Effect of dietary fish oil supplementation on peroxidation of serum lipids in patients with non-insulin dependent diabetes mellitus

Target 17 of the Health Policy for Europe calls for the health-damaging consumption of dependence-producing substances such as alcohol, tobacco and psychoactive substances to be significantly reduced in all Member States between the year 1980 and the year 2000. With regard to alcohol, it is suggested that alcohol consumption be reduced by 25%, with particular attention to reducing harmful use. A question posed by a number of Member States is what is the level of per capita alcohol consumption of lowest risk to physical, psychological and social harm. A working group was convened to consider population levels of alcohol consumption with particular reference to the Member States of the European Region of WHO. A basis for understanding population problem experience can be established through the interaction between individual risk and distribution of consumption levels within the population. The working group concluded that public health policy within the European Region should continue to advise decreases of per capita consumption. Even when taking into account coronary heart disease, it can be concluded at the population level, across all ranges of alcohol consumption found in almost all countries of Europe, that a reduction in consumption is linked to better health. However, public health policy concerning alcohol should not be based solely on mortality. All outcomes of drinking, that is mortality, morbidity, social and criminal consequences, as well as quality of life, should be considered. The existing data relating alcohol consumption to health originates from countries primarily with a cultural experience of consuming alcohol. In those countries, where there is a cultural or religious tradition of not consuming alcohol, there can be no public health grounds for recommending alcohol consumption.     

Oral health in Europe with changing socioeconomic structures as seen by the epidemiologist

During the 20th century in Europe remarkable results were obtained in health and social care systems which positively influenced general and oral health. Among others this was favoured by the WHO-initiated multinational movement "Health for all by the year 2000". Political changes in Eastern Europe levelled the way for constructive collaboration also in the field of health promotion. In contrast to this, economic deprivation in all European countries limits the financing of continually increasing costs of dental care. Oral health improved during the last decades, although differences in the health level between socioeconomic classes increased. In Eastern Europe the transformation process towards a new dental care system is quite difficult and is still going on. The establishment of new health-structures depends on socioeconomic resources and has so far attained different levels in various countries. The epidemiological situation also varies greatly. In general, caries prevalence is higher than in Western Europe.     

Scanning the horizon for emerging health technologies. Conclusions from a European Workshop

To share the existing, albeit limited, experience among nations and to explore the feasibility of international collaboration on the identification and early evaluation of health care technologies, an workshop was arranged in September 1997. Twenty-seven policy makers and researchers from twelve countries attended the meeting and concluded that: the policy environment in most European countries is characterized by insufficient data on safety, effectiveness, and cost-effectiveness of health care innovations; that an early warning system is perceived as an essential mechanism for facilitating communication among policy makers, technology experts, and health professionals; and that collaboration on early warning activities might be even more useful than traditional collaboration in health technology assessment.     

Project plan for studies on suicide, attempted suicide, and suicide prevention

Completed and attempted suicide are major public health problems in most western countries. The importance of suicidal behavior as a health problem, particularly among adolescents and young adults, has been emphasized by the European Union, the WHO (Europe), as well as the Finnish authorities. Due to the exceptionally high suicide mortality, suicide prevention has been one of the main targets of Finnish health policy since the late 1980s. However, to develop feasible strategies for suicide prevention, better knowledge of the phenomenon of self-destruction is necessary. The Department of Mental Health of the National Public Health Institute has been actively involved in suicide research and the development of suicide strategies both in Finland and western Europe since 1986. The success is based on a long tradition of suicide research in Finland, the representative and reliable suicide data, a highly motivated research group, and also the necessary economic support by both the National Public Health Institute and the Finnish Academy. This article outlines our groups research plan for the next few years.     

The European Alcohol Action Plan. The Alcohol, Drug and Tobacco Unit. Department of Lifestyles and Health, Regional Office for Europe. World Health Organization. Copenhagen, 1993

The translation to the Spanish language of the European Alcohol Action Plan, from the Regional Office for Europe of the World Health Organization, is presented as a support measure and promotion of its application. The European Alcohol Action Plan calls for a European movement to support actions at the local, national and international levels. The Action Plan calls for the participation of many partners in public, private and voluntary sectors. Its successful implementation will make a clearly recognizable contribution to improve Europeans' health and to prevent the harm done by the use of alcohol. Alcohol is a major public health problem throughout the European Region as a whole. In relation to alcohol, Member States hold two shared commitments. The first one is a commitment to the health policy for Europe, as expressed in the Targets for Health for All, and specifically the target 17 which calls for a 25% reduction in alcohol consumption between 1980 and 2000, with particular attention to reduce its harmful use. The second one is a commitment to the European Alcohol Action Plan which was strongly endorsed at the 1992 Regional Committee as a positive set of guidelines to be followed by the European Member States. Member States, nongovernmental organizations, the European Union, the Council of Europe and the Nordic Council are taking initiatives to reduce the harm produced by the use of alcohol.     

