Search

Diagnosing immediate drug hypersensitivity reactions (IDHRs) can pose a significant challenge and there is an urgent need for safe and reliable tests. Evidence has emerged that the basophil activation test (BAT), an in vitro assay that mirrors the in vivo response, can be a complementary test for many drugs. In this position paper, members of Task Force (TF) "Basophil activation test in the evaluation of Drug Hypersensitivity Reactions" from the European Academy of Allergy and Clinical Immunology (EAACI) present the data from a survey about the use and utility of BAT in IDHRs in Europe. The survey results indicate that there is a great interest for using BAT especially for diagnosing IDHRs. However, there are still main needs, mainly in the standardization of the protocols. Subsequently consensus‐based recommendations were formulated for: (i) Technical aspects of BAT in IDHRs including type of sample, management of drugs, flow cytometry protocols, interpretation of the results; and (ii) Drug‐specific aspects that should be taken into account when performing BAT in relation to betalactams, neuromuscular blocking agents, fluoroquinolones, chlorhexidine, opioids, radio contrast media, chemotherapeutics, biological agents, nonsteroidal anti‐inflammatory drugs, COVID vaccine, and excipients. Moreover, aspects in the evaluation of pediatric population have also been considered. All this indicates that BAT offers the clinician and laboratory a complementary tool for a safe diagnostic for IDHRs, although its place in the diagnostic algorithm depends on the drug class and patient population (phenotype, geography, and age). The standardization of BAT is important for generalizing this method beyond the individual laboratory. [ABSTRACT FROM AUTHOR]

Psychodermatology is a subspecialty of dermatology that is of increasing interest to dermatologists and patients. The case for the provision of at least regional psychodermatology services across Europe is robust. Psychodermatology services have been shown to have better, quicker and more cost‐efficient clinical outcomes for patients with psychodermatological conditions. Despite this, psychodermatology services are not uniformly available across Europe. In fact many countries have yet to establish dedicated psychodermatology services. In other countries psychodermatology services are in development. Even in countries where psychodermatolgy units have been established, the services are not available across the whole country. This is especially true for the provision of paediatric psychodermatology services. Also whilst most states across Europe are keen to develop psychodermatology services, the rate at which this development is being implemented is very slow. Our paper maps the current provision of psychodermatology services across Europe and indicates that there is still very much more work to be done in order to develop the comprehensive psychodermatology services across Europe, which are so crucial for our patients. [ABSTRACT FROM AUTHOR]

Introduction: Adolescence is a critical stage of rapid biological, emotional and social change and development. Adolescents and young adults (AYA) with asthma and allergies need to develop the knowledge and skills to self‐manage their health independently. Healthcare professionals (HCP), parents and their wider network play an essential role in supporting AYA in this process. Previous work showed significant limitations in transition care across Europe. In 2020, the first evidence‐based guideline on effective transition for AYA with asthma and allergies was published by EAACI. Aim: We herein summarize practical resources to support this guideline's implementation in clinical practice. Methods: For this purpose, multi‐stakeholder Task Force members searched for resources in peer review journals and grey literature. These resources were included if relevant and of good quality and were pragmatically rated for their evidence‐basis and user friendliness. Results: Resources identified covered a range of topics and targeted healthcare professionals, AYA, parents/carers, schools, workplace and wider community. Most resources were in English, web‐based and had limited evidence‐basis. Conclusions: This position paper provides a valuable selection of practical resources for all stakeholders to support effective transitional care for AYA with asthma and allergies. Future research should focus on developing validated, patient‐centred tools to further assist evidence‐based transition care. [ABSTRACT FROM AUTHOR]

Background and purpose: This position paper makes recommendations following an audit of care provided to people presenting with a seizure to emergency departments (EDs) in Europe. Methods: Participating countries were asked to include five hospitals agreeing to identify 50 consecutive seizure patients presenting to their ED between 1 August 2016 and 31 August 2017. Anonymous data were collected to a web database. Where quoted, percentages are mean site values and ranges are the 10th–90th centile. Results: Data were collected on 2204 ED visits (47 sites, up to six per country, across 15 countries): 1270 (58%) known epilepsy, 299 (14%) previous blackouts but no epilepsy diagnosis, 634 (29%) with a first seizure. Wide variability was identified for most variables. Of those with known epilepsy, 41.2% (range 26.2%–59.6%) attended the ED in the previous 12 months, but only 64.7% (range 37.2%–79.8%) had seen an epilepsy specialist in the previous 12 months. 67.7% (range 34.0%–100%) were admitted, 53.1% to a neurology ward (range 0.0%–88.9%). Only 37.5% first seizure patients (range 0.0%–71.4%) were given advice about driving. Conclusions and recommendations: It is recommended that in Europe guidance is agreed on the management and onward referral of those presenting to the ED with a seizure; a referral process is created that can be easily implemented; it is ensured that the seizure services receive referrals and see the patients within a short time period; and a simple system is developed and implemented to allow continuous monitoring of key indices of epilepsy care. [ABSTRACT FROM AUTHOR]

Genetic cardiomyopathies are disorders of the cardiac muscle, most often explained by pathogenic mutations in genes encoding sarcomere, cytoskeleton, or ion channel proteins. Clinical phenotypes such as heart failure and arrhythmia are classically treated with generic drugs, but aetiology-specific and targeted treatments are lacking. As a result, cardiomyopathies still present a major burden to society, and affect many young and older patients. The Translational Committee of the Heart Failure Association (HFA) and the Working Group of Myocardial Function of the European Society of Cardiology (ESC) organized a workshop to discuss recent advances in molecular and physiological studies of various forms of cardiomyopathies. The study of cardiomyopathies has intensified after several new study setups became available, such as induced pluripotent stem cells, three-dimensional printing of cells, use of scaffolds and engineered heart tissue, with convincing human validation studies. Furthermore, our knowledge on the consequences of mutated proteins has deepened, with relevance for cellular homeostasis, protein quality control and toxicity, often specific to particular cardiomyopathies, with precise effects explaining the aberrations. This has opened up new avenues to treat cardiomyopathies, using contemporary techniques from the molecular toolbox, such as gene editing and repair using CRISPR-Cas9 techniques, antisense therapies, novel designer drugs, and RNA therapies. In this article, we discuss the connection between biology and diverse clinical presentation, as well as promising new medications and therapeutic avenues, which may be instrumental to come to precision medicine of genetic cardiomyopathies. [ABSTRACT FROM AUTHOR]

This paper reports on the recent activity of the pan‐European consensus of the ADEE Special Interest Group for Pre‐Clinical Operative Skills. Following the previous recommendations from the group, and in order to support teachers and to harmonise the delivery of skills training across Europe, a more formal curriculum relating to pre‐clinical operative skills needs to be created. This paper reports European consensus surrounding the categorisation (level of importance, and difficulty) of basic operative dental clinical skills within the undergraduate curriculum and provides recommendations relating to session structure and timing of curricular elements for basic operative dental clinical skills teaching. [ABSTRACT FROM AUTHOR]

