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Publisher: Oxford University Press   (Total: 368 journals)

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Showing 1 - 200 of 368 Journals sorted alphabetically
Acta Biochimica et Biophysica Sinica     Hybrid Journal   (Followers: 6, SJR: 0.881, h-index: 38)
Adaptation     Hybrid Journal   (Followers: 8, SJR: 0.111, h-index: 4)
Aesthetic Surgery J.     Hybrid Journal   (Followers: 6, SJR: 1.538, h-index: 35)
African Affairs     Hybrid Journal   (Followers: 57, SJR: 1.512, h-index: 46)
Age and Ageing     Hybrid Journal   (Followers: 76, SJR: 1.611, h-index: 107)
Alcohol and Alcoholism     Hybrid Journal   (Followers: 14, SJR: 0.935, h-index: 80)
American Entomologist     Full-text available via subscription   (Followers: 5)
American Historical Review     Hybrid Journal   (Followers: 120, SJR: 0.652, h-index: 43)
American J. of Agricultural Economics     Hybrid Journal   (Followers: 41, SJR: 1.441, h-index: 77)
American J. of Epidemiology     Hybrid Journal   (Followers: 147, SJR: 3.047, h-index: 201)
American J. of Hypertension     Hybrid Journal   (Followers: 19, SJR: 1.397, h-index: 111)
American J. of Jurisprudence     Hybrid Journal   (Followers: 15)
American journal of legal history     Full-text available via subscription   (Followers: 4, SJR: 0.151, h-index: 7)
American Law and Economics Review     Hybrid Journal   (Followers: 26, SJR: 0.824, h-index: 23)
American Literary History     Hybrid Journal   (Followers: 12, SJR: 0.185, h-index: 22)
Analysis     Hybrid Journal   (Followers: 23)
Annals of Botany     Hybrid Journal   (Followers: 33, SJR: 1.912, h-index: 124)
Annals of Occupational Hygiene     Hybrid Journal   (Followers: 24, SJR: 0.837, h-index: 57)
Annals of Oncology     Hybrid Journal   (Followers: 49, SJR: 4.362, h-index: 173)
Annals of the Entomological Society of America     Full-text available via subscription   (Followers: 9, SJR: 0.642, h-index: 53)
Annals of Work Exposures and Health     Hybrid Journal  
AoB Plants     Open Access   (Followers: 4, SJR: 0.78, h-index: 10)
Applied Economic Perspectives and Policy     Hybrid Journal   (Followers: 18, SJR: 0.884, h-index: 31)
Applied Linguistics     Hybrid Journal   (Followers: 51, SJR: 1.749, h-index: 63)
Applied Mathematics Research eXpress     Hybrid Journal   (Followers: 1, SJR: 0.779, h-index: 11)
Arbitration Intl.     Full-text available via subscription   (Followers: 19)
Arbitration Law Reports and Review     Hybrid Journal   (Followers: 12)
Archives of Clinical Neuropsychology     Hybrid Journal   (Followers: 25, SJR: 0.96, h-index: 71)
Aristotelian Society Supplementary Volume     Hybrid Journal   (Followers: 2, SJR: 0.102, h-index: 20)
Arthropod Management Tests     Hybrid Journal   (Followers: 2)
Astronomy & Geophysics     Hybrid Journal   (Followers: 46, SJR: 0.144, h-index: 15)
Behavioral Ecology     Hybrid Journal   (Followers: 47, SJR: 1.698, h-index: 92)
Bioinformatics     Hybrid Journal   (Followers: 221, SJR: 4.643, h-index: 271)
Biology Methods and Protocols     Hybrid Journal  
Biometrika     Hybrid Journal   (Followers: 18, SJR: 2.801, h-index: 90)
BioScience     Hybrid Journal   (Followers: 28, SJR: 2.374, h-index: 154)
Bioscience Horizons : The National Undergraduate Research J.     Open Access   (Followers: 1, SJR: 0.213, h-index: 9)
Biostatistics     Hybrid Journal   (Followers: 15, SJR: 1.955, h-index: 55)
BJA : British J. of Anaesthesia     Hybrid Journal   (Followers: 132, SJR: 2.314, h-index: 133)
BJA Education     Hybrid Journal   (Followers: 65, SJR: 0.272, h-index: 20)
Brain     Hybrid Journal   (Followers: 61, SJR: 6.097, h-index: 264)
Briefings in Bioinformatics     Hybrid Journal   (Followers: 43, SJR: 4.086, h-index: 73)
Briefings in Functional Genomics     Hybrid Journal   (Followers: 4, SJR: 1.771, h-index: 50)
British J. for the Philosophy of Science     Hybrid Journal   (Followers: 32, SJR: 1.267, h-index: 38)
British J. of Aesthetics     Hybrid Journal   (Followers: 24, SJR: 0.217, h-index: 18)
British J. of Criminology     Hybrid Journal   (Followers: 488, SJR: 1.373, h-index: 62)
British J. of Social Work     Hybrid Journal   (Followers: 77, SJR: 0.771, h-index: 53)
British Medical Bulletin     Hybrid Journal   (Followers: 7, SJR: 1.391, h-index: 84)
British Yearbook of Intl. Law     Hybrid Journal   (Followers: 25)
Bulletin of the London Mathematical Society     Hybrid Journal   (Followers: 3, SJR: 1.474, h-index: 31)
Cambridge J. of Economics     Hybrid Journal   (Followers: 55, SJR: 0.957, h-index: 59)
Cambridge J. of Regions, Economy and Society     Hybrid Journal   (Followers: 9, SJR: 1.067, h-index: 22)
Cambridge Quarterly     Hybrid Journal   (Followers: 10, SJR: 0.1, h-index: 7)
Capital Markets Law J.     Hybrid Journal  
Carcinogenesis     Hybrid Journal   (Followers: 2, SJR: 2.439, h-index: 167)
Cardiovascular Research     Hybrid Journal   (Followers: 11, SJR: 2.897, h-index: 175)
Cerebral Cortex     Hybrid Journal   (Followers: 37, SJR: 4.827, h-index: 192)
CESifo Economic Studies     Hybrid Journal   (Followers: 15, SJR: 0.501, h-index: 19)
Chemical Senses     Hybrid Journal   (Followers: 1, SJR: 1.436, h-index: 76)
Children and Schools     Hybrid Journal   (Followers: 5, SJR: 0.211, h-index: 18)
Chinese J. of Comparative Law     Hybrid Journal   (Followers: 3)
Chinese J. of Intl. Law     Hybrid Journal   (Followers: 18, SJR: 0.737, h-index: 11)
Chinese J. of Intl. Politics     Hybrid Journal   (Followers: 8, SJR: 1.238, h-index: 15)
Christian Bioethics: Non-Ecumenical Studies in Medical Morality     Hybrid Journal   (Followers: 11, SJR: 0.191, h-index: 8)
Classical Receptions J.     Hybrid Journal   (Followers: 17, SJR: 0.1, h-index: 3)
Clinical Infectious Diseases     Hybrid Journal   (Followers: 58, SJR: 4.742, h-index: 261)
Clinical Kidney J.     Open Access   (Followers: 4, SJR: 0.338, h-index: 19)
Community Development J.     Hybrid Journal   (Followers: 23, SJR: 0.47, h-index: 28)
Computer J.     Hybrid Journal   (Followers: 8, SJR: 0.371, h-index: 47)
Conservation Physiology     Open Access   (Followers: 1)
Contemporary Women's Writing     Hybrid Journal   (Followers: 11, SJR: 0.111, h-index: 3)
Contributions to Political Economy     Hybrid Journal   (Followers: 6, SJR: 0.313, h-index: 10)
Critical Values     Full-text available via subscription  
Current Legal Problems     Hybrid Journal   (Followers: 25)
Current Zoology     Full-text available via subscription   (SJR: 0.999, h-index: 20)
Database : The J. of Biological Databases and Curation     Open Access   (Followers: 11, SJR: 1.068, h-index: 24)
Digital Scholarship in the Humanities     Hybrid Journal   (Followers: 12)
Diplomatic History     Hybrid Journal   (Followers: 18, SJR: 0.296, h-index: 22)
DNA Research     Open Access   (Followers: 4, SJR: 2.42, h-index: 77)
Dynamics and Statistics of the Climate System     Open Access   (Followers: 2)
Early Music     Hybrid Journal   (Followers: 13, SJR: 0.124, h-index: 11)
Economic Policy     Hybrid Journal   (Followers: 46, SJR: 2.052, h-index: 52)
ELT J.     Hybrid Journal   (Followers: 25, SJR: 1.26, h-index: 23)
English Historical Review     Hybrid Journal   (Followers: 45, SJR: 0.311, h-index: 10)
English: J. of the English Association     Hybrid Journal   (Followers: 12, SJR: 0.144, h-index: 3)
Environmental Entomology     Full-text available via subscription   (Followers: 11, SJR: 0.791, h-index: 66)
Environmental Epigenetics     Open Access   (Followers: 1)
Environmental History     Hybrid Journal   (Followers: 25, SJR: 0.197, h-index: 25)
EP-Europace     Hybrid Journal   (Followers: 1, SJR: 2.201, h-index: 71)
Epidemiologic Reviews     Hybrid Journal   (Followers: 10, SJR: 3.917, h-index: 81)
