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At least 19 recordsLinked to original sources
PubMed2004

Vectors of tick-borne diseases and epidemiological situation in Latvia in 1993-2002.

During the period of 1993-2002 an increase and the remarkable changes in the incidence of tick-borne encephalitis (TBE) and Lyme borreliosis (LB) as well as annual activities of vector species were noticed. The highest increase of TBE morbidity in Latvia has been observed in 1994 and 1995, and less expressed also in 1998 which was followed by a significant decrease during subsequent years. Whereas the highest peak of LB morbidity has been noticed in 1998 with only a minor decrease during subsequent years. Two epidemiologically significant Ixodes tick species are common in Latvia. Ixodes ricinus L. spread in the western and central part of Latvia; but rarely and in small numbers also in the eastern part. Ixodes persulcatus P. Sch. seems to dominate only in the eastern part of the country. The changes of seasonal and annual activities of I. ricinus were observed in two types of monitoring sites--sylvatic and peridomestic, located in the central part of Latvia. Observations of I. persulcatus were made in the eastern districts. Comparing geographically the Tick-borne diseases (TBD) incidence data for three tick distribution regions (I. ricinus dominated, I. persulcatus dominated and mixed regions), it was observed that the trend of annual changes in LB incidence during the last decade is almost of the same kind for all regions. Whereas TBE incidence extremes in 1994 and 1995 were observed almost only in I. ricinus dominated region. The annual field-collected adult tick infection rate with TBE virus (TBEV) from 1993 to 2002 for I. ricinus adults varied between 1.7% and 26.6% and for I. persulcatus--between 0% and 37.3%. The infection level in ticks removed from humans was much higher and from 1998 to 2002 surpassed 30%. TBEV investigations of removed adults and nymphs in 2002 discovered a high TBEV prevalence also in I. ricinus nymphs (43%). Typing of TBE virus isolated from ticks and patient serum samples in collaboration with German and Swedish virologists revealed that all three TBEV subtypes were co-circulating in Latvia. The mean annual tick infection rate with Borrelia burgdorferi s.l. analysed by means of a nested polymerase chain reaction of OspA gene fragment during the period of 1999-2001 was 18%-38% for I. ricinus adults and 25%-51% for I. persulcatus adults. Typing of Borrelia-positive DNA samples indicated that B. afzelii was dominant in Borrelia-positive I. ricinus (64.9%) and I. persulcatus (81.2%) followed by B. garinii (I. ricinus: 24.3%; in I. persulcatus: 14.5%). Investigations of Ehrlichia phagocytophila genogroup (by nested PCR targeted the 16S rRNA gene) revealed the presence of Ehrlichia sp. in I. ricinus from the central part of Latvia. Obtained data on TBD vectors and the epidemiological situation during the last decade indicates the complex impact of different factors influencing TBE and LB morbidity in Latvia.

Animals↗
PubMed2002

Characterization of tick-borne encephalitis (TBE) foci in Germany and Latvia (1997-2000).

