Background: The success of human population biobanks are dependent on the publics’ willingness to participate. This research aimed to determine those factors important in determining the public’s intention to donate a biological sample to a publicly funded biobank, and allow that sample to be linked with medical records. Methods: A national sample of 1000 Australians was surveyed via telephonic interviews. Questions included the reported likelihood that respondents would participate in biobank research, ratings of trust in biobanks, beliefs that biobank research will lead to improved health care and general ratings of comfort with blood taking and DNA analysis. Results: The sample reported a high level of trust in university biobanks, a strong belief that biobank research will lead to improved health care and a strong willingness to participate in biobank research. Using structural equation modelling, trust in the biobank was found to be the most important determinant of intention to participate in biobank research, followed by general comfort with blood taking and DNA analysis, belief in health-care benefits and higher education. Gender, age, parental status and experience of genetic conditions were not significantly associated with intention to participate. Conclusions: Australians are generally willing to participate in biobank research, and this is strongly determined by trust. While benefit beliefs and comfort with research are also relevant, higher trust was associated with intention regardless of these factors, suggesting reasons other than concern for improved health care are important in determining the publics’ willingness to participate in biobank research.

Background: Scientific evidence shows that climate change is very likely the product of human behaviour and lifestyle. The effects of climate change on human health are diverse in nature and range from direct effects due to extreme weather events such as heat waves, floods and storms, to indirect effects such as those caused by water and food shortages. Methods: A telephone survey was conducted between January and February 2009, on a stratified representative random sample of the Maltese population over the age of 18 years (N = 310 819). Results: Five hundred and forty-three individuals successfully participated in the survey giving a response rate of 92.7%. The respondent sample was very similar to the target population by gender ( P = 0.977), age (P = 0.767) and district (P = 0.812). The results of the study demonstrate a very strong relationship between the perception of climate change as a threat to health and well-being, support for climate change mitigation policy and a willingness to implement measures to address climate change. Conclusion: The findings of this study show that the perception that climate change may claim lives, cause disease, reduce the standard of living and worsen water shortages, may be the strongest driver behind support for climate change mitigation policy and a willingness to act. It is recommended that, in order to gain more public support, climate change campaigns and risk communication strategies should frame climate change as a threat to human health and general well-being.

Background: The disease burden of the 2009 influenza pandemic has been debated but reliable estimates are lacking. To guide future policy and control, these estimates are necessary. This study uses burden of disease measurements to assess the contribution of the pandemic influenza A(H1N1) virus to the overall burden of disease in the Netherlands. Methods: The burden of disease caused by 2009 pandemic influenza was estimated by calculating Disability Adjusted Life Years (DALY), a composite measure that combines incidence, sequelae and mortality associated with a disease, taking duration and severity into account. Available influenza surveillance data sources (primary care sentinel surveillance, notification data on hospitalizations and deaths and death registries) were used. Besides a baseline scenario, five alternative scenarios were used to assess effects of changing values of input parameters. Results: The baseline scenario showed a loss of 5800 DALY for the Netherlands (35 DALY per 100 000 population). This corresponds to 0.13% of the estimated annual disease burden in the Netherlands and is comparable to the estimated disease burden of seasonal influenza, despite a different age distribution in incidence and mortality of the pandemic compared to seasonal influenza. Conclusions: This disease burden estimate confirmed that, although there was a higher mortality observed among young people, the 2009 pandemic was overall a mild influenza epidemic. The disease burden of this pandemic was comparable to the burden of seasonal influenza in the Netherlands.

