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Vaccines against human papillomavirus (HPV) are available in Europe since 2006. They have been highly effective in preventing infection and disease caused by the vaccine types. Clinical efficacy data are available for cervical, vulvovaginal and anal precancer and invasive cervical cancer. Disease reduction is best with early vaccination and a coverage of more than 70%. Gender-neutral vaccination provides direct protection for all men and improves the coverage. A good coverage is followed by herd protection of the unvaccinated men and women. School-based programs appear to be most effective; under the age of 15 years, two doses with an interval of 6–12 months are sufficient. From the age of 15 years, the standard regimen with three doses is recommended. A broad catch-up program for young adult women and men improves the effectiveness. The vaccines are also effective in sexually active women and men with previous but cleared infections. Vaccination in addition to local treatment of HPV-related disease appears to reduce recurrent or subsequent HPV-related disease. Combination of HPV vaccination and screening with HPV testing is the most effective approach to prevention of cervical cancer. The screening intervals may increase in the vaccinated cohorts. The upper age limit for vaccination remains to be evaluated, is country specific and depends on cost-effectiveness. The European Society of Gynaecologic Oncology and the European Federation for Colposcopy strongly support gender-neutral vaccination programs for children and young adolescents, with a catch-up program for young adults. • Human papillomavirus (HPV) vaccination is highly effective in preventing cervical disease caused by the vaccine types. • It further reduces the burden of other HPV-related cancers, such as anal, oropharyngeal, vulvar and vaginal cancer. • School-based programs appear to be more cost-effective. • The vaccines have excellent safety profile. [ABSTRACT FROM AUTHOR]

Smoke-Free School Policies (SFSP) are primarily designed to ensure educational spaces remain free of second-hand smoke, whilst contributing to a reduction in adolescent smoking by challenging the practice per se. Evidence regarding the latter goal is inconclusive, however, with most studies suggesting SFSPs are ineffective in reducing smoking prevalence. A dearth of qualitative research limits our understanding of why this inefficacy persists and how it might be addressed. This paper addresses this lacuna through a critical discursive analysis of data from 56 focus groups, generated with adolescents across 17 schools in seven European cities. It reveals that, while smoking is banned on school premises in most European countries, young people experience wide variation in implementation. Despite this, participants framed SFSPs in remarkably similar ways. Among young people most likely to smoke, representations of SFSPs often undermined their efficacy, leading to the displacement of smoking (outside the school grounds) rather than a reduction in prevalence. We argue that, policy effectiveness could be improved if schools worked collaboratively with students to develop positive collective beliefs and understandings about SFSPs, but caution realism about the potentially limited power of schools to reduce adolescent smoking prevalence. [ABSTRACT FROM AUTHOR]

Background: The aim of this paper is to present the development of the Feel4Diabetes Healthy Diet Score and to evaluate its clinical validity. Methods: Study population consisted of 3268 adults (63% women) from high diabetes risk families living in 6 European countries. Participants filled in questionnaires at baseline and after 1 year, reflecting the dietary goals of the Feel4Diabetes intervention. Based on these questions the Healthy Diet Score was constructed, consisting of the following components: breakfast, vegetables, fruit and berries, sugary drinks, whole-grain cereals, nuts and seeds, low-fat dairy products, oils and fats, red meat, sweet snacks, salty snacks, and family meals. Maximum score for each component was set based on its estimated relative importance regarding T2DM risk, higher score indicating better quality of diet. Clinical measurements included height, weight, waist circumference, heart rate, blood pressure, and fasting blood sampling, with analyses of glucose, total cholesterol, HDL-cholesterol, LDL-cholesterol, and triglycerides. Analysis of (co) variance was used to compare the Healthy Diet Score and its components between countries and sexes using baseline data, and to test differences in clinical characteristics between score categories, adjusted for age, sex and country. Pearson's correlations were used to study the association between changes from baseline to year 1 in the Healthy Diet Score and clinical markers. To estimate reproducibility, Pearson's correlations were studied between baseline and 1 year score, within the control group only. Results: The mean total score was 52.8 ± 12.8 among women and 46.6 ± 12.8 among men (p < 0.001). The total score and its components differed between countries. The change in the Healthy Diet Score was significantly correlated with changes in BMI, waist circumference, and total and LDL cholesterol. The Healthy Diet Score as well as its components at baseline were significantly correlated with the values at year 1, in the control group participants. Conclusion: The Feel4Diabetes Healthy Diet Score is a reproducible method to capture the dietary information collected with the Feel4Diabetes questionnaire and measure the level of and changes in the adherence to the dietary goals of the intervention. It gives a simple parameter that associates with clinical risk factors in a meaningful manner. Trial registration: Clinicaltrials.gov NCT02393872. Registered March 20, 2015. [ABSTRACT FROM AUTHOR]

