Physical and psychosocial risk factors for musculoskeletal disorders in Brazilian and Italian nurses

As part of the international CUPID investigation, we compared physical and psychosocial risk factors for musculoskeletal disorders among nurses in Brazil and Italy. Using questionnaires, we collected information on musculoskeletal disorders and potential risk factors from 751 nurses employed in public hospitals. By fitting country-specific multiple logistic regression models, we investigated the association of stressful physical activities and psychosocial characteristics with site-specific and multisite pain, and associated sickness absence. We found no clear relationship between low back pain and occupational lifting, but neck and shoulder pain were more common among nurses who reported prolonged work with the arms in an elevated position. After adjustment for potential confounding variables, pain in the low back, neck and shoulder, multisite pain, and sickness absence were all associated with somatizing tendency in both countries. Our findings support a role of somatizing tendency in predisposition to musculoskeletal disorders, acting as an important mediator of the individual response to triggering exposures, such as work-load.

Regenwald in Guyana und Suriname : Institutionen und Akteure der Inwertsetzung des Regenwaldes durch Goldbergbau, Forstwirtschaft und Tourismus

Die südamerikanischen Staaten Guyana und Suriname sind ehemalige Kolonien, die über gigantische Rohstoffressourcen verfügen. In den Regenwäldern, die die Länder zu 80 - 90% bedecken, lagern Gold und Bauxit und es wachsen wertvolle Hölzer. Außerdem haben beide Länder das Potential für eine touristische Inwertsetzung ihres Landesinneren. rnEbenso vielfältig wie die Ressourcen der Guayanas sind die Interessen daran. International agierende Unternehmen, einheimische Goldsucher sowie Indigene, Naturschützer und Dienstleister aus der Tourismusbranche stellen sich widersprechende Ansprüche an Rohstofflagerstätten sowie an touristisch vermarktbare Landschaft und Natur. Die Regierungen stehen vor der Herausforderung, die politischen Rahmenbedingungen für die Nutzung der Ressourcen des Regenwaldes festzulegen. rnDie vorliegende empirische Studie analysiert vergleichend die Motivationen der Akteure und den Einfluss von Institutionen auf die Akteure in den unterschiedlichen politischen Systemen der Staaten Guyana und Suriname. Um die Strategien der Akteure zu verstehen, wird geklärt, welche institutionelle und länderspezifische Regelungssysteme – formeller und informeller Art – die Akteure beeinflussen und inwiefern sich dabei der Einfluss der kolonialen Vergangenheit beider Staaten bemerkbar macht. rnIm Fokus der Untersuchung stehen Akteure, die an der Inwertsetzung des Regenwaldes durch Bergbau, Forstwirtschaft und (Natur-)Tourismus auf lokaler Ebene beteiligt sind sowie länderspezifischen Institutionen, die den Handlungsrahmen für diese Akteure definieren. rn

Fiscal Constitutions: An Empirical Approach

The overarching question of this dissertation is: “why does the public debt grow, and why are fiscal (debt) crises repetitive and so widespread?” A special focus in answering this question is given to a fiscal constitution, which contains a country-specific set of laws, rules and regulations, and guides decision making in the area of fiscal policy. By shaping incentives and limiting arbitrariness, the fiscal constitution determines the course of fiscal policy and fiscal outcomes in the long term. This dissertation does not give, however, an exhaustive response to the overarching question. Instead it asks much narrower questions, which are selected after reviewing and identifying the main weaknesses and gaps in the modern literature on fiscal constitutions.

