiries into eating habits. Each respondent's KIDMED index (range 0-12), whose scores reflect 'poor', 'average' or 'good' MeDi adherence, was calculated. Scores were analyzed for gender, age and early/late medical school year. The Mann-Whitney U-test and the chi-square test were used for group comparisons. Ordinal logistic regression was applied to estimate the odds ratio (OR) and 95% confidence interval (CI) for changes in MeDi adherence from early to late medical school after adjustment for potential confounders. Results: Participants were 1038 medical students (573 females) aged 18-34 years (mean 21.9±2.4). There were 20.8% 'poor', 56.5% 'average' and 22.7% 'good' scores. Gender significantly affected scores (P<0.01). In the ordinal logistic regression model the odds for greater MeDi adherence increased for the female gender (P<0.05); females were 48% more likely to have a 'good' KIDMED score than their male peers, whereas early/late medical school year did not affect results [adjusted odds ratio (OR) = 0.95; P=0.15]. Conclusions: More than 70% of our medical students know very little about healthy eating and the MeDi. However, this knowledge is essential in their future profession both to support therapeutic decision-making and effective preventive actions. [ABSTRACT FROM AUTHOR]

Background: Neighbourhood inequalities in psychological distress are well reported, but underlying mechanisms remain poorly understood. The main purposes of this study were to investigate associations between structural neighbourhood conditions and psychological distress, and to explore the potential mediating role of neighbourhood social cohesion. Methods: Cross-sectional questionnaire study on a random sample of 18173 residents aged ≥ 16 years (response 49%) from the four largest cities in the Netherlands. Psychological distress was measured with the Kessler Psychological Distress Scale (K10). Structural environmental factors under study were neighbourhood socio-economic status (SES), neighbourhood green, urbanity and home maintenance. Neighbourhood social cohesion was measured by five statements and aggregated to the neighbourhood level by using ecometrics methodology. Multilevel linear regression analysis was used to investigate associations of neighbourhoods characteristics with psychological distress, adjusted for individual level characteristics. Results: High neighbourhood SES and neighbourhood social cohesion were associated with decreased psychological distress. Adjusted for individual level characteristics and neighbourhood SES, only neighbourhood social cohesion remained significantly associated with psychological distress. Neighbourhood social cohesion accounted for 38% of the differences in the association between neighbourhood SES and psychological distress. Conclusions: High neighbourhood social cohesion is significantly associated with decreased psychological distress among residents of the four largest cities in the Netherlands. Reducing neighbourhood inequalities in psychological distress may require increasing social interactions among neighbourhood residents. [ABSTRACT FROM AUTHOR]

Background: Both media use and cancer knowledge have been identified as important predictors of a healthy lifestyle. However, little is known about the interplay between these two variables, and about differences between cancer diagnosed and non-diagnosed consumers of media and knowledge. This study investigated the relationship between media use (television and internet exposure) and lifestyle choices of cancer diagnosed and non-diagnosed individuals, and looked at the influence of cancer knowledge on this relationship. Methods: A cross-sectional, quantitative survey (the Leuven Cancer Information Survey) was administered to 621 cancer diagnosed and 1387 non-diagnosed individuals, aged 16-88 years old in Flanders (Belgium). Bivariate analyses, hierarchical linear regression analyses and advanced moderation and mediation analyses were conducted. Results: Internet exposure was not a predictor of lifestyle choices. Television exposure, however, was a negative predictor of healthy lifestyle choices. Moreover, television exposure was a direct negative predictor of cancer knowledge, which in turn positively predicted lifestyle choices. However, no differences were found in the investigated relationships between the two subsamples. Conclusion: These results indicate that higher levels of television exposure coincide with less cancer knowledge and with less healthy lifestyle choices. It offers a pathway for intervention by suggesting that improving cancer knowledge through television might positively affect lifestyle choices. [ABSTRACT FROM AUTHOR]