The WHO encourages national diet survey (NDS) implementation to obtain relevant data to inform policies addressing all forms of malnutrition, which remains a pressing issue throughout Europe. This paper provides an up-to-date review on energy, macro- and selected micronutrient intakes in children across WHO Europe using the latest available NDS intakes. It assesses these against WHO recommended nutrient intakes (RNI) to highlight vulnerable groups and areas of concern. Dietary survey information was gathered by Internet searches, contacting survey authors and nutrition experts. Survey characteristics, energy and nutrient intakes were extracted and weighted means calculated and presented by region. Child energy and nutrient intakes were extracted from twenty-one NDS across a third (n 18) of the fifty-three WHO Europe countries. Of these, 38 % (n 6) reported intakes by socio-economic group, but by various indicators. Energy and macronutrients, where boys and older children had higher intakes, were more widely reported than micronutrients. Most countries met under half of the WHO RNI for nutrients reported in their NDS. Micronutrient attainment was higher than macronutrients, but worst in girls and older children. Only a third, mainly Western, WHO European member states provided published data on child nutrient intakes. Gaps in provision mean that dietary inadequacies may go unidentified, preventing evidence-based policy formation. WHO RNI attainment was poor, particularly in girls and older children. Inconsistent age groups, dietary methodologies, nutrient composition databases and under-reporting hinder inter-country comparisons. Future efforts should encourage countries to conduct NDS in a standardised format by age and sociodemographic variables. [ABSTRACT FROM AUTHOR]

Purpose: Interprofessional continuing education (IPCE) health care educators must plan activities as members of interprofessional teams and deliver activities to an interprofessional audience. Evidence in the literature suggests they are not well prepared to meet this challenge. This paper reviews one strategy to improve the knowledge, skills, attitudes, and practices of IPCE educators. Methods: Seven faculty development workshops were conducted within the USA, Europe, Asia, and the Middle East. Approximately 250 learners participated in the workshops in total, with 107 in an IRB-approved research study. Results: From the research cohorts demonstrated improved knowledge and skills over a 12-month period. Knowledge and skills scores increased most significantly from baseline to 3 months and remained above baseline at 6-12 months. The workshop was not an effective strategy to improve attitudes towards IPCE, though attitude scores were already high prior to participating. Conclusions: All participants actively engaged in the workshops. There were no observed differences in engagement by geographic region, gender, age, or profession. Participants stated they were better able to understand the roles of other team members; perspectives of patients, families, and caregivers; and their own roles on clinical teams. Participants described gaining a new appreciation for the complexity of designing IPCE. [ABSTRACT FROM AUTHOR]

Background: In 2015, new disability weights (DWs) for infectious diseases were constructed based on data from four European countries. In this paper, we evaluated if country, age, sex, disease experience status, income and educational levels have an impact on these DWs. Methods: We analyzed paired comparison responses of the European DW study by participants' characteristics with separate probit regression models. To evaluate the effect of participants' characteristics, we performed correlation analyses between countries and within country by respondent characteristics and constructed seven probit regression models, including a null model and six models containing participants' characteristics. We compared these seven models using Akaike Information Criterion (AIC). Results: According to AIC, the probit model including country as covariate was the best model. We found a lower correlation of the probit coefficients between countries and income levels (range rs: 0.97-0.99, P < 0.01) than between age groups (range rs: 0.98-0.99, P < 0.01), educational level (range rs: 0.98-0.99, P < 0.01), sex (rs = 0.99, P < 0.01) and disease status (rs = 0.99, P < 0.01). Within country the lowest correlations of the probit coefficients were between low and high income level (range rs = 0.89-0.94, P < 0.01). Conclusions: We observed variations in health valuation across countries and within country between income levels. These observations should be further explored in a systematic way, also in non-European countries. We recommend future researches studying the effect of other characteristics of respondents on health assessment. [ABSTRACT FROM AUTHOR]