Knowledge concerning the prevalence of the tick-borne encephalitis virus (TBEV) in wild living tick populations is very important for understanding the epidemiology of the disease and for immuno prophylactic strategy. In Germany high and low risk areas of TBE exist. In the years 1997-2000, 533 autochthonous clinical TBE cases were recorded, in the high-risk areas of Bavaria and Baden-Wuerttemberg 140 and 363, and in the low risk areas in Hesse (Odenwald) and Rhineland-Palatinate 22 and 8, respectively. Corresponding to these case reports we have measured the virus prevalence in free living ticks in these four risk areas and compared these findings with the situation in high-risk areas in Latvia. In the years 1997-2000, 2,797 clinical TBE cases were recorded in Latvia. For the studies in Germany, a total of 17,398 Ixodesricinus ticks (14,860 nymphs and 2,538 adults) were collected by flagging and examined for TBEV, in Latvia the corresponding numbers were 525 I. ricinus ticks (350 adults and 175 nymphs) and 281 I. persulcatus ticks (adults only). Information concerning annual and seasonal differences of the TBEV prevalence in natural TBE foci is not available in Germany. This paper is a continuation of the study (Süss et al., 1999), starting in 1997. We investigated every year, in May and September, the virus prevalence in ticks in high risk areas of Bavaria (8 foci) and Baden-Wuerttemberg (5 foci). A total of 15,400 ticks (13,100 nymphs and 2,300 adults) were examined for TBEV. The ticks were tested for the presence of TBEV-RNA using a sensitive, nested-RT-PCR. The virus prevalence in the Bavarian foci of the whole tick population ranged from 0.3 to 2.0% during these four years, in adults between 1.2 and 5.3% and in nymphs between 0.1 and 1.4%. In the high-risk areas of Baden-Wuerttemberg, in the Black Forest, the estimated virus prevalence rates of investigated ticks varied from 0.2 to 3.4%, in adults from 0 to 4.8%, and in nymphs from 0.2 to 3.4%. Using the same methods, we have also tested the low risk areas in the Odenwald (840 nymphs, 160 adults) and in Rhineland-Palatinate (920 nymphs, 78 adults). Ticks were collected in those areas where most TBE cases were registered. The virus prevalence in the Odenwald was 0% in adults and 0.5% in nymphs, whereas in ticks from Rhineland-Palatinate we have not found any positive PCR signal. Sequence data of the PCR products have shown that all strains in Germany were closely related to the central European virus prototype Neudoerfl. In I. ricinus ticks, collected in Riga county, the following virus prevalence rates were found: in females 2.4%, in males 3.7%, and in all adults 3.0%, in nymphs 2.4% and in the I. ricinus tick population examined 2.8%. The virus prevalence in I. persulcatus, collected in the eastern parts of Latvia was 6% in females, 4% in males and 5% in all adults. All the PCR products were sequenced and a phylogenetic tree was constructed. Studies in natural foci of TBE in Latvia have shown that I. ricinus carried the central European virus subtype (prototype Neudoerfl) whereas in I. persulcatus two strains have been found, the central European virus subtype (prototype Neudoerfl) and the Siberian virus subtype (prototype Vasilchenko). Sequences of the Far Eastern subtype have not been detected yet.

Animals↗
PubMed1998

[Industrial medicine in Latvia].

The authors have reflected new trends in occupational health in Latvia. At present the whole system of general health care in Latvia is under consolidation and reconstruction. Thus, the occupational health and safety system of Latvia, as a nature part of general health care system is also under changes and reconstruction. Today Latvia's workforce consist of 1.68 million people, working in a large number of workplaces, mainly in industry and agriculture. There are still very hazardous working conditions in many workplaces. The total number of diagnosed occupational diseases ranges from 90 to 220 cases per year. If counted per 100,000 workers the rates of occupational diseases are 5.1 in 1981 and 23.4 in 1995. New system of occupational health is under development in Latvia. New legislation and regulations are published and extensive training for specialists provided. A new system of information is under construction as well as new hygienic standards. Main stress is paid to ensure that standards of EC are met.

Adult↗
PubMed2001

Characterization of tick-borne encephalitis virus from Latvia: evidence for co-circulation of three distinct subtypes.

Viruses of the tick-borne encephalitis (TBE) antigenic complex within the family Flaviviridae cause a variety of diseases, including uncomplicated febrile illness, meningoencephalitis, and hemorrhagic fever. Different domesticated animals or wildlife species often act as reservoir hosts and ixodid ticks serve as vectors. Although TBE is a serious problem in Latvia, the knowledge concerning TBE virus (TBEV) strains circulating in the country is most limited. Only two strains (Latvia-1-96 isolated from a TBE patient, and RK1424 originating from an Ixodes persulcatus tick), which belonged to the Siberian and the Far Eastern subtypes of TBEV, respectively, have previously been characterized. In the present study, we concentrated on the western and central regions of Latvia, with predominantly Ixodes ricinus ticks. Five virus strains were isolated from serum samples of patients with clinical symptoms of an acute TBE infection. Nucleotide sequences encoding the envelope (E) protein of TBEV, which were recovered from the five TBEV isolates, showed the highest level of identity to the corresponding sequences of the prototype strain Neudoerfl and other European strains of the Western TBEV subtype characterized previously. Accordingly, phylogenetic analysis placed the new Latvian isolates within the Western genetic lineage of TBEV. Taken together with earlier observations, the results proved that all three TBEV subtypes are co-circulating in Latvia and indicated that the genetic diversity of TBEV within certain geographical areas is much more complex than previously believed.

Encephalitis Viruses, Tick-Borne↗
PubMed2006

Determinants of daily smoking in Estonia, Latvia, Lithuania, and Finland in 1994-2002.

