Burden Of Disease In Europe Research Articles

7.P. Skills building seminar: Using health impact assessment for assessing tobacco control policies

Abstract Tobacco use is the largest contributor to premature death and preventable disease in Europe. Despite decreasing tobacco use in recent years, the European Commission estimates that the number of smokers in Europe is 26% in the population, and 29% among 15-24 year olds. This persistent public health risk is amenable to policy, but targeted and effective strategies are needed. Health impact assessment (HIA) methods can aid decision-makers in exploring the consequences of policy actions on select outcomes, providing a platform for informed, evidence-based policy design. Routine data collection on risk factors including smoking and tobacco use behaviour is common and available in Europe. Analysing and valorising these data can provide a better picture of vulnerable and target groups for which tobacco use is a persistent problem, or where the attributable disease burden is particularly high. These data can form the basis for robust projections and the application of HIA methods. In addition, a number of policy strategies exist for tobacco control including changes in packaging, taxation, labelling, ingredients, creation of smoke-free environments, and restrictions on advertising. These policies have a common goal in improving tobacco control, but may lead to differential effects across age groups, populations, and different measures of tobacco use. It is thus necessary to use robust tools to understand these effects and better coordinate and plan policy. HIA methods, each with their own strengths and limitations, have been applied successfully to estimate the impact of different tobacco control measures. Novel methodologies that make use of available data, computational power, and provide a low-cost way to explore policy interventions can be an essential tool to policy planning and in particular to tackle the intractable areas of tobacco control. This skills building workshop will present two key approaches, each with their own strengths and weaknesses, that have been applied in HIA studies on tobacco control - i.e., a static approach based on the calculation of potential impact fraction, and a dynamic approach based on microsimulation models. Furthermore, the workshop will demonstrate, using two real-life examples, how policy measures can be translated into effect size estimates - which is one of the most crucial steps in any HIA. By providing a step-by-step presentation of how HIA has been applied in practice, attendees will gain unique insights in the different ways by which HIA can be used to gain insights into the relative impact of policy strategies for tobacco control. Key messages • Tobacco use remains the largest contributor to preventable disease burden in Europe; a key area for analysing policies using health impact assessment. • Attendees will gain unique insights in the different ways by which HIA can be used to gain insights into the relative impact of policy strategies for tobacco control.

Balancing barriers and strategies - Nurses' experiences of conducting lifestyle counseling.

Over 70% of the disease burden in Europe is the result of chronic diseases caused by lifestyle. Lifestyle counseling can improve lifestyle habits and thereby health. However, according to research, there are several barriers to healthcare personnel carrying out counseling. The aim of this study was to explore nurses' experiences of conducting lifestyle counseling. A qualitative descriptive study was conducted in southern Sweden between August 2021 and December 2021. Eleven nurses were recruited from both inpatient and outpatient care in northeastern Sweden through a combination of purposive and snowball sampling. Individual semistructured interviews were performed digitally using an interview guide. The interviews were analyzed via qualitative content analysis. The nurses experienced several challenges in performing lifestyle counseling. However, knowledge gaps, sensitive topics, organizational dynamics, and time constraints were balanced using strategies. The theme of their responses can be explained by the following categories: "Collaboration with patients is key," "From self-interest to teamwork," and "The organization can assist or hinder." Lifestyle counseling needs to be prioritized within healthcare. Nurses need tools and knowledge to be able to feel comfortable with the task. All healthcare organizations need to work with lifestyle counseling in a structured way according to national guidelines.

JAPreventNCD

Abstract The EU has approved a proposal for a Joint Action on Cancer and other NCDs prevention - action on health determinants. This is a large and ambitious initiative with more than 20 participating EU member states along with Iceland, Norway, and Ukraine. The aim of the Joint Action is to support strategies and policies designed to reduce the burden of cancer and other non-communicable diseases (NCDs). Cancer and other NCDs constitute a large proportion of the total burden of disease in Europe, and a large part of this disease burden can be prevented. The objectives of this Joint Actions are: • To improve joint capacities of Member states to plan and implement cancer and other NCD prevention policies and activities both at a national, regional, and local level. • To improve data and the monitoring system for cancer and other NCDs and their common risk factors. • To contribute to reduced social inequalities in cancer and other NCDs. • Engage with and support key actors in the field of cancer and NCD prevention, including decision makers at all levels of government, civil society organizations, professionals, the general population, and patients’ groups to facilitate cooperation and joint efforts. As part of the JA Best-ReMaP, we have seen important development regarding tools and methodology related to policies that can influence the food consumed by children. This includes policies related to food reformulation, reduction of food marketing, and public food procurements. While the new JA-PreventNCD will cover NCD prevention more broadly through the various life stages, specific tasks are being planned for that will allow us to build on and expand the valuable work performed as part of the JA Best-ReMaP.

