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Whilst the link between young people's well‐being and the creative arts is strengthening, there is a lack of research which focuses on the roles that artists play to help teachers and parents engage young people in the creative arts. This paper explores the benefits of and barriers to artists working in education in six European countries (England, Iceland, Germany, Greece, Italy and Austria). Using the '5A's model of creativity' and a view of professional development taking place within 'landscapes of practice', the data were analysed in order to explain how creativity is operationalised in the different contexts. Our study highlights the need for policy at a national and transnational level to value the creative arts in order to help teachers cross boundaries and utilise the full potential of the creative arts in schools. Our study also highlights that further research is needed into how artists shape teaching and curriculum and how schools engage parents in the creative arts in order to build an evidence‐base relating to young people's positive mental health that can affect policy at these levels. [ABSTRACT FROM AUTHOR]

Based on research undertaken as part of the EU funded EPPIC project, this paper aims to update and elaborate on the relationship between drug use and offending behaviours by exploring variations within a cross-national sample of drug-experienced young people in touch with criminal justice systems. Adopting a trajectory-based approach, interviews were undertaken with 198 young people aged 15–25 in six European countries (Austria, Denmark, Germany, Italy, Poland, and UK). Data were analysed by applying the Bennett and Holloway categorization of the drugs-crime link, with a focus on the concept of social exclusion as developed by Seddon. Three main types of mechanisms (economic, pharmaceutical, and lifestyles) are used to interpret the data, showing how the relationship between drugs and offending can vary according to type of substances and over time. Furthermore, it can be associated with very different degrees of social exclusion and needs. The results suggest that while economic inequalities still play key roles in explaining drug use and offending, both behaviours can originate from a state of relative deprivation, resulting from the contradictions inherent in 'bulimic societies' that raise aspirations and desires while providing young people scarce opportunities for self-realisation and social recognition. [ABSTRACT FROM AUTHOR]

Purpose: The investigation goal is the analysis of the relation between healthcare expenditures and other resources, and COVID-19 fatality rates among European countries to design effective health policies for crisis management. Design/methodology/approach: Research methodology is based on descriptive statistics and various parametric methods, also including a linear model of regression to analyze basic relationships of variables under study. Findings: Results show that a lower COVID-19 fatality rate is associated with higher levels of health expenditure (% GDP), of healthcare expenditure per capita, health expenditure in preventive care (% GDP), hospitals per million inhabitants, physicians, nurses, hospital beds and curative acute care beds per 1,000 inhabitants. Regression analysis shows that a 1% increase in healthcare expenditures per capita of countries, it reduces the level of COVID-19 fatality rate by 0.74%. In fact, many countries in Eastern Europe with low healthcare expenditures per capita in 2019 (e.g., Bulgaria, Romania, Hungary, Poland, Latvia, Slovakia, Lithuania, etc.), they have experienced high COVID-19 fatality rates. Instead, a lot of countries in Western Europe, with high healthcare expenditures per capita, such as Germany, Denmark, Austria, and the Netherlands, they had resilient health systems to face pandemic crisis and lower COVID-19 fatality rates. Practical implications: These findings suggest strategies of systematic and continuous investments in healthcare, medical technologies, and ICT infrastructures to support effective health policy of crisis management in countries to face future pandemic crisis and other emergencies in society. Originality/value: The explanation of critical role of high health expenditure (% GDP) and healthcare expenditure per capita to support robust health systems that bolster the resilience in nations to face health emergencies and worldwide crises. [ABSTRACT FROM AUTHOR]

Background: Developmental dysplasia of the hip (DDH) is a prevalent orthopaedic disorder in children, and screening methods vary across regions due to local health policies. The purpose of this review is to systematise the different ultrasound screening strategies for detecting DDH in newborns in Europe. Methods: Eligible studies from the PubMed, Embase, and Scopus databases, published between 1 January 2018 and 18 March 2023, were included. The inclusion criteria specified a European origin, a focus on newborn human patients, and information on ultrasound for DDH detection. Results: In total, 45 studies were included, covering 18 countries. Among them, six nations (Austria, Bosnia and Herzegovina, Poland, Slovenia, the Czech Republic, and Germany) perform universal ultrasound screening. The timing of the first ultrasound varies, with Austria and the Czech Republic within the 1st week, Bosnia and Herzegovina on the day of birth, Poland between 1 and 12 weeks, and Germany before the 6th week. The Graf method is the most popular ultrasound technique used. Conclusions: There is no consensus on the optimal DDH detection approach in Europe. Varied screening methods stem from epidemiological, cultural, and economic differences among countries. [ABSTRACT FROM AUTHOR]

