Mid Sweden University

Background: Given gender differences in the risk of coronary artery disease (CAD), the present study sought to investigate these dissimilarities amongst patients who underwent angiography at a major, tertiary heart hospital in Iran. Methods: Between 2005 and 2010, 44,820 patients who underwent coronary angiography were enrolled in a registry. Pre-procedural data such as demographics, CAD risk factors, presenting symptoms, and laboratory tests, as well as postprocedural data were collected. The data were, subsequently, compared between the men and women. Results: Out of the 44,820 patients (16,378 women), who underwent coronary angiography, 37,358 patients (11,995 women) had CAD. Amongst the CAD patients, the females were not only significantly older, less educated, and more overweight than were the males but also had higher levels of triglyceride, cholesterol, low-density lipoprotein, highdensity lipoprotein, and fasting blood sugar (P< 0.001). Of all the risk factors, hypertension and diabetes mellitus showed the strongest association in our female CAD patients (OR=3.45, 95%CI: 3.28-3.61 and OR=2.37, 95%CI: 2.26- 2.48, respectively). Acute coronary syndrome was more prevalent in the men (76.1% vs. 68.6%, P< 0.001), and chronic stable angina was more frequent in the females (31.4% vs. 23.9%, P< 0.001). With respect to post-procedural recommendations, the frequency of recommendations for non-invasive modalities was higher in the females (20.1% vs. 18.6%, P< 0.001). Conclusion: Hypertension and diabetes mellitus had the strongest association with CAD in our female patients. In the extensive CAD patients, medical treatment was recommended to the women more often.

Background Diverse ethnic groups may differ regarding the risk factors and severity of coronary artery disease (CAD). This study sought to assess the association between ethnicity and CAD risk and severity in six major Iranian ethnic groups.

Methods In this study, 20,165 documented coronary artery disease patients who underwent coronary angiography at a tertiary referral heart center were recruited. The demographic, laboratory, clinical, and risk factor data of all the patients were retrieved. The Gensini score (an indicator of CAD severity) was calculated for all, and the risk factors and severity of CAD were compared between the ethnical groups, using adjusted standardized residuals, Kruskal–Wallis test, and multivariable regression analysis.

Results The mean age of the participants (14,131 [70.1%] men and 6034 [29.9%] women) was 60.7 ± 10.8 years. The Fars (8.7%) and Gilak (8.6%) ethnic groups had the highest prevalence of ≥4 simultaneous risk factors. The mean Gensini score was the highest for the Gilaks (77.1 ± 55.9) and the lowest among the Lors (67.5 ± 52.8). The multivariable regression analysis showed that the Gilaks had the worst severity (β 0.056, 95% CI 0.009 to 0.102; P = 0.018), followed by the Torks (β 0.032, 95% CI 0.005 to 0.059; P = 0.020). Meanwhile, the Lors showed the lowest severity (β −0.087, 95% CI −0.146 to −0.027; P = 0.004).

Conclusions This study found that there was heterogeneity in CAD severity and a diverse distribution in its well-known traditional risk factors among major Iranian ethnic groups.

Background: Current evidence shows inequality in the outcomes of rural and urban patients treated at their place of residence. This study compared in-hospital mortality between rural and urban patients with acute coronary syndrome (ACS) to find whether there were differences in the outcome and received treatment. Methods: Between May 2007 and January 2018, patients admitted with ACS were included. The patients’ demographic, clinical, and laboratory data, as well as their in-hospital medical courses, were recorded. The association between place of residence (rural/ urban) and in-hospital mortality due to ACS was evaluated using logistic regression adjusted for potential confounders. Results: Of 9088 recruited patients (mean age =61.30±12.25 y; 5557 men [61.1%]), 838 were rural residents. A positive family history of coronary artery disease (P=0.003), smoking (P=0.002), and hyperlipidemia (P=0.026), as well as a higher body mass index (P=0.013), was seen more frequently in the urban patients, while the rural patients had lower education levels (P<0.001) and higher unemployment rates (P=0.009). In-hospital mortality occurred in 135 patients (1.5%): 10 rural (1.2%) and 125 urban (1.5%) patients (P=0.465). The Firth regression model, used to adjust the effects of possible confounders, showed no significant difference concerning in-hospital mortality between the rural and urban patients (OR, 1.57; 95% CI, 0.376 to 7.450; P=0.585). Conclusion: This study found no significant differences in receiving proper treatment and in-hospital mortality between ru-ral and urban patients with ACS. 

Background: Socioeconomic status (SES) can greatly affect the clinical outcome of medical problems. We sought to assess the in‑hospital mortality of patients with the acute coronarysyndrome (ACS) according to their SES.

Methods: All patients admitted to Tehran Heart Center due to 1st‑time ACS between March 2004 and August 2011 were assessed. The patients who were illiterate/lowly educated (≤5 years attained education) and were unemployed were considered low‑SES patients and those who were employed and had high educational levels (>5 years attained education) were regarded as high‑SES patients. Demographic, clinical, paraclinical, and in‑hospital medical progress data were recorded. Death during the course of hospitalization was considered the end point, and the impact of SES on in‑hospital mortality was evaluated.

Results: A total of 6246 hospitalized patients (3290 low SES and 2956 high SES) were included (mean age = 60.3 ± 12.1 years, male = 2772 [44.4%]). Among them, 79 (1.26%) patients died. Univariable analysis showed a significantly higher mortality rate in the low‑SES group (1.9% vs. 0.6%; P < 0.001). After adjustment for possible cofounders, SES still showed a significant effect on the in‑hospital mortality of the ACS patients in that the high‑SES patients had a lower in‑hospital mortality rate (odds ratio: 0.304, 95% confidence interval: 0.094–0.980; P = 0.046).

Conclusions: This study found that patients with low SES were at a higher risk of in‑hospital mortality due to the ACS. Furthermore, the results suggest the need for increased availability of jobs as well as improved levels of education as preventive measures to curb the unfolding deaths owing to coronary artery syndrome.

Objective: The aim of this study was to estimate the prevalence of elder abuse and neglect in Iran.

Methods: We searched PubMed, Embase, Scopus, and PsycINFO by the end of 2017. The prevalence was calculated based on the percentage or the amount reported in the studies. Heterogeneity was assessed by the I2 statistic, and the data were combined using random effects model. The results were reported as the pooled estimates and the 95% confidence intervals (CIs). The review protocol was registered in PROSPERO (CRD42017070744).

Results: A total of 16 studies involving 6,461 participants aged 60 years and over were included. The pooled prevalence for overall elder abuse was 45.7% (95% CI: 27.3–64.1, p < .001).

