Trends in educational inequalities in obesity in 15 European countries between 1990 and 2010

Background: The prevalence of obesity increased dramatically in many European countries in the past decades. Whether the increase occurred to the same extent in all socioeconomic groups is less known. We systematically assessed and compared the trends in educational inequalities in obesity in 15 different European countries between 1990 and 2010. Methods: Nationally representative survey data from 15 European countries were harmonized and used in a metaregression of trends in prevalence and educational inequalities in obesity between 1990 and 2010. Educational inequalities were estimated by means of absolute rate differences and relative rate ratios in men and women aged 30-64 years. Results: A statistically significant increase in the prevalence of obesity was found for all countries, except for Ireland (among men) and for France, Hungary, Italy and Poland (among women). Meta-regressions showed a statistically significant overall increase in absolute inequalities of 0.11% points [95% CI 0.03, 0.20] per year among men and 0.12% points [95% CI 0.04, 0.20] per year among women. Relative inequalities did not significantly change over time in most countries. A significant reduction of relative inequalities was found among Austrian and Italian women. Conclusion: The increase in the overall prevalence aligned with a widening of absolute but not of relative inequalities in obesity in many European countries over the past two decades. Our findings urge for a further understanding of the drivers of the increase in obesity in lower education groups particularly, and an equity perspective in population-based obesity prevention strategies.Peer reviewe

A global framework for integrating public health into well-being: why a public well-being system is needed

There is a growing focus on public health initiatives that prioritise well-being. The main question of our study is whether this, in its current form, can really represent a new response to the challenges of previous strategies, or whether there is a greater chance that it will essentially reproduce the problems associated with the paradoxical situation of public health.Based on a review, analysis and evaluation of the literature on well-being in public health, we outlined the foundations of a new meta-theory of well-being and a possibility for its social application. In our view, well-being is seen as a social representation of a combination of positive and negative freedom of choice concerning the quality of everyday life, used in a positioning process involving both individual and collective aspects. Health is a particular aspect of the social representation and positioning of well-being, which encompasses aspects of the physical, psychological, social and spiritual functioning of individuals.The well-being meta-theory also opens up the possibility for more effective solutions to the social challenges related to well-being and salutogenetic health. It underscores the importance of the need for a dedicated social subsystem where the goals and organizational culture of the organizations involved are focused on well-being and health promotion. In our study, we consider this to be the Public Well-being System (PWS).Our conclusion is that the development and operation of a new set of institutions -the Public Wellbeing System (PWS) -based on the co-production of services that meet the needs and demands of society, and dedicated to the promotion of well-being, may provide an opportunity to overcome the public health paradox

Inequity in uptake of maternal health care services in developing countries: a systematic review and meta-analysis

BackgroundMaternal health service uptake remains an important predictor of maternal outcomes including maternal mortality. This systematic review and meta-analysis aimed to summarize the available evidence on the uptake of maternal health care services in developing countries and to assess the impact of place of residence, education status, and wealth index on the uptake of these services.MethodsWe examined the databases MEDLINE, Web of Science, Global Index Medicus, and Scopus until June 14, 2022. Cross-sectional studies done between 2015 and 2022 were considered. Mothers of reproductive age and all states of health were included in the study. Independently, two authors determined the eligibility of studies, extracted data, evaluated the risk of bias, and ranked the evidence’s degree of certainty. To combine the data, we performed a random-effects meta-analysis. The PROSPERO registration ID is CRD42022304094.ResultsWe included 51 studies. Mothers living in urban areas were three times more likely to receive antenatal care (OR 2.95; 95% CI 2.23 to 3.89; 15 studies; 340,390 participants) than rural mothers. Compared with no education, those with primary education were twice as likely to utilize antenatal care (OR 2.36; 95% CI 1.80 to 3.09; 9 studies; 154,398 participants) and those with secondary and higher education were six and fourteen times more likely to utilize antenatal care, respectively. Mothers in the second wealth index were twice as likely as mothers in the lowest wealth index to utilize antenatal care (OR 1.62; 95% CI 1.36 to 1.91; 10 studies; 224,530 participants) and antenatal care utilization increased further among mothers in the higher wealth index. We observed similar relative inequalities in skilled delivery care and postnatal care utilization based on the pace of residence, education, and wealth index.ConclusionIn developing countries, the problem of inequity in utilizing maternal health care services persists and needs considerable attention

A global framework for integrating public health into well-being: why a public well-being system is needed

