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This paper presents an explorative holistic analysis of digitally-constructed gamification processes in mathematics education. The main aim of this study is to identify the key issues, intentions and trends by examining peer-reviewed publications using a combination of social network analysis (SNA), computerized lexical analysis and content analysis. Research findings indicate that there is a growing trend in gamification in mathematics education (GIME) research. GIME is mostly employed in primary school level. It was also found that, numbers is the most gamified math topic. Another research finding reveals that the researchers mostly use gamification to improve mathematical problem-solving, math achievement and math performance apart from the motivation and engagement. According to SNA findings, the most strategic terms in GIME research are as follows; geometry, fractions, mobile-learning, gender-studies, human-computer interaction, intelligent tutoring systems and tangible user-interfaces. GIME research is mostly influenced by USA and Brazil hence, the developing countries have an increasing interest in GIME research. Finally, findings on general research discourse implies that the general discourse among the sampled papers is positive. The findings obtained in this study may be useful to improve mathematics education by mapping a research agenda for researchers and educators with the exploration of potentials of GIME research.

This paper provides an account of the topological and its description of contemporary culture and use as a research methodology, a topological lens, generally, and in education research specifically. Some commentary is proffered on the relationships between the topological and the topographical, between relations and locations. A critical account is then provided on each of the papers in the special issue on the topological in education research and the specific contributions of each. The editors of the special issue make the important point that the topological is a spatio-temporal phenomenon, not just a spatial one. The topological does not exist in time and space, but rather constructs both and they change in a conjoint manner. As such, a topological lens rejects a construction of space as static and of time (and the temporal) as simply linear and chronological. The topological has been facilitated and articulated by and through practices of commensuration, datafication and digitalisation, flows and scapes, global connectivities and new relations, mobilities of various kinds and multiple networks. The paper argues that much greater emphasis has been given to the spatial in topological research; that is, there has been some neglect of the temporal in the spatio-temporal character of topologies.

This study aims to examine the effects of flipped learning on L2 students' overall academic achievements through meta-analysis. Forty studies (e.g., journal articles, M.A/Ph.D. theses and conference papers) on 'flipped classroom', 'flipped learning' and 'academic achievement' were included in this meta-analysis study. The data was analyzed by using Comprehensive Meta-Analysis Software. The random effects model was used in analyzing the overall effect size and the heterogeneity of the studies included in this meta-analysis. The results revealed that flipped learning has statistically significant effect on L2 learners' academic achievements (g=1.303) compared to traditional learning approaches. This result does not differ according to publication type, educational level and four basic language skills and sub-skills, but it differs according to sample size of the selected studies.

The aim of this study was to compare bibliometric indicators of scientific productivity in physical activity (PA) in children and adolescents with Autism spectrum disorder (ASD) and Down syndrome (DS) in the PubMed database. A bibliometric study was conducted for the last 5 years (2017 to 2021). The data collected for each article were: year of publication, language of publication, country, journal name, and type of paper. The results showed that there was higher scientific productivity in the population with DS (20 studies) relative to their counterparts with ASD (31 studies). The language of publication in both cases was English. There were 10 countries that published on PA in ASD and 14 countries that published on DS. Overall, the greatest interest in publishing on PA in children and adolescents with ASD was in North America (6 studies), followed by Asia (5 studies) and Europe (4 studies). In the DS population it was in Europe (13 studies), North America (9 studies) and South America (4 studies). Nineteen journals were identified that published in the ASD population and 29 journals in DS. Six experimental studies were identified in ASD and 7 in DS. There was a higher scientific productivity with original studies. There was a positive trend of increasing scientific productivity over the years in both populations. We suggest the need to promote research on PA in both populations, regardless of the type of study, as it is an indicator of overall health status.

In times of globalisation of higher education, alternative theoretical and methodological approaches were introduced in the field of comparative higher education research. To stimulate the debate on this issue, this paper firstly addresses them theoretically by combining the concept of institutional isomorphism and the 'glonacal' analytical heuristic. On this basis, it discusses arguments in favour of convergence and diversity from the perspective of the internationalisation of higher education and also points to the limits of institutional isomorphism resulting from 'glonacal' influences of agencies and agency on the development of (internationalisation of) higher education. Secondly, the paper also draws attention to the influence of globalisation on the selection of methodology in comparative higher education research by exposing the limits of methodological nationalism. Along these lines, it portrays the reversed pyramid model of different horizontal and vertical levels of comparisons with which it establishes the (missing) link between the selected theoretical and methodological framework of comparative (higher education) research. In conclusion, it acknowledges the need to integrate the contextual element into the comparative framework which allows thorough analysis of complex relationships between globalisation and higher education both theoretically and methodologically.

The importance of inclusive education receives global acceptance. The current paper presents a bibliometric analysis of 8398 papers dealing with inclusive education between 1980 and 2019. The research aim is to gain information on scientific productivity, international collaboration activities, and the conceptual structure of this research field. Descriptive analyses, co-authorship collaboration analysis and co-word analysis were conducted to obtain a comprehensive knowledge map of inclusive education research. The results show a fast growing body of research in inclusive education over the years with intensive international collaboration patterns. Six research clusters could be identified. Major and intensively studied research themes are disability issues, teacher professionalisation, teacher practices, attitudes towards inclusive education, social processes, support, curricular issues, student perspective, parent perspective, intercultural education, policy, etc. Research addressing inclusive education from a queer perspective, bullying, stigmatisation, digital education and emerging technologies in inclusive settings are under-represented and should be intensified in future studies.

The study discussed in this paper is a systematic literature review related to the role of dual language programme (DLP) in mathematics education which has been published within the last 5 years. This study was conducted to identify the distribution of DLP studies in terms of year of publication, the study context covered in previous studies, the context of study areas used, focus and trends of past studies, research methods used in previous studies and the role of language in school mathematics education. This review study followed the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) to analyze articles from Scopus and Web of Science. The findings of the study indicate that research trends in the implementation of the DLP on mathematics education for secondary school students showed an increase from 2017 to 2019. Most DLP-related articles are widely developed in the United States and Germany. The findings indicate that previous studies are more interested in studying the implementation of DLP in rural areas. Past studies have also preferred to use the design of either a qualitative study or a quantitative study to be implemented. Questionnaires, tests and interviews are among the research instruments that are often used for a study.

In 2015, the European Educational Research Association (EERA) initiated a study to examine education researchers' experiences with and attitudes towards research ethics reviews. This paper is not a result of this study; nevertheless, it is related to it while critically reflecting upon the issue of research ethics reviews. It starts with an analysis of observations and comments provided by the interviewees in their questionnaire replies. In them, some key dilemmas can be identified, which have been discussed in various academic circles in recent decades. The main part of the paper is intended to review these discussions and to determine their relevance for the debate in the specific field of education research. In the conclusion, attention is drawn to a gradual shift from the sphere of legitimacy to the sphere of legality, resulting from the current attempts of regulating research ethics, while pointing to a potential conflict between the two key research principles, which are also key academic values: ethical conduct in research and academic freedom.

