International Journal of Public Health

We used data from the Global Burden of Disease 2015 study (GBD) to calculate the burden of lower respiratory infections (LRIs) in the 22 countries of the Eastern Mediterranean Region (EMR) from 1990 to 2015. We conducted a systematic analysis of mortality and morbidity data for LRI and its specific etiologic factors, including pneumococcus, Haemophilus influenzae type b, Respiratory syncytial virus, and influenza virus. We used modeling methods to estimate incidence, deaths, and disability-adjusted life-years (DALYs). We calculated burden attributable to known risk factors for LRI. In 2015, LRIs were the fourth-leading cause of DALYs, causing 11,098,243 (95% UI 9,857,095–12,396,566) DALYs and 191,114 (95% UI 170,934–210,705) deaths. The LRI DALY rates were higher than global estimates in 2015. The highest and lowest age-standardized rates of DALYs were observed in Somalia and Lebanon, respectively. Undernutrition in childhood and ambient particulate matter air pollution in the elderly were the main risk factors. Our findings call for public health strategies to reduce the level of risk factors in each age group, especially vulnerable child and elderly populations.

The study investigates the life cycle patterns of educational inequalities in smoking according to gender over three successive generations. Based on retrospective smoking histories collected by the nationwide French Health Barometer survey 2010, we explored educational inequalities in smoking at each age, using the relative index of inequality. Educational inequalities in smoking increase across cohorts for men and women, corresponding to a decline in smoking among the highly educated alongside progression among the lower educated. The analysis also shows a life cycle evolution: for all cohorts and for men and women, inequalities are considerable during adolescence, then start declining from 18 years until the age of peak prevalence (around 25), after which they remain stable throughout the life cycle, even tending to rise for the most recent cohort. This analysis contributes to the description of the “smoking epidemic” and highlights adolescence and late adulthood as life cycle stages with greater inequalities.

Little is known about fathers’ attitudes toward human papillomavirus (HPV) vaccination in low-resource settings. We sought to determine the awareness of HPV vaccination among Honduran fathers, and to assess their intention to accept HPV vaccination for their sons and daughters. We conducted 100 structured interviews of fathers recruited from medical and business settings between May 2007 and June 2008. After assessing baseline knowledge, fathers received a brief explanation of HPV infection, cervical cancer, genital warts, and HPV vaccination. They were then asked whether they would accept HPV vaccination for their sons and daughters. Prior to receiving information about HPV, 85% of fathers believed that cervical cancer was preventable, over two-thirds could correctly name some form of prevention, 22% of fathers had heard of HPV, and 17% had heard of HPV vaccination. After receiving HPV-related information, 100% of fathers intended to accept HPV vaccination for their sons and 94% intended to accept HPV vaccination for their daughters. Few Honduran fathers were aware of HPV or HPV vaccination, but after receiving information, most would accept HPV vaccination for their sons and daughters.

To identify potential predictors of using only non-violent forms of discipline for children aged 2–14 years and of being against physical punishment among Roma and non-Roma parents/caregivers in Eastern European countries with similar cultural-historical backgrounds. UNICEF Multiple Indicator Cluster Survey data collected in 2010–2011 in Bosnia and Herzegovina, Macedonia and Serbia (total of 9973 respondents) were analysed using multivariate logistic regression modelling with receiver operating characteristic analysis. Approximately 27 % of the respondents practiced only non-violent child discipline. Roma children experienced only non-violent discipline less than half as often as their non-Roma counterparts. Household wealth index and child sex were significant predictors of positive parenting attitudes and practice. For Roma respondents, rural residence also contributed to being against physical punishment. Parents\caregivers from more affluent households are more likely than those who are less affluent to be against physical punishment of children and are more likely to practice only non-violent discipline. Evidence-based interventions are required to support existing positive forms of child rearing. These should target less affluent households from Roma settlements in the studied countries.

To analyse the factors that influence access to health services from the point of view of the Ecuadorian population living in Barcelona. A qualitative, descriptive and phenomenological study was carried out by semi-structured individual interviews on a sample of Ecuadorians (18) with maximum variation in age, sex, time since arrival and administrative status. The analysis was conducted according to Colaizzi’s method. The study area was Barcelona. Access was considered to be easy for personal health-care card (PHC) holders. However, interviewees identified few factors that facilitated access related to the Ecuadorian population (PHC holder, language, social networks) and the health system (free care, opening hours). In contrast, a number of hindering factors related to both the Ecuadorian population (insufficient knowledge of the system, problems with the documentation in obtaining the PHC, working conditions) and to the system itself (information availability, resources, organisation, attitude of staff) were also identified. Although access was perceived as easy, the Ecuadorian population has to overcome a number of barriers to obtain care. These obstacles may have consequences on immigrants’ health and on the efficiency of the system.