Spatial assessment of the attributable burden of disease due to transportation noise in England

BackgroundNoise pollution from transportation is one of the leading contributors to the environmental disease burden in Europe. We provide a novel assessment of spatial variations of these health impacts within a country, using England as an example. MethodsWe estimated the burden of annoyance (highly annoyed), sleep disturbance (highly sleep disturbed), ischemic heart disease (IHD), stroke, and diabetes attributable to long-term transportation noise exposures in England for the adult population in 2018 down to local authority level (average adult population: 136,000). To derive estimates, we combined literature-informed exposure-response relationships, with population data on noise exposures, disease, and mortalities. Long-term average noise exposures from road, rail and aircraft were sourced from strategic noise mapping, with a lower exposure threshold of 50 dB (decibels) Lden and Lnight. Results40 %, 4.5 % and 4.8 % of adults in England were exposed to road, rail, and aircraft noise exceeding 50 dB Lden. We estimated close to a hundred thousand (∼97,000) disability adjusted life years (DALY) lost due to road-traffic, ∼13,000 from railway, and ∼ 17,000 from aircraft noise. This excludes some noise-outcome pairs as there were too few studies available to provide robust exposure–response estimates. Annoyance and sleep disturbance accounted for the majority of the DALYs, followed by strokes, IHD, and diabetes. London, the South East, and North West regions had the greatest number of road-traffic DALYs lost, while 63 % of all aircraft noise DALYs were found in London. The strategic noise mapping did not include all roads, which may still have significant traffic flows. In sensitivity analyses using modelled noise from all roads in London, the DALYs were 1.1x to 2.2x higher. ConclusionTransportation noise exposures contribute to a significant and unequal environmental disease burden in England. Omitting minor roads from the noise exposure modelling leads to underestimation of the disease burden.

Clean air in Europe for all: A call for more ambitious action.

Clean air in Europe for all: A call for more ambitious action.

Implementing organized colorectal cancer screening programs in Europe—protocol for a systematic review of determinants and strategies

BackgroundWith a high mortality of 12.6% of all cancer cases, colorectal cancer (CRC) accounts for substantial burden of disease in Europe. In the past decade, more and more countries have introduced organized colorectal cancer screening programs, making systematic screening available to entire segments of a population, typically based on routine stool tests and/or colonoscopy. While the effectiveness of organized screening in reducing CRC incidence and mortality has been confirmed, studies continuously report persistent program implementation challenges. This systematic review will synthesize the literature on organized CRC screening programs. Its aim is to understand what is currently known about the barriers and facilitators that influence the implementation of these programs and about the implementation strategies used to navigate these determinants.MethodsA systematic review of primary studies of any research design will be conducted. CENTRAL, CINAHL, EMBASE, International Clinical Trials Registry Platform, MEDLINE, PsycINFO, and Scopus will be searched. Websites of (non-)government health care organizations and websites of organizations affiliated with authors of included studies will be screened for unpublished evaluation reports. Existing organized CRC screening programs will be contacted with a request to share program-specific grey literature. Two researchers will independently screen each publication in two rounds for eligibility. Included studies will focus on adult populations involved in the implementation of organized CRC screening programs and contain information about implementation determinants/ strategies. Publications will be assessed for their risk of bias. Data extraction will include study aim, design, location, setting, sample, methods, and measures; program characteristics; implementation stage, framework, determinants, strategies, and outcomes; and service and other outcome information. Findings will be synthesized narratively using the three stages of thematic synthesis.DiscussionWith its sole focus on the implementation of organized CRC screening programs, this review will help to fill a central knowledge gap in the literature on colorectal cancer screening. Its findings can inform the decision-making in policy and practice needed to prioritize resources for establishing new and maintaining existing programs in the future.Systematic review registrationPROSPERO (CRD42022306580).