Objective: Local wound infections are a major challenge for patients and health professionals. Various diagnostic and therapeutic options are available. However, a generally accepted standard is still lacking in Europe. The aim was to develop an easy-to-use clinical score for the early detection of local wound infections, as a basis for decisionmaking on antiseptic therapy or decolonisation. Method: An interdisciplinary and interprofessional panel of experts from seven European countries was brought together to discuss the various aspects of diagnosing local wound infections. Results: The result was the adoption of the Therapeutic Index for Local Infections (TILI) score, developed in Germany by Initiative Chronische Wunden e.V., specifically for health professionals not specialised in wound care. Available in six European languages, the TILI score could also be adapted for different European countries, depending on their specific national healthcare requirements. The six clinical criteria for local wound infection are erythema to surrounding skin; heat; oedema, induration or swelling; spontaneous pain or pressure pain; stalled wound healing; and increase and/or change in colour or smell of exudate. Meeting all criteria indicates that antiseptic wound therapy could be started. Regardless of these unspecific clinical signs, there are also health conditions for the clinical situation which are a direct indication for antimicrobial wound therapy. These include the presence of wound pathogens, such as meticillin-resistant Staphylococcus aureus, septic surgical wound or the presence of free pus. Conclusion: The development of the new internationally adapted TILI score, which could also be used by any caregiver in daily practice to diagnose local infections in acute and hard-to-heal wounds, is the result of expert consensus. However, the score system has to be validated through a clinical evaluation. This is to be performed in expert centres throughout Europe. Declaration of interest: JD has received research support, lecture fees and travel-cost reimbursements from 4M, Coloplast, Convatec, Draco, Engelhardt, Paul Hartmann, KCI, Lohmann&Rauscher, Mölnlycke, SastoMed and Urgo. RL has received research support, lecture fees and travel-cost reimbursements from Mölnlycke and Urgo. AK has received research support, lecture fees and travel-cost reimbursements from 3M, B. Braun Melsungen, Bode/Paul Hartmann, Ethicon, Lohmann&Rauscher, Mundipharma, Oculus, SastoMed Schülke&Mayr, SERAG-WIESSNER and Urgo. JVS has received research support, lecture fees and travel-cost reimbursements from Mundipharma, Histocell, Quesper and Urgo. This work was supported by an unlimited grant from Urgo Medical. The views expressed are those of the authors and do not necessarily reflect those of Urgo Medical. The company had no direct influence on the content of this paper. [ABSTRACT FROM AUTHOR]

Epidemiological evidence suggests that regular physical activity (PA) positively impacts individuals' mental health (MH). The PA-MH relationship may be critical among immigrants owing to psycho-social-cultural influences. This scoping review of 61 studies employed a holistic bio-psycho-socio-cultural framework to thoroughly investigate the complex relationship between PA (across life domains) and immigrants' MH in Western countries. A systematic search of five electronic databases (Medline, PubMed, Embase, PsycINFO and Anthropology Plus) was conducted to locate relevant articles. No limitations were applied to study design, age, gender, home country, MH condition or PA type. A bio-psycho-socio-cultural-informed conceptual model guided the analysis of the multi-domain PA-MH relationship. Immigrant PA-MH studies were conducted and reported most commonly in the USA (38%), Australia (18%), and Canada (11%). Overall, PA was positively related to MH. Each domain-specific PA appeared to be associated with unique MH-promoting pathways/mechanisms. Leisure-related PA may support MH by enhancing self-agency and minimizing risky behaviors, whilst travel- and domestic-related PA may promote self-accomplishment and physical engagement. Ethnic sports appeared to enhance resilience. Occupational-related PA was associated with either positive or negative MH, depending on the type of occupation. A bio-psycho-socio-cultural-informed model is required to gain an encompassing and integrated understanding of immigrants' health. The first iteration of such a model is presented here, along with an illustration of how the model may be used to deepen analysis and understanding of the multi-domain PA-MH relationship among immigrants and inform public health planners and practitioners. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to review the use of "competence" as a concept and through the use of occupational competence standards in six European countries. Design/methodology/approach: Partners in an Erasmus+ project in each of the six countries prepared a review of the use of "competence" in their countries using a common template. The authors of this paper reviewed additional literature, summarised the individual country reviews and provided an analysis and commentary. Findings: "Competence" is becoming a widely used concept across Europe, but its interpretation and application both vary. Between them, the countries in the study illustrate the use of separate occupational standards, both as a national strategy and developed by self-governing professions; as well as competence embedded directly in qualification and training specifications. The use of separate standards as a mandatory component in national vocational education and training systems is questioned, while the use of appropriate standards for licensing and qualified status is largely endorsed. Research limitations/implications: The country reviews were conducted principally from the perspective of informing the developments taking place in the project, so were not comprehensive and also differed in emphasis between countries. Practical implications: The study points to the need to avoid promoting any particular model of occupational competence at a European level, as opposed to seeking common ground that will aid mutual recognition of qualifications. It also cautions against the uncritical transfer of models and policies from one national system to another. Originality/value: The paper provides additional evidence against "policy borrowing" without careful consideration of context, and contrasts the use of competence standards as part of a system-wide strategy with their tailored application for specific purposes.

