Do health behaviour and psychosocial risk factors explain the European east-west gap in health status?

BACKGROUND: Mortality rates are much more favourable in Western European countries than in those of Eastern Europe. Health behaviour and psychosocial factors have been suggested to be important contributors to East-West differences in mortality and health status. METHODS: To compare reported health status as well as health behaviours and psychosocial factors which may be related to unequal health status in different parts of Europe, standardised postal surveys of representative populations samples were conducted in six Eastern and Western European areas. RESULTS: Higher mortality in the eastern populations was associated with more reported morbidity and generally more negative health ratings. Health behaviours and psychosocial factors were also more negative in the East. Multivariate analyses suggested that the East-West difference in health status may be partly explained by differences in health behaviours and psychosocial factors. CONCLUSION: Efforts to promote health in Eastern Europe should concentrate both on the promotion of healthier lifestyles and on improvement of social and economic conditions.

East-west differences in reported preventive practices. A comparative study of six European areas of the WHO-CINDI programme.

BACKGROUND: Differences have been reported in life expectancy and mortality between Eastern and Western European countries. Also, disparities have been found among different European countries or populations concerning the implementation of preventive practices by health professionals. This study analysed the patterns of reported preventive practices in three Eastern European areas and three Western ones. METHODS: Health surveys were carried out in particular geographical area of six countries participating in the project (three Eastern European countries; Russia, Poland and Hungary and three Western European countries; Finland, Germany and Spain). All of them are partners in the WHO-CINDI (Countrywide Integration Non-communicable Diseases Intervention) Programme. Three preventive practices are analysed: reported blood pressure and blood cholesterol measurements and reported antismoking counseling during the last year. Data are presented separately for the general population and for people reporting specific chronic conditions (cardiovascular disease, respiratory disease and/or diabetes mellitus). RESULTS: Blood pressure measurement and antismoking counseling are more frequently reported to be carried out by primary health care physicians in the Eastern European areas while blood cholesterol measurement is more frequently reported in Western European countries. All these preventive activities are more frequently reported to be done among people with chronic conditions than in the population as a whole. CONCLUSIONS: Major differences have been found in reported preventive practices between Eastern and Western European countries. Great potential exists for chronic disease prevention among them.

Effectiveness of a decentralized, community-related approach to reduce cardiovascular disease risk factor levels in Germany.

AIMS: Conventional community-oriented prevention programmes have been moderately successful in reducing cardiovascular disease risk factor levels in the population. Within the German Cardiovascular Prevention Study, a new decentralized and community-related form of preventive intervention was tested. METHODS AND RESULTS: Interested lay people and general practitioners co-operated in developing activities conducive towards a healthier lifestyle in two towns. Changes in risk factor levels were evaluated by repeated surveys of independent cross-sectional samples in two intervention communities (n=3460, baseline; 2561, final). National survey data (n=4788, baseline; 5311, final) were used to describe secular trends. Six years after the onset of intervention activities the following changes in risk factor prevalence for both sexes combined were observed in the intervention communities (95% CI in brackets): smoking -10.5% (-17.6 to -3.4); hypertension -29.0% (-38.1 to -19. 9); total cholesterol >/=250 mg. dl(-1)-8.1% (-15.4 to -0.9). In contrast to a national increase in the prevalence of obesity, this rate remained stable in the intervention communities. CONCLUSION: Initiating preventive activities developed by community members under the responsibility of local doctors is effective in lowering cardiovascular risk factors at community level. Unlike traditional intervention programmes this new approach does not require external funding and guidance.

[CINDI (Countrywide Integrated Noncommunicable Diseases Intervention) in Germany. A model for life style oriented, medical primary care for the population]. / CINDI Germany. Ein Modell zur lebensstilorientierten, ärztlichen Primärversorgung der Bevölkerung.

The WHO project "CINDI" (Country-wide Integrated Noncommunicable Diseases Intervention) is being implemented in 23 European countries and in Canada. The central goal of this project is the development of across-country strategies to combat chronic diseases caused by unhealthy lifestyles. The more Europe grows together the more it will be necessary to have such strategies. The health sector of the individual countries is shaped by cultural and/or civilizatory conditions. Such a strategy has to account for the country's specific shape of the health sector and the experience made in this point has to result in the establishment of structures and the creation of measures across Europe and worldwide. In the first step, members of the CINDI family are to ascertain country specific informations which in the second step should be used for the development of the strategy. The paper refers to the contribution made so far by CINDI Germany with regard to the first step. The "3 Level Conception of Family Physicians"-recommended by the Society of physicians of Germany the model "Community - related behavioural medicine" - which has been developed to put the above mentioned conception into practice - and quality assurance in the framework of medical primary care from the focus of the paper.

Reduction of coronary heart disease risk factors in the German cardiovascular prevention study.