There is a growing focus on public health initiatives that prioritise well-being. The main question of our study is whether this, in its current form, can really represent a new response to the challenges of previous strategies, or whether there is a greater chance that it will essentially reproduce the problems associated with the paradoxical situation of public health. Based on a review, analysis and evaluation of the literature on well-being in public health, we outlined the foundations of a new meta-theory of well-being and a possibility for its social application. In our view, well-being is seen as a social representation of a combination of positive and negative freedom of choice concerning the quality of everyday life, used in a positioning process involving both individual and collective aspects. Health is a particular aspect of the social representation and positioning of well-being, which encompasses aspects of the physical, psychological, social and spiritual functioning of individuals. The well-being meta-theory also opens up the possibility for more effective solutions to the social challenges related to well-being and salutogenetic health. It underscores the importance of the need for a dedicated social subsystem where the goals and organizational culture of the organizations involved are focused on well-being and health promotion. In our study, we consider this to be the Public Well-being System (PWS)

Health Inequity in the Distribution of Diseases Among Adults in the City of Pécs, Hungary, 2024

Background: Health inequalities between citizens of different European countries and between socially advantaged and disadvantaged groups are seen as challenges to the EU’s commitment to solidarity, social and economic cohesion, human rights, and equality of opportunity. This study aimed to assess inequity in the distribution of specific communicable and non-communicable diseases among the adult population of Pécs City, Hungary. Methods: This is an ecological study combined with health inequity analysis. The study population comprised adult patients living in the city of Pécs who were treated for circulatory, neoplasm, or respiratory diseases in 2019. Hospitalization and local socioeconomic data by zip codes were obtained from the National Health Insurance Fund of Hungary and the Hungarian Central Statistical Office. Diseases were classified according to the International Classification of Diseases, 10th revision (ICD-10). The differences and ratios of the proportions of treated diseases were calculated, along with the concentration index (C). Zip codes were ranked into categories 1 to 5 based on socio-demographic variables: education, employment status, and apartment ownership. A p-value of less than 0.05 was used as the cut-off point for statistical significance. IBM SPSS version 25 and STATA version 14.0 software were used for data analysis. Results: All 36 zip codes in the city of Pécs were included in this study. Analysis based on employment status showed a higher prevalence of neoplasms in areas with higher unemployment (C = −0.0528; 95% CI = −0.0975, −0.0080). In terms of apartment ownership, neoplasms (C = −0.0742; 95% CI = −0.1102, −0.0382) and circulatory diseases (C = −0.0280; 95% CI = −0.0520, −0.0039) were more prevalent in zip codes with fewer apartment owners. Conclusions: This study identified significant inequity in the distribution of neoplasms and circulatory diseases among the adult population of Pécs, especially in areas where the low socioeconomic segment of the population lives. Efforts should be made to establish tailored interventions such as targeted healthcare funding and employment programs for the unemployed and National Housing Trust Fund for those who do not own houses through multisectoral collaboration among healthcare providers, employers, governors, and policymakers

Effect of autogenic training on drug consumption in patients with primary headache: An 8-month follow-up study

Objective. To examine the effects of Schultz-type autogenic training on headache-related drug consumption and headache frequency in patients with migraine, tension-type, or mixed (migraine plus tension-type) headache over an 8-month period. Background. Behavioral treatments often are used alone or adjunctively for different types of headache. There are, however, only a few studies that have compared the efficacy and durability of the same treatment in different types of primary headache, and the effects of treatment on headache-related drug consumption rarely have been assessed even in these studies. Methods. Twenty-five women with primary headache (11 with mixed headache, 8 with migraine, and 6 with tension-type headache) were evaluated via an open-label, self-controlled, 8-month, follow-up study design. After an initial 4 months of observation, patients began learning Schultz-type autogenic training as modified for patients with headache. They practiced autogenic training on a regular basis for 4 months. Based on data from headache diaries and daily medication records, headache frequencies and the amounts of analgesics, "migraine-specific" drugs (ergots and triptans), and anxiolytics taken by the patients were compared in the three subgroups over the 8-month period. Results. From the first month of implementation of autogenic training, headache frequencies were significantly reduced in patients with tension-type and mixed headache. Significant reduction in frequency was achieved in patients with migraine only from the third month of autogenic training. Decreases in headache frequencies were accompanied by decreases in consumption of migraine drugs and analgesics resulting in significant correlations among these parameters. Reduction in consumption of anxiolytic drugs was more rapid and robust in patients with tension-type headache compared to patients with migraine, and this outcome failed to show any correlation with change in headache frequency. Conclusion. Schultz-type autogenic training is an effective therapeutic approach that may lead to a reduction in both headache frequency and the use of headache medication