ESHRE Monographs     Hybrid Journal  
Essays in Criticism     Hybrid Journal   (Followers: 15, SJR: 0.1, h-index: 6)
European Heart J.     Hybrid Journal   (Followers: 46, SJR: 6.997, h-index: 227)
European Heart J. - Cardiovascular Imaging     Hybrid Journal   (Followers: 9, SJR: 2.044, h-index: 58)
European Heart J. - Cardiovascular Pharmacotherapy     Full-text available via subscription   (Followers: 1)
European Heart J. - Quality of Care and Clinical Outcomes     Hybrid Journal  
European Heart J. Supplements     Hybrid Journal   (Followers: 8, SJR: 0.152, h-index: 31)
European J. of Cardio-Thoracic Surgery     Hybrid Journal   (Followers: 7, SJR: 1.568, h-index: 104)
European J. of Intl. Law     Hybrid Journal   (Followers: 140, SJR: 0.722, h-index: 38)
European J. of Orthodontics     Hybrid Journal   (Followers: 4, SJR: 1.09, h-index: 60)
European J. of Public Health     Hybrid Journal   (Followers: 23, SJR: 1.284, h-index: 64)
European Review of Agricultural Economics     Hybrid Journal   (Followers: 12, SJR: 1.549, h-index: 42)
European Review of Economic History     Hybrid Journal   (Followers: 25, SJR: 0.628, h-index: 24)
European Sociological Review     Hybrid Journal   (Followers: 37, SJR: 2.061, h-index: 53)
Evolution, Medicine, and Public Health     Open Access   (Followers: 11)
Family Practice     Hybrid Journal   (Followers: 12, SJR: 1.048, h-index: 77)
Fems Microbiology Ecology     Hybrid Journal   (Followers: 8, SJR: 1.687, h-index: 115)
Fems Microbiology Letters     Hybrid Journal   (Followers: 19, SJR: 1.126, h-index: 118)
Fems Microbiology Reviews     Hybrid Journal   (Followers: 24, SJR: 7.587, h-index: 150)
Fems Yeast Research     Hybrid Journal   (Followers: 13, SJR: 1.213, h-index: 66)
Foreign Policy Analysis     Hybrid Journal   (Followers: 22, SJR: 0.859, h-index: 10)
Forestry: An Intl. J. of Forest Research     Hybrid Journal   (Followers: 17, SJR: 0.903, h-index: 44)
Forum for Modern Language Studies     Hybrid Journal   (Followers: 6, SJR: 0.108, h-index: 6)
French History     Hybrid Journal   (Followers: 29, SJR: 0.123, h-index: 10)
French Studies     Hybrid Journal   (Followers: 19, SJR: 0.119, h-index: 7)
French Studies Bulletin     Hybrid Journal   (Followers: 10, SJR: 0.102, h-index: 3)
Gastroenterology Report     Open Access   (Followers: 2)
Genome Biology and Evolution     Open Access   (Followers: 10, SJR: 3.22, h-index: 39)
Geophysical J. Intl.     Hybrid Journal   (Followers: 31, SJR: 1.839, h-index: 119)
German History     Hybrid Journal   (Followers: 24, SJR: 0.437, h-index: 13)
GigaScience     Open Access   (Followers: 3)
Global Summitry     Hybrid Journal  
Glycobiology     Hybrid Journal   (Followers: 14, SJR: 1.692, h-index: 101)
Health and Social Work     Hybrid Journal   (Followers: 46, SJR: 0.505, h-index: 40)
Health Education Research     Hybrid Journal   (Followers: 12, SJR: 0.814, h-index: 80)
Health Policy and Planning     Hybrid Journal   (Followers: 21, SJR: 1.628, h-index: 66)
Health Promotion Intl.     Hybrid Journal   (Followers: 19, SJR: 0.664, h-index: 60)
History Workshop J.     Hybrid Journal   (Followers: 25, SJR: 0.313, h-index: 20)
Holocaust and Genocide Studies     Hybrid Journal   (Followers: 22, SJR: 0.115, h-index: 13)
Human Molecular Genetics     Hybrid Journal   (Followers: 10, SJR: 4.288, h-index: 233)
Human Reproduction     Hybrid Journal   (Followers: 73, SJR: 2.271, h-index: 179)
Human Reproduction Update     Hybrid Journal   (Followers: 15, SJR: 4.678, h-index: 128)
Human Rights Law Review     Hybrid Journal   (Followers: 60, SJR: 0.7, h-index: 21)
ICES J. of Marine Science: J. du Conseil     Hybrid Journal   (Followers: 53, SJR: 1.233, h-index: 88)
ICSID Review     Hybrid Journal   (Followers: 8)
ILAR J.     Hybrid Journal   (Followers: 1, SJR: 1.099, h-index: 51)
IMA J. of Applied Mathematics     Hybrid Journal   (SJR: 0.329, h-index: 26)
IMA J. of Management Mathematics     Hybrid Journal   (Followers: 2, SJR: 0.351, h-index: 20)
IMA J. of Mathematical Control and Information     Hybrid Journal   (Followers: 2, SJR: 0.661, h-index: 28)
IMA J. of Numerical Analysis - advance access     Hybrid Journal   (SJR: 2.032, h-index: 44)
Industrial and Corporate Change     Hybrid Journal   (Followers: 8, SJR: 1.37, h-index: 81)
Industrial Law J.     Hybrid Journal   (Followers: 29, SJR: 0.184, h-index: 15)
Information and Inference     Free  
Integrative and Comparative Biology     Hybrid Journal   (Followers: 7, SJR: 1.911, h-index: 90)
Interacting with Computers     Hybrid Journal   (Followers: 10, SJR: 0.529, h-index: 59)
Interactive CardioVascular and Thoracic Surgery     Hybrid Journal   (Followers: 4, SJR: 0.743, h-index: 35)
Intl. Data Privacy Law     Hybrid Journal   (Followers: 27)
Intl. Health     Hybrid Journal   (Followers: 4, SJR: 0.835, h-index: 15)
Intl. Immunology     Hybrid Journal   (Followers: 4, SJR: 1.613, h-index: 111)
Intl. J. for Quality in Health Care     Hybrid Journal   (Followers: 32, SJR: 1.593, h-index: 69)
Intl. J. of Constitutional Law     Hybrid Journal   (Followers: 50, SJR: 0.613, h-index: 19)
Intl. J. of Epidemiology     Hybrid Journal   (Followers: 114, SJR: 4.381, h-index: 145)
Intl. J. of Law and Information Technology     Hybrid Journal   (Followers: 3, SJR: 0.247, h-index: 8)
Intl. J. of Law, Policy and the Family     Hybrid Journal   (Followers: 18, SJR: 0.307, h-index: 15)
Intl. J. of Lexicography     Hybrid Journal   (Followers: 8, SJR: 0.404, h-index: 18)
Intl. J. of Low-Carbon Technologies     Open Access   (Followers: 1, SJR: 0.457, h-index: 12)
Intl. J. of Neuropsychopharmacology     Open Access   (Followers: 4, SJR: 1.69, h-index: 79)
Intl. J. of Public Opinion Research     Hybrid Journal   (Followers: 8, SJR: 0.906, h-index: 33)
Intl. J. of Refugee Law     Hybrid Journal   (Followers: 33, SJR: 0.231, h-index: 21)
Intl. J. of Transitional Justice     Hybrid Journal   (Followers: 12, SJR: 0.833, h-index: 12)
Intl. Mathematics Research Notices     Hybrid Journal   (Followers: 1, SJR: 2.052, h-index: 42)
Intl. Mathematics Research Surveys - advance access     Hybrid Journal  
Intl. Political Sociology     Hybrid Journal   (Followers: 24, SJR: 1.339, h-index: 19)
Intl. Relations of the Asia-Pacific     Hybrid Journal   (Followers: 17, SJR: 0.539, h-index: 17)
Intl. Studies Perspectives     Hybrid Journal   (Followers: 7, SJR: 0.998, h-index: 28)
Intl. Studies Quarterly     Hybrid Journal   (Followers: 33, SJR: 2.184, h-index: 68)
Intl. Studies Review     Hybrid Journal   (Followers: 17, SJR: 0.783, h-index: 38)
ISLE: Interdisciplinary Studies in Literature and Environment     Hybrid Journal   (Followers: 1, SJR: 0.155, h-index: 4)
ITNOW     Hybrid Journal   (Followers: 2, SJR: 0.102, h-index: 4)
J. of African Economies     Hybrid Journal   (Followers: 15, SJR: 0.647, h-index: 30)
J. of American History     Hybrid Journal   (Followers: 38, SJR: 0.286, h-index: 34)
J. of Analytical Toxicology     Hybrid Journal   (Followers: 13, SJR: 1.038, h-index: 60)
J. of Antimicrobial Chemotherapy     Hybrid Journal   (Followers: 20, SJR: 2.157, h-index: 149)
J. of Antitrust Enforcement     Hybrid Journal   (Followers: 1)
J. of Applied Poultry Research     Hybrid Journal   (Followers: 3, SJR: 0.563, h-index: 43)
J. of Biochemistry     Hybrid Journal   (Followers: 43, SJR: 1.341, h-index: 96)
J. of Chromatographic Science     Hybrid Journal   (Followers: 18, SJR: 0.448, h-index: 42)
J. of Church and State     Hybrid Journal   (Followers: 11, SJR: 0.167, h-index: 11)
J. of Competition Law and Economics     Hybrid Journal   (Followers: 34, SJR: 0.442, h-index: 16)
J. of Complex Networks     Hybrid Journal   (Followers: 1, SJR: 1.165, h-index: 5)
J. of Conflict and Security Law     Hybrid Journal   (Followers: 11, SJR: 0.196, h-index: 15)