BACKGROUND: In six regions of former West Germany, a community-oriented prevention program for coronary heart disease (CHD) was conducted over a 7-year period. METHODS: In the intervention regions, CHD prevention activities were performed with special emphasis on healthy nutrition, increased physical activity, and reduction of smoking, hypertension, and hypercholesterolemia. The impact of these activities on CHD risk factor trends was observed in three independent samples of the intervention regions. Three independent representative samples of the total West German population were used as a reference. Linear regression models with interaction terms to represent the intervention effects were used to test for differences in risk factor trends. RESULTS: In the pooled intervention regions, a net reduction in mean values of systolic (-2.0%) and diastolic (-2.0%) blood pressure, total serum cholesterol (-1.8%), as well as the percentage of smokers (-6.7%) was observed compared with the nationwide trend. From the major CHD risk factors, only body mass index was not influenced in the intervention population. CONCLUSIONS: The community-oriented German Cardiovascular Prevention program can effectively be used to reduce CHD risk factors in a broad population.

[The Ostringer (Prevention) Model. Results of family medicine supervised "community behavioral medicine"]. / Das Ostringer (Präventions-) Modell. Ergebnisse hausärztlich verantworteter "gemeindebezogener Verhaltensmedizin".

To evaluate the German intervention model of "Community-related Behavioural Medicine" in reducing cardiovascular risk during a major prevention study (phase I) and to investigate the efficiency of a long-term evaluation by establishing a Local Health Information System for which cooperating primary care physicians carry responsibility (phase II). In the intervention city of Bruchsal (GCP evaluation, phase I), the cardiovascular risk factors were reduced: smoking (-9.4%), obesity (-17.1%), hypertension (-51.4%) and hypercholesteremia (-12.8%). In the general practices of Oestringen (LOHIS-evaluation, phase II), the prevalence of smoking, from 1992 to 1994 (-23.8%, p < 0.01) as well as hypertension (-22.2%), p < 0.01) continued to decrease; there was no further reduction of hypercholesteremia and over-weight.

[Nutrition-related risk factors in the elderly]. / Ernährungsbedingte Risikofaktoren im Alter.

In industrialized countries life expectancy in the elderly is decreased mainly by degenerative cardiovascular diseases such as myocardial infarction and stroke. Nutrition, especially excessive intake of calories, unbalanced diets as well as abuse of alcohol and nicotine play an important role in cardiovascular mortality and morbidity just as these factors do in the pathogenesis of certain types of cancer. The National Health Survey 1984/86 in the FRG offers data on the prevalence of such risk factors as elevated body weight, elevated blood pressure, hypercholesterolaemia, cigarette smoking and alcohol consumption in different age groups. This knowledge provides the basis of modern primary health care and health education in order to limit diseases caused by unhealthy nutrition. In this respect the countrywide integrated programme for action called "7 against 7" is not just an important part of primary health care carried out by general practitioners but also an effective instrument in the fight against civilization diseases.

Blood thiocyanate levels and self-reported smoking habits compared in two large cardiovascular population studies.

In two representative population surveys (n1 = 1712, n2 = 3757, age-range: 25-64 years) from six towns in Northern Badenia (FRG) self-reported smoking habits and blood thiocyanate levels were compared. In Survey 1 the smoking prevalence was 44.1% in males and 32.9% in females, in Survey 2 45.0% in males and 26.5% in females. In agreement with previous studies it was proved that thiocyanate measurements allow to distinguish groups of non-smokers from smokers, whilst not being specific enough to reflect precisely the quantity of tobacco consumption of the individual. A quadratic regression of thiocyanate levels on cigarette consumption provided a better fit and a higher correlation coefficient than linear regression, indicating a saturation effect, i.e., there is no further increase of thiocyanate levels when more than about 30 cigarettes daily are consumed.

First results from the MONICA stroke register in Heidelberg.

The Stroke Register was established in 1984 in Heidelberg, as a part of the MONICA Project, covering the same population (approximately 601,000) as the Acute Myocardial Infarction Register. In the present analysis, the data for men and women (aged 25-64) for 1985 and 1986 are presented. During the two years, 303 men and 143 women were registered. The overall age-standardized attack rate was 127.2/100,000 for men and 52.8/100,000 for women, and the age-standardized incidence was 97.4/100,000 in men and 42.9/100,000 in women. The proportion of first stroke was 76.5% in men and 81% in women. The 28-days mortality was 12% for men and 19% for women. Hypertension, diabetes mellitus, smoking and heart disease (coronary heart disease, rhythm disturbances) were identified as risk factors for stroke. Among the registered victims of stroke, 61% of the men and 67% of the women had a history of hypertension. In men, a high prevalence of smokers, 54% was found (33.9% in the total population in the same age range). In women, the prevalence of smokers is nearly the same as in the total population. Diabetes mellitus was present in 23% of men and in 40% of women, and hyperlipidaemia in 30% of men and in 18% of women.

Variation in coronary risk factor levels of men and women between the German-speaking MONICA centres.

