World Health Organization Collaborative Study Research Articles

Oral hygiene predicts lower life satisfaction and subjective health: experience of post-Soviet countries

Oral diseases are among the most common non-communicable diseases around the globe and become a public health challenge that considerably impact general health and well-being in all ages across the lifespan. Oral health is an integral part of general health, where poor oral health and other lifestyle-related chronic diseases have a common risk factor background. The underlying causes of oral health inequalities are often complex and related to country-specific historical, economic, cultural, social, or political factors. For more than a decade, data from the Health Behavior in School-aged Children (HBSC) survey showed that tooth brushing rates are very low in post-Soviet countries. The general aim of our study was to focus on a more detailed profile of schoolchildren from post-Soviet countries, who have poor habits of teeth brushing, in terms of their family, social support, physical activity, nutrition, and other health-related behaviors. Data for this study was extrapolated from the Health Behavior in School-aged Children study, a World Health Organization collaborative cross-national study, conducted every 4 years since 1983/1984. For this study, the post-Soviet countries from Eastern Europe and Central Asia were selected: Armenia, Azerbaijan, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Lithuania, Latvia, Moldova, Tajikistan, Ukraine, and Uzbekistan. Data from all countries (some exceptions for Kyrgyzstan, Tajikistan, and Uzbekistan) were collected within 2017–2018 HBSC study, following international research protocol. The sample consisted of 44,760 schoolchildren, aged 11, 13, and 15 years from 12 countries. Irregular tooth brushing is more common among boys, elder adolescents, and schoolchildren from less affluent families. Low own health measures, low life satisfaction, low physical activity, and low FAS relate to poorer adolescent dental hygiene in post-Soviet countries. Adolescents characterized by irregular tooth brushing were more likely to assess their health as fair or poor rather than excellent or good (OR = 1.22), and also had greater odds of reporting low life satisfaction (OR = 1.36). Individual mental health complaints—feeling low, being irritable, being nervous, and having sleep difficulties—were assessed as a possible outcome of irregular tooth brushing. However, irregular tooth brushing was not associated with poorer mental health outcomes (p > 0.05). Conclusions: Oral hygiene in post-Soviet countries is still a major public health challenge and have to be addressed properly.What is Known:• Oral health strongly affects the overall health of children and adolescents in the future.• Oral diseases often share common determinants and risk factors with other chronic diseases.• The underlying causes of oral health inequalities are often complex and related to country-specific historical, economic, cultural, social, or political factors.What is New:• Irregular tooth brushing was more common among adolescents with low life satisfaction and poor or fair health as well as in less affluent families.• Irregular tooth brushing was not found to be associated with poorer mental health among post-Soviet countries adolescents.

Encouraging greater empowerment for adolescents in consent procedures in social science research and policy projects.

The United Nations Convention on the Rights of the Child emphasizes the importance of allowing children and adolescents to influence decisions that are important to them following their age and maturity. This paper explores the principles, practices, and implications around using parental versus child/adolescent consent when participating in social science research and policy development. Experiences from two studies are presented: The Confronting Obesity: Co-creating policy with youth (CO-CREATE) and the Health Behaviour in School-aged Children (HBSC) study, a World Health Organization (WHO) Collaborative Cross-National study. Although parental consent may be an important gatekeeper for protecting children and adolescents from potentially harmful research participation, it may also be considered an obstacle to the empowerment of children and adolescents in case they want to share their views and experiences directly. This paper argues that evaluation of possible harm should be left to ethics committees and that, if no harm related to the research participation processes is identified and the project has a clear perspective on collaborating with the target group, adolescents from the age of 12 years should be granted the legal capacity to give consent to participate in the research project. Collaboration with adolescents in the development of the research project is encouraged.