This paper addresses three central themes that run through the contributions to this special issue. The first of these is what it argues to be an inescapable connection between research and what might in some sense be regarded as the pursuit of truth, or at least of beliefs that are more deserving of belief and our confidence than others. Even forms of research like ethnography and phenomenography, those for which the pursuit of justice is the primary concern and those that seek to deconstruct the texts and discourses promoted by others -- all rest on forms of inquiry driven in one way or another by this same commitment. The second theme is the relationship between research and discipline where discipline is seen as the set of rules and principles that serve to make a community of arguers possible, but also to support the processes that thought and experience indicate provide the best assurance of opinions deserving our belief. And since there is clearly available to us in the academy and elsewhere more than one way of providing such assurance, each with some distinctive logical and procedural features, we need to consider the disciplines that might serve such purpose, not just the generic principle of discipline. Finally, the paper engages with the terrain of 'alternative epistemologies' -- terrain rendered more complex because, as described here, the term seems to encompass some rather different claims of a more or less problematic nature.

In European post-socialistic countries or more commonly known as Central and Eastern Europe (CEE) countries, regardless of their differences and specifics, the common communist and post-communist legacies in the field of educational sciences are still recognisable. The aim of this article is to explore research activity in the educational sciences in 15 CEE countries: 11 EU member states and 4 from the former Yugoslav Republic in the period from 1996 to 2013. The purpose of this research is to recognise the specificity and dynamics of subject and content issues, and development of methodological approaches in the educational science research. The sample consists of abstracts of 2,395 papers by CEE authors published in 265 journals indexed in Scopus between 1996 and 2013. Content analysis was applied, where the abstracts were grouped into specifically created categories describing the content and methods of the paper and analysed on the basis of two criterion variables -- CEE and non-CEE or international journals. The ?[superscript 2] test showed that the field of educational sciences in 15 European post-socialist countries changed over time in terms of quantity, content and methods, becoming more expansive and diverse, which is recognisable in papers published both in international and in CEE journals.

This paper focuses on young foreign language learners' attitudes and motivations. An overview is given of the main issues in this research area, based on key European studies. Approaches to studying these affective learner characteristics are described. Some attention is devoted to data elicitation techniques and the importance of triangulation. Research findings are presented through overviews of cross-sectional and longitudinal studies carried out in different European settings. The latter are presented in more detail, because their findings seem to be more revealing of the early foreign language learning process. The overall conclusion of this review paper is that young foreign language learners' attitudes and motivations are not stable learner characteristics but change over time, creating layers of complexity that warrant further research. Suggestions about possible future directions in researching young foreign language learner attitudes and motivations, and the application of its findings are also made.

Teacher agency (TA) has been increasingly supported as an influential factor for teacher professional learning, school improvement and sustainable educational change. Previous studies, however, feature a variety of discrepancies in their conceptualisation and approaches to examining teacher agency. A systematic review is essential to map the field, refine our understanding of the concept and inform relevant stakeholders of useful insights for policy making and further research. After being screened against a number of inclusion criteria, 104 empirical studies were selected to be included in this review. Thematic analysis was adopted for the data analysis of these papers. Findings indicate an imbalance in geographical, theoretical, methodological and thematic distributions in previous studies. Six major themes were identified from the literature: (1) TA enactment, (2) the role of teacher cognition, (3) influential factors, (4) implementing professional development interventions, (5) TA outcomes and (6) TA change trajectory. TA can be extrapolated in terms of its source, enactment and outcomes. Teachers' capacities, implementation strategies, and contextual factors jointly determine the achievement of their professional agency. A conceptual framework for accounting teacher agency holistically is proposed and implications for relevant stakeholders are discussed.

Background: This paper is based on results from the Survey of Health, Ageing and Retirement in Europe (SHARE), exploring many aspects (health, economic situation and welfare) of the European population aged 50+. Differently from many other international studies, SHARE includes persons living in nursing homes or residential care facilities as part of its sample. The aim of this paper is to provide a socio-demographic, functional and psychosocial snapshot of older residents in nursing homes in Europe. Methods: This paper uses data from SHARE Wave 8/2020, carried out in 27 European countries. A quantitative/descriptive approach explores the prevalence of older people aged 65+ living in residential facilities as mapped by the SHARE survey across Europe, with regard to associated dimensions, i.e., socio-demographic, family relationship, perceived health/main diseases, functional and psychological status. Results: These show that older residents live mainly in Central and Northern Europe, are aged 80+, female and widowed. A small social network (SN) size is often reported. Health is perceived, above all, as being fair–poor, and the presence of long-term illness is high, with several chronic health conditions and functional limitations. The reported quality of life (QoL) is low for most respondents, with moderate–low satisfaction with life. Conclusion: The analysis depicts a profile of seniors needing residential care in Europe, and provides useful insights for policymakers, to better sustain this frail population group, and to allow and improve access to high-quality long-term care (LTC) in Europe. Our findings could also be of help to train health professionals, and potentially drive the research towards the exploration of new housing solutions for seniors. This would in turn contribute to the effective implementation of European initiatives to strengthen LTC systems. [ABSTRACT FROM AUTHOR]

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

Background: Sustainable energy transition of a country is complex and long-term process, which requires decision-making in all stages and at all levels, including a large number of different factors, with different causality. The main objective of this paper is the development of a probabilistic model for decision-making in sustainable energy transition in developing countries of SE Europe. The model will be developed according to the specificities of the countries for which it is intended—SE Europe. These are countries where energy transition is slower and more difficult due to many factors: high degree of uncertainty, low transparency, corruption, investment problems, insufficiently reliable data, lower level of economic development, high level of corruption and untrained human resources. All these factors are making decision-making more challenging and demanding. Methods: Research was done by using content analysis, artificial intelligence methods, software development method and testing. The model was developed by using MSBNx—Microsoft Research's Bayesian Network Authoring and Evaluation Tool. Results: Due to the large number of insufficiently clear, but interdependent factors, the model is developed on the principle of probabilistic (Bayesian) networks of factors of interest. The paper presents the first model for supporting decision-making in the field of energy sustainability for the region of Southeastern Europe, which is based on the application of Bayesian Networks. Conclusion: Testing of the developed model showed certain characteristics, discussed in paper. The application of developed model will make it possible to predict the short-term and long-term consequences that may occur during energy transition by varying these factors. Recommendations are given for further development of the model, based on Bayesian networks. [ABSTRACT FROM AUTHOR]

Discusses the recent wave of mass sociopolitical mobilization in Eastern Europe. Argues that the models and methods developed after the 1960s have made it difficult for Western students to understand recent movements in the East. Compares waves of mobilization such as the Civil Rights Movement in the United States with incomplete waves of mobilization in eastern Europe. (DK)

