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PubMed2000

[Assurance and assessment of quality education in occupational medicine in selected countries of western Europe and in the United States. 1. Western Europe].

The author discusses the studies undertaken with the general aim to provide education in occupational medicine and assure and assess its quality in some countries of Western Europe advanced more than Poland in this area. It becomes quite evident that despite a widespread interest in quality of education, there is a lack of basic systemic solutions. A gap between basic theoretical and methodological guidelines and a large number of dispersed reports on concrete analytical and evaluation studies can be still observed. In addition to the presentation of an inside view of research activities carried out in some countries of Western Europe and the United States, based on selected professional publications, the author formulates general conclusions on how the assurance and quality assessment of education in occupational medicine function in those countries.

Education, Medical↗
PubMed2002

Water and health in Europe. A joint report from the European Environment Agency and the WHO Regional Office for Europe.

Shortage of water may be most urgent health problem currently facing some European countries. Climate change is predicted to influence water availability, especially in coastal areas. The extend of provision of piped drinking-water supplies to households varies across Europe and between urban and rural populations. The utilization of water for irrigation and for industry exerts pressure on water resources. Changes in populaton distribution and density are key factors influencing the quality of water resources. Outbreaks of waterborne diseases continue to occur across Europe, and minor supply problems are encountered in all countries. Inadequate sewerage systems are a significant threat to public health. Numerous chemicals are found throughout the aquatic environment. Eutrophication is a major threat to European surface waters. Considerate evidence has accrued linking the quality of bathing water with minor illnesses. Additional efforts are required to sustain the European Region's water resources and to provide safe water. Partnerships and cooperation are needed between the environment and health sectors at al levels of government to disseminate technology, to improve management and to provide financial and institutional support to ensure access to safe water and sanitation for all.

Climate↗
PubMed2000

Miospores from the Frasnian-Famennian Boundary deposits in Eastern Europe (the Pripyat Depression, Belarus and the Timan-Pechora Province, Russia) and comparison with Western Europe (Northern France).

A zonal subdivision of the Frasnian-Famennian transitional deposits in the Pripyat Depression and Timan-Pechora Province, based on a detailed palynological study, has been completed. The data obtained on miospores and conodonts from the Timan-Pechora Province enable a correlation to be made with the Standard Conodont Zonation. The lateral extent of the palynozones in Eastern Europe and the correlation with Western Europe are discussed. The following previously published new combinations are validated: Auroraspora speciosa (Naumova) Obukhovskaya, comb. nov., Corbulispora viminea (Nekriata) Obukhovskaya and Nekriata, comb. nov., Cristatisporites imperpetuus (Sennova) Obukhovskaya, comb. nov., Cymbosporites acanthaceus (Kedo) Obukhovskaya, comb. nov., Grandispora subsuta (Nazarenko) Obukhovskaya, comb. nov., and Verrucosisporites evlanensis (Naumova) Obukhovskaya, comb. nov.

Journal Article↗
PubMed2000

Surveillance of cerebral palsy in Europe: a collaboration of cerebral palsy surveys and registers. Surveillance of Cerebral Palsy in Europe (SCPE).

Although cerebral palsy (CP) is the most common cause of motor deficiency in young children, it occurs in only 2 to 3 per 1000 live births. In order to monitor prevalence rates, especially within subgroups (birthweight, clinical type), it is necessary to study large populations. A network of CP surveys and registers was formed in 14 centres in eight countries across Europe. Differences in prevalence rates of CP in the centres prior to any work on harmonization of data are reported. The subsequent process to standardize the definition of CP, inclusion/exclusion criteria, classification, and description of children with CP is outlined. The consensus that was reached on these issues will make it possible to monitor trends in CP rate, to provide a framework for collaborative research, and a basis for services planning among European countries.

Cerebral Palsy↗
PubMed1997

Cytomegalovirus retinitis in patients with AIDS in Europe. AIDS in Europe Study Group.

