Objectives
To extend the literature on educational inequalities in cancer screening participation (1) by simultaneously focusing on participation in screening for cervical, breast and colorectal ...cancer across 27 European countries and (2) by statistically testing whether these educational inequalities vary according to country-specific screening strategies: organised or opportunistic.
Methods
Self-reported data from Eurobarometer 66.2 (2006) on cancer screening participation in the preceding 12 months were used to outline cross-national variations in screening strategies, target populations and participation rates. Multilevel logistic regressions were applied.
Results
Individuals with higher levels of education were more likely to participate in screening for cervical, breast and colorectal cancer than were those with less education. Educational inequalities were significantly smaller in countries with organised cervical cancer screening than they were in countries with opportunistic screening (OR = 0.716, 95% CI 0.549–0.935). The same interaction was observed for participation in screening for breast and colorectal cancer, albeit with marginal significance.
Conclusions
This study clearly highlights the crucial role of educational level in the likelihood of participating in cancer screening. Countries can reduce educational inequalities by applying organised screening programmes.
We investigate whether the extent of educational inequalities in the use of Pap smears (cervical cancer screening) and mammograms (breast cancer screening) in Belgium has changed over time in ...accordance with the pattern predicted by diffusion of innovation theory, as well as how the regional cancer screening policies of Flanders and Wallonia influence this pattern.
Data were obtained from five successive cross-sectional waves (1997-2001-2004-2008-2013) of the Belgian Health Interview Survey. Final sample sizes consisted of 8988 women aged 25-64 years for cervical cancer screening and 4194 women aged 50-69 years for breast cancer screening. We calculated absolute and relative measures of inequality, more specifically, the slope index of inequality (SII) and the relative index of inequality (RII), and their development over time.
In both Flanders and Wallonia, mammogram use increased greatly between 1997 and 2013, while Pap smear use has remained quite stable over time. Educational inequalities in cervical-cancer screening have been largely persistent over time in both regions. In contrast, educational inequalities in breast cancer screening fluctuated more between 1997 and 2013. Between 1997 and 2001, when the breast cancer screening programme was implemented in Flanders, RII reduced significantly by 45%. Inequality measures did not change significantly in Wallonia, where it is known that most women are screened opportunistically outside the programme.
By focussing on Belgium, this study demonstrates that regional variations in the support of a national screening programme can result in regional variations in the pattern of diffusion for cancer screening, as well as to the development of inequalities in cancer screening participation. Moreover, the findings demonstrate that high visibility and awareness of the screening programme, as was more the case in Flanders than it was in Wallonia, are required in order to reduce or eliminate educational inequalities in cancer screening participation over time. General practitioners and gynaecologists can play a decisive role in this regard.
Inspired by the analytical shift toward understanding altruism from an institutional perspective, this article presents an empirical analysis of the impact of institutionalized solidarity on ...attitudes toward payment for blood or plasma donations, in terms of both the level of welfare provision and confidence in the welfare system. Postulating that institutionalized solidarity is intertwined with group-based solidarity, this article offers a more refined understanding of the relationship between institutional context and attitudes toward paid donation by incorporating measures of social cohesion in the analysis. Based on Eurobarometer data from 2014, the results indicate that support for cash payment for donation is lower in European countries where social spending is higher. Similarly, aggregated levels of trust in the social security system are associated with less support for payment for donation. These findings point to the importance of institutionalized solidarity for the manifestation of support for non-remunerated blood and plasma donation.
Drawing on a critical social-psychological framework for discourse analysis, data from a popular forum for people over 50 were analysed to study how the habitual use of benzodiazepines and Z-drugs ...(BZD/Z) is discursively negotiated by Flemish older adults. We present five different repertoires (risk and addiction; alternative pathways; suffering; rationalisation; cessation) that illustrate how a pharmaceutical imaginary of these medications is constructed online and how posters act as reflexive users taking on a health role. Most repertoires emerge from a tacit norm on the undesirability of medication use for sleeping problems. In the alternative pathways and cessation repertoires this norm is implicitly accepted by focussing on how to either prevent or overcome chronic use with various alternative solutions or through tapering off, while the risk and addiction repertoire is used to more openly defend and discursively magnify the idea that medication has to be avoided at all cost. We discuss how this reflects a prevailing imperative of health and ethos of healthicisation of sleep. The rationalisation and suffering repertoires on the other hand challenge this norm by defending medication use. We further explore how these repertoires are used to self-position as either ‘noble non-user’, ‘deserving and/or compliant patient’ or ‘rational user’, reflecting previously found moral positions in offline settings. Our data add another position that has thus far not been discussed extensively with regard to prescription medication use, namely that of a ‘recovered user’. As such, this study shows how this particular online community is a site for contestation of health promotion and medical/pharmaceuticalised discourses on sleep by users and non-users alike and offers a unique insight into how people in the age group that is known to use most BZD/Z discursively negotiate the use of these medications in pseudonymised online interactions.