Background: In a context of population ageing, it is a priority for planning and prevention to understand the socioeconomic (SE) patterning of functional limitations and its consequences on healthcare needs. This paper aims at measuring the gender and SE inequalities in functional limitations and their age of onset among the Southern European elderly; then, we evaluate how functional status is linked to formal and informal care use. Methods: We used Portuguese, Italian and Spanish data from the Survey of Health, Ageing and Retirement in Europe (SHARE) of 2011 (n = 9233). We constructed a summary functional limitation score as the sum of two variables: i) Activities of Daily Living (ADL) and ii) Instrumental Activities of Daily Living (IADL). We modelled the functional limitation as a function of age, gender, education, subjective poverty, employment and marital status using multinomial logit models. We then estimated how functional limitation affected informal and formal care demand using negative binomial and logistic models. Results: Women were 2.3 percentage points (pp) more likely to experience severe functional limitation than men, and overcame a 10% probability threshold of suffering from severe limitation around 5 years earlier. Subjective poverty was associated with a 3.1 pp. higher probability of severe functional limitation. Having a university degree reduced the probability of severe functional limitation by 3.5 pp. as compared to none educational level. Discrepancies were wider for the oldest old: women aged 65-79 years old were 3.3 pp. more likely to suffer severe limitations, the excess risk increasing to 15.5 pp. among those older than 80. Similarly, educational inequalities in functional limitation were wider at older ages. Being severely limited was related with a 32.1 pp. higher probability of receiving any informal care, as compared to those moderately limited. Finally, those severely limited had on average 3.2 hospitalization days and 4.6 doctor consultations more, per year, than those without limitations. Conclusion: Functional limitations are unequally distributed, hitting women and the worse-off earlier and more severely, with consequences on care needs. Considering the burden on healthcare systems and families, public health policies should seek to reduce current inequalities in functional limitations. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to examine differences in the experience of somatic symptoms by domain (exhaustion, musculoskeletal, gastrointestinal, heart distress) between psychologically abused and non-abused older persons, and to scrutinize associations between abuse and somatic symptoms while considering other factors (e.g. social support). Design/methodology/approach – The design was cross-sectional. The participants were 4,467 women/men aged 60-84 years living in seven European cities. The data were analysed using bivariate/multivariate methods. Findings – Psychologically abused participants scored higher on all somatic symptom domains than non-abused, and thus were more affected by the symptoms. The regressions confirmed a positive association between psychological abuse and most somatic symptom domains, but other factors (e.g. depression, anxiety) were more salient. Demographics/socio-economics were positively (e.g. marriage/cohabitation) or negatively (e.g. education) associated with somatic symptoms depending on the domain. Social support and family structure “protected” the experience of somatic symptoms. Research limitations/implications – The research focused on psychological abuse. It did not incorporate other abuse types calling for further research on the effects of other abuse types on somatic symptoms. Nevertheless, the findings indicate that psychological abuse is linked to somatic symptoms, but the role of other factors (e.g. depression, anxiety, social support) is also important. Practical implications – Improvements in the older person's situation regarding somatic symptoms need to consider psychological abuse, co-morbidities, social support and living conditions. Originality/value – The paper reports data from the ABUEL Survey, which collected population-based data on elder abuse. [ABSTRACT FROM AUTHOR]

Background and Aims: Although much has been written about the conventional cardiovascular risk factor correlates of the extent of coronary artery calcification (CAC), few studies have been carried out on symptomatic patients. This paper assesses the potential ability of risk factors to associate with an increasing CAC score.Methods: From the European Calcific Coronary Artery Disease (Euro-CCAD) cohort, we retrospectively investigated 6309 symptomatic patients, 62% male, from Denmark, France, Germany, Italy, Spain and the USA. All had conventional cardiovascular risk factor assessment and CT scanning for CAC scoring.Results: Among all patients, male sex (OR = 4.85, p<0.001) and diabetes (OR = 2.36, p<0.001) were the most important risk factors of CAC extent, with age, hypertension, dyslipidemia and smoking also showing a relationship. Among patients with CAC, age, diabetes, hypertension and dyslipidemia were associated with an increasing CAC score in males and females, with diabetes being the strongest dichotomous risk factor (p<0.001 for both). These results were echoed in quantile regression, where diabetes was consistently the most important correlate with CAC extent in every quantile in both males and females. To a lesser extent, hypertension and dyslipidemia were also associated in the high CAC quantiles and the low CAC quantiles respectively.Conclusion: In addition to age and male sex in the total population, diabetes is the most important correlate of CAC extent in both sexes. [ABSTRACT FROM AUTHOR]

