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The dramatic growth in health expenditures is an important health policy concern worldwide. Therefore, understanding the factors that increase health expenditures provides policy makers with evidence for decision-making. We aim to examine long-term effects of carbon dioxide emission, urbanization rate and GDP per capita on health expenditures. This study investigates the effect of carbon dioxide emission, urban population, and GDP per capita on health expenditure for 21 OECD countries over the period 1992–2018. Panel ARDL Approach and Gengenbach, Urbain and Westerlund Panel Co-integration Test have been used in the article. Test results indicate the long-run relationship among health expenditure and carbon dioxide emission, urban population, and GDP per capita. Effect of carbon dioxide emission (CO2), urban population, and GDP per capita is significant and positive on health expenditure. Rapid economic growths of OECD countries recently and environmental pollution have increased health expenditures in the long term. [ABSTRACT FROM AUTHOR]

Objective: Research has just begun to identify American college students who study abroad as a group at-risk for sexual violence victimization. The purpose of the current study was to examine the context of these incidents. Participants: We utilized a large longitudinal sample of 2,428 United States college students studying abroad for between 4 and 21 weeks in 12 different foreign countries. Methods: We estimated descriptive statistics and logistic regression models to assess prevalence and correlates of sexual victimization abroad, as well as effect size comparisons to quantify changes in drinking abroad. Results: Over one-fifth of students experienced sexual violence while abroad, including sexual assault and verbal coercion. Women, younger students, those who experienced sexual violence prior, and heavier drinkers had the greatest odds of sexual violence victimization abroad. Conclusions: Findings point to the need for evidence-based programming to reduce sexual violence risk among American college students studying in foreign countries. [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]

The World Health Organization recommends that "palliative care should be integrated as a routine element of all Undergraduate Medical Education." However, the provision of training for medical undergraduates is variable; only 18% of 51 European countries have mandatory training in palliative medicine. EDUPALL is an ERASMUS+ funded international collaborative project to develop and pilot an undergraduate program for training in palliative medicine. The objective of this study was to critically review and revise current European Association for Palliative Care (EAPC) Recommendations for the Development of Undergraduate Curricula in Palliative Medicine and translating these into an updated curriculum document. Clinicians, academics, and researchers from Romania, Ireland, Germany, Austria, Spain, and the United Kingdom reviewed the EAPC recommendations using a variant of consensus methodology, Nominal Group Technique. From the updated document, four working-groups translated each recommendation into a specific learning objective, and developed associated learning outcomes, stratified by domain: attitude, cognition, and skills. The outcomes and objectives were organized into discrete teaching units and transferred into a curriculum template, identifying notional hours, teaching, and assessment strategies. To ensure quality control, the draft template was circulated to experts from 17 European countries, together with a brief survey instrument, for peer review purposes. All 17 reviewers returned overwhelmingly positive comments. There was large agreement that: the teaching units were logically organized; learning outcomes covered core training needs; learning objectives provided guidance for teaching sessions; learning modalities were appropriately aligned; and assessment strategies were fit for purpose. An updated and standardized curriculum was developed, which provides a platform for the sequential development of the next phases of the EDUPALL project. [ABSTRACT FROM AUTHOR]

Purpose: To report the vitamin D status in adults from seven European countries and to identify behavioural correlates.Methods: In total, 1075 eligible adult men and women from Ireland, Netherlands, Spain, Greece, UK, Poland and Germany, were included in the study.Results: Vitamin D deficiency and insufficiency, defined as 25-hydroxy vitamin D3 (25-OHD3) concentration of <30 and 30-49.9 nmol/L, respectively, were observed in 3.3 and 30.6% of the participants. The highest prevalence of vitamin D deficiency was found in the UK and the lowest in the Netherlands (8.2 vs. 1.1%, P < 0.05). In addition, the prevalence of vitamin D insufficiency was higher in females compared with males (36.6 vs. 22.6%, P < 0.001), in winter compared with summer months (39.3 vs. 25.0%, P < 0.05) and in younger compared with older participants (36.0 vs. 24.4%, P < 0.05). Positive dose-response associations were also observed between 25-OHD3 concentrations and dietary vitamin D intake from foods and supplements, as well as with physical activity (PA) levels. Vitamin D intakes of ≥5 μg/day from foods and ≥5 μg/day from supplements, as well as engagement in ≥30 min/day of moderate- and vigorous-intensity PA were associated with higher odds (P < 0.05) for maintaining sufficient (≥50 nmol/L) 25-OHD3 concentrations.Conclusions: The prevalence of vitamin D deficiency varied considerably among European adults. Dietary intakes of ≥10 μg/day of vitamin D from foods and/or supplements and at least 30 min/day of moderate- and vigorous-intensity PA were the minimum thresholds associated with vitamin D sufficiency. [ABSTRACT FROM AUTHOR]

Background: ‘Paediatric bipolar disorder’ (PBD) is a controversial diagnosis where often prepubertal children as well as adolescents, who may have a range of psychiatric disorders or symptoms, are diagnosed with a severe mental illness requiring lifelong medication. Clinically, it has often been applied in the United States but rarely in most other countries. A meta‐analysis (Van Meter et al., Journal of Clinical Psychiatry, , 72, 1250) claimed that the prevalence of PBD was similar to adults at 1.8% with no difference between the United States and other countries. This conclusion has been highly cited. Methods: The heterogeneous nature of the original 12 epidemiological surveys warrants a qualitative analysis, rather than statistical meta‐analysis as performed by Van Meter et al. (Journal of Clinical Psychiatry, 2011, 72, 1250). Thus, the meta‐analysis and each of the 12 studies (six from the United States; six from other countries) were reexamined. Results: Most of the 12 surveys predated the emergence of the PBD hypothesis. The 12 surveys were mainly of adolescents and at times young adults with few prepubertal children. Prevalence rates in the 12 studies suggest a lower rate of bipolar disorder, especially in non‐US samples. For example, the Van Meter et al. (Journal of Clinical Psychiatry, 2011, 72, 1250) meta‐analysis chose a rate of 2.8% by summation of adolescent and parent responses in a Dutch survey, however the rate fell to 0% if requiring concordance of adolescent and parent responses. Indeed, it could be argued that four of the non‐US studies show 0% rates of PBD. Conclusions: Rates of PBD were generally substantially lower than 1.8%, particularly in non‐US surveys, and if both parent and adolescent reports were required to meet the diagnostic threshold they fell to close to zero. The reanalysis suggests that bipolar disorder is rare before the expected age of onset in later adolescence. [ABSTRACT FROM AUTHOR]