J. of Consumer Research     Full-text available via subscription   (Followers: 38, SJR: 4.896, h-index: 121)
J. of Crohn's and Colitis     Hybrid Journal   (Followers: 9, SJR: 1.543, h-index: 37)
J. of Cybersecurity     Hybrid Journal   (Followers: 2)
J. of Deaf Studies and Deaf Education     Hybrid Journal   (Followers: 8, SJR: 0.69, h-index: 36)
J. of Design History     Hybrid Journal   (Followers: 15, SJR: 0.166, h-index: 14)
J. of Economic Entomology     Full-text available via subscription   (Followers: 6, SJR: 0.894, h-index: 76)
J. of Economic Geography     Hybrid Journal   (Followers: 31, SJR: 2.909, h-index: 69)
J. of Environmental Law     Hybrid Journal   (Followers: 25, SJR: 0.457, h-index: 20)
J. of European Competition Law & Practice     Hybrid Journal   (Followers: 19)
J. of Experimental Botany     Hybrid Journal   (Followers: 13, SJR: 2.798, h-index: 163)
J. of Financial Econometrics     Hybrid Journal   (Followers: 21, SJR: 1.314, h-index: 27)
J. of Global Security Studies     Hybrid Journal   (Followers: 1)
J. of Heredity     Hybrid Journal   (Followers: 3, SJR: 1.024, h-index: 76)
J. of Hindu Studies     Hybrid Journal   (Followers: 7, SJR: 0.186, h-index: 3)
J. of Hip Preservation Surgery     Open Access  
J. of Human Rights Practice     Hybrid Journal   (Followers: 21, SJR: 0.399, h-index: 10)
J. of Infectious Diseases     Hybrid Journal   (Followers: 39, SJR: 4, h-index: 209)
J. of Insect Science     Open Access   (Followers: 9, SJR: 0.388, h-index: 31)
J. of Integrated Pest Management     Open Access   (Followers: 1)

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Journal Cover European Journal of Public Health
  [SJR: 1.284]   [H-I: 64]   [23 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1101-1262 - ISSN (Online) 1464-360X
   Published by Oxford University Press Homepage  [368 journals]
  • Commentary: ASPHER at age 50
    • Authors: Perry IJ.
      Abstract: The Association of Schools of Public Health in the European Region (ASPHER) was established as a WHO initiative at a symposium in Ankara in October 1966 and in 2016 the association produced a 50th Anniversary book: 50 Years of Professional Public Health Workforce Development.1 From modest beginnings as a ‘private club’ with a small number of member schools and an annual budget of $1500, ASPHER has become one of the key independent public health organizations in Europe with 112 members from 43 countries, 14 associate members from North America, Africa, Israel, Palestine, Japan and Australia and a budget in excess of $100 000 per annum. The book’s title reflects ASPHER’s core focus on strengthening the role of public health in Europe through improvement and standardization of education and training of public health professionals for practice and research at all levels including undergraduate bachelor level, Masters in Public Health (MPH), PhD and continuing professional development.
      PubDate: 2017-02-08
  • The return of community-based health and social care to local government:
           governance as a public health challenge
    • Authors: Reijneveld SA.
      Abstract: Community-based care seems to return to local government, i.e. the municipality, in several European countries. This holds at the least the integrated health and social care i.e. the joint provision of prevention and care aiming at both the individual, and at the social setting of that individual. In this editorial, I will highlight two challenges of relevance for readers of the Journal: the issue of accountability of such integrated community-based care, and the issue of its evidence-base.
      PubDate: 2017-02-08
  • Thank you
    • Authors: Allebeck P; Delnoij D, Leyland A, et al.
      Abstract: Ascientific journal exists only because of the good will and assistance of its reviewers. We can only publish approximately a fifth of the articles we receive and, in order to publish really high-quality papers, we depend on the expertise of many people. During 2016 a total of 555 reviewers have helped us to decide about the articles that we should publish. Their names are listed below and we would like to take this opportunity to thank them. The list refers to reviewers assigned until 1 December 2016.
      PubDate: 2017-02-08
  • Scientific research and the public good
    • Authors: Delnoij DJ.
      Abstract: Randomized clinical trials are the state-of-the-art method to study comparative effectiveness of healthcare interventions. However, sometimes a discrepancy is observed between the effects of an intervention in routine clinical practice as compared with the effects that were demonstrated in randomized controlled clinical trials.1 Real-world data, e.g. from registries or claims databases, could help to unravel the effectiveness of interventions in clinical practice. The hope is that the use of these data will allow healthcare decision makers to be more certain when it is (cost-)effective to provide access to new treatments. Real-world data could therefore contribute to the public good.
      PubDate: 2017-02-08
  • European Public Health News
    • Authors: Zeegers Paget D.
      Abstract: In this first European public health news of 2017, all authors are looking at the importance of scientific evidence and of getting your message across. Muscat emphasizes that public health leadership is needed more than ever before. Not just to bring the evidence, but also to allowing to tell the whole story and includes other areas of expertise and other factors that are influencing health. Zeegers continues by calling for innovative ways of communicating public health messages. We need to be scientific and visible at the same time.
      PubDate: 2017-02-08
  • Heath policy and Mr. Trump: public health consequences of the Trump
    • Authors: Greer SL.
      Abstract: Every election in the USA matters to the USA and the world, but the 2016 election might matter more than most. The victory of Donald Trump brings a great deal of uncertainty to American politics and it is hard to predict what its effects will be. What is certain is that health care and public health will be in the center of some big coming storms.
      PubDate: 2017-02-08
  • The dispossessed: a public health response to the rise of the far-right in
           Europe and North America
    • Authors: Stuckler D.
      Abstract: 2016 was a turbulent year. Few events in our lifetimes alter the world’s political realities. Yet two happened in rapid succession. First, on 24 June 2016, the UK public voted by a narrow margin to exit the EU, which the polls had failed to predict. Then, 8 November 2016, in the USA, democratic candidate Hillary Clinton’s seemingly safe lead against republican Donald Trump was found to have been in part an artefact of polling errors as Trump won in an upset.
      PubDate: 2017-02-08
  • Health professionals must uphold truth and human rights
    • Authors: McKee M.
      Abstract: The election of Donald Trump, a candidate who has attacked women, migrants and people with disabilities, and growing evidence of electoral support for populist politicians promoting divisive and authoritarian policies in Europe has generated concern among health professionals in many countries. Even in countries with a long history of democracy, some politicians are threatening the safeguards that have protected the vulnerable for decades. How should health professionals respond to the threat posed by authoritarian regimes that reject ideas of evidence and truth?
      PubDate: 2017-02-08
  • Changing patterns of breast cancer incidence and mortality by education
           level over four decades in Norway, 1971–2009
    • Authors: Trewin CB; Strand B, Weedon-Fekjær H, et al.
