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PubMed2000

International assessment of the internal consistency of respiratory symptoms. European Community Respiratory Health Study (ECRHS).

We aimed to assess cross-cultural validity of the reporting of respiratory symptoms in the European Community Respiratory Health Study (ECRHS). A random sample of subjects from the general population (aged 20-44 yr), from 35 centers in 15 countries, answered a questionnaire and underwent allergy tests and airway challenge with methacholine. The overall response rate to the questionnaire was 60% (n = 16,635). Exploratory factor analysis was used to identify how symptoms were grouped (i.e., to specify factor structure), using data from the United Kingdom. Subsequently, a confirmatory factor analysis of the prespecified structure for the United Kingdom was assessed for each country in consecutive nested models, increasing at each step the number of parameters forced to be equal to the United Kingdom, and assessing the goodness of fit. Variables were clustered in the same four groups (factors) in all countries. The four factors, mutually adjusted, were associated with either bronchial responsiveness, atopy, or smoking, which provides coherence for the separation of the four factors. In the confirmatory factor analysis, when the load of each of the symptoms in the corresponding factor was prespecified, all countries except Spain showed an adequate fit; in Spain there were differences in answers concerning asthma treatment. We conclude that the ECRHS multilingual translated respiratory symptoms questionnaire shows high internal consistency, suggesting that international comparisons are not affected by errors due to cross-cultural variations in the reporting of symptoms.

Adult↗
PubMed2002

Tobacco industry strategies for influencing European Community tobacco advertising legislation.

Restrictions on tobacco company advertising and sponsorship are effective parts of tobacco control programmes worldwide. Through Council Directive 98/43/EC, the European Community (EC) sought to end all tobacco advertising and sponsorship in EC member states by 2006. Initially proposed in 1989, the directive was adopted in 1998, and was annulled by the European Court of Justice in 2000 following a protracted lobbying campaign against the directive by a number of interested organisations including European tobacco companies. A new advertising directive was proposed in May, 2001. We reviewed online collections of tobacco industry documents from US tobacco companies made public under the US Master Settlement Agreement of 1998. Documents reviewed dated from 1978 to 1994 and came from Philip Morris, R J Reynolds, and Brown and Williamson (British American Tobacco) collections. We also obtained approximately 15,000 pages of paper records related to British American Tobacco from its documents' depository in Guildford, UK. This information was supplemented with information in the published literature and consultations with European tobacco control experts. The tobacco industry lobbied against Directive 98/43/EC at the level of EC member state governments as well as on a pan-European level. The industry sought to prevent passage of the directive within the EC legislature, to substitute industry-authored proposals in place of the original directive, and if necessary to use litigation to prevent implementation of the directive after its passage. The tobacco industry sought to delay, and eventually defeat, the EC directive on tobacco advertising and sponsorship by seeking to enlist the aid of figures at the highest levels of European politics while at times attempting to conceal the industry's role. An understanding of these proposed strategies can help European health advocates to pass and implement effective future tobacco control legislation.

Advertising↗
PubMed1993

Cancer research in the European Community and other non-EC countries.

AIMS: We assessed the scientific productivity in the field of cancer research of countries in the European Community (EC) and the most important non-EC countries by counting the number of papers published during the period 1988-1990 in 15 of the top scientific journals (as defined by the Journal Citation Reports, Oncology). The global and per capita data are presented for each country. METHODS: Qualitative parameters like the impact factor and the half-life were also considered in the analysis. The selection of cancer journals with a high average quotation rate gave significant results. Introducing the average impact factor and half-life of each journal modified the results only slightly. The per capita data for each country were not corrected for the number of investigators working in oncology (a datum difficult to obtain). The parameters thus do not define the performance of the average investigator but are more "economic" parameters specifically related to the field of cancer research. RESULTS AND CONCLUSIONS: Small, wealthy Western countries tended to have an advantage over large, less developed countries, as expected. However, additional individual differences that could be of interest were present in the group of developed countries.

Canada↗
PubMed1999

A new questionnaire for the repeat of the first stage of the European Community Respiratory Health Survey: a pilot study.