Background: The effectiveness of allergen immunotherapy (AIT) in seasonal and perennial allergic rhinitis (AR) depends on the definition of pollen exposure intensity or time period. We recently evaluated pollen and symptom data from Germany to examine the new definitions of the European Academy of Allergy and Clinical Immunology (EAACI) on pollen season and peak pollen period start and end. Now, we aim to confirm the feasibility of these definitions to properly mirror symptom loads for grass and birch pollen-induced allergic rhinitis in other European geographical areas such as Austria, Finland and France, and therefore their suitability for AIT and clinical practice support., Methods: Data from twenty-three pollen monitoring stations from three countries in Europe and for 3 years (2014-2016) were used to investigate the correlation between birch and grass pollen concentrations during the birch and grass pollen season defined via the EAACI criteria, and total nasal symptom and medication scores as reported with the aid of the patient's hay-fever diary (PHD). In addition, we conducted a statistical analysis, together with a graphical investigation, to reveal correlations and dependencies between the studied parameters., Results: The analysis demonstrated that the definitions of pollen season as well as peak pollen period start and end as proposed by the EAACI are correlated to pollen-induced symptom loads reported by PHD users during birch and grass pollen season. A statistically significant correlation (slightly higher for birch) has been found between the Total Nasal Symptom and Medication Score (TNSMS) and the pollen concentration levels. Moreover, the maximum symptom levels occurred mostly within the peak pollen periods (PPP) following the EAACI criteria., Conclusions: Based on our analyses, we confirm the validity of the EAACI definitions on pollen season for both birch and grass and for a variety of geographical locations for the four European countries (including Germany from a previous publication) analyzed so far. On this basis, the use of the EAACI definitions is supported in future clinical trials on AIT as well as in daily routine for optimal patient care. Further evaluation of the EAACI criteria in other European regions is recommended., (© 2019 The Authors. Allergy published by John Wiley & Sons Ltd.)

In our paper, we aim to give an overview about the emergence and evolvement of the history of education in Hungary. Nevertheless, we intend to surpass the traditional approach of giving a schematic description of these processes as we would like to depict the interconnectedness of the Hungarian history of education with the European research tendencies and the thematic variety of the Hungarian research activities. We used literature analysis, historical source analysis and descriptive statistical analysis as primary methods. Within Hungary, we pay special attention to the University of Budapest but we also reflect special peculiarities regarding the other full universities in the country. The Hungarian history of education followed the pathway of the German-speaking countries regarding the approach and the function until 1948. History of education had a self-legitimising role in the emerging national education system and modernised university environment; however, this characteristic feature did not exclude the incorporation of international research approaches. This function was slightly altered in the interwar period since leading researchers of the subfield contributed to maintaining the ideological coherence of the political structure. During the socialist period, researchers were expected to follow the directives of their Soviet colleagues; however, in the 1970s the homogeneity in themes and research approaches began loosening. As the result of the political regime change in 1989/1990, Hungarian research was given an opportunity to be integrated into the European exchange of ideas and implement research approaches prevalent in Western countries.

