Health status in Europe: comparison of 24 urban areas to the corresponding 10 countries (EURO-URHIS 2).

Background: : In Europe, over 70% of the population live in urban areas (UAs). Most international comparative health research is done using national level data, as reliable and comparable urban data are often unavailable or difficult to access. This study aims to investigate whether population health is different in UAs compared with their corresponding countries. : Routinely available health-related data were collected by the EURO-URHIS 2 project, for 10 European countries and for 24 UAs within those countries. National and UA level data for 11 health indicators were compared through the calculation of relative difference, and geographical patterns within Europe were investigated using the Mann Whitney U test. Linear regression modelling was used to adjust for population density, gross domestic product and urbanicity. : In general, the urban population in Eastern Europe is less healthy than the Western European urban population. However, people in Eastern Europe have significantly better broad health outcomes in UAs as compared with the corresponding country as a whole, whereas people in Western Europe have generally worse broader health outcomes in UAs. : For most European countries and UAs that were investigated, the national level health status data does not correspond with the health status at UA level. In order to identify health problems in UAs and to provide information for local health policy, health monitoring and international benchmarking should also be conducted at the local level.

Risk of travelling to the country of origin for tuberculosis among immigrants living in a low-incidence country.

SETTING: Two thirds of tuberculosis (TB) patients in the Netherlands are foreign-born. OBJECTIVE: To determine if travelling to the country of origin is a risk factor for TB among two different immigrant groups that have lived in the Netherlands for at least 2 years. DESIGN: In this unmatched case-control study, the frequency and duration of travel to the country of origin in the preceding 12 months were compared between adult Moroccan and Turkish TB patients and community controls. RESULTS: Moroccan patients had travelled more often (26/32 = 81%) in the preceding year than Moroccan controls (472/816 = 58%). The travel-associated odds ratio (OR) for TB among Moroccans was 3.2 (95%CI 1.3-7.7), and increased to 17.2 (95%CI 3.7-79) when the cumulative duration of travel exceeded 3 months. The corresponding population fraction of Moroccan TB cases attributable to recent travel was 56% (95%CI 19-71). Among Turkish immigrants TB was not associated with travel (OR 0.9, 95%CI 0.3-2.4). CONCLUSION: Travel to the country of origin was a risk factor for TB among Moroccans, but not among Turkish people living in the Netherlands. The difference in travel-associated OR between these two immigrant groups is probably related to differences in TB incidence in these countries.

[Considerable comorbidity in overweight adults: results from the Utrecht Health Project]. / Aanzienlijke comorbiditeit bij volwassenen met overgewicht: resultaten uit het 'Leidsche Rijn Gezondheidsproject'.

OBJECTIVE: To determine the association between overweight, physical and mental health conditions and health-related quality of life in an adult community population upon entering a new primary care practice. DESIGN: Cross-sectional study. METHOD: Baseline data from 4825 participants (mean age: 39 years; 55% women) in the Utrecht Health Project; a dynamic primary care population study with a response rate of over 50%, were used to determine and compare the prevalence of diagnosed medical conditions, complaints and quality of life between individuals of normal weight (BMI 18.5-< 25 kg/m2) and those who were overweight (BMI 25-< 30 kg/m2) or obese (BMI > or = 30 kg/m2). Normal weight was used as the reference category. RESULTS: Overweight individuals were approximately twice as likely to have cardiovascular risk factors and had a 20-60% increased risk of back pain, arthrosis, migraine, dyspepsia and respiratory symptoms than those of normal weight. Obese individuals were almost twice to four times more likely to have these conditions and were additionally at increased risk of obstructive pulmonary disease, cardiovascular disease and arthritis (range of odds ratios (ORs): 1.9-3.3). Somatization and reduced physical well-being were more common among both overweight (ORs: 1.2-1.5) and obese (ORs: 1.7-3.7) individuals, whereas only obese individuals demonstrated a 30-50% increased risk of mental health conditions and reduced mental well-being. CONCLUSION: Overweight was associated with a broad range of physical and mental health conditions and a reduced health-related quality of life. Routine measurement of BMI upon entering a primary care practice is relatively simple and may contribute to the identification of individuals at high risk of comorbidity.

[Smoking, alcohol and drug use in Utrecht, The Netherlands, risk groups and socioeconomic differences in 1999 and 2003]. / Roken, alcohol-en druggebruik in Utrecht, risicogroepen en sociaal-economische verschillen in 1999 en 2003.

OBJECTIVE: To investigate trends in socio-economic inequalities in smoking, alcohol and drug use in the community of Utrecht, the Netherlands. DESIGN: Repeated cross-sectional population surveys. METHOD: Questionnaires were used to collect information about smoking, (problematic) alcohol use and the use of cannabis, ecstasy and other drugs in the general population aged 15-64 years in Utrecht, the Netherlands. Data were collected in 1999 on 2485 responders (response: 56%) and in 2003 on 1840 responders (54%). The male-female ratio was 4:6. RESULTS: The percentage of smokers was 43 in 1999 and 34 in 2003. Excessive use of alcohol was reported by 21% in both 1999 and 2003, cannabis use was reported in 13% and 14%, respectively, and use of hard drugs was reported in 1-3% in both 1999 and 2003. Native Dutch people, men, unmarried people and people with a low education or income level were at increased risk for drinking, smoking and using drugs. People with a low socio-economic status were just as likely to smoke in 1999 as in 2003, while the use of alcohol, cannabis and ecstasy increased. Those with a higher socio-economic status were much less likely to smoke in 2003 than in 1999, while fewer used cannabis and ecstasy use remained the same. CONCLUSION: Socio-economic inequalities in substance abuse were greater in 2003 than in 1999 in the studied population in Utrecht. People with a low socio-economic status showed an increase in unhealthy behaviour concerning the use of alcohol, cannabis and ecstasy.

[Increased consultations and numbers of sexually transmitted diseases at the STD clinic of Utrecht, 1994-2002]. / Toename van het aantal bezoeken en seksueel overdraagbare aandoeningen op de soa-polikliniek van Utrecht, 1994-2002.

OBJECTIVE: To determine trends in numbers of visitors and their demographic characteristics, reasons for visit, number of STDs and high-risk groups. DESIGN: Secondary analysis of registration data. METHOD: Data of every client that visited the STD clinic in Utrecht, the Netherlands, were aggregated from 1994 to 2002 in order to analyse trends. RESULTS: The number of visitors as well as the number of STDs rose strongly over the period investigated. The age of the visitors decreased. In 1994 17% of the visitors was born outside the Netherlands, in 2002 6%. The majority of the clients (56%) visited the STD clinic to get themselves tested preventively and 27% came because of symptoms. Visitors with symptoms or who were warned by others had a three-fold increased risk of having an STD. Other risk groups were: homosexual men, visitors born outside the Netherlands and visitors who have had an STD before. Groups with an increased risk of having a Chlamydia trachomatis infection were: visitors aged under 34 years old and visitors born in Morocco, Surinam and the Antilles. The number of Chlamydia infections rose sharply among homosexual male visitors. CONCLUSION: The increase in the number of visitors and of STD requires an increase in STD prevention, aimed at high-risk groups. More research is needed into the limited help-seeking behaviour of immigrants and more attention needs to be paid to Chlamydia trachomatis infections among homosexual men.