Incident cancer burden attributable to excess body mass index in 30 European countries

Excess adiposity is associated with increased risks of developing adult malignancies. To inform public health policy and guide further research, the incident cancer burden attributable to excess body mass index (BMI >or= 25 kg/m(2)) across 30 European countries were estimated. Population attributable risks (PARs) were calculated using European- and gender-specific risk estimates from a published meta-analysis and gender-specific mean BMI estimates from a World Health Organization Global Infobase. Country-specific numbers of new cancers were derived from Globocan2002. A ten-year lag-period between risk exposure and cancer incidence was assumed and 95% confidence intervals (CI) were estimated in Monte Carlo simulations. In 2002, there were 2,171,351 new all cancer diagnoses in the 30 countries of Europe. Estimated PARs were 2.5% (95% CI 1.5-3.6%) in men and 4.1% (2.3-5.9%) in women. These collectively corresponded to 70,288 (95% CI 40,069-100,668) new cases. Sensitivity analyses revealed estimates were most influenced by the assumed shape of the BMI distribution in the population and cancer-specific risk estimates. In a scenario analysis of a plausible contemporary (2008) population, the estimated PARs increased to 3.2% (2.1-4.3%) and 8.6% (5.6-11.5%), respectively, in men and women. Endometrial, post-menopausal breast and colorectal cancers accounted for 65% of these cancers. This analysis quantifies the burden of incident cancers attributable to excess BMI in Europe. The estimates reported here provide a baseline for future modelling, and underline the need for research into interventions to control weight in the context of endometrial, breast and colorectal cancer.

Regional Differences in Living Standards in Eastern European Countries - Changes During the Transition

This research aimed to discover how differences in living standards between regional units changed during the period of transformation from 1990 to 1995 in Poland, the Slovak Republic, the Czech Republic and Hungary. The standard of living was measured by the so-called Living Standard Index (LSI), a composite taxonomic measure. Fixed reference points make it possible to compare the standard of living in regional administrative units and to study its dynamics. The analysis was country-specific, since the lists of variable were not fully identical for all the countries studied. The main tools used were LSI variability measures (mainly variance and standard deviation). By identifying trend patterns in the characteristics of LSIs, it was possible to compare the different countries. It was found that * differences in living standards between regional units have been decreasing during the transformation in Poland and in the Czech Republic. In the latter this process is slow and smooth, while in Poland there was a relatively sharp decline which then stopped entirely in 1994 * the only country with increasing differences between regions is Hungary and these differences are growing at a constant rate * the lowest level of regional differences in the LSI was found in Poland, followed by the Slovak Republic and the Czech Republic * the regional differences in Hungary are almost twice as high as in the Czech Republic

The rate of outpatient cataract surgery in ten European countries: an analysis using data from the SHARE survey

BACKGROUND: The aim of this study was to determine the rates of outpatient cataract surgery (ROCS) in ten European countries and to find country-specific health indicators explaining the differences. METHODS: Using data from the Survey of Health, Ageing and Retirement in Europe (SHARE), 251 eligible respondents were identified for which cataract surgery was the last surgical procedure. The ROCS of ten countries were compared using logistic regression. The influence of the public expenditure on health as per cent of the total expenditure on health, of the number of acute care beds per 1,000 population, and of the number of practicing physicians per 1,000 population, was studied by multiple logistic regression. Additional information was obtained from country-specific opinion leaders in the field of cataract surgery. RESULTS: The ROCS differed significantly between the ten analysed European countries where Denmark had the highest (100%) and Austria the lowest (0%) rate of day care surgery. A decrease in the density of acute care beds (p < 0.0000001) and in the density of practicing physicians (p < 0.05) and an increase in the public expenditure on health as per cent of the total health expenditure (p < 0.01) lead to an increase in the ROCS. According to the opinion leaders, regulations and financial incentives also have a strong influence on the ROCS. CONCLUSIONS: The outpatient rate of cataract surgery in the ten European countries was mainly influenced by the acute-care beds density, but also by the density of practicing physicians, and by the public expenditure on health.