Pharmacoepidemiology of Clozapine in 202 Inpatients with Schizophrenia

OBJECTIVE: To evaluate clozapine in a field trial for hospitalized patients with treatment-resistant schizophrenia. METHOD: The setting consisted of a large, state-operated, public psychiatric system. The protocol called for the treating psychiatrist to provide symptom- and adverse-effect ratings at four times following the start of drug therapy. The outcome criteria included the Sandoz study outcome measure of symptom improvement as well as discharge status for one year of follow-up. To assess the validity of the ratings, several measures of internal consistency were determined. Clozapine therapy was started in 227 patients, and symptom data are available for 202. RESULTS: Overall, 33 percent (n=66) of the patients were improved at the end of one year of treatment; 12 percent (n=24) maintained symptom improvement at all three evaluation times. Modest, statistically significant improvement after 12 weeks compared with baseline Brief Psychiatric Rating Scale (BPRS) total scores was observed for the patients continuing medication (n=152); the emergence of a previously unimproved group (n=26) explains this modest improvement. However, in the analysis of all patients (n=202), (including dropouts), there was no significant symptom improvement after 12 weeks. Lower baseline BPRS scores predicted significant symptom improvement after 12 weeks of treatment. Among those medicated for one year, the pattern of symptom improvement showed that the probability of late improvement was 0.26 for those previously unimproved, and the probability of a 12-week responder losing improvement was 0.23, resulting in a net group gain of 3 cases in 100. By the end of one year, 8 percent (n=17) of the cohort was discharged, and 3 percent (n=7) was transferred to another facility while continuing to receive clozapine. Of the 227 original patients started on clozapine therapy, medication was discontinued for adverse effects in 11 percent (n=25): white blood cell count (WBC) decrease (but no agranulocytosis) in 5 percent (n=12), seizures in 1 percent (n=3), one patient with seizures and decreased WBC count, and other events (e.g., cardiovascular changes, fever, or possible neuroleptic malignant syndrome) in 4 percent (n=9). Patient refusal was reported for 6 percent (n=13) of those starting treatment. CONCLUSIONS: Although only 19 percent of the patients exhibited improvement at 6 weeks, the response rate at 12 weeks (29 percent) for this naturalistic study cohort was similar to that in the major, double-blind, six-week, controlled, clinical trial of clozapine. The impersistence of response as symptoms were followed for up to one year is a finding that deserves rigorous evaluation. </jats:sec

NO-induced migraine attack: Strong increase in plasma calcitonin gene-related peptide (CGRP) concentration and negative correlation with platelet serotonin release

The aim of the present study was to investigate changes in the plasma calcitonin gene-related peptide (CGRP) concentration and platelet serotonin (5-hydroxytriptamine, 5-HT) content during the immediate headache and the delayed genuine migraine attack provoked by nitroglycerin. Fifteen female migraineurs (without aura) and eight controls participated in the study. Sublingual nitroglycerin (0.5 mg) was administered. Blood was collected from the antecubital vein four times: 60 min before and after the nitroglycerin application, and 60 and 120 min after the beginning of the migraine attack (mean 344 and 404 min; 12 subjects). In those subjects who had no migraine attack (11 subjects) a similar time schedule was used. Plasma CGRP concentration increased significantly ðP , 0:01Þ during the migraine attack and returned to baseline after the cessation of the migraine. In addition, both change and peak, showed significant positive correlations with migraine headache intensity ðP , 0:001Þ: However, plasma CGRP concentrations failed to change during immediate headache and in the subjects with no migraine attack. Basal CGRP concentration was significantly higher and platelet 5-HT content tended to be lower in subjects who experienced a migraine attack. Platelet serotonin content decreased significantly ðP , 0:01Þ after nitroglycerin in subjects with no migraine attack but no consistent change was observed in patients with migraine attack. In conclusion, the fact that plasma CGRP concentration correlates with the timing and severity of a migraine headache suggests a direct relationship between CGRP and migraine. In contrast, serotonin release from platelets does not provoke migraine, it may even counteract the headache and the concomitant CGRP release in this model

Neuroleptics in Acute Mania: A Pharmacoepidemiologic Study

OBJECTIVE: To provide an epidemiologic descriptive analysis of the acute drug treatment of inpatients with bipolar mania in state psychiatric facilities in 1990. METHODS: We surveyed the first 3 weeks of drug treatment of all inpatients with bipolar mania who were admitted to 22 New York State adult psychiatric facilities during a 6-month period (n = 528). RESULTS: Almost all patients with mania were treated with neuroleptics. The mean ± SD neuroleptic dosage was 684 ± 543 mg/d chlorpromazine equivalents. Sixty-one percent of the patients received lithium and 12% received carbamazepine or valproate. Neuroleptic dosage was related to age, with older patients receiving lower dosages. Patients receiving combination treatment of a neuroleptic with either lithium, an anticonvulsant, or a benzodiazepine received a mean neuroleptic dosage similar to that of patients treated with a neuroleptic alone. CONCLUSIONS: Although their use has been widely discouraged for mood disorders, neuroleptics have been the standard treatment for acute mania. </jats:sec