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Engagement with stakeholders is an essential part of the research process. This is particularly the case for early autism research with infant cohorts and their families, where a range of ethical issues are pertinent. Here, we report on a large survey of parents who have a child on the autism spectrum (n = 1040) which specifically probed attitudes to early autism research. The large majority of parents showed positive attitudes overall, and these were associated with greater access to services, higher service quality ratings and higher rates of intellectual disability among their children. Parents valued the scientific goals of research, but half of parents also reported that an intervention component would be an essential prerequisite for them to participate in research. If enrolled in a study, parents were positive about most commonly used measures though less favourably disposed towards brain scans for children. They valued direct contact with the research team and openness in data sharing. We interpret our findings in terms of lessons for the early autism research community and for stakeholder engagement projects. [Members of the COST ESSEA Working Groups contributed to the writing of this paper.]

Background:The European Disability Strategy (2010–2020) seeks to significantly raise the proportion of people with disabilities working in the open labour market. The ERGO WORK project is a collaboration of academic and industrial partners in six European countries, focused on understanding and tackling barriers to workplace inclusion for workers with disabilities. Methods:This study sought to explore the perceptions and needs of stakeholders in terms of workplace adaptation to the needs of employees with disabilities. An exploratory online survey was completed by 480 participants across six countries. Results:The analysis suggests that workplaces could be further improved to meet the needs of employees with considerable scope for training within companies to raise awareness about employees’ needs, employers’ obligations and workplace adaptation. Conclusions:This snapshot suggests there is still a gap between intent and reality in workplace inclusion and further strategies are needed to improve the opportunities for employees with disabilities. The paper argues that ergonomics may have a key role to play in tackling these challenges and adapting the workplace environment and job design to suit the needs of individual employees.Implications for rehabilitationThis study suggests there is considerable scope for workplace adaptation and improvements to meet the needs of employees with disabilities.Employers need and want further specialist practitioner guidance to facilitate workplace inclusion and support adaptation to individual needs.Organisations would benefit from training to raise awareness about potential solutions and approaches that would support more widespread employment of people with disabilities. [ABSTRACT FROM PUBLISHER]

This paper focusses on coping strategies employed by children and adolescents with diagnosed short stature, assesses the impact of socio-demographic and clinical characteristics on coping, examines the relationship between coping and health related quality of life (QoL) and investigates the role of coping strategies in mediating the relationship between height and QoL. Coping with a disease (CODI) and quality of life in short stature youth (QoLISSY-QoL) questionnaires were completed by 137 short-statured children and adolescents between 8 and 18 years, participating in the crosssectional European QoLISSY study. Clinical and socio-demographic data were collected to examine differences in coping via variance and regression analyses, associations between CODI and QoLISSY were inspected using correlation and mediation analyses. Most frequently employed coping strategies in the CODI were 'Acceptance' and 'Wishful Thinking', with 'Emotional Reaction' used least. Significant effects of age, diagnosis and treatment status on coping strategies were detected. CODI scales 'Acceptance' and 'Distance' were associated with higher QoLISSY-QoL scores, 'Emotional Reaction' and 'Wishful Thinking' with lower scores. Coping strategies predicted 60 % of the QoLISSY-QoL variance. Relationships between height deviation and QoLISSY-QoL were mediated by the coping strategies of 'Wishful Thinking' and 'Distance'. Findings suggest that coping efforts vary with socio-demographic and clinical characteristics, that protective coping strategies in terms of QoL can be identified and that coping mediates the relationship between short stature and QoL. Future longitudinal research should focus on the adaptive function of coping in relation to QoL over time. [ABSTRACT FROM AUTHOR]

