There is evidence that the prevalence of allergies and asthma differs between populations in western and eastern Europe. This study investigated the prevalence of wheezing, rhinitis and eczema among schoolchildren in urban and rural areas of Scandinavia and the formerly socialist countries of Eastern Europe. A total of 79,000 children from two age groups (13-14 yrs and 6-7 yrs) in 18 study centres responded to a questionnaire within the International Study of Asthma and Allergy in Children (ISAAC). The 12 month period prevalence of symptoms of asthma, allergic rhinoconjunctivitis and atopic eczema was calculated. The prevalence of wheezing among the 13-14 yr old children was 11.2-19.7% in Finland and Sweden, 7.6-8.5% in Estonia, Latvia and Poland and 2.6-5.9% in Albania, Romania, Russia, Georgia and Uzbekistan (except Samarkand). The prevalence of itching eyes and flexural dermatitis varied in a similar manner between the three regions. The regional differences were less pronounced among the 6-7 yr old children in the seven participating centres. The highest prevalence of rhinitis was recorded in April-July in Scandinavia and during the winter months in the other countries. The prevalence of atopy-related disorders was higher in Scandinavia than in Estonia, Latvia and Poland, which in turn had a higher prevalence than five other countries of eastern Europe with a culture less similar to western Europe. This supports the hypothesis that "Western life style" is associated with a high prevalence of childhood allergy.

The International Study of Asthma and Allergies in Childhood (ISAAC) Phase One showed large worldwide variations in the prevalence of symptoms of asthma, rhinoconjunctivitis and eczema, up to 10 to 20 fold between countries. Ecological analyses were undertaken with ISAAC Phase One data to explore factors that may have contributed to these variations, and are summarised and reviewed here.In ISAAC Phase One the prevalence of symptoms in the past 12 months of asthma, rhinoconjunctivitis and eczema were estimated from studies in 463,801 children aged 13 - 14 years in 155 centres in 56 countries, and in 257,800 children aged 6-7 years in 91 centres in 38 countries. Ecological analyses were undertaken between symptom prevalence and the following: Gross National Product per capita (GNP), food intake, immunisation rates, tuberculosis notifications, climatic factors, tobacco consumption, pollen, antibiotic sales, paracetamol sales, and outdoor air pollution.Symptom prevalence of all three conditions was positively associated with GNP, trans fatty acids, paracetamol, and women smoking, and inversely associated with food of plant origin, pollen, immunisations, tuberculosis notifications, air pollution, and men smoking. The magnitude of these associations was small, but consistent in direction between conditions. There were mixed associations of climate and antibiotic sales with symptom prevalence.The potential causality of these associations warrant further investigation. Factors which prevent the development of these conditions, or where there is an absence of a positive correlation at a population level may be as important from the policy viewpoint as a focus on the positive risk factors. Interventions based on small associations may have the potential for a large public health benefit.

The prevalence of gallstone disease in a large Romanian town was determined on 6275 necropsies performed during a 10-year period (1973-1982). The "crude" prevalence of gallstone disease in women was 17.1% and in men, 6.9%. Age-standardized prevalence was 8.4% in women and 5.0% in men. This rate is lower than the prevalence of gallstones in northern or central European countries, but it is higher than that established in some southern countries of Europe. A comparison of the "crude" prevalence of gallstone disease was compared with that calculated for a similar 10-year period 100 years ago (1873-1882), on 1538 necropsies performed in the same town. Prevalence of gallstones rose significantly in a century (from a mean of 1.2% to 11.3%; P less than 0.001), a finding consistent with the concept that gallstone disease is a "disease of civilization."

To study whether the increasing prevalence of gallstone disease noted in a 100-year interval in a large Romanian town has continued in recent years, we analyzed all necropsies (5234) performed during 10 years (1983-1992) in Cluj-Napoca. Gallstone disease (GD) was defined as the presence of stones or the absence of the gallbladder due to cholecystectomy. The results obtained were compared to those of the previous 10-year period (1973-1982). We found a significant increase of GD both in men (6.9% to 9.8%) (P < 0.001) and women (17.1% to 21.7%) (P < 0.001). The ratio of women to men with GD decreased as compared to the first time period (1.4/1 vs 1.8/1). The actual age-standardized prevalence of GD was higher than that calculated for the first time period: 7.6% in men (5.0% in 1973-1982) and 16.9% in women (8.4% in 1973-1982) (P < 0.001). The necropsy cholecystectomy rate rose markedly; 42.1% of the GD men and 43.0% of the GD women had undergone operation during their life. The present study indicates a higher prevalence of GD in the Romanian town than previously found. The actual prevalence is comparable with that of other central European countries, but it is less than that found in England, Scotland, or Sweden.

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