AIMS: To investigate time trends in the smoking prevalence and the sociodemographic and psychosocial background of smoking in the Baltic countries in comparison with Finland during 1994-2002. METHODS: Differences in daily smoking according to age, education, urbanization, and psychological distress in the Baltic countries and Finland were studied using postal surveys in 1994, 1996, 1998, 2000, and 2002 among adults (20-64 years old) in Estonia (n = 6,271), Latvia (n = 6,106), Lithuania (n = 9,824), and Finland (n = 15,764). RESULTS: In 1994, 1996, 1998, 2000, and 2002 the prevalence of smoking in Estonia, Latvia, Lithuania, and Finland was 47%, 54%, 46%, and 29% among men, and 21%, 19%, 11%, and 19% among women, respectively. Smoking increased among Lithuanian women from 6% in 1994 to 13% in 2002, but decreased among Estonian men and women. Smoking was generally more common among younger individuals, the less educated, and people with distress in all four countries. The odds ratios for smoking for those with low education compared with those with high education were 2.18 (1.69-2.81), 3.32 (2.55-4.31), 2.20 (1.79-2.70) and 2.80 (2.40-3.27) in men, and 1.90 (1.42-2.52). 3.09 (2.28-4.18), 0.86 (0.59-1.26), and 3.00 (2.53-3.55) in women, in Estonia, Latvia, Lithuania, and Finland, respectively. There were indications of increasing educational differences in Latvian men. Smoking was less common among rural women in all countries except Estonia. CONCLUSIONS: Estonia, Latvia, and Finland show characteristics of the "mature" phase of a smoking epidemic, and smoking may not increase in these countries. In Lithuanian women smoking may increase. Smoking may be increasingly unequally distributed in the future in all the studied countries.

Adult↗
PubMed2000

Characterization of tick-borne encephalitis virus from Latvia.

Viruses of the tick-borne encephalitis (TBE) antigenic complex, within the family Flaviviridae, cause a variety of diseases including uncomplicated febrile illness, encephalitis, meningo-encephalitis, hemorrhagic fever and chronic disease in humans, domesticated animals or wildlife species. TBE is a serious problem in Latvia with up to a 1,000 patients confirmed serologically annually 1994-1995. No previous data had been reported on the causative agent of TBE in Latvia. In the present study, a virus was isolated from serum of a patient with clinical symptoms of an acute TBE infection. Nucleotide sequence information obtained by direct reverse transcription-polymerase chain reaction (RT-PCR) and the serological characteristics of the isolated virus strain, designated TBE-Latvia-1-96, indicated a closer relationship to the Vasilchenko strain, isolated in Novosibirsk (Siberia, Russia), as compared to the western European or far eastern subtypes of TBE viruses. In a mouse neurovirulence assay, a significant difference in survival rates (days) was shown between Latvia-1-96 and the western European TBE virus subtype.

Animals↗
PubMed2006

The main trends in the palaeodemography of the 7th-18th century population of Latvia.

The study represents palaeodemographic research of osteological material of 3304 individuals from the funds of the Anthropological Laboratory of the Institute of History of the University of Latvia in Riga, dating from the 7th to the 18th century AD. Compensated life expectancy at birth is varying between 20.3 and 22.2 years during the research period. Crude mortality has changed between 49.3 and 45% per hundred. In the early period (7th-13th century) there is a significant male prevalence (2.2-1.4); female life expectancy at the age of 20 is on average 6.6 years less than for males. This difference decreases to 5.4 years in the 13th-18th century. According to historical demography, female life span exceeded male only in the 2nd half of 19th century. The palaeodemographic data indicate that in the 7th-18th century, women in Latvia gave birth to a mean of 4-5 children (the figure includes childless women), of whom half, at most 2-2.5, reached reproductive age, on account of high child mortality. The net reproductive rate R0 (the number of descendants per individual of the parents' generation) varies between 1 and 1.25 in the study period. Concerning the completely excavated cemeteries of Lejasbiteni (7th-10h century) and Daudziesi (16th-17th century), it was possible to calculate the size and structure of the populations that had used these cemeteries. They were similar, having 45.3-49.9% of children up to an age of 14 and 24-28% individuals over the age of 30. According to historical demography, radical improvement of the demographic situation in Latvia began in the second half of the 19th century, when the process of demographic transition in Latvia started.