Background: Community-based studies are required to accurately describe the supportive services needed by people with multiple sclerosis (MS). Methods: A total of 1205 people with MS participated in a cross-sectional study evaluating their unmet health and social care needs through a questionnaire collecting information used in the study. It was specifically developed by a multi-disciplinary team. Results: Overall, 79% of the responders declared at least one health or social care needs. The most prevalent health care need was the psychological support (27.5%), whereas the transport was the social care need more frequent (over 41%) in our sample. The multivariate analysis highlighted that unmet health care needs depended mainly on clinical factors such as disease stage, influenced by disease duration, and disability degree, whereas the social care needs were related to both clinical and socio-demographic factors. Conclusion: These findings suggest that MS needs significantly change over time during the disease development and to find the best way to personalize PwMS management is crucial. Moreover, more public funding directed at improving the health-related quality of life of people with MS is needed. For this reason, we think that these results will provide important information and baseline data on how to build the national service strategies thereby making healthcare planning more efficient. [ABSTRACT FROM AUTHOR]

Background: Violence in the workplace is a serious social and public health problem. The objective of this study was to estimate the prevalence of workplace violence and to identify potential predictors of workplace violence at Serbian Primary Health Care (PHC) centres. Methods: A cross-sectional study was conducted between October 2012 and July 2013. The sample consisted of medical and non-medical staff employed at PHC centres in Belgrade, Serbia. Among 1757 currently presented at work, 1526 returned the questionnaires. The data were collected by questionnaire Workplace Violence in the Health Sector—Country Case Studies, developed by the ILO/ICN/WHO/PSI. Binary logistic regression was conducted to assess the association between exposure to workplace violence and sociodemographic and work-related characteristics. Results: The prevalence of workplace violence, was 803 (52.6%), with 147 (18.3%), exposed to physical violence. Multiple logistic regression models indicated that the following work-related characteristics were positive associated of workplace violence with working between 18:00 and 07:00 h [odds ratio (OR): 1.37, 95% confidence interval (CI): 1.08-1.73], nurses as a professional group (OR: 1.91, 95% CI: 1.16-3.17), working with preschool children (OR: 0.56, 95% CI: 0.34-0.91). There was negative association of workplace violence with encouragement to report violence (OR: 0.61, 95% CI: 0.49-0.76) and the number of staff in the same work setting (OR: 0.73, 95% CI: 0.56-0.96). Conclusions: More than half of employees in Belgrade PHC centres were exposed to different types of workplace violence. There is a need for interventions to protect health workers and provide safer workplace environments. [ABSTRACT FROM AUTHOR]

Background: Fruit and vegetable consumption is linked to many positive health outcomes, nevertheless many adolescents do not consume fruit and vegetables on a daily basis. Methods: Data of 488,951 adolescents, aged 11-, 13- and 15- years, from 33 mainly European and North American countries/regions participating in the cross-sectional Health Behaviour in School-aged Children surveys in 2002, 2006 and 2010, were used to investigate trends in daily fruit and vegetable consumption between 2002 and 2010. Results: Multilevel logistic regression analyses showed an increase in daily fruit and vegetable consumption between 2002 and 2010 in the majority of countries for both genders and all three age groups. A decrease in consumption was noticed in five countries for fruit and five countries for vegetables. Conclusion: Overall, a positive trend was noticed, however increases in daily fruit and vegetable consumption are still indicated. [ABSTRACT FROM AUTHOR]

Background: The connections between alcohol use, mental health problems and mental well-being have been under-researched. We examined the links between different aspects of alcohol use and positive and negative aspects of mental health, and the effect of protective social factors on these links. Methods: A cross-sectional general population survey of Finns aged 15-69 years was carried out in 2008 (n = 2725, response rate 74%). The included aspects of alcohol use were the frequency and volume of drinking, binge drinking and hazardous drinking using Alcohol Use Disorders Identification Test (AUDIT). The included aspects of mental health were subjective well-being (life satisfaction), self-efficacy (sense of mastery) and psychological distress using the General Health Questionnaire. The protective social factors examined were social support (loneliness, having a confidant) and socioeconomic status. Results: Binge drinking and, particularly, hazardous drinking were associated with different aspects of mental health. The proportion of respondents with poor mental well-being increased when binge drinking was more frequent than monthly, and when respondents scored ⩾6 on the AUDIT scale. Abstainers reported poor sense of mastery and former drinkers additionally reported poor satisfaction with life. Frequency and volume of drinking did not have a consistent connection with mental health. These associations between alcohol use and mental health did not depend on the protective social factors. Conclusions: Frequent binge drinking and alcohol problems are associated with poor mental health, especially with a lack of life satisfaction and psychological distress. This result applies equally to lower and higher social status groups. [ABSTRACT FROM AUTHOR]