Background: Several studies have shown great differences in physicians’ way to sick list. The roles of physician-related factors and local structural factors on the length of the sick leaves have been ambiguous. The aim was to examine the variation in short-term sick-listing practices among primary care physicians. Methods: A questionnaire study with 19 hypothetical patient cases was conducted among 300 Finnish primary care physicians. The effects of both physician related and local structural background variables on sick leave prescribing were studied using univariate and multiple linear regression models. Economic consequences of the variation in sick leave prescribing were estimated. Results: On an average, the overall number of sick leave days prescribed for the entire group of the 19 patient cases was 97.4, varying between 42 and 165 days. The economic consequences to the society of the sick leaves prescribed to them would be 29 442 on average, varying between 11 837 and 51 613. Clinical specialists prescribed shorter sick leaves than general practitioners, with estimated costs of 27 888 and 30 789, respectively. More days of sick leave was prescribed in smaller municipalities than in larger ones. Conclusion: There is a lot of variation in physicians’ sick leave prescribing practices and it depends both on physician-related factors and local structural factors. The speciality status of a physician was the most significant single factor affecting the variation. Notable savings for the society might be possible to achieve by increasing sick-listing education and training.

Background: The study was carried out in order to examine the effect of unemployment on the incidence of disability pension in Iceland by examining changes in this relationship from 1992 to 2007. Methods: The annual incidence of disability pension for the period 1992–2007 was calculated. Correlations and significance tests for the relationship between unemployment rates and disability pension incidence rates were calculated. The relationship was examined for different disease groups. Results: Two big fluctuations occurred in the unemployment rate during the study period with an upswing in unemployment from 1993 to 1995 and in 2002 and 2003. In both cases, there were corresponding increases in the incidence of disability pension. The incidence of disability pension declined again when the level of unemployment went down, even though not to the same extent. Conclusions: Health and mental and physical capability determine the overall incidence of disability pension, but marginal fluctuations over time seem to be related to environmental conditions in the labour market, especially the unemployment rate. The observed disability pension incidence pattern in the two unemployment cycles of the study period indicates mainly that people with impaired health are forced out of the labour market in times of increasing unemployment rather than pointing towards a negative effect of unemployment on health. Our findings indicate that there is a need to strengthen the vocational rehabilitation system in Iceland as well as the support system for employment and social participation.

Background: The aim of this study is to assess the impact of combined work and family demands on all-cause sickness absence and to examine variation in this relationship by occupational grade and gender. Methods: The study sample consists of 13 179 employees of Electricité de France-Gaz de France (EDF-GDF) who were members of the GAZEL occupational cohort in 1995. Combined work and family demands are assessed based on measures of job strain and number of dependants assessed at baseline (1995). Covariates include occupational grade and demographic, behavioural and social variables assessed at baseline. Ratios of sickness absence days to total person-days contributed by each employee were established from administrative data between baseline and the end of follow-up in 2003. Rate ratios across levels of work–family demands were then calculated. Effect modification by gender and grade of employment was tested. Results: In fully adjusted models, individuals with the highest work–family demands had a rate ratio of sickness absence of 1.78 (95% CI 1.47–2.14) compared with low-demand workers. This association was independent of occupational grade and did not vary with gender. Results were not attributable solely to psychiatric sickness absences. Conclusion: High work–family demands at baseline predict long-term all-cause sickness absence across a socio-economically diverse occupational cohort.

Background: The aim of the study was to evaluate trends in intra-individual weight changes over the last four decades in Finland. Methods: Within the eight FINRISK surveys conducted during the years 1972–2007, we identified individuals who had participated, by chance in at least two surveys. First, individuals aged 25–54 years who had undergone a health examination within 10 years of the first examination (n = 2033) were categorized into five cohorts covering different time periods, and the annual weight change was calculated at follow-up. Second, for each individual aged 25–69 years the longest possible follow-up time (5–35 years) was identified (n = 3443), and the corresponding annual weight change was evaluated. Results: Comparing the five cohorts from different time periods, the annual increase in body weight among men between 25- and 54-year old remained stable in the range of 0.27–0.47 kg per year over the decades, whereas women belonging to the most recent cohorts (the 1990s) gained weight at 0.53–0.63 kg per year, which is more than double the oldest cohort’s weight gain of 0.24 kg. Overall, the annual increase in weight was around 0.3 kg in both sexes. The younger participants had a stronger tendency to gain weight than the older, and those with BMI < 25 kg/m2 gained more than overweight or obese individuals. Conclusion: The amount of intra-individual annual increase in body weight among men remained stable over the decades, while it increased among women. The tendency to gain weight was most pronounced among the youngest and among those initially leanest.