Discussion: The prevalence of elder abuse and neglect is substantial in the Iranian population aged 60 years and over. More research is needed to investigate the actual prevalence of elder abuse at the national level.

Background: Employment status has an impact on health and is a source of health inequalities. But little is known about its impact on the health of people residing in the County of Västernorrland, Sweden. The recent economic recession affected this region in a way which worsened the already existing unemployment rate.Objective of the study: This study aimed to examine the relationship between employment status, gender and self-reported health in the County of Västernorrland, Sweden in the year 2010.Setting and Design: The study used data from a cross-sectional "Health on Equal Terms" survey, carried in the County of Västernorrland in 2010. A total of 6,050 women and men aged 16-65 years were included in the analysis. Descriptive statistics and logistic regression analyses were performed, and results were expressed as odds ratio with 95% confidence intervals.Results: Women and men who were out of work had odds of poor self-reported health of 2.31 (CI 1.94-2.94) and 2.39 (CI 1.96-2.58), respectively. Controlling for other variables reduced the odds of poor health, but the relationship continued to be statistically significant.Conclusion: Results of this study found that at the pick of the most recent economic crises there were equal odds of poor self-reported health among women and men residing in Gävleborg County. The observed association was to some extent explained by demographic, socioeconomic and health-related variables. Policymakers need to pay attention to the health status of those out of work, particularly during times of economic recession and hardship.

Suicide is a leading cause of death world-wide. However, adolescent suicidal behavior is a neglected public health issue, especially in low-income countries such as Bangladesh. The study was conducted to estimate the prevalence of suicidal ideation among adolescents in a rural community and to examine factors associated with suicidal ideation. A cross-sectional survey was carried out in 2013 among 2,476 adolescents aged 14–19 years, selected randomly from a rural community of Bangladesh. An adapted version of the WHO/SUPRE-MISS questionnaire was used to collect data in the Raiganj sub-district. A two stage screening was performed to identify the suicidal ideation cases. It was found that the life-time prevalence for suicidal ideation was 5 percent among adolescents. The majority of the adolescents with suicidal ideation were females 66 (52.8%), unmarried 103 (82.4%), and students 92 (73%). Suicidal ideation was statistically significantly associated with age, education, occupation, living with parents or others, and house ownership. Respondents who were aged 18–19 years, had secondary school certificate (SSC) and secondary school certificate (HSC) or higher education, were day laborers, had own house, and do not lived with parents had odds ratios of 2.31 (CI 1.46–3.65), 2.38 (CI 1.51–3.77), 4.15 (CI 2.41–7.14), 0.28 (CI 0.13–0.60), 0.14(CI 0.05–0.35), and 1.80 (CI 1.07–3.03), respectively. Among adolescents, the prevalence of life-time suicidal ideation was moderately high. Age, education, occupation, house ownership, and living with parents were statistically significantly associated with suicidal ideation. It is important to design and implement effective community based suicide prevention programs for adolescents in Bangladesh.

Background:  Suicide is a leading cause of death worldwide and becoming a public health concern among adolescents. However, adolescent suicidal behaviour is a neglected public health issue, especially in low-income countries such as Bangladesh. Of great importance is the understanding of which factors might be related to this growing public problem. 

Objective: To examine the relationship between parental socio-economic position and suicide ideation among adolescents in rural Bangladesh

Methods: A cross-sectional survey was conducted in 2013 among 2,476 adolescents, aged 14-19 years, selected randomly from a rural community of Bangladesh. An adapted version of the WHO/SUPRE-MISS questionnaire was used to collect data in the Raiganj sub-district, which is a surveillance area of the Centre for Injury Prevention and Research, Bangladesh (CIPRB).

Descriptive statistics and binary logistic regression analyses were used to analyze the data. Comparisons of proportions between groups were carried out using the χ2 test. Multivariate logistic regression analysis was used to examine the relationship between parental co-variants and suicidal thoughts among adolescents. The significance level was set atp <0.05. All analyses were performed using SPSS 20.

Results: The majority of parents had education only up to primary school (mothers 58.7% and fathers 49.5%). Most of them were farmers (53.3% of fathers) and housewives (96.5% of mothers). Monthly income and expenditure of the adolescent’s parents were mainly upto 10,000 taka only. Suicidal ideation is more common among adolescents of low income group parents 104 (5.5%) and who were not living with their parents 18 (8.2%). Adolescent’s suicidal ideation was found to be significantly associated with education, marital status and house ownership of their parents. Not being able to live with their parents was also a significant factor. Parents who received education up to SSC had odds ratio of 2.10 (1.21,3.64) and 1.92 (1.15, 3.23) for mothers and fathers respectively. Parent’s income or expenditure was not associated with adolescent’s suicidal ideation. Adolescent’s suicidal ideation of single parents had higher odds (OR 3.00, CI 1.75-5.19) in comparison to adolescents who had both parents. Adolescents whose parents owned a house and who weren’t living withtheir parents had odds ratios of 0.14 (0.05,0.35), and 1.80 (1.07,3.03) respectively. After adjusting for other covariates parents’ marital status and house ownership significantly associated with the adolescent suicide ideation.

Conclusion: Parental socio-economic position was associated with suicidal ideation. Adolescent with single parents were more likely to report suicidal ideation. Low parental education and socio-economic status, marital status, house ownership, not living with parents at home as well as adolescent loneliness were the important factors for suicidal ideation.

Abstract

Background: Intimate partner violence (IPV) is a major public health problem worldwide but research on IPV in Africa remains limited. This study aims to estimate the prevalence of sexual and physical intimate partner violence against women and its associated factors, in a sample of women using prenatal care in  Nampula, province-Mozambique.

Methods: This is a cross-sectional study, carried out in six health units, from February 2013 to January 2014. One in every three pregnant women who visited primary health facilities for the first pre-natal appointment was eligible and invited to participate. After obtaining informed consent 869 pregnant answered the Conflict Tactics Scale 2. Odds ratios (OR) and respective 95% confidence intervals (95%CI) were calculated by using Logistic Regression.

Results: The prevalence of sexual abuse ever in life was 49% and of physical abuse was 46%. The past year prevalence was 46% and 44% for sexual and physical abuse, respectively. Sexual abuse and physical violence occurred in every age group. Significant associations were found between previous neonatal deaths and being physically abused, during the life-time (OR= 3.00, 95% IC: 1.67 to 5:39), and the past year (OR=3.23, 95% CI: 1.80 - 5.80).

Conclusion: This study found a high lifetime and past year violence prevalence among women using prenatal care in Mozambique. Prenatal care provides a window of opportunity for identifying women who experience violence.