      Abstract: Background: In the last century, breast cancer incidence and mortality was higher among higher versus lower educated women in developed countries. Post-millennium, incidence rates have flattened off and mortality declined. We examined breast cancer trends by education level, to see whether recent improvements in incidence and mortality rates have occurred in all education groups. Methods: We linked individual registry data on female Norwegian inhabitants aged 35 years and over during 1971–2009. Using Poisson models, we calculated absolute and relative educational differences in age-standardised breast cancer incidence and mortality over four decades. We estimated educational differences by Slope and Relative Index of Inequality, which correspond to rate difference and rate ratio, comparing the highest to lowest educated women. Results: Pre-millennium, incidence and mortality of breast cancer were significantly higher in higher versus lower educated women. Post-millennium, educational differences in breast cancer incidence and mortality attenuated. During 2000–2009, breast cancer incidence was still 38% higher for higher versus lower educated women (Relative Index of Inequality: 1.38, 95% confidence interval: 1.31–1.44), but mortality no longer varied significantly by education level (Relative Index of Inequality: 1.09, 95% confidence interval: 0.99–1.19). Among women below 50 years, however, the education gradient for mortality reversed, and mortality was 28% lower for the highest versus lowest educated women during 2000–2009 (Relative Index of Inequality: 0.72, 95% confidence interval: 0.51–0.93). Conclusions: Post-millennium improvements in breast cancer incidence and mortality have primarily benefited higher educated women. Breast cancer mortality is now highest among the lowest educated women below 50 years.
      PubDate: 2017-02-08
  • Interventions that stimulate healthy sleep in school-aged children: a
           systematic literature review
    • Authors: Busch V; Altenburg TM, Harmsen IA, et al.
      Abstract: Background: Healthy sleep among children has social, physical and mental health benefits. As most of today’s children do not meet the healthy sleep recommendations, effective interventions are urgently needed. This systematic review summarizes the characteristics and effectiveness of interventions aiming to stimulate healthy sleeping in a general population of school-aged children. Methods: The search engines PubMed, Embase, Web of Science, PsycInfo and the Cochrane Database Library were systematically searched up to March 2016. We included all studies evaluating interventions targeting healthy sleep duration and/or bedtime routines of children aged 4–12 years. All steps in this systematic review, i.e. search, study selection, quality assessment and data extraction, were performed following CRD Guidelines and reported according to the PRISMA Statement. Results: Eleven studies were included, of which only two were of strong quality. The interventions varied in terms of targeted determinants and intervention setting. Overall, no evidence was found favoring a particular intervention strategy. One intervention that delayed school start time and two multi-behavioral interventions that targeted both the school and home setting showed promising effects in terms of increasing sleep duration. Conclusion: Due to few high quality studies, evidence for the effectiveness of any particular intervention strategy to stimulate healthy sleep in children is still inconclusive. However, the more effective interventions in stimulating healthy sleep duration and adherence to regular bedtimes were mostly multi-behavioral interventions that included creating daily healthy routines and combined intervention settings (e.g. home and school). In conclusion, high-quality studies evaluating systematically developed interventions are needed to move this field forward.
      PubDate: 2017-02-08
  • European studies on prevalence and risk of autism spectrum disorders
           according to immigrant status—a review
    • Authors: Kawa R; Saemundsen E, Lóa Jónsdóttir S, et al.
      Abstract: Background: Autism spectrum disorders (ASDs), once considered to be rare, are now reaching prevalence estimates of 1% and higher. Studies conducted in North America indicate large racial/ethnic disparities in the diagnosis of ASDs. Others show, that immigrant children have similar prevalence rates of ASDs as native children, although they are diagnosed later compared with native children. In relation to a EU funded network action, Enhancing the Scientific Study of Early Autism, it was considered important to review the literature on this subject. Method: A comprehensive literature search was undertaken for original articles reporting on prevalence and risk for ASD in Europe among immigrants and ethnic minorities and data across studies were compared. Results: Seventeen studies conducted in Europe concerning immigrants and ethnic minorities were found. Fifteen studies suggest a higher prevalence rate of ASDs among children of immigrants in comparison to native children (RR = 1.02–1.74; OR = 0.6–10.5). One study revealed higher prevalence of autism (OR = 2.2; 95% CI 1.6–3.1) and lower prevalence of Asperger syndrome in immigrants (OR = 0.6; 95% CI 0.3–0.97). One study showed a lower prevalence of Asperger syndrome in immigrants (aOR = 0.1, 95% CI 0.01–0.5). The majority of those analyses involved immigrants from outside Europe, e.g. from Africa and South America. Conclusion: After analysing the results of studies conducted in Europe, it is unclear if higher prevalence estimates of ASDs among immigrants in this region reflect true differences, especially considering many potential confounding factors, e.g. genetic, biological, environmental and cultural. Considering the number of people migrating within Europe there is a substantial need to study further the prevalence of ASDs in immigrant groups.
      PubDate: 2016-12-24
  • The social gradient of sleep in adolescence: results from the
           youth@hordaland survey
    • Authors: Hysing M; Petrie KJ, Bøe T, et al.
      Abstract: Background: A social gradient of sleep problems has been demonstrated in both children and adults, but our knowledge about possible social determinants of adolescent sleep problems remains limited. Methods: A large population-based study in Norway surveyed 10 220 adolescents aged 16–19 years in 2012. Multiple socioeconomic status (SES) indicators and assessment of sleep, including DSM-5 insomnia, sleep duration, weekend–weekdays differences, as well as sleep deficit and delayed sleep phase were included. Results: Insomnia was more frequent among adolescents from families with lower parental education, parents outside the workforce and among adolescents reporting lower perceived family financial circumstances. Adolescents from lower social strata reported a significantly shorter sleep duration, more sleep deficits, later bedtimes and larger weekday–weekend sleep differences. The associations were present across all SES measures. For example, the mean sleep duration was 6:03 (95% CI: 5:55–6:12) among adolescents with mothers with primary school education, compared with sleep duration of 6:24 (95% CI: 6:20–6:27) and 6:35 (95% CI: 6:31–6:38) among adolescent with mothers having a secondary school and university degree, respectively (P < 0.001). The highest rate of insomnia was found in families with worse perceived financial circumstances (32%), when compared with 17–18% in families with better perceived financial circumstances. Depressive symptoms and family cohesion could account for some, but not all of the association. Conclusions: Lower SES was a robust determinant of adolescent sleep patterns and sleep problems, corroborating evidence of a social gradient in sleep from young children and adults. Targeted intervention for adolescents in low SES may be indicated to improve sleep.
      PubDate: 2016-11-17
  • Nutritional evaluation of undocumented children: a neglected health issue
           affecting the most fragile people
    • Authors: Comandini O; Cabras S, Marini E.
      Abstract: The precise knowledge of age is necessary for assessing a child’s nutritional status. We show the magnitude and the effects of age error in real and hypothetical situations, and discuss possible compensative strategies. Using data collected in different years, we found that 79.8% of 1056 Ugandan children had some age knowledge, but there was a mean shift of 7.5 (±8.8) months between ages obtained from different sources. Using a free software for calculating the effect of bias and random error, we showed the variation in malnutrition prevalence in hypothetical cases.
      PubDate: 2016-11-17
  • Disability pension due to common mental disorders and healthcare use
           before and after policy changes; a nationwide study
    • Authors: Rahman SS; Mittendorfer-Rutz EE, Alexanderson KK, et al.
      Abstract: Background: Despite common mental disorders (CMDs) being a main reason for preterm exit from the labour market, there is limited knowledge regarding healthcare use around the time of being granted disability pension (DP) due to CMD. The aim was to study specialized healthcare use before and after being granted DP due to CMD and whether these trajectories differed before and after changes in DP granting criteria in Sweden in 2008. Methods: Included individuals lived in Sweden, aged 19–64 years with incident DP due to CMD before (wave 1, 2005–06, n = 24 298) or after (wave 2, 2009–10, n = 4056) the changes in 2008. Healthcare trajectories during a 7-year window were assessed by generalized estimating equations. Between- and within-wave differences were examined by interaction models. Results: Psychiatric healthcare increased until the year preceding DP and declined thereafter, with one exception; such outpatient care kept increasing in wave 1 following DP. In the year preceding DP, 4.6 and 19.2% of the individuals in wave 1 had psychiatric in- and specialized outpatient care, respectively, compared with 7.9 and 46.6% in wave 2. No clear pattern was observed regarding somatic healthcare. The slopes of the different DP waves differed mainly during DP granting years (1 year prior to 1 year after), showing a sharper decline in wave 2. Conclusion: Transition to DP due to CMD seems to be associated with changes in psychiatric healthcare use, with higher rates in the year preceding DP. Outpatient healthcare patterns somewhat differed among those granted DP after stricter rules were introduced.
      PubDate: 2016-11-17
  • Female lung cancer mortality and long-term exposure to particulate matter
           in Italy
    • Authors: Uccelli R; Mastrantonio M, Altavista P, et al.