The current COVID-19 pandemic has come to impact all areas of life involving the health, psycho-social and economic wellbeing of individuals, as well as all stages of life from childhood to old age. Particularly, the frail elderly have had to face the gravest consequences of the disease; while reporting measures tend to differ between countries making direct comparisons difficult, national statistics worldwide point to a disproportionate and staggering share of COVID-19 related mortality coming from residential long-term care facilities (LTCFs). Still, the severity of the impact on the institutionalized elderly has not been uniform across countries. In an effort to better understand the disparities in impact on Europe's elderly living in LTCFs, we review data on mortality outcomes seen during the first wave of the pandemic (months March to June 2020). We then set out to understand the role played by the following two factors: (1) the infection rate in the general population and (2) member state adherence to policy recommendations put forth by the European Centre for Disease Prevention and Control (ECDC) targeting the LTC sector. Regarding the latter, we compare the content of national policy measures in six countries – Austria, Denmark, Germany, Ireland, Spain and Sweden – with those of the ECDC. Our findings establish that infection rates in the general population accounted for most of the variation in mortality among member states, however adherence to EU policy helped to explain the residual variation between cases. This suggests that in order to best protect the institutionalized elderly from infectious disease of this kind, countries need to adopt a two-pronged approach to developing measures: one that aims at reducing transmission within the general population and one that specifically targets LTCFs. [ABSTRACT FROM AUTHOR]

The study examined the relationship between perception of COVID-19, travel risk perception and travel behaviour among travellers in the DACH region (Germany, Austria, Switzerland) – an important tourism market and, after Italy, the second region in Europe that was impacted by COVID-19. Data were collected at two points of time: the sample of the study in Period 1 (n = 1158) was collected at a critical point in time in the beginning of March 2020, when Italy was already massively affected by COVID-19; the sample of the study in Period 2 (n = 212) was collected two weeks later, when Europe has seen immense impacts and COVID-19 was declared a pandemic. Cluster analysis was performed and defined three unique clusters in both periods with distinctive characteristics. In addition, results revealed a significant increase in risk perception of COVID-19, travel risk perception and travel behaviour over a short period of time. [ABSTRACT FROM AUTHOR]

Objective: Cancer imposes a substantial economic burden on society, health and social care systems, patients and their families. This study aims to examine the out‐of‐pocket spending of cancer patients in their last year of life, in six countries with health insurance system hat have a defined benefits package. Methods: Data from SHARE and SHARE End‐of‐Life surveys among people aged +50 were analysed. Family members of deceased persons were interviewed in order to learn about the circumstances of their relative's death. Results: The average out‐of‐pocket spending for health and social services during the last year of life was 4.5% of the total household income, 2.2% in the Netherlands, 4.3% in Israel, 5% in Germany, 5.1% in Austria, 5.1% in Belgium and 8.2% in Switzerland. Whereas the out‐of‐pocket spending on nursing home care was 7.8% of the total household income in Switzerland, in the Netherlands and in Israel it was negligible. In contrast, the out‐of‐pocket spending for home care due to disability surged to 5.6% in Israel and 3.7% in Austria, whereas in other countries it was very low. Conclusion: This information is important to health and social policymakers, in order to better adapt the benefits package to the patients' needs. [ABSTRACT FROM AUTHOR]

Background: The objective of this work was to analyse the prevalence trends of multimorbidity among European community-dwelling adults.Methods: A temporal series study based on waves 1, 2, 4, 5, 6 and 7 of the Survey of Health, Ageing and Retirement in Europe (SHARE) was conducted, and community-dwelling participants aged 50+ (n = 274,614) from 15 European countries were selected for the period 2004-2017. Prevalence, adjusted by age, Average Annual Percentage Change (APC) and 95% confidence interval (95% CI) were all calculated. Trend analyses were realised by period, age groups and groups of diseases.Results: The results showed a large variability in the prevalence of multimorbidity in adults aged 50 and over among European countries. Increase in the prevalence of multimorbidity in the countries of central Europe (Austria, Belgium, Czech Republic, France, Germany and Switzerland) and Spain in both sexes, and in the Netherlands among men. Stability was observed in northern and eastern European countries. Musculoskeletal and neurodegenerative groups showed more significant changes in the trend analyses.Conclusions: This information can be useful for policy makers when planning health promotion and prevention policies addressing modifiable risk factors in health. [ABSTRACT FROM AUTHOR]

In the wake of the recent increase in the inflows of refugees to Europe, governments have made considerable investments in public policies aimed at facilitating the labour market integration of refugees. Despite these efforts, the labour market participation of refugees remains low. This situation raises the question of whether employers actually appreciate these public policies and whether refugees' participation in specific active labour market policies (ALMPs), such as work practice or wage subsidies, increases their likelihood of being hired. In this article, we take a novel approach and combine employers' evaluations of specific ALMPs with their attitudes towards refugees. We argue that these labour market policies can only be successful when employers hold positive attitudes towards refugees in the first place. We investigate this question by means of a factorial survey experiment with employers in Austria, Germany and Sweden. Our results show that, indeed, employers' evaluations of fictional refugee candidates who participated in ALMPs are influenced by their attitudes towards this group. Participation in these policy measures is regarded positively only by those employers who already hold positive attitudes towards refugees. [ABSTRACT FROM AUTHOR]

