Journal of Public Health

Background In response to increased case numbers of meningococcal group C disease, catch-up vaccination strategies have been shown to be successful. This paper describes the results of a repeat vaccination program in Galicia, Spain, and the strategy used for it. Methods and results Three vaccination waves were performed: first, in 1996/1997 with a meningococcal group A and C polysaccharide vaccine in individuals aged 18 months to 19 years; second, in 2000 with a conjugate serogroup C polysaccharide vaccine in children born since 1993 and all children and adolescents up to 19 years not previously vaccinated; third, a campaign in 2006 that became necessary because of the development of a new Neisseria strain and an increase in both the incidence and lethality of meningococcal C disease. The conjugate vaccine de-O-acetylated group C meningococcal polysaccharide coupled to tetanus toxoid was used (GCMP-TT; brand name, NeisVac-C). Results: Applying a strategy based on model calculations derived from the UK setting and focusing on a population aged 13–25 years, including students, employees of companies, and underage individuals, a total of 286,000 subjects were vaccinated, resulting in global vaccination coverage of 82.2% (all age groups over 74%). Only 17 adverse events in 17 individuals were reported, which all were mild. Incidence of meningococcal disease serogroup C by season was reduced from 0.84 cases per 100,000 in 2004/05 to 0.76 cases per 100,000 in 2005/2006 to 0.18/100,000 in 2007/08. In parallel, mortality was also decreased from 8 cases during 2005/06 (0.29 per 100,000) to 1 case in 2007/2008 (0.03 per 100,000). No cases of breakthrough disease occurred in the vaccinated population. Conclusion In Galicia, a series of vaccination campaigns, particularly focusing on high-risk groups, has shown high effectiveness, with a marked reduction in the disease incidence in the vaccination cohort accompanied by a relevant reduction in the overall population.

Background This study evaluates differences in smoking abstinence between white and minority smokers using pharmaceutical aids. Methods This is an analysis of data from a multi-center, randomized, clinical trial conducted in the United States. Of the 1,684 subjects randomized to one of three medications (nicotine inhaler, bupropion, or a combination of both), 60% were women and 10% were minority races. Results Factors associated with a decreased likelihood of smoking at 12 weeks were older age (OR = 0.971, p < 0.0001), being married (OR = 0.678, p = 0.0029), using bupropion SR (OR = 0.480, p < 0.0001), and using combination therapy (OR = 0.328, p < 0.0001). Factors associated with an increased likelihood of smoking were higher tobacco dependence scores (OR = 1.244, p < 0.0001), prior quit attempts (OR = 1.812, p = 0.004), and being a minority (OR = 1.849, p = 0.0083). Compared to white smokers, minority smokers were significantly older at time of study entry (46 vs. 42 years, p < 0.0001), less likely to be married (35% vs. 59%, p < 0.0001), older at smoking initiation (21 vs. 19 years of age, p < 0.0001), and had a lower abstinence rate (16% vs. 26%, p = 0.0065). Conclusion Regardless of the treatment used, minority smokers in the US have lower smoking abstinence after treatment for tobacco dependence. Future research should focus on the improvement in treatment strategies for minority smokers.

Aim The aim of the study was to evaluate whether socio-economic inequalities in the practice of physical activity existed among children and adolescents, using different indicators of socio-economic status (SES). Subjects and methods Data were derived from the Italian National Health Interview Survey carried out in 2004–2005, which examined a large random sample of the Italian population using both an interviewer-administered and a self-compiled questionnaire. This study was based on a sample of 15,216 individuals aged 6–17 years. The practice of physical activity was measured on the basis of questions regarding frequency and intensity of activity during leisure time over the past 12 months. Parents’ educational and occupational level, as well as family’s availability of material resource, were used as indicators of SES. Multivariable logistic regression analyses were performed to estimate the contribution of each SES indicator to the practice of physical activity, adjusting for potential confounding factors. The results of the regression models are expressed as odds ratio (OR) with 95% confidence intervals (95% CI). Results About 64% of children and adolescents in the sample declared that they participated in moderate or vigorous physical activity at least once a week. After adjustment for gender, age, parental attitudes towards physical activity and geographical area, the practice of physical activity increased with higher parental educational and occupational level and greater availability of material resources. Children and adolescents whose parents held a middle or high educational title were 80% more likely to practice moderate or vigorous physical activity than subjects whose parents had a lower level of education (OR = 1.80, 95% CI: 1.40–2.33), while subjects with unemployed parents had an odds of practicing moderate or vigorous physical activity 0.43 times that of those children whose parents belonged to the top job occupation category (administrative/professionals). Socio-economic differences were about the same when the practice of vigorous physical activity only was considered instead of that of moderate or vigorous physical activity. Conclusion Interventions that promote the practice of physical activity, and especially those aimed at the wider physical and social environment, are strongly needed to contrast socio-economic differences in physical activity among children and adolescents.