Migrant Differences in Adolescents’ Medicine Use for Common Health Problems: A National Representative Survey

Aim: Despite the substantial proportion of adolescents use medicine for common health problems, prevalence of medicine use among adolescents with migrant background have rarely been documented, and the causal pathway continue to be poorly understood. The aim was to examine whether there are migrant differences in adolescents’ medicine use for common health problems, and if feeling safe at school, as a non-exposure to discrimination, explained these differences. Methods: Data derived from the 2006 Danish contribution to the World Health Organization collaborative study Health Behaviour in School-aged Children (HBSC). Medicine use for headache, stomach-ache, difficulties getting to sleep and nervousness and feeling safe at school were self-reported. The population included boys and girls from ages 11 to 15 who were enrolled in the cross-sectional study. Included were 8480 ethnic Danes, 508 descendants and 456 migrants. Logistic regression was applied to assess associations. Multi-level logistic regression was used to assess the independent effect of school cluster. Results: Immigrant girls reported the highest past-month prevalence of medicine use for the four ailments included in the analysis. The highest prevalence of medicine use was found for alleviating headache (54.7%), followed by stomach-ache (30.4%). Among the boys who took medicine for stomach-ache, the odds were 2.11 (1.46-3.05) for descendants and 1.55 (1.00-2.39) for immigrants. Feeling safe at school modifies the effect by reducing the odds to 1.93 (1.32-2.81) for descendants and to 1.30 (0.81-2.07) for immigrants. When simultaneously controlling for the clustering effect of school, feeling safe at school and specific symptoms, the risk of using medicine for stomach-ache was still higher for descendant boys 1.90 (1.26-2.85). Conclusions: Self-reported medicine use for common health problems is high among adolescents with migrant background, particularly among first generations immigrant girls. Feeling safe at school partially mediated the association between migrant background and adolescent’s medicine use. As the process of migration is becoming more and more frequent, our findings suggest that more adolescents may be using medicines for reasons that cannot only be explained by frequency of symptoms alone.

Cyberbullying and Bullying: Impact on Psychological Symptoms and Well-Being

Related, but with different impacts on psychological symptoms and well-being, bullying and cyberbullying have been the subject of numerous studies. The present study analysed the associations between cyberbullying and bullying, specifically: 1) gender, school grade and age associations with cyberbullying and bullying; 2) the impact of cyberbullying and bullying on psychological, social and contextual symptoms and well-being according to cyberbullying involvement, and 3) a combined bullying context was compared to single bullying contexts and to non-involvement for psychological, social and contextual factors, and well-being, among a cross-sectional and randomly assigned sample based on the 2014 Health Behaviour in School-aged Children Portuguese Study, a World Health Organization collaborative study (HBSC/ WHO). Composed by 6026 adolescents (47.7% male), aged between 10 and 19.92 years old (M = 13.77; SD = 1.68), in the 6th, 8th, and 10th grades, results showed that 10.9% of the participants reported being involved in cyberbullying, as cybervictims, cyberbullies or cyberbully-victims, and 47.9% in bullying. Most of the cybervictims reported being involved as victims and bully-victims in bullying; cyberbullies as bully-victims in bullying, and most of the cyberbully-victims reported having the same role in bullying. Frequently, cybervictims were females and most of the cyberbullies and cyberbully-victims were males. No significant associations were found for age and for Body Mass Index. Comparisons between groups, based on the participants’ role in cyberbullying, showed significant differences for substances use, emotional symptoms, school context, fights and friends. Further comparisons (according to participant’s role, not involved, or involved in single or combined bullying) evidenced the cumulative effect of combined bullying. In conclusion, given the different characteristics and impact of cyberbullying on cybervictims, cyberbullies and cyberbully-victims, is crucial to consider the interrelations between the groups and focus on a more engaging perspective, based on an ecological intervention model. Results will be discussed from a public policy perspective.