Depression and Suicide in Regards to Sex

Psychiatric disorders represent one of the leading problems of the public health community in the modern world today, especially because their incidence is steadily increasing and they are one of the main reasons for the overall disease burden in Europe. One of the most frequently diagnosed, yet under recognized diseases, is depression. Depression, whether a symptom, part of a syndrome or an independent diagnosis, is characterized by feelings of sadness, loss of interest and pleasure in activities that normally bring joy to a person, and can affect how a person feels, thinks and behaves. It affects all age and social groups, as well as both sexes, it is often comorbid with other physical diseases, and increases the risk of developing other physical diseases. There are certain differences between the sexes in the prevalence, the way a certain sex group deals with problems caused by depression, and the possible causes of these differences, which we present in more detail in this paper. Differences are observed in all cultures, environments and across different age groups. Patients suffering from depression have a particularly high risk of committing suicide. Suicide is a psychopathological phenomenon of multifactorial aetiology that is most often associated with psychiatry and mental disorders and is not a diagnosis in itself, but a complication of many psychiatric disorders. here are many differences in the rate of suicide by age and sex, as well as in the method of suicide, which we also present in more detail in this paper.

Noise Disturbance and Well-Being in the North of Spain

Environmental noise is considered one of the main risks for physical and mental health and well-being, with a significant associated burden of disease in Europe. This work aims to explore the main sources of noise exposure at home and its effect on well-being in northern Spain. A transversal opinion study has been performed through a closed questionnaire. The questionnaire included three different parts: sociodemographic data, noise disturbance, and the 5-item World Health Organization Well-Being Index (WHO-5). A Binary Logistics Regression model was performed to analyze the relationship between noise exposure and well-being. Overall, 16.6% of the participants consider that the noise isolation of their homes is bad or very bad. The noise generated by the neighbors (air and impact noise) is considered the most disturbing indoor noise source, while street works are the most disturbing outdoor noise source in urban areas and road traffic is the most disturbing in rural areas. People who indicate that noise interferes with their life at home have a worse score on the WHO-5 (decreased perception of well-being). The exposure to outdoor noise (specifically the noise coming from the street and trains), internal impact noise produced by neighbors, and in general, the noise that wakes you up, is related to receiving a worse score in the WHO-5 (p < 0.05). Administrative bodies must ensure that laws regulating at-home noise levels, which are continually being updated with stricter restrictions, are enforced.

The computer-assisted interview In My Shoes – a successful method to capture children’s perspectives

Abstract Background Child mental health problems are considered the second highest cause of burden of disease in Europe and the Americas. Children’s own opinions and experiences are pivotal in addressing these problems. However, including young children as active informants in health research and practice not only requires a well-trained and highly qualified workforce, but also valid methods that enhance and support children’s self-expression. The aim was to investigate preschool aged children’s experiences in two health and welfare contexts using the interactive computer-assisted interview In My Shoes (IMS). Methods Interviews were conducted using IMS in three studies encompassing 43 children aged 3-6 years old. The setting for the first and second study was Child Health Centres and the third setting was families entering the Triple P group parenting programme. Qualitative content analysis was performed. Results The IMS interview aided preschool aged children to report on the factual, emotional and physical aspects of their experiences within a health care context. In addition, IMS helped young children verbalise unique information on negative interplay within their families, especially experiences of negative parenting including verbal and physical child abuse. The successes with IMS are likely related to the structured and systematic approach, that it is pictorial-based and emotion-focused, as well as the interactive, collaborative and triadic conversation between the child, the interviewer and the computer. Conclusions The interactive computer-assisted interview IMS, is a suitable and valid method for aiding young children to provide unique and extensive information about different aspects of their experiences and lives. We urge professionals and researchers to systematically include the young children’s own perspectives to better tailor and evaluate interventions on all levels to improve children’s health and wellbeing. Key messages • Young children’s own perspectives on their health and wellbeing are pivotal to better tailor and evaluate interventions. • The interactive computer-assisted interview In My Shoes is a suitable and valid method to capture children’s voices.