One of every three women diagnosed with breast cancer (BC) in Gaza does not live for more than 5 years. They are faced by unreliable treatment plans. Radiotherapy is not available locally and there ...are chronic shortages in the chemotherapy medications. This paper aims to provide understanding of how socio-demographic factors affect the stage at which the cancer is diagnosed and what treatment is prescribed.
Data were collected through a cross-sectional survey targeting women living in Gaza who had been diagnosed with BC at least once. The survey was self-administered and distributed to 350 women between 1 March 2021 and 30 May 2021. Multinomial logistic regression (SPSS, version 28.0) was used to explore the association between stage of the cancer at diagnosis and socio-demographic characteristics. The relationship between the stage at diagnosis and prescribed treatment was explored using a cluster analysis and crosstabulations.
Socio-demographic inequalities were reflected in stage at diagnosis and varied by age, education, employment, marital status, and refugee status. Breast cancer was less likely to be detected at an advanced stage among educated respondents (women with primary education OR = 0.093,
= 0.008 and women with preparatory education OR = 0.172,
= 0.005), employed women (OR = 0.056,
= 0.022). It was more likely to be detected at an early stage (OR = 3.954,
= 0.011) in women aged 41-50. In widowed and separated/divorced women, it was less likely to be detected at an early stage (OR = 0.217,
= 0.029) and (OR = 0.294,
= 0.028) respectively, than among married women. Among refugee women, it was less likely to be detected at early stage than among non-refugee women (OR = 0.251,
= 0.007). Among the total respondents, only 30% of the full prescribed treatment was available locally.
Our research showed various levels of inequalities at the stage of diagnosis by age, marital status, education, employment and refugee status. Most of the survivors needed treatment that was unavailable locally.
BACKGROUND
Ageing European populations put pressure on national blood supplies, increasing the need for blood and donor base rejuvenation. Therefore, we investigate how European countries' blood ...donor populations differ and how they have evolved over the last 2 decades. Previous comparative research, based on 1994 Eurobarometer data, indicate that the typical donor is an educated, middle‐aged, white, married male. Other sociodemographic and socioeconomic correlates, such as employment status and type of community, are less clear.
STUDY DESIGN AND METHODS
Multilevel analyses are performed on repeated cross‐level data from the Eurobarometer (waves 1994, 2002, 2009, and 2014) to compare information on “ever having donated” across sociodemographic categories, countries, and periods.
RESULTS
There are consistent but moderate country and period differences. The donor population rose to become largest in most countries by 2009, and stabilized thereafter. Over the studied period, donors were more likely to be higher educated, married men. Nevertheless, changes across time in donor profiles within countries did occur. Women were less likely to donate blood, especially in Southern and Eastern Europe, but this gender gap has declined. Furthermore, educational attainment seems more relevant for women, although, more recently, to a lesser extent.
CONCLUSION
Although there is a promising trend in which women, young people, and students are increasingly likely to donate, more attention is needed to reach the unemployed and the low to medium educated. Because the unemployed may lack structural opportunities to donate, and the low to medium educated may lack relevant knowledge on blood donation necessity, we recommend providing practical opportunities and information on the necessity of blood donation.
The fulfilment of expectations, labour pain, personal control and self-efficacy determine the postpartum evaluation of birth. However, researchers have seldom considered the multiple determinants in ...one analysis. To explore to what extent the results can be generalised between countries, we analyse data of Belgian and Dutch women. Although Belgium and the Netherlands share the same language, geography and political system and have a common history, their health care systems diverge. The Belgian maternity care system corresponds to the ideal type of the medical model, whereas the Dutch system approaches the midwifery model. In this paper we examine multiple determinants, the fulfilment of expectations, labour pain, personal control and self-efficacy, for their association with satisfaction with childbirth in a cross-national perspective.
Two questionnaires were filled out by 605 women, one at 30 weeks of pregnancy and one within the first 2 weeks after childbirth either at home or in a hospital. Of these, 560 questionnaires were usable for analysis. Women were invited to participate in the study by independent midwives and obstetricians during antenatal visits in 2004-2005. Satisfaction with childbirth was measured by the Mackey Satisfaction with Childbirth Rating Scale, which takes into account the multidimensional nature of the concept. Labour pain was rated retrospectively using Visual Analogue Scales. Personal control was assessed with the Wijma Delivery Expectancy/Experience Questionnaire and Pearlin and Schooler's mastery scale. A hierarchical linear analysis was performed.