      Abstract: Background: Outdoor air pollution and particulate matter (PM) have recently been classified in Group 1 by IARC. In Italy there is no epidemiological study on the association between female lung cancer and PM as measured by the official monitoring stations. Methods: We estimated the dose–response relationship between female lung cancer mortality and available long-term outdoor PM10 and/or PM2.5 concentrations for all the Italian province capital city municipalities (respectively, 64 and 32 municipalities). Multiple regression analysis of standardized mortality rates (SMRates) for the period 2000–11, as a function of PM concentrations, considering percentage of smokers and deprivation index as additional explanatory variables, was performed for PM10 only. Results: The number of province capital cities with available PM2.5 data was not sufficient to detect a significant increment of SMRates as a function of concentrations. An SMRate increase of 0.325 for 1 μg m−3 increment of PM10 concentration was calculated. Moreover, the attributable risk of the overall SMRates for the two subgroups of municipalities under/equal and above 20 μg m−3 value was evaluated. Attributable deaths were computed by both the unitary SMRate increase and the attributable risk. A rough estimate of the impact of PM10 exposure at level above the WHO guideline value of 20 μg m−3 in these 64 municipalities is between 2920 and 3449 lung cancer deaths out of 22 162 (13–16%). Conclusion: Maintaining the PM10 concentrations below such WHO recommendation, an overall saving of nearly 300 lung cancer deaths per year in a population of 8 146 520 women living in the municipalities at study has been evaluated.
      PubDate: 2016-11-11
  • Four-year outcomes of an educational intervention in healthy habits in
           schoolchildren: the Avall 3 Trial
    • Authors: Llargués E; Recasens M, Manresa J, et al.
      Abstract: Background: The prevalence of obesity among children is increasing, but treating obesity is difficult and has poor outcomes. We assessed the 4-year impact of a school-based educational intervention on physical activity, body mass index (BMI) and the prevalence of overweight and obesity. Methods: A 6-year cluster-randomised study was used to evaluate an intervention programme for children in primary school in 2006–08. The intervention promoted healthy eating habits and physical activity in the school setting through the investigation, vision, action and change educational methodology that involves children as active participants in healthy change. BMI and physical activity were measured in 2006, 2008, 2010 and 2012. Multilevel mixed-effects linear regression was used to assess change in BMI over time. Results: The effect of the intervention was maintained 4 years after completion. Average increase in BMI was greater in the control than in the intervention group (3.85 ± 2.82 vs. 2.79 ± 2.37); the mean difference was 1.06 (95% confidence interval: 0.14–1.97). In the intervention group, the prevalence of overweight and obesity decreased (1.4 and 3.7%, respectively). In the control group, the prevalence of overweight increased (9.4%) and the prevalence of obesity decreased (1.6%). The control group spent more time in sedentary activities. No differences were observed in physical activities. Conclusions: Control of weight gain was sustained 4-years after an educational intervention during the first 2 years of primary school. Future interventions to prevent obesity should build on principles viewing children as active agents of healthy change. Trial registration: NCT01156805.
      PubDate: 2016-11-11
  • Breast cancer trends differ by ethnicity: a report from the South African
           National Cancer Registry (1994–2009)
    • Authors: Singh EE; Joffe MM, Cubasch HH, et al.
      Abstract: Background: To describe breast cancer (BC) incidence and mortality by ethnicity in South Africa (SA). Methods: Sources of data included the South African National Cancer Registry (NCR) pathology-based reports (1994–2009) and Statistics South Africa (SSA) mortality data (1997–2009). Numbers of cases, age-standardised incidence rates (ASIR) and lifetime risk (LR) were extracted from the NCR database for 1994–2009. Age-specific incidence rates were calculated for five-year age categories. The direct method of standardisation was employed to calculate age-standardised mortality rates (ASMR) using mortality data. Results: Between 1994 and 2009, there were 85 561 female BC. For the Black, Coloured and Asian groups, increases in ASIR and LR were observed between 1994 and 2009. In 2009, the ASIR for the total population, Blacks, Whites, Coloureds and Asians were 26.9, 18.7, 50.2, 40.9 and 51.2 per 100 000, respectively. For Asians, an increase in proportion of BC as a percentage of all female cancers was observed between 1994 and 2002 (11.1%) and continued to increase to 2009 (a further 4.5%). Whites and Asians presented higher incidences of BC at earlier ages compared with Blacks and Coloureds in 2009. In 1998, there were 1618 BC deaths in SA compared with 2784 deaths in 2009. ASMR between 1997 and 2004 increased but stabilised thereafter. Conclusion: This paper demonstrated that SA BC incidence rates are similar to other countries in the region, but lower than other countries with similar health systems. Ethnic differences in BC trends were observed. However, the reasons for observed ethnic differences are unclear.
      PubDate: 2016-10-24
  • A European perspective on GIS-based walkability and active modes of
    • Authors: Grasser G; van Dyck D, Titze S, et al.
      Abstract: Background: The association between GIS-based walkability and walking for transport is considered to be well established in USA and in Australia. Research on the association between walkability and cycling for transport in European cities is lacking. The aim of this study was to test the predictive validity of established walkability measures and to explore alternative walkability measures associated with walking and cycling for transport in a European context. Methods: Outcome data were derived from the representative cross-sectional survey (n = 843) ‘Radfreundliche Stadt’ of adults in the city of Graz (Austria). GIS-based walkability was measured using both established measures (e.g. gross population density, household unit density, entropy index, three-way intersection density, IPEN walkability index) and alternative measures (e.g. proportion of mixed land use, four-way intersection density, Graz walkability index). ANCOVAs were conducted to examine the adjusted association between walkability measures and outcomes. Results:Household unit density, proportion of mixed land use, three-way intersection density and IPEN walkability index were positively associated with walking for transport, but the other measures were not. All walkability measures were positively associated with cycling for transport. Conclusion: The established walkability measures were applicable to a European city such as Graz. The alternative walkability measures performed well in a European context. Due to measurement issues the association between these walkability measures and walking for transport needs to be investigated further.
      PubDate: 2016-10-23
  • Suicide mortality in Belgium at the beginning of the 21st century:
           differences according to migrant background
    • Authors: Bauwelinck M; Deboosere P, Willaert D, et al.
      Abstract: Background: Suicidal behaviour has long been recognized to vary widely between countries. Yet, rates of suicidal behaviour do not only vary between, but also within countries. Gender and socioeconomic differences in suicidal behaviour are well established, but the literature on suicidal behaviour and migrants is sparse, particularly in Belgium. The present study maps out the occurrence of suicide mortality across three of the largest migrant groups (Italians, Turks and Moroccans) versus the native population in Belgium, and verifies whether this association persists after accounting for socioeconomic variables. Methods: Census-linked mortality follow-up data covering the period 2001–2011 were used to probe into suicide mortality. To compare absolute differences by migrant background, indirect standardisation analyses were carried out. To assess relative differences, Cox proportional hazards models were performed. Analyses were restricted to 18- to 64-year-olds. Results: Belgian men and women have the highest suicide mortality risk, persons of Moroccan/Turkish origin the lowest, and Italians are somewhere in between. When migration generation is considered, the risk is higher for second-generation groups compared to that of the first-generation. Accounting for socioeconomic determinants, the difference between the native population and the various nationality groups intensifies. Conclusion: Although the risk is generally lower for minorities compared to the majority population, the results across migration generations underscore minorities’ increased vulnerability to suicide over time. Future research should focus on understanding the risks and protective factors of suicidal behaviour across different nationality groups. This way, tailored policy recommendations can be developed in order to tackle the burden of suicide.
      PubDate: 2016-10-19
  • Mortality and causes of death among the migrant population of Finland in
    • Authors: Lehti V; Gissler M, Markkula N, et al.
      Abstract: Background: Lower mortality among migrants than in the general population has been found in many, but not in all, previous studies. The mortality of migrants has not been studied in Finland, which has a relatively small and recent migrant population. Methods: People who were born abroad and whose mother tongue is not Finnish were identified from the Finnish Central Population Register (n = 185 605). A Finnish-born control matched by age, sex and place of residence was identified for each case (n = 185 605). Information about deaths was collected from the Finnish Causes of Death Register. Cox proportional hazards model was used for assessing the association between migrant status and death in 2011–13. Results: The mortality risk was found to be significantly lower for migrants than for Finnish controls (adjusted hazard ratio 0.77, 95% CI 0.72–0.84), both for migrant men (aHR 0.80, 95% CI 0.73–0.89) and women (aHR 0.78, 95% CI 0.70–0.88). The difference was statistically significant only among people who were not married and among people who were not in employment. There was variation by country of birth, but no migrant group had higher mortality than Finnish controls. No differences in mortality were found by duration of residence in Finland. The higher mortality of Finnish controls was largely explained by alcohol-related conditions and external causes of death. Conclusions: The mortality risk of migrants is lower than of people who were born in Finland. Possible explanations include selection and differences in substance use and other health behaviour.