The purpose of the paper is to highlight the evolution of the psychocentric pedagogy paradigm in the modern and postmodern eras. Although they are historically integrated in the modern era, the analyzed pedagogues, L.S. Vygotsky and P.I. Galperin and D. Elkonin, have a recognized influence at the level of postmodern (contemporary) pedagogy. The epistemological foundations of a science, especially a socio-human science, relate to the fundamental concepts, which define the object of study, the normativity and the research methodology. The specific object of study of pedagogy is the formation of the educated, mediated by the educator in the socio-cultural environment favorable to the optimal development of the educated in the "zone of proximal development", in constructivist psychological pedagogy, in the achievement of education / training / learning at the level of the optimal ratio between information (with content non-psychological object) and pupil training (which has a psychological content), in the psychological pedagogy of mental actions, and play, as a psychological and pedagogical activity specific to preschoolers and young schoolchildren and in the psychological pedagogy of play. Regarding the specific pedagogy normativity, the paper highlights the basic principles used by the three representative pedagogues, by "creating the scaffolding", for L.S. Vygotsky, the principle of capitalizing on the pupils' mental actions in relation to the psychological age and learning stage, for P.I. Galperin, the principle of the relationship between play and development, which is the "source of learning" at D. Elkonin. The specific research methodology of pedagogy, the qualitative structural analysis method, the genetic method, the comparative method, the instrumental method, with L.S. Vygotsky, the method of the constructivist interpretation of the theory of mental actions from the perspective of their pedagogical resources, with P.I. Galperin, the method of the constructivist interpretation of the game from the perspective of the resources of his pedagogy, at D. Elkonin, alongside the object of study and normativity, highlights the scientific nature of pedagogy. The originality of the study results from the analysis-synthesis method of the contribution of the authors selected on epistemologically explicit criteria, by using the hermeneutic method, based on text analysis, from a historical, synchronic and diachronic perspective. The conclusions of the research are that, in addition to defining the key concepts, through which they contributed not only to the evolution of Russian pedagogy, but also to the consolidation of the system of pedagogical sciences worldwide, the representatives of psychological pedagogy in Russia also left as legacy the proof of some results of practical activity. The zone of proximal development of L.S. Vygotsky, the concern for effective learning through mental actions of P.I. Galperin and the pedagogical foundation of the game by D.B Elkonin are always current concepts, which are the basis of the explanation of various aspects of the human personality evolution through education. [ABSTRACT FROM AUTHOR]

Background: The PACE Steps to Success programme is a complex educational and development intervention to improve palliative care in nursing homes. Little research has investigated processes in the cross-cultural adaptation and implementation of interventions in palliative care across countries, taking account of differences in health and social care systems, legal and regulatory policies, and cultural norms. This paper describes a framework for the cross-cultural development and support necessary to implement such an intervention, taking the PACE Steps to Success programme as an exemplar.Methods: The PACE Steps to Success programme was implemented as part of the PACE cluster randomised control trial in seven European countries. A three stage approach was used, a) preparation of resources; b) training in the intervention using a train-the-trainers model; and c) cascading support throughout the implementation. All stages were underpinned by cross-cultural adaptation, including recognising legal and cultural norms, sensitivities and languages. This paper draws upon collated evidence from minutes of international meetings, evaluations of training delivered, interviews with those delivering the intervention in nursing homes and providing and/or receiving support.Results: Seventy eight nursing homes participated in the trial, with half randomized to receive the intervention, 3638 nurses/care assistants were identified at baseline. In each country, 1-3 trainers were selected (total n = 16) to deliver the intervention. A framework was used to guide the cross-cultural adaptation and implementation. Adaptation of three English training resources for different groups of staff consisted of simplification of content, identification of validated implementation tools, a review in 2 nursing homes in each country, and translation into local languages. The same training was provided to all country trainers who cascaded it into intervention nursing homes in local languages, and facilitated it via in-house PACE coordinators. Support was cascaded from country trainers to staff implementing the intervention.Conclusions: There is little guidance on how to adapt complex interventions developed in one country and language to international contexts. This framework for cross-cultural adaptation and implementation of a complex educational and development intervention may be useful to others seeking to transfer quality improvement initiatives in other contexts. [ABSTRACT FROM AUTHOR]

Background: Since the early 1980s all European countries have given priority to reforming the management of health services. A distinctive feature of these reforms has also been the drive to co-opt professionals themselves into the management of services, taking on full time or part time (hybrid) management or leadership roles. However, although these trends are well documented in the literature, our understanding of the nature and impact of reforms and how they are re-shaping the relationship between medicine and management remains limited. Most studies have tended to be nationally specific, located within a single discipline and focused primarily on describing new management practices. This article serves as an Introduction to a special issue of BMC Health Services Research which seeks to address these concerns. It builds on the work of a European Union funded COST Action (ISO903) which ran between 2009 and 2013, focusing specifically on the changing relationship between medicine and management in a European context.Main Text: Prior to describing the contributions to the special issue, this Introduction sets the scene by exploring four main questions which have characterised much of the recent literature on medicine and management. First is the question of what we understand by the changing relationship between medicine and management and in particular which this means for the emergence of so called 'hybrid' clinical leader roles? A second question concerns the forces that have driven change, in particular those relating to the wider project of management reforms. Third, we raise questions of how medical professionals have responded to these changes and what factors have shaped their responses. Lastly we consider what some of the outcomes of greater medical involvement in management and leadership might be, both in terms of intended and unintended outcomes.Conclusions: The paper concludes by summarising the contributions to the special issue and highlighting the need to extend research in this area by focusing more on comparative dimensions of change. It is argued that future research would also benefit theoretically by drawing together insights from health policy and management literatures. [ABSTRACT FROM AUTHOR]

Background: Medical data from family doctors are of great importance to health care researchers but seem to be locked in German practices and, thus, are underused in research. The RADAR project (Routine Anonymized Data for Advanced Health Services Research) aims at designing, implementing and piloting a generic research architecture, technical software solutions as well as procedures and workflows to unlock data from family doctor's practices. A long-term medical data repository for research taking legal requirements into account is established. Thereby, RADAR helps closing the gap between the European countries and to contribute data from primary care in Germany.Methods: The RADAR project comprises three phases: (1) analysis phase, (2) design phase, and (3) pilot. First, interdisciplinary workshops were held to list prerequisites and requirements. Second, an architecture diagram with building blocks and functions, and an ordered list of process steps (workflow) for data capture and storage were designed. Third, technical components and workflows were piloted. The pilot was extended by a data integration workflow using patient-reported outcomes (paper-based questionnaires).Results: The analysis phase resulted in listing 17 essential prerequisites and guiding requirements for data management compliant with the General Data Protection Regulation (GDPR). Based on this list existing approaches to fulfil the RADAR tasks were evaluated-for example, re-using BDT interface for data exchange and Trusted Third Party-approach for consent management and record linkage. Consented data sets of 100 patients were successfully exported, separated into person-identifying and medical data, pseudonymised and saved. Record linkage and data integration workflows for patient-reported outcomes in the RADAR research database were successfully piloted for 63 responders.Conclusion: The RADAR project successfully developed a generic architecture together with a technical framework of tools, interfaces, and workflows for a complete infrastructure for practicable and secure processing of patient data from family doctors. All technical components and workflows can be reused for further research projects. Additionally, a Trusted Third Party-approach can be used as core element to implement data privacy protection in such heterogeneous family doctor's settings. Optimisations identified comprise a fully-electronic consent recording using tablet computers, which is part of the project's extension phase. [ABSTRACT FROM AUTHOR]

