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PubMed1986

Geographic variation in the incidence of and mortality from inflammatory bowel disease.

The geographic and temporal variations in mortality from Crohn's disease and ulcerative colitis were investigated. The validity of mortality data as indicators of morbidity was tested by comparing the death rates and incidences among different countries. Death rates from Crohn's disease and ulcerative colitis were high in England, Germany, and the Scandinavian countries, and low in the Mediterranean countries. There was a significant correlation between the incidence and mortality of both diseases among different countries. In addition, the incidence and mortality of Crohn's disease were correlated with those of ulcerative colitis. In countries with a low mortality rate from Crohn's disease, the death rates in men tended to be higher than those in women. In contrast, countries with high death rates from Crohn's disease showed female predominance. No such relationship existed for ulcerative colitis. The overall change in mortality rates during the last 20 to 30 years was characterized by a rise of Crohn's disease and a marked fall of ulcerative colitis. In countries with a high mortality rate from Crohn's disease, the death rates started to fall in recent times. The significant correlations between incidence and mortality show that the death rates from both diseases represent reliable indicators of the morbidity and that the severity of the two diseases is similar in different countries. The marked temporal and geographic variations in both incidence and mortality suggest that environmental factors play an important role in the etiology of both diseases.

Adolescent↗
PubMed2004

[Trends in cardiovascular diseases in Bosnia-Herzegovina and some European countries].

In the last twenty years, the European office of WHO with its expert groups designated CVD as a problem of top priority in European health policy. The documents of WHO related to CVD, and their directives to member countries, are illustrated in this paper. The authors emphasize that according to available data, CVDs are cause of 40% of total mortality among the European population above the age of 75. In Bosnia and Herzegovina, CVDs are the leading cause of mortality in the last few years. The difference in incidence and prevalence of CVD among European countries is emphasized in the paper. According to the available data of WHO, the greatest incidence and prevalence of these diseases is in East European and Central European countries and the lowest in Mediterranean countries, with the exception of Bosnia and Herzegovina. The evaluation of the present state of frequency of CVD in Europe and the projection of their trends in some countries until 2020 is given in the paper. An alternative projection of the trends of CVD in Bosnia and Herzegovina, including a variant of application of organized preventive programs, is presented in the paper. Illustrative examples of the effects of preventive programs in some European countries, and possibilities of their application in Bosnia and Herzegovina are presented in this paper. Cost analysis of the application of preventive programs and their effects on the reduction of number of people affected by CVD in the short period until 2010 and 2020 is also elaborated in this paper.

Aged↗
PubMed2006

[Trans fatty acids: foods and effects on health].

Trans fatty acids can be found in foods derived from ruminant animals and foods that contain partially hydrogenated fat such as fast foods. The consumption of trans fatty acids is larger in the United States, Canada, and some European countries than in Japan and Mediterranean countries. The incidence of coronary heart diseases is higher in countries where the consumption of trans fatty is high. Studies show that trans fatty acids can contribute to increase LDL and lipoprotein [a], and to reduce the levels of HDL. In addition, trans isomeric seems to inhibit the action of desaturase enzymes of essential fatty acids (A5- and A6-desaturase) by holding back the biosynthesis of important fatty acids such as arachidonic acid and docosahexaenoic acid (DHA). With respect to pregnant women's and infant's health, concentrations of trans fatty acids ingested by the mother are associated to concentrations found in the maternal milk. Besides the milk, the trans fatty acids can be transferred to the newly born through the placenta. Studies suggest that trans fatty acids can affect intrauterine growth due to the inhibition of the conversion of essential fatty acids by desaturase enzymes. The inhibition of DHA can also cause early atherosclerosis lesion. However, studies on the effects of trans fatty acids on health are still inconclusive and there are no current recommendations on their consumption. Additionally, in Brazil, studies to determine the composition of trans isomeric in foods are still incipient, which indicates a great need of research in this area.

Cardiovascular Diseases↗
PubMed1990

The NT 1311 polymorphism of G6PD: G6PD Mediterranean mutation may have originated independently in Europe and Asia.

