Socioeconomic differences in the associations between diabetes and hospital admission and mortality among older adults in Europe

The aim of this study is to explain the trends in socioeconomic inequality and diabetes outcomes in terms of hospital admission and death in old European people. The sample includes 73,301 individuals, across 16 European countries taken from the Survey of Health, Ageing and Retirement in Europe (SHARE). People being diagnosed of diabetes were more likely to be admitted to hospital than those without diabetes, although its effect dropped after controlling for clinical and functional complications. Largest asscociations were observed in women, people aged 50–65 years old, with medium educational level and medium household income. Diabetes was significant and positively related to mortality in the whole sample. Diabetes is significantly associated with mortality risk especially in males, oldest old people, low education and medium income people. These findings have important implications for public policies to reduce socioeconomic-related health inequalities.     

Ecomigration and Violent Conflict: Case Studies and Public Policy Implications

In 2005, a hurricane named Katrina hit the states of Louisiana and Mississippi in the US, destroying properties and flooding areas. Many people left the region and still have not returned. While some of these people may eventually return, some may not, becoming “migrants.” Assuming this phenomenon will occur, is it unique? What is the role of the environment in migration? Can there be violent conflict between such migrants and residents in areas absorbing migrants? We evaluate these questions in the cases of Hurricane Katrina, the US Dust Bowl in the 1930s, and Bangladesh since the 1950s, demonstrating that environmental change can trigger large out-migration, which can cause violent conflict in areas receiving migrants. These findings have important policy implications. Climate change is expected to degrade the environment considerably in this century. Minimizing climate change-induced migration and violent conflict in receiving areas requires an engineered economic slowdown in the developed countries, and population stabilization and economic growth in the developing countries financed by the developed countries.     

Fiscal implications of population ageing.

In all developed countries the fiscal ties of the tax and benefit system serve to complement, and sometimes substitute for, traditional family bonds between young and old. Older people are major recipients of public pensions and public health care systems. Since these public transfers and services are financed primarily from the taxes paid by people of working age, the welfare system in effect transfers resources from young to old. But rather than see the fiscal interdependency between young and old as being analogous to the ties that bind children, parents and grandparents together in familial networks, it is often interpreted as an oppressive burden that the old place on the young. This paper examines arguments that population ageing will exacerbate this burden, and may lead to the collapse of public welfare systems. It shows that the financial problems currently associated with public pensions are a function of system design rather than demographic change, and that wholesale privatization of pension systems will do little to solve the major dilemma--of persuading people to transfer a larger part of their lifetime income to their later years in order to sustain a reasonable standard of living throughout an ever lengthening period of retirement.     

Childlessness in old age--an anthropological approach to a current problem

The amount of aged and old aged people is increasing markedly in all industrialized nations as well as in many developing countries. Additionally to the increasing life expectancy, a trend towards voluntary childlessness is observable. This trend will not only result in a continuing change of the population structure, it will also result in several individual problems of the aged population caused by childlessness. In the present paper the possible effects of voluntary childlessness on quality of life during old age are discussed from an anthropological point of view.     

Public Support for Conserving Bird Species Runs Counter to Climate Change Impacts on Their Distributions

There is increasing evidence that global climate change will alter the spatiotemporal occurrences and abundances of many species at continental scales. This will have implications for efficient conservation of biodiversity. We investigate if the general public in Denmark are willing to pay for the preservation of birds potentially immigrating and establishing breeding populations due to climate change to the same extent that they are for native species populations currently breeding in Denmark, but potentially emigrating due to climate change. We find that Danish citizens are willing to pay much more for the conservation of birds currently native to Denmark, than for bird species moving into the country – even when they are informed about the potential range shifts associated with climate change. The only exception is when immigrating species populations are under pressure at European level. Furthermore, people believing climate change to be man-made and people more knowledgeable about birds tended to have higher WTP for conservation of native species, relative to other people, whereas their preferences for conserving immigrant species generally resembled those of other people. Conservation investments rely heavily on public funding and hence on public support. Our results suggest that cross-country coordination of conservation efforts under climate change will be challenging in terms of achieving an appropriate balance between cost-effectiveness in adaptation and the concerns of a general public who seem mostly worried about protecting currently-native species.     