Background: The aim of the study is to analyse the association between job stress and interpersonal relationships on and outside of the job in Europe. The main assumption of the paper is that since social relations at various levels enhance individual well-being, they may counteract stress created by an unfavourable work environment.Methods: The econometric analysis, based on a standard ordered probit model, employs data taken from the Sixth European Working Conditions Survey carried out in 2015 and released in 2017.Results: The results show significant correlations between interpersonal contacts on and outside of the job and job stress. Help and support provided by one's manager decreases the probability of being stressed at work, while receiving help and support from co-workers is likely to increase the probability of job stress occurrence. However, maintaining cooperation and getting on well with colleagues decrease the probability of experiencing stress, confirming the positive and gratifying features of contact with co-workers reported by the literature.Conclusions: While we were not able to establish the direction of causality between job stress and interpersonal relationships (a limitation of this paper), the present work contributes new evidence to the literature on occupational stress. Our results show that interpersonal relationships on and outside of the job can be considered valuable resources that, when available to an individual, are useful for managing stress created by workplace stressors. [ABSTRACT FROM AUTHOR]

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Background: Randomised clinical trials are key to advancing medical knowledge and to enhancing patient care, but major barriers to their conduct exist. The present paper presents some of these barriers.Methods: We performed systematic literature searches and internal European Clinical Research Infrastructure Network (ECRIN) communications during face-to-face meetings and telephone conferences from 2013 to 2017 within the context of the ECRIN Integrating Activity (ECRIN-IA) project.Results: The following barriers to randomised clinical trials were identified: inadequate knowledge of clinical research and trial methodology; lack of funding; excessive monitoring; restrictive privacy law and lack of transparency; complex regulatory requirements; and inadequate infrastructures. There is a need for more pragmatic randomised clinical trials conducted with low risks of systematic and random errors, and multinational cooperation is essential.Conclusions: The present paper presents major barriers to randomised clinical trials. It also underlines the value of using a pan-European-distributed infrastructure to help investigators overcome barriers for multi-country trials in any disease area. [ABSTRACT FROM AUTHOR]

Background: Network meta-analysis (NMA) has become a popular method to compare more than two treatments. This scoping review aimed to explore the characteristics and methodological quality of knowledge synthesis approaches underlying the NMA process. We also aimed to assess the statistical methods applied using the Analysis subdomain of the ISPOR checklist.Methods: Comprehensive literature searches were conducted in MEDLINE, PubMed, EMBASE, and Cochrane Database of Systematic Reviews from inception until April 14, 2015. References of relevant reviews were scanned. Eligible studies compared at least four different interventions from randomised controlled trials with an appropriate NMA approach. Two reviewers independently performed study selection and data abstraction of included articles. All discrepancies between reviewers were resolved by a third reviewer. Data analysis involved quantitative (frequencies) and qualitative (content analysis) methods. Quality was evaluated using the AMSTAR tool for the conduct of knowledge synthesis and the ISPOR tool for statistical analysis.Results: After screening 3538 citations and 877 full-text papers, 456 NMAs were included. These were published between 1997 and 2015, with 95% published after 2006. Most were conducted in Europe (51%) or North America (31%), and approximately one-third reported public sources of funding. Overall, 84% searched two or more electronic databases, 62% searched for grey literature, 58% performed duplicate study selection and data abstraction (independently), and 62% assessed risk of bias. Seventy-eight (17%) NMAs relied on previously conducted systematic reviews to obtain studies for inclusion in their NMA. Based on the AMSTAR tool, almost half of the NMAs incorporated quality appraisal results to formulate conclusions, 36% assessed publication bias, and 16% reported the source of funding. Based on the ISPOR tool, half of the NMAs did not report if an assessment for consistency was conducted or whether they accounted for inconsistency when present. Only 13% reported heterogeneity assumptions for the random-effects model.Conclusions: The knowledge synthesis methods and analytical process for NMAs are poorly reported and need improvement. [ABSTRACT FROM AUTHOR]

Objectives Overdiagnosis, the detection through screening of a breast cancer that would never have been identified in the lifetime of the woman, is an adverse outcome of screening. We aimed to determine an estimate range for overdiagnosis of breast cancer in European mammographic service screening programmes. Methods We conducted a literature review of observational studies that provided estimates of breast cancer overdiagnosis in European population-based mammographic screening programmes. Studies were classified according to the presence and the type of adjustment for breast cancer risk (data, model and covariates used), and for lead time (statistical adjustment or compensatory drop). We expressed estimates of overdiagnosis from each study as a percentage of the expected incidence in the absence of screening, even if the variability in the age range of the denominator could not be removed. Estimates including carcinoma in situ were considered when available. Results There were 13 primary studies reporting 16 estimates of overdiagnosis in seven European countries (the Netherlands, Italy, Norway, Sweden, Denmark, UK and Spain). Unadjusted estimates ranged from 0% to 54%. Reported estimates adjusted for breast cancer risk and lead time were 2.8% in the Netherlands, 4.6% and 1.0% in Italy, 7.0% in Denmark and 10% and 3.3% in England and Wales. Conclusions The most plausible estimates of overdiagnosis range from 1% to 10%. Substantially higher estimates of overdiagnosis reported in the literature are due to the lack of adjustment for breast cancer risk and/or lead time. [ABSTRACT FROM AUTHOR]

Background: Acute respiratory infections (ARIs) accounted for an estimated 3.9 million deaths worldwide in 2015, of which 56% occurred in adults aged 60 years or older. We aimed to identify the cost of ARI management in older adults (≥50 years) in order to develop an evidence base to assist decision-making for resource allocation and inform clinical practice.Methods: We searched 8 electronic databases including Global Health, Medline and EMBASE for studies published between January 1, 2000 and December 31, 2021. Total management costs per patient per ARI episode were extracted and meta-analysis was conducted by World Health Organization (WHO) region and World Bank income level. All costs were converted and inflated to Euros (€) (2021 average exchange rate). The quality of included studies and the potential risk of bias were evaluated.Results: A total of 42 publications were identified for inclusion, reporting cost data for 8 082 752 ARI episodes in older adults across 20 countries from 2001 to 2021. The majority (86%) of studies involved high-income countries based in Europe, North America and Western Pacific. The mean cost per episode was €17 803.9 for inpatient management and €128.9 for outpatient management. Compared with costs reported for patients aged <65 years, inpatient costs were €154.1, €7 018.8 and €8 295.6 higher for patients aged 65-74 years, 75-84 years and over 85 years. ARI management of at-risk patients with comorbid conditions and patients requiring higher level of care, incurred substantially higher costs for hospitalization: €735.9 and €1317.3 respectively.Conclusions: ARIs impose a substantial economic burden on health systems, governments, patients and societies. This study identified high ARI management costs in older adults, reinforcing calls for investment by global health players to quantify and address the scale of the challenge. There are large gaps in data availability from low-income countries, especially from South East Asia and Africa regions. [ABSTRACT FROM AUTHOR]