Background: People experiencing homelessness (PEH) are known to be at higher risk of adverse health outcomes and premature mortality when compared to the housed population and often face significant barriers when attempting to access health services. This study aimed to better understand the specific health care needs of PEH and the barriers and facilitators associated with their timely and equitable access to health services in the European context. Methods: We conducted an exploratory cross-national qualitative study involving people with lived experience of homelessness and health and social care professionals in Austria, Greece, Spain, and the UK. A total of 69 semi-structured interviews comprising 15 social care professionals, 19 health care professionals, and 35 PEH were completed, transcribed, and analysed thematically. Results: Findings were organised into three overarching themes relating to the research question: (a) Health care needs of PEH, (b) Barriers to health care access, and (c) Facilitators to health care access. Overall, the general health of PEH was depicted as extremely poor, and mainstream health services were portrayed as ill-equipped to respond to the needs of this population. Adopting tailored approaches to care, especially involving trusted professionals in the delivery of care, was identified as a key strategy for overcoming existing barriers. Conclusions: The results of this study indicate there to be a high degree of consistency in the health care needs of PEH and the barriers and facilitators associated with their access to health care across the various European settings. Homelessness in itself is recognized to represent an essential social determinant of health, with PEH at risk of unequal access to health services. Changes are thus required to facilitate PEH's access to mainstream primary care. This can also be further complemented by investment in 'in-reach' services and other tailored and person-centred forms of health care. Trial registration: This study was registered retrospectively on June 6, 2022, in the registry of ClinicalTrials.gov under the number NCT05406687. [ABSTRACT FROM AUTHOR]

Body awareness is tightly linked to motor action. Non-verbal greetings constitute a behaviour through which an awareness of both socio-cultural habits (exteroceptive awareness) and internal bodily states (interoceptive awareness) play out to influence the structure of action. To establish the effect of culture on non-verbal greeting behaviours, naturalistic observations were carried out in two countries (Britain and Spain) that are purported to exhibit differences in greeting types. Interoceptive awareness (IA) was subsequently measured in a proportion of observed participants (N = 33) who filled in the Multidimensional Assessment of Interoceptive Awareness, Version 2 (MAIA-2). As expected, a significant difference in greeting type was observed between British (N = 252) and Spanish (N = 244) greeters. Scores of greeting intimacy and competency did not differ significantly between Britain and Spain. However, independent of culture, several moderate and strong relationships emerged between selective dimensions of the MAIA-2 and scores of intimacy and competency. Specifically, intimacy and competency scores were positively correlated with the 'Awareness of Mind-Body Integration' dimension. Greeting intimacy yielded additional positive relationships with the Not Distracting and Trusting subscales, and a negative relationship with the Not Worrying subscale. These relationships suggest that IA facilitates healthy social approach behaviour as expressed through greetings, irrespective of cultural greeting differences. We discuss IA and greeting behaviour in the context of attachment, consider the clinical implications for social anxiety and the future implications for social interactions in a post-COVID-19 era. [ABSTRACT FROM AUTHOR]

Background: Adolescents who participate as peer leaders can benefit and acquire competencies from their peer leadership experience. Objectives: To identify the competencies gained by adolescents who participated as peer leaders in a healthy lifestyle study and to determine whether the training characteristics were related to improvement in competencies. Design: The present study was part of the European Youth Tackling Obesity (EYTO) project, a multicentre social marketing intervention involving four European countries. Setting and Participants: Eighteen peer leaders (aged 13–15 years, three or five leaders per country) from disadvantaged neighbourhoods received training in designing and implementing activities for their peers. Measures: The peer leaders' confidence, experience and interest in 11 tasks related to lifelong learning competencies were assessed with questions rated on a colour scale at baseline and at the end of the study. Results: The peer leaders demonstrated improvements in experience, confidence and interest in different tasks, such as research, website or logo design, oral presentations, social media use and collaboration with people from other countries. They increased their confidence in management tasks (p = 0.03) and their confidence and experience in communication tasks (p = 0.01). The peer leaders from Spain and Portugal had greater improvements than those from the other countries. Conclusion: The peer leaders improved their confidence in management tasks and their confidence and experience in communication tasks. Slight differences were detected in improvement in competencies by country, likely due to the differences in the peer training applied. Recommendations for peer leader training are proposed, although these results should be verified with larger sample size. Patient or Public Contribution: The peer leaders contributed to the design and implementation of the training and intervention. [ABSTRACT FROM AUTHOR]