Background: Genetic testing and family history assessment can be used as an aid in the prevention of common chronic diseases. The aim of this study was to determine public attitudes and interests towards offering genetic testing and family history-based risk assessment for common chronic disease prevention. Methods: Cross-sectional questionnaire survey of a consumer panel representative for the Dutch population. The questionnaire was sent to 1399 panel members, aged ≥18 years. Results: The response was 70% (978/1399). About half of the respondents expressed an interest in genetic testing to prevent specific diseases (cancer, cardiovascular disease, diabetes or dementia), with lower-educated respondents showing more interest than higher-educated respondents. Few respondents (24%) agreed that people should be preventively tested for all kinds of diseases. According to the respondents, genetic testing should be performed in the hospital (66%) and be directed to curable (57%) or preventable diseases (69%). Half of the respondents believed that family history assessment could help prevent disease, but only 21% thought it should be offered to everyone, as this could cause people to be worried. A minority (12%) reported that their family history had been assessed, whereas 59% did not have it assessed and did not think this would be necessary. Respondents have differentiated interests in preventive genomics, which varies depending on sex, age and level of education. Conclusions: Members of the public are interested in genetic testing for preventable and curable diseases, but they are ambivalent about family history risk assessment to prevent disease. [ABSTRACT FROM AUTHOR]

Background: South African alcohol-serving establishments (i.e., shebeens) offer unique opportunities to reduce HIV risks among men who drink. Purpose: To test an individual- and a social structural-level HIV prevention intervention for men who drink in shebeens. Methods: Twelve matched pairs of township neighbourhoods were randomized to receive either (i) an HIV prevention intervention (guided by Social Action Theory) to reduce sexual risk and increase risk reduction communication in social networks, or (ii) an attention-matched control intervention that focused on the prevention of relationship violence. At the individual level, the interventions delivered skills building workshops focused on sexual risk reduction. At the social structural level, the intervention aimed to increase conversations about safer sex among men in the shebeens, distributed small media and implemented community educational events. Individual-level outcomes were assessed by following the workshop cohorts for 1 year (N = 984), and community-level outcomes were examined through cross-sectional community surveys conducted for 1 year in the shebeens (N = 9,678). Results: Men in the HIV prevention workshops demonstrated greater condom use, more HIV prevention-oriented conversations and greater perceptions of safer sex norms than men in the comparison workshops. Changes at the community level demonstrated significant differences in condom use, although the pattern was not consistent over time. Conclusions: Multi-level interventions that target men who drink in South African shebeens may help reduce risks for HIV and other sexually transmitted infections. [ABSTRACT FROM AUTHOR]

Background: In recent years, Bulgaria has increasingly relied on out-of-pocket payments as one of the main sources of health care financing. However, it is largely unknown whether the official patient charges, combined with informal payments, are affordable for the population. Our study aimed to explore the scale of out-of-pocket payments for health care services and their affordability. Methods: Data were collected in two nationally representative surveys, conducted in Bulgaria in 2010 and 2011, using face-to-face interviews based on a standardized questionnaire. To select respondents, a multi-stage random probability method was used. The questionnaire included questions on the out-of-pocket payments for health care services used by the respondent during the preceding 12 months. Results: In total, 75.7% (2010) and 84.0% (2011) of outpatient service users reported to have paid out-of-pocket, with 12.6% (2010) and 9.7% (2011) of users reporting informal payments. Of those who had used inpatient services, 66.5% (2010) and 63.1% (2011) reported to have made out-of-pocket payments, with 31.8% (2010) and 18.3% (2011) reporting to have paid informally. We found large inability to pay indicated by the need to borrow money and/or forego services. Regression analysis showed that the inability to pay is especially pronounced among those with poor health status and chronic diseases and those on low household incomes. Conclusion: The high level of both formal and informal out-of-pocket payments for health care services in Bulgaria poses a considerable burden for households and undermines access to health services for poorer parts of the population. [ABSTRACT FROM AUTHOR]