Differential associations of health literacy with Austrian adolescents’ tobacco and alcohol use

ObjectivesTobacco use and alcohol use have their origin in adolescence, and risky use of these substances is amongst the leading preventable causes of morbidity and mortality. Health literacy (HL) encompasses the skills that are decisive to make appropriate health decisions in this context. Given the paucity of evidence on the link between HL and adolescents' health behaviors, the present study examined overall HL and different components of HL and their associations with smoking and alcohol use among 13 to 17-year-old Austrian students. Study designData were obtained from a national survey carried out in Austria (N = 4219; 56% females) as part of the Health Behaviour in School-aged Children: World Health Organization (WHO) collaborative cross-national study. MethodsWe tested two structural equation models, one including the overall HL scale as the predictor and one with the three subscales of HL ‘finding,’ ‘understanding and appraising,’ and ‘applying’ health-related information as predictors of smoking and alcohol use. ResultsAlthough overall HL was related to all indicators of adolescents' smoking and drinking, the three HL components had differential effects on these behaviors. The easier it was for the participants to ‘understand and appraise’ and ‘apply’ health-related information, the less frequently they had smoked and drunk alcohol and the less was the amount of alcohol they had consumed. Contrarily, the easier it was for the participants to ‘find’ information, the more they had smoked and drunk alcohol. ConclusionsOur results indicate that availability of health-related information may be insufficient on its own to prevent or reduce risky substance use. This is of particular importance for the development and improvement of primary prevention programs targeting adolescent populations.

Hepatitis E Virus (HEV) Detection and Quantification by a Real-Time Reverse Transcription-PCR Assay Calibrated to the World Health Organization Standard for HEV RNA

Hepatitis E virus (HEV) has emerged as a cause of chronic hepatitis among immunocompromised patients. Molecular assays have become important tools for the diagnosis and management of these chronically infected patients. A real-time reverse transcription-quantitative PCR (RT-qPCR) assay utilizing Pleiades probe chemistry and an RNA internal control for the simultaneous detection and quantification of HEV RNA in human serum was developed based on an adaptation of a previously described and broadly reactive primer set targeting the overlapping open reading frame 2/3 (ORF2/3) nucleotide sequence of HEV. A chimeric bovine viral diarrhea virus construct containing an HEV RNA insert (SynTura HEV) was developed, value assigned with the first World Health Organization (WHO) international standard for HEV RNA (code 6329/10), and used to prepare working assay calibrators and controls, which supported an assay quantification range of 100 to 5,000,000 IU/ml. The analytical sensitivity (95% detection rate) of this assay was 25.2 IU/ml (95% confidence interval [CI], 19.2 to 44.1 IU/ml). The assay successfully amplified 16 different HEV sequences with significant nucleotide mismatching in primer/probe binding regions, while evaluation of a WHO international reference panel for HEV genotypes (code 8578/13) showed viral load results falling within the result ranges generated by WHO collaborative study participants for all panel members (genotypes 1 to 4). Broadly reactive RT-qPCR primers targeting HEV ORF2/3 were successfully adapted for use in an assay based on Pleiades probe chemistry. The availability of secondary standards calibrated to the WHO HEV international standard can improve the standardization and performance of assays for the detection and quantification of HEV RNA.

Comparative Study of the Impact of Intoxication on Injuries in China and Korea

ObjectivesAlcohol misuse has been widely studied as a substantial contributor to injured patients' visits to emergency departments. The current research studied differences in alcohol-related injury variables in China and Korea. MethodsData were collected from a sample of 4,509 patients (2,862 males and 1,667 females) reporting at emergency departments in China and Korea using the World Health Organization collaborative study on alcohol and injuries protocol. ResultsMore injuries were reported by men, young people aged 25–34 years, employed individuals, and persons who had at least a high-school education. The proportion of injury cases among intoxicated patients was 14% for Chinese and 20% for Koreans. The odds of intentional injuries to intoxicated patients increased significantly when the perpetrator had been drinking, especially for severely intoxicated victims in both countries. The odds of injuries for intoxicated persons in both countries were high during sports and leisure activities; odds ratio (OR) = 3.93, 95% confidence interval (CI) = 2.76–5.59 for Chinese and OR = 10.97, 95% CI = 6.06–19.85 for Koreans. ConclusionThese findings are a contribution to research in the two Asian countries about the effect of intoxication on injuries especially when both victim and perpetrator are intoxicated.