The incidence of cytomegalovirus (CMV) retinitis and risk factors associated with the condition were studied in patients with the acquired immune deficiency syndrome (AIDS) in a multicenter retrospective cohort study of 6458 patients from 52 centers in 17 countries in Europe. Cytomegalovirus retinitis was diagnosed in 154 patients (2.4%) at the time of AIDS diagnosis, the probability of this diagnosis being significantly higher for those with CD4+ cell counts of < 100/mm3 (3.4%) than with counts of 100-200/mm3 (1.3%) or > 200/mm3 (0.8%). The rate of developing CMV retinitis after AIDS diagnosis was 9.4 per 100 patient years of follow-up. Multivariate analysis showed that risk behavior was significantly associated with the risk of developing CMV retinitis: lower for intravenous drug users [relative risk (RR) 0.47] and those engaged in "other risk behavior" (RR 0.58) than for homosexual men. The risk of developing CMV retinitis after AIDS diagnosis was significantly associated with CD4+ cell count at the time of AIDS diagnosis: for counts < 100/mm3 (RR 2.90) and from 100 to 200/mm3 (RR 2.13), there was a higher risk than for counts > 200/mm3. Patients with Pneumocystis carinii pneumonia, toxoplasmosis, or extraocular CMV infection at time of AIDS diagnosis exhibited an increased risk of developing CMV retinitis. Patients treated with zidovudine exhibited an increased rate of CMV retinitis: RR was 1.75 during and 2.87 after the second year of treatment as compared to those who had not received zidovudine. Median survival after CMV retinitis at time of AIDS diagnosis was eight months.

AIDS-Related Opportunistic Infections↗
PubMed1995

European School of Oncology Advisory report to the European Commission for the Europe Against Cancer Programme: oral carcinogenesis in Europe.

A European School of Oncology Advisory Group has reviewed current knowledge on the epidemiology, treatment and prevention of cancer of the oral cavity. While the major factors in the aetiology of such cancers are thought to be well understood, i.e. tobacco and alcohol consumption, current increases in the occurrence of the disease, especially in young adults throughout Europe, are cause for concern. The reasons for such increases are not clearly evident and the Advisory Group has suggested further work which is required to be carried out to understand the aetiology. In treatment of the disease there have been no major improvements in survival for patients in recent decades and the importance of examining new radiotherapy modalities and defining the role of chemotherapy is emphasized. Primary prevention of oral cancer could be achieved by stopping smoking tobacco, limiting alcohol consumption to a minimum (2-3 drinks per day) and increasing intake of fruits and vegetables. To supplement these actions, while neither population screening programmes nor screening trials could be recommended by the Advisory Group, initial chemoprevention trials have produced some promising results and this represents an interesting area which is the focus of much current research.

Europe↗
PubMed1999

Is group C meningococcal disease increasing in Europe? A report of surveillance of meningococcal infection in Europe 1993-6. European Meningitis Surveillance Group.

A surveillance system to assess the impact and changing epidemiology of invasive meningococcal disease in Europe was set up in 1987. Since about 1991, contributors from national reference laboratories, national communicable disease surveillance centres and institutes of public health in 35 European countries provided information on all reported cases of meningococcal disease in their country. We describe some trends observed over the period 1993-6. The main findings were: the overall incidence of meningococcal disease was 1.1 per 100000 population but there was some evidence of a slow increase over time and with northern European countries tending to have a higher incidence (Kendall correlation 0.5772, P < 0.001), an increasing predominance of serogroup C, and a shift in the age distribution towards teenagers and away from younger children (chi2 test for trend 44.56, P < 0.0001), although about half of the cases were under 5 years of age. The overall case fatality rate was 8.3% and the most common serosubtypes were B:15:P1.7,16 and C:2a:P1.2,5.

Adolescent↗
PubMed1999

Systolic Hypertension in Europe (Syst-Eur) trial phase 2: objectives, protocol, and initial progress. Systolic Hypertension in Europe Investigators.

