Risk of leukaemia or cancer in the central nervous system among children living in an area with high indoor radon concentrations: results from a cohort study in Norway.

BACKGROUND: Over the past few years, there has been growing interest in assessing the relationship between exposure to radon at home and the risk of childhood cancer. Previous studies have produced conflicting results, probably because of limitations assessing radon exposure, too few cancer cases and poorly documented health statistics. METHODS: We used a cohort approach of 0-15-year-old children to examine whether residential radon exposure was associated with childhood leukaemia and cancer in the central nervous system in the Oslo region. The study was based on Norwegian population registers and identified cancer cases from The Cancer Registry of Norway. The residence of every child was geo-coded and assigned a radon exposure. RESULTS: In all, 712 674 children were followed from 1967 to 2009 from birth to date of cancer diagnosis, death, emigration or 15 years of age. A total of 864 cancer cases were identified, 437 children got leukaemia and 427 got cancer in the central nervous system.Conclusions or interpretation:No association was found for childhood leukaemia. An elevated nonsignificant risk for cancer in the central nervous system was observed. This association should be interpreted with caution owing to the crude exposure assessment and possibilities of confounding.

Take action to prevent diabetes--the IMAGE toolkit for the prevention of type 2 diabetes in Europe.

When we ask people what they value most, health is usually top of the list. While effective care is available for many chronic diseases, the fact remains that for the patient, the tax payer and the whole of society: prevention is better than cure. Diabetes and its complications are a serious threat to the survival and well-being of an increasing number of people. It is predicted that one in ten Europeans aged 20-79 will have developed diabetes by 2030. Once a disease of old age, diabetes is now common among adults of all ages and is beginning to affect adolescents and even children. Diabetes accounts for up to 18 % of total healthcare expenditure in Europe. The good news is that diabetes is preventable. Compelling evidence shows that the onset of diabetes can be prevented or delayed greatly in individuals at high risk (people with impaired glucose regulation). Clinical research has shown a reduction in risk of developing diabetes of over 50 % following relatively modest changes in lifestyle that include adopting a healthy diet, increasing physical activity, and maintaining a healthy body weight. These results have since been reproduced in real-world prevention programmes. Even a delay of a few years in the progression to diabetes is expected to reduce diabetes-related complications, such as heart, kidney and eye disease and, consequently, to reduce the cost to society. A comprehensive approach to diabetes prevention should combine population based primary prevention with programmes targeted at those who are at high risk. This approach should take account of the local circumstances and diversity within modern society (e.g. social inequalities). The challenge goes beyond the healthcare system. We need to encourage collaboration across many different sectors: education providers, non-governmental organisations, the food industry, the media, urban planners and politicians all have a very important role to play. Small changes in lifestyle will bring big changes in health. Through joint efforts, more people will be reached. The time to act is now.

A European evidence-based guideline for the prevention of type 2 diabetes.

BACKGROUND: The prevalence and socioeconomic burden of type 2 diabetes (T2DM) and associated co-morbidities are rising worldwide. AIMS: This guideline provides evidence-based recommendations for preventing T2DM. METHODS: A European multidisciplinary consortium systematically reviewed the evidence on the effectiveness of screening and interventions for T2DM prevention using SIGN criteria. RESULTS: Obesity and sedentary lifestyle are the main modifiable risk factors. Age and ethnicity are non-modifiable risk factors. Case-finding should follow a step-wise procedure using risk questionnaires and oral glucose tolerance testing. Persons with impaired glucose tolerance and/or fasting glucose are at high-risk and should be prioritized for intensive intervention. Interventions supporting lifestyle changes delay the onset of T2DM in high-risk adults (number-needed-to-treat: 6.4 over 1.8-4.6 years). These should be supported by inter-sectoral strategies that create health promoting environments. Sustained body weight reduction by >or= 5 % lowers risk. Currently metformin, acarbose and orlistat can be considered as second-line prevention options. The population approach should use organized measures to raise awareness and change lifestyle with specific approaches for adolescents, minorities and disadvantaged people. Interventions promoting lifestyle changes are more effective if they target both diet and physical activity, mobilize social support, involve the planned use of established behaviour change techniques, and provide frequent contacts. Cost-effectiveness analysis should take a societal perspective. CONCLUSIONS: Prevention using lifestyle modifications in high-risk individuals is cost-effective and should be embedded in evaluated models of care. Effective prevention plans are predicated upon sustained government initiatives comprising advocacy, community support, fiscal and legislative changes, private sector engagement and continuous media communication.

