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Biomedical subjects

Martin McKee

Publications and source records attributed to Martin McKee.

At least 109 records · Page 6Linked to original sources
PubMed2003

Prevalence and determinants of smoking in Tirana city, Albania: a population-based survey.

BACKGROUND: Smoking is the leading cause of premature death in Europe yet there are still many countries in which there is little information on its patterns and determinants. Albania is one such country. METHODS: A survey of health and lifestyle, including questions on smoking practice and attitudes, and its determinants was undertaken in Tirana, the capital of Albania in mid 2001. SUBJECTS: One thousand one hundred and twenty adults aged 25 years and over (response rate 72.7%). RESULTS: Forty-one percent of the study population (61% male and 24% female) were current or ex-smokers-28% were current smokers (37.6% of males and 19.3% of females) and 13% were ex-smokers (23.4% of males and 4.7% of females). Age-standardized (to the European standard population) prevalence of smoking for the adult population of Tirana was 31.2% (42.8% in males and 21.2% in females). Smoking was most common among those aged 25-34 years (59% of males and 30% of females in this age group). Of the current smokers, 16.5% smoked more than 20 cigarettes/day, and 67.3% smoked the first cigarette within 30 min of waking. Only 11% of current smokers had tried to quit smoking once during their life. Concern about health was the most common reason for quitting cited by ex-smokers (44%). In men, smoking was inversely associated with educational achievement. While the probability of smoking decreases with age, there was no consistent association with employment or income. CONCLUSION: The prevalence of smoking in Albania is comparable with other Western societies. The high rates of smoking among young men and women suggest that tobacco will make an increasingly large contribution to premature morbidity and mortality in the future. The high rate of smoking among young women in Albania, while a common phenomenon in post-communist countries, is especially worrying. This study emphasizes the need for a robust, evidence-based strategy for tobacco control in Albania.

Adult↗
PubMed2003

Trends in mortality attributable to current alcohol consumption in east and west Germany.

There is emerging awareness of alcohol as a cause of the persisting health divide between east and west Germany. This study quantifies the burden of alcohol attributable mortality in the two parts of Germany in the 1990s, taking account of both adverse and beneficial effects of alcohol. We used an epidemiological approach that applies cause-specific alcohol attributable fractions derived from published relative risks and data on the distribution of alcohol consumption in east and west Germany in 1990/1992 and 1998 to mortality data for the two regions in 1992 and 1997, thus producing an estimate of the number of alcohol attributable deaths 'caused' or 'prevented'. Including the cardio-protective effect of alcohol, there were about 1.4% more deaths among men aged 20+ in 1992 in Germany than would have been expected in a non-drinking population, while there were 0.1% fewer deaths among women. By 1997, this had increased to 1.8% excess male deaths and 0.1% excess female deaths. In 1997, alcohol 'caused' 9.0% of all deaths in east German men compared with 5.6% in the west (women east: 2.5%; women west: 2.2%). At the same time, alcohol 'prevented' 5.2% deaths in east German men compared with 4.3% in the west, while there were 2.9% and 2.0% fewer deaths in women. This resulted in a net excess of deaths due to alcohol, except east German women, where 0.3% deaths were estimated to have been averted by alcohol. Although by 1997 net deaths 'caused' by alcohol had increased in the west and declined in the east, the burden of mortality due to alcohol among men remained highest in the east whereas in women the order had reversed.Mortality attributable to alcohol contributes considerably to overall mortality and to the east-west gap in Germany. This study points to the need for comprehensive policies on alcohol in Germany to close the persisting east-west health gap.

Accidents, Traffic↗
PubMed2003

Discrepancies between ecological and individual data on fruit and vegetable consumption in fifteen countries.

Although food supply statistics are commonly used in ecological studies of diet and disease, little information is available on how they compare with reported intakes of foods. The objective of the present study was to compare fruit and vegetable availability with estimates of national mean intakes derived from national food consumption surveys. Food availability statistics from the FAO were used. For each country, mean national supply, based on at least 3 years of FAO data, was calculated. National estimates of mean fruit and vegetable intakes were derived from population-based surveys from fifteen countries, gathered for the World Health Organization Global Burden of Disease Study revision for 2000. Extrapolations were made when survey data did not cover all age groups. For each country, the FAO:survey estimate ratio was calculated. This ratio ranged from 0.93 to 2.70 (median value=1.39). Although there was a tendency for FAO data to overestimate intakes (fourteen out of fifteen countries), the degree of overestimation varied greatly among the countries included in this study (5-270 %). As food supply statistics are the only source of information on dietary patterns in most countries of the world, further information on how they reflect food intakes is needed. Obtaining detailed and valid estimates of dietary intakes in more countries around the world will be essential for such comparisons.

Asia↗
PubMed2003

Body weight patterns in a country in transition: a population-based survey in Tirana City, Albania.