Message 1

The prevalence of intimate partner violence is very high among women in Mozambique and prenatal care can be a sentinel setting

Message 2

The implementation of strategies to support women victims of violence in Mozambique is urgently needed

The aim was to estimate the prevalence of sexual and physical intimate partner violence (IPV) and its associated factors, in a sample of pregnant women using antenatal care (ANC) in Nampula province - Mozambique. This cross-sectional study was carried out in six health units in Nampula, from February 2013 to January 2014. Overall, 869 participants answered the Conflict Tactics Scale 2. The lifetime and past year prevalence of sexual abuse was 49% and 46%, and of physical abuse was 46% and 44%, respectively. Lifetime and past year sexual abuse was significantly associated with living as a couple, alcohol drinking and having a past diagnosis of gonorrhea. Lifetime and past year physical abuse increased significantly with age and was associated with living as a couple, alcohol drinking and history with syphilis. The prevalence of lifetime and previous year violence among women using ANC was high and similar showing that most women were constantly exposed to IPV. ANC provides a window of opportunity for identifying and acting on violence against women.

Objectives

This work explores the association between socio-economic position (SEP) and intimate partner violence (IPV) considering the perspectives of men and women as victims, perpetrators and as both (bidirectional).

Study design

Cross-sectional international multicentre study.

Methods

A sample of 3496 men and women, (aged 18–64 years), randomly selected from the general population of residents from six European cities was assessed: Athens; Budapest; London; Östersund; Porto; and Stuttgart. Their education (primary, secondary and university), occupation (upper white collar, lower white collar and blue collar) and unemployment duration (never, ≤12 months and >12 months) were considered as SEP indicators and physical IPV was measured with the Revised Conflict Tactics Scales.

Results

Past year physical IPV was declared by 17.7% of women (3.5% victims, 4.2% perpetrators and 10.0% bidirectional) and 19.8% of men (4.1% victims, 3.8% perpetrators and 11.9% bidirectional). Low educational level (primary vs university) was associated with female victimisation (adjusted odds ratio, 95% confidence interval: 3.2; 1.3–8.0) and with female bidirectional IPV (4.1, 2.4–7.1). Blue collar occupation (vs upper white) was associated with female victimisation (2.1, 1.1–4.0), female perpetration (3.0, 1.3–6.8) and female bidirectional IPV (4.0, 2.3–7.0). Unemployment duration was associated with male perpetration (>12 months of unemployment vs never unemployed: 3.8; 1.7–8.7) and with bidirectional IPV in both sex (women: 1.8, 1.2–2.7; men: 1.7, 1.0–2.8).

Conclusions

In these European centres, physical IPV was associated with a disadvantaged SEP. A consistent socio-economic gradient was observed in female bidirectional involvement, but victims or perpetrators-only presented gender specificities according to levels of education, occupation differentiation and unemployment duration potentially useful for designing interventions.

Abstract

Purpose

Little is known on the specific relation between

being a perpetrator or both a victim and perpetrator of

intimate partner violence (IPV) and health-related quality

of life (HRQoL). We assessed the association between

HRQoL and abuse, considering men and women as victims,

perpetrators or reciprocally.

Methods

Participants were adult men and women

(

n=

3,496), randomly selected from the general population

of six European cities. The Revised-Conflict-Tactics-Scales

and the Medical-Outcomes-Study 36-item Short-Form

Health Survey (SF-36) were used to measure IPV and

HRQoL. The age-, education-, and city-adjusted mean

scores[standard error] of the physical and of the mental SF-

36 component summaries were used to compare victimsonly,

perpetrators-only, and those involved in both (bidirectional

or reciprocal cases) with those not involved in pastyear

and lifetime physical assault and/or sexual coercion.

Results

The physical component summary was significantly

lower in women involved in past-year bidirectional

physical assault compared with non-abused women. The

mental component summary in women not involved in IPV

was significantly higher than in those physically abused,

regardless of type of involvement. Women victims-only of

past-year sexual coercion and victims or involved in bidirectional

concomitant physical and sexual IPV also presented

lower scores in the mental component summary than

women not involved in IPV. In men, significantly lower

scores in the mental component summary were found in the

past-year bidirectional physically assaulted group and

among those involved bidirectionally in both physical and

sexual IPV compared with men not involved in IPV.

Background:

Different service characteristics are known to influence mental health care delivery. Much less is

known about the impact of contextual factors, such as the socioeconomic circumstances, on the provision of care

to socially marginalized groups.

The objectives of this work were to assess the organisational characteristics of services providing mental health care

for marginalized groups in 14 European capital cities and to explore the associations between organisational

quality, service features and country-level characteristics.

Methods:

617 services were assessed in two highly deprived areas in 14 European capital cities. A Quality Index of

Service Organisation (QISO) was developed and applied across all sites. Service characteristics and country level

socioeconomic indicators were tested and related with the Index using linear regressions and random intercept

linear models.

Results:

The mean (standard deviation) of the QISO score (minimum = 0; maximum = 15) varied from 8.63 (2.23) in

Ireland to 12.40 (2.07) in Hungary. The number of different programmes provided was the only service characteristic

significantly correlated with the QISO (p < 0.05). The national Gross Domestic Product (GDP) was inversely

associated with the QISO. Nearly 15% of the variance of the QISO was attributed to country-level variables, with

GDP explaining 12% of this variance.

Conclusions:

Socioeconomic contextual factors, in particular the national GDP are likely to influence the

organisational quality of services providing mental health care for marginalized groups. Such factors should be

considered in international comparative studies. Their significance for different types of services should be explored

in further research.

Keywords:

Mental health services, Quality index of service organization, Socially marginalized groups,

Multi-level analysis

We aimed to assess intimate partner violence (IPV) among men and women from six cities in six European countries.

Four IPV types were measured in a population-based multicentre study of adults (18-64 years; n = 3,496). Sex- and city-differences in past year prevalence were examined considering victims, perpetrators or both and considering violent acts' severity and repetition.

Male victimization of psychological aggression ranged from 48.8 % (Porto) to 71.8 % (Athens) and female victimization from 46.4 % (Budapest) to 70.5 % (Athens). Male and female victimization of sexual coercion ranged from 5.4 and 8.9 %, respectively, in Budapest to 27.1 and 25.3 % in Stuttgart. Male and female victims of physical assault ranged from 9.7 and 8.5 %, respectively, in Porto, to 31.2 and 23.1 % in Athens. Male victims of injury were 2.7 % in A-stersund and 6.3 % in London and female victims were 1.4 % in A-stersund and 8.5 % in Stuttgart. IPV differed significantly across cities (p < 0.05). Men and women predominantly experienced IPV as both victims and perpetrators with few significant sex-differences within cities.