This paper is based on longitudinal ethnographic work among Bulgarian migrant women who work as live‐in caregivers and domestic workers in Italian households and explores the analytical potential of place and place making for transmigration literature by conceptualizing the co‐production of place with subjectivities. Such approach sensitizes to mundane practices of care and belonging, which actively create migratory lives of meaning. Drawing on Deleuze's concept of the fold as subjectivity and Clifford's notion of dwelling‐in‐travelling, I propose the term 'dwelling‐in‐folds' – and its mechanism 'folding place' – in order to make sense of temporary migrants' experience of place(s) that foregrounds their ability to connect and reconcile fractures and discontinuities, particularly when doing transnational motherhood. In doing so, the paper folds place empirically – showing how 'dwelling‐in‐folds' is achieved and unfolds place analytically – demonstrating the potential of this concept for sociology and transmigration studies. [ABSTRACT FROM AUTHOR]

Background: Information about airborne pollen concentrations is required by a range of end users, particularly from the health sector who use both observations and forecasts to diagnose and treat allergic patients. Manual methods are the standard for such measurements but, despite the range of pollen taxa that can be identified, these techniques suffer from a range of drawbacks. This includes being available at low temporal resolution (usually daily averages) and with a delay (usually 3–9 days from the measurement). Recent technological developments have made possible automatic pollen measurements, which are available at high temporal resolution and in real time, although currently only scattered in a few locations across Europe. Materials & Methods: To promote the development of an extensive network across Europe and to ensure that this network will respond to end user needs, a stakeholder workshop was organised under the auspices of the EUMETNET AutoPollen Programme. Participants discussed requirements for the groups they represented, ranging from the need for information at various spatial scales, at high temporal resolution, and for targeted services to be developed. Results: The provision of real‐time information is likely to lead to a notable decrease in the direct and indirect health costs associated with allergy in Europe, currently estimated between €50–150 billion/year.1 Discussion & Conclusion: A European measurement network to meet end user requirements would thus more than pay for itself in terms of potential annual savings and provide significant impetus to research across a range of disciplines from climate science and public health to agriculture and environmental management. [ABSTRACT FROM AUTHOR]

Since the introduction of allergen immunotherapy (AIT) over 100 years ago, focus has been on standardization of allergen extracts, with reliable molecular composition of allergens receiving the highest attention. While adjuvants play a major role in European AIT, they have been less well studied. In this Position Paper, we summarize current unmet needs of adjuvants in AIT citing current evidence. Four adjuvants are used in products marketed in Europe: aluminium hydroxide (Al(OH)3) is the most frequently used adjuvant, with microcrystalline tyrosine (MCT), monophosphoryl lipid A (MPLA) and calcium phosphate (CaP) used less frequently. Recent studies on humans, and using mouse models, have characterized in part the mechanisms of action of adjuvants on pre‐existing immune responses. AIT differs from prophylactic vaccines that provoke immunity to infectious agents, as in allergy the patient is presensitized to the antigen. The intended mode of action of adjuvants is to simultaneously enhance the immunogenicity of the allergen, while precipitating the allergen at the injection site to reduce the risk of anaphylaxis. Contrasting immune effects are seen with different adjuvants. Aluminium hydroxide initially boosts Th2 responses, while the other adjuvants utilized in AIT redirect the Th2 immune response towards Th1 immunity. After varying lengths of time, each of the adjuvants supports tolerance. Further studies of the mechanisms of action of adjuvants may advise shorter treatment periods than the current three‐to‐five‐year regimens, enhancing patient adherence. Improved lead compounds from the adjuvant pipeline are under development and are explored for their capacity to fill this unmet need. [ABSTRACT FROM AUTHOR]

Diagnostic allergens are defined as medicinal products in the EU. Marketing authorization by national authorities is necessary; however, diagnostic allergens are not homogeneously regulated in different EU member states. Allergen manufacturers argue with increasing costs forcing them to continuously reduce the diagnostic allergen portfolios offered to allergists. In contrast, EAACI and national European Allergy Societies see the need for the availability of a wide range of high‐quality diagnostic allergens for in vivo diagnosis of IgE‐mediated allergies not only covering predominant but also less frequent allergen sources. In a recent EAACI task force survey, the current practice of allergy diagnosis was shown to rely on skin tests as first option in almost 2/3 of all types of allergic diseases and in 90% regarding respiratory allergies. With the need to ensure the availability of high‐quality diagnostic allergens in the EU, an action plan has been set up by EAACI to analyse the current regulatory demands in EU member states and to define possible solutions stated in this document: (a) simplification of authorization for diagnostic allergens; (b) specific regulation of special types of diagnostic allergens; (c) new models beyond the current model of homologous groups; (d) simplification of pharmacovigilance reporting; (e) reduction of regulation fees for diagnostic allergens; (f) reimbursement for diagnostic allergens. Joining forces of allergists, manufacturers and authorities are of high importance to ensure remaining relevant allergens in the EU markets to facilitate a sustainable and comprehensive service for the diagnosis and treatment of allergic diseases. [ABSTRACT FROM AUTHOR]

ABSTRACT Substance use is a persistent concern for adolescents in many countries due to the significant negative impact on mental, physical and social outcomes. US research indicates that while 4.1% of 12–17‐year‐olds require treatment, <10% of those who require it access it. This paper summarises the literature available on the barriers and enablers to those under 18s attending substance use treatment to inform policy and practice. Using a systematic approach, we searched six databases for studies which reported barriers and enablers to those aged 18 and under accessing substance use treatment. Thirty‐two papers met the inclusion criteria and we present the findings using a narrative synthesis. Only one paper identified explored this topic in Europe. Barriers and enablers are presented across four themes: (1) individual factors, (2) societal factors, (3) Gateway Providers and (4) treatment service factors. Mental health nurses, especially those working with young people, should be aware that adolescents are unlikely to perceive their substance use as problematic and rely on adults to access treatment. Access appears more difficult for females and socially marginalised youth. Various professionals direct young people towards treatment, but clear protocols are needed to encourage them to intervene, which could be an opportunity for nurses to be innovative and lead in this area. Services perceived as adolescent‐specific, youth‐friendly and flexible encourage attendance while the cost of treatment, including time off work and transport, function as barriers. [ABSTRACT FROM AUTHOR]

Introduction: Oral health professional (OHP) education is likely to vary across Europe in accordance with an EU directive that is open to broad interpretation. It is not clear how OHP curricula are structured or delivered across Europe. The objectives of Part 2 of this paper series are: (i) to provide an overview of common practices in curriculum structure, the availability of facilities, staffing (faculty) and quality assurance processes and (ii) to consider how the existing programme structures align to stakeholder guidance documents. Methods: A total of 27 questions from a 91‐item questionnaire were used for this manuscript. The questionnaire was developed following the Delphi method to establish consensus from a group of experts. Members of the research team and colleagues from other countries in Europe completed a multi‐step piloting process. An online data hub was created to allow the respondents to be data controllers and respond to the questionnaire. ADEE member schools (n = 144) were invited to provide data. Results: Totally, 71 institutions from 25 European countries provided data between June 2021 and April 2023, which represents a response rate of 49.3% of ADEE members. Data on curriculum approaches, teaching methods, integration of topics of interest, clinical education, staff–student ratios, access to facilities and new technologies, teaching staff (faculty) and quality assurance processes are presented for Primary Dental Degree Programmes. Conclusion: To the best of our knowledge, this series of papers are the first attempts to provide a comprehensive overview of OHP education in Europe. Results showed that the majority of European dental programmes are engaged in providing innovative and scientifically grounded education in order to develop quality future OHPs. Nevertheless, significant variability in the delivery of clinical education across the European OHP schools was notable in this dataset. A comprehensive view of the state of OHP education in Europe is not yet available but the O‐Health‐Edu data hub provides a means for all education providers in Europe to contribute data to reach this goal. It is anticipated that the data hub will be updated and built upon over time to continually establish a clearer picture of the state of OHP education in Europe. [ABSTRACT FROM AUTHOR]