Ten challenges for 2010 and beyond to conserve Lepidoptera in Europe

Butterflies and moths have undergone a serious decline in most European countries following rapid changes in land use in recent decades. The main drivers of loss have been agricultural and forestry intensification, abandonment of marginal land (especially in mountainous regions), loss of traditional management of grasslands and woodlands, and urban spread. Over the same period the science and practice of Lepidoptera conservation has developed considerably and concerted action to save biodiversity has been taken in many countries, with vast areas designated as nature reserves or national parks. Despite this effort, Lepidoptera are still declining at an alarming rate and it is clear that the 2010 target of halting biodiversity loss will not be met. We suggest ten challenges that conservationists in Europe need to address if we are to be successful in halting these losses over coming decades. In this continent, Lepidoptera and their habitats often rely on traditional farming and forestry systems. How can these be brought together in harmony to create a healthier environment in which both humans and wildlife can thrive? The ten challenges include reform of agricultural support, identifying and supporting beneficial forestry systems, managing the matrix between habitats, managing habitats on a landscape scale, mitigating for climate change, creating a robust planning system that protects key sites, developing a comprehensive monitoring programme for Europe, securing long term funding for nature conservation, and ensuring both political and public support.     

Platelet function and ageing

There are clear age-related changes in platelet count and function, driven by changes in hematopoietic tissue, the composition of the blood and vascular health. Platelet count remains relatively stable during middle age (25–60 years old) but falls in older people. The effect of age on platelet function is slightly less clear. The longstanding view is that platelet reactivity increases with age in an almost linear fashion. There are, however, serious limitations to the data supporting this dogma. We can conclude that platelet function increases during middle age, but little evidence exists on the changes in platelet responsiveness in old age (>75 years old). This change in platelet function is driven by differential mRNA and microRNA expression, an increase in oxidative stress and changes in platelet receptors. These age-related changes in platelets are particularly pertinent given that thrombotic disease and use of anti-platelet drugs is much more prevalent in the elderly population, yet the majority of platelet research is carried out in young to middle-aged (20–50 years old) human volunteers and young mice (2–6 months old). We know relatively little about exactly how platelets from people over 75 years old differ from those of middle-aged subjects, and we know even less about the mechanisms that drive these changes. Addressing these gaps in our knowledge will provide substantial understanding in how cell signalling changes during ageing and will enable the development of more precise anti-platelet therapies.     

How many, how old, how soon?

This article highlights the population projections for the UK to 2066 and their health implications. The changes in the demographic age structure of human populations have dual implications. Although they represent accomplishments in social and health development considering the fact that more individuals are able to live until old age, these changes also bring new demands that affect all aspects of society, including employment, taxation, pension, education, and health. Age specific population projections presented were obtained from the Office for National Statistics. It is projected that the total number of people aged 60 years and older will rise from 12 million in 2001 to 18.6 million in 2031 and the number of individuals suffering with chronic diseases and disabilities will see a three-fold increase. Although these projections rely on assumptions and are subject to some changes, it is made clear that the proportion of the population aged 65 and above will continue to increase substantially over the next decades. These population trends will have a large impact on the health and health care needs of the population. Thus, there is a need to develop and plan institutions and policies that address the demands of the aging population. Understanding and identification of the causes and prevention of conditions that could result to serious disabilities must be a high priority.     

Geroscience and climate science: Oppositional or complementary?

Two of this century's most significant public health challenges are climate change and healthy aging. The future of humanity will be both warmer and older than it is today. Is it socially responsible, in a warming planet of a population exceeding 8 billion people, for science to aspire to develop gerotherapeutic drugs that aim to reduce the burden of aging-related diseases that may also increase lifespan? This question is the “elephant in the room” for geroscience advocacy. Science communication concerning what constitutes empirically valid and morally defensible ways of navigating the dual public health predicaments of climate change and healthy aging must be sensitive to both the interdependence of the environment (including planetary health) and the mechanisms of aging, as well as the common (mis)perceptions about the potential conflict between the goals of climate science and geroscience. Geroscience advocacy can transcend narratives of intergenerational conflict by highlighting the shared aspirations of climate science and geroscience, such as the goals of promoting health across the lifespan, redressing health disparities, and improving the economic prospects of current and future generations.     

Teaching and training in geriatric medicine in the European Union

In 1993 about 20% of the population in the 15 'old' member countries of the European Union (EU) was over 60 years of age and this percentage will increase to more than 25% in 2020. These developments play a key role for the investments in education and training to meet societies needs for health care services. In 2002 about 25% of the medical students in the 'old' EU did not receive any education in geriatric medicine. A question is who will provide the services for older people in related areas, like social care, community care, acute care in the hospitals, long-term care, permanent care and care for psychiatric patients? Geriatric medicine has been recognized as an independent specialty in 8 of the 15 member countries of the 'old' EU. In all EU member states the governments are autonomous regarding all aspects of health care services, including the recognition of specialties and specialist training programmes. A two years training in internal medicine has been recommended in the EU, followed by another four years of training in geriatric medicine. The specialist training has a hospital oriented character, however, it includes also community care and other institutionalised care like nursing homes. The curriculum should contain: biological, social, psychological and medical aspects of common diseases and disturbances in older people. A problem in many EU countries is the shortage of well trained researchers and leading persons for academic positions for geriatric medicine. In a number of countries chairs at the universities remain vacant for long periods of time or even disappear. Good services in the health care for older people need a high quality curriculum and training programme.     