Results support the need to consider men and women as both potential victims and perpetrators when approaching IPV.

BACKGROUND:

To examine the relationship between forgone healthcare and involvement in intimate partner violence (IPV) as victims, perpetrators or both.

METHODS:

This cross-sectional multicentre study assessed community non-institutionalized residents (n = 3496, aged 18-64) randomly selected from six European cities: Athens, Budapest, London, Östersund, Porto, Stuttgart. A common questionnaire was used, including self-reports of IPV and forgone healthcare ('Have you been in need of a certain care service in the past year, but did not seek any help?'). Odds ratios (ORs), 95% confidence intervals (CIs) were computed fitting logistic regression models adjusted for city, chronic disease, self-assessed health status and financial strain.

RESULTS:

Participants experiencing past year IPV (vs. no violence) reported more often to forgone healthcare (n = 3279, 18.6% vs. 15.3%, P = 0.016). IPV experienced as both a victim and perpetrator was associated with forgone healthcare (adjusted OR, 95%CI: 1.32, 1.02-1.70).

CONCLUSION:

IPV was associated with forgone healthcare, particularly for those experiencing violence as both victims and perpetrators. Results suggest that preventing IPV among adults may improve timely healthcare uptake.

Background: Victims of intimate partner violence (IPV) are known to refrain from seeking care when in need. Whether the impact on forgone care differs according to the victim-perpetrator role remains unexplored. We aimed to describe the relation between past-year IPV and forgone healthcare according to victims, perpetrators or both (bidirectional). Methods: Adult men and women (n=3496, aged 18-64), randomly sampled from the general population of Athens, Porto, London, Budapest, Östersund and Stuttgart were assessed using a common questionnaire. IPV was ascertained with the Revised-Conflict-Tactics-Scales. The association between IPV and forgone healthcare (“Have you been in need of a certain care service in the past year, but did not seek any help?”), sociodemographics (sex, age, education, city) and health factors (self-assessed health, public or private healthcare sector use), in victims, perpetrators and both was estimated using adjusted logistic regression odds ratios (AOR, 95% confidence intervals). Results: Forgone healthcare ranged from 12.6% (Budapest) to 22.4% (Stuttgart) and was associated with bidirectional involvement in IPV (AOR, 95%CI= 1.37, 1.05-1.78). A lower educational level was associated with forgone care in multivariate models fitted for victims of and for bidirectional involvement in IPV. A fair/poor self-assessed health (contrasting to a good/very good/excellent health) was significantly associated with forgone care in victims (AOR, 95%CI=2.61, 1.96-3.47), in bidirectional IPV (AOR, 95%CI=2.94, 2.27-3.82) and for perpetrators (AOR, 95%CI=2.58, 1.96-3.40). Conclusion: Beside the known barriers identified for inequalities and access to healthcare, the role of IPV in forgone healthcare should be considered.

Objective To describe the design, methods, procedures and characteristics of the population involved in a study designed to compare Intimate Partner Violence (IPV) in eight European countries.

Methods Women and men aged 18–65, living in Ghent-Belgium (n = 245), Stuttgart-Germany (n = 546), Athens-Greece (n = 548), Budapest-Hungary (n = 604), Porto-Portugal (n = 635), Granada-Spain (n = 138), Östersund-Sweden (n = 592), London-United Kingdom (n = 571), were sampled and administered a common questionnaire. Chi-square goodness of fit and five-age strata population fractions ratios for sex and education were computed to evaluate samples' representativeness.

Results Differences in the age distributions were found among women from Sweden and Portugal and among men from Belgium, Hungary, Portugal and Sweden. Over-recruitment of more educated respondents was noted in all sites.

Conclusion The use of a common research protocol with the same structured questionnaire is likely to provide accurate estimates of the general population IPV frequency, despite limitations in probabilistic sampling and restrictions in methods of administration.

This comparative study of the perceptions of mental health nurses and psychiatrists about aspects of their work environment was undertaken in the West Midlands in England. The aim of the study was to ascertain the extent to which the environment in which mental health professionals' work impacts on their own mental and physical well-being. Seventy-four psychiatrists and 301 mental health nurses responded to a postal questionnaire. Analysis of data indicated that significant differences exist between nurses and psychiatrists in their working conditions, their physical working environment, their sources of support with a work-related problem, and the effects of their work on their own mental and physical health. The main recommendation derived from this study was to improve communication between mental health professionals and their managers by giving more structured feedback and guidance about one's work performance. This may help to alleviate the mental strain many mental health professionals experience in their work.

Abstract. Background: Health services in Europe face the challenge of delivering care to a heterogeneous group of irregular migrants (IM). There is little empirical evidence on how health professionals cope with this challenge. This study explores the experiences of health professionals providing care to IM in three types of health care service across 16 European countries. Results: Semi-structured interviews were conducted with health professionals in 144 primary care services, 48 mental health services, and 48 Accident & Emergency departments (total n = 240). Although legal health care entitlement for IM varies across countries, health professionals reported facing similar issues when caring for IM. These issues include access problems, limited communication, and associated legal complications. Differences in the experiences with IM across the three types of services were also explored. Respondents from Accident & Emergency departments reported less of a difference between the care for IM patients and patients in a regular situation than did respondents from primary care and mental health services. Primary care services and mental health services were more concerned with language barriers than Accident & Emergency departments. Notifying the authorities was an uncommon practice, even in countries where health professionals are required to do this. Conclusions: The needs of IM patients and the values of the staff appear to be as important as the national legal framework, with staff in different European countries adopting a similar pragmatic approach to delivering health care to IM. While legislation might help to improve health care for IM, more appropriate organisation and local flexibility are equally important, especially for improving access and care pathways. © 2012 Dauvrin et al; licensee BioMed Central Ltd.

Background: European Member States are facing a challenge to provide accessible and effective health care services for immigrants. It remains unclear how best to achieve this and what characterises good practice in increasingly multicultural societies across Europe. This study assessed the views and values of professionals working in different health care contexts and in different European countries as to what constitutes good practice in health care for immigrants. Methods: A total of 134 experts in 16 EU Member States participated in a three-round Delphi process. The experts represented four different fields: academia, Non-Governmental Organisations, policy-making and health care practice. For each country, the process aimed to produce a national consensus list of the most important factors characterising good practice in health care for migrants. Results: The scoring procedures resulted in 10 to 16 factors being identified as the most important for each participating country. All 186 factors were aggregated into 9 themes: (1) easy and equal access to health care, (2) empowerment of migrants, (3) culturally sensitive health care services, (4) quality of care, (5) patient/health care provider communication, (6) respect towards migrants, (7) networking in and outside health services, (8) targeted outreach activities, and (9) availability of data about specificities in migrant health care and prevention. Although local political debate, level of immigration and the nature of local health care systems influenced the selection and rating of factors within each country, there was a broad European consensus on most factors. Yet, discordance remained both within countries, e. g. on the need for prioritising cultural differences, and between countries, e. g. on the need for more consistent governance of health care services for immigrants. Conclusions: Experts across Europe asserted the right to culturally sensitive health care for all immigrants. There is a broad consensus among experts about the major principles of good practice that need to be implemented across Europe. However, there also is some disagreement both within and between countries on specific issues that require further research and debate.

