RESUMEN
BACKGROUND: Injury remains a major concern to public health in the European region. Previous iterations of the Global Burden of Disease (GBD) study showed wide variation in injury death and disability adjusted life year (DALY) rates across Europe, indicating injury inequality gaps between sub-regions and countries. The objectives of this study were to: 1) compare GBD 2019 estimates on injury mortality and DALYs across European sub-regions and countries by cause-of-injury category and sex; 2) examine changes in injury DALY rates over a 20 year-period by cause-of-injury category, sub-region and country; and 3) assess inequalities in injury mortality and DALY rates across the countries. METHODS: We performed a secondary database descriptive study using the GBD 2019 results on injuries in 44 European countries from 2000 to 2019. Inequality in DALY rates between these countries was assessed by calculating the DALY rate ratio between the highest-ranking country and lowest-ranking country in each year. RESULTS: In 2019, in Eastern Europe 80 [95% uncertainty interval (UI): 71 to 89] people per 100,000 died from injuries; twice as high compared to Central Europe (38 injury deaths per 100,000; 95% UI 34 to 42) and three times as high compared to Western Europe (27 injury deaths per 100,000; 95%UI 25 to 28). The injury DALY rates showed less pronounced differences between Eastern (5129 DALYs per 100,000; 95% UI: 4547 to 5864), Central (2940 DALYs per 100,000; 95% UI: 2452 to 3546) and Western Europe (1782 DALYs per 100,000; 95% UI: 1523 to 2115). Injury DALY rate was lowest in Italy (1489 DALYs per 100,000) and highest in Ukraine (5553 DALYs per 100,000). The difference in injury DALY rates by country was larger for males compared to females. The DALY rate ratio was highest in 2005, with DALY rate in the lowest-ranking country (Russian Federation) 6.0 times higher compared to the highest-ranking country (Malta). After 2005, the DALY rate ratio between the lowest- and the highest-ranking country gradually decreased to 3.7 in 2019. CONCLUSIONS: Injury mortality and DALY rates were highest in Eastern Europe and lowest in Western Europe, although differences in injury DALY rates declined rapidly, particularly in the past decade. The injury DALY rate ratio of highest- and lowest-ranking country declined from 2005 onwards, indicating declining inequalities in injuries between European countries.
RESUMEN
The rates of incidence and mortality of breast cancer in Lithuania are increasing and, although a mammography screening program is present, attendance rate is rather low. The aim of this study was to assess the reliability and validity of the revised Champion's Health Belief Model Scale in measuring Lithuanian women's beliefs about breast cancer and screening. The data were collected from 350 female citizens 40 to 69 years old living in the urban district, and having no history of breast cancer and no mammogram in the past. The Champion's Health Belief Model Scale was translated to Lithuanian, validated by professional judges, back-translated to English, and pretested. Analysis included descriptive statistics of demographic data, content and construct validity, using factorial analysis, internal consistency, reliability estimates, and using the Cronbach alpha technique. Factor analysis yielded 11 factors related to breast self-examination and 7 factors to mammography. All items on each factor were from the same construct. The motivation subscale split into the items related to general concern about health and preventive health practices. Alpha coefficients ranged from.61 to.92. Only the mammography barrier item "having a routine mammogram or x-ray of the breast would make me worry about breast cancer" loaded as a separate factor in factor analysis and showed low correlation with other subscale items. Participants in the mammography group showed lower perceived susceptibility in 3 items and perceived severity in 1 item. They reported having not enough privacy for breast self-examination, and were less confident in their skills to perform it. However, the women in the nonparticipating mammography group showed lower results in one benefit-mammogram item, and had more barriers for mammography in comparison with the participating group. We conclude that the Champion's Health Belief Model Scale is a reliable and valid tool for measuring the screening beliefs toward breast cancer among Lithuanian women. The model gave better results when the motivation items were subdivided into subscales related to general concern about health and related to preventive health practices and were considered separately. Mammography barrier item "having a routine mammogram or x-ray of the breast would make me worry about breast cancer" was deleted from the Lithuanian Champion's Health Belief Model Scale.
