Caries experience and oral health behaviour among 11 -13-year-olds: an ecological study of data from 27 European countries, Israel, Canada and USA.

OBJECTIVE: This study is a part of the cross-national survey on health behaviour in school-aged children (HBSC) - World Health Organization Collaborative Study. The aim was to compare the HBSC data on frequency of toothbrushing, consumption of sweets, soft drinks, fruits and vegetables among 11-13-year-old children in different countries and to estimate the relation of these factors with caries experience at the country level. METHODS: Oral health behaviour patterns were assessed from the HBSC survey conducted in the 2001-2002 school year in 27 countries in Europe, Israel, Canada, and the USA. PARTICIPANTS: Representative samples of 11- and 13-year-old schoolchildren were drawn from participating countries and aggregated by the direct age standardisation method. DMFT of 12-year-olds was collected from the international data banks and recent publications. Statistical analysis was performed using multiple linear regression. RESULTS: The most significant factor related with the cross-regional variation of DMFT was the proportion of children who reported regular toothbrushing; it explained 26.3% of the DMFT variation. Low rates of regular toothbrushing and high rates of sweets consumption were related with higher DMFT while high rates of drinking of soft drinks were related with lower DMFT. Consumption of fruits and vegetables had no significant impact. Altogether, factors of this model explained 51.2% of the total DMFT variation across countries. CONCLUSION: The findings of the study demonstrate that different oral health behaviour profiles among young people across European countries, Israel, Canada, and the USA significantly contribute to the variation in caries experience.

Overweight and obesity in infants and pre-school children in the European Union: a review of existing data.

The objective of this study was to synthesize available information on prevalence and time trends of overweight and obesity in pre-school children in the European Union. Retrieval and analysis or re-analysis of existing data were carried out. Data sources include WHO databases, Medline and Google, contact with authors of published and unpublished documents. Data were analysed using the International Obesity Task Force reference and cut-offs, and the WHO standard. Data were available from 18/27 countries. Comparisons were problematic because of different definitions and methods of data collection and analysis. The reported prevalence of overweight plus obesity at 4 years ranges from 11.8% in Romania (2004) to 32.3% in Spain (1998-2000). Countries in the Mediterranean region and the British islands report higher rates than those in middle, northern and eastern Europe. Rates are generally higher in girls than in boys. With the possible exception of England, there was no obvious trend towards increasing prevalence in the past 20-30 years in the five countries with data. The use of the WHO standard with cut-offs at 1, 2 and 3 standard deviations yields lower rates and removes gender differences. Data on overweight and obesity in pre-school children are scarce; their interpretation is difficult. Standard methods of surveillance, and research and policies on prevention and treatment, are urgently needed.

The relationship of childhood to adult blood pressure: longitudinal study of juvenile hypertension in Lithuania.

OBJECTIVE: To assess changes in blood pressure from childhood to adulthood and the ability to predict adult blood pressure. DESIGN: Longitudinal study of a cohort of children with baseline data and a follow-up survey after 20 years. SETTING: Epidemiological survey of schoolchildren and subsequent inhabitants of Kaunas, a town in Lithuania. PARTICIPANTS: The children came from 15 schools and accounted for 25% of all 12- and 13-year-old children born in 1964 in Kaunas. The first survey (n = 1082) was carried out in 1977. The same population was re-examined in 1997 (n = 505). Data from 217 men and 288 women, who participated in both the first and the most recent surveys, is presented. MAIN OUTCOME MEASURES: Systolic and diastolic blood pressure at the age of 32-33 years. RESULTS: In the 20 years between the two surveys blood pressure increased more in men than in women. Statistically significant correlation between childhood and adult blood pressure levels was estimated (for systolic blood pressure r=0.40 in men and r=0.24 in women; for diastolic blood pressure r=0.14 in men and r=0.34 in women). Stepwise regression analysis of the data showed that the best predictors of adult blood pressure were the initial childhood blood pressure levels and change in BMI during the 20-year period for both men and women. Other factors were less predictive. CONCLUSIONS: Childhood blood pressure is related to adult levels and, together with changes in body mass index, is a significant predictor of adult blood pressure.