Violence and non-violence-related injuries and alcohol in women from developed and developing countries: A multi-site emergency room study

This study sought to analyze the association between alcohol consumption and the occurrence of injuries in women attending the emergency room (ER) from developing and developed countries. The sample consisted of ER data from women in 15 countries that were collected as part of two multi-site studies using similar methodologies: the Emergency Room Collaborative Alcohol Analysis Project (ERCAAP), and World Health Organization Collaborative Study on Alcohol and Injuries (WHO Study). Women ranged in age from 18 to 98years. Those from developed countries had higher levels of education (43% completed high-school) than women from developing countries (37%). Over half of the women from developing countries reported they had not consumed alcohol in the last 12months (abstentious), while 2% reported drinking every day. In addition, current drinking women from developing countries reported more binge drinking episodes (33% reported 5 to 11 drinks and 15% reported 12 or more drinks on an occasion) compared to those from developed countries (28% and 11%, respectively). Violence-related injury was more prevalent in developing countries (18%) compared to developed countries (9%). An association between injury and the frequency of alcohol consumption in the last 12months was observed in both developing and developed countries. Although women from developing countries who suffered violence-related injuries were more likely to demonstrate alcohol abstinence or have lower rates of daily alcohol consumption, these women drank in a more dangerous way, and violence-related injuries were more likely to occur in these women than in those living in developed countries.

World Health Organization collaborative study to calibrate the 3rd International Standard for Hepatitis C virus RNA nucleic acid amplification technology (NAT)‐based assays

A collaborative study was undertaken to evaluate a replacement World Health Organization International Standard for hepatitis C virus (HCV) RNA for nucleic acid amplification technology (NAT)-based assays. The candidate preparations were calibrated in International Units (IUs). Three new candidate preparations were produced from a single bulk containing anti-HCV-negative, genotype 1a HCV RNA-positive plasma. Two samples were lyophilized (coded Sample 2 and Sample 3), whilst a third (Sample 4) contained liquid/frozen material. The samples were distributed together with the 2(nd) International Standard (Sample 1, NIBSC code 96/798) for evaluation by thirty-three laboratories, from fourteen countries. The panel of samples were assayed on four separate occasions. Stability studies were performed for the lyophilized samples by accelerated thermal degradation. Participants returned data from a wide range of commercial and in-house quantitative and qualitative assays. Twenty-five data sets were returned for quantitative assays and fourteen for qualitative assays. Excellent agreement was observed between laboratories and assay methods. The mean relative potencies of Samples 2-4 were 5·19, 5·41 and 5·70 log(10) IU/ml, respectively, when compared against the 2(nd) International Standard. Samples 2 and 3 demonstrated stability of a similar order to the previous standards. Based upon the results of the collaborative study, Sample 2 (code number 06/100) was established as the 3rd International Standard for HCV RNA with an assigned unitage of 5·19 log(10) IU/ml. Each vial contains the equivalent of 0·5 ml of material; each vial contains 4·89 log(10) IU of HCV RNA.

