Health monitoring and health indicators in Europe

Demographic change, new health threats and inequalities in health and healthcare provision in and between European Union (EU) member states pose a great challenge to European health care systems. Not only for these reasons does it make sense to collect comparable European health data. Such information provides insights on the distribution of risk and protection factors, the prevalence of chronic diseases and the levels of care provided in the member states and supports the planning and implementation of (health) policy measures. Since 2013, in the context of the European Health Interview Survey (EHIS), all EU member states are obliged to collect data on the health status, the provision of healthcare, health determinants and socio-economic conditions of their populations. In Germany, the EHIS is integrated into health monitoring at the Robert Koch Institute (RKI). The RKI is thus Germany's interface to the European health monitoring presented here. European health monitoring relies on different indicator systems such as the European Core Health Indicators (ECHI), EU social indicators and the health indicators of the European Sustainable Development Strategy. These are based on administrative and survey data, which stem for example from the EHIS or the European Union Statistics on Income and Living Conditions (EU-SILC) survey. Comparative data analyses must take into account the differences between health care systems, socioeconomic conditions and the age structures of societies. Variances in the prevalence of allergies for example are also due to differences in the available diagnostic tools. Significant differences in the prevalence of hypertension in Europe (with a range of 20% for women and 17% for men) are also related to different levels of awareness of hypertension. Comparative analyses can support the planning of and provide information for policy measures, and enhance the sharing of experiences between EU member states. A forthcoming EU regulation aims to harmonise the content of and intervals between health and social statistical data collection. Moreover, plans exist to establish a European Research Infrastructure Consortium (ERIC), which is set to develop and institutionalise European health monitoring.

German Health Update: New data for Germany and Europe: The background to and methodology applied in GEDA 2014/2015-EHIS

GEDA 2014/2015-EHIS is an up-to-date health survey of the adult population undertaken within the framework of the Robert Koch Institute's (RKI) health monitoring system. It uses the EHIS (European Health Interview Survey) Wave 2 questionnaire and includes four modules covering health status, health care, health determinants, and socio-economic variables. Data on nationally relevant issues is also collected. The study employs a mixed-mode design, using both online and paper-based questionnaires to gather data from 24,016 people aged 18 and above: the response rate was 26.9%. The Statistical Office of the European Union (Eurostat) provides prepared data from 28 European Union (EU) member states (plus Norway and Iceland) on the Eurostat website. National analyses for Germany are published as Fact sheets on health reporting in the Journal of Health Monitoring.

Comparison of phenotype and outcome in microscopic polyangiitis between Europe and Japan

OBJECTIVE

There are differences between Europe and Japan in the incidence and antineutrophil cytoplasmic antibody (ANCA) serotype of patients with microscopic polyangiitis (MPA). However, differences in phenotype or outcome have not been explored. We aimed to identify differences in phenotype and outcome of MPA between Europe and Japan.

METHODS

Sequential cohorts of patients with MPA and renal limited vasculitis were collected from European and Japanese centers (n = 147 and n = 312, respectively). Trial databases from the European Vasculitis Society and the Japanese patients with Myeloperoxidase (MPO)-ANCA-Associated Vasculitis (JMAAV) trial were studied (n = 254 and n = 48, respectively). We evaluated baseline characteristics including ANCA status and organ involvement, treatment, survival, and renal survival. Differences in survival and renal survival were studied using multivariate analysis.

RESULTS

The non-trial cohorts showed patients with MPA in Japan had a higher age at onset, more frequent MPO-ANCA positivity, lower serum creatinine, and more frequent interstitial pneumonitis than those in Europe (all p < 0.01). Comparisons between the trial databases demonstrated similar results. Cumulative patient survival and renal survival rates were not different between Europe and Japan (p = 0.71 and p = 0.38, respectively). Multivariate analysis identified age at onset, serum creatinine, gastrointestinal, and respiratory involvement as factors with higher risk of death. For endstage renal failure, serum creatinine and use of plasma exchange were identified as factors with higher risk, and immunosuppressant use as lower risk factors.

CONCLUSION

Phenotypes in patients with MPA were different between Europe and Japan. However, the outcomes of patient survival and renal survival were similar.

CHARACTERISTICS OF CLOSTRIDIUM PERFRINGENS STRAINS ASSOCIATED WITH FOOD AND FOOD-BORNE DISEASE

Hall, Herbert E. (Robert A. Taft Sanitary Engineering Center, Cincinnati, Ohio), Robert Angelotti, Keith H. Lewis, and Milton J. Foter. Characteristics of Clostridium perfringens strains associated with food and food-borne disease. J. Bacteriol. 85:1094-1103. 1963.-A total of 83 strains of Clostridium perfringens-30 from England, Europe, and Asia, associated with food-poisoning outbreaks; 28 from the United States, associated with outbreaks or contaminated foods; and 25 from natural or pathological sources-have been studied to determine their serological relationships, sporulation and heat-resistance of spores, and their hemolytic activity on mammalian bloods. A comparison of the results obtained with these three groups of strains reveals that the Eurasian group is characterized by serological typability, poor sporulation with the production of heat-resistant spores, and a hemolytic activity limited to the production of partial hemolysis on horse, ox, and sheep bloods, whereas the strains from natural and pathological sources in this country are not serologically typable, sporulate well but the spores are not heat-resistant, and are hemolytically active, producing both partial and complete hemolysis on horse, ox, and sheep bloods. The American food-poisoning strains have a wide variety of characteristics. Some strains resemble the Eurasian in their serological typability and the production of heat-resistant spores, but sporulation and hemolytic activity are more like the strains from classical sources. On the basis of these data, it appears unlikely that C. perfringens food-poisoning outbreaks in the United States are restricted to strains meeting the criteria of classification described by British workers and that the isolation of large numbers of any strain of this organism from an incriminated food must be considered as having a possible bearing on the etiology of the outbreak.

FEMALE FOOT DEFORMATION IN MODERN EUROPE AND IN ANCIENT CHINA

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