23.05.2013

Rosano, A., Loha, C. A., Falvo, R., van der Zee, J., Ricciar...

Background: Avoidable hospitalization (AH) has been widely studied as a possible measure of the performance of primary health care (PHC). However, studies examining the relationship between the efficiency and quality of PHC and AH have found mixed results. Our study aims at highlighting those factors related to the relationship between AH and accessibility to PHC in different countries. Methods: We conducted a systematic search for peer-reviewed studies published between 1990 and October 2010 in English, German, French, Italian or Spanish and indexed primary electronic databases. Results: The final analysis was conducted on the basis of 51 papers. Of them, 72.5% revealed a significant inverse association between the indicator of PHC accessibility and rates of AH. Indicators of PHC calculated at individual level are more likely to reveal contradictory aspects of the relationship between rates of AH and indicators of quality and PHC accessibility. Conclusions: Most studies confirmed the expected relationship between indicators of PHC accessibility and hospitalization for ambulatory care sensitive conditions (ACSCs), showing lower hospitalization rates for ACSC in areas with greater access to PHC. The findings support the use of ACSC hospitalization as an indicator of primary care quality, with the precaution of applying appropriate adjustment factors.

23.05.2013

McCarthy, M.

The structural funds are used to promote economic development as part of European Union Cohesion Policy. Previously the main beneficiary countries were in southern Europe and on the periphery. For 2007–13, the funds are being increased, and directed towards the EU’s new Member States. The Commission has been working with national health ministries, and regions, to develop expertise in applications and implementation. Fields suitable in the next phase, from 2014 onwards, include social and health care for elderly people and public health research systems. Public health practitioners and academics have relevant skills and advice to provide.

23.05.2013

Draper, A. K., Adamson, A. J., Clegg, S., Malam, S., Rigg, M...

Background: Nutrition labels are a potentially valuable tool to assist consumers in making healthy food choices. Front-of-pack labels are a relatively new format and are now widely used across many European countries, but it is unclear which of the many formats in use are best understood by consumers. It is also unclear whether the existence of multiple formats impedes understanding and use. This article addresses this question with findings from a study commissioned by the UK Food Standards Agency to provide evidence to inform policy decisions in this area. Methods: In-depth qualitative interviews were used to explore consumers’ decision-making processes when using two different front-of-pack label formats to judge the relative healthiness of a pair of products. Participants were presented with product pairs differently labelled and a series of structured prompts were used to access their internal dialogues and to identify any difficulties encountered. Results: The interviews revealed that making product comparisons using different label formats was challenging for participants and particularly for those product pairs where there was not an obvious answer. When the label formats on the product pairs lacked a common element, such as text, this also caused difficulties and misinterpretation. The comparisons also took time and effort that would be a deterrent in real-life situations. Conclusions: These findings indicate that the existence of multiple front-of-pack label formats in the marketplace may impede consumer comprehension and discourage use. They suggest that a single format may encourage consumers to use front-of-pack labels in making healthy food choices.

23.05.2013

Rugulies, R., Aust, B., Madsen, I. E. H., Burr, H., Siegrist...

Background: Depression is a major concern for public health. Both adverse working conditions and low socio-economic position are suspected to increase risk of depression. In a representative sample of the Danish workforce we investigated (i) whether adverse psychosocial working conditions, defined by the effort–reward imbalance (ERI) model, predicted onset of severe depressive symptoms after 5-year follow-up and (ii) whether the effect of ERI was differential across occupational grades. Methods: A cohort of 2701 Danish employees filled in a questionnaire on work and health in 2000 and 2005. ERI was measured with four effort and seven reward items. Depressive symptoms were assessed with the five-item Mental Health Inventory. Participants scoring ≤52 points were defined as cases. We used logistic regression to investigate the association of ERI and occupational grade in 2000 with onset of severe depressive symptoms in 2005. Analyses were adjusted for socio-demographics, health behaviours, survey method, self-rated health, sleep disturbances and non-severe depressive symptoms at baseline. Results: High ERI predicted onset of severe depressive symptoms at follow-up, after adjustment for co-variates and occupational grade (OR = 2.19, 95% CI = 1.12–4.25). Participants with high ERI and low occupational grade showed a considerably higher OR (2.43, 95% CI = 1.07–5.53) compared to participants with low/medium ERI and low grade (OR = 1.45, 95% CI = 0.72–2.92), high ERI and high grade (OR = 1.26, 95% CI = 0.59–2.70) and low/medium ERI and high grade (reference group). Conclusion: Adverse psychosocial working conditions predicted onset of severe depressive symptoms. The effect was stronger among employees of lower occupational grades compared to those of higher grades.

23.05.2013

Maindal, H. T., Toft, U., Lauritzen, T., Sandbaek, A.

Background: Healthy diet is a core component in prevention and self-management of type 2 diabetes and cardiovascular disease. The long-term efficacy was assessed of a theory-based health education programme ‘Ready to Act’ on dietary quality in people with screen-detected dysglycaemia. Methods: Five hundred and nine adults with prediabetes (impaired glucose tolerance, impaired fasting glycaemia) or type 2 diabetes were recruited through screening for type 2 diabetes [the ADDITION (Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care) study, DK] and then randomly assigned to health education or to a control group (I = 322; C = 187). The intervention group was offered a 12-week programme in health-related action competence including 2 one-to-one and 8 group sessions (18 h). Dietary quality was measured by the Dietary Quality Score_revised (0–8 points) at baseline and at one- and 3-year follow-up. Changes were analysed by multilevel analyses. Results: The analysis included data from 444 participants (87%). At the 3-year follow-up, the intervention group had significantly increased dietary quality compared with the control group (net change: 0.39 Dietary Quality Score_revised points, P = 0.04). The intake of unsaturated fats used on bread and for cooking increased in the intervention group compared with the control group at the 3-year follow-up (net change: 31 g/week; P = 0.02). A non-significant tendency toward an increased intake of vegetables in the intervention group compared with the control group was seen (net change: 111 g/week; P = 0.16). No changes were seen in fish intake. Conclusions: Health education aiming at action competence improved the long-term dietary quality in a population with dysglycaemia, especially according to the intake of unsaturated fat. The ADDITION trial was registered at ClinicalTrials.gov ID no NCT00237549.

23.05.2013

Paget, D. Z., Ricciardi, W., Paget, D. Z., Jakab, Z., Giraud...

23.05.2013

Quigg, Z., Hughes, K., Bellis, M. A.

We explore the impact of the 2010 World Cup, held in South Africa, on levels of assault attendances to 15 emergency departments in England. The majority (70.1%) of assault attendees during the 2010 World Cup was male and aged 18–34 years (52.5%). Assault attendances increased by 37.5% on the days that England played (P < 0.01). Preparation for major sporting events in non-host countries should include violence prevention activity. Emergency department data can be used to identify violence associated with such events and thus inform both the targeting of prevention efforts and assessments of their effectiveness.

23.05.2013

Lazarevik, V., Spasovski, M., Donev, D.