BACKGROUND: Several studies have been performed on the relationship between working conditions and health. Numerous parameters still require further study, including working hours and obesity among different groups, specifically older workers in national, regional, and international levels. OBJECTIVE: Working hours have considerable effects on the socio-cultural, psychological, and economic aspects of people's lives and health. While long working hours increases income level and raises living standards, it increases the risk of certain health problems. This study investigated whether working hours are associated with obesity in upper-middle-aged workers. METHODS: The Survey of Health, Ageing and Retirement in Europe (SHARE) dataset was used for the analyses. Analyses were carried out by means of a Cox regression of the panel dataset created with the data in question, surveyed by European Commission to 12,000 participants. RESULTS: The survey was performed in Austria, Belgium, Switzerland, Germany, Denmark, Spain, France, Greece, Italy, the Netherlands, Sweden, the Czech Republic, Poland, and Ireland. We found that in most countries, especially Sweden and the Netherlands, upper-middle-aged employees working > 59 hours per week are more likely to gain weight than their counterparts working < 59 hours. CONCLUSIONS: Our findings raise awareness of obesity in older workers, and highlight the need to regulate working conditions and hours in the European Union and other countries. [ABSTRACT FROM AUTHOR]

This paper reports on an investigation examining provision of physical education continuing professional development (CPD) in European countries undertaken to identify the types of practices being employed. We begin by providing a brief overview of what we currently know about CPD internationally in general education and physical education. Data are reported to reflect Parker and Patton's (2017) key characteristics of CPD that highlight effective CPD, summarise current trends and issues in physical education, and are intended to serve as a guide to how teachers learn and how they might be better served in that learning in these European countries. Studying current practices in CPD provision identified in this study provided modest insight to inform teacher education programmes and CPD providers on the current status of physical education CPD currently being employed in Europe. We propose these findings might inform international and comparative education with respect to CPD and set the foundation for physical education colleagues in Europe to develop a CPD network where endeavours such as sharing of CPD practices, engaging in discussion of those practices, and the design of collaborative research on such CPD practices are based.

Objective: To examine and compare the clinical characteristics and treatment of youth with type 2 diabetes (T2D) in two registries: one in Europe and one in the United States. Methods: Youth with onset of T2D at 10 to 18 years of age with current age <20 years and an office visit after diabetes duration >1 year were identified in the European (Prospective Diabetes Follow‐up, DPV) and the United States (Pediatric Diabetes Consortium, PDC) databases. Demographic, physical and clinical characteristics and treatment at diagnosis as well as physical characteristics, treatment, laboratory data, and diabetes adverse events at most recent visit were analyzed from both registries. Results: At diagnosis, the majority were female and obese; 70% of DPV vs 34% of PDC youth were diagnosed by targeted diabetes testing. PDC youth were younger, 12 vs 13 years (P < 0.001), had a greater body mass index‐SDS, 3.07 vs 2.74 (P < 0.001), a higher hemoglobin A1c (HbA1c), 9.9% vs 7.1% (P < 0.001), were more likely to present in DKA, 7.5% vs 1.3% (P < 0.001) and more likely to be treated with insulin, 62% vs 32% (P < 0.001); insulin treatment difference was not significant when adjusted for HbA1c. At follow‐up, DPV youth had shorter diabetes duration, 2.1 vs 3.2 years (P < 0.001), lower HbA1c, 6.5% vs 7.8% (P < 0.001), were less likely to be treated with insulin, 36% vs 56%, (P < 0.001), and were more likely to have dyslipidemia and hypertension than PDC youth. PDC youth had a higher rate of microalbuminuria. Conclusions: Both DPV and PDC youth have multiple risks for diabetes complications. Understanding reasons for persistently higher HbA1c in PDC youth requires further study. [ABSTRACT FROM AUTHOR]