Background: Sick-leave is an important source of productivity losses to society. The objective of this study was to investigate the association between body mass index (BMI) status in young adulthood and future sick-leave. Methods: A nation-wide cohort of 43 989 Swedish men (18.7 ± 0.5 years) performing military conscription tests in 1969–70 were followed between 1986 and 2005 regarding sick-leave. BMI was used to define underweight (<18.5), normal weight (18.5–24.9), overweight (25.0–29.9) and obesity (≥30.0). Relative risks of sick-leave were estimated with Cox proportional hazards models adjusted for smoking, socio-economic index and muscular strength, using normal weight as the reference. Results: During 803 684 person-years of follow-up, 488 570 sick-leave episodes were recorded. On average, one short-term (≤7 days) episode occurred every eight person-months, one intermediate-term (8–30 days) every five person-years and one long-term (>30 days) episode every 15 person-years. Overweight was associated with 20% and obesity with >30% risk elevation for episodes ranging from 8 to 30 days [hazard ratio (HR) 1.20; 95% CI 1.15–1.24 and HR 1.35; 95% CI 1.24–1.47, respectively] as well as for episodes >30 days (HR 1.19; 95% CI 1.15–1.23 and HR 1.34; 95% CI 1.24–1.47, respectively) compared to normal weight. Obesity was also associated with an increased risk of sick-leave episodes ≤7 days (HR 1.13; 95% CI 1.09–1.16), but the corresponding risk increase for overweight was very small (HR 1.02; 95% CI 1.00–1.03). Underweight showed increased risk only for short-term episodes (HR 1.05; 95% CI 1.04–1.07). Discussion: Overweight and obesity are associated with increased risk for sick-leave compared to normal weight, especially for sick-leave episodes of longer duration.

Background: Body weight dissatisfaction is a common problem in many modern societies and it appears to have grown over time. This study examined the prevalence and predictors of body weight dissatisfaction among 18- to 79-year-old Icelanders. The distribution of body weight dissatisfaction according to the WHO body mass index criteria for underweight, normal weight, overweight and obesity was also assessed. Methods: The study was based on 5832 participants in the cross-sectional survey ‘Health and Well-Being of Icelanders’, administered by the Public Health Institute in Iceland in the fall of 2007. Results: Around 43% of adult Icelanders are dissatisfied with their own body weight (50% of females; 35% of males) and 72% believe they need to lose weight (80% of females; 63% of males). Despite being in normal range according to the WHO-based BMI criteria, 64% of females in that category believe they need to lose weight. Multivariate results show that indicators of socio-economic status (SES) are not significantly associated with body weight dissatisfaction among females, while among males, those with university education are more often dissatisfied than those with secondary education (OR = 1.5, P < 0.05; for self-perceived need to lose weight, estimates are OR = 1.4, P < 0.05 for females, and OR = 2.5, P < 0.001 for males). Conclusion: The prevalence of body dissatisfaction is so prominent among Icelandic female adults that it can rightfully be labelled a normative discontent in this population.

Background: Obesity has become a health problem in western Europe and Belgium. In Belgium, 54% of the males and 40% of the females are overweight. A high percentage of overweight kids endure teasing because of their weight. The effect of history of teasing on body dissatisfaction and the intention to eat healthy is studied. Methods: In a sample of 239 overweight and obese participants with a history of teasing about their weight, factors contributing to weight-controlling behaviour were studied to gain more insight into the understanding of the lack of such behaviour. By means of a path model, the intention to eat healthy was estimated by body mass index (BMI), social norm, internalization, history of teasing, body dissatisfaction and self-efficacy. Results: History of teasing and social norm had a direct effect on body dissatisfaction as well as an indirect effect through internalization. BMI appeared to have no effects. Both body dissatisfaction and self-efficacy had effects on the intention to eat healthy. Conclusion: Self-efficacy has a large effect on intention to eat healthy and should be heightened. The environmental factors contribute to high body dissatisfaction. This high body dissatisfaction, however, does not have a large effect on the intention to eat healthy.