Purpose To explore differences in health behaviors and factors contributing to overweight among 12 to 17 year olds in California. Methods Data from the 2005 California Health Interview Survey for 3,315 adolescents self-identified as Latino, Asian, or white were reviewed. Adolescents reported their weight, height, gender, ethnicity, parents’ educational level, household income, physical activity, sedentary activity, breakfast consumption, and family meals. Results Overall 34% of boys and 22% of girls in this study were overweight (>85th percentile for age and gender). Approximately 38% of Latinos, 25% of whites, and 16% of Asians were overweight. Latinos were more than twice as likely to be overweight as whites (2.07) and Asians (2.53). Younger adolescents (12–13 years old) and adolescents whose family income is less than 200% of the federal poverty level were more likely to be overweight. Low level of parental education is a risk factor for Latino and Asian girls and white and Latino boys. White girls with a lower socioeconomic status and white boys with more than 2 h daily of television, video, and computer time were more likely to be overweight. Conclusion Results suggest gender and ethnic variations in factors that contribute to overweight in California adolescents. To influence the current overweight epidemic, clinicians must develop culturally sensitive and gender-specific interventions that address the unique needs of an ethnically diverse adolescent population.

Aim Previous studies have demonstrated relationships between sleep and both obesity and diabetes. Additionally, exercise may improve sleep and daytime function, in addition to weight and metabolic function. The present study extends these findings by examining how general sleep-related complaints are associated with body mass index (BMI), diabetes diagnosis, and exercise in a large, nationally representative sample. Subject and methods Participants were respondents to the Behavioral Risk Factor Surveillance System (BRFSS). Sleep complaint (SC) was measured with “Over the last 2 weeks, how many days have you had trouble falling asleep or staying asleep or sleeping too much?” Daytime complaint (DC) was measured with “Over the last 2 weeks, how many days have you felt tired or had little energy?” Responses were dichotomized, with ≥6 days indicating complaint. Covariates included age, race/ethnicity, income, and education. Results Being overweight was associated with DC in women only. Obesity was significantly associated with SC and DC in women, and DC in men. Diabetes was associated with SC and DC in both genders. Any exercise in the past 30 days did not attenuate any BMI or diabetes relationships, but was independently associated with a decrease in SC and DC in both men and women. Conclusion These results suggest that for both men and women diabetes is a significant predictor of sleep and daytime complaints, and there is a relationship between obesity and sleep and complaints for women to a greater extent than men. Finally, exercise was associated with much fewer sleep and daytime complaints in both genders.

Rising concern for demonstrated real world comparative effectiveness has heightened interest in "pragmatic trials" design. Pragmatic trials investigate whether the efficacy, presumed or found in explanatory trials under ideal conditions, can also be detected under real world conditions, i.e. effectiveness. It is also recognized that 'real world' effects which are usually addressed in public health research gain growing interest in confirming the 'road capability' of results obtained under ideal study conditions. This paper demonstrates that studies under ideal or real world conditions use different methods, generate different information and cannot replace each other. The PCT design meets four requirements of public health and of effectiveness research. It includes all individuals who presented with the selected condition. It classifies the included individuals according to baseline risks. It enables plausibility controls. Finally, it compares the outcomes resulting from specified and not-specified interventions or treatments. We propose a pragmatic controlled trial (PCT) design in which patient preference and other co-factors crucial in determining the actual effectiveness of interventional options will not be neutralized by concealed randomization and blinding. This design is applicable to record the selected interventions and generated outcomes in day-to-day health care and is capable of incorporating preference and other participative factors into assessment of effectiveness. The PCT design is useful for public health research, e.g. the effectiveness of interventions to change smoking habits or to prevent death from breast cancer, as well as for comparative effectiveness research where it will supplement the traditional randomized controlled trial (RCT).

