An increasing number of diseases is linked to deterioration of quality of life (QoL). Part of this association can be explained by socio-economic factors, which are most commonly accounted for. Our ...aim was to explore the potential contribution of other factors related to clinical burden, social interaction and functioning. A cross-sectional analysis was conducted on wave 6 of the population-based Survey of Health, Ageing and Retirement in Europe (SHARE), among participants aged 50+ (n = 67 179). The Control, Autonomy, Self-Realization and Pleasure (CASP-12v1) questionnaire measured QoL. The association between number of diseases and QoL was tested in a mixed-effects linear regression model. The base model controlled for socio-economic characteristics. Factors of interest (symptoms, polypharmacy, unmet care needs, utilisation of care, social network, personal and financial help, loneliness and activities of daily living (ADL) with instrumental activities (IADL)) were added to the base model one at a time and tested for relevance (i.e. change in the beta-coefficient of the number of conditions of 15% or more). Symptoms, polypharmacy, loneliness and ADL/IADL appeared relevant and were retained in the final model. The association between number of conditions and QoL in the base model was -2.44 95% CI: -2.72; -2.16, while this association was -0.76 95%CI: -0.97; -0.54 after all relevant factors were included. Factors beyond the socio-economic circumstances play an important role in explaining the association between number of conditions and QoL. These factors should be considered to better estimate the impact of chronic diseases on QoL, and for improving patient care.
Despite inititatives to reduce tobacco consumption, smoking remains a primary cause of death for both smokers and nonsmokers exposed to environmental tobacco smoke (ETS). The characteristics of some ...specific groups can make them more exposed to ETS or limit the benefit of prevention measures. This study investigated determinants of ETS in a population of young adult students, considered at higher risk of exposure due to their specific lifestyle. This cross-sectional study involved 90 students aged 20 ± 1.7 years, from the University of Luxembourg, prior to the smoking ban enforcement in public places in the country. Participants reported their tobacco consumption and exposure to ETS at home and/or in public places, and provided a hair sample analyzed for nicotine and cotinine. Nicotine and cotinine were significantly higher in smokers than in nonsmokers' hair in general (median: 2.6 vs. 0.9 ng/mg and 87.1 vs. 22.5 pg/mg respectively). However, nonsmokers exposed to ETS at home and in public places had comparable concentrations to smokers (nic = 2.2 ng/mg; cot = 56.2 pg/mg), whereas unexposed nonsmokers presented significantly lower values (nic = 0.4 ng/mg, cot = 8.5 pg/mg). Nonsmokers exposed to ETS only at home presented higher values than nonsmokers only exposed in public places (nic: 1.3 vs. 0.8 ng/mg, cot: 70.4 vs. 15.0 pg/mg). The study shows the widespread exposure to ETS in this population, the importance of exposure assessment, and the relevance of hair analysis for this purpose. Results suggest that ETS can lead to equivalent exposure to active smoking and that exposure at home can highly contribute to ETS, which is not solved by smoking ban in public places.
Background
Visceral adipose tissue (VAT) accumulation is a major cardiometabolic risk factor, associated with increased inflammation. Oxidative stress (OS) is also associated with inflammation and ...cardiometabolic issues, yet mainly through general obesity. Both OS and obesity were linked to vitamin D deficiency.
Objectives
To investigate whether OS increase is associated with VAT accumulation in youth, and whether in the presence of VAT accumulation, a higher vitamin D status is associated with lower OS.
Methods
One hundred and fifty‐eight youth with overweight/obesity, 7 to 17 years old, were recruited (Pediatric Clinic, Luxembourg). We assessed visceral and subcutaneous abdominal adipose tissues by magnetic resonance imaging, OS by DNA/RNA oxidative damage with ELISA and vitamin D by high‐performance liquid chromatography.
Results
VAT was the body fat compartment the most strongly associated with OS (RPearson: 0.298; P < 10−4). The general linear (GLM) models assessing the relationship between OS, VAT and vitamin D concentrations showed that “Log10 OS = (0.003 × VAT) + 3.911 (R2adjusted: 0.083; P‐value < 10−4)”; “Log10 OS = (0.003 × VAT) – (0.156 × log10 vitamin D) + 4.110 (R2adjusted: 0.101; P‐value < 10−4)”. After back‐transformation of the log‐values into normal values, the GLM showed that, for a person with an average value of VAT (40.7 cm2), a 10 cm2 increase in VAT would increase OS by approx. 771.833 pg/mL, after age, gender, Tanner stage and physical activity adjustment. An approximate increase of 9 ng/mL of vitamin D would counterbalance this negative effect of increased VAT.