Satisfaction with childbirth benefited most consistently from the fulfilment of expectations. In addition, the experience of personal control buffered the lowering impact of labour pain. Women with high self-efficacy showed more satisfaction with self-, midwife- and physician-related aspects of the birth experience.
Our findings focus the attention toward personal control, self-efficacy and expectations about childbirth. This study confirms the multidimensionality of childbirth satisfaction and demonstrates that different factors predict the various dimensions of satisfaction. The model applies to both Belgian and Dutch women. Cross-national comparative research should further assess the dependence of the determinants of childbirth satisfaction on the organisation of maternity care.
Research on inequalities in cervical cancer screening (CCS) participation has overlooked the distinction between 'never-' and 'under-screeners' while different socioeconomic and demographic ...determinants may underlie 'non-' and 'under-' screening participation. This study examines socioeconomic and demographic inequalities in never and under CCS participation. We compare cross-national prevalence and trends among these two groups in Switzerland and Belgium, two countries with similar opportunistic CCS strategy but different healthcare systems.
Data on 38,806 women aged 20-70 from the Swiss Health Interview Survey (1992-2012) and 19,019 women aged 25-64 from the Belgian Health Interview Survey (1997-2013), both population-based cross-sectional nationally representative surveys, was analysed. Weighted adjusted prevalence ratios were estimated with multivariate Poisson regressions.
Over the studied period, never screening prevalence was about 15% in both Switzerland and Belgium and under screening prevalence about 14.0%. Socioeconomic gradients were found among both never- and under-screeners. Higher income women had lower never and under screening prevalence in Switzerland and a similar gradient in education was observed in Belgium. Importantly, distinct socioeconomic and demographic determinants were found to underlie never and under screening participation. Never screening was significantly higher among foreign nationals in both countries and this association was not observed in under screening. Never screening prevalence was lower among older age groups, while under screening increased with older age. Over time, age inequalities diminished among never- and under- screeners in Switzerland while educational inequalities increased among never-screeners in Belgium.
Findings revealed that determinants of screening inequalities differed among never- and under-screeners and hence these should be addressed with different public health strategies. Crucially, socioeconomic and demographic inequalities were more pronounced among never-screeners who appeared to face more structural and persistent inequalities. Differences between the two countries should also be noted. The more liberal-type Swiss healthcare systems appeared to shape income-related screening inequalities, while education appeared to be a stronger determinant of never- and under-screening in Belgium.
Abstract
Background
Cervical cancer screening (CCS) by means of Pap smears has led to a decrease in cervical cancer incidence and mortality. In the absence of organized programmes, CCS is ...opportunistic in Belgium and Switzerland. This might result in a high level of CCS overuse, as screening practices do not conform to the recommended 3-yearly screening interval and the target age-ranges (Belgium: 25–64, Switzerland: 20–70). This study aimed to assess trends in CCS uptake and overuse in Belgium and Switzerland and their social determinants, in the light of reimbursement initiatives, which were implemented in both countries.
Methods
Data from five waves of the Belgian Health Interview Survey (1997–2013) (N=11 141) and Swiss Health Interview Survey (1992–2012) (N=32 696) were used. We performed Poisson regressions to estimate adjusted prevalence ratios (APR), controlled for socio-economic and socio-demographic characteristics and health status. CCS overuse was operationalized as screening more than once every 3 years and screening above recommended age-range.
Results
CCS uptake remained relatively stable over time, with a mean coverage of 70.9% in Belgium and 73.1% in Switzerland. Educational and income gradients were found in both countries. Concerning CCS overuse, women above screening-eligible age showed consistently high screening rates, but screening within the past year declined significantly in both countries, matching the temporal implementation of the reimbursement initiatives.
Conclusions
Although no increase in CCS coverage could be established, CCS has become more efficient in both countries as Pap smear overuse at the population level has declined after the implementation of reimbursement measures tackling CCS overuse.
Although the prevalence of common mental health conditions such as depression and anxiety, is higher among people with a migration background, these groups are generally underrepresented in all forms ...of institutionalized mental health care. At the root of this striking discrepancy might be unequal referral by health care practitioners. In this article we describe the development of a quasi-experimental video vignette methodology to assess potential forms of unequal diagnosing, treatment and referral patterns, based on clients’ migration background and asylum status. The presented methodology also allows to explore whether potential differences are related to provider bias, i.e. underlying attitudes and expectations held by general practitioners. Potential assets and drawbacks of this methodology are discussed in detail.
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