The Systolic Hypertension in Europe (Syst-Eur) trial proved that blood pressure (BP) lowering therapy starting with nitrendipine reduces the risk of cardiovascular complications in older (> or = 60 years) patients with isolated systolic hypertension (systolic BP > or = 160 mm Hg and diastolic BP < 95 mm Hg). After the completion of the Syst-Eur trial on 14 February 1997, 3506 consenting patients (93.0% of those eligible) were enrolled in phase 2 of the Syst-Eur trial. This open follow-up study aims to confirm the safety of long-term antihypertensive therapy based on a dihydropyridine. To lower the sitting systolic BP below 150 mm Hg (target BP), the first-line agent nitrendipine (10-40 mg/day) may be associated with enalapril (5-20 mg/day), hydrochlorothiazide (12.5-25 mg/day), both add-on study drugs, or if required any other antihypertensive agent. On 1 November 1998, 3248 patients were still being followed, 86 patients had proceeded to non-supervised follow-up, and 43 had died. The median follow-up in Syst-Eur 2 was 14.3 months. At the last available visit, systolic/diastolic BP in the patients formerly randomised to placebo (n = 1682) or active treatment (n = 1824), had decreased by 13.2/5.2 mm Hg and by 4.6/1.6 mm Hg, respectively, so that the between-group BP difference was 1.7 mm Hg systolic (95% Ci: 0.8 to 2.6 mm Hg; P < 0.001) and 0.9 mm Hg diastolic (95% Cl: 0.4 to 1.5 mm mm Hg; P < 0.001). At the beginning of Syst-Eur 2, the goal BP was reached by 25.4% and 50.6% of the former placebo and active-treatment groups; at the last visit these proportions were 55.9% and 63.1%, respectively. At that moment, 45.9% of the patients were on monotherapy with nitrendipine, 29.3% took nitrendipine in combination with other study drugs. Until the end of 2001, BP control of the Syst-Eur 2 patients will be further improved. Cardiovascular complications and adverse events, such as cancer or gastro-intestinal bleeding, will be monitored and validated by blinded experts.

Aged↗
PubMed1998

Evolution of renal replacement therapy in Central and Eastern Europe 7 years after political and economical liberation. Central and Eastern Europe Advisory Board in Chronic Renal Failure.

PURPOSE OF THE STUDY: The conditions of renal replacement therapy (RRT) were very poor in the countries located in Central and Eastern Europe (CEE) when they were members of the so-called 'socialist bloc'. The aim of the present analysis was to document the impact of the socioeconomic changes on dialysis therapy in the CEE countries. DESIGN: This was a special survey with the participation of 12 CEE countries, with data obtained through national registries (with the exception of Russia). RESULTS: During the period 1990-1996 the number of haemodialysis units increased by 56% and the number of centres performing peritoneal dialysis by 296%. The number of patients increased respectively by 78% (haemodialysis) and 306% (peritoneal dialysis). The percentage of patients with diabetic nephropathy and elderly patients rose dramatically during this period. One of the main reasons of such expansion was the rapid development of peritoneal dialysis programmes in the majority of the CEE countries. The introduction of modern haemodialysis machines and a wider choice of different dialysers and concentrates permitted individualization of dialysis procedures. These points and the wider use of erythropoietin had a positive influence on quality of life and treatment outcome. There was also a notable increase in the number of transplant centres, but less so of the number of transplanted patients. CONCLUSION: Renal replacement therapy experienced a major expansion in the CEE countries. Despite the progress achieved, the level of RRT is not yet completely satisfactory in most CEE countries.

Europe↗
PubMed2001

Research in cardiovascular nursing in Europe: toward a UNITED approach. Undertaking Nursing Interventions Throughout Europe Research Group.

This article describes the efforts of a recent initiative of the Working Group on Cardiovascular Nursing of the European Society of Cardiology. The Undertaking Nursing Interventions Throughout Europe (UNITE) Research Group represents a truly international team of nurses who collaborate on a number of research studies. The major focus of the group is to provide better care to patients in whom modern day treatment has proven to be ineffectual such as patients with chronic, intractable angina.

Cardiovascular Diseases↗
PubMed2001

Dealing with emergencies in rural areas of Europe: proceedings from WONCA Europe 2000.

On 4 July 2000, two workshops on handling emergencies in rural areas of Europe were held at the WONCA (World Organisation of National Colleges and Academies of Family Medicine/General Practice) conference in Vienna under the auspices of EURIPA (European Rural and Isolated Practitioners' Association). Papers submitted covered varying patterns of service provision and examples of short intensive training for emergencies at resident and general practitioner levels. Ways of collecting data routinely for accident prevention were also discussed. The workshops concluded that there was a need for more research in the application of emergency skills, that lack of confidence in dealing with emergencies may contribute to recruitment problems, and that further work towards a document detailing training requirements for emergencies was needed. This will be developed at a EURIPA workshop at WONCA in Tampere, June 2001.

Accident Prevention↗
PubMed1998

Prenatal care incentives in Europe. Study Group on Barriers and Incentives to Prenatal Care in Europe.