Aims In Malaysia, Shigella spp. is the third most common bacterial agent responsible for childhood diarrhoea. This study was conducted to determine the prevalence and antimicrobial susceptibility patterns of Shigella spp. isolated from patients admitted to the Hospital Universiti Sains Malaysia from January 2001 to December 2009. Subjects and methods A hospital-based retrospective study was used. Stool samples from patients were cultured using a standard culture method. Shigella spp. isolates were identified by biochemical and serological methods, and the antimicrobial susceptibility pattern was evaluated using the Kirby-Bauer disc-diffusion method. Results A total of 138 Shigella spp. were isolated from a total of 14,830 routine stool specimens, yielding an isolation rate of 0.93% that corresponded to 9.99% of the 1,381 bacterial pathogens isolated. Of these isolates, S. sonnei was the predominant species, followed by S. flexneri and S. boydii. Seasonal variation was noticed, and no significant differences were detected in the demographic data for S. flexneri and S. sonnei. The susceptibility of all isolated Shigella strains was tested against seven antibiotics. Ceftriaxone (99.1%), ciprofloxacin (98.4%), and nalidixic acid (93.8%) were effective against the Shigella strains, whereas tetracycline and trimethoprim-sulfamethoxazole exhibited high frequencies of resistance (58.4% and 53.8%, respectively). Conclusion This study is important for public health education aimed at reducing the morbidity and mortality associated with Shigella spp. infection. Our results also will be helpful for paediatricians and microbiologists in the selection of appropriate antibiotics for the management of diarrhoea.

Aim Each year almost 15,000 Danish women are diagnosed with cervical dysplasia, a precursor to cervical cancer. The period of medical follow-up, or ‘watchful waiting’, to monitor for regression or progression of the lesion before deciding if treatment by conisation is necessary can be long. The aim of this study was to examine the experiences of women with different stages of cervical dysplasia and to examine whether their knowledge of human papillomavirus (HPV) as the cause of cervical dysplasia influenced their perception of their disease. Subject and methods We used focus group and individual interviews with 12 women diagnosed with different stages of cervical dysplasia—women who had and had not been conised. Interview guides were prepared on the basis of a literature review that identified important issues and questions for the participants. Results The participants considered cervical dysplasia to be a highly distressing condition and experienced monitoring as a worrying delay before regression of the lesions or treatment could be initiated. Women expressed a fear of cancer that was not proportional to the stage of their dysplasia, but was determined by their degree of knowledge about their condition. Unlike other sexually transmitted diseases, information about HPV did not result in stigmatisation as the perception of this disease was dominated by cancer. Conclusion This study showed that it is extremely important to address women’s fears, their need for information and to ensure better communication with medical practitioners about cervical dysplasia immediately after diagnosis, irrespective of the disease stage.

Aim This article aims at giving an overview of five ethical problem areas relating to traffic safety, thereby providing a general framework for analysing traffic safety from an ethical perspective and encouraging further discussion concerning problems, policies and technology in this area. Subjects and methods The problems presented in the article are criminalisation, paternalism, privacy, justice and responsibility, and the reasons for choosing these are the following. First, they are all important areas in moral philosophy. Second, they are fairly general and it should be possible to categorise more specific problems under these headings. Ethical aspects of road traffic have not received the philosophical attention they deserve. Every year, more than 1 million people die globally in traffic accidents, and 20 to 50 million people are injured. Ninety per cent of the road traffic fatalities occur in low- and middle-income countries, where it is a growing problem. Politics, economics, culture and technology affect the number of fatalities and injuries, and the measures used to combat deaths in traffic as well as the role of road traffic should be ethically scrutinised. The topics are analysed and discussed from a moral-philosophical perspective, and the discussion includes both theory and applications. Results and conclusion The author concludes with some thoughts on how the ethical discussion can be included in the public debate on how to save lives in road traffic. People in industrialised societies are so used to road traffic that it is almost seen as part of nature. Consequently, we do not acknowledge that we can introduce change and that we can affect the role we have given road traffic and cars. By acknowledging the ethical aspects of road traffic and illuminating the way the choices society makes are ethically charged, it becomes clear that there are alternative ways to design the road traffic system. The most important general conclusion is that discussion concerning these alternative ways of designing the system should be encouraged.