Objectives: To assess whether city-level characteristics influence the risk of intimate partner violence (IPV) victimization across six European cities. Methods: The DOVE study included 3496 participants from Athens–Greece, Budapest–Hungary, London–UK, Östersund–Sweden, Porto–Portugal and Stuttgart–Germany. IPV victimization was assessed using the Revised Conflict Tactics Scales, and several contextual variables were included: GINI coefficient, gender equality index, an index of social support, unemployment rate and proportion of residents with tertiary education. Multilevel models were fitted to estimate the associations (odds ratio, 95% confidence intervals) between each type of victimization and contextual and individual-level variables. Results: 62.3% of the participants reported being a victim of IPV during the previous year, with large between-city differences (53.9%–72.4%). Contextual variables accounted for a substantial amount of this heterogeneity. Unemployment rates were associated with psychological (1.05, 1.01–1.08) and physical IPV (1.07, 1.01–1.13). GINI coefficient showed a positive association with any form of IPV (1.06, 1.01–1.11) and sexual coercion (1.13, 1.01–1.25). Conclusions: We found significant associations between contextual determinants and IPV, which emphasizes the importance of considering contextual socioeconomic conditions when policy measures are designed to address IPV. 

Background

Social support may buffer the negative effects of violence on physical and mental health. Family medicine providers play an essential role in identifying the available social support and intervening in intimate partner violence (IPV).

Objective

This study aimed at assessing the association between social support and the IPV victimization among adults from six European countries.

Methods

This is a cross-sectional multi-centre study that included individuals from Athens (Greece), Budapest (Hungary), London (UK), Östersund (Sweden), Porto (Portugal) and Stuttgart (Germany). Data collection was carried out between September 2010 and May 2011. The sample consisted of 3496 adults aged 18–64 years randomly selected from the general population in each city. The revised Conflict Tactics Scales was used to assess IPV victimization. Social support was assessed with the Multidimensional Scale of Perceived Social Support.

Results

Participants reporting physical assault victimization experienced lower social support (mean ± SD) than their counterparts, 66.1 ± 13.96 versus 71.7 ± 12.90, P< 0.001, for women; and 67.1 ± 13.69 versus 69.5 ± 13.52, P = 0.002 for men. Similar results were found regarding sexual coercion victimization, 69.1 ± 14.03 versus 71.3 ± 12.97, P = 0.005 for women and 68.0 ± 13.29 versus 69.3 ± 13.62, P= 0.021 for men. This study revealed lower levels of social support among participants reporting lifetime and past year victimization, independent of demographic, social and health-related factors.

Conclusion

Results showed a statistically significant association between low social support and IPV victimization. Although the specific mechanisms linking social support with experiences of violence need further investigation, it seems that both informal and formal networks may be associated with lower levels of abusive situations.

Social support may encourage victims to disclose their experiences of intimate partner violence (IPV), but also to seek the appropriate help and care in the social and health services. Using data from a multicenter European project, DOVE (Domestic Violence Against women/men in Europe-prevalence, determinants, effects, and policies/practices), the present study aimed at measuring the frequency of primary care and emergency use according to IPV types of victimization, and to investigate whether victims receiving different levels of informal social support are using health care differently. Results suggested a significant association between IPV types and use of emergency services, and no association was found regarding primary care services. Victims of physical abuse and sexual coercion went to the emergency department (ED) more frequently (more than once a year). Also, victims of physical abuse receiving low social support visited an ED more frequently than those with high social support, whereas victims of sexual coercion with high informal social support went more often to the ED compared with victims of sexual coercion with low social support, even after controlling for other covariates. These results seem to suggest that social support has a significant role in the decision to use health care among victims of IPV. 

Background

Research suggests that survivors of interpersonal violence have an increasing experience of bodily symptoms. This study aims to scrutinise the association between lifetime abuse and somatic symptoms among older women and men, considering demographics/socio-economic, social support and health variables.

Methods

A sample of 4,467 community-dwelling persons aged 60–84 years (57.3% women) living in seven European countries (Germany, Greece, Italy, Lithuania, Portugal, Spain, Sweden) was recruited for this cross-sectional study. Lifetime abuse (psychological, physical, sexual, financial and injury) was assessed on the basis of the UK study of elder abuse and the Conflict Tactics Scale-2, while somatic symptoms were assessed by the Giessen Complaint List short version.

Results

Women reported somatic symptoms more frequently than men. Multiple regression analyses revealed that lifetime exposure to psychological abuse was associated with higher levels of somatic symptoms among both women and men, while experiencing lifetime sexual abuse was associated with somatic symptoms only among older women, after adjusting for other demographic and socio-economic variables. Country of residence, older age, and low socio-economic status were other independent factors contributing to a higher level of somatic symptoms.

Conclusions

The positive association between the experience of abuse during lifetime and the reporting of higher levels of somatic symptoms, in particular among older women, seems to suggest that such complaints in later life might also be related to the experience of mistreatment and not only to ageing and related diseases. Violence prevention throughout lifetime could help to prevent somatic symptoms in later life.

This study aimed to investigate the association of lifetime abuse and mental health among older persons, considering associated factors (e.g., demographics) through a cross-sectional design. We recruited 4,467 women and men ages 60–84 years from 7 European cities. Mental health was measured with the Hospital Anxiety and Depression Scale, and abuse (psychological, physical, sexual, financial, and physical injuries) based on the Revised Conflict Tactics Scale and the UK survey of abuse/neglect of older people. Multiple logistic regression analyses showed that country of residence, low educational level, and experienced financial strain increased the odds of probable cases of anxiety and depression. Female sex, white-collar profession, and financial support by social/other benefits/or partner income were associated with higher odds of anxiety, while older age and experience of lifetime injury were associated with increased odds of depressive symptoms. The findings of this study indicate that socioeconomic factors, as well as experienced lifetime severe physical abuse leading to injuries, are significant in perceived mental health of adults in later life.