Background: Chronic nodular prurigo (CNPG) is a condition characterized by chronic itch, a prolonged scratching behaviour and the presence of pruriginous nodules. A comprehensive understanding of this condition, especially regarding its clinical characteristics and impact on quality of life is still lacking. Objectives: Aim of this pan‐European multicentre cross‐sectional study was to establish the clinical profile of CNPG, including its associated burden. Methods: Fifteen centres from 12 European countries recruited CNPG patients presenting at the centre or using the centres' own databases. Patients were asked to complete a questionnaire in paper or electronic format. Demography, current co‐morbidities, underlying disease, itch intensity, additional sensory symptoms, quality of life, highest burden and emotional experience of itch were assessed. Results: A total of 509 patients (210 male, median age: 64 years [52; 72]) were enrolled. Of these, 406 reported itch and CNPG lesions in the previous 7 days and qualified to complete the whole questionnaire. We recorded moderate to severe worst itch intensity scores in the previous 24 h. Scores were higher in patients with lower educational levels and those coming from Eastern or Southern Europe. Most patients experience itch often or always (71%) and report that their everyday life is negatively affected (53%). Itch intensity was considered to be the most burdensome aspect of the disease by 49% of the patients, followed by the visibility of skin lesions (21%) and bleeding of lesions (21%). The majority of patients was unaware of an underlying condition contributing to CNPG (64%), while psychiatric diseases were the conditions most often mentioned in association with CNPG (19%). Conclusions: This multicentre cross‐sectional study shows that itch is the dominant symptom in CNPG and reveals that the profile of the disease is similar throughout Europe. [ABSTRACT FROM AUTHOR]

The high prevalence of allergic diseases warrants for sufficient health care provisions available to patients with allergic diseases. Allergy care should be delivered by well‐trained specialists. However, the current status of allergy care is not well documented. For this reason a survey among European and a few non‐European countries was launched by the National Allergy Society Committee from the European Academy of Allergy and Clinical Immunology and the Union Européenne des Médecins Spécialistes section and board of Allergology. The survey shows that in the vast majority of countries allergy care services are available. However, a substantial heterogeneity is reported regarding recognition of the full specialty, the number of practicing specialists or subspecialists, and training aspects. Growth but also decline of specialty and subspecialties is reported. In addition, the survey gives insight in strengths, weaknesses, opportunities and threats in this field. It appears that the recognition of the full specialty determines strength as well as weakness. Aging of specialists combined with a decline in the number of trainees form a major threat. Opportunities are seen in creating awareness for allergy, focus on attracting young physicians. The conclusion is that harmonization of allergy services across Europe is needed. Investment in young doctors, creating new opportunities and lobbying for the full specialty is required. [ABSTRACT FROM AUTHOR]

As heart failure with preserved ejection fraction (HFpEF) rises to epidemic proportions, major steps in patient management and therapeutic development are badly needed. With the current position paper we seek to update our view on HFpEF as a highly complex systemic syndrome, from risk factors and mechanisms to long-term clinical manifestations. We will revise recent advances in animal model development, experimental set-ups and basic and translational science approaches to HFpEF research, highlighting their drawbacks and advantages. Directions are provided for proper model selection as well as for integrative functional evaluation from the in vivo setting to in vitro cell function testing. Additionally, we address new research challenges that require integration of higher-order inter-organ and inter-cell communication to achieve a full systems biology perspective of HFpEF. [ABSTRACT FROM AUTHOR]

Reflexive commitments tend to be lacking, particularly from the perspective of early career scholars. This is particularly true in relation to published research, but evident in doctoral studies exploring teachers work. Using principles of phenomenological reflexivity, this methodological paper explores the critical incidents that have come to shape a qualitative, ethnographical case study before entering the field. Key findings highlight four implications for novice researchers: an engagement with critical independent reflection, critical friendship, skills development through academic modules and reflexive reading, and communities of practice. The paper calls for continued attention to the methodological framing of research, particularly during and after entering the field. [ABSTRACT FROM AUTHOR]

This paper explores the implementation of grand spatial planning narratives such as the compact city and polycentricity in planning practice. The effects of overlapping scales on the application of spatial imaginaries in metropolitan space are examined. Using post‐socialist space, the research enriches the geographical context of metropolitan studies. On the basis of a spatial analysis of metropolitan form and centrality and a textual analysis of the relevant spatial plans of three Czech metropolitan areas, the key features in efforts of planning polycentric and compact metropolitan areas are identified as "Administrative blindness", "(De)centralization ambiguity", and "Reactive passivity". By identifying the limits of translating spatial visions into the practical language of statutory regional and land‐use plans, the paper contributes to the debate on the effectiveness of metropolitan planning based on the specific context of Central Europe. [ABSTRACT FROM AUTHOR]

Aim: This paper introduces the Surveillance of Cerebral Palsy in Europe (SCPE) classification of events contributing to postneonatally acquired cerebral palsy, presents its interrater reliability, and describes the cases identified in the SCPE database. Method: The development of the classification, based on literature review and expert discussions, resulted in six main categories and 19 subcategories. The first chronological event designated as the primary event was mainly reported. Interrater reliability was assessed through online exercise providing 24 clinical vignettes representing single/complex pathways. Percent agreement and Gwet's AC1 index of reliability were estimated. Primary events were described using data of 221 children born between 2008 and 2012. Results: Thirty‐nine professionals (21 registries) participated in the reliability exercise. Substantial overall agreement was reached (0.75), with some contrast between complex (0.48, moderate agreement) and single events involved (0.89, almost perfect). The distribution of primary events showed that 32.1% were infections (category A), 23.1% head injuries (B), 15.4% related to surgery or medical interventions (C), 13.1% cerebrovascular accidents (D), 9.1% hypoxic brain damaging events of other origins (E), and 7.2% miscellaneous (F). Interpretation: This classification allows all the events involved to be recorded while consistently reporting the primary event, and may be used in different settings. What this paper adds: A standardized classification enables the description of the events contributing to postneonatal cerebral palsy (CP).The first chronological event in complex pathway leading to CP is coded.Category choice and coding of the primary event identify preventable situations.The detailed 2‐level classification is easy to use in various settings.Substantial overall interrater reliability shows that main categories can be consistently differentiated. [ABSTRACT FROM AUTHOR]