Purpose This study analyzed associations between war-related internal displacement, housing quality and the prevalence of chronic illness in Nabaa, a low-income neighborhood on the outskirts of Beirut, Lebanon. Methods A cross-sectional survey of sociodemographics, household characteristics and health conditions of the study population was carried out in 2002. Using a structured questionnaire, the research team surveyed 1,151 households representing 4,987 residents of all ages. The survey was administered to a proxy respondent from each household in face-to-face interviews. A multiple logistic regression model using the generalized estimation equation method was constructed to assess the simultaneous effect of displacement and housing quality on reported ill health, while adjusting for potential confounders. Results Housing quality and internal displacement were strongly associated with occurrences of chronic illness. The most vulnerable respondents were older residents, females and internally displaced people, who reported high rates of chronic illnesses. Residents with high levels of education were less likely to report a chronic illness than those that had elementary education or less. Conclusion Nabaa residents’ experience of poor health was associated with inadequate housing quality. Moreover, residents who have been displaced experience worse living conditions and were more likely to experience poor health than those who were not displaced. These results reveal a need for policies to improve housing quality and alleviate war-related consequences in low-income neighborhoods.

Health warning labels on cigarette packages are one way to reach youth thinking about initiating tobacco use. The purpose of this study was to examine awareness and understanding of current health warning labels among 5 and 6 year old children. Researchers conducted one-on-one interviews with urban and rural 5 and 6 year olds from Brazil, China, India, Nigeria, Pakistan, and Russia. Among the 2,423 participating children, 62 % were unaware of the health warnings currently featured on cigarette packages, with the lowest levels of awareness in India and the highest levels in Brazil. When shown the messages, the same percentage of participating children (62 %) showed no level of message understanding. While youth are receiving social and informational messages promoting tobacco use, health warning labels featured on cigarette packages are not effectively reaching young children with anti-smoking messages.

Aim To define food safety and risk perception of foodborne diseases in the private home setting and identify specific behaviours during food purchase, storage and preparation in a large survey study. Subject and methods A large sample of individuals (n = 1,000) living in the area of Cassino, Italy, volunteered to participate in the study. All participants were randomly recruited and underwent a questionnaire-based interview at their home regarding food-safety measures. Logistic regression analyses were used to test for correlations between demographic characteristics and knowledge/behaviours of food diseases. Risks of hazardous practices in the home were calculated according to educational, physical, occupational and marital status. All analyses were performed using the EPIINFO 3.5 statistical program. Results Our data showed that there was an insufficient amount of knowledge regarding foodborne diseases and pathogens. In most families, we found that there was a lack of correct adherence to food hygiene, mainly due to errors during both food preparation and storage. There was a higher risk for food safety errors in families with children, older persons and pregnant women. Conclusion Our findings confirm that the home environment represents an important site for the spread of pathogens responsible for foodborne diseases. In order to adopt good hygiene practices in the home setting, consumers need to be informed about safety procedures of domestic food handling, storage and preparation.

