Lifestyle-related risks: are trends in Europe converging?

OBJECTIVES: What has become of lifestyle differences in a united Europe, where member states become more and more similar on aspects such as welfare systems and population dynamics? In this paper, we try to answer the question whether the gap in lifestyle-related risk factors in Europe has narrowed over the past 30-40 years. METHODS: Smoking, alcohol consumption, physical activity, obesity and food consumption all have an impact on cancer, cardiovascular disease and other non-communicable diseases. Databases of Eurostat, OECD (Organisation for Economic Co-operation and Development) and the World Health Organisation were screened for data on lifestyle-related risk factors in the European Union, and a literature search was performed for studies that collected international comparable data about the selected factors. RESULTS: The gap in European lifestyle has narrowed over the past 30-40 years for smoking (women), alcohol consumption and total fat intake. For fruit and vegetable consumption, convergence is not occurring. For some risk factors, such as smoking and obesity, intranational differences surpass the international differences. CONCLUSIONS: The results support the notion of convergent lifestyles among Europeans over time. We also found that there is a serious lack of reliable data on lifestyle-related risk factors that are suitable for international comparison. It is essential to invest in reliable and internationally comparable data, obtained according to best evidence, to get more insight into real differences regarding risk factors in Europe. The European Public Health programme may be an opportunity to realize these goals.

[Performance of the Dutch health care from an international perspective: background and implications for policy]. / De prestaties van de Nederlandse gezondheidszorg in internationaal perspectief: achtergronden en implicaties voor beleid.

The 'World Health Report 2000' has stimulated discussions on the Netherlands' performance in health and healthcare from an international perspective. The only concrete result it provided was a world ranking in which the Netherlands stood in 17th place. The comparative data which have appeared in several other recent reports, are more useful to policy makers, a notable example being those from the Organization for Economic Cooperation and Development (OECD). One issue arising from these reports is that the increase in life expectancy in the Netherlands is lagging behind the European Union average. This is particularly the case for women and a major cause of this is smoking. Developments in Dutch perinatal mortality are also unfavourable and are associated with a strong increase in the age at which women bear children. International comparisons of public health data are valuable inputs for health policy development and it is therefore important to invest in the international harmonisation of such data collection.

Transient neurological attacks in the general population. Prevalence, risk factors, and clinical relevance.

BACKGROUND AND PURPOSE: Patients with typical transient ischemic attacks (TIAs) have a higher risk of stroke but a lower risk of cardiac events than patients with nonspecific transient neurological symptoms. We assessed the prevalences of typical TIAs and nonspecific transient neurological attacks (TNAs) and their determinants in the general population because such data are virtually absent. METHODS: The Rotterdam Study is a population-based cohort study of 7983 subjects, aged 55 years and over, conducted in a district of Rotterdam, the Netherlands. At baseline examination, a history of episodes of disturbances in sensibility, strength, speech, and vision that lasted less than 24 hours and occurred within the preceding 3 years was determined by a trained physician. When such a history was present, information on time of onset, duration, and disappearance of symptoms and a detailed description of the symptoms (in ordinary language) were obtained. Subjects were classified by a neurologist as typical TIA or nonspecific TNA. RESULTS: Prevalence of TNAs was 1.9% in subjects aged 55 to 64 years, 3.5% in subjects aged 65 to 74 years, 4.3% in subjects aged 75 to 84 years, and 5.1% in subjects aged 85 years or over. Prevalence figures for typical TIA were 0.9%, 1.7%, 2.3%, and 2.2% and for nonspecific TNA 1.0%, 1.8%, 2.0%, and 2.9%, respectively. Clinical parameters such as number of attacks, onset, duration, and disappearance of symptoms were similar for typical TIA and nonspecific TNA. Increased age, male sex, diabetes mellitus, low HDL cholesterol, Q-wave myocardial infarction on electrocardiogram, and carotid atherosclerosis were related to typical TIA, whereas increased age, hypertension, low HDL cholesterol, smoking, and angina pectoris were associated with nonspecific TNA. CONCLUSIONS: About half of the subjects with a TNA had symptoms that were not entirely typical for a TIA. Differences in associations with risk factors between typical TIA and nonspecific TNA point toward different underlying mechanisms of symptoms and may lead to different ancillary investigations and possibly treatment.