Assessment of blood pressure measurement quality in the baseline surveys of the WHO MONICA project.

Because of the general inavailability of reference standards, there exist no common procedures to assess the quality of blood pressure measurements in epidemiological population surveys. To approach this problem within the collaborative international WHO MONICA Project, a standardized assessment of BP measurement quality was developed and applied to the forty-seven baseline surveys of that project. The entire assessments were carried out in retrospect, that is, only after each population survey had been completed. The assessment was focused on the procedures of quality assurance and control as reportedly applied in each survey, and on quality indicators which were derived from the recorded blood pressure values of each survey. The definitions of specific quality assessment items were based on the MONICA project protocol and on sources in the pertinent literature. The available information on quality assurance and control procedures depended solely on self-reports by local survey organizers and on site visits, and was occasionally found to be at variance with the actual blood pressure recordings. Therefore, quality indicators derived from actual blood pressure recordings were far more informative and comparable between surveys. Each survey was rated as optimal, satisfactory, or unsatisfactory with regard to single quality items and these single scores were used jointly to compute a summary score of blood pressure measurement quality for each survey. This summary score indicated that 39 out of 47 MONICA baseline surveys showed optimal or satisfactory BP measurement quality. Limitations and potentials for improvement of quality assessments became apparent. We conclude that a standardized assessment of BP measurement quality in epidemiological population surveys seems feasible and propose that quality assessment methods similar to the ones suggested here become a routine part of future epidemiological analyses of blood pressure values and hypertension in populations. This should facilitate valid study comparisons.

[General risk factors of chronic non-infectious diseases among schoolchildren in Kaunas and Moscow]. / Urovni obshchikh faktorov riska khronicheskikh neinfektsionnykh zabolevanii sredi shkol'nikov v Kaunase i Moskve.

Representative samples of 16-year-old school-children including 126 children from Kaunas and 124 children from Moscow were surveyed by one and the same team consisting of researchers from Kaunas and Moscow. The survey indicated a statistically valid higher level of systolic blood pressure among Kaunas schoolchildren as compared to Moscow schoolchildren of the same age group. Diastolic blood pressure was somewhat higher among Moscow schoolchildren. Moscow schoolchildren smoked statistically valid more often and more intensively. During leisure time boys from Kaunas and girls from Moscow were less physically active. A higher level of arterial blood pressure was found among schoolchildren with high rates of IMT and among non-smoking boys. There was no dependence between the duration of physical activity in leisure time and the level of arterial blood pressure. The established correlations between levels of general risk factors for chronic noninfectious diseases (CNID) among Kaunas and Moscow schoolchildren are important for the evaluation of the effectiveness of CNID integrated prevention programme.

Quality assessment of blood pressure measurements in epidemiological surveys. The impact of last digit preference and the proportions of identical duplicate measurements. WHO Monica Project [corrected].

In the WHO MONICA Project, cardiovascular risk factor surveys including measurements of arterial blood pressure (BP) were conducted in more than 50 different populations. In the course of a retrospective BP measurement quality assessment effort, two indicators of "prejudiced" blood pressure reading, last digit preference and high proportions of identical results in duplicate measurements, are used in addition to other items to evaluate blood pressure measurement quality. We used fictitious blood pressure distributions and applied to them Last Digit Preference scores and Proportions of Identical Duplicate Measurements actually found in the MONICA surveys. The analysis showed that Last Digit Preference affects predominantly the shape of the BP distribution curve, whereas high Proportions of Identical Duplicate Measurements may cause a shift of the entire BP distribution curve. Although the two items are partly interrelated, a clear distinction between them and their effects is advocated.

[Predicting the dynamics of elevated arterial pressure in 12--13-year-old children of Kaunas and Berlin]. / Prognozirovanie dinamiki povyshennogo arterial'nogo davleniia u 12--13-letnikh detei Kaunasa i Berlina.