Taking sides and constructing identities: reflections on conflict theory

Conflicts are often explained in terms of the interests of the groups involved, especially their competition for resources or gains. There is much merit in this approach. Theories of this type appear more realistic than those which take the legitimizing accounts of participants at face value. What people are fighting about is a fundamental question in conflict analysis, but there is another equally fundamental question that remains poorly understood, namely, who is fighting whom and why? How and why do people draw the distinction between friend and foe precisely where they do?     

Prevalencia de los trastornos de ansiedad en las personas mayores de 65 años: una revisión sistemática

Anxiety is an emotional problem that causes discomfort and suffering to those that suffer from it. Anxiety disorders can affect the functioning in different facets of a person's life. Studies on the prevalence of anxiety disorders in people over 65 years show variable results, ranging between 0.1% and 17.2%. Most of these studies include samples of the general population, in which the population of people over 65 years is under-represented. These studies evaluate older people with the same diagnostic tools used to assess anxiety disorders in people under 65 years, and collect data from people between 65 and 75 years old, leaving out people aged 75 and over. A systematic review of the prevalence studies of anxiety disorders in elderly people is presented. It is concluded that when representative samples of people over 65 years are used and evaluated with suitable tools, the prevalence rate of these disorders in the elderly is much higher than previously thought, reaching an annual prevalence rate of 20.8%.     

Pain trends and pain growth disparities, 2009–2021

Physical pain is a major public health concern. Yet evidence on trends in physical pain around the world barely exists. Using nationally representative data from 146 countries (N = 1.6 million respondents), this paper finds that, all over the world, the percentage of people in pain increased from 26.3 in 2009 to 32.1 in 2021. This rising trend was present in both higher- and lower-income countries. This article also documents pain disparities: In the worldwide population, pain grew faster among women, the less educated, and the poor. Although the aggregate level of pain was greater among the elderly (> 60 years old), the growth in pain was faster among the younger (< 35 years old). These findings hold after controlling for sociodemographic factors. Disparities of pain growth in higher- and lower-income nations and potential explanatory factors are also discussed. Understanding how the level of pain varies over time and across demographic groups is crucial to evaluate and shape public health policies.     

Guidelines for basic life support. European Resuscitation Council Basic Life Support Working Group.

A basic life support working group of the European Resuscitation Council was set up in 1991. It was given the objective of producing agreed standards of basic life support to ensure uniform teaching of the techniques to health care professionals and lay people throughout Europe. A common complaint in the past, particularly from members of the public who have received instruction in basic life support, is that different organisations teach different techniques. This problem exists within countries as well as among countries. The European Resuscitation Council presents below its basic life support guidelines, which it hopes will be detailed enough to avoid any ambiguities and to be acceptable for use in all the countries represented by the council.     

Is affordable and cost-effective assisted reproductive technology in low-income countries possible? What should we know to answer the question?

¹ Correspondence address. E-mail: j.d.f.habbema{at}erasmusmc.nl Decision making on infertility treatment in low-income countries(LIC) assumes answers to quite a few questions: how should theinfertility problem be defined? How often does infertility occur?What is the burden-of-disease of infertility? What is the incomein LIC, and what can be spend on health care? How cheap shouldIVF be in order to be accessible to a considerable part of thepopulation? With what alternative health interventions shouldinfertility treatment be compared? How cost-effective shouldIVF be in order to compete with those other interventions? Thesequestions will be discussed. The emphasis is on the situationin Sub-Saharan Africa (SSA). It is concluded that a place forART in a health care package is not straightforward. Many ofthe questions are not or only partially answered. Moreover,cheap and effective ART has yet to be developed and tested.From the limited evidence available for each of the questions,it could be calculated that an IVF cycle should cost between50 and 75 dollar in order to be a candidate for the inclusionin a health package in SSA. This estimate can easily changeconsiderably when in the future the calculations will be basedon thorough research. Thus, a targeted research programme foranswering the open questions, especially on quality-of-lifeimplications of infertility in different societies, is the preferredoption for facilitating the future evaluation of ART in LIC.     

Trends in incidence of AIDS associated with transfusion of blood and blood products in Europe and the United States, 1985-93.