Background Life-expectancy of adults with congenital heart disease (CHD) has improved world-wide, but there are limited data on these patients' experiences of quality of life (QoL), life satisfaction (LS), and their determinants (e.g. social support), particularly among patients from developing countries.

Design Cross-sectional case-control.

Methods A total of 347 CHD patients (18-64 years, 52.2% women) and 353 non-CHD participants, matched by sex/age, were recruited from two heart hospitals in Tehran, Iran. LS and QoL served as dependent variables, and demographic/socioeconomic status, mental-somatic symptoms, social support, and clinical factors (e.g. defect category) served as independent variables in multiple regression analyses once among all participants, and once only among CHD patients.

Results The CHD patients had significantly lower scores in LS and all domains of QoL than the control group. However, having CHD was independently negatively associated only with overall QoL, physical health, and life and health satisfaction. Additionally, multivariate analyses among the CHD patients revealed that female sex, younger age, being employed, less emotional distress, and higher social support were significantly associated with higher perceived QoL in most domains, while LS was associated with female sex, being employed, less emotional distress, and better social support. Neither QoL nor LS was associated with cardiac defect severity.

Conclusions The adults with CHD had poorer QoL and LS than their non-CHD peers in our developing country. Socio-demographics, emotional health, and social support were important 'determinants' of QoL and LS among the CHD patients. Longitudinal studies are warranted to establish causal links.

Objective The objective of this study is to compare coping strategies between adults with and without congenital heart disease and to scrutinize the associations between different available resources (e.g., social support) and adoption of certain coping strategies.

DesignThe study has a cross-sectional case-control design.

SettingThe study was conducted in two university-affilliated heart hospitals in Tehran, Iran.

Patients The participants comprised 347 persons (18–64 years) with and 353 individuals without congenital heart disease, matched by gender and age.

Outcome Measures Coping strategies, assessed with the Utrecht Coping List-short form, were compared between both groups. Block-wise multiple regression analyses were conducted to scrutinize the associations between different independent variables (e.g., demographic/socioeconomic statuses) and adoption of certain styles of coping (dependent variables) among all participants and separately for each group.

Results The styles of coping in the patients were comparable with those of the control group. Multivariate analyses revealed that congenital heart disease per se was not associated with style of coping except for palliative reaction pattern. The active problem-solving coping style was associated with never married marital status, parenthood, unemployment, higher level of anxiety/somatic symptoms, lower level of depressive symptoms, and better social support. The avoidance behavior style was associated with having a low income, whereas the expression of emotion style was associated with higher anxiety symptoms, experience of financial strain, and income. None of the adopted coping strategies was related to the heart disease variables.

Conclusions The adults with congenital heart disease coped as well as adults without congenital heart disease. Marital status, parenthood, annual income, financial strain, psychological adjustment, and perceived social support were important explanatory factors in adopting a certain style of coping among adults with congenital heart disease. However, longitudinal studies with repeated measures are warranted.

Background Providing appropriate care for adults with congenital heart disease requires the evaluation of their current situation. There is limited research in Iran about these patients, particularly in relation to gender differences in the demographic/socio-economic and lifestyle factors, as well as disease parameters.

Materials and methods The sample consisted of 347 congenital heart disease patients in the age group of 18–64 years, including 181 women, assessed by an analytical cross-sectional study. The patients were recruited from the two major heart hospitals in Tehran. Data were collected using questionnaires.

Results The mean age of the patients was 33.24 years. Women were more often married and more often had offspring than men (p < 0.001). Educational level and annual income were similar between women and men. Unemployment was higher among women (p < 0.001), but financial strain was higher among men (p < 0.001). Smoking, alcohol, and water-pipe use was higher among men than among women (p < 0.001). Cardiac factors, for example number of cardiac defects, were similar among women and men, except that there were more hospitalisations owing to cardiac problems, for example arrhythmia, among men. Disease was diagnosed mostly at the hospital (57.4%). Most medical care was provided by cardiologists (65.1%). Only 50.1% of patients had knowledge about their type of cardiac defect.

Conclusion Gender differences exist in the socio-economic and lifestyle characteristics of adults with congenital heart disease, in some cases related to the disease severity. Our findings also point to the need for interventions to increase patients’ knowledge about, and use of, healthier lifestyle behaviours, irrespective of gender. Furthermore, providing appropriate jobs, vocational training, and career counselling may help patients to be more productive.

Objective

Despite the improvement in life-expectancy of adults with congenital heart disease, they may experience unique medical and social challenges that could impact on their psychological functioning. The aims of this study were to address the experience of anxiety, depressive and somatic symptoms among adults with congenital heart disease in comparison with that of non-heart diseased persons considering the role of various factors (e.g. socio-economic).

Methods

In cross-sectional case–control study, the participants consisted of 347 patients with congenital heart disease (18–64 years, 52.2% female) and 353 matched (by sex/age) non-heart diseased persons. The participants completed a questionnaire. The data were analyzed with bivariate and multivariate methods.

Results

In bivariate analyses, scores in anxiety and somatic symptoms were higher among patients than the healthy controls (both at p ≤ 0.001), whereas the groups did not differ in depressive symptoms. Following multiple-linear-regression-analyses, only the association between congenital heart disease and somatic symptoms was confirmed. Among the patients, perceived financial strain was significantly related to anxiety, depressive and somatic symptoms; lower perceived social support to anxiety and depression; and low annual income to somatic symptoms. Additionally, somatic symptoms were associated with anxiety and depressive symptoms, and vice versa. And no medical variables were related to anxiety, depressive and somatic symptoms.

Conclusions

Congenital heart disease was only independently associated with somatic symptoms. Financial strain, social support and co-existence of emotional distress with somatic symptoms should be considered in developing appropriate interventions to improve the well-being of patients with congenital heart disease. However, longitudinal research is warranted to clarify causality.

Objectives To investigate the lifetime prevalence rate of abuse among older persons and to scrutinize the associated factors (e.g. demographics).

Methods This cross-sectional population-based study had 4467 participants, aged 60–84, from seven European cities. Abuse (psychological, physical, sexual, financial and injuries) was measured based on The Revised Conflict Tactics Scale, and the UK survey of abuse/neglect of older people.

Results Over 34 % of participants reported experiencing lifetime psychological, 11.5 % physical, 18.5 % financial and 5 % sexual abuse and 4.3 % reported injuries. Lifetime psychological abuse was associated with country, younger age, education and alcohol consumption; physical abuse with country, age, not living in partnership; injuries with country, female sex, age, education, not living in partnership; financial abuse with country, age, not living in partnership, education, benefiting social/partner income, drinking alcohol; and sexual abuse with country, female sex and financial strain.