Conventional signals are maintained via social costs and commonly used in the animal kingdom to assess conspecifics' agonistic ability during disputes over resources. In the last decade, some experimental studies reported the existence of visual conventional signals in several social wasp species, being good rank predictors in different social contexts. Females of the social wasp Polistes gallicus do not cooperate to start nests but they often try to usurp conspecific nests. Here, we showed that the reproductive females of this species have variable facial colour patterns that function as conventional signals. Wasps with larger black spots on their clypeus are more likely to successfully overwinter, are larger, and are better at fighting and at holding a nest. Furthermore, in field experiments, resident foundresses rely on facial pattern to assess usurpers' fighting abilities, modulating their defence reaction accordingly, so that rivals with larger black spot receive more aggression than rivals with smaller or no black spots on the clypeus. Our study reveals that visual recognition abilities are widespread among paper wasps that, regardless of their social biology, face similar selective pressures within competitive contexts. [ABSTRACT FROM AUTHOR]

Background Skin diseases constitute up to 40% of all notified occupational diseases in most European countries, predominantly comprising contact dermatitis, contact urticaria, and skin cancer. While insufficient prevention of work-related skin diseases (WRSD) is a top-priority problem in Europe, common standards for prevention of these conditions are lacking. Objective To develop common European standards on prevention and management of WRSD and occupational skin diseases (OSD). Method Consensus amongst experts within occupational dermatology was achieved with regard to the definition of minimum evidence-based standards on prevention and management of WRSD/OSD. Results By definition, WRSDs/OSDs are (partially or fully) caused by occupational exposure. The definition of OSD sensu stricto additionally includes diverging national legal requirements, with an impact on registration, prevention, management, and compensation. With the implementation of the classification of WRSD/OSD in the International Classification of Diseases (ICD) 11th Revision in future, a valid surveillance and comparability across countries will be possible. Currently, WRDS and OSD are still under-reported. Depending on legislation and regulations, huge differences exist in notification procedures in Europe, although notification is crucial to prevent chronic and relapsing disease. Facilities for early diagnosis, essential for individual patient management, should be based on existing guidelines and include a multidisciplinary approach. Patch testing is essential if contact dermatitis persists or relapses. Workplace exposure assessment of WRSD/OSD requires full labelling of product ingredients on material safety data sheets helping to identify allergens, irritants and skin carcinogens. Comparable standards in primary, secondary and tertiary prevention must be established in Europe to reduce the burden of WRSD/OSD in Europe. Conclusion The adoption of common European standards on prevention of WRSD/OSD will contribute to reduce the incidence of OSD and their socio-economic burden. [ABSTRACT FROM AUTHOR]

In Europe, gambling policy is conditioned by different administrative levels, including national authorities and the EU, as well as institutions of the European Economic Area (EEA). The legal framework of the EU/EEA requires Member States to pursue evidence‐based policy. The current scoping review focuses on what kind of policy research is available on gambling in the European context to support evidence‐based policy. We searched three scientific databases for research literature on gambling regulation and policy in the European context. The final sample consists of 88 papers. We analysed the corpus with Term Frequency‐Inverse Document Frequency mapping, and, narratively, by applying the policy cycle phases (agenda‐setting, formulation, adoption, implementation, and evaluation). Overall, the results show that gambling policy research is a growing field in Europe, and the policy cycle describes the available literature amply. The largest part of the existing research concerns the evaluation phase, while the formulation and implementation phases are under‐represented. The findings are discussed in terms of the main outcomes, as well as in terms of the gaps in the existing research. [ABSTRACT FROM AUTHOR]

This study presents an update of forensic accounting of the numbers and demographics of migrants found deceased in the Evros region of Greece in the years from 2015–22. Compared to data from 2000–14, this update reflects the mounting number of border‐related deaths in the region, as well as the changing demographic trends associated with the migrants who perish crossing the Greek‐Turkish border. Specifically, the paper documents a broadening of locations from which migrants originate, the increasing diversity of migrant death locations, and a shift in the leading causes of death. It contains important forensic accounting of the unique humanitarian crisis occurring along the Greek‐Turkish land border while also providing an additional context for the global migration crisis. The data presented here offer insights into other forensic stakeholders impacted by the global migration crisis, with respect to what factors contribute to and detract from identification rates, and can help stakeholders make informed policy decisions. [ABSTRACT FROM AUTHOR]

Motivated by the growing prominence of fertility incentivisation and long‐term child development in European family policymaking, this paper examines the distribution of financial support for parents over the course of childhood and between birth orders in Europe. We use the term 'older‐oriented age bias' to refer to support that is more generous for older children and the term 'younger‐oriented age bias' for more generous support for younger children. Similarly, we refer to distribution patterns tilted towards later birth orders as 'later‐oriented parity bias' and to those that favour earlier birth orders as 'earlier‐oriented parity bias'. Based on a list of four classical policy functions of financial support for parents (child cost compensation, fertility incentivisation, child poverty reduction, and child development), we formulate six (sets of) hypotheses for the age and parity distribution of financial support for parents. To assess these distribution patterns, we examine monthly financial support (allowance‐ and tax‐based) for the first four birth orders at child ages 2, 9, and 17 in low‐income and middle‐income households across 28 European countries as of January 2021. We find that European welfare states typically provide more generous support for younger children, while the support distribution in terms of birth orders depends on pre‐support household income. We also find considerable cross‐country heterogeneity, with fertility incentivisation and (especially) child development being reflected by more countries than child cost compensation and poverty reduction. Our analysis sheds light on previously underexplored trends and implications in the design of financial support for parents in Europe. [ABSTRACT FROM AUTHOR]

Introduction: Current legislation leaves Oral Health Professional (OHP) education open to wide interpretation and may result in significant variation in educational practice and resultant professional attributes across Europe. Data regarding the current state of OHP education across Europe is limited. The aim of Part 1 of this series is to provide programme‐level data for Primary Dental Degree Programmes, Dental Hygiene and Postgraduate Education. Methods: A 91‐item questionnaire was developed following the Delphi method. The questionnaire and the Articulate glossary of OHP education terms were developed concurrently to facilitate a common understanding of language. Piloting was performed in multiple stages and included institutions internal and external to the research group. The questionnaire was uploaded online and converted to a data hub, allowing dental schools to control their own data and update the data provided whenever they wish. All ADEE member schools (n = 144) were invited to provide data. Forty questions relating to school details, Primary Dental Degree Programmes, Dental Hygiene and Postgraduate Education were included in this part of the series. Results: Seventy‐one institutions from 25 European countries provided data between June 2021 and April 2023, which represents a response rate of 49.3% of ADEE members. Programme‐level data for Primary Dental Degree Programmes, Dental Hygiene and Postgraduate Education is presented including programme length, funding, languages and fees, student numbers and demographics, student admission and selection processes and permission to practice after graduation. Conclusion: This series of papers, as far as the authors are aware, are the first attempts to build a comprehensive picture of the current state of OHP education in Europe. A comprehensive view of the state of OHP education in Europe is not yet available but the O‐Health‐Edu data hub provides a means for all education providers in Europe to contribute data to reach this goal. It is anticipated that the data hub will be updated and built upon over time to continually establish a clearer picture of the state of OHP education in Europe. [ABSTRACT FROM AUTHOR]

