The changing association between socioeconomic circumstances and the incidence of colorectal cancer: a population-based study

Background:There is emerging evidence to suggest that the association between socioeconomic circumstances and colorectal cancer incidence has changed over recent decades.Methods:We conducted a descriptive population-based study to describe the relationship between socioeconomic circumstances and the incidence of colorectal cancer in a pre-screened population. Incident cases of colorectal cancer from the West of Scotland were identified from the Scottish Cancer Registry and European age-standardised incidence rates (EASR) were calculated. Socioeconomic circumstances were measured using the area-based Scottish Index of Multiple Deprivation (SIMD).Results:In total, 14?051 incident cases of colorectal cancer were recorded from 1999 to 2007. Incidence of colorectal cancer was associated with increased deprivation in men but not among women; an association that became evident from 2005 onwards. From 2005 to 2007, the deprivation gap in incidence among men was 13.3 per 100?000 (95% confidence interval 3.2-23.4), with rates 19.5% lower among the least deprived compared with the most deprived. This deprivation gap now accounts for an estimated 75 excess cases per year of male colorectal cancer in the West of Scotland.Conclusion:Deprivation was associated with higher incidence rates of male, but not female, colorectal cancer before the implementation of a national bowel screening programme

Investigation of relative risk estimates from studies of the same population with contrasting response rates and designs

Background: There is little empirical evidence regarding the generalisability of relative risk estimates from studies which have relatively low response rates or are of limited representativeness. The aim of this study was to investigate variation in exposure-outcome relationships in studies of the same population with different response rates and designs by comparing estimates from the 45 and Up Study, a population-based cohort study (self-administered postal questionnaire, response rate 18%), and the New South Wales Population Health Survey (PHS) (computer-assisted telephone interview, response rate ~60%). Methods: Logistic regression analysis of questionnaire data from 45 and Up Study participants (n = 101,812) and 2006/ 2007 PHS participants (n = 14,796) was used to calculate prevalence estimates and odds ratios (ORs) for comparable variables, adjusting for age, sex and remoteness. ORs were compared using Wald tests modelling each study separately, with and without sampling weights. Results: Prevalence of some outcomes (smoking, private health insurance, diabetes, hypertension, asthma) varied between the two studies. For highly comparable questionnaire items, exposure-outcome relationship patterns were almost identical between the studies and ORs for eight of the ten relationships examined did not differ significantly. For questionnaire items that were only moderately comparable, the nature of the observed relationships did not differ materially between the two studies, although many ORs differed significantly. Conclusions: These findings show that for a broad range of risk factors, two studies of the same population with varying response rate, sampling frame and mode of questionnaire administration yielded consistent estimates of exposure-outcome relationships. However, ORs varied between the studies where they did not use identical questionnaire items

The effect of a comprehensive lifestyle intervention on cardiovascular risk factors in pharmacologically treated patients with stable cardiovascular disease compared to usual care: a randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>The additional benefit of lifestyle interventions in patients receiving cardioprotective drug treatment to improve cardiovascular risk profile is not fully established.</p> <p>The objective was to evaluate the effectiveness of a target-driven multidisciplinary structured lifestyle intervention programme of 6 months duration aimed at maximum reduction of cardiovascular risk factors in patients with cardiovascular disease (CVD) compared with usual care.</p> <p>Methods</p> <p>A single centre, two arm, parallel group randomised controlled trial was performed. Patients with stable established CVD and at least one lifestyle-related risk factor were recruited from the vascular and cardiology outpatient departments of the university hospital. Blocked randomisation was used to allocate patients to the intervention (n = 71) or control group (n = 75) using an on-site computer system combined with allocations in computer-generated tables of random numbers kept in a locked computer file. The intervention group received the comprehensive lifestyle intervention offered in a specialised outpatient clinic in addition to usual care. The control group continued to receive usual care. Outcome measures were the lifestyle-related cardiovascular risk factors: smoking, physical activity, physical fitness, diet, blood pressure, plasma total/HDL/LDL cholesterol concentrations, BMI, waist circumference, and changes in medication.</p> <p>Results</p> <p>The intervention led to increased physical activity/fitness levels and an improved cardiovascular risk factor profile (reduced BMI and waist circumference). In this setting, cardiovascular risk management for blood pressure and lipid levels by prophylactic treatment for CVD in usual care was already close to optimal as reflected in baseline levels. There was no significant improvement in any other risk factor.</p> <p>Conclusions</p> <p>Even in CVD patients receiving good clinical care and using cardioprotective drug treatment, a comprehensive lifestyle intervention had a beneficial effect on some cardiovascular risk factors. In the present era of cardiovascular therapy and with the increasing numbers of overweight and physically inactive patients, this study confirms the importance of risk factor control through lifestyle modification as a supplement to more intensified drug treatment in patients with CVD.</p> <p>Trial registration</p> <p>ISRCTN69776211 at <url>http://www.controlled-trials.com</url></p