Quality indicators for the prevention of type 2 diabetes in Europe--IMAGE.

BACKGROUND: The marked increase of type 2 diabetes necessitates active development and implementation of efficient prevention programs. A European level action has been taken by launching the IMAGE project to unify and improve the various prevention management concepts, which currently exist within the EU. This report describes the background and the methods used in the development of the IMAGE project quality indicators for diabetes primary prevention programs. It is targeted to the persons responsible for diabetes prevention at different levels of the health care systems. METHODS: Development of the quality indicators was conducted by a group of specialists representing different professional groups from several European countries. Indicators and measurement recommendations were produced by the expert group in consensus meetings and further developed by combining evidence and expert opinion. RESULTS: The quality indicators were developed for different prevention strategies: population level prevention strategy, screening for high risk, and high risk prevention strategy. Totally, 22 quality indicators were generated. They constitute the minimum level of quality assurance recommended for diabetes prevention programs. In addition, 20 scientific evaluation indicators with measurement standards were produced. These micro level indicators describe measurements, which should be used if evaluation, reporting, and scientific analysis are planned. CONCLUSIONS: We hope that these quality tools together with the IMAGE guidelines will provide a useful tool for improving the quality of diabetes prevention in Europe and make different prevention approaches comparable.

Life course influence of residential area on cause-specific mortality.

OBJECTIVE: To examine the relative influence of area of residence on mortality risk along the life course in different age groups and to see if this differs for causes known to be related differently to various models of the life course. METHODS: Individual data from the Censuses in 1960, 1970, 1980 and 1990 from Oslo, Norway, were linked to the death register 1990-1998. All male inhabitants living in Oslo in 1990 aged 30-69 years who had lived in Oslo at the three previous Censuses were included. RESULTS: In the youngest age group, area of residence closest to the time of death is most important for violent and psychiatric causes. In older age groups, area of residence at all time points in the period studied seemed to have a similar influence. Cardiovascular deaths were related to earlier as well as later area of residence in both young and old age groups. For violent and psychiatric causes, the most recent area may be the most important. CONCLUSION: This paper explores a research strategy to investigate how the area of residence through the life course influences mortality. The associations seem to vary according to age at, and cause of, death.

Prevention of type 2 diabetes: a review.

One of the major public health challenges of the 21st century is type 2 diabetes. WHO estimates that by 2025 as many as 200-300 million people worldwide will have developed the disease. A distressing increase in children is perhaps the most alarming sign of something going wrong. Roughly half of the risk of type 2 diabetes can be attributed to environmental exposure and the other half to genetics. Central themes for prevention are the risk factors overweight, sedentary lifestyle, certain dietary components and perinatal factors. Overweight is the most critical risk factor, and should be targeted for prevention of type 2 diabetes especially among children and youths. Ethnicity and perinatal factors are also worth considering. Today we know that prevention helps. In the US Diabetes Prevention Programme for high risk individuals, there was a 58% relative reduction in the progression to diabetes in the lifestyle group compared with the controls. Within the lifestyle group, 50% achieved the goal of more than 7% weight reduction, and 74% maintained at least 150 min of moderately intense activity each week. This review discusses different forms of prevention, and proposes first of all to target people with Impaired Glucose Tolerance with increasing activity and altering dietary factors. And secondly, population-based measures to encourage increased physical activity and decreased consumption of energy-dense foods are important, and may target school children and young people, certain ethnic groups and women with gestational diabetes.

Impact of childhood and adulthood socioeconomic position on cause specific mortality: the Oslo Mortality Study.