Adolescent↗
PubMed1987

[Pages from the history of roentgenology and radiology in Latvia].

The author discusses the history of roentgenology in Latvia singling out 3 periods in its development: 1) from the discovery of x-rays up to the Great October Socialist Revolution and the establishment of Soviet power in Latvia; 2) the bourgeois period in Latvia (1920-1940); 3) from the beginning of the Great Patriotic War to the present period. The paper is devoted to an analysis of the main historical events and facts pertaining to the formation and further development of roentgenology and radiology in Latvia. The role and importance of the roentgenology and radiology chair and the Republican roentgenoradiological center in the development of roentgenoradiology as independent clinical branches, training of specialists, the development and clinical application of present-day methods of radiation therapy are considered. The chief advances of Latvian radiologists and their contacts with leading specialists are marked.

History, 19th Century↗
PubMed1997

The epidemiology of tuberculosis in Latvia.

An increase in the number of outbreaks of tuberculosis (TB) has been reported during recent years in many parts of the world, including the countries of Eastern Europe and the former USSR. This study was performed with the aim of assessing the current epidemiological situation with respect to TB in Latvia, one of the three Baltic States, in comparison to the previous decades (since 1950), and to evaluate trends in the incidence of TB during recent years. Data on the incidence of TB were obtained from the Tuberculosis Registers and the Information Department of the State TB and Lung Diseases Centre of Latvia. The results of this study show that, in Latvia, a deterioration in the epidemiological situation with respect to TB occurred from 1990 onwards. The incidence of TB and TB mortality rates virtually doubled from 1991 to 1995: from 28.7 to 50.4 and from 6.4 to 14.1 per 100,000 population, respectively. The majority of new TB cases occurred in persons from the economically productive age group, i.e. 25-54 yrs. In 1995, 61% of pulmonary TB patients were found to be sputum and/or culture positive, the rate of primary drug resistance was 19%, and of total drug resistance was 38%. In order to prevent a further deterioration in the epidemiology of TB in Latvia, it is vital to revise the National TB Control Programme according to the recommendations of the World Health Organization (WHO) and International Union Against Tuberculosis and Lung Disease (IUATLD).

Humans↗
PubMed1997

Perinatal problems and quality assurance in Latvia--a country in economic transition.

PURPOSE: To characterize the perinatal situation in Latvia today and to elaborate a program for future perinatal care. METHOD: We have analyzed the causes and structure of perinatal mortality at the Riga Maternity Home (RMH), a tertiary hospital where one-fifth of all Latvia's babies are born, and compared the results with Latvia in general. RESULTS: Since 1991, perinatal mortality has varied between 17 and 23 per 1000 births annually at the ORMH and between 17 and 19 per 1000 births in Latvia as a whole. According to official statistics, perinatal hypoxia is the main cause of perinatal death in about half of the cases. There is a high percentage of antenatal (45%) and intrapartum (12%) deaths. CONCLUSIONS: We have elaborated a number of measures to develop antenatal care and improve the intranatal care for term and preterm infants.

Female↗
PubMed2006

Molecular epidemiology of Trichinella spp. in three Baltic countries: Lithuania, Latvia, and Estonia.

Meat of domestic pigs and wild boars has been the significant source of emerged human trichinellosis in Lithuania, Latvia, and Estonia over the past two decades. However, there is very little known on the occurrence of Trichinella spp. in main wildlife reservoirs and its transmission in domestic and sylvatic cycles in these countries. The present study demonstrated considerably higher endemicity of Trichinella spp. in main sylvatic reservoirs (28.9-42% in foxes (Vulpes vulpes) and raccoon dogs (Nyctereutes procyonoides) in all three countries than previously reported. Molecular identification of Trichinella larvae from more than 500 sylvatic and domestic animals revealed four Trichinella species (Trichinella spiralis, Trichinella britovi, Trichinella nativa, and Trichinella pseudospiralis) sympatric in a relatively small area and several as the first records for the respective countries. The nonencapsulating T. pseudospiralis is found for the first time in the Eastern Europe. Sylvatic T. britovi was found in domestic pigs in Lithuania and Latvia (16 and 57.1%, respectively) and only in these countries, domestic T. spiralis was detected in sylvatic animals in areas where domestic trichinellosis was registered. The study suggests that transmission of Trichinella between domestic and sylvatic cycles in Lithuania and Latvia is favored by improper human behavior, e.g., pig and slaughter waste management.