Background: This study predicts the implications of under-reporting of alcohol consumption in England for alcohol consumption above Government drinking thresholds. Methods: Two nationally representative samples of private households in England were used: General LiFestyle survey (GLF) and Health Survey for England (HSE) 2008. Participants were 9608 adults with self-reported alcohol consumption on heaviest drinking day in the last week (HSE) and 12 490 adults with self-reported average weekly alcohol consumption (GLF). Alcohol consumption in both surveys was revised to account for under-reporting in three hypothetical scenarios. The prevalence of drinking more than UK Government guidelines of 21/14 (men/women) alcohol units a week, and 4/3 units per day, and the prevalence of binge drinking (>8/6 units) were investigated using logistic regression. Results: Among drinkers, mean weekly alcohol intake increases to 20.8 units and mean alcohol intake on heaviest drinking day in the last week increases to 10.6 units. Over one-third of adults are drinking above weekly guidelines and over three-quarters drank above daily limits on their heaviest drinking day in the last week. The revision changes some of the significant predictors of drinking above thresholds. In the revised scenario, women have similar odds to men of binge drinking and higher odds of drinking more than daily limits, compared with lower odds in the original survey. Conclusion: Revising alcohol consumption assuming equal under-reporting across the population does not have an equal effect on the proportion of adults drinking above weekly or daily thresholds. It is crucial that further research explores the population distribution of under-reporting. [ABSTRACT FROM AUTHOR]

Background: The national health and social care systems in Europe remain poorly integrated with regard to the care needs of older persons. The present study examined the range of health and social care services used by older people and their unmet care needs, across six European countries. Methods: Family carers of older people were recruited in six countries via a standard protocol. Those providing care for disabled older people (n = 2629) provided data on the older person’s service use over a 6-month period, and their current unmet care needs. An inventory of 21 services common to all six countries was developed. Analyses considered the relationship between older people’s service use and unmet care needs across countries. Results: Older people in Greece, Italy and Poland used mostly health-oriented services, used fewer services overall and also demonstrated a higher level of unmet care needs when compared with the other countries. Older people in the United Kingdom, Germany and Sweden used a more balanced profile of socio-medical services. A negative relationship was found between the number of different services used and the number of different areas of unmet care needs across countries. Conclusions: Unmet care needs in older people are particularly high in European countries where social service use is low, and where there is a lack of balance in the use of health and social care services. An expansion of social care services in these countries might be the most effective strategy for reducing unmet needs in disabled older people. [ABSTRACT FROM AUTHOR]

Background: The aim of the present study was to assess the relative validity of a self-administered qualitative food frequency questionnaire (FFQ) applied in the Belgian food consumption survey. Methods: Comparison of food consumption data from an FFQ with 7-day estimated diet records (EDR) was made in a sample of 100 participants (aged 15–90 years). The FFQ comprised a total of 50 foods. Both FFQ and EDR foods were categorized into 15 conventional food groups. Results: De-attenuated Spearman rank correlation coefficients between the FFQ and the EDR ranged from −0.16 for potatoes and grains to 0.83 for alcoholic beverages, with a median of 0.40 for all 15 food groups. The proportion of participants classified in the same tertile of intake by the FFQ and EDR ranged from 32% for potatoes and grains to 76% for alcoholic beverages. Extreme classification into opposite tertiles was <10% for milk and soy products, alcoholic beverages, fried restgroup foods and fats. Conclusion: Notwithstanding the short nature and the absence of portion size questions, the FFQ appears to be reasonably valid in both genders and across different age categories for most food groups. However, for the food groups bread and cereals, potatoes and grains, and sauces, estimates should be interpreted with caution because of poor ranking agreement. [ABSTRACT FROM AUTHOR]

Background: Approximately 18 000 personnel leave the UK Armed Forces annually. Those leaving before completing the minimum term of their contracts are called early Service leavers (ESLs). This study aims to identify characteristics associated with being an ESL, and compare the post-discharge mental health of ESLs and other Service leavers (non-ESLs). Method: A cross-sectional study used data on ex-Serving UK Armed Forces personnel. ESLs were personnel leaving before completing their 3–4.5 years minimum Service contracts and were compared with non-ESLs. Multivariable logistic regression was used to estimate odds ratios and 95% confidence intervals for the associations between Service leaving status with socio-demographics, military characteristics and mental health outcomes. Results: Of 845 Service leavers, 80 (9.5%) were ESLs. Being an ESL was associated with younger age, female sex, not being in a relationship, lower rank, serving in the Army and with a trend of reporting higher levels of childhood adversity, but not with deployment to Iraq. ESLs were at an increased risk of probable post-traumatic stress disorder (PTSD), common mental disorders, fatigue and multiple physical symptoms, but not alcohol misuse. Conclusions: The study suggests that operational Service is not a factor causing personnel to become an ESL. Current mental health problems were more commonly reported among ESLs than other Service leavers. There may be a need to target interventions to ESLs on leaving Service to smooth their transition to civilian life and prevent the negative mental health outcomes experienced by ESLs further down the line. [ABSTRACT FROM PUBLISHER]