Abstract: Which parties use simple language in their campaign messages, and do simple campaign messages resonate with voters’ information about parties? This study introduces a novel link between the language applied during election campaigns and citizens’ ability to position parties in the ideological space. To this end, how complexity of campaign messages varies across parties as well as how it affects voters’ knowledge about party positions is investigated. Theoretically, it is suggested that populist parties are more likely to simplify their campaign messages to demarcate themselves from mainstream competitors. In turn, voters should perceive and process simpler campaign messages better and, therefore, have more knowledge about the position of parties that communicate simpler campaign messages. The article presents and validates a measure of complexity and uses it to assess the language of manifestos in Austria and Germany in the period 1945–2013. It shows that political parties, in general, use barely comprehensible language to communicate their policy positions. However, differences between parties exist and support is found for the conjecture about populist parties as they employ significantly less complex language in their manifestos. Second, evidence is found that individuals are better able to place parties in the ideological space if parties use less complex campaign messages. The findings lead to greater understanding of mass‐elite linkages during election campaigns and have important consequences for the future analysis of manifesto data. [ABSTRACT FROM AUTHOR]

Objective: The main goal of this study was to determine the knowledge and beliefs of otorhinolaryngologists in a secondary setting in selected economically advanced European countries concerning severe hearing loss, hearing aids, and cochlear implants (CIs). Secondary goals of the study looked into the information sources of the otorhinolaryngologists and into key topics of importance for these professionals. In Europe, many adults, who could benefit from a CI, do not have one despite their availability via national health care systems. This lack of coverage might be due, in part, to the knowledge and beliefs of otorhinolaryngologists.Methods: Otorhinolaryngologists in a secondary setting in Germany, England, France, Austria, and Sweden were emailed a custom-made questionnaire on their knowledge and beliefs regarding hearing loss and its treatments. Results were presented in relative frequencies (%) according to each nation.Results: Two-hundred and forty otorhinolaryngologists responded (50 from each nation except Sweden). Each nation regarded rehabilitation and hearing preservation as particularly important in CIs. National and international conferences and conversations with colleagues were much more popular methods of keeping abreast of medical issues than other information sources such as online media or company information.Conclusion: The otorhinolaryngologists of the surveyed nations share many common beliefs about hearing loss, hearing aids, and CIs, although some national variation in opinion is present. The otorhinolaryngologists of each nation are knowledgeable, but could still benefit from an increased knowledge and awareness of hearing loss treatment modalities. [ABSTRACT FROM AUTHOR]

In the context of the prospective increase in the numbers of older adults in Europe and of conflicting findings regarding recent disability trends, the present study uses cross-sectional data from four waves of the Survey of Health, Ageing and Retirement in Europe (SHARE), covering the period 2004–2013, and aims at the assessment of trends in disability by sex and broad age group (50–64 and 65 and over) for the ten countries participating in all waves, based on four different measures: limitations in activities of daily living (ADLs), limitations in instrumental ADLs, mobility difficulties and the Global Activity Limitation Indicator. The analysis uses logistic regression models adjusted for age and, subsequently, also for chronic conditions. The findings indicate improvements both in mild/moderate activity restrictions and in functional limitations for several countries, especially among men and women aged 65 and over. Regarding severe disability (ADLs) there is mostly a lack of any significant trend and only a few declines. In several instances, the observed trends are linked to changes in chronic conditions; significant improvements net of chronic conditions are found mainly in Sweden but also in the Netherlands, Austria, Germany, Italy and France. Overall, the estimated trends often differentiate by country, age group and sex while they depend upon the specificities of the measures used in the analysis. [ABSTRACT FROM PUBLISHER]

Purpose: The aim of this study was to compare the demographics, injury patterns, and outcomes following major trauma between Alpine skiing, snowboarding, and sledding winter sports. Methods: An international population-based prospective trauma database (TraumaRegister DGU) was analyzed for demographic data, types and severity of injuries [body regions, Injury Severity Score (ISS)], early physiology [Glasgow Coma Scale (GCS), blood pressure, body temperature], rescue modality, surgical care, length of stay, and major complications (shock, multiple organ failure mortality). Participating countries included Germany, Austria, Switzerland, Finland, Slovenia, Belgium, Luxembourg, and The Netherlands. Results: A total of 243 winter sport athletes with major trauma were identified (1993-2012), and subjects were divided into Alpine skiers ( n = 174), snowboarders ( n = 29), and sledders ( n = 40). Athletes were predominantly male and presented hypothermic at emergency room arrival, despite a large proportion of air rescue (77 %). Alpine skiing was associated with higher injury severity (ISS 20.8 ± 14.0, p = 0.010) when compared with snowboarding (ISS 18.7 ± 14.0) and sledding (ISS 13.8 ± 9.5). Snowboarding was associated with the highest pre-hospital intubation rate (40.9 %, p = 0.007), despite comparable GCS values and prevalence of loss of consciousness at scene. The injury patterns were different between the three groups. Skiing was associated with head (47.1 %), chest (40.2 %, p = 0.047), and spinal injuries (40.9 %, p = 0.022). Snowboarding was associated with the highest percentage of upper extremity trauma. Sledders had the highest prevalence of facial and lower extremity trauma. Conclusions: Alpine skiing, snowboarding, and sledding result in different injury patterns and affect various age groups. Our data suggest an increased risk for chest and spinal injuries in Alpine skiers. Due to high-energy injury mechanisms, all three winter sports involve a risk of severe multiple trauma. While all athlete groups required a high rate of emergency surgery procedures, the observed in-hospital mortality from winter sports remains low. [ABSTRACT FROM AUTHOR]