The increased arterial blood pressure (BP) variation between 12-13 and 15-16 years of age was examined in 119 schoolchildren of Kaunas and 169 schoolchildren of Berlin. The 90th percentile for systolic and/or diastolic BP was used as a criterion of increased arterial BP. The data were treated by multivariate logistical regression analysis. Independent samples were used to construct and test the model. The reproducibility of increased arterial BP was shown to be affected by physical developmental status as well as baseline systolic and diastolic BP, the influence being more pronounced in girls, as compared to boys. The derived formulas are presented as a nomogram to facilitate their practical application.

[Value of the "regression-to-mean" effect in the evaluation of arterial blood pressure in adolescents in epidemiological studies]. / Znachenie "effekta regressii k srednemu" pri otsenke arterial'nogo davleniia u podrostkov v epidemiologicheskikh issledovaniiakh.

Patterns of systolic and diastolic blood pressure were assessed in adolescents who were 12-13 at the time of first examination. Three-year follow-up consisted of 5 check-ups. Upon the first examination, all adolescents were divided into three groups: those with low (below the 10th percentile), normal (between the 10th and 90th percentiles) and high (above the 90th percentile) arterial BP values. Repeated checkups covered all adolescents with low and high arterial BP as well as a 20% sample of normotensive subjects. Over the three years of follow-up; the greatest increment in systolic and diastolic arterial BP was noted in the hypotensive group, and the smallest, in the hypertensive group. Various hypotheses are discussed that might explain the demonstrated regularity; the "regression-to-mean" effect is proposed as a possible explanation.

Preventive study of atherosclerosis and ischaemic heart disease risk factors among Kaunas school-children.

In a series of 1,216 Kaunas school-children aged 10-15 years, a study was conducted of risk factors for atherosclerosis and ischaemic heart disease (elevated blood pressure, overweight, reduced physical activity, and smoking), and of the influence of nonmedicamentous measures on the risk factors' level. After three-years intensive health education concentrated on school-children and their parents, the number of smokers and subjects with reduced physical activity among school-children significantly decreased and the number of overweight school-children also dropped in the preventive intervention district, compared to the control district. The study showed the need for regular examinations of school-children for detecting the presence of risk factors, and the effectiveness of primary non-medicamentous prevention of atherosclerosis and ischaemic heart disease, carried out from school-age.

[Mortality and its determining factors in patients who have had a myocardial infarct]. / Letal'nost' i opredeliaiushchie ee faktory u bol'nykh, perenesshikh infarkt miokarda.

The two-year mortality in 993 patients aged from 29 to 86 years included into the register of the acute myocardial infarction and survived during the first 4 weeks totalled 22.9%. The more frequent causes of lethal outcome was sudden death (31.3%) and progressing circulatory insufficiency (19.1%). A system of factors has been established acting favourably or unfavourably on the late results. Attention is drawn to the fact that different factors act differently in persons of different age.

[Epidemiological studies of arteriosclerosis precursors among 10- to 15-year-old schoolchildren]. / Epidemiologicheskie issledovaniia nekotorykh predvestnikov ateroskleroza sredi skhol'nikov 10-15 let.

Epidemiological study of atherosclerosis precursors in schoolchildren whose ages ranged from 10 to 15 was undertaken in 1977; 2 296 schoolchildren have been screened. The follow-up groups were formed according to the following factors: high arterial blood pressure, overweight and obesity, low physical activity, smoking. Analysis of the data showed the distribution of the precursors of atherosclerosis to be as follows: 47.4% of boys and 42.2% of girls had no precursors: 34.3% of boys and 42.2% of girls had one precursor; 14.1% of boys and 13.8% of girls had two precursors, and 4.2% of boys and 4.9% of girls had three precursors. To lower the incidence of the precursors of atherosclerosis special attention should be paid to the children with such precursors.