Background: The laws governing abortion access vary across Europe. Even in countries with relatively liberal laws, numerous barriers to abortion access exist. In response to these barriers, evidence suggests that people living in countries with both restrictive and liberal laws travel outside of their home country for abortion care. England and Wales are common destinations for those who travel to seek abortions, but little is known about the motivations and experiences of those who undertake cross-country travel to England or Wales to obtain care. This paper aims to describe the abortion seeking and travel experiences of women and pregnant people who traveled to England and Wales for an abortion between 2017 and 2019. Methods: We recruited 97 participants who had traveled cross-country from both liberal and restrictive contexts to seek abortion care at three participating BPAS clinics in England and Wales. Participants completed an electronic survey about their reproductive histories, abortion decision-making, experiences seeking abortion care, and traveling. We conducted a descriptive analysis, and include comparisons between participants who traveled from liberal and restrictive contexts. Results: Over a third of participants considered abortion four weeks or more before presenting for care at BPAS, and around two-thirds sought abortion services in their home country before traveling. The majority of participants indicated that they would have preferred to have obtained an abortion earlier and cited reasons including scheduling issues, a dearth of local services, delayed pregnancy recognition, and financial difficulties as causing their delay. About seventy percent of participants reported travel costs between €101–1000 and 75% of participants reported that the cost of the abortion procedure exceeded €500. About half of participants indicated that, overall, their travel was very or somewhat difficult. Conclusions: This analysis documents the burdens associated with cross-country travel for abortion and provides insight into the factors that compel people to travel. Our findings highlight the need for expanded access to abortion care throughout Europe via the removal of legal impediments and other social or procedural barriers. Removing barriers would eliminate the need for cumbersome abortion travel, and ensure that all people can obtain necessary, high-quality healthcare in their own communities. Plain language summary: In Europe, people who live in countries where abortion is severely restricted or illegal altogether lack access to abortion care entirely, but even people who live in countries with more liberal laws face barriers due to gestational age limits, waiting periods, and a lack of trained and willing providers. Existing evidence suggests that restrictions and barriers compel people from both countries with restrictive laws as well as those from countries with more liberal laws to travel outside of their home country for abortion services. England and Wales are common destinations for people traveling within Europe to obtain abortion services, but little is known about the experiences of these travelers. We surveyed individuals who had traveled from another country to seek abortion services in England or Wales. Our analysis documents that many participants contemplated getting an abortion and sought care in their home countries before traveling. Likewise, many participants indicated that they would have preferred to have obtained an abortion earlier in their pregnancy, and referenced scheduling issues, a dearth of local services, delayed pregnancy recognition, and financial difficulties as causing their delay. A majority of participants indicated that covering the costs of their abortion, and the costs of travel was difficult, and that the travel experience in its entirety was difficult. Our findings document the reasons for, and burdens associated with abortion travel and highlight the need to expand access to abortion across Europe via the elimination of all legal restrictions and impediments. [ABSTRACT FROM AUTHOR]

The gender gap in life expectancy (GGLE) varies substantially in EU 28 Member States. This paper addresses the question of whether gender inequality affects the GGLE as well as life expectancy (LE) in both genders. We conducted an ecological study and used the gender inequality index (GII) developed by the United Nations as well as the gender difference in LE in 2015. We found a correlation between GGLE and GII (r 2=0.180) and between GII and LE of 0.418 (women) and 0.430 (men). Gender equality policies are still necessary and will have an effect on women's as well as men's health. [ABSTRACT FROM AUTHOR]

Background: The Sarcoma Policy Checklist was created by a multidisciplinary expert group to provide policymakers with priority areas to improve care for sarcoma patients.Main Body: This paper draws on this research, by looking more closely at how France, Germany, Italy, Spain, Sweden and the United Kingdom are addressing each of these priority areas. It aims to highlight key gaps in research, policy and practice, as well as ongoing initiatives that may impact the future care of sarcoma patients in different European countries. A pragmatic review of the published and web-based literature was undertaken. Telephone interviews were conducted in each country with clinical and patient experts to substantiate findings. Research findings were discussed within the expert group and developed into five core policy recommendations. The five identified priority areas were: the development of designated and accredited centres of reference; more professional training; multidisciplinary care; greater incentives for research and innovation; and more rapid access to effective treatments. Most of the countries studied have ongoing initiatives addressing many of these priorities; however, many are in early stages of development, or require additional funding and resources.Conclusion: Gaps in access to quality care are particularly concerning in many of Europe's lower-resourced countries. Equitable access to information, clinical trials, innovative treatments and quality specialist care should be available to all sarcoma patients. Achieving this across Europe will require close collaboration between all stakeholders at both the national and European level. [ABSTRACT FROM AUTHOR]

Background: In Europe, knowledge about the social determinants of health among undocumented migrants is scarce. The canton of Geneva, Switzerland, implemented in 2017-2018 a pilot public policy aiming at regularizing undocumented migrants. We sought to test for associations between self-rated health, proven eligibility for residence status regularization and social and economic integration.Methods: This paper reports data from the first wave of the Parchemins Study, a prospective study whose aim is to investigate the effect of residence status regularization on undocumented migrants' living conditions and health. The convenience sample included undocumented migrants living in Geneva for at least 3 years. We categorized them into those who were in the process of receiving or had just been granted a residence permit (eligible or newly regularized) and those who had not applied or were ineligible for regularization (undocumented). We conducted multivariate regression analyses to determine factors associated with better self-rated health, i.e., with excellent/very good vs. good/fair/poor self-rated health. Among these factors, measures of integration, social support and economic resources were included.Results: Of the 437 participants, 202 (46%) belonged to the eligible or newly regularized group. This group reported better health more frequently than the undocumented group (44.6% versus 28.9%, p-value < .001), but the association was no longer significant after adjustment for social support and economic factors (odds ratio (OR): 1.12; 95% confidence interval (CI): 0.67-1.87). Overall, better health was associated with larger social networks (OR: 1.66; 95% CI: 1.04-2.64). This association remained significant even after adjusting for health-related variables.Conclusion: At the onset of the regularization program, access to regularization was not associated with better self-rated health. Policies aiming at favouring undocumented migrants' inclusion and engagement in social networks may promote better health. Future research should investigate long-term effects of residence status regularization on self-rated health. [ABSTRACT FROM AUTHOR]

Study Question: How many twins are born in human populations and how has this changed over recent decades?Summary Answer: Since the 1980s, the global twinning rate has increased by a third, from 9.1 to 12.0 twin deliveries per 1000 deliveries, to about 1.6 million twin pairs each year.What Is Known Already: It was already known that in the 1980s natural twinning rates were low in (East) Asia and South America, at an intermediate level in Europe and North America, and high in many African countries. It was also known that in recent decades, twinning rates have been increasing in the wealthier parts of our world as a result of the rise in medically assisted reproduction (MAR) and delayed childbearing.Study Design, Size, Duration: We have brought together all information on national twinning rates available from statistical offices, demographic research institutes, individual survey data and the medical literature for the 1980-1985 and the 2010-2015 periods.Participants/materials, Setting, Methods: For 165 countries, covering over 99% of the global population, we were able to collect or estimate twinning rates for the 2010-2015 period. For 112 countries, we were also able to obtain twinning rates for 1980-1985.Main Results and the Role Of Chance: Substantial increases in twinning rates were observed in many countries in Europe, North America and Asia. For 74 out of 112 countries the increase was more than 10%. Africa is still the continent with highest twinning rates, but Europe, North America and Oceania are catching up rapidly. Asia and Africa are currently home to 80% of all twin deliveries in the world.Limitations, Reasons For Caution: For some countries, data were derived from reports and papers based on hospital registrations which are less representative for the country as a whole than data based on public administrations and national surveys.Wider Implications Of the Findings: The absolute and relative number of twins for the world as a whole is peaking at an unprecedented level. An important reason for this is the tremendous increase in medically assisted reproduction in recent decades. This is highly relevant, as twin deliveries are associated with higher infant and child mortality rates and increased complications for mother and child during pregnancy and during and after delivery.Study Funding/competing Interest(s): The contribution of CM was partially supported by the European Research Council (ERC) under the European Union's Horizon 2020 Research and Innovation Programme (grant No 681546, FAMSIZEMATTERS), Nuffield College, and the Leverhulme Trust. The contribution of GP was partially supported by the French Agence Nationale de la Recherche (grant No ANR-18-CE36-0007-07). The authors declare no conflict of interest.Trial Registration Number: N/A. [ABSTRACT FROM AUTHOR]