A letter to the editor discussing stereotactic body radiotherapy in different European countries is presented.

This article is based on research on preschool childcare services and analyses the issues of its provision in Russia in comparison to Western and Eastern European countries. A micro-level cross-sectional data analysis of the first waves of the Generations and Gender Survey (GGS) is performed. The results show that variations in using childcare services can be partly explained by the age and number of children in the family, mother’s education and characteristics of her employment. [ABSTRACT FROM AUTHOR]

Background: In accordance the WHO framework of health system functions and by using the indicators collected within the EURO-HEALTHY project, this work aims to contribute to the discussion on the classification of EU health systems.Methods: Three methods were used in this article: factor analysis, cluster analysis and descriptive analysis; data were mainly collected from the WHO and Eurostat databases.Results: The most relevant result is the proposed classification of health systems into the following clusters: Austria-Germany, Central and Northern Countries, Southern Countries, Eastern Countries 'A' and Eastern Countries 'B'.Conclusions: The proposed typology contributes to the discussion about how to classify health systems; the typology of EU health systems allows comparisons of characteristics and health system performance across clusters and policy assessment and policy recommendation within each cluster. [ABSTRACT FROM AUTHOR]

The issue of sustainable management of biosolids (excess sludge) from wastewater treatment is an important issue in the entire developed world. Residual sludge disposal costs and environmental impact may be significant, and reducing such costs, as well as the energy consumption for dewatering and drying, is a key issue for safe and sustainable sludge disposal, considering the recent ban of some disposal options, such as landfilling, in many European countries. An alternative to thermal technologies is solar drying (not to be confused with bio-drying, very close to the concept of composting). Solar greenhouse drying technology is characterized by reduced land requirements compared with traditional outdoor drying beds, as well as by low-energy requirements compared with other thermal drying methods. Process operation is cost-efficient, with close to no maintenance, and observed specific evaporation rates up to threefold higher than conventional drying beds. Many applications of this technology exist in Poland, Germany and Austria: more than 10,000 t of wet sludge per year is treated in this way in Germany alone and almost as many (9000 t/year) in Poland. This paper examines current biosolids treatment technologies applicable to small wastewater treatment plants (2000-9999 population equivalents served) and opportunities for possible solids reuse in Poland in view of sustainable circular economy schemes. In particular, a purely solar-driven greenhouse facility for sewage sludge drying was investigated under different conditions (season, temperature, environmental humidity) and possible improvements for its efficiency evaluated. Sludge processed by solar drying could have different final disposal pathways, according to season, in accordance with the prescriptions of the new National Waste Management Plan of Poland.

With the implementation of European integration policies such as the single market, the Euro and the Schengen Visa, the EU member states are developing closer economic ties through tourism, and their level of tourism integration is constantly improving. Taking the 28 EU member states as research objects, this paper constructs a tourism economic connection network among them, measures the strength of their tourism economic connections from 1995 to 2018 by using the modified gravity model and social network method, and analyzes the spatial structure characteristics and effects of the EU tourism economy. The results are as follows: (1) The tourism economic ties of EU member states are growing increasingly close, enhancing network stability. (2) Germany, France, Italy, Austria and the United Kingdom are the top five countries in the degree centrality and closeness centrality rankings, meaning that they are located in the center of the network and have great influence, and the network is becoming increasingly concentrated. Germany, Italy, Sweden, Austria and France play an important intermediary role in the network, and the centrality of most member states has increased. (3) The core areas are mainly concentrated in Western Europe, Southern Europe, Mediterranean mainland countries and Central Europe, while the marginal areas are mainly concentrated in Eastern Europe, Northern Europe and Mediterranean island countries; the network connection density of the core area, the network connection density of the marginal area, and the network connection density between the core and marginal area overall show an increasing trend. (4) Improvements in the complete network connectedness and a reduction in graph efficiency can significantly reduce differences in EU tourism economic development levels and improve spatial equity.