Aim To investigate the impact of an entire episode of herpes zoster (HZ) or post-herpetic neuralgia (PHN) on an individual’s quality of life (QoL). Subjects and methods Individuals aged ≥50 years with painful HZ in the previous 5 years were identified across six European countries (Spain, Portugal, The Netherlands, Belgium, Sweden and Switzerland). They participated in a survey comprising bespoke questions to evaluate their previous HZ/PHN episode. Results A total of 1,005 individuals participated, 874 (87%) having had HZ, and 13% having had PHN. Generally, pain and QoL outcomes were similar irrespective of when HZ was diagnosed (≤12 versus 13–60 months) and age (50–59 versus ≥60 years). Mean pain scores were significantly higher in those with PHN versus HZ both on average (7.2 versus 6.4) and at worst (8.3 versus 7.4). PHN had a significantly higher impact on patients’ perception of their overall QoL, with 37% reporting a high impact (HZ: 19%). Pain restrictions in the following QoL domains significantly impacted on the respondents’ perception of QoL: enjoyment of life (level of impact, 31%), general activity (29%), mood (25%), sleep (8%) and walking ability (8%), and were significantly higher in those with PHN than in those with HZ. Sleep was the area worst affected. Conclusion HZ, and particularly PHN, is associated with considerable levels of pain that have a significant impact on the QoL of participants across six European countries.

Aim The goal of the study was to investigate the use of nutrition information on food labels and understanding of guideline daily amount (GDA) front-of-pack nutrition labels in six European countries. Subjects and methods In-store observations and in-store interviews were conducted in major retailers in the UK (n = 2019), Sweden (n = 1858), France (n = 2337), Germany (n = 1963), Poland (n = 1800) and Hungary (n = 1804), supplemented by questionnaires filled out at home and returned (overall response rate 50.3%). Use of labels was measured by combining in-store observations and in-store interviews on concrete purchases in six product categories. Understanding of GDA front-of-pack nutrition labels was measured by a variety of tasks dealing with conceptual understanding, substantial understanding and health inferences. Demographics, nutrition knowledge and interest in healthy eating were measured as potential determinants. Results Across six product categories, 16.8% of shoppers were found to have looked for nutrition information on the label, with the nutrition grid (table or list), GDA labels and the ingredients list as the main sources consulted and calories, fat and sugar the information most often looked for. Understanding of GDA labels was high in the UK, Sweden and Germany, and more limited in the other countries. Regression analysis showed that, in addition to country-specific differences, use and understanding are also affected by differences in interest in healthy eating and in nutrition knowledge and by social grade. Conclusion Understanding of nutrition information seems to be more widespread than use, suggesting that lack of use is a question of not only understanding, but also motivation. Considerable national differences exist in both understanding and use, some of which may be attributed to different histories of the role of nutrition in the public debate.

Aim The Framework Programmes for Research and Technological Development (FP) are the European Union’s funding programmes for research in Europe. The study analyses the features of external experts involved in evaluating the research proposals in FP6 (years 2003–2006) in the area of Life Sciences. Subjects and methods Experts were analysed with respect to nationality, gender, organisational affiliation and rotation. The correlations between the number of experts by nationality and scientific research indicators were also explored. Result Experts from 70 countries participated, with 70% coming from 10 countries. The gender composition was relatively stable, with approximately 30% of female experts. The majority of experts came from higher education establishments (51%) and 12% from industry. About 40% of experts participated in the evaluation process two or more times. The number of experts by nationality was linearly correlated with gross national income (r = 0.95, p < 0.0001), population (r = 0.91, p < 0.0001), and number of research publications in health sciences (r = 0.93, p < 0.0001). However, using multiple linear regression analysis, only gross national income had partial regression coefficients significantly different from zero (p = 0.017). The observed value of experts for Italy (312) and Belgium (155) were higher than predicted by this regression model (231 and 71 respectively). Conclusion The expert panels involved were balanced with respect to nationalities, whereas the gender distribution was lower than the target. There was a satisfactory degree of rotation of experts between evaluation rounds. The percentage of experts from industry was lower than expected.