Background: For better supporting the science-governance interface, the potential of health assessments appears underrated. Aims: To identify what various types of health assessment have in common; how they differ; which assessment(s) to apply for which purpose; and what needs and options there are for future joint development. Methods: This review is based on five types of health assessment: monitoring/surveillance/reporting, assessment of health impact, of health technology, of health systems performance, health-related economic assessment. The approach is exploratory and includes: applying an agreed set of comparative criteria; circulating and supplementing synoptic tables; and interpreting the results. Results: Two of the assessments deal with the question 'Where do we stand?', two others with variants of 'What if' questions. Economic Assessment can take place in combination with any of the others. The assessments involve both overall 'procedures' and a variety of 'methods' which inescapably reflect some subjective assumptions and decisions, e.g. on issue framing. Resources and assistance exist for all these assessments. The paper indicates which type of assessment is appropriate for what purpose. Conclusions: Although scientific soundness of health assessments is not trivial to secure, existing types of health assessment can be interpreted as a useful 'toolkit' for supporting governance. If current traces of 'silo' thinking can be overcome, the attainability of a more unified culture of health assessments increases and such assessments might more widely be recognized as a prime, 'tried and tested' way to voice Public Health knowledge and to support rational governance and policy-making. [ABSTRACT FROM AUTHOR]

Objective Analysing trends in population breast cancer mortality statistics appears a simple method of estimating the effectiveness of mammographic screening programmes. We reviewed such studies of population-based screening in Europe to assess their value. Methods A literature review identified 17 papers, of which 12 provided quantitative estimates of the impact of screening. Due to differences in comparisons and outcome measures, no pooled estimate of effectiveness was calculated. Results Comparisons included breast cancer mortality before and after the introduction of screening, trends in early and late starting areas and trends in age groups affected and unaffected by screening. Studies that calculated the percentage annual change after the start of screening found reductions of 1-9% per year (1%, 2.3-2.8% and 9% for those with adequate follow-up). Of studies that compared mortality in time periods before and after introduction of screening, three single country studies all had adequate follow-up and estimated mortality reductions ranging from 28% to 36%. Limitations of studies of population mortality rates include the inability to exclude deaths in women with breast cancer diagnosed before invitation to screening, diluting any observable impact of screening, and the gradual implementation of screening in a country or region. Conclusions Although analysing population breast cancer mortality rates over time can be a first step in examining changes following the introduction of screening, this method is of limited value for assessment of screening impact. Other methods and individual data are necessary to properly quantify the effect. [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]

Background: Accounting for patients' perspective has become increasingly important. Based on the Consumer Quality Index method (founded on Consumer Assessment of Healthcare Providers and Systems) a questionnaire was recently developed for Dutch cancer patients. As a next step, this study aimed to adapt and pilot this questionnaire for international comparison of cancer patients experience and satisfaction with care in six European countries.Method: The Consumer Quality Index was translated into the local language at the participating pilot sites using cross-translation. A minimum of 100 patients per site were surveyed through convenience sampling. Data from seven pilot sites in six countries was collected through an online and paper-based survey. Internal consistency was tested by calculating Cronbach's alpha and validity by means of cognitive interviews. Demographic factors were compared as possible influencing factors.Results: A total of 698 patients from six European countries filled the questionnaire. Cronbach's alpha was good or satisfactory in 8 out of 10 categories. Patient satisfaction significantly differed between the countries. We observed no difference in patient satisfaction for age, gender, education, and tumor type, but satisfaction was significantly higher in patients with a higher level of activation.Conclusion: This European Cancer Consumer Quality Index(ECCQI) showed promising scores on internal consistency (reliability) and a good internal validity. The ECCQI is to our knowledge the first to measure and compare experiences and satisfaction of cancer patients on an international level, it may enable healthcare providers to improve the quality of cancer care. [ABSTRACT FROM AUTHOR]

This paper discusses recent migration to North America with reference to the 1962 and 1967 Canadian immigration regulations and the 1965 United States Immigration and Nationality Act. Despite the similar emphasis on manpower and kinship criteria as the basis for the admission of immigrants, differences between Canada and the United States exist with respect to the importance of immigration for the respective economies, the organization of immigration, the formal regulations, and the size and composition of migrant streams. After an examination of the volume, origin, and occupational composition of immigration to Canada and the United States, flows between the two countries are studied. The paper concludes with a scrutiny of changes in immigration regulations which are pending in both countries. [ABSTRACT FROM AUTHOR]