Alcohol: Crossroads Between Nursing Research and Psychiatric Nursing Practice

This special issue of the Journal of the American Psychiatric Nurses Association highlights research related to alcohol use and abuse and the associated adverse social, behavioral, economic, and health outcomes. Alcohol is the most commonly abused substance. The lifetime prevalence rate for alcohol use disorder is considerably higher among persons with psychiatric disorders than among persons in the general U.S. population. As such, alcohol is a topic of great concern to psychiatric nurses. In this issue, Goldstein and colleagues examined rates and types of additional psychiatric disorders among persons who had posttraumatic stress disorder (PTSD) plus antisocial personality disorder (ASPD), adult-onset antisocial behavior syndrome, or no antisocial behavior. The data for this article were drawn from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Goldstein and colleagues note that because persons with antisocial syndromes (ASPD or adult-onset antisocial behavior) had higher odds of alcohol use disorders and other psychiatric disorders compared with those with no antisocial behavior, nurses need to carefully assess persons with PTSD for co-occurring antisocial behavior and other comorbid conditions. In the article titled “Alcohol and Violence-Related Injuries Among Emergency Room Patients in an International Perspective,” Cherpitel and Ye present data substantiating the global and strong relationship between recent alcohol consumption and violence-related injuries among emergency room patients. In this article, data are reported from 15 countries comprising the Emergency Room Collaboration Alcohol Analysis Project and the World Health Organization Collaborative Study on Alcohol and Injury. The magnitude of the relative risk for alcohol drinking associated violence-related injuries varied among countries. However, the relative risk for violencerelated injury because of drinking prior to the emergency room admission was more than five times greater than risk for injuries because of other causes. These data suggest an urgent need for global educational programs to raise awareness about the strong relationship between alcohol and violence-related injuries. In a relatively new APNA initiative, Buccola, Rosedale, and Bryan wrote a “Clinical Translation” of Cherpitel and Ye’s research article. They clearly articulate that nurses bring a specialized skill set of screening, brief interventions, motivational interviewing, and crisis intervention that can help patients recognize the risks associated with alcohol use/abuse. They also highlight the role of nurses in caring for the “whole patient.” In the article titled “Early Drinking and Its Association With Adolescents’ Participation in Risky Behaviors,” Calvert and colleagues conducted a secondary data analysis using data from the first wave of the Missouri Family Study, which is an ongoing prospective community-based family study designed to examine familial influences on health compromising behaviors among adolescent offspring. Cigarette smoking and marijuana use were significantly more common among early onset drinkers (age 12 or younger) compared with later-onset drinkers. Early drinking was also associated with other adverse health behaviors including disordered eating behavior, having sex, having multiple sex partners, and having sex without a condom. These findings continue to support the need for practitioners to screen for alcohol use as well as the use of other drugs such as marijuana and tobacco among adolescents. These data also support routine screening for other adverse health behaviors. Alcohol dependence among women and alcohol use among girls are areas of growing concern. Corte, Rongmuang, and Stein review the nursing empirical literature on alcohol and women’s health published over the past 5 years. They summarize findings related to (a) determinants of alcohol use and alcohol problems; (b) patterns of use, assessment of alcohol use, and comorbidity; (c) consequences of alcohol use; and (d) the effects of treatment or specific interventions. They also propose a research agenda for nursing that addresses the most pressing issues related to alcohol use and alcohol problems in women. As can be seen in the articles in this special issue, psychiatric nurses have a particularly important role in identifying persons at risk across the lifespan, caring for persons who have alcohol use disorders and their families, educating nurses and other health care providers, and collaborating in or conducting alcohol-related nursing research.

The Relationship Between Self‐Reported Drinking and BAC Level in Emergency Room Injury Cases: Is it a Straight Line?

While the validity of self-reported consumption based on blood alcohol concentration (BAC) has been found to be high in emergency room (ER) samples, little research exists on the estimated number of drinks consumed given a BAC level. Such data would be useful in establishing a dose-response relationship between drinking and risk (e.g., of injury) in those studies for which the number of drinks consumed is not available but BAC is. Several methods were used to estimate the number of drinks consumed in the 6 hours prior to injury based on BAC obtained at the time of ER admission of n = 1,953 patients who self-reported any drinking 6 hours prior to their injury and who arrived to the ER within 6 hours of the event, from the merged Emergency Room Collaborative Alcohol Analysis Project (ERCAAP) and the World Health Organization Collaborative Study on Alcohol and Injury across 16 countries. The relationship between self-reported consumption and averaged BAC within each consumption level appeared to be fairly linear up to about 7 drinks and a BAC of approximately 100 mg/dl. Above about 7 reported drinks, BAC appeared to have no relationship with drinking, possibly representing longer consumption periods than only the 6 hours before injury for those reporting higher quantities consumed. Both the volume estimate from the bivariate BAC to self-report relationship as well as from a Widmark calculation using BAC and time from last drink to arrival to the ER indicated a somewhat weak relationship to actual number of self-reported drinks. Future studies may benefit from investigating the factors suspected to be driving the weak relationships between these measures, including the actual time over which the reported alcohol was consumed and pattern of drinking over the consumption period.