HABITAT: A longitudinal multilevel study of physical activity change in mid-aged adults

Purpose. To explore the role of the neighborhood environment in supporting walking Design. Cross sectional study of 10,286 residents of 200 neighborhoods. Participants were selected using a stratified two-stage cluster design. Data were collected by mail survey (68.5% response rate). Setting. The Brisbane City Local Government Area, Australia, 2007. Subjects. Brisbane residents aged 40 to 65 years. Measures. Environmental: street connectivity, residential density, hilliness, tree coverage, bikeways, and street lights within a one kilometer circular buffer from each resident’s home; and network distance to nearest river or coast, public transport, shop, and park. Walking: minutes in the previous week categorized as < 30 minutes, ≥ 30 < 90 minutes, ≥ 90 < 150 minutes, ≥ 150 < 300 minutes, and ≥ 300 minutes. Analysis. The association between each neighborhood characteristic and walking was examined using multilevel multinomial logistic regression and the model parameters were estimated using Markov chain Monte Carlo simulation. Results. After adjustment for individual factors, the likelihood of walking for more than 300 minutes (relative to <30 minutes) was highest in areas with the most connectivity (OR=1.93, 99% CI 1.32-2.80), the greatest residential density (OR=1.47, 99% CI 1.02-2.12), the least tree coverage (OR=1.69, 99% CI 1.13-2.51), the most bikeways (OR=1.60, 99% CI 1.16-2.21), and the most street lights (OR=1.50, 99% CI 1.07-2.11). The likelihood of walking for more than 300 minutes was also higher among those who lived closest to a river or the coast (OR=2.06, 99% CI 1.41-3.02). Conclusion. The likelihood of meeting (and exceeding) physical activity recommendations on the basis of walking was higher in neighborhoods with greater street connectivity and residential density, more street lights and bikeways, closer proximity to waterways, and less tree coverage. Interventions targeting these neighborhood characteristics may lead to improved environmental quality as well as lower rates of overweight and obesity and associated chromic disease

Sense of Coherence and Gambling: Exploring the Relationship Between Sense of Coherence, Gambling Behaviour and Gambling-Related Harm

Understanding why some people experience problems with gambling whilst others are able to restrict gambling to recreational levels is still largely unexplained. One potential explanation is through salutogenesis, which is a health promotion approach of understanding factors which move people towards health rather than disease. An important aspect of salutogenesis is sense of coherence. Individuals with stronger sense of coherence perceive their environment as comprehensible, manageable and meaningful. The present study examined the relationship of individuals’ sense of coherence on their gambling behaviour and experience of gambling related harm. This exploratory study utilised an archival dataset (n = 1236) from an online, cross sectional survey of people who had experienced negative consequences from gambling. In general, a stronger sense of coherence was related to lower problem gambling severity. When gambling behaviour was controlled for, sense of coherence was significantly related to the experience of individual gambling harms. A strong sense of coherence can be seen as a protective factor against problematic gambling behaviour, and subsequent gambling related harms. These findings support the value of both primary and tertiary prevention strategies that strengthen sense of coherence as a harm minimisation strategy. The present study demonstrates the potential value of, and provides clear direction for, considering sense of coherence in order to understand gambling-related issues.This study was funded by the Victorian Responsible Gambling Foundation, Grant VRGF1-13