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Background: Knowledge of HIV status can be important in reducing the risk of HIV exposure. In a European sample of men-who-have-sex-with-men (MSM), we aimed to identify factors associated with HIV serostatus disclosure to the most recent anal intercourse (AI) partner. We also aimed to describe the impact of HIV serostatus disclosure on HIV exposure risks.Methods: During 2013 and 2014, 4901 participants were recruited for the bio-behavioural Sialon-II study in 13 European cities. Behavioural data were collected with a self-administered paper questionnaire. Biological specimens were tested for HIV antibodies. Factors associated with HIV serostatus disclosure with the most recent AI partner were examined using bivariate and multilevel multivariate logistic regression analysis. We also describe the role of serostatus disclosure for HIV exposure of the most recent AI partner.Results: Thirty-five percent (n = 1450) of the study participants reported mutual serostatus disclosure with their most recent AI partner or disclosed having HIV to their partner. Most of these disclosures occurred between steady partners (74%, n = 1077). In addition to the type of partner and HIV diagnosis status, other factors positively associated with HIV serostatus disclosure in the multilevel multivariate logistic regression model were recent testing, no condom use, and outness regarding sexual orientation. Disclosure rates were lowest in three south-eastern European cities. Following condom use (51%, n = 2099), HIV serostatus disclosure (20%, n = 807) was the second most common prevention approach with the most recent AI partner, usually resulting in serosorting. A potential HIV exposure risk for the partner was reported by 26% (111/432) of HIV antibody positive study participants. In 18% (20/111) of exposure episodes, an incorrect HIV serostatus was unknowingly communicated. Partner exposures were equally distributed between steady and non-steady partners.Conclusions: The probability of HIV exposure through condomless AI is substantially lower after serostatus disclosure compared to non-disclosure. Incorrect knowledge of one's HIV status contributes to a large proportion of HIV exposures amongst European MSM. Maintaining or improving condom use for anal intercourse with non-steady partners, frequent testing to update HIV serostatus awareness, and increased serostatus disclosure particularly between steady partners are confirmed as key aspects for reducing HIV exposures amongst European MSM. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has necessitated changes in European healthcare systems, with a significant proportion of COVID-19 cases being managed on an outpatient basis in primary healthcare (PHC). To alleviate the burden on healthcare facilities, many European countries developed contact-tracing apps and symptom checkers to identify potential cases. As the pandemic evolved, the European Union introduced the Digital COVID-19 Certificate for travel, which relies on vaccination, recent recovery, or negative test results. However, the integration between these apps and PHC has not been thoroughly explored in Europe. Objective: To describe if governmental COVID-19 apps allowed COVID-19 patients to connect with PHC through their apps in Europe and to examine how the Digital COVID-19 Certificate was obtained. Methodology: Design and setting: Retrospective descriptive study in PHC in 30 European countries. An ad hoc, semi-structured questionnaire was developed to collect country-specific data on primary healthcare activity during the COVID-19 pandemic and the use of information technology tools to support medical care from 15 March 2020 to 31 August 2021. Key informants belong to the WONCA Europe network (World Organization of Family Doctors). The data were collected from relevant and reliable official sources, such as governmental websites and guidelines. Main outcome measures: Patient's first contact with health system, governmental COVID-19 app (name and function), Digital COVID-19 Certification, COVID-19 app connection with PHC. Results: Primary care was the first point of care for suspected COVID-19 patients in 28 countries, and 24 countries developed apps to complement classical medical care. The most frequently developed app was for tracing COVID-19 cases (24 countries), followed by the Digital COVID-19 Certificate app (17 countries). Bulgaria, Italy, Serbia, North Macedonia, and Romania had interoperability between PHC and COVID-19 apps, and Poland and Romania's apps considered social needs. Conclusions: COVID-19 apps were widely created during the first pandemic year. Contact tracing was the most frequent function found in the registered apps. Connection with PHC was scarcely developed. In future pandemics, connections between health system levels should be guaranteed to develop and implement effective strategies for managing diseases. [ABSTRACT FROM AUTHOR]

Background: Primary Health Care (PHC) plays a crucial role in managing the COVID-19 pandemic, with only 8% of cases requiring hospitalization. However, PHC COVID-19 data often goes unnoticed on European government dashboards and in media discussions. This project aims to examine official information on PHC patient care during the COVID-19 pandemic in Europe, with specific objectives: (1) Describe PHC's clinical pathways for acute COVID-19 cases, including long-term care facilities, (2) Describe PHC COVID-19 pandemic indicators, (3) Develop COVID-19 PHC activity indicators, (4) Explain PHC's role in vaccination strategies, and (5) Create a PHC contingency plan for future pandemics. Methods: A mixed-method study will employ two online questionnaires to gather retrospective PHC data on COVID-19 management and PHC involvement in vaccination strategies. Validation will occur through focus group discussions with medical and public health (PH) experts. A two-wave Delphi survey will establish a European PHC indicators dashboard for future pandemics. Additionally, a coordinated health system action plan involving PHC, secondary care, and PH will be devised to address future pandemic scenarios. Analysis: Quantitative data will be analysed using STATA v16.0 for descriptive and multivariate analyses. Qualitative data will be collected through peer-reviewed questionnaires and content analysis of focus group discussions. A Delphi survey and multiple focus groups will be employed to achieve consensus on PHC indicators and a common European health system response plan for future pandemics. The Eurodata research group involving researchers from 28 European countries support the development. Discussion: While PHC manages most COVID-19 acute cases, data remains limited in many European countries. This study collects data from numerous countries, offering a comprehensive perspective on PHC's role during the pandemic in Europe. It pioneers the development of a PHC dashboard and health system plan for pandemics in Europe. These results may prove invaluable in future pandemics. However, data may have biases due to key informants' involvement and may not fully represent all European GP practices. PHC has a significant role in the management of the COVID-19 pandemic, as most of the cases are mild or moderate and only 8% needed hospitalization. However, PHC COVID-19 activity data is invisible on governments' daily dashboards in Europe, often overlooked in media and public debates. [ABSTRACT FROM AUTHOR]

Background: Premenstrual dysphoric disorder is a depressive disorder affecting 5%–8% of people with menstrual cycles. Despite evidence that facial emotion detection is altered in depressive disorders, with enhanced detection of negative emotions (negativity bias), minimal research exists on premenstrual dysphoric disorder. Objectives: The goal of this study was to investigate the effect of premenstrual dysphoric disorder symptoms and the premenstrual phase on accuracy and intensity at detection of facial emotions. Design: Cross-sectional quasi-experimental design. Method: The Facial Emotion Detection Task was administered to 72 individuals assigned female at birth with no premenstrual dysphoric disorder (n = 30), and provisional PMDD (n = 42), based on a retrospective Diagnostic and Statistical Manual of Mental Disorders—Fifth Edition -based measure of premenstrual dysphoric disorder. Facial emotion detection was examined both irrespective of menstrual cycle phase, and as a function of premenstrual phase (yes, no). The task used neutral-to-emotional facial expression morphs (15 images/morph). Participants indicated the emotion detected for each image within the progressive intensity morph. For all six basic emotions (sad, angry, fearful, happy, disgust, and surprise), two scores were calculated: accuracy of responses and the intensity within the morph at which the correct emotion was first detected (image number). Results: Individuals reporting moderate/severe symptoms of premenstrual dysphoric disorder had more accurate and earlier detection of disgust, regardless of cycle phase. In addition, those with provisional premenstrual dysphoric disorder detected sad emotions earlier. A premenstrual dysphoric disorder group × cycle phase interaction also emerged: individuals reporting premenstrual dysphoric disorder symptoms were more accurate at detecting facial emotions during the premenstrual phase compared to the rest of the cycle, with a large effect size for sad emotions. Conclusion: The findings suggest enhanced facial emotion processing in individuals reporting symptoms of premenstrual dysphoric disorder, particularly for sadness and disgust. However, replication is required with larger samples and prospective designs. This premenstrual dysphoric disorder premenstrual emotion detection advantage suggests an adaptive cognitive mechanism in premenstrual syndrome/premenstrual dysphoric disorder, and challenges stigma surrounding premenstrual experiences. Plain Language Summary: Women with Severe Premenstrual Syndrome or Probable Premenstrual Dysphoric Disorder are Better at Identifying Emotional Expressions on People's Faces, Especially During the Premenstrual Phase Premenstrual dysphoric disorder is a depressive disorder affecting women where they experience emotional and physical symptoms during the premenstrual phase (i.e. the week before one's period). It is a severe form of premenstrual syndrome. Research indicates that depression can affect facial emotion recognition. Accurately recognizing other people's emotions is an important skill that helps us develop social connections and keep ourselves and others safe. Quick recognition of facial emotions allows us to understand and support others, and quickly identify dangerous situations by recognizing other people's emotional responses. The goal of this study was to examine how premenstrual dysphoric disorder symptoms and the premenstrual phase may affect the ability of women to recognize and identify emotions on other people's faces. A total of 72 women (42 with premenstrual dysphoric disorder, 30 without premenstrual dysphoric disorder) completed the Facial Emotion Detection Task. This task measured how accurate and early the women were able to detect happiness, sadness, anger, fear, surprise, and disgust in faces. Women with moderate/severe symptoms of premenstrual dysphoric disorder had more accurate and earlier detection of disgust, regardless of where they were in their menstrual cycle. Women with premenstrual dysphoric disorder detected sad emotions earlier. Furthermore, women with premenstrual dysphoric disorder were more accurate at detecting facial emotions when they were tested in the premenstrual phase, and were especially more accurate in detecting sad emotions. The findings suggest that women with premenstrual dysphoric disorder are better at detecting facial emotions and show a premenstrual dysphoric disorder premenstrual emotion detection advantage. This tendency for women with premenstrual dysphoric disorder to better detect emotions in others, particularly when they are in the premenstrual cycle phase, would have benefits. As one of the first reports of a potentially beneficial effect of premenstrual syndrome for women, the findings may help decrease stigma associated with premenstrual dysphoric disorder and premenstrual syndrome. Further research is needed to replicate and extend these findings. [ABSTRACT FROM AUTHOR]