Conclusion
Dietary strategies improving vitamin D status should be investigated to tackle VAT and OS increase.
Abstract
Background
Even though the prevalence of allergies is increasing, population‐based data are still scarce. As a read‐out for chronic inflammatory information, new methods are needed to ...integrate individual biological measurements and lifestyle parameters to mitigate the consequences and costs of allergic burden for society.
Methods
More than 480.000 data points were collected from 1462 Luxembourg adults during the representative, cross‐sectional European Health Examination Survey, spanning health and lifestyle reports. Deep IgE‐profiles based on unsupervised clustering were correlated with data of the health survey.
Findings
42.6% of the participants reported a physician‐diagnosed allergy and 44% were found to be IgE‐positive to at least one allergen or extract. The main sensitization sources were tree pollens followed by grass pollens and mites (52.4%, 51.8% and 40.3% of sensitized participants respectively), suggesting seasonal as well as perennial burden. The youngest group of participants (25–34 years old) showed the highest burden of sensitization, with 18.2% of them having IgE to 10 or more allergen groups. Unsupervised clustering revealed that the biggest cluster of 24.4% of participants was also the one with the highest medical need, marked by their multi‐sensitization to respiratory sources.
Interpretation
Our novel approach to analyzing large biosample datasets together with health information allows the measurement of the chronic inflammatory disease burden in the general population and led to the identification of the most vulnerable groups in need of better medical care.
Visceral adiposity is a major risk factor of cardiometabolic diseases. Visceral adipose tissue (VAT) is usually measured with expensive imaging techniques which present financial and practical ...challenges to population-based studies. We assessed whether cardiometabolic conditions were associated with VAT by using a new and easily measurable anthropometric index previously published and validated. Data (1529 participants) came from the European Health Examination Survey in Luxembourg (2013-2015). Logistic regressions were used to study associations between VAT and cardiometabolic conditions. We observed an increased risk of all conditions associated with VAT. The total adjusted odds ratio (AOR, 95% CI) for hypertension, prediabetes/diabetes, hypercholesterolemia, and hypertriglyceridemia for the fourth quartile of VAT compared to the lowest were (10.67 6.95, 16.39), (6.14 4.14, 9.10), (6.03 3.97, 9.16) and (9.18 5.97, 14.12). We observed higher odds in women than in men for all outcomes with the exception of hypertension. Future studies should investigate the impact of VAT changes on cardiometabolic health and the use of anthropometrically predicted VAT as an accurate outcome when no biomedical imaging is available.
ObjectivesWe estimated the prevalence of short sleep duration and multimorbidity in Luxembourg, and assessed whether sleep duration was associated with multimorbidity after adjusting for ...sociodemographic and behavioural characteristics.DesignCross-sectional study.ParticipantsData from 1508 Luxembourg residents (48% men and 52% women) aged 25 to 64 years came from the European Health Examination Survey 2013–2015.Outcome measuresShort sleep duration and multimorbidity.ResultsParticipants reported sleeping 6.95 hours/night during work days, nearly 1 hour less than during non-work days (7.86 hours/night). Nearly half of participants reported having been diagnosed with ≥2 chronic conditions/diseases. Short sleep duration was associated with the number of chronic conditions (OR 4.65, 95% CI 1.48 to 14.51; OR 7.30, 95% CI 2.35 to 22.58; OR 6.79, 95% CI 2.15 to 21.41 for 1, 2 and ≥3 chronic conditions/diseases, respectively), independently of socioeconomic and behavioural characteristics.ConclusionsHealth promotion programmes should aim at improving and promoting healthy lifestyles among the general population to improve sleep habits as well as decrease multimorbidity in middle-aged adults.