A polymorphic site exists in exon 11 of G6PD: in the wild-type enzyme, nucleotide (NT) 1311 is a C, but is some individuals from diverse populations a T is present instead. Nine of 54 X chromosomes from Europeans of mixed origins, nine of 41 X chromosomes of Ashkenazi Jewish subjects, three of 18 X chromosomes of Sicilians, five of 20 African X chromosomes, and nine of 20 Asian Indian X chromosomes had the mutant genotype. In contrast, the mutation was found in only three of 59 Oriental X chromosomes and in three of 30 Central/South American X chromosomes. The mutation was absent from four samples of chimpanzee DNA. Twenty-one of 22 male subjects from Mediterranean countries who had the G6PD Mediterranean 563T genotype investigated in the present study or reported previously had a T at NT 1311. Only one had the normal C at NT 1311. In contrast, both G6PD Mediterranean563T males from the Indian subcontinent had the normal C at NT 1311. These findings suggest that the same mutation at nucleotide 563 giving rise to G6PD Mediterranean may have arisen independently in Europe and in Asia.

Animals↗
PubMed1993

Cardiovascular mortality trends in Spain and Catalonia. Comparisons with Europe.

Cardiovascular mortality trends in Spain during the last 15 years have been reviewed and compared with those observed in other European countries. Future coronary heart disease (CHD) mortality trends in Catalonia have been estimated, and its expected evolution with intervention programmes on the prevalence of hypercholesterolaemia is discussed. The main conclusions are: (a) a reduction in stroke and no changes in CHD mortality in Spain and Catalonia has been observed during recent years; (b) this evolution was similar to that observed in other European countries; (c) Spain, like other Mediterranean countries, shows a peculiar cardiovascular mortality pattern with predominance of stroke over CHD; (d) no spectacular changes in CHD mortality trends during the next few years can be expected in Catalonia, but reductions in the prevalence of hypercholesterolaemia may contribute to modify the stable CHD mortality trends.

Adult↗
PubMed1984

[Population distribution in Algeria: inertia and change].

"This study is an attempt to measure the meaning of the inter-regional movements of population in Algeria during a long period of time (1897-1977). As in the whole of the Mediterranean countries, these movements have resulted in rebalancing the differences in density between mountains and plains. Nevertheless, as a result of demographic growth, the population in the mountains is much denser than it was in 1897. And the populations moving from the mountains have not settled equally in the different types of plains: coastal plains, and amongst them chiefly Algiers, received most of it." (summary in ENG, GER)

Africa↗
PubMed1998

Olive oil, other seasoning fats, and the risk of colorectal carcinoma.

BACKGROUND: An association between fats and colorectal carcinoma has been suggested, but the epidemiologic evidence by type of dietary fat is far less clear. Colorectal carcinoma rates have been relatively low in Mediterranean countries compared with most other Western countries, but the components of the Mediterranean diet responsible for this favorable pattern are unclear. METHODS: The relationship between various added (seasoning) fats and colorectal carcinoma risk was investigated using data from a case-control study conducted between January 1992 and June 1996 in six Italian areas. Cases were 1953 patients with incident, histologically confirmed colorectal carcinoma (1225 of the colon and 728 of the rectum) admitted to the major teaching and general hospitals in the study areas. Controls were 4154 subjects with no history of cancer who were admitted to hospitals in the same catchment areas for acute, nonneoplastic diseases unrelated to the the digestive tract and requiring no long term modifications of diet. Dietary habits were investigated using a validated food frequency questionnaire including 78 items. Lipid intake was estimated by taking into account the content of seasoning lipids in different dishes, the frequency of consumption and portion size of each dish, and individual fat intake patterns. RESULTS: The odds ratios (OR) for successive tertiles of olive oil intake, compared with the lowest one, were 0.87 (95% confidence interval [CI], 0.75-1.01) and 0.83 (95% CI, 0.70-0.99) (chi2trend = 4.49, P = 0.03) when colorectal carcinoma was analyzed as a whole, 0.82 (95% CI, 0.68-0.98) and 0.81 (95% CI, 0.66-0.99) (chi2trend = 4.05, P = 0.04) for colon carcinoma, and 0.96 (95% CI, 0.77-1.19) and 0.88 (95% CI, 0.66-1.12) for rectal carcinoma. For specific seed oils (including sunflower, maize, peanut, and soya), the OR for colorectal carcinoma was 0.91 in the highest tertile of intake, and the corresponding values were 1.01 for mixed seed oils and 0.93 for butter. None of these estimates was significantly different from the unity. Allowance for vegetable intake attenuated the apparent protection from olive oil consumption (OR, 0.94 for colon and 0.97 for rectum for the highest tertile), which still was apparent in younger subjects (OR, 0.82 for colon and 0.69 for rectum). CONCLUSIONS: In this study, seasoning fats did not appear to increase the risk of colorectal carcinoma, and there was little evidence for a differential effect by fat type. If such a differential effect exists, it is minor and could favor olive oil.