Background The impact of herpes zoster (HZ) and post-herpetic neuralgia (PHN) on patients’ quality of life (QoL) is currently poorly documented. Subjects and methods Telephone interviews in Germany identified patients ≥50 years old with painful HZ diagnosed during the previous 5 years. Bespoke questions evaluated previous HZ episodes. Results Of 11,009 respondents, 280 met the screening criteria, and 32 (11%) developed PHN. PHN was associated with significantly worse outcomes than HZ (all P < 0.05). Mean pain scores associated with PHN and HZ, respectively, were 7.1 and 6.2 (average) and 8.2 and 7.0 (worst). Many patients with PHN (91%) and HZ (73%) experienced problems with daily activities, including work, studies, housework, family and leisure activities. Mean pain interference scores in patients with PHN versus HZ were highest for sleep (6.5 versus 4.9), normal work (6.1 versus 4.4) and mood (5.9 versus 4.4). Most employed interviewees with PHN (70%) and HZ (64%) stopped work during the disease. Pain and QoL outcomes were not significantly different between all patients versus those diagnosed during the previous 12 months or between patients aged 50–59 years versus ≥60 years. Conclusions HZ causes substantial pain, which seriously interferes with many aspects of daily life, particularly in patients with PHN.

Aim The aims of this study were to identify clustering of behaviours in young adolescents and to analyse differences in food intake according to clusters. Subject and methods A cross-sectional study was carried out on adolescents’ behaviours comprising 2,160 adolescents aged 13 years attending schools of Porto, Portugal. We used data of 875 girls and 737 boys with complete information for all variables considered in the cluster definition (tobacco and alcohol use, sport activities, fruit intake, daily sleep hours). The average method was used to find the natural structure of clusters. Results We identified three clusters: cluster 1 characterized by never smokers and never drinkers represented those with higher intake of fruits and lower intake of soft drinks. Cluster 2 comprised essentially tobacco and alcohol experimenters and was almost similar to cluster 1 regarding the other characteristics. Cluster 3 represented mostly regular smokers and drinkers, and those with the lowest daily sport activities, the lowest number of daily sleep hours, the lowest mean of fruit consumption and the highest intake of sweets and soft drinks. Conclusion Our findings show that even in the early stages of adolescence there is a cluster of smoking, alcohol use and food intake, providing further evidence of the clustering of unhealthy behaviours.

Aim The Strengthening Families Program 10–14 (SFP 10–14) was developed in 1993 at the Iowa State University as a universal family-based prevention program against substance abuse and behavioral problems in youth aged 10 to 14 years. Its effectiveness in delaying the initiation of tobacco, alcohol and cannabis use, in decreasing the average amount consumed and in reducing adolescents’ problem behavior in school and at home has been repeatedly evaluated in randomized-controlled studies in the US. While there is a well-established system of school- and community-based prevention in Germany, there is a lack of family-based prevention. This situation would be improved by the cultural adaptation and evaluation of SFP 10–14 in Germany. Subjects and methods Focus group meetings were held with experts from family assistance and drug prevention, as well as with parents of children within the ages of the target group, in three geographically different cities in Germany (Hamburg, Schwerin and Munich). Group members were presented the original version of the material from the US (teaching manuals and DVDs), as well as an already adapted version from the UK. Group members developed criteria in a group discussion process necessary for the adaptation of the material to the German culture. Following the newly defined criteria, new teaching DVDs and manuals were produced. Results As a result of the focus groups meetings, several aspects concerning the adaptation of the material had to be considered. Four aspects were especially important: (1) application to the regional social structures in Germany, within the target group (risk population: migration background, socioeconomic status, family structure), (2) adaptation to the German language (colloquial language, idiomatic expressions, non-verbal language), (3) consideration of culturally dependent norms about parents’ and children’s role model behavior, as well as the problem definition for behavior that is supposed to be addressed (family, school, peer group) and (4) the program’s adequate incorporation into the conditions of the local support system. Conclusions Neither of the two existing SFP versions (US and UK version) could serve as a matrix for the German version, extensive adaptations were necessary. Results from the adaptation process carried out earlier in the UK with the original material from the US were helpful in this process. The German version of the program (Familien stärken) will be evaluated for a target group that consists of families with low socioeconomic status. This randomized-controlled multicenter study will be carried out in different German cities (Hamburg, Hanover, Schwerin, Rostock and Munich) between 2010 and 2013.