The analyses of geographic variations in the prevalence of major chronic conditions, such as overweight and obesity, are an important public health tool to identify "hot spots" and inform allocation ...of funding for policy and health promotion campaigns, yet rarely performed. Here we aimed at exploring, for the first time in Luxembourg, potential geographic patterns in overweight/obesity prevalence in the country, adjusted for several demographic, socioeconomic, behavioural and health status characteristics. Data came from 720 men and 764 women, 25-64 years old, who participated in the European Health Examination Survey in Luxembourg (2013-2015). To investigate the geographical variation, geo-additive semi-parametric mixed model and Bayesian modelisations based on Markov Chain Monte Carlo techniques for inference were performed. Large disparities in the prevalence of overweight and obesity were found between municipalities, with the highest rates of obesity found in 3 municipalities located in the South-West of the country. Bayesian approach also underlined a nonlinear effect of age on overweight and obesity in both genders (significant in men) and highlighted the following risk factors: 1. country of birth for overweight in men born in a non-European country (Posterior Odds Ratio (POR): 3.24 1.61-8.69) and women born in Portugal (POR: 2.44 1.25-4.43), 2. low educational level (secondary or below) for overweight (POR: 1.66 (1.06-2.72) and obesity (POR:2.09 1.05-3.65) in men, 3. single marital status for obesity in women (POR: 2.20 1.24-3.91), 4.fair (men: POR: 3.19 1.58-6.79, women: POR: 2.24 1.33-3.73) to very bad health perception (men: POR: 15.01 2.16-98.09) for obesity, 5. sleeping more than 6 hours for obesity in unemployed men (POR: 3.66 2.02-8.03). Protective factors highlighted were: 1. single marital status against overweight (POR: 0.60 (0.38-0.96)) and obesity (POR: 0.39 0.16-0.84) in men, 2. the fact to be widowed against overweight in women (POR: 0.30 (0.07-0.86), as well as a non European country of birth (POR: 0.49 0.19-0.98), tertiary level of education (POR: 0.34 0.18-0.64), moderate alcohol consumption (POR: 0.54 0.36-0.90) and aerobic physical activity practice (POR: 0.44 0.27-0.77) against obesity in women. A double burden of environmental exposure due to historic mining and industrial activities and past economic vulnaribility in the South-West of the country may have participated to the higher prevalence of obesity found in this region. Other demographic, socioeconomic, behavioural and health status covariates could have been involved as well.
ObjectivesWe investigate the prevalence of unmet need arising from wait times, distance/transportation and financial affordability using the European Health Interview Survey. We explore associations ...between individual characteristics and the probability of reporting unmet need.DesignCross-sectional survey conducted between February and December 2014.Setting and participants4004 members of the resident population in private households registered with the health insurance fund in Luxembourg aged 15 years and over.Outcome measuresSix binary variables that measured unmet need arising from wait time, distance/transportation and affordability of medical, dental and mental healthcare and prescribed medicines among those who reported a need for care.ResultsThe most common barrier to access arose from wait times (32%) and the least common from distance/transportation (4%). Dental care (12%) was most often reported as unaffordable, followed by prescribed medicines (6%), medical (5%) and mental health (5%) care. Respondents who reported bad/very bad health were associated with a higher risk of unmet need compared with those with good/very good health (wait: OR 2.41, 95% CI 1.53 to 3.80, distance/transportation: OR 7.12, 95% CI 2.91 to 17.44, afford medical care: OR 5.35, 95% CI 2.39 to 11.95, afford dental care: OR 3.26, 95% CI 1.86 to 5.71, afford prescribed medicines: OR 2.22, 95% CI 1.04 to 4.71, afford mental healthcare: OR 3.58, 95% CI 1.25 to 10.30). Income between the fourth and fifth quintiles was associated with a lower risk of unmet need for dental care (OR 0.29, 95% CI 0.16 to 0.53), prescribed medicines (OR 0.38, 95% CI 0.17 to 0.82) and mental healthcare (OR 0.17, 95% CI 0.05 to 0.61) compared with income between the first and second quintiles.ConclusionsRecent and planned reforms to address waiting times and financial barriers to accessing healthcare may help to address unmet need. In addition, policy-makers should consider additional policies targeted at high-risk groups with poor health and low incomes.
Throughout life individuals are exposed to a large array of diverse environmental exposures (exposome). Hair analyses can assess chronic exposure to a large number of chemicals with less ...intra-variability than urine and blood. This is essential for studies that aim to achieve a global vision of the exposome. We aimed at characterizing the adult exposome by describing 175 environmental exposures and correlation patterns between and within exposure groups. A subsample of participants of the European Health Examination Survey, covering information on exposure to chemical pollutants in hair samples, were included in the present analysis (N = 442). Concentrations of micronutrients, lifestyle, home environment and socioeconomic information completed the exposome description and were obtained through blood analyses and questionnaires. We detected 29 persistent and non-persistent chemical pollutants in more than 70% of hair samples. Compared to women, men had higher concentrations of pesticides, lower concentrations of micronutrients (with the exception of vitamin A), and presented higher alcohol consumption. Across all exposures, a low median absolute correlation was found, 0.05 (5th − 95th centiles = 0.10, 0.20). We observed higher correlations and median correlations within exposure groups than between groups of exposure. The highest median correlation was observed between plasticizers (bisphenol A and S) in both men (0.50) and women (0.31). A 70% and 95% of cumulative variance was explained by 37 and 73 principal components respectively. We found a wide range of chemical exposures in hair samples of men and women. The adult exposome was complex and multidimensional. Future exposome studies should include hair as a matrix for characterizing exposure to multiple environmental chemicals.
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