Background: Research has shown that individual socio-economic circumstances throughout life affect health in older ages. However, little attention has been paid to the broad economic context affecting individual's life-chances. This paper examines whether economic downturns experienced during young and mid-adulthood have long-run effects on physical health. Methods: We exploit data on economic fluctuations in the period 1945-2010 in 11 European countries, linked to longitudinal data from three waves of the Survey of Health, Ageing and Retirement in Europe. We estimate a country fixed effect model assessing whether downturns experienced at 5-year intervals between ages 25 and 54 are associated with levels and onset of new limitations with Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) in older age (55-80). Results: Experiencing an economic downturn at ages 45-59 is associated with increased risk of having at least one disability limitation in later-life (odds ratio [OR] for ADL = 1.66, 95% CI [Confidence Interval] 1.24, 2.22; OR for IADL = 1.46, 95% CI 1.10, 1.94). Economic downturns at ages 40-44 and 45-49 also increase the risk of a new functional limitation in later-life (OR for IADL ages 40-44 = 1.20, 95% CI 1.03, 1.40; OR for IADL ages 45-49 = 1.44, CI 1.10-1.88). Economic downturns experienced around these ages are also associated with significantly greater risks of smoking and excessive alcohol consumption as well as lower incomes in older age. Conclusions: Exposure to an economic downturn at ages 40-49 is associated with poorer health in older ages, possibly by increasing risk of unhealthy behaviours and low incomes persisting into older age. [ABSTRACT FROM AUTHOR]

Background: Previous population-based studies revealed major variation in survival for patients with colorectal cancer (CRC) in Europe by age and between different countries and regions, but also a sustained improvement in survival for patients with CRC in recent years. This EUROCARE-5 paper aims to update available knowledge from previous studies and to provide the latest survival estimates for CRC patients from Europe. Methods: The study analysed data of patients diagnosed with CRC from population-based cancer registries diagnosed in 29 European countries. Estimates of 1-year and 5-year relative survival (RS) were derived for patients diagnosed in 2000-2007 by European region, country and age at diagnosis. Additionally to these cohort estimates, time trends in 5-year RS were obtained for the calendar periods 1999-2001 and 2005-2007, using the period analysis methodology. Results: European average 5-year RS for patients diagnosed with colon and rectum cancer was 57% and 56%, respectively. The analyses showed persistent differences in cancer survival across Europe with lowest survival for CRC patients observed in Eastern Europe. The analyses further showed a strong gradient in age-specific survival. Even though the study revealed sustained improvement in patient survival between 1999-2001 and 2005-2007 (absolute increase of 4 and 6 percentage points for colon and rectum, respectively), the differences in the survival for CRC patients observed at the beginning of the millennium persisted over time. Conclusion: Although survival for CRC patients in Europe improved markedly in the study period, significant geographic variations and a strong age gradient still persisted. Enhanced access to effective diagnostic procedures and treatment options might be the keys to reducing the existing disparities in the survival of CRC patients across Europe. [ABSTRACT FROM AUTHOR]

The aim of the present systematic review is to investigate the role of both classroom and school ethnic diversity, a structural aspect of interethnic relationships, in relation to bullying and victimization. Several moderators of this association have been analyzed: country or area of data collection, how ethnicity is operationalized and computed, and participants' school level. A systematic literature search on Scopus, Web of Science and Eric databases was conducted in January 2021; 4496 articles were identified and a final set of 20 papers have been selected. Almost half of the analyses did not find any significant association between bullying perpetration and ethnic diversity, while the other half found a positive one; few studies found a positive association between ethnic diversity and victimization. Operationalization of ethnicity and area of data collection play a role for both bullying perpetration and victimization. In North America, focusing on race, ethnic diversity has shown a protective role for victimization; in Europe, where the focus is on immigrant backgrounds, diversity may constitute a risk factor. About victimization, ethnic diversity represents a risk factor at younger ages and turns into a more protective factor in secondary schools. Results are discussed in terms of practical implications across development. • Ethnic diversity (ED) may affect rates of bullying and victimization. • In North America, focused on race, ED may be a protective factor for victimization. • In Europe, focused on immigrant background, ED may be a risk factor for bullying. • Developmental trends emerged, suggesting early interventions to promote inclusion. • Ethnic diversity at the school level is a protective factor for victimization. [ABSTRACT FROM AUTHOR]