Animals↗
PubMed2003

Molecular diversity of the coat protein-encoding region of Barley yellow dwarf virus-PAV and Barley yellow dwarf virus-MAV from Latvia and Sweden.

The sequence variability of Barley yellow dwarf virus-PAV (PAV) and Barley yellow dwarf virus-MAV (MAV) was studied by comparing 502 nucleotides from the coat protein-encoding region of six isolates from Latvia and four from Sweden. The diversity within MAV was low (>97% sequence identity), also when compared to isolates from USA and China. In contrast, the variability among PAV isolates was greater and phylogenetic analysis including isolates of a wide geographic origin detected two major clusters, of which both contained isolates from Latvia and Sweden. A new distinct variant of BYDV-PAV was discovered in Latvia, and because of the sequence difference it is proposed to belong to a new species (BYDV-OYV).

Capsid Proteins↗
PubMed2002

Hantavirus infections in Latvia.

In order to investigate the presence of hantavirus infections in Latvia, 333 randomly selected human serum samples were screened using an enzyme-linked immunoassay. Fifteen samples were positive for hantavirus-specific IgG and were subsequently serotyped using a focus reduction neutralization test. Fourteen of these samples neutralized at least one of the hantaviruses included in the test, indicating a 4.2% overall seroprevalence in Latvia. Among 14 focus reduction neutralization test-positive sera, specific reactivity (at least 4-fold higher endpoint titer) of neutralizing antibodies was as follows: six sera were specific for Saaremaa hantavirus, three showed equal titers to Saaremaa and Dobrava hantaviruses, and five showed the highest endpoint titers to Puumala hantavirus. Hantavirus infections were confirmed in individuals residing in 11 of 26 investigated counties. The sex ratio was 1:2.5 (M:F), and the antibody prevalence increased with age. This is the first report on the presence of hantavirus infections in Latvia, and the results indicate that two hantaviruses pathogenic to man, Saaremaa virus and Puumala virus, are widely distributed in this country.

Adult↗
PubMed2004

A population-based study of cervical carcinoma and HPV infection in Latvia.

OBJECTIVES: We wished to quantify the population-based importance of cervical carcinoma risk factors in Latvia. METHODS: Totally, 223 of 224 eligible cases of incident invasive cervical carcinoma were enrolled during July 1998-February 2001 in Latvia. An age-matched sample of 300 healthy control women was selected from the Latvian population registry and 239 of these women (79%) were enrolled. A demographic and life-style questionnaire was completed, cervical brush samples were analyzed for human papillomavirus (HPV) DNA by PCR and serum samples for HPV antibodies. RESULTS: Risk factors for cervical cancer in multivariate analysis were HPV type 16 or 18 DNA positivity (OR = 32.4; CI 95% 16.5-63.6) and living in the capital (OR = 2.4; CI 95% 1.2-4.7). Oral contraceptive use was not a risk factor (OR = 0.4; CI 95% 0.2-1.1). A strong protective effect was found for having had more than three Pap smears in the last 5 years (OR = 0.07 CI 95% 0.03-0.19). CONCLUSIONS: Inadequate population coverage of Pap smears, in spite of excessive smear usage, caused 28.4% of cervical cancers in age groups eligible for screening. HPV type 16 infection was the most important risk factor for cervical cancer in Latvia, with a population-attributable risk percent for all ages of 58.5%.

Adult↗
PubMed1999

Polychlorinated biphenyls and some pesticides in perch (Perca fluviatilis) from inland waters of Latvia.

Polychlorinated biphenyls (PCBs), DDT-related substances, hexachlorocyclohexane (HCH) isomers and hexachlorobenzene (HCB) were analysed in perch (Perca fluviatilis) from Latvian lakes and rivers. DDE is present in the highest concentrations in all samples; 62-170 ng/g lipid weight in perch from rural areas and 460 ng/g in perch from the Riga area. Individual dominating PCB congeners were in the range 16-45 ng/g and 200-210 ng/g, respectively. The degree of contamination of rural areas in Latvia of these organohalogen substances is in the same range as in background areas in Sweden. Riga, the major urban area in Latvia, is shown to be more polluted with PCBs than other areas in Latvia.