De‐aliasing products are used in the estimation process of satellite‐based gravity field computation to reduce errors from high‐frequency mass variations that alias into monthly gravity fields. The latest official product is AOD1B RL07 and describes non‐tidal atmosphere and oceanic mass variations at 3‐hourly resolution. However, the model‐based de‐aliasing products are inevitably incomplete and prone to temporally and spatially correlated errors that substantially contribute to errors in the estimated gravity fields. Here, we investigate possible enhancement of current de‐aliasing products by nesting a regional high‐resolution atmospheric reanalysis over Europe into a global reanalysis. As further novelty we include almost mass consistent terrestrial water storage variability from a regional hydrological model nested into a global model as additional component of the de‐aliasing product. While we find in agreement with earlier studies only minor contributions from increasing the temporal resolution beyond 3‐hourly data, our investigations suggest that contributions from continental hydrology and from regional non‐hydrostatic atmospheric modeling to sub‐monthly mass variations could be relevant already for gravity fields estimated from current gravity missions. Moreover, in the context of extreme events, we find regionally contributions from additional moisture fields, such as cloud liquid water, in the order of a few mm over Europe. We suggest this needs to be taken into account when preparing data analysis schemes for future space gravimetric missions. Plain Language Summary: Observing temporal variations in the Earth's gravity field with satellite gravimetry plays an essential role for monitoring mass transports on and underneath the Earth's surface. This is crucial for understanding the evolution of floods and droughts, the role of groundwater pumping, and to quantify the melting of ice sheets and glaciers and the resulting sea level rise. In order to isolate the target variable (e.g., terrestrial water storage changes) unwanted signals (e.g., fast mass variations in the atmosphere) need to be removed in the gravity field estimation process using background models, so‐called de‐aliasing models. This paper focuses on improving background models by incorporating regional high‐resolution models, which more specifically resolve certain processes in the atmosphere. Our hypothesis is that this will lead to better gravity fields with increased spatial resolution and less noise. Moreover, we find that considering fast hydrological variations as additional background model could improve gravity fields from the current satellite mission GRACE‐FO. For the first time, we quantify contributions from so far neglected atmospheric moisture fields, such as cloud liquid water, to enhance background models in the context of extreme events—which, however, will likely be in particular relevant for more sensitive gravity missions in the future. Key Points: We provide an atmosphere‐hydrology de‐aliasing product with regional mass‐consistent refinement over EuropeUsing non‐hydrostatic as opposed to hydrostatic numerical weather prediction model output significantly impacts the de‐aliasing productWe found that for extreme events additional moisture fields unaccounted in present Atmosphere and Ocean De‐aliasing (AOD) models can reach magnitudes relevant for de‐aliasing [ABSTRACT FROM AUTHOR]

Although leisure constraints that individuals have to cope with can negatively affect their social inclusion and satisfaction with life, little research has addressed the link between these variables. Therefore, the current paper examined the moderator role of leisure constraints on the relationship between satisfaction with life and leisure constraints among adults living in five different European countries. The respondents were 1,382 women and 877 men adults. The findings of analysis revealed that all factors used in the study accounted for 15% of the variance in satisfaction with life and social inclusion had a significant and positive impact on satisfaction with life. As a result, it can be said that leisure constraints had a moderating effect on the relationship between satisfaction with life and social inclusion. The present research study recommends that social inclusion should be encouraged through decreasing to leisure constraints to increase the life satisfaction. [ABSTRACT FROM AUTHOR]

Political parties are typically seen as conservative institutions which rarely change. Despite this common perception, parties do change, and on occasion, transform themselves by changing features such as the party name and logo, or their policy program. How can we conceptualize these kinds of changes, and what are the electoral consequences for parties which change in these ways? In this paper, I argue that feature changes and policy changes are instances of party rebranding, or situations where a party attempts to overhaul its entire image. I then test the electoral consequences of feature and policy rebrands on a dataset of 239 political parties from 1945 to 2019. The results indicate that feature rebrands increase party vote share for the election after the rebrand, while policy rebrands have no effect. These findings have implications for our understanding of parties themselves and the kinds of party signals that voters respond to. [ABSTRACT FROM AUTHOR]

Glued laminated timber made from hardwood is a sustainable structural product that is currently gaining momentum due to climatic changes and afforestation policy. Diversities in hardwood species have led to a lack of a complete standard for the production of glued laminated timber from hardwood in Europe. This paper addresses hardwood species available in Croatian forests, namely Carpinus Betulus L. (European hornbeam), Quercus Cerris L. (Turkey oak), and Acer Campestre L. (Maple), in terms of their suitability for the production of glued laminated timber. The suitability is assessed by a multi‐criteria analysis with seven criteria. Visual and physical properties include density, the occurrence of knots, and grain deviation in lamellas. Mechanical properties include the bending strength, modulus of elasticity, and shear strength of glue lines. In order to obtain physical and mechanical properties, corresponding experimental research has been carried out. Production costs have been evaluated in collaboration with the manufacturer. Results indicate a very high potential of European hornbeam and Turkey oak for the production of glued laminated timber. [ABSTRACT FROM AUTHOR]

Type 2 diabetes mellitus (T2DM) is common in patients with heart failure (HF) and associated with considerable morbidity and mortality. Significant advances have recently occurred in the treatment of T2DM, with evidence of several new glucose-lowering medications showing either neutral or beneficial cardiovascular effects. However, some of these agents have safety characteristics with strong practical implications in HF [i.e. dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1 RA), and sodium-glucose co-transporter type 2 (SGLT-2) inhibitors]. Regarding safety of DPP-4 inhibitors, saxagliptin is not recommended in HF because of a greater risk of HF hospitalisation. There is no compelling evidence of excess HF risk with the other DPP-4 inhibitors. GLP-1 RAs have an overall neutral effect on HF outcomes. However, a signal of harm suggested in two small trials of liraglutide in patients with reduced ejection fraction indicates that their role remains to be defined in established HF. SGLT-2 inhibitors (empagliflozin, canagliflozin and dapagliflozin) have shown a consistent reduction in the risk of HF hospitalisation regardless of baseline cardiovascular risk or history of HF. Accordingly, SGLT-2 inhibitors could be recommended to prevent HF hospitalisation in patients with T2DM and established cardiovascular disease or with multiple risk factors. The recently completed trial with dapagliflozin has shown a significant reduction in cardiovascular mortality and HF events in patients with HF and reduced ejection fraction, with or without T2DM. Several ongoing trials will assess whether the results observed with dapagliflozin could be extended to other SGLT-2 inhibitors in the treatment of HF, with either preserved or reduced ejection fraction, regardless of the presence of T2DM. This position paper aims to summarise relevant clinical trial evidence concerning the role and safety of new glucose-lowering therapies in patients with HF. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to provide an update on the development of the long‐term relative poverty rate in Europe. We use European Statistics on Income and Living Conditions data (EU‐SILC) for 26 European countries between 2009 and 2018. In addition to describing the development of long‐term poverty, we also analyse the drivers of poverty on the country level via fixed effects panel regression analysis. We are particularly interested in how economic growth, employment rates, social expenditure, and short‐term poverty rates are related to long‐term poverty. Overall, the results show that long‐term poverty has increased in 13 out of 26 countries, but was unchanged or decreased in 13 countries. Gross domestic product growth is not related to the development of long‐term poverty. However, we find that male employment and social welfare expenditure reduce poverty rates. Furthermore, short‐term poverty is negatively associated with long‐term poverty. Hence, short‐term poverty and long‐term poverty rather substitute than complement each other. [ABSTRACT FROM AUTHOR]