Continuing medical education in Europe: a survey

The Continuing Medical Education (CME) in Europe Project is conducted by the World Federation for Medical Education, in conjunction with the Association for Medical Education in Europe, the Association for Medical Deans in Europe, and the European Office of the World Health Organization, with Upjohn Medical Sciences Liaison Division. The aim of the Project is to promote the development of CME in all European countries. It also has global relevance: all six Regions participated in initiating the Project, and its progress and outcomes will be generalized to the other five Regions. This Project coordinates information about the important developments in CME in all countries of Europe. In addition to this coordinating function, the Project has a dissemination function, promoting knowledge about good examples and CME experience (demonstration projects) in the countries of Europe. A survey was made of the methods of CME in each country, the informants being the members of the Project's CME Task Force. It consists of nominated representatives from the National Associations for Medical Education of countries in the European Region.     

Continuous improvement of oral health in Europe

The oral health action programmes of the WHO Regional Office for Europe (WHO/EURO) comply with the overall European Health Policy and targets for the improvement of health in Europe by the year 2000 (HFA2000) and focus on promotive and preventive care approaches primarily at the community level. Various activities, including the development of guidelines for local action projects, have been established to support WHO/EURO's Member States in initiating preventive oral health care system and introducing the concept of continuous quality development in oral health care. The main focus for Countries of Central and Eastern Europe (CCEE) is to formulate national goals for oral health and to further develop oral health services in the region. Collection of national data using agreed European quality indicators for oral health will form the basis of appropriate monitoring and development of technologies to improve oral health care services and the oral health status at large. The WHO/EURO action programmes aim to implement oral disease prevention and health promotion activities. Guidelines have been established to support individual Member States who intend to establish community-based programmes in accordance with scientifically sound principles and methods. The ORATEL Project (Telematic System for Quality Assurance in Oral Health Care) is part of the Commission of European Communities (CEC) strategy for harmonization and standardization in health care (CEC) Programme for advanced informatics in medicine--AIM/CEC) and ORATEL is the only AIM/CEC project related to oral health. The ORATEL Project aims to improve the oral health status in the European Region through use of appropriate computerized information systems. The Project will support management and administration of dental clinics and will be an integral part of a quality assurance system to promote a standardized level of quality in the field. Its advanced educational and decision-support tools can be used by professionals at all levels of the system. ORATEL possesses tools for aggregating and transmitting data upwards for monitoring and evaluation purposes at local, national and supranational administrative levels.     

Health reforms in Europe

Health care systems share some common features all over Europe both in terms of strengths and weaknesses. Health care reforms have been implemented in Europe to overcome those weaknesses. Contracting as a way of health services provision is an outstanding feature of most reforms. Financing and management changes as a result of contracting are briefly reviewed. The importance of the cultural and economic environment cannot be overstressed and it is wise to implement contracting systems after pilot experiences.     

Self-perceived health in East and West Europe: another European health divide

There is a great, and possibly also a growing, difference in public health between the central, eastern (CEE) and western European countries. Several suggestions have been put forward as explanations for this health divide. A broader framework than one focusing on medical care systems or behavioural patterns is necessary to examine this difference. It will be more fruitful to try to identify social and economic factors at large, as well as specific explanatory factors. The aim of this study is to find out to what extent "The East-West Mortality Divide" was apparent in people's perception of their own health in 1990-1991, as a division in self-perceived health across Europe. If there were indeed differences, the aim is to examine whether or not they can be explained by specific economic and social conditions present in the early 1990s. Data from "World Values Survey 1990" reveal a striking east west divide in self-perceived health among people in the age group 35-64 yr, one of greater size than the gender gap in self-perceived health. The importance of a number of circumstances for people's self-perceived health in the 25 European countries was estimated. The assumption was that any resulting difference between eastern and western European countries could help to explain the health divide. An attempt was made to estimate how much the east-west health divide would be reduced if some of these circumstances were similar in CEE to those in the west. The results indicate that people's participation in civic activities has a positive effect on their health. This effect is recognised especially on a societal level. This supports theories about civic activities and community performance. In western Europe the tradition of the active citizen is more developed than in eastern Europe. People's life control was important for their self-perceived health in almost every European country, both in the west and the east. In the former communist countries, however, people did not feel that they had the same control over their lives as did people in the west. People's economic satisfaction was the most powerful predictor of self-perceived health, both in the eastern and western parts of Europe. The average level of economic satisfaction in 1990 1991 was considerably lower in CEE. If people's influence and economic resources were the same in the former communist countries as in the west, the health divide, according to my estimations, would decrease by something between 10-30%.     