The aim of this study was to analyze whether physically active persons have fewer cardiovascular diseases and lower overall mortality than sedentary persons and whether there is a benefit for persons performing vigorous physical activities compared to those reporting light or moderate levels. In 1984–1985, a population-based random sample of women and men aged 25–69years was recruited for the National Health Interview Survey in Germany. Self-reported duration of sports and leisure-time physical activities at baseline were evaluated in relation to cardiovascular morbidity and overall mortality after 14years of follow-up among participants free of cardiovascular diseases, cancer and obstructive pulmonary diseases at baseline. An inverse association of the duration of sports with cardiovascular morbidity was found for women (regular 1–2h a week: odds ratio, 1.42, 95% CI: 0.75, 2.67; less than 1h: odds ratio, 1.85, 95% CI: 1.06, 3.23) as well as for men (odds ratio, 2.47, 95% CI: 1.51, 4.05; odds ratio, 2.43, 95% CI: 1.58, 3.74), if compared to a reference, defined as regular sports for at least 2h/week. Regarding overall mortality, an inverse association was also found. Women with 1–2h of regular sports (odds ratio, 1.49, 95% CI: 0.53, 4.22) and less than 1h (odds ratio, 3.31, 95% CI: 1.34, 8.14) as well as men (odds ratio, 1.27, 95% CI: 0.75, 2.14; odds ratio, 1.59, 95% CI: 1.04, 2.44) are under higher risk of dying compared to the reference. Similar results were found regarding the intensity of physical activities. We concluded that regular sports as well as regular physical activity are related to lower levels of cardiovascular diseases and overall mortality. An additional benefit was found for those reporting vigorous activities.

Using follow-up data from an interview survey representative for the German population from the year 1974 an inquiry was made into whether those who were told by a doctor that they had ”too low blood pressure“ at some point prior to the survey had better survival rates during the 16 year follow-up than those having not been so diagnosed. The method of Relative Survival based on cohort life-tables for all sex and age groups in Germany was used to compare the differential mortality effects. The result was surprising, despite the fact that only the diagnosis before 1974 was tested regarding its effect on future mortality: after making exact adjustments for demographic parameters, it was found that persons with ”low blood pressure“ survived markedly better than persons with normal or high blood pressure. If one considers smoking additionally, a strong effect of smoking on survival rates can be seen, but the advantage of persons with ”low blood pressure“ remains unchanged. The debate in medicine whether ”low blood pressure“ can be considered a disease or whether it justifies drug treatment at all, got an astonishingly clear answer.

Aim The main purpose of the study was to analyze the changes in the prevalence of underweight, overweight, and obesity among Czech children and adolescents aged 3–18 within the last 50 years. The secondary purpose of the study was to determine the prevalence of overweight and obesity among children and adolescents in 2001 and compare it to the reference standards recommended by the International Obesity Task Force (IOTF). Subject and methods Anthropometric data collected from nationally representative samples of 3–18-year-old children and adolescents in the Czech Republic in 1951, 1981, 1991, and 2001 were analyzed in the study. The prevalence of child overweight and obesity among Czech children using data from the most recent 2001 National Anthropological Survey was estimated using the 1991 Czech reference values and the IOTF standards. Results There has been a gradual increase in the number of children in both extreme categories of BMI values in most age categories, including underweight (90th percentile), and obesity (>97th percentile) between 1951 and 2001. In both genders, the number of underweight children increased dramatically in the lowest age categories. At the same time, the rates of overweight and obesity increased among 6–11- and 11–15-year-old individuals. The prevalence of underweight has also increased among older adolescents. However, our study indicated that the 2001 prevalence of overweight/obesity among Czech adolescents, especially in older age categories and among girls, was lower compared to the 1991 reference values. Conclusion Given the continuous increase in child obesity rates in the US and most of Europe, it is interesting that the prevalence of overweight and obesity has remained relatively low among children and adolescents in the Czech Republic. Given the increased number of Czech school-aged children with excess adiposity, a gradual rise in the prevalence of overweight and obesity among Czech adolescents could be expected.