Background and purpose: Neurology residency programmes, which were first established at the beginning of the 20th century, have become mandatory all over Europe in the last 40–50 years. The first European Training Requirements in Neurology (ETRN) were published in 2005 and first updated in 2016. This paper reports the most recent revisions of the ETRN. Methods: Members of the EAN board performed an in depth revision of the ETNR 2016‐version, which was reviewed by members of the European Board and Section of Neurology of the UEMS, the Education and Scientific Panels, the Resident and Research Fellow Section and the Board of the EAN, as well as the presidents of the 47 European National Societies. Results: The new (2022) ETRN suggest a 5‐year training subdivided in three phases: a first phase (2 years) of general neurology training, a second phase (2 years) of training in neurophysiology/neurological subspecialties and a third phase (1 year) to expand clinical training (e.g., in other neurodisciplines) or for research (path for clinical neuroscientist). The necessary theoretical and clinical competences as well as learning objectives in diagnostic tests have been updated, are newly organized in four levels and include 19 neurological subspecialties. Finally, the new ETRN require, in addition to a programme director, a team of clinician‐educators who regularly review the resident's progress. The 2022 update of the ETRN reflects emerging requirements for the practice of neurology and contributes to the international standardization of training necessary for the increasing needs of residents and specialists across Europe. [ABSTRACT FROM AUTHOR]

Identification of archeological fish remains requires the use of comparative reference materials, generally in the form of disarticulated fish skeletons. Photographic or illustrative atlases provide an additional resource for the analysis of fish remains. Photographic resources exist for many marine species and for specific geographic regions, whereas freshwater European species have not been covered in great detail. Here, we present a photographic atlas for the bones of freshwater and migratory fish commonly recovered from archeological sites in Central Europe, alongside a discussion of the difficulties and considerations for the analysis of freshwater fish remains. The atlas also highlights the morphological similarity of many species and the interpretive limits of freshwater fish assemblages. The atlas aims to act as an accessible and user‐friendly resource, which can be used for basic identification purposes when access to physical collections is not possible, to supplement pre‐existing collections, or for training purposes. This paper acts as a platform from which the full atlas can be downloaded. [ABSTRACT FROM AUTHOR]

If unauthorized resource use is prevented, managing marine resources by allocating property rights may match economic and environmental conservation incentives. However, because of the developing exploitation of marine resources and accompanying pollution, species' living conditions in Europe's waters are changing more quickly than before. By considering the roles of fisheries productivity, intellectual property rights, intellectual capital rights, market size, governance, and economic growth from 1990 to 2022, this paper aims to investigate the dynamic effect of property rights factors on the sustainability of the fisheries industry in 27 European countries. At higher quantiles, the findings showed a significant positive association between governance and fisheries sustainability adopting a new method, the MMQR with fixed effects, the Method of Moments Quantile Regression. In addition, in EU27 nations, the impact of intellectual property rights was favorable and statistically significant from the first to ninth quantiles. The findings show that the EU14 developed nations have more excellent governance and intellectual capital rights than the EU13 developing countries, significantly benefiting fisheries sustainability. In the same way that market size and economic growth condense fisheries sustainability in EU14 developed and EU13 developing countries, it has been discovered that intellectual property rights do the same across all quantiles, supporting the growth hypothesis for fisheries‐producing countries. The findings specifically show that the beneficial solid impact of intellectual property rights, market size, and economic development on the sustainability of fisheries is more significant in EU13 developing nations than in EU14 developed countries. These results provide policymakers with helpful information for promoting property rights aspects in EU14 and EU13 nations via effective green technologies in the fisheries sector to meet sustainable development objectives. [ABSTRACT FROM AUTHOR]

In 2014, the European Academy of Allergy and Clinical Immunology (EAACI) published the first systematic review that summarized the prevalence of food allergy (FA) and food sensitization in Europe for studies published 2000–2012. However, only summary estimates for tree nut allergy (TNA) were feasible in that work. In the current update of that systematic review, we summarized the prevalence of tree nut allergy/sensitization to individual tree nuts. Six databases were searched for relevant papers published 2012–2021 and 17 eligible studies were added to the 15 studies already identified between 2000 and 2012, giving a total of 32 studies. Of the investigated tree nuts, meta‐analysis was possible for hazelnut, walnut, almond, and in few cases, for cashew, and Brazil nut. The lifetime self‐reported prevalence was 0.8% (95% CI 0.5–1.1) for hazelnut and 0.4% (0.2–0.9) for walnut. The point self‐reported prevalence was 4.0% (2.9–5.2) for hazelnut, 3.4% (2.0–4.9) for Brazil nut, 2.0% (1.1–2.9) for almond, and 1.8% (1.1–2.5) for walnut. Point prevalence of food challenge‐confirmed TNA was 0.04% (0.0–0.1) for hazelnut and 0.02% (0.01–0.1) for walnut. Due to paucity of data, we could not identify any meaningful and consistent differences across age groups and European regions. [ABSTRACT FROM AUTHOR]

The transition toward the circular economy of European small and medium‐sized enterprises (SMEs) is one of the focuses of the Agenda in Europe. The paper aims to evaluate if this drive should transform the SMEs and keep European production sustainable and competitive. The paper offers a comparative analysis of the circular economy SMEs shift within the 13 sectors of EU Member States, that have involved innovative SMEs and have begun to use or have long adopted smart technologies for the needs of control, effectiveness, efficiency, and environmental protection and energy aspect. The study highlights and evaluates the transition in 13 sectors with the highest SMEs performance with a major specialization in Smart Technologies. Five key points are identified and evaluated to analyze, the transition degree of every sector toward the circular economy. The research shows a heterogeneous transition with both sectors and countries during which the existence of best practices, are discovered, but cannot be transmitted to other sectors. A series of deterrents to the transition from a linear to a circular economy is composed within the SMEs sectors, specifically technical, commercial, and regulatory. [ABSTRACT FROM AUTHOR]