OBJECTIVE--To quantify patterns and trends in incidence of AIDS associated with transfusion of blood and its products in 14 European countries and the United States. DESIGN--Data were derived from the World Health Organisation''s European non-aggregate AIDS dataset and, for the United States, from the Centers for Disease Control AIDS public information dataset. Rates were standardised by using the world standard populations and adjusted for reporting delays in each country. SUBJECTS--Cases of AIDS in patients with haemophilia and recipients of transfusions. RESULTS--Overall, between 1985 and 1993 almost 6000 cases of AIDS associated with transfusions were registered in the 14 European countries considered and over 8000 in the United States between 1985 and 1992. Most European countries had annual age adjusted rates lower than 0.5 per million children aged 12 or less and between 1 and 2 per million adults. The United States had rates around 1 per million children and 5 per million adults in the most recent period. For children, the highest rates were generally reached in 1985-7, whereas in adults the highest rates were in the late 1980s. France had the highest overall incidence of AIDS related to transfusion in Europe (3.3 per million). Romania had a major epidemic in children (over 30 cases per million children in 1988-90). Incidence rates of AIDS associated with transfusion were still increasing in some southern European countries in the early 1990s. CONCLUSIONS--Apart from in France and Romania it is clear that rates of bloodborne AIDS in European countries are lower than those registered in the United States.     

High cancer mortality rates in the elderly in the UK

Introduction: Cancer is largely a disease of older individuals. We compared UK cancer mortality rates with those for other countries to assess progress. Methods: Death details were obtained from the WHO Mortality Database for the UK, the USA and 11 European countries. Mortality rates were calculated for the age groups 55–64, 65–74, 75–84 and ≥85 years. Trends between 1995–97 and 2003–05 were determined. The number of excess cancer deaths in the UK was calculated by applying the age-specific mortality rates observed in other regions to the UK. Results: For all cancers combined, UK rates for 2003–05 in those aged ≥75 years were 11–31% higher than in other regions. From 1995–97 to 2003–05, UK rates decreased by 16–17% in those aged <75 years, but increased by 2% in those ≥85 years compared with decreases of 4–16% for the other geographic areas. More than 14,000 cancer deaths in the UK in those aged ≥75 years would be avoided each year if UK mortality rates were identical to those in the USA. Conclusion: The UK is making poor progress in controlling cancer in older age groups. The gap in mortality rates between the UK and other countries and between old and young in the UK is widening.     

How much Ascariasis is there in Africa?

What is the real burden of parasitic infections? How many people, for example, are infected with the common roundworm Ascaris lumbricoides-usually cited as'number one' in the 'league table' of human parasite prevalence? Extrapolations are often made from figures for helminth infection published in 1947 by Stoll. More recent estimates suggest almost unbelievable numbers of oscoriosis cases - about 1000 million people representing about one quarter of the world population. Such figures are important because they contribute to the perennial debate about: allocation o f scarce health resources in affected countries to infections of greatest public health importance. But where do such figures come from? In this article, David Crompton and Jim Tulley report on their appraisal of Ascaris prevalence data for Africa. Their figures were used to compile the geographic histogram on this month's cover.     

Educational differences in smoking: international comparison

ObjectiveTo investigate international variations in smoking associated with educational level.DesignInternational comparison of national health, or similar, surveys.SubjectsMen and women aged 20 to 44 years and 45 to 74 years.Setting12 European countries, around 1990.ResultsIn the 45 to 74 year age group, higher rates of current and ever smoking among lower educated subjects were found in some countries only. Among women this was found in Great Britain, Norway, and Sweden, whereas an opposite pattern, with higher educated women smoking more, was found in southern Europe. Among men a similar north-south pattern was found but it was less noticeable than among women. In the 20 to 44 year age group, educational differences in smoking were generally greater than in the older age group, and smoking rates were higher among lower educated people in most countries. Among younger women, a similar north-south pattern was found as among older women. Among younger men, large educational differences in smoking were found for northern European as well as for southern European countries, except for Portugal.ConclusionsThese international variations in social gradients in smoking, which are likely to be related to differences between countries in their stage of the smoking epidemic, may have contributed to the socioeconomic differences in mortality from ischaemic heart disease being greater in northern European countries. The observed age patterns suggest that socioeconomic differences in diseases related to smoking will increase in the coming decades in many European countries.     

Health care rationing: the public's debate.

OBJECTIVE--To elicit the views of a large nationally representative sample of adults on priorities for health services. DESIGN--An interview survey based on a random sample of people aged 16 and over in Great Britain taken by the Office of Population Censuses and Surveys. SUBJECTS--The response rate to the survey was 75%, and the total number of adults interviewed was 2005. MAIN OUTCOME MEASURES--A priority ranking exercise of health services supplemented with attitude questions about priorities, who should set priorities, and budget allocation. RESULTS--The results of the main priority ranking exercise of 12 health services showed that the highest priority (rank 1) was accorded to "treatments for children with life threatening illness," the next highest priority (rank 2) was accorded to "special care and pain relief for people who are dying." The lowest priorities (11 and 12) were given to "treatment for infertility" and "treatment for people aged 75 and over with life threatening illness." Most respondents thought that surveys like this one should be used in the planning of health services. CONCLUSIONS--The public prioritise treatments specifically for younger rather than older people. There is some public support for people with self inflicted conditions (for example, through tobacco smoking) receiving lower priority for care, which raises ethical issues.