Adult↗
PubMed1992

The molecular basis of beta-thalassemia in Turkey.

By using oligonucleotide hybridization, restriction endonuclease analysis and direct sequencing of amplified genomic DNA, we have been able to characterize 18 different mutations in the beta-globin genes of 161 beta-thalassemia homozygotes and 107 beta-thalassemia heterozygotes from Turkey (429 beta-thalassemia chromosomes). Previous studies dealing with beta-thalassemia in Mediterranean countries have shown that, in most Mediterranean populations, only a few mutations are prevalent. In contrast, beta-thalassemia in Turkey does not seem to be associated with a few predominant mutations. The six most frequent alleles, IVS-I-110 (G----A), IVS-I-6(T----C), FSC-8 (-AA), IVS-I-1(G----A), -30(T----A) and FSC-5 (-CT), account for only 69.3% of the disease genes; indeed, all 26 mutations assayed represent 85.8% of the disease genes, confirming the considerable molecular heterogeneity of beta-thalassemia among Turks, and indicating the possible presence of rare, previously undefined, mutations in the population. Two mutations observed in this study, IVS-I-116 (T----G) and Cd44(-C), have not been reported in the Turkish population to date. Since preventive medical services, such as genetic counseling and prenatal diagnosis, are greatly improved by detailed knowledge of the molecular pathology of beta-thalassemia, we strongly believe that the presented data will facilitate the intended establishment of a prenatal diagnosis center, based on DNA analysis, in Turkey.

Alleles↗
PubMedDate not supplied

Prevalence of overweight and obesity in 7-9-year-old Portuguese children: trends in body mass index from 1970-2002.

The aim of this study was to assess the prevalence of overweight and obesity in Portuguese children age 7-9 years and to analyze trends in body mass index (BMI) from 1970-2002. Data were collected from October 2002 to June 2003 in a random sample of Portuguese children. Height and weight were measured and BMI (Kg/m(2)) was calculated. The International Obesity TaskForce (IOTF) cutoffs to define overweight and obesity were used. In the total sample we found 20.3% of overweight children and 11.3% of obese children. These results indicate a prevalence of overweight/obesity of 31.5%. Girls presented higher percentages of overweight than boys except at age 7.5. Girls also showed a higher percentages of obesity than boys except at age 9. From 1970 to 1992 and 1992 to 2002, height, weight, and BMI increased at different velocities: weight increased faster than height, and, consequently, BMI increased more in the last period than in the first one, leading to an increase in obesity values. Compared to published data by IOTF on other European countries, who applied the same methods to define overweight and obesity, Portuguese children showed the second-highest mean values in overweight/obesity. Italy showed the highest values (36%). The present study shows a very high prevalence of overweight/obesity (31.5%) in Portuguese children compared to other European countries. Portugal followed the trend of other Mediterranean countries like Spain (30%), Greece (31%), and Italy (36%). These high values require a national intervention program to control childhood obesity.

Body Height↗
PubMed2001

Hemodialysis in diabetic patients.

Diabetic nephropathy is a leading cause of end-stage renal disease, and its prevalence and incidence vary greatly from country to country, being highest in the United States and Japan. In the United States, diabetic nephropathy accounts for approximately 40% of patients beginning renal replacement therapy. Type 2 diabetes is the largest and fastest-growing single disease that requires dialytic therapy. Most patients succumb to cardiovascular causes, including coronary artery disease and myocardial infarction, sudden death, cardiac failure, and stroke. The survival from cardiovascular complications is relatively better in East Asian countries and to a lesser extent in Mediterranean countries compared with countries that traditionally have higher cardiovascular death rates. Peripheral vascular disease and sepsis contribute to increased morbidity and mortality. Amputation of limbs secondary to peripheral vascular disease in particular has adverse effects on rehabilitation. Asymptomatic hypoglycemia may develop in hemodialysis patients. Such hypoglycemia is not associated with a hormonal balance but is postulated to be due to blunted hormonal response to hypoglycemia. Diabetic muscle infarction is another rare complication attributable to diabetic microangiopathy; magnetic resonance imaging may help in the diagnosis. Risk factors for increased mortality include advanced age, poor glycemic control before starting dialysis, smoking, left ventricular hypertrophy, hypoalbuminemia, and neuropathy, in particular, autonomic dysfunction. In addition to adequate dialysis, it is advisable to achieve tight blood pressure control (at least <140/90 mm Hg and preferably much lower), better blood glucose control (hemoglobin A(1c), <7%), correction of nutritional status, and appropriate foot care.