Establishment of the 1st World Health Organization international standards for human papillomavirus type 16 DNA and type 18 DNA

A World Health Organization collaborative study was conducted to evaluate candidate international standards for human papillomavirus (HPV) Type 16 DNA (NIBSC code 06/202) and HPV Type 18 DNA (NIBSC code 06/206) for use in the amplification and detection steps of nucleic acid-based assays. The freeze-dried candidate international standards were prepared from bulk preparations of cloned plasmid containing full-length HPV-16 or HPV-18 genomic DNA. Nineteen laboratories from 13 countries participated in the study using a variety of commercial and in-house quantitative and qualitative assays. The data presented here indicate that, upon freeze-drying, there is no significant loss in potency for the candidate HPV-18 DNA and a slight loss in potency for the candidate HPV-16 DNA; although this is likely not scientifically relevant when assay precision is considered. In general, the individual laboratory mean estimates for each study sample were grouped +/- approximately 2 log(10) around the theoretical HPV DNA concentration of the reconstituted ampoule (1 x 10(7) HPV genome equivalents/mL). The agreement between laboratories is improved when potencies are made relative to the candidate international standards, demonstrating their utility in harmonizing amplification and detection steps of HPV-16 and -18 DNA assays. Degradation studies indicate that the candidate international standards are extremely stable and suitable for long-term use. Based on these findings, the candidate standards were established as the 1st WHO international standards for HPV-16 DNA and HPV-18 DNA, each with a potency of 5 x 10(6) international units (IU) per ampoule or 1 x 10(7) IU mL(-1) when reconstituted as directed.

The contribution of club participation to adolescent health: evidence from six countries

Background:Social networks have been recognised as an important factor for enhancing the health of people and communities. Bridging social capital, characterised by numerous and varied weak ties, exemplifies a particular...

Facteurs personnels et facteurs sociaux associés à la perception de santé et à la perception de bonheur dans une population adolescente non clinique

A theoretical conceptualization of the relationship between health and happiness and associated factors was studied using a structural equation model. Data from the Portuguese part of a World Health Organization collaborative study, health behavior in school-aged children [Currie C, Smith R, Boyce W, et al. HBSC, a WHO cross national study: Research protocol for the 2001/2002 survey. Copenhagen: WHO; 2001], were used. A representative national sample (N=6131) of 11-, 13- and 15-year-old pupils was studied [Matos M.G., Equipa do Projecto Aventura Social. A saúde dos adolescentes portugueses: Quatro anos depois (La santé des adolescents portugais : quatre ans après). Lisboa: Edições FMH; 2003] and data were analyzed for the purpose of this paper. Results showed a significant positive correlation between perception of health and perception of happiness. A group of personal and social factors was associated with this correlation. Results demonstrated that personal factors had more impact on health perception, and social factors had more impact on happiness perception. Adjustment fit indexes were good. Socioeconomic status (SES) was significantly associated with a positive health perception, and SES was also significantly but modestly associated with the perception of happiness. Results highlighted the importance of a holistic and positive approach to adolescent health. This study confirmed the importance of family, peer relationship and positive evaluation of the school on adolescents' health and well-being. Results may suggest that preventive interventions in school settings should target both personal factors (e.g., promoting social competence) and social factors (e.g., promoting social support and acceptance). Interventions should also target physical and mental health in order to help adolescents to cope with the daily challenges they meet.