OBJECTIVE: To study the impact of childhood and adulthood social circumstances on cause specific adult mortality. DESIGN: Census data on housing conditions from 1960 and Personal Register income data for 1990 were linked to 1990-94 death registrations, and relative indices of inequality were computed for housing conditions in 1960 and for household income in 1990. PARTICIPANTS: The 128 723 inhabitants in Oslo aged 31-50 years in 1990. MAIN RESULTS: Adulthood mortality was strongly associated with both childhood and adulthood social circumstances among both men and women. Cardiovascular disease mortality was more strongly associated with childhood than with adulthood social circumstances, while the opposite was found for psychiatric and accidental/violent mortality. Smoking related cancer mortality was related to both adulthood and childhood social circumstances in men, but considerably more strongly to adult social circumstances. CONCLUSIONS: Childhood social circumstances have an important influence on cardiovascular disease risk in adulthood. Current increases in child poverty that have been seen in Norway over the past two decades could herald unfavourable future trends in adult health.

[Applications for disability benefits before and after the 1991 restrictions]. / Søknader om uførepensjon før og etter innstrammingen i 1991.

In 1991, the eligibility criteria for disability benefits were restricted in Norway. Some effects are described in the present evaluation. Based on documents, first time applicants in 1990 and in 1993 in two counties were analysed according to social and medical variables. "Social security careers" before application are described, and proposals from physicians and the local social security office are compared with the decisions made by the county social security administration. Over a three-month period, applications decreased from 2.2 per 1,000 inhabitants in 1990 to 1.4 in 1993, a 39% decrease. About the same decrease was observed in all social and diagnostic groups. The proportion on vocational rehabilitation before application increased from 19% to 23% (p = 0.02). The certifying physicians proposed refusals in 9% and 8% in the two samples, and the local social security office did so in 12% and 13%. The refusal rate increased from 8% in 1990 to 21% in 1993. Refusals were mostly given to women, the middle-aged, those living alone, those with short education, and applicants with medically unclear conditions. It is pointed out that the restrictions on disability benefits in 1991 had the greatest impact on applicants with few resources.

[Sources of income after being denied disability pension]. / Kilder til livsopphold etter avslag på søknad om uførepensjon.

Restrictions in eligibility criteria for disability pension were introduced in Norway in 1991. The effect of these restrictions on sources of income is an important question in social policy. 157 first time applicants from two counties who were denied disability pension before (1990) and after (1993) the restrictions were studied three years later. Sources of income were established through searches in registers of wages and social security benefits. NOK 3,000 per month was set as the lowest income allowing economic independence. Of the applicants in 1990, 14% were in the workforce three years later. In the post-restriction 1993 sample, this proportion was 21% (p = 0.29). The proportions receiving disability pension were 25% and 22% respectively. The spouse supported 33% of the 1990 applicants, and 22% in the 1993 sample (p = 0.13). Social welfare was the main source of income for 6% and 10% (p = 0.25). Changes in main sources of income following the restriction were relatively small. The main result of this study is that family support is the most prevalent source of income when disability benefits are denied. This is not in accordance with the Government's policy of promoting gainful employment.

Health and re-employment in a five-year follow-up of long-term unemployed.

OBJECTIVES: To study health and re-employment in a five-year follow-up of a community sample of long-term unemployed people. METHODS: A random sample registered for more than 12 weeks at the labour offices in Grenland, Norway, were given medical check-ups in 1988 and 1990, and a postal questionnaire in 1993. RESULTS: Only 37% were employed five years after the first spell of long-term unemployment. Recovery after re-employment was demonstrated, indicating that unemployment causes poor mental health. Health-related selection to continuous unemployment was only found for medical diagnoses. The unemployed who might be selected to continuous unemployment because of poor health at the two-year follow-up seemed to deteriorate most. CONCLUSION: The high morbidity of mental health problems among unemployed people is mostly explained by the causal hypothesis. This is a challenge to preventive medicine. Sick unemployed people should be given special attention.

Alcohol disorders and re-employment in a 5-year follow-up of long-term unemployed.