      PubDate: 2016-10-19
  • The influence of parental modelling on children’s physical activity and
           screen time: Does it differ by gender?
    • Authors: Schoeppe S; Vandelanotte C, Bere E, et al.
      Abstract: Background: Parents play an important role in modelling healthy behaviours to their children. This study investigated associations between parent and child physical activity and screen time behaviours across specific domains, including moderating effects by parent and child gender. Method: The sample comprised 3300 school children and 2933 parents participating in the UP4FUN project (mean ages: child 11.2 ± 0.8 years, mother 40.0 ± 4.9 years, father 43.4 ± 5.8 years; 49% boys, 83% mothers). Data were collected in 2011 in Belgium, Greece, Hungary, Germany and Norway. Questionnaires assessed physical activity (sport, outdoor activities, walking and cycling for transport) and screen time (TV/DVD viewing, computer/games console use) in children and parents. Multilevel multivariate regression was applied to assess associations between parent and child physical activity and screen time. Results: Maternal, but not paternal, participation in sport, outdoor activities and walking for transport were associated with higher participation in these activities in children (P < 0.001). In contrast, both maternal and paternal TV/DVD viewing and computer/games console use were related to higher engagement in these screen-based activities in children (P < 0.01). Furthermore, maternal modelling of outdoor activities was significantly associated with outdoor activities in girls (P < 0.001). In contrast, paternal modelling of TV/DVD viewing and computer/games console were significantly associated with these screen-based behaviours in boys (P < 0.001). Conclusions: Maternal modelling of healthy active behaviours may have a greater influence on children compared to paternal modelling, whereas unhealthy sedentary behaviours seem to be modelled by both parents equally.
      PubDate: 2016-10-15
  • Impact of Chronic Care Model on diabetes care in Tuscany: a controlled
           before-after study
    • Authors: Barletta V; Profili F, Gini R, et al.
      Abstract: Background: In 2010, Tuscany (Italy) implemented the Chronic Care Model (CCM), to improve general practitioner (GP) management of chronic diseases. Aim: assessing how the introduction of CCM affected GPs’ compliance with standards of care for diabetes patients. Methods: A controlled before-after study was performed. Two exposed groups of GPs, one entering the study in 2010 and one in 2011, were considered. Patients with diabetes assisted by GPs of the groups were identified through the healthcare administrative data of the Regional Healthcare System and followed up from 2009 to 2012. A diabetes care indicator called Guideline Composite Indicator (GCI: annual assessment of glycated haemoglobin and at least two assessment among eye examinations, total serum cholesterol, and microalbuminuria) and an indicator of adherence to statin therapy were computed per year and by group. Impact of intervention was estimated by difference in differences analysis for panel data, stratified by GP performance level at baseline. Results: 483 GPs constituting the first group entered the study in 2010, 258 GPs of the second group entered it in 2011, and 1,820 GPs constituted the control group. After 1 year, the diabetes care indicator increased of 8.1%. During the second year, it showed a further increase of 1.6%. The mean impact on the adherence to statin therapy was smaller (+1%), yet statistically significant. Conclusion: The first year of the CCM implementation had a significant impact on the diabetes care indicator, and performance was stabilized after the first year. Impact on therapy indicator was smaller.
      PubDate: 2016-10-15
  • Changes in diabetes care introduced by a Chronic Care Model-based
           programme in Tuscany: a 4-year cohort study
    • Authors: Profili F; Bellini I, Zuppiroli A, et al.
      Abstract: Background: In 2010, Tuscany (Italy) implemented a Chronic Care Model (CCM)-based programme for the management of chronic diseases. The study’s objective was to evaluate its impact on the care of patients with type 2 diabetes. Methods: A population-based cohort study was performed on patients with diabetes, identified by an administrative data algorithm, exposed to a CCM-based programme versus patients not exposed (8486 patients in each group). The groups were matched using a propensity score approach and observed from 2011 to 2014. The outcomes measured were: mortality rate and hazard ratio (HR), hospitalisation incidence rate (IR) (all causes and diabetes-related diseases) and incidence rate ratio (IRR), and Guideline Composite Indicator (GCI) as proxy of adherence to guidelines (IR and IRR). Stratified Cox regression analysis and conditional fixed effect Poisson regression analyses were performed to compute HR and IRR. Results: A significant improvement was observed for GCI (IRR 1.58; 95% CI 1.53–1.62) and for cardiovascular long-term complications (IRR 1.11; 95% CI 1.04–1.18). A protective effect was observed for neurological long-term complications (IRR 0.85; 95% CI 0.76–0.95), acute cardio-cerebrovascular long-term complications—stroke and ST segment elevation myocardial infarction—(IRR 0.81; 95% CI 0.71–0.92) and mortality (HR 0.88; 95% CI 0.81–0.96). Conclusion: The implementation of a CCM-based programme was followed by better management and benefits for the health status of patients. The increase in hospitalisations for cardiovascular long-term complications could engender cost-efficacy issues, but a better integrated care (GPs and specialists) and a more appropriate specialist outpatient services organisation could avoid a part of these, while still maintaining the benefits seen.
      PubDate: 2016-10-10
  • Impact of smoke-free regulations on smoking prevalence trends in Spain
    • Authors: León-Gómez BB; Colell E, Villalbí JR, et al.
      Abstract: Background: Studies assessing Spanish smoke-free laws have found a decrease in second-hand smoke exposure, but the impact of such laws on general smoking trends is not clear. This study proposes to analyse trends in the prevalence of smoking in Spain, including changes by educational level, following the implementation of smoke-free regulations (2005 and 2010). Methods: Seven editions of the Spanish Household Survey on Alcohol and Drugs from 1999 to 2011 were used to analyse the standardised prevalence of daily smokers, the proportion of ex-daily smokers, and the average cigarettes smoked daily in both sexes and by educational level, among the population aged 15–64. The annual percentage of change (APC), and Poisson and linear multiple regressions were used to identify differences in terms of years and educational levels. Results: The overall prevalence of Spanish daily smokers decreased from 33.5% in 1999 to 30.2% in 2011 (APC = −1.7% for men, APC = −1.0% for women). Differences between low and high educational levels in the prevalence of daily smokers and ex-daily smokers increased. For both sexes, the prevalence ratio (PR) of daily smokers was positive for the years before 2005 and negative afterwards. Conversely, for ex-daily smokers the PR in all years was lower than in 2005. The mean number of cigarettes decreased from 17.6 cig/day in 1999 to 14.2 in 2011 [APC= day 1.8 (95% confidence interval: day 2.2, day 1.3)]. Conclusion: Six years after the national smoke-free regulation was implemented, previously reported decreasing trends of smoking for both men and women persisted, while inequalities between educational levels increased in both sexes.
      PubDate: 2016-09-28
  • Projecting the future smoking prevalence in Norway
    • Authors: Gartner CE; Lund KE, Barendregt JJ, et al.
      Abstract: Background: Norway has achieved a noteworthy reduction in smoking prevalence over the past forty years. In 2015, 13% of Norwegians aged 13–74 smoked daily and a further 9% smoked occasionally. One of the objectives of the Norwegian 2013–16 national strategy for tobacco control is to achieve a reduction in the daily smoking prevalence to < 10% by 2016. This paper aims to estimate how long it will take for Norway to achieve the 10% smoking prevalence. Methods: A dynamic forecasting model using smoking prevalence data from national survey data on the prevalence of current, former and never smokers in the Norwegian population from 1985 to 2012 was used to estimate future smoking prevalence in the Norwegian population based on a continuation of current patterns in smoking cessation and initiation rates. Results: The result suggests that Norway’s smoking prevalence among men and women will continue to decline if current trends of smoking initiation and cessation continue. Our model predicts, based on figures for 1985–2012, that the prevalence of current daily and occasional smoking among men and women will not fall below the 10% mark until 2029 for men and 2026 for women, if current trends continue. Conclusion: Smoking is likely to remain an important public health issue in Norway for many years. New strategies are needed to accelerate the decline in smoking in Norway.
      PubDate: 2016-09-28
  • Hospital, local palliative care network and public health: how do they
           involve terminally ill patients?
    • Authors: Scaccabarozzi G; Limonta F, Amodio E.