The aim of this analysis was to compare levels of risk factors for coronary heart disease (CHD) in men and women aged 25-64 years between German-speaking MONICA collaborating centres, the German Democratic Republic (GDR), Augsburg - the Federal Republic of Germany (FRG)(Au), Bremen - FRG (Br), Heidelberg - FRG (He), and Vaud/Fribourg - Switzerland (CH, with a German-speaking minority). Prevalence of cigarette smoking in men showed little variation in four centres (34 to 40%) and was higher in BR men (49%), while it varied from 17% (GDR) to 33% (BR) in women. Mean total serum cholesterol values (mmol/L) were highest in GDR and CH men (both 6.2) and GDR women (6.1), and lowest in both He men (5.7) and He women (5.6). The proportion with cholesterol values greater than or equal to 6.7 mmol/L was largest in CH men (34%) and smallest in FRG (He) women (17%), while lowering the cut-off point from 6.7 to 6.5 mmol/L raised the prevalence of hypercholesterolaemia in all centres by 5 to 10%. Mean values (mmHg) of blood pressure (BP) were highest in both GDR men (140/88) and women (138/86), as was the prevalence of hypertensive BP values. In all centres, women aged 25-34 had BP values approximately 12/5 mmHg lower than age-matched men, but BP values similar to men at age 55-64, which indicates that age-parallel increase in BP was steeper in women than men.(ABSTRACT TRUNCATED AT 250 WORDS)

[Modification of the risk profile of obese essential hypertensive patients by the group "hypertension discussion" program]. / Beeinflussung des Risikoprofils von adipösen essentiellen Hypertonikern durch das Gruppenprogramm "Hypertonie im Gespräch".

The programme "Discussions on Hypertension" is a programme for group treatment of obese essential hypertensives in medical practices on the basis of behavioural therapy. A co-operation model was developed between the Department for General Medicine of the "Medizinische Hochschule Hannover", the Institute for Medical Psychology of the "Philipps-Universität Marburg" and the company Galenus Mannheim and was offered to doctors in general practice. The effects of the programme on the modifying of the risk profile for coronary heart disease was investigated in a controlled study in 137 patients by nine general practitioners. 81 patients were enrolled in the experimental group and 56 patients were assigned to a control group that was not using the programme. The experimental and control groups were comparable with respect to sociodemographic, psychological and medical parameters. Three months after completing the programme, the results of the study was shown in specific effect both on the psychological criteria of success (well-being, health knowledge, healthy behaviour, salt use and compliance) and in a reduction of the diastolic blood pressure in spite of a reduction of the antihypertensive drug treatment. The blood lipid levels (cholesterol and triglycerides) and the blood glucose level were also favourably affected. Patients in the experimental group had reduced their weight by an average of 5.6 kg. The patients in the control group only by 0.8 kg. Overall, there was a marked reduction in the proportion of patients with several risk factors in the experimental group, so that the programme can be attributed a preventive effect.

The Eberbach/Wiesloch Study: lipoprotein profiles of 35- to 49-year-old men and women.

Plasma lipid- and lipoprotein profiles of a representative sample of men and women aged 35 to 49 years in the Federal Republik of Germany were investigated. Mean plasma cholesterol levels, triglyceride levels, and phospholipid levels were significantly higher in men than in women. An extensive investigation of plasma lipoproteins, including measurement of all major apolipoproteins and lipids in each density class revealed profound sex differences in the distribution and composition of lipoproteins. In men mean plasma levels of VLDL-cholesterol (33.20 mg/dl) and of VLDL-triglycerides (155 mg/dl) were three times as high as in women (11.38 mg/dl and 50.08 mg/dl, respectively). The relative amount of triglyceride was 15% higher in VLDL of men, due to decreased relative amounts of VLDL-phospholipids. Intermediate-density lipoproteins (IDL) were significantly higher in men. Men had also higher levels of Apo B in low-density lipoproteins (LDL). Interestingly, LDL-cholesterol levels of men and women were not significantly different. Women had more high-density lipoproteins (HDL), and the absolute and relative amounts of HDL2-cholesterol were significantly higher in women. In summary, besides well-known sex differences in plasma lipid levels, sex-specific differences in the levels of certain plasma lipoproteins were observed. The most important finding was that the composition of the lipoproteins showed profound differences between men and women. With regard to risk for atherosclerotic cardiovascular disease, women have more favorable lipoprotein profiles than men. These data may provide a basis for further investigations on alterations in plasma lipid and lipoprotein profiles in respect to risk for atherosclerotic cardiovascular disease.

[Coronary risk factors and extent of angiographically proven coronary artery stenoses (author's transl)]. / Beziehungen von "Risikofaktoren" der Arterioskelrose zum Schweregrad der angiographisch nachweisbaren Koronarsklerose.

In 196 patients with angina pectoris selective coronary angiography was performed, and the extent of angiographically proven coronary artery stenoses was described by means of a coronary score. A significant correlation between the degree of atherosclerotic lesions on the one hand and hypertriglyceridemia, hypercholesterolemia as well as smoking habits on the other hand was detected. No correlation between other risk factors, such as hypertension, diabetes mellitus, hyperuricemia and obesity, and the coronary score was observed.