AIMS: To establish whether the high prevalence of alcohol abuse among unemployed people is explained by alcohol abuse causing unemployment, or vice versa. DESIGN: A 5-year postal follow-up survey of a community sample of unemployed from Grenland, southern Norway. PARTICIPANTS: Two hundred and twenty-eight unemployed people, registered for more than 12 weeks, aged 16 to 63 years. Response rate 74%. MEASUREMENTS: The Alcohol Use Disorder Identification Test (AUDIT) and DSM-III diagnoses of alcohol disorders in medical examinations. FINDINGS: At the 5-year follow up, 23% of those still unemployed and 12% of those re-employed scored higher than the AUDIT cut-point of 10. Re-employment reduced the chance of scoring positive on the AUDIT to 34% of the chance for those still unemployed. Significant selection to long-term unemployment according to AUDIT score was not demonstrated. None of the 7% who had a DSM-III diagnosis of an alcohol disorder had a job 5 years later, however, suggesting that alcohol-related selection to unemployment does occur. CONCLUSION: The high prevalence of harmful drinking among Norwegian unemployed is explained mainly by unemployment causing alcohol abuse rather than vice versa. Reducing unemployment should contribute to reduced alcohol problems in Norway.

[Unemployment as a challenge for general practice]. / Arbeitslosigkeit als eine Herausforderung für die Allgemeinmedizin.

Tasks for general practitioners in this field are discussed in connection with a two-year follow up of a randomised community sample of 310 unemployed persons in Norway. This study supported both the selective and causative mechanisms for explaining high morbidity among the unemployed. Thus, medicine is faced with both clinical and preventive tasks. Unemployed patients must be cared for by proper somatic and/or psychiatric diagnosing. A sociomedical diagnosis of the main unemployment problem is suggested. Counselling should be an important part of the treatment of unemployed patients. General practitioners may be the only independent counsellors of the many possibilities within the social security system. Secondary prevention may also be necessary to encourage passive unemployed patients to participate in activation programmes offered by the community (education, work opportunity programmes, sports, cultural activities, etc.). Primary prevention should help to avoid unemployment of more than three months' duration. Physicians are encouraged to lobby such measures in their communities.

Restricting the influx of disability beneficiaries by means of law: experiences in Norway.

OBJECTIVES: To study effects of restricting eligibility criteria for disability pension in Norway 1991. METHODS: Documents of 288 applicants from 1990 and 1993 in one county were analysed for social and medical variables as well as for the determination and its causes. RESULTS: Incidence of applications for disability benefits during a three-month period was 223 per 100,000 inhabitants in 1990. The focused group of 'medically imprecise' musculoskeletal diagnoses concerned 26% of all applicants, while 'precise' musculoskeletal diagnoses were given to 15%, 'imprecise' psychiatric diagnoses to 7% and 'precise' ones to 6%. The number of applicants fell by 39%, surprisingly about the same in all social and diagnostic groups. Denial rate increased from 8% to 21%. Denials mostly struck women, middle-aged, those living alone, those with short education, and applicants with 'medically imprecise' diagnoses. CONCLUSIONS: Restriction of disability benefits affected applicants with the least resources the hardest, and seems to contribute to the on-going process of marginalizing the weaker part of the population.

Suicidal ideation among the long-term unemployed: a 5-year follow-up.

Suicidal ideation was monitored in a 5-year follow-up of a representative sample of long-term unemployed Norwegians. Four items from the General Health Questionnaire-28 were used as a Suicidal Ideation Index, which showed a prevalence of 17% in the present sample of unemployed subjects, higher than the value of 11% in a sample of Australian students used to construct the Index. Five years later, suicidal ideation was found in 6% of those who had been re-employed and 22% of those still unemployed, indicating that the high prevalence of suicidal ideation may be due to unemployment. Routine clinical examination was also tried for preventive purposes. In total, 8% of the unemployed subjects showed clinically significant suicidal ideation. They were referred to a psychologist or their GP, and were given the standard advice about suicide prevention. A Resource Centre, which many employees at the Labour Office have missed, has now been set up in the area under the National Plan for Suicide Prevention.