Aged↗
PubMed2001

Fatty acid composition of plasma lipids in healthy Portuguese children: is the Mediterranean diet disappearing?

BACKGROUND: Adults and children in Mediterranean countries are believed to consume a Mediterranean-type diet which is higher in monounsaturated and n-3 polyunsaturated fatty acids than compared to central and northern parts of Europe and has preventive effects for cardiovascular risks. SUBJECTS AND METHODS: In preschool children from Porto, Portugal (n = 35) and Munich, Germany (n = 18) we determined the plasma phospholipid fatty acid composition considered as a biomarker for dietary fat intake. RESULTS: The plasma phospholipid contents of total saturated fatty acids are similar in both groups, but the Portuguese children have lower values of monounsaturated and n-3 polyunsaturated fatty acids. The results indicate that the food habits of Portuguese children are even less close to the traditional Mediterranean diet than those of German children. CONCLUSIONS: Efforts should be made to encourage young families as well as manufacturers and distributors of food products in Portugal to emphasize traditional Mediterranean food habits, especially in young children.

Biomarkers↗
PubMedDate not supplied

[Human resources of the health system: status and evolution in industrialized countries].

The physician-population ratio is high in the Mediterranean countries: nearly 4 doctors per 1000 population in Spain, more than 4 in Greece, nearly 6 in Italy. In Northern Europe, the ratio is lower. On the other side, as concerns nurses and other paramedical personnels, their ratio is much higher in the Scandinavian countries than in the South of Europe. Since 1945 onwards, all countries in Western Europe and Northern America have steadily increased the number of their health workers. The trend will no doubt continue during the decades ahead. The question is to what extent the current cost containment policies can decelerate this upward trend. As concerns physicians, the future panorama will be different. The "graduate-boom" cohorts of the 70's and 80's will reach their retirement age between 2010 and 2025 and will not be totally replaced. In other words, the (currently) plethoric medical profession will decrease after 2010 in most Western European countries, precisely at a time of growing population aging.

Allied Health Personnel↗
PubMed2004

Regional variability in population acute myocardial infarction cumulative incidence and mortality rates in Spain 1997 and 1998.

BACKGROUND: Myocardial infarction (MI) incidence and mortality display a high geographic variation. AIMS: The objective of the present study was to analyze MI mortality, cumulative incidence rate variability in seven regions of Spain from 1997 to 1998. METHODS AND RESULTS: Standardized methods were used to identify, find, register, and classify MI cases that were classified as definite, possible, insufficient-data MI, and non-MI. The total population of the seven monitored regions was 7,364,682 inhabitants. Of the 11,256 cases fulfilling eligibility criteria to investigate, 10,660 were selected to calculate MI rates: 6554 (61.5%) non-fatal definite MI, 1179 (11.1%) fatal definite MI, 1859 (17.4%) fatal possible MI, 1068 (10.0%) fatal cases with insufficient data. The IBERICA 25-74 years age-standardized cumulative incidence rates for men and women, were 207 (range: 175-252) and 45 (range: 36-65) per 100,000, respectively. The age-standardized mortality rates for men and women, were 73 (range: 62-94) and 20 (range: 13-29) per 100,000, respectively. Age-standardized case-fatality was 31.4 and 24.2% in men aged 25-74 and 35-64 years, respectively, and 32.7 and 27.0%, respectively, in women. CONCLUSIONS: MI cumulative incidence and mortality rates are low compared with other industrialized countries but, vary considerably among regions in a Mediterranean country like Spain.

Adult↗
PubMed1984

Platelet count and mean platelet volume in an Algerian population indicating a low prevalence of Mediterranean macrothrombocytopenia.

Platelet count was 225 X 10(9)/l in 225 healthy male Algerians and 263 X 10(9)/l in 208 females. The mean platelet volume was 9.15 fl in the males and 9.30 in the females. The figures agree with those obtained in a British and an American population, but differed from those of an Australian population of immigrants from Mediterranean countries, essentially Italy and Greece. The prevalence of Mediterranean thrombocytopenia must therefore be low in Algeria.

Algeria↗
PubMed2005

Trauma systems in Europe.