Summary: We estimated and characterized the imminent fracture risk (1–2 years) of high-risk fracture patients through a multinational (UK, Spain, Denmark) cohort study. Older individuals with newly diagnosed osteoporosis and individuals who had a fracture while on treatment with a bisphosphonate were at a high risk of imminent fracture. Purpose: To characterize and estimate 1- to 2-year fracture risk in high-risk fracture patients. Methods: Multi-cohort study in (database/study period) UK (CPRD/1995–2017), Spain (SIDIAP/2006–2016) and Denmark (DHR/1995–2016) including individuals ≥ 50 years old in NDO (newly diagnosed osteoporosis), OFx (incident osteoporotic fracture), BP (incident oral bisphosphonates use) or FWOT (fracture while on treatment with bisphosphonates). Outcomes (ICD-10/READ): hip, clinical spine, non-hip, non-spine and hip/humerus/distal forearm fracture. Follow-up: from cohort entry until death, migration/transfer or end of the study. Statistics: baseline characteristics and incidence rate (IR per 1000 persons). Results (1-year IR): NDO included 69,899 (UK), 37,901 (Spain) and 158,191 (Denmark) individuals. Spanish-IR was lowest for hip (4.7), clinical spine (2.5) and major osteoporotic fracture (MOF) (17.3) and highest in Denmark (74.2, 26.0 and 120.1, respectively). OFx included 83,514 (UK), 51,044 (Spain) and 509,551 (Denmark) individuals. IR in Denmark was highest for hip (24.1) and MOF (47.2), in Spain was highest for the clinical spine (9.4) and lowest for hip (9.5) and in the UK was lowest for the clinical spine (2.8) and MOF (20.7). BP included 148,507 (UK), 52,037 (Spain) and 204,010 (Denmark) individuals. Spanish-IR was lowest for hip (5.0) and MOF (21.1) and highest in Denmark (20.3 and 48.6, respectively). FWOT included 28,930 (UK), 1,865 (Spain) and 31,882 (Denmark) individuals. Clinical spine-IR was highest for Spain (12.0). Hip-IR was lowest for Spain (7.6) and highest for Denmark (33.6). Comparing young subjects, those who have FWOT started with an increased fracture rate. Conclusion: OFx and FWOT individuals experience higher re-fracture incidence rates than those with osteoporosis with or without treatment. [ABSTRACT FROM AUTHOR]

Introduction: Chemsex in a European context is the use of any of the following drugs to facilitate sex: crystal methamphetamine, mephedrone and gamma‐hydroxybutyrate (GHB)/gamma‐butyrolactone (GBL) and, to a lesser extent, cocaine and ketamine. This study describes the prevalence of self‐reported recreational drug use and chemsex in HIV‐positive men who have sex with men (MSM) accessing HIV services in four countries. It also examines the problematic impacts and harms of chemsex and access to chemsex‐related services. Methods: This is a cross‐sectional multi‐centre questionnaire study of HIV‐positive MSM accessing nine HIV services in the UK, Spain, Greece and Italy. Results: In all, 1589 HIV‐positive MSM attending HIV services in four countries completed the questionnaire. The median age of participants was 38 years (interquartile range: 32–46 years) and 1525 (96.0%) were taking antiretroviral therapy (ART). In the previous 12 months, 709 (44.6%) had used recreational drugs, 382 (24.0%) reported chemsex and 104 (6.5%) reported injection of chemsex‐associated drugs ('slamsex'). Of the 382 engaging in chemsex, 155 (40.6%) reported unwanted side effects as a result of chemsex and 81 (21.2%) as a result of withdrawal from chemsex. The reported negative impacts from chemsex were on work (25.1%, 96), friends/family (24.3%, 93) and relationships (28.3%, 108). Fifty‐seven (14.9%) accessed chemsex‐related services in the past year, 38 of whom (67%) felt the service met their needs. Discussion: A quarter of participants self‐reported chemsex in the past 12 months. There were high rates of harms from chemsex across all countries, including negative impacts on work, friends/family and relationships. Although a minority of those engaging in chemsex accessed support, most found this useful. [ABSTRACT FROM AUTHOR]