Background: Adverse effects of single parenthood on children’s health have been reported before. Socio-economic difficulties are discussed as mediating factors. As child health also depends on environmental conditions, we investigated the impact of environmental exposures and socio-economic factors on differences in health outcomes of children with single mothers vs. couple families. Methods: Data on 17 218 pre-school children (47% female) from three cross-sectional surveys conducted during 2004–07 in Germany were analysed. Health and exposure assessment were primarily based on parental report. Effects of socio-economic indicators (maternal education, household income) and environmental factors (traffic load at the place of residence, perceived environmental quality) on associations of four health outcomes (parent-reported health status, asthma, overweight, psychological problems) with single parenthood were determined by logistic regression analyses. Results: Children with single mothers showed an increased risk regarding parent-reported poor health status [boys: odds ratio (OR) 1.39 (95% confidence interval (CI): 1.06–1.82), girls: 1.73 (1.28–2.33)], psychological problems [boys: 1.90 (1.38–2.61), girls: 1.58 (1.03–2.42)], overweight [only boys: OR 1.23 (1.01–1.50) and asthma [only girls: OR 1.90 (1.15–3.15)]. Adjusting for socio-economic factors attenuated the strength of the association of family type with child health. Although environmental factors were associated with most health outcomes investigated and children of single mothers were more often exposed, these environmental factors did not alter the differences between children with single mothers and couple families. Conclusions: The increased health risks of children from single-mother families vs. couple families are partly explained by socio-economic factors, but not by the environmental exposures studied. [ABSTRACT FROM PUBLISHER]

Background: The risk of malnutrition is widely recognized in institutional settings but few studies have been conducted among community-dwelling older people. The objective of this study was to describe the nutritional status and factors associated with possible malnutrition among community-dwelling older people. Methods: A randomly selected sample (n = 696) of persons aged ≥75 years were included in the study. Baseline information was obtained for nutritional status (mini nutritional assessment short-form MNA-SF), depressive symptoms (15-item geriatric depression scale), cognitive status (mini-mental state examination MMSE) and daily activities (Barthel ADL index and Lawton and Brody IADL scale), self-reported health, oral health and medication use. Univariate and multivariate regression analyses were conducted to identify demographical, clinical and functional factors associated with possible malnutrition. Results: Of the 696 participants, 15% had possible malnutrition. In the univariate analysis, low MNA-SF scores were associated with advanced age, poor self-rated health, dry mouth/chewing problems, depressive symptoms and an increasing number of drugs in regular use. Higher albumin level, ADL, IADL and MMSE scores, and the ability to walk 400 m independently were inversely associated with possible malnutrition. In the multivariate analysis, dry mouth/chewing problems (OR 2.01, 95% CI: 1.14–3.54), IADL (OR 0.85, 95% CI: 0.75–0.96) and MMSE scores (OR 0.90, 95% 0.85–0.96) were independently associated with possible malnutrition. Conclusion: Being at risk of malnutrition was common among community-dwelling older people. Problems with mouth, IADL and cognitive impairments were linked to possible nutritional risks. [ABSTRACT FROM PUBLISHER]

Background: Today’s children spend a great deal of time viewing electronic screen material, but the consequences of such behaviors, if any, are unknown. This study sought to identify (i) the magnitude of total daily electronic screen time and (ii) the relations between electronic screen use and mental well-being indicators, in a sample of 10–12-year-old children. Methods: We analysed cross-sectional, population-based data of 10–12-year-old children from the 2007 Youth in Iceland school survey (n = 10 829, response rate: 81.7%, boys: 50.5%). Logistic regression models with odds ratios and 95% confidence intervals were conducted to assess the odds of each selected mental well-being indicator, depending on the number of daily hours spent on each electronic screen-based activity. All analyses were conducted separately for boys and girls and adjusted for family structure. Results:The prevalence of self-reported screen use of 4 hours per day or more ranges from 2.8% to 6.6% among boys and from 1.0% to 3.8% among girls. All five screen-based activities were significantly associated with all seven well-being indicators (P < 0.001) with symptoms being more common with increased time spent on screen use. Conclusions: This study is the first of its kind to demonstrate a dose-response relationship between electronic screen use and mental well-being in 10–12-year-old children. Further research is needed to assess the validity and potential implications of these findings. [ABSTRACT FROM PUBLISHER]