PURPOSE OF REVIEW: The purpose of this review is to evaluate the current state and recent developments of trauma systems in Europe. RECENT FINDINGS: The introduction of a pilot trauma system in the United Kingdom seemed to halve the mortality rate in 6 years. This improvement was thought to result, at least in part, from improved patient care. A comparison of United States and French trauma systems suggested equivalent outcomes among patients who survive to reach the hospital. Epidemiologic studies from Europe show an incidence of 30 to 52 per 1,00,000 per year of major trauma (Injury Severity Score above 15), the vast majority of injuries caused by blunt trauma. The total economic costs of traffic accidents in European countries vary from approximately 7,500 US dollars to 1,20,000 US dollars per injury. SUMMARY: There is little original research on trauma systems in Europe, although some positive effects on mortality of trauma system creation are reported. The level of trauma system development in Europe shows great country-by-country variation. It seems to be in a more advanced stage in the central European countries and less developed in other countries, including the Scandinavian countries, the Baltic states, the United Kingdom, and the Mediterranean countries. In general, specialized trauma surgery training is more advanced in countries with a higher level of trauma system development.

Europe↗
PubMed2003

Secular trends in sex ratios at birth in North America and Europe over the second half of the 20th century.

CONTEXT: A previous study showed that significantly more boys were born in southern latitudes in Europe than in northern latitudes and the converse pattern was observed in North America. OBJECTIVE: This study analyses secular trends in gender ratios for live births over the second half of the 20th century. DESIGN, SETTING, PARTICIPANTS: Analysis was carried out from a World Health Organisation dataset comprising live births over the above period. This included 127034732 North American and 157947117 European live births. MAIN OUTCOME MEASURES: Analysis of trends in gender ratios for countries in both continents. RESULTS: The findings show a highly significant overall decline in male births in both Europe and North America (p<0.0001), particularly in Mexico (p<0.0001). Interestingly, in Europe, male births declined in North European countries (latitude>40 degrees, p<0.0001) while rising in Mediterranean countries (latitude congruent with 35-40 degrees, p<0.0001). These trends produced an overall European male live birth deficit 238693 and a North American deficit of 954714 (total male live birth deficit 1193407). CONCLUSIONS: No reasonable explanation/s for the observed trends have been identified and the causes for these trends may well be multifactorial.

Birth Rate↗
PubMed2004

Reproductive performance and milk production of Assaf sheep in an intensive management system.

The Assaf breed of dairy sheep, a stabilized cross of the Awassi and East Friesian breeds, has replaced the Awassi as the breed of choice in its country of origin, Israel, and has spread to other Mediterranean countries. In Israel the Assaf breed is managed under an intensive production system involving weaning lambs at birth, rearing them artificially, and milking ewes after parturition. There are several breeding periods in the year when ewes are mated following hormonally synchronized estrus. Records of 18,976 lactations from 5 farms were analyzed to investigate factors that influenced Assaf milk and reproductive performance. Lactation curves were fitted to each lactation, and a range of parameters and calculated values were analyzed. Daily milk yield records also were analyzed to describe a typical Assaf lactation and compared with those of the Awassi breed. Factors affecting age at first lambing also were studied. An average Assaf ewe kept under this intensive management regimen was found to produce 334 L of milk during a 173-d lactation. Mean litter size was 1.57 lambs/ewe lambing, and lambing interval was 272 d. Milk production was affected by litter size, with twin- and triplet-bearing ewes producing approximately 20 L more milk per lactation than single-bearing ewes. Day length was the major environmental variable influencing milk yield. The difference between midsummer and midwinter day lengths accounted for a difference in daily milk yield of 0.44 L in favor of summer. Ewe lambs that were mated for the first time at later ages produced more lambs and more milk due to greater early lactation characteristics. Milk production was found to be negatively associated with subsequent reproductive performance. Comparing these results with those from an earlier study in the Awassi breed, the Assaf was found to produce less milk during a shorter lactation than the Awassi, but its greater litter size made it a more profitable breed.

Age Factors↗
PubMed1990

[Family characteristics and the labor market in developed countries: a clear distinction between north and south].

The relationship between family characteristics and the labor market is explored using data concerning 15 OECD countries. Several distinct geographical groupings are identified, including the Mediterranean countries, Scandinavia, North America, and Japan and West Germany. Belgium, France, the Netherlands, and the United Kingdom occupy a middle ground and are less specifically defined. Furthermore, "the statistical map shows a strong relationship which manifests itself in two opposite ways. On the one hand, it shows the link between a traditional family structure and a weak integration of women in the working population (Spain, Ireland), and, on the other hand, it shows a close link between a divided family and the fact women have a paying job, often just part time (Sweden, Denmark)." (SUMMARY IN ENG AND SPA)

Developed Countries↗