In the early 1990s a multicentre survey on asthma was performed on the young adult population (European Community Respiratory Health Survey - ECRHS). This study is to be repeated in order to estimate changes in the prevalence of asthma-like symptoms during the last decade and to assess the social and economic costs of the disease and their variations among countries. The self-administered questionnaire devised for this purpose is a two-page questionnaire. The first page contains the same items as those used in the first survey with four additional questions related to: 1) the frequency and severity of asthma attacks; 2) the presence of chronic bronchitis; 3) smoking habits; and 4) a visual analogue scale assessing perception of outdoor pollution. The second page aims to collect information regarding the direct and indirect costs of asthma. The influence of the length of the questionnaire on the response rate was assessed in a pilot study in Italy. Two random samples of 150 subjects received either the one-page questionnaire (first page) or the two-page questionnaire. The response rate was compared with that obtained from the first postal wave in the 1991-1992 survey. Although the response rate was unchanged when using the one-page questionnaire (45% versus 45%), it decreased by 7% when the two-page questionnaire was used (38% versus 45%). On the basis of these results, no problem should arise if four more questions are added to the one-page questionnaire. The slight reduction in the response rate of the two-page questionnaire is worrying but could be corrected by the use of telephone interviews.

Adult↗
PubMed1998

Improvement of the quality and comparability of causes-of-death statistics inside the European Community. EUROSTAT Task Force on "causes of death statistics".

BACKGROUND: Cause-of-death statistics are widely used for comparing health characteristics of European Community (EC) countries. Before attempting to interpret between-country differences, it is essential to assess the biases affecting the comparability of the data. EUROSTAT decided to address globally this problem with the objective to improve the quality and comparability of cause-of-death data within the EC. METHODS: The material is based on a review of results of international comparative cause-of-death studies and on specific inquiries among EC. Both cause-of-death certification and codification practices are analysed. Certification is studied comparing the models of death certificates, the type of information captured, certifiers training and querying practices. The different coding systems are analysed (International classification of diseases (ICD) in use, interpretation of the ICD rules, implementation of automated coding systems). RESULTS: International studies on comparability of certification and coding practices between countries are rare. These studies are based on certification of cases histories and recoding of samples of death certificates. Recent studies on respiratory diseases, cancers and diabetes outline differences that influenced on the reported level of mortality. The specific EUROSTAT investigation (1997) outline general discrepancies: models of death certificates, nature and amount of information entered, way to establish the diagnosis, degree of consistency of the certification process, autopsy practices, certifiers practices, implementation of ICD-10 and implementation of automated coding systems. CONCLUSION: EUROSTAT studies are now focused on causes of death requiring special attention for comparability (e.g. suicide, accidental deaths, drug and alcohol related deaths, unknown and ill-defined causes), on procedures to improve the homogeneity of certifiers training and querying practices, on the effect of the transition to ICD-10. The international model of death certificate recommended by the World Health Organization should be adopted as widely as possible. Uniform complementary information (e.g. surgery, pregnancy, autopsy, place of occurrence of accidental deaths, work accident) should also be adopted. The EUROSTAT investigations must result in definitions of common recommendations and guidelines to EC.

Cause of Death↗
PubMed1995

The European Community Directive on the classification and labeling of chemicals for reproductive toxicity.

The classification and labeling of dangerous substances was first introduced in 1967 in the European Community with Council Directive 67/548/EEC, known as the Dangerous Substances Directive. The Sixth Amendment to this directive in 1979 introduced a notification procedure for new chemicals and a requirement for labeling chemicals for toxicity. Three special categories for labeling were for carcinogenicity, mutagenicity, and teratogenicity. The teratogenicity classification was restricted to chemicals inducing teratogenic effects in the classical sense of the word, ie, producing only gross structural malformations. Discussions by expert advisors to the European Commission over several years led to a widening of concern in this area of toxicology and, under the recent Seventh Amendment, the classification of "teratology" has been changed to "toxic to reproduction." This includes adverse effects on fertility, pre- and postnatal development, and lactation, and encompasses not only structural but also functional deficits. This will bring about a major change in the testing requirements to allow adequate classification of chemicals for these other aspects of reproductive toxicity.

European Union↗
PubMed1999

Generational increase of self-reported first attack of asthma in fifteen industrialized countries. European Community Respiratory Health Study (ECRHS).