      Abstract: Background: Over one quarter of the health care expenditures is estimated to be spent for patients in the last year of life (LYL). For these patients, palliative care (PC) has been suggested as a response for improving the standards of care and reducing health costs. The aim of this study was to analyze a cohort of LYL people, in terms of comparing hospitalised patients who had been referred for PC to patients receiving usual care (UC). Methods: Retrospective study carried out on patients resident in Lecco (Italy) who died between 2012 and 2013. Records of patients were obtained from the Death certificate registry and cross-linked with Regional Healthcare Information System, Hospital Discharge Records and Palliative Care Registry. A total of 5830 patients were analyzed. Results: At least one hospitalization was reported by 2586 (44.3%) patients in the last month of life and 3957 (67.9%) patients in the last year of life. A total of 1114 (19.1%) patients were referred to palliative care with median duration of enrollment of 31 days (IQR = 11–69). PC was found to decrease the risk of hospital admission (adj-OR = 0.21; 95% CI = 0.18–0.26) and dying in hospital (adj-OR = 0.03; 95% CI = 0.02–0.04). Conclusions: Patients in the last year of life show a high risk of hospitalization, which represents a substantial component of health-care costs. Our study suggests that home PC consultation could represent an important public health strategy in order to lower hospital costs for LYL patients and reduce the probability of dying in hospital.
      PubDate: 2016-09-28
  • Conflict between diabetes guidelines and experienced counselling in sports
           and physical activity. An exploratory study
    • Authors: Stuij M; Elling A, Abma TA.
      Abstract: According to medical guidelines counselling on sports and physical activity should be part of diabetes treatment. Using an online questionnaire (n = 181), we explored how people with both type 1 and type 2 diabetes experienced this counselling in the Netherlands. Most respondents were critical, indicating that they did not receive proper guidance or helpful advices. A third of the respondents mentioned that there was hardly any attention for the subject during their treatment. This conflict between guidelines and experiences point towards the need for more insight in critical issues in counselling regarding taking up sports and physical activity (again) after diagnosis.
      PubDate: 2016-09-27
  • The relationship between outpatient department utilisation and
           non-hospital ambulatory care in Austria
    • Authors: Czypionka T; Röhrling G, Mayer S.
      Abstract: Background: Coordinated health service utilisation in the ambulatory care sector is of major interest from a health policy perspective. This ecological study investigates the interplay between medical care utilisation in hospital outpatient departments and in freestanding physician practices by drawing on the example of the Austrian healthcare system, which is standing out due to three features: ambulatory care is provided by both free-standing public (contract) and private (non-contract) practitioners; medical specialists operate in free-standing physician practices and in hospital outpatient departments; essentially, no gatekeeping is in place. As the ongoing health care reform aims to strengthen the primary care sector, we investigate whether in the current system care in general practitioner and specialist physician practices is in a substitutive, complementary or independent relation with medical care in outpatient departments. Methods: Hypotheses were tested using ordinary least square regression analysis based on administrative data of all Austrian districts with a hospital department in 2010, including a proxy for actual utilisation rather than physician headcount. Results: Controlling for socio-demographic and geographic characteristics and inpatient activity, we find that a higher level of care provision by contract GPs is associated with lower use of hospital outpatient departments on the district level. In contrast, a higher level of care by non-contract specialists is related to a higher utilization in outpatient departments. Conclusion: While care by non-contract specialists seems to be in a complementary and potentially demand-inducing relation with outpatient departments, primary care by contract GPs appears to be capable of replacing care in outpatient departments.
      PubDate: 2016-09-27
  • Beyond return to work from sickness absence due to mental disorders:
           5-year longitudinal study of employment status among production workers
    • Authors: Norder G; van der Ben CA, Roelen CM, et al.
      Abstract: Background: Mental disorders are increasing and account for one-third of all disability benefits in OECD countries. This study investigated the work status after mental sickness absence (SA). Methods: Five-year longitudinal cohort study of 6678 male production workers. Work status, work schedule and work hours/week were retrieved from employer records in five years following RTW from mental SA. Longitudinal analysis was done with linear and logistic generalized estimating equations estimating relative risks (RRs) and odds ratios (ORs), respectively, controlled for age, marital status and occupational grade. Results: In total, 4613 (69%) workers had complete data and were included in the analyses; 552 of them had experienced mental SA. In the years following mental SA, 102 (18%) workers left employment compared to 384 (9%) workers without mental SA. In the first year after mental SA, workers left employment at their own request and in later years they were dismissed because of poor work functioning. After mental SA, workers more often (RR = 2.93; 95% CI 1.83–4.03) reduced their work hours/week than those without mental SA, whereas the odds of changing work schedule did not differ between them (OR = 1.02; 95% CI 0.84–1.24). Conclusions: After mental SA, workers left employment or reduced work hours/week more often than those without mental SA. The results suggest that changes in employment status are more common after SA caused by mental disorders as compared with somatic disorders.
      PubDate: 2016-09-22
  • Use of telemedicine in the European penitentiaries: current scenario and
           best practices
    • Authors: Gualano MR; Bert F, Andriolo V, et al.
      Abstract: Background: Telemedicine has demonstrated to improve access and quality of health services in underserved area, curtailing the costs, therefore its application to the delivery of health care in prison would be desirable. Little is known about its use across European penal institutions. Our study aimed to assess the state of telemedicine within the European jails. Methods: To maximize data availability, we used two different approaches. A bottom-up approach was used by gathering information directly from prison directors of every single penal establishment of the 28 European members. A top-down approach was used to collect information from persons involved in prison administration or project leaders at national level. In both approaches questions were sent by mail. Results: Information gathered directly by contacting prison directors and/or persons in charge come from all the 28 EU members. In total, we contacted 211 prison directors and 116 persons in charge, with a total response rate of 67%. We have found that telemedicine, as additional healthcare delivery model, is used only in 11 countries, especially among members of Northern and Western Europe. Only Romania showed to have a pilot project for a nationwide program of telemedicine. Conclusions: Telemedicine services among European penitentiaries appear still poorly developed. Given the numerous and demonstrated advantages of this technology, it would be desirable to implement its utilization in penal healthcare and to integrate it in the routine services, as benefit not only for prison environments but also for the whole community of each country.
      PubDate: 2016-09-10
  • Determinants of maternal and paternal empowerment: exploring the role of
           childhood adversities
    • Authors: Vuorenmaa M; Halme N, Kaunonen M, et al.
      Abstract: Background: Childhood adversities are known to increase the life-long risk of negative life events and health problems. Less is known about how childhood conditions affect parental empowerment, which is crucial to family well-being and resources. This study aimed to find out how parents’ own childhood adversities predict maternal and paternal empowerment, and how these predictors differ between mothers and fathers. Methods: The study design was cross-sectional. The sample consisted of mothers (n = 571) and fathers (n = 384) of children aged 0–9 years in Finland. Parents were selected using stratified random sampling in 2009. Parental empowerment was measured by the Generic Family Empowerment Scale. Eleven types of childhood adversity were inquired about. Associations were examined by linear regression analysis, and empowerment was predicted by multiple linear regression. Results: Childhood adversities had a negative effect on parental empowerment. The effect was more significant on maternal than paternal empowerment. Adversities were particularly associated with parents’ confidence in managing their children in everyday life. Parental empowerment of both mothers and fathers was affected significantly by their parents’ mental health problems and serious conflicts within their families during childhood. Financial difficulties, parents’ unemployment and bullying at school affected maternal empowerment. Conclusions: Early recognition of adversities and appropriate intervention may help to increase present and future well-being and prevent long-term difficulties of each family member.
      PubDate: 2016-09-10
  • Effects of child long-term illness on maternal employment: longitudinal
           findings from the UK Millennium Cohort Study
    • Authors: Hope S; Pearce A, Whitehead M, et al.
      Abstract: Background: Maternal employment has increased in European countries, but levels of employment are lower among mothers whose children have a limiting long-term illness or disability. However, we do not know whether having a child with a limiting illness prevents take-up or maintenance of paid employment or whether ‘common causes’, such as lack of qualifications or maternal disability lead to both maternal unemployment and childhood illness. Longitudinal data have the potential to distinguish between these. Methods: We analyzed four waves (3, 5, 7 and 11 years) of the Millennium Cohort Study (MCS) to examine the relationship between childhood limiting illness and maternal employment, unadjusted and adjusted for covariates. Multinomial regression models were used to test the association between child illness and trajectories of maternal employment. Fixed effects models assessed whether a new report of a child illness increased the odds of a mother exiting employment. Results: At every wave, maternal employment was more likely if the child did not have a limiting illness. After adjustment for covariates, childhood illness was associated with risks of continuous non-employment (adjusted Relative Risk Ratio = 1.46 [Confidence Interval: 1.21, 1.76]) or disrupted employment (aRRR = 1.26 [CI: 1.06, 1.49]), compared with entering or maintaining employment. If a child developed a limiting long-term illness, the likelihood of their mother exiting employment increased (adjusted Odds Ratio = 1.27 [CI: 1.05, 1.54]). Conclusions: ‘Common causes’ did not fully account for the association between child illness and maternal employment. Having a child with a limiting illness potentially reduces maternal employment opportunities.