Country-level determinants of gender differences in major depression and alcohol use disorder

Abstract Background Major depressive disorder (MDD) and alcohol use disorder (AUD) are leading causes of disease burden in Europe, with MDD disproportionately affecting women and AUD being more prevalent among men. However, it is unclear how country-level political and socio-cultural characteristics contribute to gender differences in these conditions. Methods Data for 30,416 participants from 16 countries were obtained from the 2014 European Social Survey. Depressive symptoms were ascertained using the 8-item CES-D scale, and alcohol use was assessed with items on past-year alcohol use frequency and quantity, as well as frequency of heavy episodic drinking. Country-level data for attitudes to gender equality, needs-adjusted public social expenditure, and other covariates came from the 2012 International Social Survey Programme and the OECD. Modified Poisson and linear regression with log link examined additive and multiplicative interactions of country-level characteristics with gender for MDD, AUD, and their specific symptoms/dimensions. Results Public social expenditure was not associated with gender differences in MDD (CES-D&amp;gt;10), but with greater differences in the prevalence of the loneliness and sadness symptoms; support for gender equality was associated with smaller differences in loneliness (p &amp;lt; 0.05). For AUD, there was evidence of increased alcohol use frequency and quantity among women, and decreased frequency and quantity among men associated with support for gender equality, resulting in lower gender differences in predicted probabilities (from 23% to 5% across exposure levels; p &amp;lt; 0.001). Heavy episodic drinking was strongly positively associated with support for gender equality among women (p &amp;lt; 0.001), but not among men. Conclusions Country-level characteristics appear to exert differential impact on the prevalence of AUD and certain psychological symptoms of MDD among men and women in Europe. Pending replication, future research should examine underlying mechanisms. Key messages

Malignant pleural mesothelioma: treatment patterns and humanistic burden of disease in Europe

BackgroundMalignant pleural mesothelioma (MPM) is an aggressive and rare tumour with poor prognosis. Most patients are diagnosed with advanced disease and there is a paucity of data on the humanistic burden of MPM in terms of impact on health-related quality of life (HRQoL) and activity. This study examined real-world treatment patterns and humanistic disease burden of MPM in Europe.MethodsPhysicians abstracted demographic/clinical characteristics and treatment data from MPM-patient medical records; MPM patients self-completed a questionnaire including symptoms, 3-level-EQ-5D questionnaire and Visual Analogue Scale (VAS), Lung Cancer Symptom Scale for Mesothelioma (LCSS-Meso), and Work Productivity and Activity Impairment (WPAI) questionnaire.ResultsPhysicians (n = 171) abstracted data of 1390 patients; 767/1390 patients self-completed questionnaires. Patients were elderly with advanced, unresectable MPM. Treatment patterns followed guidelines with most (81%) patients receiving platinum+antifolate chemotherapy at first line (1 L). Maintenance treatment use was high (51.1%) despite no recommended maintenance therapies. Symptom burden was high and health states and HRQoL were poor at 1; declining further with progression. Overall mean (SD): LCSS-Average Symptom Burden Index score was 48.8 (19.3; n = 758); EQ-5D Utility Index score was 0.510 (0.349; n = 763); EQ-5D VAS score was 54.2 (20.3;n = 766); LCSS-3-Item Global Index score was 143.2 (64.5; n = 762); LCSS-normal activities score was 51.9 (24.6;n = 765); WPAI-activity impairment was 56.0% (23.2%; n = 737).ConclusionThe humanistic burden of MPM is high, despite treatments being prescribed as per available guidance. Treatments that delay progression and provide palliation of symptoms are most likely to improve/maintain HRQoL.

Noise and air pollution during lockdown around a school site in the UK

Noise and air pollutants share many common sources including traffic volume. Noise pollution causes annoyance and disturbs sleep and it is the second risk factor, after air pollution, to the estimated environmental burden of disease in Europe. It can also act as a proxy for some of the air pollutants, to allow building of holistic view of environmental pollution. During the pandemic and the resulting lockdowns in cities across the world, traffic volumes reduced significantly, leading to reduced pollutant concentrations and noise levels. In this work, we present an analysis of the multiple pollutants (e.g., fine particulate matter, nitrogen oxide) and noise data that are monitored continuously during the lockdown at 15-minute resolution at a school site in the UK, which is situated next to a busy road. This talk will present trends of noise and the air pollutants during the lockdown period, explore possible relationship of noise as a proxy for air pollutants; variations between pollutants and the underlining reasons explaining the temporal variations. [This work is supported by Guildford Living Lab and INHALE (EP/T003189/1). We thank the Sandfields Primary school, its governors and the parent group for supporting this work.]