The prevalence of asthma has increased worldwide. However, there is only local evidence for changes in incidence. Data from the European Community Respiratory Heath Survey (ECRHS) can be analysed to reconstruct trends in incidence from 1946-1991 in cohorts born between 1946-1971 in 35 areas corresponding to 15 countries. The authors report the time trends in self-reported first occurrence of asthma and its geographical distribution. All centres completed the same cross-sectional study in 1991-92. A total of 17,613 individuals (63% of those randomly selected) were included. Recall of age of first asthma attack was recorded at an interview at one point in time in subjects aged 20-44 yrs. Relative risk of asthma by cohort was estimated using survival methods with age as the time scale. Yearly incidence of asthma increased progressively by birth cohort. The relative risks were 1.12 (0.94-1.34), 1.39 (1.17-1.66), 2.01 (1.60-2.51), and 2.33 (1.81-2.98) for the cohorts born in the years 1951-55, 1956-60, 1961-65, and 1966-71, respectively, in comparison with the cohort born in the years 1946-50. The increase occurred concurrently in most of the countries, in both males and females, and both in childhood and adulthood onset asthma. These results are consistent with a generational increase in asthma incidence during the previous decades (explained by both a period and/or a cohort effect), although some of the findings could be explained by generational increases in asthma diagnosis.

Adult↗
PubMed1996

[Immigration from outside the European Community in Campania: results of empirical research in three provinces].

"The study is based on the results of empirical research and deals with non-European Community immigrants living in Campania [Italy]....The essential aspects analyzed in the study refer to immigrants' motivations, place and country of origin, working conditions at home and in the new environment, [and] characteristics of working activity in Campania. The final part deals with social integration and migrants' relations with local institutions. The specific character of Campanian immigration is for many reasons connected with a widespread irregular economy which deeply affects migrants' personal attitudes and strategies." (SUMMARY IN ENG AND FRE)

Acculturation↗
PubMedDate not supplied

ECRHS screening questionnaire scoring: a methodological suggestion for asthma assessment. European Community Health Survey.

Univocal definition and classification of Asthma have always been a matter of discussion, and that is reflected in the difficulty of constructing a measure of pathology severity. The European Community Health Survey is a multinational survey designed to compare the prevalence of asthma in subjects, aged 20 to 44 years, in several European areas. In each participating center a sample of 3000 adults filled a self-administered screening questionnaire composed by 9 dichotomous items. Aim of the present study is to investigate unidimensionality of the ECRHS screening questionnaire and to determine and validate a scoring of asthma-like symptoms seriousness. Dimensionality and scoring was determined through a Homogeneity Analysis by Alternating Least Square; while scoring validation was assessed by a cross validation technique. This study found the existence of a sole dimension underlying the screening questionnaire; furthermore a scoring of asthma-like symptoms seriousness was determined with the indication of a cut-off in order to distinguish between asthma symptomatic and non symptomatic subjects.

Adult↗
PubMed1998

[The situation of classical swine fever in wild boars in the European community and selected aspects of disease transmission].

The situation of classical swine fever (CSF) in Europe is described on the basis of the literature. In the European Community, CSF is present among wild boars in Germany (Federal states Mecklenburg-Western Pomerania, Brandenburg and lower Saxony), in France (Northern Vosges) and in Italy (Regio Emìlìa Romagna in 1997 and Sardinia--enzootically infected). Infected wild boars are important as a source of infection for domestic pigs in Germany. Selected aspects of the transmission of CSF virus from wild boars to domestic pigs and within the wild boar population are discussed. Measures for the eradication of CSF in wild boars are described briefly.

Animals↗
PubMed1976

National Health Survey Systems in the European community.

This paper is based on the report of a conference held in October 1975 to discuss the possibilities for collaborative action between countries of the European Community in conducting various forms of health survey. Health interview surveys offer the principal opportunity for such action, and it may be possible to incorporate health questions into multi-purpose international surveys. Health examination surveys are less likely to be developed widely in the immediate future. Hospital in-patient discharge records are collected routinely in many countries, and further international cooperation seems feasible. These possibilities are now being kept under continuous review by a working party.

Costs and Cost Analysis↗
PubMed1998

Adipose tissue omega-3 and omega-6 fatty acid content and breast cancer in the EURAMIC study. European Community Multicenter Study on Antioxidants, Myocardial Infarction, and Breast Cancer.