Faced with demographic ageing, European policy makers since the mid-1990s have taken a turn from fostering early retirement to promoting longer working life by reducing early exit incentives and facilitating work continuation. However, it remains open whether these reforms are yet reflected in the retirement plans and preferences of future pensioners’ cohorts. Using most recent data on desired retirement ages from the fifth wave of the European Social Survey (2010/11 wave), this paper empirically investigates how far current policy reforms are in line with the retirement age preferences of older workers aged 45 and over. Results show that older workers approaching retirement ages still intend to retire before the politically envisioned age of 65, and in many cases also before nationally defined standard retirement ages. Despite visible progress in implementing active ageing measures, the challenge of motivating older workers to continue working until or even beyond retirement ages thus remains. At the same time, there are regime-specific problem groups that face difficulties in adjusting to the active ageing paradigm of longer working life. Especially in countries with little employment support, those with unstable work careers, employment interruptions and few financial resources are at a high risk of being crowded out from late career employment and thus from the possibility of ensuring a decent standard of living in old age. [ABSTRACT FROM PUBLISHER]

A large number of studies have reported on the validity of autism spectrum disorder (ASD) screening procedures. An overall understanding of these studies' findings cannot be based solely on the level of internal validity of each, since screening instruments might perform differently according to certain factors in different settings. Europe has led the field with the development of the first screening tool and first prospective screening study of autism. This paper seeks to provide an overview of ASD screening studies and ongoing programmes across Europe, and identify variables that have influenced the outcomes of such studies. Results show that, to date, over 70,000 children have been screened in Europe using 18 different screening procedures. Differences among findings across studies have enabled us to identify ten factors that may influence screening results. Although it is impossible to draw firm conclusions as to which screening procedure is most effective, this analysis might facilitate the choice of a screening method that best fits a specific scenario, and this, in turn, may eventually improve early ASD detection procedures. [ABSTRACT FROM AUTHOR]

Self-rated health (SRH) is arguably the most widely used generic health measurement in survey research. However, SRH remains a black box for researchers. In our paper, we want to gain a better understanding of SRH by identifying its determinants, quantifying the contribution of different health domains to explain SRH, and by exploring the moderating role of gender, age groups, and the country of residence. Using data from 61,365 participants of the fifth wave (2013) of the Survey of Health, Ageing and Retirement in Europe (SHARE) living in fifteen European countries, we explain SRH via linear regression models. The independent variables are grouped into five health domains: functioning, diseases, pain, mental health, and behavior. Via dominance analysis, we focus on their individual contribution to explaining SRH and compare these contributions across gender, three age groups, and fifteen European countries. Our model explains SRH rather well (R2 =.51 for females/.48 for males) with functioning contributing most to the appraisal (.20/.18). Diseases were the second most relevant health dimension (.14/.16) followed by pain (.08/.07) and mental health (.07/.06). Health behavior (.02/.01) was less relevant for health ratings. This ranking held true for almost all countries with only little variance overall. A comparison of age groups indicated that the contribution of diseases and behavior to SRH decreased over the life-course while the contribution of functioning to R2 increased. Our paper demonstrates that SRH is largely based on diverse health information with functioning and diseases being most important. However, there is still room for idiosyncrasies or even bias. • Self-rated health (SRH) is explained via five dimensions of health information. • Amount of explained variance by dimension is compared by gender, age group, and country. • Functioning and diseases were the most important dimensions. • Only minor differences in importance were found by gender and country. • Importance of diseases/behavior decreased with age, increased for functioning. [ABSTRACT FROM AUTHOR]

The demographic changes that have occurred in European countries in recent decades have made the policies of the public pension system one of the most debated issues of the welfare state. In this paper, I focus on preferences for three pension policy reforms with different distributive consequences: raising contributions, raising the age of retirement, and allowing free choice between public and private pension plans. I use multilevel models to analyse how individual attachment to different solidarity principles (universalistic, conservative, liberal and familistic) affects attitudes toward pension system reforms while controlling for institutional factors. The empirical results strongly support the hypothesis that solidarity principles have a significant influence on individual preferences. I find that individuals who adhere to universalistic or conservative principles are more in favour of increasing contributions in order to maintain the level of pensions, whereas they oppose a postponement of retirement age. In contrast, those who adhere to liberal or familistic principles are against increasing contributions and prefer extending retirement age. The findings at least partially support the ‘regime hypothesis’, as a more generous pension system appears to increase support for raising contributions while decreasing support for a raise in the age of retirement. [ABSTRACT FROM PUBLISHER]