Introduction: To give an overview of patient-reported outcome measures (PROMs) programs in routine cancer care that allow for both major purposes of PROM assessment: 1) monitoring of an individual patient's outcome to assist treatment decision making, and 2) use in quality improvement initiatives including the benchmarking of providers. We synthesize information on program elements like the mode of assessment and questionnaire used, as well as information relevant for adaptation following a PDCA scheme., Method: We carried out a systematic literature research in the databases PubMed and EMBASE using MeSH terms and keywords related to PROM assessment in routine cancer care to identify eligible studies published between January 2003 and November 2018 (PROSPERO reg. no. CRD42019141402). We included studies in which PROM assessment programs had been reported as being implemented in clinical practice as well as collected multicentrically with at least one site in Europe and in which PROMs had been collected before and at least once after intervention. Study authors were queried to verify or correct the program elements extracted and merged during the review. Study quality assessment was not done, since it is not expedient for the objective of this review., Results: Overall, 5,545 unique references were identified, 5,416 of which were excluded after the screening of titles and abstracts. Of the 29 references assessed, five programs were identified and included in the synthesis. The programs included those from Germany, Austria, Denmark, the Netherlands and the UK, and patients with different cancer types and tumor stages, which used paper-based or purely electronic PROM assessment., Discussion and Conclusion: Few reports have so far been published on PROM programs that allow for both the monitoring of an individual patient's outcome and use in quality improvement initiatives. The studies revealed relevant information on existing PROM programs and gave valuable insight into issues that need to be considered when setting up such an infrastructure. Some critical issues, however, were hardly addressed, among them costs, staff resources and methods of reporting and responding., (Copyright © 2020. Published by Elsevier GmbH.)

Cadmium (Cd) and its forms has recently been a focus of attention due to its toxic effects on human health and the environment. We evaluated the atmospheric deposition of Cd during three consecutive winter seasons (2009-2011) at 10 mountain-top locations in the Czech Republic along the borders with Poland, Germany, Austria and Slovakia. Cadmium concentrations of soluble and insoluble forms in both horizontal (rime) and vertical (snow) deposition were determined using sector-field ICP-MS. Across the sites, 94% of the total winter Cd deposition occurred in the soluble (environmentally available) Cd form. Mean concentrations of soluble Cd in rime were six times higher than in snow (398 vs. 66 ng L -1 ). Vertical deposition contributed as much as 41% to the total winter Cd input. Between-site variability in Cd deposition was large, ranging between 13 and 108 μg m -2 winter -1 . Overall, Cd concentrations in winter deposition did not reach the drinking water limits and did not pose a direct threat for human health. Long-term trends (1996-2017) in winter Cd deposition were evaluated at six GEOMON sites (a monitoring network of small forested catchments). Since 1996, Cd input in winter atmospheric deposition decreased by 73-93%. Simultaneously, we found declines in between-site variability in winter Cd inputs. The highest recent winter Cd inputs were found at sites located in the northeast of the country. A north-south pollution gradient, which has frequently been mentioned in the literature, was not observed, with both northwestern sites and southern sites being among those with the lowest Cd pollution. Backward trajectories of the HYSPLIT model for fresh snow samples identified Poland and Germany as major transboundary Cd pollution sources for the Czech Republic., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

The recently completed Massive Open Online Course for Accessibility Partnership project (MOOCAP), had the twin aims of establishing a strategic partnership around the promotion of Universal Design and Accessibility for ICT professionals and of developing a suite of Open Educational resources (OERs) in this domain. MOOCAP's eight university partners from Germany, Norway, Greece, Ireland, the UK and Austria have a significant history in developing and providing courses in the domains of Universal Design and Accessibility, as well as leading research and advocacy roles within Europe. The MOOCAP project consisted of two phases: the development of an introductory MOOC on Digital Accessibility and the delivery of set of online courses with more in-depth and focused learning topics. During the lifetime of the project over 10,000 students signed up for these courses. This paper reflects on the challenges of creating and delivering MOOCs, especially in topics around Digital Accessibility and Universal Design. It considers the outcomes, impacts and legacies of the project. Based on our experiences of integrating these materials into our courses and on feedback and project evaluations, this paper will assess the potential of MOOCs to promote Universal Design for ICT and other professionals, while pointing up the possible trials and opportunities of such activities.