Road traffic noise, mortality and incidence of cardio-cerebrovascular diseases in Rome

Background/Aim: Transportation noise is among the most important environmental exposures contributing to the burden of disease in Europe. The aim of the study is to assess whether long-term exposure to road traffic noise is associated with mortality and incidence of coronary and cerebrovascular events in the Rome Longitudinal Study.Methods: All city residents at October 21 2001, aged 30 years and over, followed up until 31 December 2015. Lden (db(A)) and NO2 (µg/m3) concentrations were estimated at each residential address (Sound Plan 8.1, Lagrangian microscale model). The association between a 10 (db(A)) increase of Lden and non-accidental mortality, incidence of acute coronary events and stroke was assessed using Cox models adjusted for individual variables, including SEP, and NO2 concentrations (HR, CI95%). We also studied the effect of Lden (low ≤48.1 dB(A), medium 48.1-54.4 dB(A), high ≥54.4 db(A)) in three categories of NO2 concentrations (≤34.4 μg/m3, 34.4-39.9 μg/m3, ≥39.9 μg/m3) Results: 1,263,712 residents were enrolled (55% women, mean age (DS) 55 (15.4), 19% low SEP). The average population exposure levels [mean (SD)] were 53.8 (8.1) dB(A) for Lden, and 41.3 (10.1) µg/m3 for NO2 (ρ=0.47). For all the outcomes, after adjustment for NO2 we failed to find a clear association with traffic noise. However, at medium and high NO2 exposure levels we found an effect at all the noise levels considered: at Lden &gt;54.4 db(A) we found an HR=1.05 (IC95% 1.03-1.07) for non-accidental mortality, HR=1.07 (IC95% 1.00-1.14) for fatal acute coronary events and HR=1.05 (IC95% 1.00-1.11) for stroke incidence. Conclusion: We found an independent effect of noise exposure especially at medium and high NO2 levels. Policies to reduce the exposure of residents and prevent harmful effects on their health are urgent.

4566 The Impact of Migration on Viral Hepatitis Prevalence and Elimination Among 30 European Nations: A modeling approach

OBJECTIVES/GOALS: Hepatitis B and C virus causes inflammation of the liver and can lead to cirrhosis, liver failure, and hepatocellular carcinoma. The aim of this study is to generate a modeled estimate of changes in hepatitis B and C prevalence, and future sequelae, that accounts for recent mass migration to the European Union stemming from 50 high-emigration countries. METHODS/STUDY POPULATION: Total migrant population from 2013-2017 was obtained from the Eurostat population database. Demographics including country-of-origin, sex, and age distributions were used to determine migrant contributions to HBV and HCV prevalence where available. Undocumented migration estimates were obtained from the Institute of Migration database. Country-of-origin HBV and HCV prevalences were obtained for the select 50 country-of-origin nations from the Polaris Observatory and from systematic reviews. Disease progression was estimated using HBV and HCV outcome data for total populations from treatment guideline publication from the European Association for the Study of the Liver. RESULTS/ANTICIPATED RESULTS: Between 2013 and 2017, a total of 11,030,786 documented migrants born outside the EU arrived to the 30 nations. Germany, United Kingdom, and Spain received the greatest influx of persons and the majority of migration stemmed from countries in West Asia, the Middle East, and Africa. A significant proportion of total migration was driven by conflict-related crisis in Syria, and East and North Africa. The most significant increases in estimated total hepatitis case numbers, national prevalence increases, and future sequelae were seen in Germany and Sweden. DISCUSSION/SIGNIFICANCE OF IMPACT: Mass migration has significantly changed HBV and HCV disease burden in Europe over the past 5 years. Consequently, long-term outcomes of cirrhosis and HCC are also expected to increase. These increases are likely to disproportionally impact individuals of the migrant and refugee communities. HBV and HCV surveillance and management programs must strategically focus on individuals from high-burden age cohorts and nations. Screening and treatment would aid WHO elimination efforts while benefiting both the vulnerable individuals and host nations through reduction of morbidity, mortality, and associated healthcare expenses.

