Recent trends and sociodemographic distribution of cardiovascular risk factors: results from two population surveys in the Austrian WHO CINDI demonstration area

OBJECTIVE

The major risk factors for cardiovascular diseases are well established; however, only a few studies report on recent trends in risk factor profiles. This study analyses the sociodemographic distribution of risk factors and gives an account of their changes from 1991 to 1999.

METHODS

Two cross-sectional population surveys as part of the CINDI (Countrywide Integrated Noncommunicable Diseases Intervention) program of the World Health Organization were performed in 1991 and 1999 in the province of Vorarlberg (Austria). The surveys included a standardized interview and a medical examination. 1863 persons aged 25 to 64 years in 1991 and 1550 persons in 1999 participated in the interview section of the surveys. From these, 1446 in 1991 and 841 persons in 1999 underwent medical examination. Prevalence of overweight and obesity, mild and severe hypertension, hypercholesterolemia, hypertriglyceridemia, hyperglycemia, regular smoking and lack of physical activity were estimated. Framingham risk functions were calculated to compare overall risk for coronary heart disease.

RESULTS

In women, prevalence of overweight including obesity increased from 34% in 1991 to 41% in 1999. Almost 50% of the male population were estimated to be overweight or obese in 1991 and 1999. Hypertension showed a favorable trend and decreased substantially in both genders. Hypercholesterolemia decreased only in men, from 27% to 21%. In 1999, women aged 55-64 showed a prevalence of over 50% in highly elevated cholesterol. Hypertriglyceridemia decreased in men from 21% to 18%, in women it remained almost unchanged. Total prevalence of smoking did not change from 1991 to 1999. 34% of the men and 24% of the women reported to smoke more than one cigarette daily. In women under 45 years of age, regular smoking increased slightly and reached a prevalence of over 30%. Less educated people and people of non-national origin had significantly higher risk factor levels. The risk functions did not reveal a significant difference in 10 year risk for coronary heart disease between the two surveys.

CONCLUSIONS

Decreasing levels in hypertension and in male hypercholesterolemia showed favorable developments in risk factor prevalence. Preventive measures should concentrate on reducing overweight in older people and smoking in young women as well as on intensifying the care for less educated people and people of non-national origin.

[Health promotion by sports and physical activity: politics, behavior and infrastructures in a European comparison]

OBJECTIVES

The focus of physical activity promotion is moving from measures to increase health-enhancing physical activity on the individual level to higher-level strategies including policy and environmental approaches. Scientific evidence, traditionally related to individual-based strategies, calls for adaptation and refinement when environmental and policy changes become more relevant.

METHODS

This paper investigates differences in physical activity promotion and public policy among six European countries. Data from a European study on public health promotion policy and health behaviours (MAREPS) is analysed to study behaviour, community-based opportunities for physical activity, and populations' perception of the effectiveness of their national policies in promoting physical activity.

RESULTS

Analyses show significant differences in both involvement in and perceived opportunities for physical activity among the investigated countries. Populations in Finland, Switzerland, and The Netherlands show comparably higher participation and, at the same time, perceive better opportunities for physical activity within the residential environment than people in East Germany, Belgium, and Spain. Moreover, respondents from the former group of nations report considerably greater contribution of health policy in their country to the promotion of physical activity than respondents from the latter group.

CONCLUSIONS

In conclusion, the results provide empirical support for the significance of environmental and policy approaches with regard to physical activity. Opportunities created by implementing such approaches may enable populations to develop more active lifestyles conducive to health. Further research employing longitudinal designs could be especially helpful to explore the causalities of the relationship between policy, environment and physical activity.

[Necessary and desirable future emphasis in social medicine from the theoretical viewpoint]

Social medicine, like medicine as a whole, is based on biomedical science and has responsibilities in clinical care, at the same time linking the health system, an important element in the welfare state, to society. Social medicine investigates and expands the scientific basis for securing and promoting health by way of social action, sharing common roots with public health. In the biomedical sphere, emphasis is on improving our understanding of the biological foundations of social behaviour; scanning and assessing the ethical, legal, economical and social implications of scientific progress; influencing the social and economic effects of demographic developments, and improving the scientific basis of preventive, styles of living and interventions. In the clinical sphere, the main objectives are to expand such areas as clinical epidemiology and clinical health economics, to assert patients' rights and to promote population-related medicine in the training of doctors. As far as the health care system is concerned, emphasis is on restoring the solidarity concept between the healthy and the sick as the principle of statutory health insurance, and on securing transparency of performance, quality, and cost. A further objective is to encourage more creative management by the health insurance funds by granting freedom of contract. Open public discussion about the rationale of an ethical health care system is required, discussion in which independent experts trained in population-related medicine must play an active part.