The fatty acid content of adipose tissue in postmenopausal breast cancer cases and controls from five European countries in the European Community Multicenter Study on Antioxidants, Myocardial Infarction, and Cancer (EURAMIC) breast cancer study (1991-1992) was used to explore the hypothesis that fatty acids of the omega-3 family inhibit breast cancer and that the degree of inhibition depends on background levels of omega-6 polyunsaturates. Considered in isolation, the level of omega-3 or omega-6 fat in adipose tissue displayed little consistent association with breast cancer across study centers. The ratio of long-chain omega-3 fatty acids to total omega-6 fat showed an inverse association with breast cancer in four of five centers. In Malaga, Spain, the odds ratio for the highest tertile relative to the lowest reached 0.32 (95% confidence interval 0.13-0.82). In this center, total omega-6 fatty acid was strongly associated with breast cancer. With all centers pooled, the odds ratio for long-chain omega-3 to total omega-6 reached 0.80 for the second tertile and 0.65 for the third tertile, a downward trend bordering on statistical significance (p for trend = 0.055). While not definitive, these results provide evidence for the hypothesis that the balance between omega-3 and omega-6 fat may play a role in breast cancer.

Adipose Tissue↗
PubMed1998

Additional Essential Criteria for Quality Systems of Medical Laboratories. European Community Confederation of Clinical Chemistry (EC4) Working Group on Harmonisation of Quality Systems and Accreditation.

Essential Criteria for Quality Systems of Medical Laboratories have been published recently by the European Community Confederation of Clinical Chemistry (EC4) Working Group on Harmonisation of Quality Systems and Accreditation. The Essential Criteria address the majority of critical aspects of quality management in the medical laboratory. They have been accepted by the EC4 General Assembly and are endorsed by the Forum of European Societies for Clinical Chemistry (FESCC). However, a supplement to the Essential Criteria was necessary, addressing two aspects, which are only partly covered by the Essential Criteria: the management of resources and point of care testing. Thus, the EC4 Working Group on Harmonisation of Quality Systems and Accreditation has decided to formulate Additional Essential Criteria for Quality Systems of Medical Laboratories, directed at the issues of management of resources and point of care testing. Criteria on management of resources address financial aspects, information logistics and acceptance by clients. Criteria on point of care testing address responsibilities, education of non-laboratory staff and operational aspects. The Additional Criteria are supplementary to the previously published Essential Criteria and should be read as an integral part of these.

Accreditation↗
PubMed1995

Predictors of spirometric test failure: a comparison of the 1983 and 1993 acceptability criteria from the European Community for Coal and Steel.

OBJECTIVES: To identify, in this general population study, predictors of spirometric test failure on the 1983 and 1993 acceptability criteria from the European Community for Coal and Steel (ECCS). METHODS: All men aged 30-46 years living in western Norway (n = 45,380) were invited to join a cross sectional community survey. Respiratory symptoms, smoking habits, and marital status were found from self administered questionnaires, and measurements of forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were performed with dry wedge bellow spirometers. RESULTS: Altogether 29,611 subjects (65%) participated in this survey. Spirometric recordings were obtained in 26,803 of these (91%) of whom 1.6% failed the 1983 criterion (< or = 300 ml between the two highest FVC values) and 9.5% failed the 1993 criteria (< or = 5% or 100 ml between the two highest FEV1 and the two highest FVC values). Spirometric failures on both criteria were more prevalent in never smokers, single men, and subjects with respiratory symptoms than in ever smokers, married, and asymptomatic subjects. Failure of the 1993 criteria increased with age and declining height. Morning cough and phlegm, breathlessness uphill, attacks of breathlessness, and wheezing were related to failure of the 1993 criteria after adjustment for demographic variables and smoking, whereas only breathlessness uphill was related to failure of the 1983 criterion. CONCLUSIONS: In men aged 30-46 years, spirometric test failures on both the 1983 and 1993 ECCS acceptability criteria occurred more often in never smokers than in smokers and ex-smokers after adjustment for other covariables. Spirometric test failure with the 1993 criteria also varied with height and most respiratory symptoms. The higher failure rates found in non-smokers, in shorter, and in single men could be due to late compression of the airways, smaller lung volumes, and poor general health, respectively.

Adult↗
PubMed1983

A prospective atmospheric emission inventory for cadmium--the European community as a study area.