Incorporating tick feeding behaviour into [formula omitted] for tick-borne pathogens

Tick-borne pathogens pose a considerable disease burden in Europe and North America, where increasing numbers of human cases and the emergence of new tick-borne pathogens has renewed interest in resolving the mechanisms underpinning their geographical distribution and abundance. For Borrelia burgdorferi and tick-borne encephalitis (TBE) virus, transmission of infection from one generation of ticks to another occurs when older nymphal ticks infect younger larval ticks feeding on the same host, either indirectly via systemic infection of the vertebrate host or directly when feeding in close proximity. Here, expressions for the basic reproduction number, R0, and the related tick type-reproduction number, T, are derived that account for the observation that larval and nymphal ticks tend to aggregate on the same minority of hosts, a tick feeding behaviour known as co-aggregation. The pattern of tick blood meals is represented as a directed, acyclic, bipartite contact network, with individual vertebrate hosts having in-degree, kin, and out-degree, kout, that respectively represent cumulative counts of nymphal and larval ticks fed over the lifetime of the host. The in- and out-degree are not independent when co-aggregation occurs such that T∝〈kinkout〉〈kin〉,where 〈.〉 indicates expected value. When systemic infection in the vertebrate host is the dominant transmission route R02=T, whereas when direct transmission between ticks co-feeding on the same host is dominant then R0=T and the effect of co-aggregation on R0 is more pronounced. Simulations of B. burgdorferi and TBE virus transmission on theoretical tick-mouse contact networks revealed that aggregation and co-aggregation have a synergistic effect on R0 and T, that co-aggregation always increases R0 and T, and that aggregation only increases R0 and T when larvae and nymphs also co-aggregate. Co-aggregation has the greatest absolute effect on R0 and T when the mean larval burden of hosts is high, and the largest relative effect on R0 for pathogens sustained by co-feeding transmission, e.g. TBE virus in Europe, compared with those predominantly spread by systemic infection, e.g. B. burgdorferi. For both pathogens, though, co-aggregation increases the mean number of ticks infected per infectious tick, T, and so too the likelihood of pathogen persistence.

Epidemiology and cost of seasonal influenza in Germany - a claims data analysis

BackgroundSeasonal influenza contributes substantially to the burden of communicable diseases in Europe, especially among paediatric populations and the elderly. The aim of the present study was to estimate the incidence of seasonal influenza in Germany, the probabilities of related complications and the economic burden of influenza per case and on a population level for different age groups.MethodsClaims data from 2012 to 2014 from > 8 million insured of a large German sick-ness fund were analysed. A matched case control study was used on a sub-sample of 100,000 influenza cases to calculate complication rates for ear infections/acute otitis media (AOM) and community-acquired pneumonia (CAP) as well as resource use and costs for seven age groups.ResultsIncidence of seasonal influenza varies between the years and is highest among infants and children 2 to 5 years of age. AOM is more likely in the younger age groups with up to 14% more patients in the influenza group than in the control group. CAP is more frequently observed in the younger age groups and in influenza patients 60 years and older. The manifestation of one influenza complication (AOM or CAP) significantly in-creases the occurrence of a second complication (AOM or CAP). The economic burden per case is highest in infants (€251.91) and persons over 60 years of age (€131.59).ConclusionThe burden of influenza is highest among infants and young children, which is also reflected in the economic burden. Influenza related costs per case are nearly double for infants compared to persons over 60 years of age.

Usefulness of New Indicators of Obesity (BAI and VAI) in Estimation of Weight Reduction

Objective: Obesity is responsible for a large proportion of the total burden of diseases in Europe. The aim of this study was to compare classic anthropometric parameters with new obesity-related indices (the visceral adiposity index [VAI] and the body adiposity index [BAI]) and to examine their usefulness in the assessment of weight reduction and its effect on the leptin concentration.Methods: We tested 50 patients with obesity, undergoing the implementation of the BioEnterics® Intragastric Balloon (BIB-system) for 6 months. The leptin concentrations and the calculated subcutaneous fat thickness as well as the anthropometric indices were determined prior to the implementation and after the balloon removal.Results: The therapy resulted in a drop in the BAI value without a significant effect on the VAI in subgroups of patients with class I, II, and III obesity. The therapy-induced changes in BAI both in the entire tested group and in patients with class I and II obesity correlated well with the percentage of drop in body weight, body mass index (BMI), subcutaneous fat thickness, waist-to-height ratio (WHtR), and leptin concentration. Changes in the VAI value correlated with changes in the body weight, BMI, WHtR values, subcutaneous fat thickness, and leptin concentration decrease only in patients with class III obesity.Conclusions: BAI seems to be a better indicator than VAI for reflecting the reduction in body weight in people with class I and II obesity treated with the BIB-System. VAI appears to be a better obesity indicator than BAI only in people with class III obesity.