'Make a better choice' portal: Framework Report, 2005

Since September 2004 RIVM's Centre for Public Health Forecasting (VTV) in the Netherlands has been working on the development of an Internet portal for the general public called kiesBeter.nl ('Make a better choice'). Via this portal, consumers will have access to integrated information on health, care and healthcare-insurance services, and be able to get answers to their questions on these items. Members of the public always have a lot of questions on disease, treatment and healthcare insurance. The planned changes in the healthcare system will also mean that consumers/patients will have to make more of their own decisions on healthcare insurance and treatment. People will therefore need more accurate information to be able to make choices. KiesBeter.nl hopes to satisfy this need by supplying easily accessible and reliable information on health and care. Here, we present the 2005 detailed draft programme for kiesBeter.nl, including a guide to healthcare insurance, costs of medicines, hospitals, physicians, nursing services, care and homecare facilities, and care for the mentally retarded. The information service for reporting complaints and illnesses, and information on illness, and preventive and patient organizations is expected to be up and running in the course of 2005. The specific needs of visitors to the site will continue to be inventoried during construction and development of the portal. However, making material accessible to the general public demands sound knowledge and skills in communication, marketing & marketing research - all points that will be receiving extra attention.Sinds september 2004 werkt het centrum voor Volksgezondheid Toekomst Verkenningen van het RIVM aan kiesBeter.nl. Dit is de naam van de te ontwikkelen portal waar consumenten toegang wordt geboden tot samenhangende en vraaggerichte informatie over gezondheid, zorg en zorgverzekeringen. Burgers hebben veel vragen over de zorg, over ziektes, behandelingen of verzekeringen. De op stapel staande veranderingen in het zorgstelsel leggen de keuzes voor zorgverzekeringen en behandelingen steeds dichter bij de consument / patient. Om deze keuzes verantwoord te kunnen maken is het noodzakelijk dat men over de juiste informatie beschikt. KiesBeter.nl zal op een eenvoudige manier betrouwbare informatie over zorg en gezondheid presenteren. In dit ontwerprapport presenteren we de uitgewerkte plannen voor kiesBeter.nl in 2005. Op de agenda staan een keuzegids voor zorgverzekeringen, medicijnkosten, ziekenhuizen, verpleging, verzorging en thuiszorg, gehandicaptenzorg, geestelijke gezondheidszorg en huisartsen. Ook informatie met betrekking tot klachten, ziekten, preventie en patienten- en consumentenorganisaties wordt in de loop van 2005 via kiesBeter.nl gepresenteerd. Tijdens de bouw en de verdere ontwikkeling van kiesBeter.nl zal steeds nagegaan worden aan welke informatie de gebruikers behoefte hebben. Het doel is kiesBeter.nl zo te ontwikkelen, dat consumenten met vragen over gezondheid en zorg zich als eerste richten tot kiesBeter.nl. Het toegankelijk maken van beschikbare informatie voor burgers vereist goede kennis en vaardigheden op het gebied van marktonderzoek, marketing en communicatie. Hier zal dan ook speciaal aandacht aan worden besteed

Progress report 2003, local and national monitor of public health

In 2002 is het project "Lokale en Nationale Monitor Volksgezondheid" (Monitor VGZ) van start gegaan. Het project is een samenwerking tussen GGD'en, het RIVM en GGD Nederland. Met dit project wordt een basis gelegd voor continue monitoring van de belangrijkste indicatoren van de gezondheid op lokaal en landelijk niveau. Het project is erop gericht de lokale gegevensverzamelingen die plaatsvinden bij GGD'en, op elkaar af te stemmen zodat na samenvoeging een nationaal beeld kan worden verkregen. Gegevens uit diverse regio's kunnen dan tevens onderling vergeleken worden, en de vergelijking met landelijke referentiecijfers behoort tot de mogelijkheden. In deze voortgangsrapportage 2003 wordt een beschrijving gegeven van de projectstructuur, van de in 2003 geplande en uitgevoerde activiteiten en van de planning voor 2004. De activiteiten van 2003 hadden vooral betrekking op de ontwikkeling van standaardvraagstellingen en van een ondersteuningsstructuur. De ondersteuningsstructuur is nodig voor het opslaan van de lokaal verzamelde gegevens, het creeren en toegankelijk maken van landelijke referentiecijfers en het ter beschikking stellen van verschillende datasets.The project "Local and National Public Health Monitor" was launched in 2002 as a joint venture of the regional Community Health Services, the National Institute of Public Health and the Environment, and the Netherlands Association of Community Health Services. Its major aim is to bring about a uniform collection of regional data by the Community Health Services. This will enable both a comparison of regional data and a comparison of regional with national reference data, ultimately to support health policies at a local and national level. The project also entails the development of a support structure and database, to store the information collected and to generate national and regional reference data. This progress report describes the structure of the project, the activities performed in 2003 and the activities planned for 2004. The activities carried out in 2003 include the design of standardised questionnaires for a uniform data collection, and the development of the support structure. The activities planned for 2004 include the standardisation of questionnaires, the further development of the support structure and the enhancement of methodological support.VWS-POG VW