Background: The implementation science literature acknowledges a need for engagement of key stakeholders when designing, delivering and evaluating implementation work. To date, the literature reports minimal or focused stakeholder engagement, where stakeholders are engaged in either barrier identification and/or barrier prioritisation. This paper begins to answer calls from the literature for the development of tools and guidance to support comprehensive stakeholder engagement in implementation research and practice. The paper describes the systematic development of the Implementation‐STakeholder Engagement Model (I‐STEM) in the context of an international, large‐scale empirical implementation study (ImpleMentAll) aimed at evaluating the effectiveness of a tailored implementation toolkit. The I‐STEM is a sensitising tool that defines key considerations and activities for undertaking stakeholder engagement activities across an implementation process. Methods: In‐depth, semistructured interviews and observations were conducted with implementers who were tailoring implementation strategies to integrate and embed internet‐based cognitive behavioural therapy (iCBT) services in 12 routine mental health care organisations in nine countries in Europe and Australia. The analytical process was informed by principles of first‐ and third‐generation Grounded Theory, including constant comparative method. Results: We conducted 55 interviews and observed 19 implementation‐related activities (e.g., team meetings and technical support calls). The final outcome of our analysis is expressed in an initial version of the I‐STEM, consisting of five interrelated concepts: engagement objectives, stakeholder mapping, engagement approaches, engagement qualities and engagement outcomes. Engagement objectives are goals that implementers plan to achieve by working with stakeholders in the implementation process. Stakeholder mapping involves identifying a range of organisations, groups or people who may be instrumental in achieving the engagement objectives. Engagement approaches define the type of work that is undertaken with stakeholders to achieve the engagement objectives. Engagement qualities define the logistics of the engagement approach. Lastly, every engagement activity may result in a range of engagement outcomes. Conclusion: The I‐STEM represents potential avenues for substantial stakeholder engagement activity across key phases of an implementation process. It provides a conceptual model for the planning, delivery, evaluation and reporting of stakeholder engagement activities. The I‐STEM is nonprescriptive and highlights the importance of a flexible, iterative approach to stakeholder engagement. It is developmental and will require application and validation across a range of implementation activities. Patient or Public Contribution: Patient contribution to ImpleMentAll trial was facilitated by GAMIAN‐Europe at all stages—from grant development to dissemination. GAMIAN‐Europe brings together a wide variety of patient representation organisations (local, regional and national) from almost all European countries. GAMIAN‐Europe was involved in pilot testing the ItFits‐toolkit and provided their views on the various aspects, including stakeholder engagement. Patients were also represented in the external advisory board providing support and advice on the design, conduct and interpretation of the wider project, including the development of the ItFits‐toolkit. Trial registration: ClinicalTrials.gov NCT03652883. Retrospectively registered on 29 August 2018. [ABSTRACT FROM AUTHOR]

Consultants are increasingly a part of public policy formulation, and their policy involvement draws extensive interest in research and public debate. However, there is a gap in how we think about their formulation role: they are often conceptualized as a type of expert, while their actual interaction with and contribution to policy formulation is much more varied. This paper develops a conceptualization of consultants' formulation roles. It demonstrates that rather than just informing policy formulation, consultants take multiple roles and interact with policymaking and makers in multiple ways. Using a policy network/subsystem distinction and a substance/process distinction as the main axes for analysis, the paper develops four role categories: (1) experts and knowledge brokers, in which consultants provide policy advice and analysis; (2) seeing for the government, in which they construct a picture of the policy field; (3) legitimizers and validators, in which they provide symbolic capital to policy; and (4) channels for stakeholders' policy preferences, in which they manage deliberation and synthesize actors' policy preferences. The paper provides much‐needed clarity on how consultants engage with policy formulation and policymakers and forwards our understanding of how consultants exert their policy influence. [ABSTRACT FROM AUTHOR]

Focuses on options for reforming European governance. White Paper of the European Commission.

The concept of ‘civil society’ has been rediscovered in contemporary discourses concerning the relationship between democracy and governance. This paper analyses this rediscovery in the more specific context of the European Commission’s 2001 White Paper on European Governance. However, processes of transnationalisation, governmentalisation and autonomisation may compromise much of the potential of ‘European civil society’ as an intermediating sphere of social action. By reinforcing these processes, the White Paper undermines the normative claims made for a civil society premised upon the voluntary nature of its associative forms and its distinctive open, communicative and deliberative rationality. [ABSTRACT FROM AUTHOR]

Undergraduate clinical orthodontic experience may be expressed in a variety of ways. The most common way (used, inter alia, in the DentEd school visits) is by number of curriculum hours. Other ways include the number of patients seen, or number of procedures carried out. Whilst any of these methods may allow comparison between cohorts of students within a school or between schools, none of them are suitable to determine how much experience is ‘satisfactory’, nor do they indicate what the student should know, understand, or be able to do, to be considered ‘satisfactory’, and hence fit to graduate. This situation may be addressed by the use of competences and/or learning outcomes, and in 2004 the Association for Dental Education in Europe (ADEE) adopted a document that contained one major competence and five supporting competences in orthodontics. This paper considers the shortcomings of conventional methods of recording orthodontic experience in relation to the acquisition of these competences, and some ways in which staff and students may assess competence. [ABSTRACT FROM AUTHOR]

Objective: To present the European Network of (ex-)users and survivors of psychiatry and discuss issues of concern among (ex-)users and survivors. Method: Material from papers and documents published by and discussed among (ex-)users and survivors of psychiatry is used to outline topics of interest. Results: The European Network of (ex-)Users and Survivors of Psychiatry (ENUSP) was founded in 1991 as an association of national/regional organizations of (ex-)users and survivors of psychiatry. The network organizes biennial conferences, all delegates are (ex-)users and survivors of psychiatry. ENUSP aims include the fight against discrimination of people with experience of the psychiatric system, support for (ex-)user/survivor organizations, influence on policy-making, legislation and human rights debates, demedicalizing psychiatry, and opposition to unidimensional approaches to mental and emotional distress. Conclusion: (Ex-)users and survivors should be involved in monitoring psychiatric services, education and examination of mental health professionals. User/survivor-controlled services constitute an important innovative service. [ABSTRACT FROM AUTHOR]

Peripartum cardiomyopathy is an idiopathic cardiomyopathy presenting with heart failure secondary to left ventricular systolic dysfunction towards the end of pregnancy or in the months following delivery, where no other cause for heart failure is identified. Outcome varies from full recovery to residual left ventricular systolic dysfunction and even death. Many women return to their physician to acquire information on their long-term prognosis, to seek medical advice regarding contraception, or when planning a subsequent pregnancy. This position paper summarizes current evidence for long-term outcome, risk stratification of further pregnancies and overall management. Based on the best available evidence, as well as the clinical experience of the European Society of Cardiology Study Group on Peripartum Cardiomyopathy members, a consensus on pre- and postpartum management algorithms for women undergoing a subsequent pregnancy is presented. [ABSTRACT FROM AUTHOR]

Exercise training (ET) and secondary prevention measures in cardiovascular disease aim to stimulate early physical activity and to facilitate recovery and improve health behaviours. ET has also been proposed for heart failure patients with a ventricular assist device (VAD), to help recovery in the patient's functional capacity. However, the existing evidence in support of ET in these patients remains limited. After a review of current knowledge on the causes of the persistence of limitation in exercise capacity in VAD recipients, and concerning the benefit of ET in VAD patients, the Heart Failure Association of the European Society of Cardiology has developed the present document to provide practical advice on implementing ET. This includes appropriate screening to avoid complications and then starting with early mobilisation, ET prescription is individualised to meet the patient's needs. Finally, gaps in our knowledge are discussed. [ABSTRACT FROM AUTHOR]

This review gives an update on recent epidemiologic data on periodontal diseases and a description of current periodontal services in Europe. A Medline search of articles published within the last decade with the keywords epidemiology, prevalence, periodontitis, tooth loss, and Europe was performed. Data on provision of dental services originated from international databases. Epidemiologic data on the prevalence of edentulism, the number of missing teeth, the prevalence of probing depth (Community Periodontal Index – CPI ≥ 3 or Pocket Depth – PD ≥ 4 mm), and clinical attachment loss (CAL ≥ 4 mm) displayed a fragmentary picture within Europe. With respect to the limited data on periodontal health, Spain, Sweden, and Switzerland ranked as the healthiest among European countries in contrast to Germany where increased tooth loss and the highest prevalence of CAL ≥ 4 mm were reported. The role of dental auxiliaries especially of dental hygienists and/or the medico-legal framework in which they work, appears to be an important factor in provision of effective periodontal care. Actual epidemiologic data on periodontal diseases are non-homogeneous and absent from several European countries. This emphasises the need for more national representative epidemiological studies with a uniform design to permit comparability between different nations. Merging actual epidemiologic data with former data on provision of periodontal care may help to explain differences in periodontal parameters on a population basis and to define future provision of dental care. [ABSTRACT FROM AUTHOR]