The quantities of cadmium emitted to the atmosphere from natural and human sources have been estimated for the member states of the European Community, allowing the construction of an atmospheric emission inventory for cadmium at the regional level. A survey of the available emission data was used to calculate an emission factor (g cadmium emitted tonne -1 material consumed or produced) for each source. This value was applied to the most recent consumption or production data for the region to obtain an annual discharge estimate. Predictions of future trends in cadmium emissions from human sources over the next two decades were based on economic forecasts for the process in question. The iron and steel industries and refuse incineration are the two largest sources of airborne cadmium in the region, followed by volcanic action and zinc production. It is forecast that there will be an increase in cadmium emissions over the next two decades due mainly to the iron and steel industries and zinc production. A comparison of the emission estimates obtained in this study with those given in previously published inventories reveal disparities in the source strengths for some processes. In particular, it would appear that cadmium emissions from coal combustion and non-ferrous metal production have been overestimated in some past studies.

Air Pollutants↗
PubMed1996

Variations in the prevalence of respiratory symptoms, self-reported asthma attacks, and use of asthma medication in the European Community Respiratory Health Survey (ECRHS).

Asthma is a common chronic disorder which may be increasing in prevalence. However, little is known of its distribution and determinants. The European Community Respiratory Health Survey (ECRHS) is a multicentre survey of the prevalence, determinants and management of asthma. This paper presents a descriptive account of the variation in self-reported attacks of asthma and asthma symptoms across Europe, and in part fulfils the first aim of the study. A screening questionnaire, including seven questions relating to the 12 month prevalence of symptoms of asthma, was distributed to representative samples of 20-44 year old men and women in 48 centers, predominantly in Western Europe. The median response rate to the questionnaire was 75% but, after removing from the denominator those who were the wrong age, were known to have moved out of the area, or had died, it was 78% (range 54-100). The prevalence of all symptoms varied widely. Although these were generally lower in northern, central and southern Europe and higher in the British Isles, New Zealand, Australia and the United States, there were wide variations even within some countries. Centres with a high prevalence of self-reported attacks of asthma also reported high prevalences of nasal allergies and of waking at night with breathlessness. The use of asthma medication was more common where wheeze and asthma attacks were more frequent. In most centres in The Netherlands, Sweden, New Zealand and the United Kingdom over 80% of those with a diagnosis of asthma were currently using asthma medication. In Italy, France and Spain the rate was generally less than 70%. These data are the best evidence to date that geographical differences in asthma prevalence exist, are substantial and are not an artefact of the use of noncomparable methods.

Adult↗
PubMed1987

Interlaboratory survey of the quality of urinary arsenic and thallium assays in the European community.

The present investigations were performed to assess the feasibility of an international round robin on biological samples, to assess the overall performance of toxicological laboratories in the European Community (EC) and the applicability of analytical methods used. Twelve laboratories representing 10 member countries within the Community, which could be considered to be well qualified for this type of work, participated in this study. The set-up chosen was that of a so-called long-term interlaboratory survey. It appeared that quality assurance by an international round robin is feasible within the EC. The samples consisted of arsenic and thallium, both at a high and a low level and the results of the individual laboratories as well as interlaboratory data are reported. In general, a good overall performance was seen, and the methods used showed acceptable accuracy and precision.

Arsenic↗
PubMed1998

The association of respiratory symptoms and lung function with the use of gas for cooking. European Community Respiratory Health Survey.

The association of respiratory symptoms and lung function with the use of gas for cooking was examined using data collected as part of the European Community Respiratory Health Survey, an international multicentre study. Associations between gas cooking and respiratory symptoms and respiratory function were assessed by logistic and multiple regression models. Tests for interaction were used to examine whether the effect of gas cooking varied between centres and, as there was evidence for this, the average effects were estimated using standard methods for random effects meta-analysis. Data from 5,561 males and 6,029 females living in 23 centres in 11 countries were analysed. There was no significant association found between respiratory symptoms and gas cooking in males. In females the association between some respiratory symptoms and gas cooking varied between centres with an overall positive association with "wheeze in the last 12 months" (odds ratio (OR) 1.24: 95% confidence interval (95% CI) 1.00-1.54) and "wheeze with breathlessness in the last 12 months" (OR 1.33: 95% CI 1.06-1.69). There was no evidence that atopy modified this association. Cooking with gas was associated with airways obstruction in both males and females although the differences failed to reach statistical significance. In some countries the use of gas for cooking is associated with respiratory symptoms suggestive of airways obstruction in females.

Air Pollution, Indoor↗