The evaluation of mental disorders research reported in British and Irish newspapers between 2002 and 2013, and a comparison with the relative disease burdens and with research outputs in the two countries

Mental disorders are a major contributor to the disease burden in Europe. We studied how research on them was communicated to British and Irish newspaper readers through an analysis of stories in the Daily Mail (DML) and The Guardian (GDN) in the UK and the Irish Times (IET) in Ireland, in 2002–13, and whether the coverage reflected the relative burdens of mental disorders, or the amount of research, in the two countries. The cited papers were identified through the newspapers’ archive or the Factiva database, and their details and those of the research they cited from the Web of Science, with 1,128 stories in total. Alzheimer’s and other dementias was the leading UK press research topic, but depression was for Ireland. The countries whose research was most cited were the United States, followed by Canada and Europe, notably the UK and Ireland in their respective newspapers. Over 68% of the Irish research papers cited by IET were supported by the state, compared with only 38% of all Irish mental disorders research. The UK newspapers had many stories on lifestyle factors (DML) or drug treatments (GDN); IET gave more space to epidemiology. The UK papers gave little attention to non-drug treatments. Many stories quoted commentators, who in the UK were often charities, but the IET tended to use academics.

Rotavirus: Genetics, pathogenesis and vaccine advances.

Since its discovery 40years ago, rotavirus (RV) is considered to be a major cause of infant and childhood morbidity and mortality particularly in developing countries. Nearly every child in the world under 5years of age is at the risk of RV infection. It is estimated that 90% of RV-associated mortalities occur in developing countries of Africa and Asia. Two live oral vaccines, RotaTeq (RV5, Merck) and Rotarix (RV1, GlaxoSmithKline) have been successfully deployed to scale down the disease burden in Europe and America, but they are less effective in Africa and Asia. In April 2009, the World Health Organization recommended the inclusion of RV vaccination in national immunization programs of all countries with great emphasis in developing countries. To date, 86 countries have included RV vaccines into their national immunization programs including 41 Global Alliance for Vaccines and Immunization eligible countries. The predominant RV genotypes circulating all over the world are G1P[8], G2P[4], G3P[8], G4P[8], and G9P[8], while G12[P6] and G12[P8] are emerging genotypes. On account of the segmented genome, RV shows an enormous genetic diversity that leads to the evolution of new genotypes that can influence the efficacy of current vaccines. The current need is for a global RV surveillance program to monitor the prevalence and antigenic variability of new genotypes to formulate future vaccine development planning. In this review, we will summarize the previous and recent insights into RV structure, classification, and epidemiology and current status of RV vaccination around the globe and will also cover the status of RV research and vaccine policy in Pakistan.

What Persons with Chronic Health Conditions Need to Maintain or Return to Work-Results of an Online-Survey in Seven European Countries.

Chronic health conditions represent the major share of the disease burden in Europe and have a significant impact on work. This study aims to: (1) identify factors that have a negative or positive impact on the work lives of persons with chronic health conditions; (2) explore the needs of these persons to maintain a job or return to work and (3) compare these results with respect to these persons’ occupational status. An online survey was performed in seven European countries. Open-ended survey questions were analyzed using qualitative methods. In total, 487 participants with six chronic health conditions participated. The majority of participants named work-related aspects (such as career development, stress at the workplace, work structure and schedule as well as workload), support of others and attitudes of others as being the factors positively and negatively impact their work lives the most. Our study shed light on the importance of changing the attitudes of supervisors and co-workers to counteract stigmatization of persons with chronic health conditions in the workplace. In conclusion, this study provides a basis for developing new strategies of integration and reintegration at work for persons with chronic health conditions in European countries.