Aim The objective of this study was to assess beliefs, misconception, and anxiety in relation to swine flu outbreak and whether perception of the outbreak predicted changes in behavior. Subject and methods In November 2009, we conducted an Internet-based cross-sectional survey of college students aged 18–24 years in a Midwestern State in the USA. We collected information on swine flu knowledge, perception on immunization safety, perceived efficacy of recommended behavior, changed behavior, and anxiety. Results Of the 236 respondents, 83.1% had some anxiety about swine flu, 64.8% believed avoiding crowded places was preventive, 33.5% believed the 2009 swine flu vaccine was safe, and 36.9% showed interest in receiving the vaccine. Misconceptions about swine flu contagion via eating cooked pork, water sources, and insect bites were common. Respondents were unaware of transmissions via contaminated objects and droplets. Only 42.6% were satisfied with governmental efforts. Women were more likely to wash hands frequently than men (odds ratio 2.80, p < 0.001). Conclusion There is a gap in swine flu knowledge, minimal risk reduction, increased amount of anxiety, and skepticism about swine flu vaccine safety. These gaps warrant serious attention to inform the public about specific actions regarding swine flu.

Aims The purpose of this study was to examine the impacts of demographic changes, socioeconomic inequality, and availability of health resources on infant mortality rates (IMR) in Singapore. Subjects and methods A retrospective study design was used to collect yearly data for Singapore covering the period from 1969 to 2008. The IMR was the dependent variable and demographics, socioeconomic status, and health resources were the three main determinants. Results A structural equation model was employed and results showed that more available health resources (beta = −0.43, p < 0.01) were more likely to reduce the IMR. By contrast, socioeconomic inequality (beta = 0.43, p < 0.01) and demographic changes (beta = −0.31, p < 0.01) were more likely to increase the IMR. Conclusions These results therefore imply that more effort, particularly during economic downturns, should be put into removing the barriers that impede access to health care services and increasing preventive care for the population that currently has less access to health care in communities where there is a scarcity of medical resources.

Myocardial infarction has great importance for the populations in industrial countries because of the high morbidity and mortality rates. For research of the epidemiological trends in the 1970s and especially in the 1980s, the World Health Organization (WHO) began registering myocardial infarction throughout the world. The most important aspect was the WHO Monitoring of Trends and Determinants of Cardiovascular Diseases (MONICA) project. From 1974 to 1994 and in 1999 in Chemnitz, Germany, data from patients with acute myocardial infarction were collected for the myocardial infarction register. Despite changes in the event rates from year to year, no decrease in the number of myocardial infarctions in the German population aged 25–64 years was detected, contrary to the trend in the Western industrial states in the period from 1984 to 1994. The event rates in men were significantly higher than in women. In 1999, a significant decrease in the event rates in men and women was found. This may be explained by an incomplete registration of patients with myocardial infarction in 1999 because of the change in the structure of the Public Health System. The highest 28-day fatality rates in men were detected in 1989 and 1990. In women with classic myocardial infarction, a decrease in the 28-day fatality rates after 1993 was recorded, reaching lower rates than those of men. Despite methodological problems, the myocardial infarction register can contribute to a comparison of the morbidity, mortality and case fatality rates of myocardial infarction for a longer period.

Studies on the cost of illness, more specifically on the direct and indirect cost of illness, still fall within the area of experimental reporting. The reason for this is the still inadequate classification of health-related expenditure (direct costs) by illness, age group and gender. Although these problems do not play a substantial role in the case of indirect costs, reservations exist with regard to the human capital approach, the limitations for attributing predominantly epidemiological meaning to the results of such studies, and their concentration on those members of the population who are gainfully employed, just to name the most common objections. Results on the direct and indirect costs of illnesses in the Federal Republic of Germany (territory prior to October 3, 1990) from the 1980 and 1990 cost of illness studies are for the first time compared over a 10-y ear-period using the diagnostic groups of the ICD-9. An evaluation of these results is envisaged. The appropriateness of the study of cost of illness to contribute to discussions about reconstructing the social system, the future of labour, and demographic change, will be discussed. In the opinion of the authors information on indirect costs from cost of illness studies is appropriate for generating work related characteristics for causes of illness and loss of human resources due to alleged illness, which could not be produced by epidemiological studies alone. In relation to this research requirements will be formulated, and it will be suggested, to integrate cost of illness studies step by step into the health reporting system of the Federal Republic of Germany.