Background: The purpose of this study was to examine the association between weight status and exposure to bullying among 11-, 13- and 15-year-old Danish school children. Furthermore, the purpose was to investigate the potentially mediating effect of body image. Methods: Data from the Danish contribution to the international cross-sectional research project Health Behaviour in School-aged Children (HBSC) 2002 was used. Data were assessed from questionnaires and 4781 students aged 11-, 13- and 15-years old were included in the analyses. Logistic regression was used for the analyses. Results: The regression analyses showed that overweight and obese students were more exposed to bullying than their normal weight peers. Among boys, odds ratios (ORs) for exposure to bullying were 1.75 (1.18–2.61) in overweight and 1.98 (0.79–4.95) in obese boys compared with normal weight. Among girls, the corresponding ORs were 1.89 (1.25–2.85) in overweight and 2.74 (0.96–7.82) in obese girls. The mediation analyses showed that body image fully mediated the associations between weight status and exposure to bullying in both boys and girls. Conclusions: This study shows that overweight and obese boys and girls are of higher odds of being exposed to bullying than their normal weight peers. Moreover, this study finds that body image may statistically explain this association between overweight and exposure to bullying. However, the study is cross-sectional, and hypotheses of possibilities for opposite causality are possible.

Background: To assess the prevalence of negative body image and weight loss behaviour among children in primary and secondary school. Methods: Data were collected during the routine health assessment, in 10 767 children in the 6th grade (9–10 years) of primary school and the 2nd grade (13–14 years) of secondary school in Utrecht, a province in The Netherlands. Weight loss behaviour and body image were assessed during an interview and weight and height were measured. Results: A total of 7.8% of the boys and 13.9% of the girls of primary school had a negative body image (P < 0.001); 2.9% of the boys and 6.9% girls found themselves too fat, while having a normal body weight (P < 0.001). Weight-loss behaviour is found in 3.7% of the boys and 7.0% of the girls (P < 0.001). At secondary school, 15.8% of the boys and 32.5% of the girls found themselves too fat (P < 0.001). A total of 8.6% of the boys and 27.5% of the girls found themselves too fat, while having a normal body weight (P < 0.001); 4.7% of the boys and 12.9% of the girls with a normal weight showed weight loss behaviour (P < 0.001). Conclusion: A negative body image and weight loss behaviour were already present in 9- to 10-year-old children and among children with a normal weight in The Netherlands. Among secondary school children (13–14 year), the prevalence of a negative body image and of weight loss behaviour was high, especially for girls. Diagnostic tools are needed for youth health-care workers to detect unnecessary weight loss behaviour.

Background: As a part of the National Plan for Measles and Congenital Rubella Elimination, a catch-up campaign targeting children aged 7–14 years with Measles–Mumps–Rubella (MMR) vaccine was conducted during 2004–05 in Tuscany, Central Italy. Methods: To assess the profile of measles and rubella susceptibility, immunoglobulin G antibodies against measles (945 subjects) and rubella (1110 subjects) were detected using two commercial enzyme-linked immunosorbent assay tests in sera from a population aged 1–49 years. Results: Overall immunity towards measles increased in the last years, but the WHO-Euro recommended threshold of susceptibility for elimination was attained only in 2- to 4-year-olds. All fertile women up to 29 years had rates of susceptibility clearly higher than those required by WHO-Euro (5%) to eliminate congenital rubella. Despite the reduction of susceptibility among subjects targeted by the catch-up campaign, continuous efforts to increase immunization coverage are needed to eliminate measles and rubella circulation. Our results are predictive of a high chance of measles and rubella outbreaks because of the accumulation of susceptible individuals. Conclusion: Additional catch-up vaccination strategies targeting the adult population (particularly fertile women) are strongly needed to eliminate the risk of measles and congenital rubella syndrome for future generations.