Animals↗
PubMed2000

Heavy metals in rivers of Latvia.

Total heavy metal concentrations in waters and sediments (HNO3 digestible Pb, Cu, Co, Ni, Mn, Zn) and their speciation forms in sediments (exchangeable, carbonate bound, iron-manganese oxide bound, organic matter bound and residual) in major and common small watercourses (31 sampling stations) along their flow in Latvia were determined. The metal loads entering the Baltic Sea from Latvia were calculated. Increased metal concentrations were found only in lower reaches of the largest rivers and locally around known industrial pollution sources. Differences in metal concentrations and loads in rivers from different regions of Latvia were related to natural geochemical processes. Metal speciation analysis showed that the dominant metal species are residual metals and those bound to organic matter. Residual and carbonate-bound metal dominated only in rhitral regions of rivers. The concentrations of exchangeable metals increased below pollution sources.

Animals↗
PubMedDate not supplied

Clinical outcome of individualised treatment of multidrug-resistant tuberculosis in Latvia: a retrospective cohort study.

BACKGROUND: Latvia has one of the highest rates of multidrug-resistant tuberculosis (MDRTB). Our aim was to assess treatment outcomes for the first full cohort of MDRTB patients treated under Latvia's DOTS-Plus strategy following WHO guidelines. METHODS: We retrospectively reviewed all civilian patients who began treatment with individualised treatment regimens for pulmonary MDRTB in Latvia between Jan 1, and Dec 31, 2000. We applied treatment outcome definitions for MDRTB, developed by an international expert consensus group, and assessed treatment effectiveness and risk factors associated with poor outcome. FINDINGS: Of the 204 patients assessed, 55 (27%) had been newly diagnosed with MDRTB, and 149 (73%) had earlier been treated with first-line or second-line drugs for this disease. Assessment of treatment outcomes showed that 135 (66%) patients were cured or completed therapy, 14 (7%) died, 26 (13%) defaulted, and treatment failed in 29 (14%). Of the 178 adherent patients, 135 (76%) achieved cure or treatment completion. In a multivariate Cox proportional-hazards model of these patients, independent predictors of poor outcome (death and treatment failure) included having previously received treatment for MDRTB (hazard ratio 5.7, 95% CI 1.9-16.6), the use of five or fewer drugs for 3 months or more (3.2, 1.1-9.6), resistance to ofloxacin (2.6, 1.2-5.4), and body-mass index less than 18.5 at start of treatment (2.3, 1.1-4.9). INTERPRETATION: The DOTS-Plus strategy of identifying and treating patients with MDRTB can be effectively implemented on a nationwide scale in a setting of limited resources.

Adolescent↗
PubMed2004

Socioeconomic health inequalities in Latvia: a cross-sectional study.

AIMS: Socioeconomic health differences have been studied elaborately for many Western societies. Relatively little is know about the social variations in health in the former communist states of Eastern Europe. This study investigated socioeconomic health inequalities in Latvia. METHODS: Cross-sectional analysis was undertaken of the 1999 Norbalt-II Living Conditions Survey, a random population-based sample in Latvia, and included males and females aged 25 to 70. RESULTS: Lower educated subjects had higher rates of self-assessed poor health than those with tertiary education (men OR 2.21; 1.31-3.71 95% CI, and women OR 2.48; 1.74-3.54 95% CI). After adjusting for income, educational differences were significant only for women. Income differences were larger than educational differences in self-assessed poor health for both genders (OR of highest vs. lowest quintile for men: 5.10; 2.26-11.5 95% CI, women: OR 3.26; 1.92-5.51 95% CI). For long-standing health problems socioeconomic differences were smaller. After adjusting for income no educational differences were found, but income differences were significant (men: OR 2.06; 1.15-3.69 95% CI, women: OR 1.42; 1.12-2.63 95% CI). The economically non-active were in worse health than the (self-)employed subjects (men: OR 6.12; 3.65-10.3 95% CI, women: OR 2.79; 1.66-3.39 95% CI). CONCLUSIONS: Substantial social inequalities in self-assessed poor health and longstanding health problems exist in Latvia for both sexes. Inequalities by material circumstances, as measured by income, appear to be larger than educational differences. Economic activity was also strongly associated with health. There were no inequalities with regard to urbanization and ethnic differences were found only for long-standing health problems among women.

Adult↗