In this paper, we propose new methods for investigating the extent of heterogeneity in effective contact rates relevant to the transmission of infections. These methods exploit the correlations between ages at infection for different infections within individuals. The methods are developed for serological surveys, which provide accessible individual data on several infections, and are applied to a wide range of infections. We find that childhood infections are often highly correlated within individuals in early childhood, with the correlations persisting into adulthood only for infections sharing a transmission route. We discuss 2 applications of the methods: 1) to making inferences about routes of transmission when these are unknown or uncertain and 2) to estimating epidemiologic parameters such as the basic reproduction number and the critical immunization threshold. Two examples of such applications are presented: elucidating the transmission route of polyomaviruses BK and JC and estimating the basic reproduction number and critical immunization coverage of varicella-zoster infection in Belgium, Italy, Poland, and England and Wales. We speculate that childhood correlations stem from confounding of different transmission routes and represent heterogeneity in childhood circumstances, notably nursery-school attendance. In contrast, it is suggested that correlations in adulthood are route-specific. [ABSTRACT FROM PUBLISHER]

Annual suicide rates of Hungary were unexpectedly high in the previous century. In our narrative review, we try to depict, with presentation of the raw data, the main descriptive epidemiological features of the Hungarian suicide scene of the past decades. Accordingly, we present the annual suicide rates of the period mentioned and also data on how they varied by gender, age, urban vs. rural living, seasons, marital status, etc. Furthermore, the overview of trends of other factors that may have influenced suicidal behavior (e.g., alcohol and tobacco consumption, antidepressant prescription, unemployment rate) in the past decades is appended as well. Based on raw data and also on results of the relevant papers of Hungarian suicidology we tried to explain the observable trends of the Hungarian suicide rate. Eventually, we discuss the results, the possibilities, and the future tasks of suicide prevention in Hungary. [ABSTRACT FROM AUTHOR]

There are several measures that summarize the mortality experience of a population. Of these measures, life expectancies are generally preferred based on their simpler interpretation and direct age standardization, which makes them directly comparable between different populations. However, traditional life expectancy estimations are highly inaccurate for smaller populations and consequently are seldom used in small-area applications. In this paper, the authors compare the relative performance of traditional life expectancy estimation with a Bayesian random-effects approach that uses correlations (i.e., borrows strength) between different age groups, geographic areas, and sexes to improve the small-area life expectancy estimations. In the presented Monte Carlo simulations, the Bayesian random-effects approach outperforms the traditional approach in terms of bias, root mean square error, and coverage of the 95% confidence intervals. Moreover, the Bayesian random-effects approach is found to be usable for populations as small as 2,000 person-years at risk, which is considerably smaller than the minimum of 5,000 person-years at risk recommended for the traditional approach. As such, the proposed Bayesian random-effects approach is well-suited for estimation of life expectancies in small areas. [ABSTRACT FROM AUTHOR]

Working-age households where no-one is in work have become an increasing focus of policy concern even before the economic crisis, and the European Union (EU) has included household joblessness in its new poverty reduction target for 2020. This paper focuses on the variation across EU countries in the prevalence of household joblessness and its impact on income poverty and deprivation, and on the implications for the new EU poverty reduction target. It highlights first that there are some divergences across key data sources in the extent of joblessness. The prevalence of household joblessness varies substantially across EU countries, but there is little evidence of a consistent pattern among groupings of countries often categorized together in terms of welfare regime or geographically. In aggregate there is little association between the overall extent of household joblessness in a country and the percentage in relative income poverty or above a material deprivation threshold. At a micro level, being in a jobless household has a substantial impact on the likelihood of being in relative income poverty or deprived, but the scale of these impacts is shown to be very much greater in some countries than in others, and to vary between single-adult and multiple-adult households. In most EU countries little more than half the working-age adults in jobless households are either income-poor or deprived, so including joblessness in the poverty reduction target does make a difference, without a clearly articulated rationale. [ABSTRACT FROM PUBLISHER]