The purpose of the study was to identify prenatal care incentives and benefits in 17 European countries. All participating countries completed a questionnaire on their prenatal care delivery system, incentives and benefits. Results were analyzed according to their direct or indirect relationship with prenatal care attendance. Direct incentives require a prenatal care visit to be eligible for the benefit. Indirect incentives support the pregnant woman but do not require a prenatal care visit to be eligible for the benefit. All 17 countries offer direct incentives, such as paid maternity leave. In 9 countries, pregnant women receive direct financial incentives. Eleven countries offer indirect incentives, such as transportation benefits. Prenatal care incentives such as financial benefits and social supports are widespread in Europe. The combination of incentives superimposed upon an inclusive health care system create a supportive environment which encourages prenatal care attendance.

Delivery of Health Care↗
PubMed1998

Neuroblastoma in Europe: differences in the pattern of disease in the UK. SENSE. Study group for the Evaluation of Neuroblastoma Screening in Europe.

BACKGROUND: Neuroblastoma is a major contributor to childhood cancer mortality, but its prognosis varies with age and stage of disease, and some tumours regress spontaneously. Urinary screening programmes or clinical examination may detect the disease before symptoms appear, but the benefit of early diagnosis is uncertain. We examined the incidence, pattern, and presentation of neuroblastoma in four European countries. METHOD: Population-based incidence rates were derived for France, Austria, Germany, and the UK. Age, sex, and stage distribution were analysed by Mantel-Haenszel techniques and Poisson regression. The proportion of incidental diagnoses (cases without symptoms found at routine health checks or during investigation of other disorders) and mortality rates were also compared. FINDINGS: Between 1987 and 1991, 1672 cases of neuroblastoma were diagnosed in children under 15 years old (France, 624; Austria, 69; Germany, 493; UK, 486). Age-standardised annual incidence was significantly lower in the UK (10.1/million) than in France (12.5) and Germany (11.4). In the UK a deficit of low-stage disease in infants was accompanied by an excess of stage IV in older children. The UK had significantly fewer incidental diagnoses (8%) than Austria (27%) and Germany (34%). UK mortality rates were significantly higher than German or French rates. INTERPRETATION: In the UK, neuroblastoma diagnosis is delayed, possibly because of a less rigorous system of health checks for children. Although some overdiagnosis occurs in mainland Europe, our data suggest that in the UK some low-stage cases, undetected in infancy, may later present as advanced disease. This finding has implications for screening programmes and organisation of routine surveillance of infant health in the UK.

Adolescent↗
PubMed1997

Cross-cultural variations and changes in food-group intake among elderly women in Europe: results from the Survey in Europe on Nutrition and the Elderly a Concerted Action (SENECA).

To study cross-cultural variations and changes in intake of food groups in elderly Europeans, longitudinal data on food-group intake from Danish (n = 55), Dutch (n = 65), Swiss (n = 79), and Spanish (n = 46) female participants in the Survey in Europe on Nutrition and the Elderly a Concerted Action (SENECA) were compared. Participants were born between 1913 and 1918. Information on food intake was obtained with use of the same diet-history method at all sites and in both 1988-1989 and 1993. Actual food intake was coded according to the Eurocode system, the applicability of which for European multicenter studies was evaluated in this study. All participants, regardless of site, reported consumption of milk, grain products, and vegetables, and almost all ate meat, fats, and fruit. Fewer women ate eggs, fish, and sugar. The variations between the sites were in the food groups consumed and the types of foods within the groups. Spanish women appeared to have the most healthy food-intake pattern. They also had more changes in their dietary pattern than did women in the other countries. The Eurocode was adequate for describing the actual food intake of elderly women in four European towns. The coding for meat, however, was ambiguous and should be revised.

Aged↗
PubMed1990

Clinical pharmacology and primary health care in Europe--a gap to bridge. The WHO Working Group on Clinical Pharmacology in Europe.

A group of senior European clinical pharmacologists presents a position paper on the possible role of clinical pharmacology (CP) in bridging the gap between academic drug evaluation and drug prescribing in primary health care (PHC). As a teaching, research and service discipline CP has developed in academic or other major hospitals while 80% of all drugs are prescribed in PHC. CP therefore has to extend its functions to PHC. Examples are given of how joint ventures between clinical pharmacologists and PHC physicians may improve the quality of drug research and increase the clinical relevance of drug information in PHC, thereby contributing towards rational drug utilization in PHC. Colleagues in PHC are invited to respond to this call for collaboration.

Drug Prescriptions↗