Establishment of the 1st World Health Organization International Standard for Plasmodium falciparum DNA for nucleic acid amplification technique (NAT)-based assays

BackgroundIn order to harmonize results for the detection and quantification of Plasmodium falciparum DNA by nucleic acid amplification technique (NAT)-based assays, a World Health Organization (WHO) collaborative study was performed, evaluating a series of candidate standard preparations.MethodsFourteen laboratories from 10 different countries participated in the collaborative study. Four candidate preparations based upon blood samples parasitaemic for P. falciparum were evaluated in the study. Sample AA was lyophilized, whilst samples BB, CC and DD were liquid/frozen preparations. The candidate standards were tested by each laboratory at a range of dilutions in four independent assays, using both qualitative and quantitative NAT-based assays. The results were collated and analysed statistically.ResultsTwenty sets of data were returned from the participating laboratories and used to determine the mean P. falciparum DNA content for each sample. The mean log10 "equivalents"/ml were 8.51 for sample AA, 8.45 for sample BB, 8.35 for sample CC, and 5.51 for sample DD. The freeze-dried preparation AA, was examined by accelerated thermal degradation studies and found to be highly stable.ConclusionOn the basis of the collaborative study, the freeze-dried material, AA (NIBSC code No. 04/176) was established as the 1st WHO International Standard for P. falciparum DNA NAT-based assays and has been assigned a potency of 109 International Units (IU) per ml. Each vial contains 5 × 108 IU, equivalent to 0.5 ml of material after reconstitution.

Gender Differences in the Relationship Between Alcohol and Violent Injury: An Analysis of Cross-National Emergency Department Data

The objectives of the present study were twofold: (1) to determine whether gender differences exist in the roles of drinking in the event (i.e., self-reported drinking before the injury and estimated blood alcohol concentration [BAC] captured after injury) and drinking pattern (i.e., heavy episodic drinking) in explaining violent versus nonviolent injuries and (2) to assess whether these gender differences vary by country. Emergency department data were analyzed from 30 hospitals in 15 countries, as part of the Emergency Room Collaborative Alcohol Analysis Project and the World Health Organization Collaborative Study of Alcohol and Injuries. Interaction effects between gender and alcohol were tested in the prediction of violent versus nonviolent injury for each country. The bivariate analyses revealed significantly larger effects of drinking-in-the-event variables for men than for women in three countries (i.e., 6 hours before the injury in Argentina and having a positive BAC in Belarus and Spain). In the multivariate analyses, restricted to countries with sufficient sample sizes (i.e., Mexico, South Africa, and the United States), no significant gender differences were found between the drinking-in-the-event variables and violent injury. In the bivariate and multivariate analyses, a significant interaction effect between gender and heavy episodic drinking was found in the United States, indicating that heavy episodic drinking predicted violent injury for women but not for men. Although the results are preliminary, treatment and prevention programs may need to target both genders equally or perhaps even focus more on heavydrinking women, particularly in the United States.

Migraine With Aura and Ischemic Stroke

See related article, pages 2438–2445. Migraine with aura has been consistently associated with increased risk of ischemic stroke.1–3 Most studies suggest that this association is particularly strong for younger women. Although several potential biological mechanisms have been proposed to explain the migraine-stroke association, the precise mechanisms remain unknown. Because migraine is particularly prevalent in an age group in which ischemic stroke, even among migraineurs with aura, is very rare, it seems likely that factors in addition to migraine with aura must be present to lead to an increased risk of stroke. In this issue of Stroke , MacClellan and colleagues4 evaluate several additional features that may help to identify patients with migraine with aura who are at particular increased risk of ischemic stroke. In this population-based case-control study of 386 women aged 15 to 49 with a first- ever ischemic stroke event and 614 age and ethnicity-matched controls, migraine and visual aura symptoms were ascertained using a standardized headache questionnaire. Participants could be classified into patients with probable migraine with visual aura (PMVA), probable migraine without visual aura, and patients without migraine. Compared with nonmigraineurs, …

Family joint activities in a cross-national perspective.