Identification of volatile organic compounds emitted in the field by oilseed rape (Brassica napus ssp. oleifera) over the growing season

There is currently a trend gaining acceptance that explicitly recognizes the need to set priorities for making rational decisions in health policy, respecting at the same time the underlying purpose of health care - to improve people's health. This trend in health policy is referred to as "health targets" although definitions vary considerably. Having been initiated by the World Health Organization in the late 1970s, the international policy on health targets is in the process of renewal to become Health for All in the Twenty-First Century. The new program highlights 10 global targets, from the reduction of worldwide burden of diseases to improvement of access to comprehensive, essential quality care. Countries such as the United Kingdom and Australia have adopted and implemented such programs which basically include cardiovascular, cancer, accidents, and mental health targets. For many countries, however, there are several difficulties in establishing similar programs. One of them is the unavailability of reliable data, although political factors and structure of health systems also play a key role in the creation of health targets. Overall, health targets appear to be a key element in building a strong public health policy, taking into consideration not only the cost of healthcare, but also the outcomes in improving health which is the ultimate goal of health care systems.     

Learning from abroad: the benefits for nursing

Contemporary curriculum guidelines for nurse education advocate the development of a broader European or international perspective. This is enhanced by curriculum changes which now enable student nurses to undertake clinical experience overseas, either for observation or direct participation in health care. Such initiatives are to be welcomed, given the implications of the Maastricht Treaty and the transition to a single European market. Furthermore, changes within Europe and further afield may have an impact on nursing practice at a time when those involved in health care may be facing similar challenges in the UK in terms of diminishing health resources and demographic trends. If nurses are to adapt to these socio-economic challenges and develop pro-active nursing practice they need to be tolerant of cultural issues, and have an understanding of health care in the wider European and international context. The aim of this paper is to discuss the evidence for incorporating a European dimension into nurse education, before examining the benefits for nurses with reference to activities within one department of nursing.     

Health care reforms in Bulgaria: an initial appraisal

Bulgaria is in the process of re-structuring its health care system from one based on command and control to one founded on pluralism. This paper explores the way this transformation is taking place from the comparative perspective of the health care reforms being implemented in Britain and elsewhere. It draws out the lessons that there may be for Bulgaria based on western European experience and concludes with an assessment of the applicability and desirability of relying on the experience of other countries as a precursor for policy development and formulation in another.     

The standard ''Healthcare Information Systems Architecture'' and the DHE middleware

The integration and evolution of existing systems represents one of the most urgent priorities of health care information systems in order to allow the whole organisation to meet the increasing clinical organisational and managerial needs. This paper discusses how an open architecture, based on the introduction of a middleware of common health care-specific services not only reduces the effort necessary for allowing existing systems to interwork, but also automatically establishes a functional and information basis common to the whole organisation, on top of which also new applications can be rapidly developed, natively integrated with the rest of the system. Such architecture has been already formalised through the European standard, defined by the CEN/TC251 prENV 12967-1 'Architecture for Health care Information Systems' (CEN prENV 12967-1 'Health care Information Systems Architecture'). Thanks to the availability of industrial products conforming to the standard, the effectiveness and the validity of this approach has been already demonstrated in practice. For example, through the Hansa collaboration hospitals and industries from countries of the Western and Eastern Europe, as well as of the Middle East use the same industrial middleware (i.e. 'The DHE middleware-Information view'-SPRI, 1998, 'The DHE middleware-Functional view'-SPRI, 1998) for integrating existing systems as well as for developing new applications.     

Psychiatric diseases and their treatment in general practice in Germany. Results of a World Health Organization (WHO) study

As part of an international study initiated by the World Health Organization (WHO) about psychological disorders in primary health care, patients in the Federal Republic of Germany were compared with patients in other European centres. Patients from Germany do not differ from other European patients in respect to sociodemographic variables or psychiatric disorders. The most frequent CIDI-based diagnoses recorded in patients attending general practices are current depressive episodes (8.6%), generalized anxiety disorders (8.5%), neurasthenia (7.5%), and alcohol dependence (6.3%). In 20.9% of the patients at least one psychiatric diagnosis based on ICD-10 was recorded. In Germany significantly lower global ratings of health status are given than in other European centres although there is no difference in diagnostic prevalence rates. The recognition rate, i.e. the agreement between the CIDI-based ICD-10 diagnoses and the recognition as a case by the physician, is 56.2%-60.2%. On the other hand, the CIDI detects 90% of the patients described as psychologically ill by the physicians if subthreshold cases are also counted, or 46.4% if only defined diagnoses are taken into account. There is a significant correlation between severity of the psychiatric disorder and disability in social functioning. In Mainz and in the other European countries the disability rate of patients with a well-defined disorder is between 67.0% and 72.7%, whereas in Berlin this relation is not as clear, because especially in East Berlin there is a higher rate of unemployment in view of the political situation. Drug treatment is prescribed for 16.1% of the patients in primary care for psychiatric disorders. Half the patients recognized by physicians as cases receive medication. In the rest of Europe patients receive significantly more tranquillizers than in Germany, where the use of herbal drugs is more wide spread.     