This paper has contributed to confirming the link between education and health in developed countries. The analysis is based on 11 European Union countries. We estimate country-specific health functions, where the dependent variable is self-reported health status and the education attainment is one of the main inputs. All eight waves (1994–2001) of the European Community Household Panel are deployed. A random effects ordered probit is estimated in order to control, to a given extent, for unobserved heterogeneity. Explanatory variables are both time invariant (education attainment and gender) and time varying (gross wages, hours of work, age and living alone). Results confirm the positive impact of secondary education on health in most cases and tertiary education in all cases, even after controlling for other inputs in the health function and taking unobserved heterogeneity into account. Secondary education has an impact on health in all countries in the sample except for The Netherlands and UK. The effect does not differ between secondary and tertiary education in France, Ireland and Greece. The correlation between education and health is interpreted in different but complementary ways by diverse approaches and we may not disentangle the precise mechanism that connects health with education from our results. Anyway, it seems clear that better coordination is needed between education and health policies to effectively improve health literacy. Other relevant results from our study are that women register poorer health than men, age contributes to worsening health status and wages contribute positively to health. [ABSTRACT FROM AUTHOR]

Background: We aimed to determine the status of and factors associated with adolescent health care delivery and training in Europe on behalf of the European Paediatric Association-UNEPSA.Materials and Methods: A questionnaire was mailed to the presidents of 48 national paediatric societies in Europe. For statistical analyses, non-parametric tests were used as appropriate.Results: Six of the countries had a paediatric (PSPCA), 14 had a combined and nine had a general practitioner/family doctor system for the primary care of adolescents (GP/FDSA). Paediatricians served children 17 years of age or older in 15 and 17, up to 16 years of age in three and six, and up to 14 years of age in six and six countries in outpatient and inpatient settings, respectively. Fifteen and 18 of the countries had some kind of special inpatient wards and outpatient clinics for adolescents, respectively. Twenty-eight of the countries had some kind of national/governmental screening or/and preventive health programmes for adolescents. In countries with a PSPCA, the gross national income (GNI) per capita was significantly lower than in those with a GP/FDSA, and the mean upper age limit of adolescents was significantly higher than in those with the other systems. In the eastern part of Europe, the mortality rate of 10-14 year olds was significantly higher than that in the western part (p=0.008). Training in adolescent medicine was offered in pre-graduate education in 14 countries in the paediatric curriculum and in the context of paediatric residency and GP/family physician residency programmes in 18 and nine countries, respectively. Adolescent medicine was reported as a recognised subspecialty in 15 countries and as a certified subspecialty of paediatrics in one country. In countries with a PSPCA, paediatric residents were more likely to be educated in adolescent medicine than paediatric residents in countries with a GP/FDSA.Conclusion: The results of the present study show that there is a need for the reconstruction and standardisation of adolescent health care delivery and training in European countries. The European Paediatric Association-UNEPSA could play a key role in the implementation of the proposals suggested in this paper. [ABSTRACT FROM AUTHOR]

Background: Mortality decreased in European Union (EU) countries during the last century. Despite these similar trends, there are still considerable differences in the levels of mortality between Eastern and Western European countries. Sub-group analysis of mortality in Europe for different age and sex groups is common, however to our knowledge a spatio-temporal methodology as in this study has not been applied to detect significant spatial dependence and interaction with time. Thus, the objective of this paper is to quantify the dynamics of mortality in Europe and detect significant clusters of mortality between European countries, applying spatio-temporal methodology. In addition, the joint evolution between the mortality of European countries and their neighbours over time was studied. Methods: The spatio-temporal methodology used in this study takes into account two factors: time and the geographical location of countries and, consequently, the neighbourhood relationships between them. This methodology was applied to 26 European countries for the period 1990-2012. Results: Principally, for people older than 64 years two significant clusters were obtained: one of high mortality formed by Eastern European countries and the other of low mortality composed of Western countries. In contrast, for ages below or equal to 64 years only the significant cluster of high mortality formed by Eastern European countries was observed. In addition, the joint evolution between the 26 European countries and their neighbours during the period 1990-2012 was confirmed. For this reason, it can be said that mortality in EU not only depends on differences in the health systems, which are a subject to national discretion, but also on supra-national developments. Conclusions: This paper proposes statistical tools which provide a clear framework for the successful implementation of development public policies to help the UE meet the challenge of rethinking its social model (Social Security and health care) and make it sustainable in the medium term. [ABSTRACT FROM AUTHOR]