Background In responding to Covid-19, governments have tried to balance protecting health while minimizing gross domestic product (GDP) losses. We compare health-related net benefit (HRNB) and GDP losses associated with government responses of the UK, Ireland, Germany, Spain and Sweden from UK healthcare payer perspective. Methods We compared observed cases, hospitalizations and deaths under 'mitigation' to modelled events under 'no mitigation' to 20 July 2020. We thus calculated healthcare costs, quality adjusted life years (QALYs), and HRNB at £20,000/QALY saved by each country. On per population (i.e. per capita) basis, we compared HRNB with forecast reductions in 2020 GDP growth (overall or compared with Sweden as minimal mitigation country) and qualitatively and quantitatively described government responses. Results The UK saved 3.17 (0.32–3.65) million QALYs, £33 (8–38) billion healthcare costs and £1416 (220–1637) HRNB per capita at £20,000/QALY. Per capita, this is comparable to £1455 GDP loss using Sweden as comparator and offsets 46.1 (7.1–53.2)% of total £3075 GDP loss. Germany, Spain, and Sweden had greater HRNB per capita. These also offset a greater percentage of total GDP losses per capita. Ireland fared worst on both measures. Countries with more mask wearing, testing, and population susceptibility had better outcomes. Highest stringency responses did not appear to have best outcomes. Conclusions Our exploratory analysis indicates the benefit of government Covid-19 responses may outweigh their economic costs. The extent that HRNB offset economic losses appears to relate to population characteristics, testing levels, and mask wearing, rather than response stringency. [ABSTRACT FROM AUTHOR]

Aims and objectives: The aim of the study was to compare advanced practice in epilepsy nurses in Spain and United Kingdom, identifying differences in the domains of standard advanced practice. Background: Europe has recently faced the challenge of providing high‐quality care for patients with epilepsy, a disease that generates many health demands. In some countries, such as the United Kingdom, advanced practice nursing is well established and could serve as a guide for implantation in countries where it is still in development, as is the case of Spain. Design: A multicentre cross‐sectional descriptive cohort study compared differences in the roles of advanced practice nurses in Spain and the United Kingdom. Methods: The Advanced Practice Role Delineation Tool and its validated Spanish version were administered using an online questionnaire in a cohort of advanced practice epilepsy nurses in both countries. A convenience sample was recruited between January to December 2019. The study complied with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. Results: Most United Kingdom nurses in our sample came from community environments, in contrast to Spanish nurses who worked in hospital. All domains analysed in the survey had significantly higher scores in the United Kingdom than in the Spanish cohort, especially in the research and leadership domains. Conclusions: The advanced practice role in Spain is underdeveloped compared with the United Kingdom. Differences in the settings of advanced roles in epilepsy nurses may be explained by greater community practice in the United Kingdom and differences in organisational and health systems. Relevance to clinical practice: Our study showed the need to implement specific policies to develop advance practice nurse roles in Spain to improve the quality of care of patients with epilepsy. [ABSTRACT FROM AUTHOR]

The dominant approaches to public health policy on childhood obesity are based on the neoliberal emphasis of personal choice and individual responsibility. We study adolescents' (N = 81) beliefs about responsibility for childhood obesity as a public health issue, through an innovative participatory method, PlayDecide, organised in two countries: the UK and Spain. There is no evidence of a blanket rejection of individual responsibility, rather, a call for renegotiation of the values that inform adolescents' food choices. The findings suggest the need to broaden the framing of obesity-related policy to go beyond the nutritional paradigm and include other values that signal health. [ABSTRACT FROM AUTHOR]