Waiting times for cataract surgery in ten European countries: an analysis using data from the SHARE survey

AIMS: To assess waiting times for cataract surgery and their acceptance in European countries, and to find explanatory, country-specific health indicators. METHODS: Using data from the survey of health, ageing and retirement in Europe (SHARE), waiting times for cataract surgery of 245 respondents in ten countries were analysed with the help of linear regression. The influence of four country specific health indicators on waiting times was studied by multiple linear regression. The influence of waiting time and country on the wish to have surgery performed earlier was determined through logistic regression. Additional information was obtained for each country from opinion leaders in the field of cataract surgery. RESULTS: Waiting times differed significantly (p<0.001) between the ten analysed European countries. The length of wait was significantly influenced by the total expenditure on health (p<0.01) but not by the other country specific health indicators. The wish to have surgery performed earlier was determined by the length of wait (p<0.001) but not by the country where surgery was performed. CONCLUSION: The length of wait is influenced by the total expenditure on health, but not by the rate of public expenditure on health, by the physician density or by the acute bed density. The wish to have surgery performed earlier depends on the length of wait for surgery and is not influenced by the country.

Mortality of HIV-infected patients starting antiretroviral therapy in sub-Saharan Africa: comparison with HIV-unrelated mortality

BACKGROUND: Mortality in HIV-infected patients who have access to highly active antiretroviral therapy (ART) has declined in sub-Saharan Africa, but it is unclear how mortality compares to the non-HIV-infected population. We compared mortality rates observed in HIV-1-infected patients starting ART with non-HIV-related background mortality in four countries in sub-Saharan Africa. METHODS AND FINDINGS: Patients enrolled in antiretroviral treatment programmes in Côte d'Ivoire, Malawi, South Africa, and Zimbabwe were included. We calculated excess mortality rates and standardised mortality ratios (SMRs) with 95% confidence intervals (CIs). Expected numbers of deaths were obtained using estimates of age-, sex-, and country-specific, HIV-unrelated, mortality rates from the Global Burden of Disease project. Among 13,249 eligible patients 1,177 deaths were recorded during 14,695 person-years of follow-up. The median age was 34 y, 8,831 (67%) patients were female, and 10,811 of 12,720 patients (85%) with information on clinical stage had advanced disease when starting ART. The excess mortality rate was 17.5 (95% CI 14.5-21.1) per 100 person-years SMR in patients who started ART with a CD4 cell count of less than 25 cells/microl and World Health Organization (WHO) stage III/IV, compared to 1.00 (0.55-1.81) per 100 person-years in patients who started with 200 cells/microl or above with WHO stage I/II. The corresponding SMRs were 47.1 (39.1-56.6) and 3.44 (1.91-6.17). Among patients who started ART with 200 cells/microl or above in WHO stage I/II and survived the first year of ART, the excess mortality rate was 0.27 (0.08-0.94) per 100 person-years and the SMR was 1.14 (0.47-2.77). CONCLUSIONS: Mortality of HIV-infected patients treated with combination ART in sub-Saharan Africa continues to be higher than in the general population, but for some patients excess mortality is moderate and reaches that of the general population in the second year of ART. Much of the excess mortality might be prevented by timely initiation of ART.

Survey of public knowledge about Echinococcus multilocularis in four European countries: Need for proactive information

Background Public information about prevention of zoonoses should be based on the perceived problem by the public and should be adapted to regional circumstances. Growing fox populations have led to increasing concern about human alveolar echinococcosis, which is caused by the fox tapeworm Echinococcus multilocularis. In order to plan information campaigns, public knowledge about this zoonotic tapeworm was assessed. Methods By means of representative telephone interviews (N = 2041), a survey of public knowledge about the risk and the prevention of alveolar echinococcosis was carried out in the Czech Republic, France, Germany and Switzerland in 2004. Results For all five questions, significant country-specific differences were found. Fewer people had heard of E. multilocularis in the Czech Republic (14%) and France (18%) compared to Germany (63%) and Switzerland (70%). The same effect has been observed when only high endemic regions were considered (Czech Republic: 20%, France: 17%, Germany: 77%, Switzerland: 61%). In France 17% of people who knew the parasite felt themselves reasonably informed. In the other countries, the majority felt themselves reasonably informed (54–60%). The percentage that perceived E. multilocularis as a high risk ranged from 12% (Switzerland) to 43% (France). In some countries promising measures as deworming dogs (Czech Republic, Switzerland) were not recognized as prevention options. Conclusion Our results and the actual epidemiological circumstances of AE call for proactive information programs. This communication should enable the public to achieve realistic risk perception, give clear information on how people can minimize their infection risk, and prevent exaggerated reactions and anxiety.