      PubDate: 2016-08-26
  • Premature mortality after suicide attempt in relation to living
           arrangements. A register-based study in Finland in 1988–2007
    • Authors: Mäki NE; Martikainen PT.
      Abstract: Background: Several studies have shown that individuals with a history of suicide attempt form a high-risk mortality group. Completed suicide is the main cause of death among them, but excess mortality for other causes of death is much less studied. Furthermore, little is known whether living with others modifies the excess risk of mortality among suicide attempters. Methods: We evaluated an 11% sample from the population registration data of Finns aged 15 years and older in the period 1988–2007 with an 80% oversample of death records and a linkage with information on causes of hospitalisation. We estimate standardised mortality rates and Poisson regression models separately for the general population and those treated in hospital for suicide attempt. Results: Compared with the general population, all-cause mortality risk was ∼10-fold among women and well over 10-fold among men during the first 3 months following suicide attempt. The risk for suicide was even greater, but in addition to external causes of death, mortality from smoking- and alcohol-related diseases was elevated. Instead, the proportion of alcohol-associated suicides was smaller among the suicide attempters. Among suicide attempters, the association between living arrangements and mortality was much weaker than in the general population. Conclusion: Premature mortality is extremely high after suicide attempt, especially in the first year. Our results do not support the idea that the resources provided by living with others ameliorate the effects of suicide attempt on subsequent mortality. Suicide prevention should focus on designing adequate aftercare following the attempt, especially for those with alcohol problems.
      PubDate: 2016-08-23
  • Cervical cancer screening in Switzerland: cross-sectional trends
           (1992–2012) in social inequalities
    • Authors: Burton-Jeangros C; Cullati S, Manor O, et al.
      Abstract: Background: Incidence and mortality of cervical cancer declined thanks to Pap smear screening. However cervical cancer screening (CCS) inequalities are documented, including in high income countries. This population-based study aims to assess the importance and 20-year trends of CCS inequalities in Switzerland, where healthcare costs and medical coverage are among the highest in the world. Methods: We analyzed data from five waves of the population-based Swiss Health Interview Survey (SHIS) covering the period 1992–2012. Multivariable Poisson regression were used to estimate weighted prevalence ratios (PR) of CCS and 95% Confidence Intervals (CI) adjusting for socio-economic, socio-demographic characteristics, family status, health status, and use of healthcare. Results: The study included 32’651 women aged between 20 and 70 years old. Between 1992 and 2012, rates of CCS over the past 3 years fluctuated between 71.7 and 79.6% (adjusted P < 0.001). Lower CCS was observed among women with low education, low income, those having limited emotional support, who were non-Swiss, single, older, living in non-metropolitan area or in the French-speaking region, overweight. Over the analyzed period, differences in CCS across age groups diminished while rates among women who visited a GP over the previous year, versus those who did not, increased. Conclusions: While important changes occurred in screening recommendations and in social circumstances of the targeted population, CCS rates remained fairly stable in Switzerland between 1992 and 2012. At the same time, inequalities in CCS persisted over that period.
      PubDate: 2016-08-18
  • Associations between social support and depressive symptoms: social
           causation or social selection—or both?
    • Authors: Almquist YB; Landstedt E, Hammarström A.
      Abstract: Background: Numerous studies have demonstrated an association between social support and health, almost regardless of how social support and health have been conceptualised or measured. Even so, the issue of causality has not yet been sufficiently addressed. This issue is particularly challenging for mental health problems such as depressive symptoms. The aim of the present study is to longitudinally assess structural and functional aspects of social support in relation to depressive symptoms in men and women, through a series of competing causal models that, in contrast to many other statistical methods, allow for bi-directional effects. Methods: Questionnaire data from the Northern Swedish Cohort (n = 1001) were utilised for the years 1995 (age 30) and 2007 (age 42). Associations were analysed by means of gender-specific structural equation modelling, with structural and functional support modelled separately. Results: Both structural and functional support were associated with depressive symptoms at ages 30 and 42, for men and women alike. A higher level of support, particularly functional support, was associated with a decrease in depressive symptoms over time among men. Among women, there were bi-directional effects of social support and depressive symptoms over time. Conclusion: Concerning social support and health, the social causation hypothesis seems relevant for men whereas, for women, the associations appear to be more complex. We conclude that preventive and health promoting work may need to consider that the presence of depressive symptoms in itself impedes on women’s capability to increase their levels of social support.
      PubDate: 2016-08-13
  • Healthcare utilization among urban homeless followed by an outpatient
           clinic: more intensive use by migrant groups
    • Authors: Silvestrini G; Federico B, Damiani G, et al.
      Abstract: Introduction: The increasing share of homeless represents a challenge for the healthcare system. In Rome, Italy, a large ambulatory care centre for the homeless had adopted several measures to improve access to health care facilities by migrants. We aimed to determine the rate of utilization among migrants as compared to the Italian homeless. Methods: We collected data on 2604 homeless adults who had their first medical examination between 2007 and 2011. We conducted Poisson regression to analyse the association of medical and demographic variables with the number of revisits within 1 year after the first contact. Results: As compared to the Italian-born homeless, the number of revisits among the migrants which included undocumented migrants, homeless EU citizens, forced migrants and refugees, was increased. These differences were also noted among those with chronic conditions detected on the first contact. The differences were substantial among males but not among females. A greater frequency of revisits was also observed among the uneducated and those who were not registered with the National Health Service. Conclusion: The specialised services in this clinic were able to achieve relatively high rates of revisits among the homeless of foreign background. This suggests that the utilization of health care services by these people may be effectively increased by the implementation of a series of migrant-oriented practices.
      PubDate: 2016-08-07
  • Joint associations between smoking and obesity as determinants of
           premature mortality among midlife employees
    • Authors: Roos ET; Lallukka T, Lahelma E, et al.
      Abstract: Background: Both smoking and obesity increase mortality, however, only few studies have considered premature death. The joint effect of smoking and obesity is less studied. The aim of this study was to examine the joint associations of smoking and obesity with all-cause and cancer mortality among midlife employees. Methods: Baseline mail surveys among employees of the City of Helsinki, Finland, during 2000-2002 include data on smoking (never-, ex-, moderate and heavy), BMI (non-obese, obese), and covariates (N = 8960, response rate 67%). Data were linked with register data on mortality until 2013. The final sample included 6437 employees. Cox proportional hazard models were used. Finally synergistic interaction effect was examined. Results: Adjusting for age and gender, non-obese heavy smokers had an elevated risk of all-cause mortality (HR 2.98, 95% CI 2.05–4.32). The joint association of obesity and smoking with all-cause mortality was stronger (HR 3.46, 95% CI 1.87–6.40), but there was no synergistic interaction (Synergy Index 0.9). Non-obese heavy smokers had an elevated cancer mortality (HR 2.94, 95% CI 1.79–4.82). The joint association of obesity and smoking with cancer mortality was stronger (HR 4.57, 95% CI 2.14–9.76) suggesting a synergistic interaction (Synergy Index 1.6, NS). Ex-smokers’ risk of death was not elevated irrespective of their weight status. Conclusions: Smoking increases the risk of death, and obesity strengthens this association. Quitting smoking, especially among obese people, may reduce premature mortality.
      PubDate: 2016-07-28
  • External validation of the Motivation To Stop Scale (MTSS): findings from
           the International Tobacco Control (ITC) Netherlands Survey
    • Authors: Hummel K; Brown J, Willemsen MC, et al.
      Abstract: Background: The Motivation To Stop Scale (MTSS) is a single-item instrument which has been shown to predict quit attempts in the next 6 months in a previous validation study conducted in England. The aim of the current study was to determine the external validity of the MTSS among Dutch smokers in predicting quit attempts in the next 12 months. A secondary aim was to compare the discriminative accuracy of the MTSS with that of a Stages of Change assessment. Methods: We analysed data from three consecutive waves of the International Tobacco Control (ITC) Netherlands Survey (n = 1272). We conducted logistic regression analyses with the baseline score of the MTSS (measured in 2012 or 2013) predicting a quit attempt in the next 12 months (measured in 2013 or 2014). We furthermore compared the area under the Receiver Operating Characteristics (ROCAUC) curves of the MTSS and a Stages of Change measure. Results: A total of 450 smokers (35.4%) made a quit attempt between baseline and 12-month follow-up. The regression analysis showed a positive relationship between scoring on the MTSS and quit attempts (odds ratio = 18.15, 95% confidence interval = 8.12–40.58 for the most vs. least motivated group). The discriminative accuracy of the MTSS (ROCAUC = 0.68) was marginally higher than that of a Stages of Change assessment (ROCAUC = 0.65), but not statistically significant (P = 0.21). Conclusion: The MTSS is an externally valid instrument to predict quit attempts in the next 12 months.
      PubDate: 2016-07-24
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