OBJECTIVE: This paper reports the distribution and determinants of body mass index (BMI) and obesity in Tirana City (Albania). DESIGN: Cross-sectional survey conducted in mid-2001. SETTING: Tirana City. SUBJECTS: One thousand one hundred and twenty adults aged 25 years and over (response rate 72.7%), selected using multi-stage cluster sampling. RESULTS: Over three-quarters of male and female respondents had an excess body weight. The overall population prevalence of obesity in Tirana was estimated to be 22.0% in men and 30.9% in women. Obesity affected both genders (age-standardised prevalence in males 22.0%, females 30.9%; age-adjusted odds ratio (OR) 1.89; 99% confidence interval (CI) 1.33-2.67) and all age groups, but most particularly middle-aged women. The age-standardised overall prevalence of central obesity was 21.6% in men and 29.4% in women (age-adjusted OR 1.58; 99% CI 1.11-2.25), increasing with age (P<0.01). In women, the likelihood of being obese was inversely related to educational achievement (trend P=0.001) and alcohol consumption (trend P=0.009). Income, smoking and leisure-time physical activity were not associated with obesity. CONCLUSIONS: Excess weight and obesity are major public health problems in the adult population of Tirana, but most particularly in middle-aged women. The high obesity prevalence observed along with the recent decrease in physical activity, dietary changes and increase in smoking prevalence make it probable that there will be substantial increases in many non-communicable diseases in Albania in the coming decades. Health promotion strategies are needed that prevent excess weight gain in the Albanian population.

Adult↗
PubMed2003

The burden of disease attributable to nutrition in Europe.

OBJECTIVE: This review examines the extent to which differences in nutrition could explain the diversity of health in Europe and how dietary patterns might contribute to the overall burden of disease in the region. SETTING: Europe. DESIGN: Between-country variations and time trends in dietary and health patterns in Europe are described, taking into account recent evidence on east-west mortality differentials. Existing information on the contribution of dietary factors to the overall burden of disease in Europe and to the burden of cardiovascular diseases and cancer is then reviewed, including a discussion of the methodological challenges that face those seeking to quantify this burden accurately. RESULTS: While evidence from ecological data have long suggested that variations in health patterns in Europe may be at least partly attributed to differences in dietary intake, recent research into the major risks to disease, disability and death is confirming the importance of poor nutrition to major health problems and overall disease burden in Europe. Findings from the Global Burden of Disease 2000 study suggest that 4.4% of the overall burden of disease in the region could be attributed to low fruit and vegetable intake, and 7.8% to overweight and obesity. CONCLUSIONS: The burden of disease attributed to poor nutrition in Europe appears to be substantial and probably underestimated. However, better quantification of the contribution of nutrition to the region's burden of disease awaits further research to assess the dietary intake of Europeans and to explore the relationship between nutritional factors and health outcomes in diverse parts of Europe.

Cardiovascular Diseases↗
PubMed2003

The evolving pattern of avoidable mortality in Russia.

BACKGROUND: Life expectancy at birth in Russia is over 12 years less than in western Europe. This study explores the possible role of medical care in explaining this gap by examining the evolving pattern of mortality amenable to timely and effective medical care in Russia compared with Estonia, Latvia, and Lithuania, and the UK. METHODS: Analysis of standardized death rates from causes amenable to health care (treatable) or inter-sectoral health policies (preventable) in all regions and decomposition of differences in life expectancy between Russia and the UK by age, sex, and cause of death for the period 1965-1999/2000. RESULTS: Death rates from treatable causes remained stable between the mid-1960s and mid-1980s in Russia and the Baltic republics while steadily falling in the UK to less than half the rate in Russia. In the 1990s, rates increased in the former Soviet republics, reaching a peak in 1994 but reversing again in Russia in 1998. Deaths from causes amenable to inter-sectoral health interventions were higher in the UK in 1965 than in the Soviet Union but subsequently fell steadily while they increased in the East. Between 1965 and 1999, the male life expectancy gap between Russia and the UK rose from 3.6 to 15.1 years (women: 1.6 and 7.4 years). Treatable causes became an increasingly important contributor to this gap, accounting for almost 3 years by the end of the 1990s in men and 2 years in women. In Russia, elimination of treatable causes of death would have increased life expectancy by 2.9 years in men in 1995/99 compared with 1.2 years in the UK (women: 3.3 and 1.8 years), suggesting that, were the outcomes of health care achieved in the UK to be obtained in Russia, life expectancy for men might improve by about 1.7 years and for women by about 1.5 years. CONCLUSIONS: Our findings suggest that the Soviet health care system has failed to match the achievements of the West over the past three decades, highlighting the need to establish a system that provides effective and equitable care for the Russian population.

Adolescent↗
PubMed2003

Winners and losers: expansion of insurance coverage in Russia in the 1990s.

OBJECTIVES: This study sought to describe the evolution of the Russian compulsory health insurance system and to identify factors associated with noncoverage. METHODS: Data from successive waves of the Russian Longitudinal Monitoring Survey (1992-2000) were analyzed. RESULTS: Insurance coverage grew rapidly throughout the 1990s, although 11.8% of the country's citizens were still uninsured by 2000. Coverage initiation rates were greater at first among citizens who were better off, but this gap closed over the study period. Among individuals of working age, coverage rates diminished with age and were lower for the unemployed, for the self-employed, and for those residing outside Moscow or St. Petersburg. CONCLUSIONS: The growth of insurance coverage in Russia slowed toward the end of the 1990s, and gaps remain. Achievement of universal coverage will require new, targeted policies.

Adult↗
PubMed2002

Responding to the challenge of communicable disease in Europe.

In the 1960s and 1970s, communicable disease seemed a minor threat, but since then the emergence of new infections and the reemergence of old diseases has provoked a renewed focus on European communicable disease surveillance and control. A "network approach" among European countries has been successful in detecting some international outbreaks, but management and funding aspects remain unresolved. Surveillance outside the European Union has faced new challenges as a result of economic and political change following the collapse of communism. Subsequently, innovative international surveillance schemes are currently being implemented in the countries of Central and Eastern Europe and the former Soviet Union. The challenge for surveillance in Europe is to ensure that it has the capacity to meet both the needs of today and the diseases of the future.

Communicable Disease Control↗