• Prevalence of self-medication was around 25 % among older Europeans. • Women presenting greater odds of self-medication. • Not using medication prescribed presented a higher chance to self-medicate. • Longstanding illness is associated with higher risk of self-medication. Self-medication, despite some benefits, carries many risks, especially when practiced by older adults who are polymedicated. Information addressing the prevalence and associated factors of self-medication in older age in a European context is scarce and sometimes contradictory. This paper aims to estimate the prevalence of self-medication among older adults across Europe and to identify its predictive factors. Cross-sectional study. Micro-data from the European Health Interview Survey (2006–2009) was used. The sample comprised 31,672 community-dwelling individuals aged 65 and over living in private households in 14 European countries. The analyses explored the use, over the last two weeks, of any medicines, supplements, or vitamins that were not prescribed by a doctor. The mean self-medication prevalence was 26.3 %, being the highest in Poland (49.4 %) and the lowest in Spain (7.8 %). Greater odds of self-medication were found for women and for participants who were younger, divorced, or presented a higher educational degree. The presence of long-standing illness and physical pain or not using prescribed medication also significantly increased the possibility of self-medication. A wide variation in the odds of self-medication between countries was also observed (up to 8 times more for Poland, compared to Spain). Self-medication is a prevalent problem among older Europeans, and even though some think it is risk-free, dangers tend to be greater with advancing age. This study will help identify the groups most likely to have this behavior so that we can focus on targeted educative and preventive initiatives. [ABSTRACT FROM AUTHOR]

With global improvements in life expectancy, one important concern is to understand whether there is reduction in inequalities or greater cross-country convergence in expected length of life at various age thresholds. Insights on convergence patterns can help governments and other stakeholders decide upon health investments across age groups. This paper applies a novel econometric approach to test convergence and identify convergent clubs in life expectancy at various age groups for 201 countries/areas between 1950 and 2015. Life expectancy estimates for 201 countries/areas (1950 and 2015) from United Nations Department of Economic and Social Affairs (UNDESA) World Population Prospects (2015 Revision) are used for the analysis. We find global convergence in life expectancy at birth, but do not observe grand convergence for any other age groups. In the case of life expectancy at younger ages, most countries are moving in the same direction, but significant cross-country variations and convergence clubs are noted for older adults and elderly. Most of the better performing countries/areas are from Western Europe, Northern Europe and North America, the average performers are from South America, Eastern Europe, Southern Europe, South Asia, Central Asia, Eastern Africa, Central Africa, and the Caribbean Islands whereas the poor-performing ones are mainly Western Africa, Southern African and Oceania. In addition, we observe increasing between-country variance in life expectancy for older adults and elderly. The analysis reveals increasing global heterogeneity in the survival experience of older adults and the elderly population which has remained a neglected aspect in the discussions on global life expectancy improvements. Data, research and policy focus on life-expectancy at older ages is therefore critical to accelerate survival gains among older adults and elderly, particularly from the developing world. • Country explains 34% of the variability in life expectancy improvement. • At older ages, there are three life expectancy trajectories a country can be in. • Studying variability is a better metric for capturing life expectancy inequities. [ABSTRACT FROM AUTHOR]

The article presents the authors' reply to a letter from D. Meyre regarding their systematic review and meta-analysis on the associations of variants of proprotein convertase subtilisine/kexin type I gene (PCSKI) with obesity. The reply addresses Meyre's criticisms of what he perceives as errors in the paper including an assertion that meta-analysis included 2 overlapping cohorts and suggestion that the analysis was underpowered to find significant association of rs632 with body mass index.

Background: Sedentary behaviour has been associated with obesity and related chronic diseases. Disentangling the nature of this association is complicated due to interactions with other lifestyle factors, such as dietary habits, yet limited research has investigated the relation between domain-specific sedentary behaviours and dietary habits in adults. The aim of this paper was to examine the association between domain-specific sedentary behaviours and dietary habits in adults and to test the moderating effect of age and gender on this association.Methods: A total of 6,037 participants from five urban regions in Europe completed an online survey, of which 6,001 were included in the analyses. Multilevel mixed-effects logistic regression analyses were used to examine main associations and interaction effects.Results: All domain-specific sedentary behaviours, except transport-related sitting time, were significantly related to dietary habits. In general, having a higher sitting time was related to having less healthy dietary habits, especially for television viewing. Gender did not moderate any of the relations, and age was only a significant moderator in the relation between other leisure sitting time and alcohol consumption.Conclusion: Domain-specific sitting behaviours were related to unhealthy dietary behaviours. However, the small effect sizes suggest that individual level behavioural interventions focusing on sedentary behaviour will not be sufficient to improve dietary habits. The fact that almost none of the associations were moderated by age or gender suggests that these associations, and possibly also the effects of interventions targeting both behaviours, may hold across age and gender groups. [ABSTRACT FROM AUTHOR]