The identification of new health care technologies by the Health Council of The Netherlands

The article gives a global overview of the 14 years of signposting experience of the Health Council of the Netherlands. The Council signals new health care technologies and emerging health care problems in briefs, comprehensive reports, and bulletins. Its main purpose is to provide the government with timely information to support rational policy decision making.     

Leukemia inhibitory factor involvement in human ulcerative colitis and its potential role in malignant course

This article is based on the report, Anticipating and Assessing Health Care Technology, written in the Netherlands between 1985-88. The project was carried out because of increasing concern in the Dutch Ministry of Health (STG, then WVC) about the costs and benefits of new technologies for health care. At that time, there were no established models for early identification, so the project was not only the most extensive such effort to that date, but had to develop its own methods. Overseen by a special commission, the project staff identified many future and emerging technologies in health care and assessed selected technologies. Although the actual information produced was quickly dated and the project was discontinued in 1988, it did stimulate the Ministry of Health to ask the Dutch Health Council (Gezondheidsraad) to continuously identify important new technologies. The reports also demonstrated the potential usefulness of such an effort to Dutch policy makers, and probably to those in other countries as well.     

The challenges of health care restructuring

Since the late 1980s, virtually every developed, and many developing, countries have re-examined the structure of their health care systems. Health care reform has become a truly global phenomenon with considerable potential for cross-nation lesson-learning. In countries where the state has been the central actor in the health sector, its role is being reassessed and, in some cases, reconfigured. The introduction of market principles to health care is a feature of many countries: market romantics believe markets in health care will improve efficiency, empower consumers, control costs, and overthrow monolithic bureaucracies. But will they? The evidence, such as it is, suggests otherwise. The greatest pressure for change and for introducing markets into health care has been in the relative role of the private sector in the operation, and in some countries also the financing of health care services. But it is not a simple case of the state versus the market. The issues are much more complex and various hybrid models are emerging involving some sort of public-private mix. The move is towards greater diversity and pluralism, an inevitable consequence of which is growing fragmentation in the funding and provision of care with all the associated on-costs in terms of increased coordination and management that this entails. The policy aim is to harness the benefits of market behaviour without also adopting the inherent weaknesses of markets with regard to questions of distributive justice and equity.     

TSH receptor antibody-associated thyroid dysfunction following subacute thyroiditis

The variation in the range of services provided by general practitioners (GPs) is not only related to personal characteristics and features of the country's health care system but also to the geographical circumstances of the practice location. In conurbations health services are more widely available than in the countryside, where GPs often are the only providers. With highly mobile populations and a plentiful supply of doctors, in cities the prevailing regulations for access and use of services are more difficult to maintain. It is also more difficult to control access and thus opportunities for inappropriate use are greater. Against this background an international study was conducted on variation in task profiles of GPs, especially focusing on differences between urban and rural practices. In 1993 standardised questionnaires in the national languages were sent to samples of GPs in 30 countries. Various aspects of service provision were measured as well as practice organisation, location of the practice and personal backgrounds of the GP. Completed questionnaires were received from 7,233 respondents, an overall response rate of 47%. Sources of variation have been analysed by using a two-level model. Rural practices provided more comprehensive services regardless of the health care system. Approximately half of the variation was explained by features of a country's health care system. The GP's position at the point of access to health care was strongly associated with the gatekeeper function controlling access to secondary care. In western countries where the GPs were self employed they had greater involvement in technical procedures and chronic disease management. There was a considerable gap between the task profiles of GPs in eastern and western Europe. We found evidence of a reduced gatekeeper role in inner cities in those countries where GPs held this position. GPs with an estimated overrepresentation of socially deprived people and elderly in the practice population reported a wider range of services. Differences also appeared to be related to factors which are largely controlled by the individual doctor, such as level of training and education, availability of equipment and practice staff. The results have important implications for education, policy development and health care planning both in eastern and western Europe.     

Access to medical care under strain: new pressures in Canada and Australia

Health policy changes intended to achieve cost control in OECD countries run the risk of reintroducing financial barriers to health care. However, although the problems faced are similar, different countries are dealing with the situation in different ways. For example, Canada and Australia, which share many similarities, have taken quite different policy paths in the last decade: Canada has preserved universal access, whereas Australian policy is promoting a two-tier system through the provision of public subsidies for private insurance. The evidence is that country-specific factors such as institutional arrangements, attitudes, and values intersect with economic and financial factors to shape policy outcomes. Moreover, the Canadian and Australian experiences suggest that in relation to access issues, attitudes and values are the key policy determinants.