Background: Obesity is increasing worldwide and weight-control strategies, including the consumption of plant food supplements (PFS), are proliferating. This article identifies the herbal ingredients in PFS consumed for weight control and by overweight/obese dieters in six European countries, and explores the relationship between their consumption and their self-reported BMI. Methods: Data used were a subset from the PlantLIBRA PFS Consumer Survey 2011-2012, a retrospective survey of 2359 PFS consumers. The survey used a bespoke frequency-of-PFS-usage questionnaire. Analyses were performed in two consumer subsamples of 1) respondents taking the products for "body weight reasons", and 2) "dieters for overweight/obesity", to identify the herbal ingredients consumed for these reasons. The relationship between the 5 most consumed herbal ingredients and self-reported BMI in groups 1 and 2 is explored by comparing BMI proportions of consumers vs. non-consumers (using Chi-squared test). Results: 252 PFS (8.8 %) were consumed for "body weight reasons" (by 240 PFS consumers); 112 PFS consumers (4.8 %) were "dieting for overweight/obesity". Spain is the country where consuming herbal ingredients for body weight control and dieting were most popular. Artichoke was the most consumed herbal ingredient. Considering only the 5 top products consumed by those who responded "body weight", when using the total survey sample, a greater proportion of BMI ≥ 25 was observed among consumers of PFS containing artichoke and green tea as compared to non-consumers (58.4 % vs. 49.1 % and 63.2 % vs. 49.7 % respectively). Considering only the 5 top products consumed by "dieters" and using only the "dieters" sample, a lower proportion of BMI ≥ 25 was observed among pineapple-containing PFS consumers (38.5 % vs. 81.5 %); however, when using the entire survey sample, a greater proportion of BMI ≥ 25 was observed among artichoke-containing PFS consumers (58.4 % vs. 49.1 %). Conclusions: A comparison of results among the scarce publications evaluating the use of weight-loss supplements at the population level is limited. Nevertheless every hint is important in finding out which are the self-treatment strategies used by overweight/obese individuals in European countries. Although limited by a small sample size, our study represents a first attempt at analysing such data in six EU countries. Our findings should encourage the conduction of further studies on this topic, long-term and large sample-sized studies, ideally conducted in the general population. [ABSTRACT FROM AUTHOR]

Background: The Seven Countries Study in the 1960s showed very low mortality from coronary heart disease (CHD) in Japan, which was attributed to very low levels of total cholesterol. Studies of migrant Japanese to the USA in the 1970s documented increase in CHD rates, thus CHD mortality in Japan was expected to increase as their lifestyle became Westernized, yet CHD mortality has continued to decline since 1970. This study describes trends in CHD mortality and its risk factors since 1980 in Japan, contrasting those in other selected developed countries.Methods: We selected Australia, Canada, France, Japan, Spain, Sweden, the UK and the USA. CHD mortality between 1980 and 2007 was obtained from WHO Statistical Information System. National data on traditional risk factors during the same period were obtained from literature and national surveys.Results: Age-adjusted CHD mortality continuously declined between 1980 and 2007 in all these countries. The decline was accompanied by a constant fall in total cholesterol except Japan where total cholesterol continuously rose. In the birth cohort of individuals currently aged 50-69 years, levels of total cholesterol have been higher in Japan than in the USA, yet CHD mortality in Japan remained the lowest: >67% lower in men and > 75% lower in women compared with the USA. The direction and magnitude of changes in other risk factors were generally similar between Japan and the other countries.Conclusions: Decline in CHD mortality despite a continuous rise in total cholesterol is unique. The observation may suggest some protective factors unique to Japanese. [ABSTRACT FROM AUTHOR]