BackgroundParents and children joint activities are considered to be an important factor on healthy lifestyle development throughout adolescence. This study is a part of the Cross-National Survey on Health Behaviour in School-aged Children – World Health Organization Collaborative Study (HBSC). It aims to describe family time in joint activities and to clarify the role of social and structural family profile in a cross-national perspective.MethodsThe research was carried out according to the methodology of the HBSC study using the anonymous standardized questionnaire. In total, 17,761 students (8,649 boys and 9,112 girls) aged 13 and 15 years from 6 European countries (Czech Republic, Finland, Greenland, Lithuania, Spain, and Ukraine) were surveyed in the 2001–2002 school-year. The evaluation of joint family activity is based on 8 items: (1) watching TV or a video, (2) playing indoor games, (3) eating meals, (4) going for a walk, (5) going places, (6) visiting friends or relatives, (7) playing sports, (8) sitting and talking about things (chatting).ResultsStudents from Spain and Ukraine reported spending the most time together with their families in almost all kinds of joint activities, whereas students from Greenland and Finland reported spending the least of this time. Boys were more likely than girls to be spending time together with family. Joint family activity goes into decline in age from 13 to 15 years. Variability of family time in a cross-national perspective was relatively small and related to children age category. Considering national, gender and age differences of studied population groups, we found that the distribution of joint family activities tends to be dispersed significantly by family structure (intact/restructured family) and family wealth.ConclusionOur study compares children and parent joint activities in European countries and reveals differences and similarities in these patterns between countries. The findings underline the role of family structure (intact/restructured family) and family wealth in the distribution of time spent in joint family activities, which should be considered by health promoters.

Validity of Self-Reported Drinking Before Injury Compared With a Physiological Measure: Cross-National Analysis of Emergency-Department Data From 16 Countries*

Self-reports of alcohol consumption among patients visiting an emergency department (ED) have been used extensively in the investigation of the relationship between drinking and injury. Little is known, however, about the associations between validity of self-reports with patient and injury characteristics and whether these relationships vary across regions or countries. Both of these issues are explored in this article. In the construct of a multilevel logistical model, validity of self-reports was estimated as the probability of a positive self-report given a positive blood alcohol concentration (BAC). The setting included 44 EDs across 28 studies in 16 countries. Participants included 10,741 injury patients from the combined Emergency Room Collaborative Alcohol Analysis Project (ERCAAP) and the World Health Organization Collaborative Study of Alcohol and Injuries. Data were analyzed on self-reported drinking within 6 hours before injury compared with BAC results obtained from breath-analyzer readings in all but two studies, which used urine screens. Covariates included demographic, drinking, and injury characteristics and aggregate-level contextual variables. At the individual level, a higher BAC measurement was associated with a higher probability of reporting drinking, as was heavy drinking and sustaining injuries in traffic accidents or violence-related events. At the study level, neither aggregate BAC nor other sociocultural variables affected the validity of self-reported drinking. This study provides further evidence of the validity of self-reported drinking measures in crossnational ED studies based on the objective criterion of BAC estimates.

The Effect of Alcohol Consumption on Emergency Department Services Use Among Injured Patients: A Cross-National Emergency Room Study

Although injured patients in the emergency department (ED) report more frequent use of the ED compared with the general population, and alcohol-related admissions and chronic alcohol misuse have been found to be predictive of future ED admissions, these data are based on only a few U.S. studies. The purpose of this article was to explore the association of alcohol use and ED services use among injured patients cross-nationally. Binary and multinomial logistic regression were used to analyze the association of alcohol consumption with prior ED visits among 9,743 injured patients surveyed in 37 EDs in 14 countries and reported in 23 studies from the combined Emergency Room Collaborative Alcohol Analysis Project (ERCAAP) and World Health Organization Collaborative Study of Alcohol and Injuries. Drinking within 6 hours before injury was associated with prior ED visits during the last 12 months (odds ratio = 1.25, p < .05), with a positive dose-response relationship. Heavy drinkers and those drinkers who were alcohol-dependent were also significantly more likely to report multiple prior ED visits, reflecting an elevated burden of services use. At the ED level, stigmatization of alcohol use was the only significant contextual variable that consistently predicted cross-ED variation in the relationship between drinking and ED use, in which the association was weaker in areas where alcohol use is less accepted. This study lends additional support to the potential effectiveness of screening for acute and chronic alcohol use among ED injured patients to reduce ED services use and associated costs.