["Data for action" from the viewpoint of the Regional Dental Board and the Regional Professional Group for Dental Health]

Lecture by the President of the Landeszahnärztekammer (Regional Chamber of Dental Surgeons) Baden Wuerttemberg and Chairman of the Landesarbeitsgemeinschaft Zahngesundheit (Regional Task Force for Dental Health) on the occasion of the 50th scientific convention "Healthy into the Future" of the Federal Association of Doctors and Dentists in the Public Health Sector. This lecture by Dr. Rüdiger Engel highlights the planned goals of the Landesarbeitsgemeinschaft Zahngesundheit (Regional Task Force for Dental Health) as well as those of the 37 associated Regional Task Forces for Dental Health up to year 2003.

Health-care quality promotion through infection prevention: beyond 2000

Health-care value purchasing, complex health-care systems, and information technology are the three most important change drivers influencing the interrelated themes of the 4th decennial conference: accountability, quality promotion through infection prevention across the health-care delivery system, and medical informatics. Among the change drivers influencing themes of future conferences may be a societal mandate for health promotion and health-care access for all.

Race, ethnicity and preventive services: no gains for Hispanics

Three years ago, the Clinton administration initiated multiple efforts to identify and eliminate health disparities among various populations, including ethnic minority groups. Recent findings from the Community Tracking Study Household Survey show that between 1997 and 1999 there was an increase in the percentage of white and African American persons receiving preventive care-such as mammography screening among women and physicians counseling cigarette smokers to quit-but that there was no such increase in preventive measures for Hispanics. If policy makers want to remove disparities in health status based on race and ethnicity, they need to promote preventive care for minorities and monitor progress by regularly measuring preventive care indicators. This Issue Brief focuses on change in key preventive care indicators between 1997 and 1999.

ASHP national survey of pharmacy practice in acute care settings: monitoring, patient education, and wellness--2000

Results of the 2000 ASHP national survey of pharmacy practice in acute care settings that pertain to patient medication monitoring, education, and wellness are presented. Pharmacy directors at 1063 general and children's medical-surgical hospitals in the United States were surveyed by mail. The response rate was 50.2%. Although the respondents indicated that most pharmacists spent less than 20% of their time on medication-monitoring activities, the amount of time devoted to such activities was increasing. Pharmacists were selective about which patients they chose to monitor for medication-related problems. Patients were frequently chosen on the basis of service or medication. Pharmacists used a number of mechanisms to monitor patients for adverse drug events (ADEs). Although internal ADE reporting had generally increased within the preceding three years, 81% of the Institutions had implemented strategies to improve reporting. When ADEs were reported externally (59% of the respondents), FDA was most commonly alerted. About 92% of the respondents indicated that nursing had primary responsibility for counseling patients about medications. Pharmacists were infrequently involved in medication education during the hospital stay; however, 48% of the institutions used some method to identify patients needing counseling by pharmacists. Slightly more than half of the respondents reported having wellness programs. Pharmacists were most commonly involved in disease-based wellness programs. Pharmacists in acute care settings appear to be well positioned to improve the patient-monitoring, education, and wellness components of the medication-use process.

[Improving performance and promoting health by sports participation]

The 20th century witnessed the globalization of international sporting competitions, most notably in Olympic Competition. Thus whereas fewer than 20 countries competed in the 1900 Olympic Games, close to 200 countries were represented at the 2000 Olympic Games in Sydney. There has also been a progressive improvement in athletic performance during the past century, for reasons that are described in this article. A question that needs to be asked is whether this increased global participation in competitive sport has improved the health of the general population in those countries in which international competitive sports have been promoted. There is little evidence to support this possibility. An important goal of the beginning century must be to globalize sporting participation amongst the general population specifically for health enhancement.

The symbolization of eggs in American culture: a sociologic analysis

OBJECTIVE

To demonstrate that the recent decline in egg consumption in the United States was, in part, the result of a food scare that began in the 1960's.

METHODS

Using the Reader's Guide to Periodical Literature, the frequency of articles about eggs, dietary cholesterol and heart disease in popular magazines was obtained. A content analysis was performed on a random sample of these articles.

RESULTS

The increased trend in magazine articles and public statements by groups such as the American Heart Association linking eggs, blood cholesterol and heart disease is associated with the downward trend in egg consumption.

CONCLUSIONS

Public exposure to negative messages about particular foods can contribute to a decline in their consumption. Exposure to more consistently positive messages about foods can bring about an increase in the consumption of those foods.