Background: Parents play a central role in the treatment of childhood stuttering. Addressing parental attitudes toward stuttering is helpful therapeutically. The extent to which differences in attitudes toward stuttering exist on the basis of sex, geographical region and parental status (e.g., parent of a stuttering child, parent of a nonstuttering child, nonparent) is unclear. Many studies investigating such factors have used the Public Opinion Survey of Human Attributes–Stuttering (POSHA–S) questionnaire. A large POSHA–S database has collected responses from over 20 000 people from 49 countries. Aims: The aim of this study was to use the POSHA‐S database to examine the extent to which the following variables influence attitudes toward stuttering: (a) parents' sex (mothers vs. fathers), (b) geographic region (Middle East vs. Europe and North America), (c) parents' children (stuttering vs. nonstuttering) and (d) parental status (parents versus nonparents). Methods & Procedures: Data used in this study were extracted from selected, relevant studies that administered the POSHA–S to respondents. The Overall Stuttering Scores were compared on the basis of sex and parent status (i.e., mothers and fathers; nonparent women and men) and were then compared within and across the two geographical areas. Group comparisons were performed using analysis of variance followed by independent t tests, and Cohen's d was calculated to determine effect sizes. Outcomes & Results: Statistically significant differences were observed upon the basis of geographical region. In general, male parents and nonparents tend to have more positive stuttering attitudes among the Middle Eastern samples while female parents and nonparents tend to show more positive attitudes in European and North American samples in the POSHA–S database. Effect sizes were small for all comparisons. Conclusions & Implications: The effect of geographic region and culture may predict sex‐based differences among mothers' and fathers' attitudes toward stuttering; however, the clinical significance is unclear. Additional research is needed to better understand how children who stutter are affected by their parents' attitudes toward stuttering. What this paper adds: What is already known on this subject: The research clearly indicates that attitudes toward stuttering vary according to geographical region. Less clear is whether mothers and fathers from geographically diverse backgrounds hold different attitudes toward stuttering and the extent to which parental status (being a parent, parent of a child who stutters or nonparent) affects attitudes toward stuttering. What this study adds: This study's findings confirm that geographical differences do influence attitudes toward stuttering. Male parents and nonparents tend to have equal or more positive attitudes toward stuttering in Middle Eastern samples, whereas non‐Middle Eastern female parents and nonparents tend to show hold more positive attitudes. What are the clinical implications of this work?: In addition to being culturally sensitive when working with parents of children who stutter, clinicians should also consider that mothers and fathers may have some differences in attitudes and behaviours toward their child's stuttering. These differences should be considered when designing treatment plans. It should also be noted that, despite statistical significance, the effect sizes in this study were low, suggesting that further research as well as close collaboration with parents of children who stutter is warranted. [ABSTRACT FROM AUTHOR]

Objective: To provide a framework of mental health care reform across Europe. Method: On the basis of summary quantitative indices and expert ratings of broad aspects of mental health care structure, the process and outcome of psychiatric reform common trends and differences are outlined. Results: There has been a broad trend away from an institutional model of care with the mental hospital as the dominant institution, and community- and general hospital-based mental health services of varying comprehensiveness are in place in most countries. The social and broad community aspects of psychiatric reform have generally been somewhat less successful than changes in service set-up. Assessment of reform outcomes proves particularly difficult. Conclusion: Psychiatric reform processes have achieved some of their aims, and there are broadly similar trends. Regional variation is substantial and may be as important as cross-national differences. Mental health care reform is ongoing across the European region. [ABSTRACT FROM AUTHOR]

Objective: To describe mental health care needs and challenges across the WHO European region of 51 nations. Method: Based on morbidity and mortality data from HFA Statistical Database and Health21, the policy framework of WHO Europe, major trends in mental health care needs, psychiatric reform and mental health promotion are discussed. Results: There is a mortality crisis related to mental ill health in Eastern European populations of transition. Destigmatization is required to improve early intervention and humanization of services, and national mental health audits are needed to create the basis for national mental health planning, implementation and monitoring. There are both problems and advances in service restructuring, and comprehensive mental health promotion programmes, preventive and monitoring strategies are required. Conclusion: Partnerships between national and international organizations, especially WHO and the European Union, have to be strengthened to make progress on the way to integrated community mental health services. [ABSTRACT FROM AUTHOR]

Objective: To present the work of the European Federation of Associations of Families of Mentally Ill People (EUFAMI) and discuss issues of concern to family carers. Method: The problem areas identified and discussed by family carers are presented on the basis of questionnaire surveys organized by EUFAMI. Addresses of national organisations of family carers are included. Results: A range of problem areas are identified; they include subsistence and welfare payments for the severely mentally ill, some shortage of general hospital units, problems of care co-ordination, issues of respect for family carers and family involvement. Conclusion: The aim of best practice in mental health care throughout Europe has not yet been reached. Key activities of EUFAMI are aimed at empowerment of families and best practice in psychiatry in Europe. [ABSTRACT FROM AUTHOR]

This paper presents new evidence on the interaction between demographic and occupational change in Europe over the last 25 years. We use data from the European Union Labour Force Survey covering six European countries. The analysis is based on a cross‐sectional comparison between the population and employment distributions in 1995 and 2019. This strategy allows us to study the changing demographic dynamics, which have brought a more feminized, aged, and educated working population, in a context of structural employment change, where higher job polarization or occupational upgrading are the main patterns. The results indicate that the increasing female participation has been associated with a strong general process of occupational upgrading that particularly benefited women. Still, the occupational profile of women is polarized relative to men. Although the process of educational upgrading was also stronger for women and overall they improved their occupational profile more than that of men, we find declining occupational returns to higher education for female workers in two countries. Finally, while European labor markets could accommodate the large increase in older workers, their occupational profile suffered some downgrading. [ABSTRACT FROM AUTHOR]

This paper unites disparate literature to test the influence of religious belonging and behavior characteristics along with secular welfare boundaries on anti‐immigrant attitudes. We suggest that welfare states varied in their religious foundations during the transition from religious‐based solidarity to modern state‐based solidarity and formulate a novel analytical framework to hypothesize effects across individuals and welfare regime types. Using eight waves of the European Social Survey (2002–16), we find that religious effects are strongest in welfare states with the most religious foundations, the Southern European welfare states, and weak in the universalist welfare states, which lacked historical state‐church tensions. Other welfare types show a mix of religious effects, with some challenging expectations. Furthermore, Christian majority membership is often associated with heightened anti‐immigrant attitudes, most consistently in contrast to the non‐Christian minority. For welfare‐based forms of inclusion, we find consistent institutional trust effects and two competing logics for secular boundaries: a propensity for welfare chauvinism and a culture of inclusion. [ABSTRACT FROM AUTHOR]