Background: The government set a series of targets to reduce health inequalities in England by 2010. Primary care has an important role in reducing health inequalities. The aim of the study was to assess the impact of general practice on reducing area-based health inequalities. Methods: Analysis of differences in achievement on clinical indicators between practices in Spearhead and non-Spearhead Primary Care Trusts (PCTs) using data from the Quality and Outcomes Framework (QOF) for 2004/05 and 2005/06, practice characteristics and Spearhead status of PCTs. The study used data on 8339 primary care practices in England. Unweighted mean reported achievement on subset of 26 clinical indicators was calculated. The study analysed differences in achievement by Spearhead status and deprivation in both years and the change between years. Multiple regression analysis of relationship between Spearhead status, income deprivation, reported achievement and other factors also were carried out. Results: Practices in Spearhead PCTs performed worse than practices in non-Spearhead PCTs in both years but showed greater improvement. Among the most deprived practices, there were no differences in QOF achievement between Spearhead and non-Spearhead PCTs. Previous year’s achievement was the strongest predictor of performance. Conclusion: The narrowing in performance between practices in Spearhead and non-Spearhead PCTs may have indirectly contributed to a reduction in area-based health inequalities but the differences are small. The lack of difference between the most deprived practices in Spearhead and non-Spearhead PCTs suggest that area-based initiatives to tackle inequalities have not yet had an observable impact on deprived practices. Unobserved factors explain most of the variation in achievement.

Background: The objective of this study was to evaluate the metric properties of a selection of items of the Primary Care Assessment Tool (PCAT) included into 2006 Catalonia Health Survey and adapted to evaluate experiences of primary care (PC) under population perspective. Methods: This was a cross-sectional study. The study population was composed of non-institutionalized residents of Catalonia over 15 years of age (n = 12 933). The instrument used was a 10-item selection of the adult user’s version of the PCAT (PCAT10-AE). We assessed internal consistency, correlation between items and performed exploratory factor analysis and external validity analysis. Results: The instrument presented adequate internal consistency (0.72). All items showed acceptable correlation with other items that constitute the scale. The single extracted factor explained 64% of the common variance in the responses, allowing the construction of a global index for evaluation of PC. We observed an association between better evaluation of PC and more satisfaction with the health system. Conclusions: Metric analysis supported the integrity and general adequacy of this very short tool included in a population health survey. The global index proposed could be a good measure for assessing and monitoring the adequacy of part of the PC experiences in first-contact care and person-focused care over time, under population perspective. On the other hand, the loss of content as a consequence of the selection of items, suggesting use of the expanded versions of the PCAT-AE whenever a global evaluation of PC is desired and it is possible.

Background: Belgium legalized euthanasia in 2002. Physicians must report each euthanasia case to the Federal Control and Evaluation Committee. This study examines which end-of-life decisions (ELDs) Belgian physicians label ‘euthanasia’, which ELDs they think should be reported and the physician characteristics associated with correct labelling of euthanasia cases, the awareness that they should be reported and the reporting of them. Methods: Five hypothetical cases of ELDs: intensified pain alleviation, palliative/terminal sedation, euthanasia with neuromuscular relaxants, euthanasia with morphine and life-ending without patient request were presented in a cross-sectional survey of 914 physicians in Belgium in 2009. Results: About 19% of physicians did not label a euthanasia case with neuromuscular relaxants ‘euthanasia’, 27% did not know that it should be reported. Most physicians labelled a euthanasia case with morphine ‘intensification of pain and symptom treatment’ (39%) or ‘palliative/terminal sedation’ (37%); 21% of physicians labelled this case ‘euthanasia’. Cases describing other ELDs were sometimes also labelled ‘euthanasia’. Factors associated with a higher likelihood of labelling a euthanasia case correctly were: living in Flanders, being informed about the euthanasia law and having a positive attitude towards societal control over euthanasia. Whether a physician correctly labelled the euthanasia cases strongly determined their reporting knowledge and intentions. Conclusion: There is no consensus among physicians about the labelling of euthanasia and other ELDs, and about which cases must be reported. Mislabelling of ELDs could impede societal control over euthanasia. The provision of better information to physicians appears to be necessary.