Differences in Internet Usage - Social Inequality and Informal Education

In the public debate the internet is regarded as a central resource for knowledge and information. Associated with this is the idea that everyone is able and even expected to serve himself or herself according to his or her own needs via this medium. Since more and more services are also delivered online the internet seems to allow its users to enjoy specific advantages in dealing with their everyday life. However, using the internet is based on a range of preconditions. New results of empirical and theoretical research indicate the rise of a social divide in this context. Within the internet, different ways of use can be identified alongside social inequalities. Boundaries of the "real life" are mirrored in the virtual space e.g. in terms of forms of communification and spaces for appropriation. These are not only shaped by invidual preferences but particularly by social structures and processes. In the context of the broader debate on education it is stated that formal educational structures are to be completed by arrangements which are structured in informal respectively nonformal ways. Particularly the internet is suggested to play an important role in this respect. However, the phenomenon of digital inequality points to limitations consolidated by effects of economic, social, and cultural ressources: Economical resources affect opportunities of access, priorities of everyday life shape respective intentions of internet use, social relationships have an impact on the support structures available and ways of appropriation reproduce a specific understanding of informal education ("informelle Bildung"). This produces an early stratification of opportunities especially for the subsequent generation and may lead to extensive inequalities regarding the distribution of advantages in terms of education. Thus the capacity of the virtual space in terms of participatory opportunities and democratic potentials raises concerns of major relevance with respect to social and educational policy. From the perspective of different disciplines involved in these issues it is essential to clarify this question in an empirical as well as in a theoretical way and to make it utilizable for a future-orientied practice. This article discusses central questions regarding young people's internet use and its implications for informal education and social service delivery on the basis of empirical findings. It introduces a methodological approach for this particular perspective and illustrates that the phenomena of digital divide and digital inequality are as much created by social processes as by technical issues.

Anomic Crime in Post-Welfarist Societies. Cult of the Individual, Integration Patterns and Delinquency

Post-Fordist economies come along with post-welfarist societies marked by intensified cultural individualism and increased structural inequalities. These conditions are commonly held to be conducive to relative deprivation and, thereby, anomic crime. At the same time, post-welfarist societies develop a new ‘balance of power’ between institutions providing for welfare regulation, such as the family, the state and the (labour) market – and also the penal system. These institutions are generally expected to improve social integration, ensure conformity and thus reduce anomic crime. Combining both perspectives, we analyse the effects of moral individualism, social inequality, and different integration strategies on crime rates in contemporary societies through the lenses of anomie theory. To test our hypotheses, we draw on time-series cross-section data compiled from different data sources (OECD, UN, WHO, WDI) for twenty developed countries in the period 1970-2004, and run multiple regressions that control for country-specific effects. Although we find some evidence that the mismatch between cultural ideal (individual inclusion) and structural reality (stratified exclusion) increases the anomic pressure, whereas conservative (i. e. family-based), social-democratic (i. e. state-based) and liberal (i. e. market-based) integration strategies to a certain extent prove effective in controlling the incidence of crime, the results are not very robust. Moreover, reservations have to be made regarding the effects of “market” income inequality as well as familialist, unionist and liberalist employment policies that are shown to have reversed effects in our sample: the former reducing, the latter occasionally increasing anomic crime. As expected, the mismatch between cultural ideal (individual inclusion) and structural reality (stratified exclusion) increases the anomic pressure, whereas conservative (i. e. family-based), social-democratic (i. e. state-based) and liberal (i. e. market-based) integration strategies generally prove effective in controlling the incidence of crime. Nevertheless, we conclude that the new cult of the individual undermines the effectiveness of conservative and social-democratic integration strategies and drives societies towards more “liberal” regimes that build on incentive as well as punitive elements.