Conclusions High lifetime prevalence rates confirm that elder abuse is a considerable public health problem warranting further longitudinal studies. Country of residence is an independent factor associated with all types of elder abuse which highlights the importance of national interventions alongside international collaborations.

Keywords Determinant Elder abuse Financial Injuries Psychological Sexual

Objectives To compare the prevalence of elder abuse using a multilevel approach that takes into account the characteristics of participants as well as socioeconomic indicators at city and country level.

Methods In 2009, the project on abuse of elderly in Europe (ABUEL) was conducted in seven cities (Stuttgart, Germany; Ancona, Italy; Kaunas, Lithuania, Stockholm, Sweden; Porto, Portugal; Granada, Spain; Athens, Greece) comprising 4467 individuals aged 60–84 years. We used a 3-level hierarchical structure of data: 1) characteristics of participants; 2) mean of tertiary education of each city; and 3) country inequality indicator (Gini coefficient). Multilevel logistic regression was used and proportional changes in Intraclass Correlation Coefficient (ICC) were inspected to assert explained variance between models.

Results The prevalence of elder abuse showed large variations across sites. Adding tertiary education to the regression model reduced the country level variance for psychological abuse (ICC = 3.4%), with no significant decrease in the explained variance for the other types of abuse. When the Gini coefficient was considered, the highest drop in ICC was observed for financial abuse (from 9.5% to 4.3%).

Conclusion There is a societal and community level dimension that adds information to individual variability in explaining country differences in elder abuse, highlighting underlying socioeconomic inequalities leading to such behavior.

Few studies have evaluated the impact of lifetime abuse on quality of life (QoL) among older adults. By using a multinational study authors aimed to assess the subjective perception of QoL among people who have reported abuse during the course of their lifetime. The respondents (N = 4,467; 2,559 women) were between the ages of 60 and 84 years and living in seven European countries (Germany, Greece, Italy, Lithuania, Portugal, Spain, and Sweden). Lifetime abuse was assessed by using a structured questionnaire that allowed to assess lifetime experiences of abuse. QoL was assessed with the World Health Organization Quality of Life–Old module. After adjustment for potential confounders, authors found that to have had any abusive experience decreased the score of sensory abilities. Psychological abuse was associated with lower autonomy and past, present, and future activities. Physical abuse with injuries significantly decreased social participation. Intimacy was also negatively associated with psychological abuse, physical abuse with injury, and sexual abuse. The results of this study provide evidence that older people exposed to abuse during their lifetime have a significant reduction in QoL, with several QoL domains being negatively affected.

A sample of 1442 women attending a Forensic Healthcare Service provided information on their own and their partners' use of controlling behaviors, partner violence, and sexual abuse, as well as their own experiences of childhood abuse. Using Johnson's typology, the relationships were categorized as Nonviolent, Intimate Terrorism, or Situational Couple Violence. Findings suggest that help-seeking women’s experiences of intimate violence may be diverse, with their roles ranging from victim to perpetrator.1. Introduc

Gender differences in coping with musculoskeletal pain were cross-sectionally investigated, using questionnaires (Coping Strategies Questionnaire), in 446 Swedish patients (mean age 46 years, 72% women) seeking care for their ailments. Compared to male patients, women reported more disability, a larger consumption of analgesics, more work strain, higher levels of posttraumatic stress reactions, a lower self-esteem, and higher scores for the Coping Strategies Questionnaire indexes: diverting attention, praying/hoping, catastrophizing, increased behavioural activity, and pain behaviours. All gender differencesin coping were ruled out in multivariate analyses, except for the association between the interaction term Gender x Posttraumatic Stress Reactions and Catastrophizing. Among women, catastrophizing was positively associated with posttraumatic stress reactions, perceived disability, and the number of previous treatments for pain.Nosuch associations were found among men. Women’s poorer capacity to cope with musculoskeletal pain is related to higher level of emotional distress, greater disability, and a history of treatments for pain.

The study investigated the associations between burnout—conceptualized as a syndrome of emotional exhaustion/physical fatigue and cognitive weariness—and pain parameters (overall pain, pain sites, intensity and frequency, and perceived disability) among 2,300 women living in Stockholm County. The study was a longitudinal panel survey with two assessments by means of questionnaires, 1 year apart. After adjustment for socio-demographic and work characteristics, smoking, psychological distress, physical health and basal pain parameters, T1 levels of burnout and/or their change scores were the most important predictors of overall pain, neck–shoulderpain, back pain and disability. Pain frequency was related to increases in tension and listlessness.

The results indicated that burnout contributes to the onset and maintenance of pain and to the functional impairment that it causes. Further studies are needed to evaluate the extent to which pain and burnout, may be mutually reinforcing.

Background Evaluation of child safety in designated SC is still a neglected indicator.

Aims The purpose was to introduce a comprehensive model to conduct SC evaluation in terms of child safety.

Methods Applications of designated SC with emphasis on child safety were reviewed. Besides, Pubmed and Embase were searched to find scientific articles of child safety evaluation.

Results Key ways of child safety evaluation can be summed up as follows: In order to evaluate the impact of SC on child safety, quasi experimental study with emphasis on safe home, school, street, sport place and other environments is conducted to compare SC and control community at designation and re-designation time. When it comes to do outcome evaluation, in another quasi experimental study, incidence, severity and burden of child injuries are assessed in SC and control community by four household surveys where there is no data registry. Besides WHO and CDC questionnaires, delphi technique is an useful alternative to prepare questionnaires.

Contribution to the Field Importance of child safety among growing number of SC has given rise to the necessity of a practical method for child safety evaluation in SCs.

Background: Our aim in this survey was to explore descriptive epidemiology of injuries in Tehran in 2012 and to report the recalled estimates of injury incidence rates.

Methods: A population survey was conducted in Tehran during 2012, within which a total of 8626 participants were enrolled. The cluster sampling was used to draw samples in 100 clusters with a pre-specified cluster size of 25 households per cluster. Data were collected on demographic features, accident and injury characteristics based on the International Classification of Diseases (ICD10).

Results: A total of 618 injuries per 3 months were reported, within which 597 cases (96.6%)were unintentional injuries. More than 82% of all injuries were those caused by exposure to inanimate mechanical forces, traffic accidents, falls and burns. Above 80% of the traffic injuries happened among men (P<0.001). About 43% of the unintentional injuries were mild injuries.After the age of 40, women, unlike men, had higher risks for being injured. The estimated annual incidence rate for all types of injuries was 284.8 per 1000 (95% CI: 275.4-294.4) and for unintentional injuries was 275.2 per 1000.