Background: Trends in obesity have been reported to level off in several Western countries. The aim of this study was to investigate trends in body mass index (BMI) and prevalence of obesity between 2002 and 2010 in Stockholm County, Sweden. Methods: Three cross-sectional questionnaires from the Stockholm Health Surveys were used for this study. A total of 31 182, 34 707 and 30 767 men and women aged between 18 and 64 years completed the questionnaire regarding sociodemographic factors, health parameters, physical activity, smoking habits and anthropometry in 2002, 2006 and 2010, respectively (response rate: 62.5, 61.3 and 55.6%, respectively). Linear regression was used to investigate changes in mean BMI. Relative risk regression models were used to investigate changes in prevalence of obesity, defined as BMI &geq; 30 kg/m2. All analyses were stratified on age and further adjusted for smoking, education and socioeconomic position. Results: Between 2002 and 2006, a stabilization was found in BMI and prevalence of obesity in both men and women. But from 2006 to 2010, BMI and prevalence of obesity had increased, also among the young. In 2010, the prevalence of obesity was 12.2% among men and 10.3% among women. Conclusion: After a period of stabilization in 2002–06, BMI and prevalence of obesity are increasing in Stockholm County, Sweden. [ABSTRACT FROM PUBLISHER]

Background: Previous cross-sectional studies revealed that obesity is associated with lower health-related quality of life (HRQOL). This study aimed to investigate the longitudinal association between 5-year weight change and HRQOL. Methods: Data from 2414 Dutch men and women was collected. HRQOL was measured with the RAND-36. Weight change was calculated as change in weight between 1998 and 2003. Using generalized estimation equations, we primarily analyzed the influence of weight change on HRQOL for the total population and additionally, by change groups (weight losers, weight maintainers and weight gainers) using regression analysis. All analyses were stratified for gender. Results: After 5 years, 598 men (50%) and 646 women (54%) maintained their weight, 177 men (15%) and 163 women (14%) lost >2.5 kg and 410 men (35%) and 379 women (32%) gained >2.5 kg. Longitudinal associations of 5-year weight change and HRQOL were found for mental component score (MCS) in women (β = 0.13; 95% CI: 0.02–0.24), and physical component score (PCS) in men (β = −0.09; 95% CI: −0.17 to −0.00) and women (β = −0.10; 95% CI: −0.19 to −0.01). Categorizing for 5-year weight change showed that weight gainers and weight losers did not significantly differ from weight maintainers on both MCS and PCS for both men and women. Conclusion: Weight change over 5 years leaded to a slight, though significant reduction on the PCS in both genders. In women, we found a positive association between weight change and MCS. [ABSTRACT FROM PUBLISHER]

Background: Financial crisis and worsened socio-economic conditions are associated with greater morbidity, less utilization of health services and deteriorated population’s health status. The aim of the present study was to investigate the determinants of self-rated health in Greece. Methods: Two national cross-sectional surveys conducted in 2006 and 2011 were combined, and their data were pooled giving information for 10 572 individuals. The sample in both studies was random and stratified by gender, age, degree of urbanization and geographic region. Logistic regression analysis was used to determine the impact of several factors on self-rated health. Results: Poor self-rated health was most common in older people, unemployed, pensioners, housewives and those suffering from chronic disease. Men, individuals with higher education and those with higher income have higher probability to report better self-rated health. Furthermore, the probability of reporting poor self-rated health is higher at times of economic crisis. Conclusion: Our findings confirm the association of self-rated health with economic crisis and certain demographic and socio-economic factors. Given that the economic recession in Greece deepens, immediate and effective actions targeting health inequalities and improvements in health status are deemed necessary. [ABSTRACT FROM PUBLISHER]