Internet-Based Interventions for Social Anxiety Disorder - an Overview

Internet-based interventions hold specific advantages and disadvantages in the treatment of social anxiety disorder (SAD). The present review examines different approaches in the internet-based treatment of SAD and reviews their efficacy and effectiveness. 21 studies investigated the potential of guided and unguided internetbased cognitive-behavioral treatments (ICBT) for SAD, comprising a total of N = 1,801 socially anxious individuals. The large majority of these trials reported substantial reductions of social anxiety symptoms through ICBT programs. Within effect sizes were mostly large and comparisons to waitlist and more active control groups were positive. Treatment gains were stable from 3 months to 5 years after treatment termination. In conclusion, ICBT is effective in the reduction of social anxiety symptoms. At the same time, not all participants benefit from these treatments to a sufficient degree. Future research should focus on what makes these interventions work in which patient populations, and at the same time, examine ways to implement internet-based treatment in the routine care for socially anxious patients

The relationship between adolescents’ social capital and individualism-collectivism in Estonia, Germany, and Russia

The present study examines the relationship between adolescents’ social capital and individualism-collectivism using data from the Value of Children Study (Trommsdorff and Nauck, 2005) from Estonia (N=228), Germany (N=278), and Russia (N=280). Two social capital indexes for adolescents (measuring parental social capital and peer-group social capital) were developed for the analysis. The COLINDEX Scale (Chan 1994) was used to measure individualistic and collectivistic values. In all three countries collectivistic values predicted parental social capital whereas individualistic values predicted peer-group social capital. There were also a few country-specific relationships between the constructs, with collectivism and peer-group social capital being positively related in Estonia and individualism and parental social capital signif- icantly negatively correlated in Russia. The current analysis suggests that during the adolescence, collectivistic values are more likely to be related to higher levels of parental social capital and individualistic values to higher levels of peer-group social capital. Therefore, it seems that at the individual level and for adolescents the individualism and collectivism are related to different forms of social capital in the different manner.

The Determinants of Personal Income Tax Progressivity Around the Globe

This paper utilizes a novel database collected by the authors to document features of the progressivity of personal income tax systems across 209 countries for the years 1980-2009. We measure progressivity in several ways. First, we associate it with the increase in effective average (marginal) tax rates between a wage of zero and ten times the average wage in a country. Second, we consider the curvature of the tax schedule expressed as the difference between the effective average (marginal) tax schedule from a wage of zero to ten times the average wage and a linear average tax schedule and, alternatively, the diference between the effective average (marginal) tax schedule from the minimum positive taxable income, to ten times the average wage as opposed to a linear average tax schedule. Moreover, the paper assesses patterns regarding the conditional correlation of country-specifc tax progressivity measures with a host of economic and political country-specific characteristics and find the labor supply elasticity and the income replacement rates for the unemployed to be key determinants of progressivity around the globe, in line with economic theory.

Laboratory diagnosis of ruminant abortion in Europe.

Abortion in ruminants is a major cause of economic loss worldwide, and the management and control of outbreaks is important in limiting their spread, and in preventing zoonotic infections. Given that rapid and accurate laboratory diagnosis is central to controlling abortion outbreaks, the submission of tissue samples to laboratories offering the most appropriate tests is essential. Direct antigen and/or DNA detection methods are the currently preferred methods of reaching an aetiological diagnosis, and ideally these results are confirmed by the demonstration of corresponding macroscopic and/or histopathological lesions in the fetus and/or the placenta. However, the costs of laboratory examinations may be considerable and, even under optimal conditions, the percentage of aetiological diagnoses reached can be relatively low. This review focuses on the most commonly occurring and important abortifacient pathogens of ruminant species in Europe highlighting their epizootic and zoonotic potential. The performance characteristics of the various diagnostic methods used, including their specific advantages and limitations, are discussed.