Conclusion: Injuries are major health problems in Tehran with a highly reported incidence. The status is not substantially improved over the recent years which urges the need to be adequately and emergently addressed. As the incidence rate was estimated based on participant recalls, the real incidence rate may even be higher than those reported in the current study.

We investigated the association between type and frequency of elder maltreatment (EM) and residential setting (rural, suburban,and urban settings in the U.S. and northern and southern cities in Europe). We used data on 7,225 participants from European and U.S. cross-sectional studies to estimate rates of EM in three domains in the five settings in logistic-linear models that included setting and demographic variables and tested prespecified contrasts on settings. Northern Europe is similar to the U.S. in rate of financial exploitation; the Mediterranean has higher rates than either of the other two. For emotional and physical maltreatment, the Mediterranean is similar to the U.S; Northern Europe has higher rates. EM differs between and within settings in the U.S. and Europe. There is a need for rigorous research to examine the effects of residential settings and environment on EM. Interventions to reduce EM should be explored.

Background: The aim of this study was to investigate the impact of employment status on self-reported health in gävleborg county.Methods: The study used data from the 2010 health in equal terms survey, a cross-sectional survey carried out in gävleborg county in sweden. a total of 4,245 individuals, aged 16–65 years were included in the analyses. descriptive and logistic regression analyses were used to assess the relationship between employment status and self-reported healthResults: Individuals outside the labour market had odds of poor health of 2.64 (cl 2.28–3.05) compared to their employed counterparts. controlling for other covariates reduced the risk slightly to 2.10 (1.69-2.60), but remained statistically significant. In addition, other variables were associated with self-reported poor health.Conclusions: This study found a statistically significant association between being outside the labour market and poor self-reported health. The relation was explained partially by socio-economic and demographic variables. More studies, in particular longitudinal, are needed to further investigate the observed relationships. Policy-makers within the gävleborg county need to pay attention to the health status of those out of work, especially during times of combined economic and labour market fluctuations.Results of the study suggest the need to pay attention to the health status of those outside the labour market, especially during times of economic hardship.

Objective: Suicide is a public health problem and an important indicator of severe mental ill-health. Thus, identifying risk factors for suicidal ideation is a public health priority. The aim of this study was to examine the relationship between employment status and suicidal ideation in Gävleborg County. Method: The study used data from the 2010 Health in Equal Terms survey, a cross-sectional survey carried out in Gävleborg County in Sweden. A total of 4,245 individuals, aged 16–65 years were included in the analyses. Descriptive and logistic regression analyses were carried out to assess the relationship between employment status and suicidal ideation. Results: Individuals outside the labour market had odds of suicidal ideation of 4.21 (CI 3.14-5.64) compared to their employed counterparts. Controlling for other covariates, reduced the risk from 4.21(CI 3.14-5.64) in model I, to 1.73 (CI 1.16- 2.57) in model IV, but remained statistically significant. In addition, other variables were associated with suicidal ideation. Conclusion: There was a statistically significant association between being out of work and suicidal ideation. The association was explained partly by demographic, socio-economic and self-reported psychological variables. Results of the study suggest the need for primary prevention strategies among those out of the labour market, especially during times of economic hardship.

Objectives: This  study  aimed  to  investigate  the  prevalence  of  anxiety  and  depression  by  employment status among a sample of the working age population residing in Gävle Municipality in Sweden.

Methods:  A  total  of  241  persons  completed  a  self-administered  postal  questionnaire  in  the  baseline survey  of  the  Gävle  Household,  Labour  Market  and  Health  Outcomes  (GHOLDH)  survey,  which collected  information  on  the  employment  status  and  psychological  health  (anxiety  and  depression) among persons aged 18-65 years. Descriptive and multivariate analyses were performed.

Results:  The  prevalence  and  risk  of  anxiety  and  depression  were  high  among  people  who  were  out  of work. In the multiple regression analysis, compared to employed people, those who were not employed had a risk of anxiety of 7.76 (5.97-9.75) and 4.67 (3.60-5.74) for depression.

Conclusion: The prevalence of anxiety and depression was higher among those who were out of labour marketas compared to those employed. Furthermore, people who were out of work had a higher risk of anxiety and depression. The odds were slightly higher for anxiety than for depression.

Post-traumatic stress disorder (PTSD) is an anxiety disorder that may follow major psychological trauma. The disorder is longstanding, even chronic, and there is a need for effective treatment. The most effective short-term treatments are cognitive behavioural therapy and eye movement desensitization and reprocessing (EMDR). Twenty subjects with chronic PTSD following occupational health hazards from "person under train" accidents or assault at work were treated with five sessions of EMDR. They were assessed with psychometric scales and diagnostic interviews before treatment, directly after treatment, at 8 months, and at 35 months after the end of Therapy. The primary outcome variable was full diagnosis of PTSD according to the DSM-IV diagnostic criteria. Results from interview-based and self-evaluation psychometric scales were used as secondary outcome variables. Immediately following treatment, the patients were divided up into two groups, initial remitters (12 of 20) and non-remitters (8 of 20). There were no drop-outs during therapy, but three patients withdrew during follow-up. The initial result was maintained at the 35-month follow-up. The secondary outcome variables also showed a significant immediate change towards normality that was stable during the long-term follow-up. After 3

Previous studies on post-traumatic stress disorder (PTSD) investigated a variety of treatments and included mostly patients victims of sexual and combat assault. This study aimed to determine the short-term efficacy of eye movement desensitization and reprocessing (EMDR) in occupation-based PTSD. Employees of the public transportation system in Stockholm, who had been experiencing a person-under-train accident or had been assaulted at work were recruited. Subjects with trauma exposure since more than 3 months but less than 6 years were included. Twenty-four subjects who fulfilled the DSM-IV criteria for PTSD were randomized to either EMDR therapy (n=13) or waiting list (WL, n=11). They were assessed pre-treatment and shortly after completion of treatment or WL period. The pre-defined primary outcome variable was full PTSD diagnosis. Secondary outcome variables were the results of various psychometric scales. Twelve participants began and completed five sessions of EMDR and nine completed the WL. After therapy, eight subjects in the EMDR group (67%) and one (11%) in WL did not fulfil the criteria for PTSD diagnosis (difference, P=0.02). Among the secondary outcome variables, there were significant differences post-treatment between the groups EMDR/WL in Global Assessment of Function (GAF) score and Hamilton Depression (HAM-D) score. This study indicates that EMDR has a short-term effect on PTSD in public transportation workers exposed to occupational traumatic events. Such intensive and brief therapy might be further validated in larger samples of exposed workers with longer periods of follow-up.