Background: The aim of our study was to determine vaccination coverage among Slovenian physicians and dentists and assess their knowledge and attitudes regarding the pandemic and seasonal influenza vaccine. Methods: In February 2010, an anonymous, self-administered questionnaire was developed and sent to all practising physicians and dentists in Slovenia. Results: Out of 7092 physicians/dentists, 1718 (24%) completed the questionnaire and 41.7% of the respondents were vaccinated against pandemic and seasonal influenza, while 58.3% of the study participants decided not to adhere to the recommendation: 15.6% received the pandemic vaccine only, 10.1% the seasonal vaccine only and 32.4% were not vaccinated at all. Acceptance of the pandemic and seasonal influenza vaccine was determined by higher age, being an internal medical trainee or specialist, working in a hospital, performing any kind of vaccination and having a chronic disease. Unvaccinated participants were more often working in out-patient clinics, were without a specialty, were dentists and were not performing any vaccinations. Those who declined vaccination believed that they did not need to be vaccinated, had safety concerns and were afraid of side effects. Physicians/dentists vaccinated against pandemic and seasonal influenza had better knowledge and a more positive attitude towards the issue compared with their non-vaccinated colleagues. Conclusions: Education on the efficacy and safety of vaccines should be one of the priority public health measures taken to improve knowledge and eliminate misconceptions and attitudinal barriers regarding immunization in physicians and dentists. [ABSTRACT FROM AUTHOR]

Background: Graphs are often used in medical communication, both in clinical practice and health management. They can help the processing of quantitative information but may also contribute to drawing wrong conclusions. The aim of the survey is to study the graphical perception of the data at the management level and its possible effects, showing how some criteria of appraisal of a phenomenon are influenced by the graphical format. Methods: One hundred and five medical doctors and health direction professionals of hospitals in Naples, Rome, Siena and Turin were interviewed. Four different graphs or table related to the same hypothetical data on average hospital stay in the period January 2000 to September 2003 were shown to participants, and their impressions were recorded. Results: Less than one-fourth of the participants understood that the data set was the same for the different diagrams. The process of understanding is mostly correlated with being a director, having a degree in medicine and working in central–northern cities. The table seems easier for interpretation (98.1%), more suitable (84.8%), more used (92.4%) and more pleasant than other data presentation. On the other hand radar format had worse results in all questions. Conclusions: The choice of a graphical format may influence the understanding of data. Further research is needed in order to sustain the improvement of medical and health professionals’ knowledge in the display data format. [ABSTRACT FROM PUBLISHER]

Background: We document the health-related quality of life (HRQoL) of people living in the Gaza Strip 6 months after 27 December 2008 to 18 January 2009, Israeli attack. Methods: Cross-sectional survey 6 months after the Israeli attack. Households were selected by cluster sampling in two stages: a random sample of enumeration areas (EAs) and a random sample of households within each chosen EA. One randomly chosen adult from each of 3017 households included in the survey completed the World Health Organization Quality of Life instrument, in addition to reported information on distress, insecurities and threats. Results: Mean HRQoL score (range 0–100) for the physical domain was 69.7, followed by the psychological (59.8) and the environmental domain score (48.4). Predictors of lower (worse) scores for all three domains were: lower educational levels, residence in rural areas, destruction to one's private property or high levels of distress and suffering. Worse physical and psychological domain scores were reported by people who were older and those living in North Gaza governorate. Worse physical and environmental domain scores were reported by people with no one working at home, and those with worse standard of living levels. Respondents who reported suffering stated that the main causes were the ongoing siege, the latest war on the Strip and internal Palestinian factional violence. Conclusion: Results reveal poor HRQoL of adult Gazans compared with the results of WHO multi-country field trials and significant associations between low HRQoL and war-related factors, especially reports of distress, insecurity and suffering [ABSTRACT FROM PUBLISHER]

Background: Incidents in health care happen every now and then. Incidents are often extensively covered by the news media. In this study, we investigated the impact of an incident in a Dutch hospital on public trust in health care in the population living in the vicinity of where the incident took place and in the national population. News media coverage of the incident started in Fall 2008. Methods: We collected data in three samples, using a postal questionnaire on public trust in health care. Two samples were a cross-section of the Dutch population; one was questioned in October 2006 and the other in October 2008. The third sample, also questioned in October 2008, consisted of 1000 people living in the surrounding area of the hospital where the incident occurred. The cross-sectional sample of October 2006 was a reference group, and at that time no incidents in health care were covered in the media. Results: In the local population, the incident had a strong impact on public trust in the hospital and among the specialists working there. Also, in the local population, the impact of the incident was generalized to trust in hospitals and specialists in general. In the national population, no impact of the incident on the public's trust was found, despite national news media coverage. Conclusion: Local incidents have an impact on public trust in health care in the local population. However, these incidents do not influence public trust in health care in the national population. [ABSTRACT FROM AUTHOR]