While "integrated" systems regulate the quantity of health services, "Bismarckian" systems regulate their price. This paper compares the consumers' allocations implemented within the two reimbursement systems. In the model, illness has a negative impact on labor productivity while public insurance is financed through income tax. Consumers have private information with respect to a parameter which can be interpreted as heterogeneity either in intensity of their preferences for treatment or in the type of illness. The social planner may be constrained to adopt uniform insurance plans, or may be free to choose self selecting plans. The analysis of uniform plans shows that Bismarckian systems dominate integrated systems from the social welfare point of view; whereas the opposite ranking holds with self-selecting plans. [ABSTRACT FROM AUTHOR]

AIM:This paper deals with some methodological aspects of data collection in the context of measuring dietary intake in individuals in their adolescence life stage.METHOD:Experiences from three partners of the HELENA project in dietary intake measurement in children and adolescents are presented in this paper with emphasis on characteristics of under-reporting, long-term diet measurement and food patterns (Dortmund DONALD group), influences of survey duration on under-reporting (Ghent group) and meal habits (Spanish AVENA group).RESULTS:Under-reporters in the DONALD Study, particularly female adolescents, had a significantly higher body mass index (BMI) than non-under-reporters; BMI could not be explained by different long-term dietary patterns during childhood and adolescence clustered according to fat consumption; consumers of fast food had higher BMI values than nonconsumers. In the Ghent experience, the decline in population mean energy intake as calculated over selected clusters of days is 184 kcal (6.5%) in boys and 116 (5.6%) in girls; the cluster of 1 recording day and the cluster of 3 recording days were not significantly different but they were both significantly different from the 7-day cluster; no significant interaction was observed between the effect of time and BMI. In the AVENA Study, the percentage of adolescents skipping breakfast was higher in females (8.6%) than in males (3.5%, P<0.001); higher BMI values were observed in those skipping breakfast than in those notskipping breakfast, but differences were statistically significant in males at 15 y and in females at 14 and 17 y; adolescents avoiding some food groups for breakfast had higher BMI values (carbohydrates, fruits and pastries in males and milk, fruits and pastries in females).CONCLUSION:Dietary and nutrient intake data in the HELENA project will be obtained by means of repeated 24-h dietary recalls. Data from HELENA might be a basis for developing complex approaches like Healthy Eating Indices.International Journal of Obesity (2005) 29, S66–S77. doi:10.1038/sj.ijo.0803063 [ABSTRACT FROM AUTHOR]

Background: The paper presents the first ethnobotanical application of Ellenberg indicator values, which are widely used in European plant ecology. The aim of the study was to find out if Ellenberg values (indicating habitat preferences) differ for wild food and medicinal plants used in north-eastern Istria (Croatia). We used Ellenberg-Pignatti values (the version of Ellenberg values used in this part of Europe). Methods: Fifty semi-structured interviews were carried out among local key informants, asking which wild food and medicinal plants they used. Results: The mean number of food and medicinal plants mentioned per interview was 30. Altogether, 121 species were recorded as food or medicine used or previously used in the study area. Thirty-one species are used exclusively as food or everyday drink, 50 species are used exclusively as medicine and 40 species are used for both food and medicine. There were no significant differences between Ellenberg values for food and medicinal plants, apart from the Nitrogen indicator value - the plants used exclusively as food had a significantly higher index than those used in medicine. This probably stems from the fact that plants with soft fleshy shoots are attractive as food and they are more likely to come from nitrogen-rich ruderal habitats. Conclusions: Food plants and medicinal plants are collected from a variety of habitats and no clear difference between the two categories of plants was detected, however further testing of Ellenberg values in ethnobotanical studies could be interesting. [ABSTRACT FROM AUTHOR]

Background: The European Organisation for Research and Treatment of Cancer (EORTC) Group has developed a new multidimensional instrument measuring cancer-related fatigue to be used in conjunction with the quality of life core questionnaire (EORTC QLQ-C30). The module EORTC QLQ-FA13 assesses physical, cognitive, and emotional aspects of cancer-related fatigue.Methods: The methodology follows the EORTC guidelines for phase IV validation of modules. This paper focuses on the results of the psychometric validation of the factorial structure of the module. For validation and cross-validation confirmatory factor analysis (maximum likelihood estimation), intraclass correlation and Cronbach alpha for internal consistency were employed. The study involved an international multicenter collaboration of 11 European and non-European countries.Results: A total of 946 patients with various tumor diagnoses were enrolled. Based on the confirmatory factor analysis, we could approve the three-dimensional structure of the module. Removing one item and reassigning the factorial mapping of another item resulted in the EORTC QLQ-FA12. For the revised scale, we found evidence supporting good local (indicator reliability ≥ 0.60, factor reliability ≥ 0.82) and global model fit (GFI t1|t2 = 0.965/0.957, CFI t1|t2 = 0.976/0.972, RMSEA t1|t2 = 0.060/0.069) for both measurement points. For each scale, test-retest reliability proved to be very good (intraclass correlation: R t1-t2 = 0.905-0.921) and internal consistency proved to be good to high (Cronbach alpha = .79-.90).Conclusion: Based on the former phase III module, the multidimensional structure was revised as a phase IV module (EORTC FA12) with an improved scale structure. For a comprehensive validation of the EORTC FA12, further aspects of convergent and divergent validity as well as sensitivity to change should be determined. [ABSTRACT FROM AUTHOR]

Introduction: EURO-URHIS 2 aimed to collect comparable health indicators across a large number of urban areas (UAs) across Europe and Vietnam using four data collection tools. This paper outlines the process for the selection of indicators to be collected from routinely available sources, and the piloting of the data collection tool. Methods: A long-list of indicators potentially collectable from routinely available sources was generated by the EURO-URHIS 2 consortium. Key contacts from each UA completed an e-mail survey reporting for each indicator whether it could be collected using the given definition, an alternative definition or not at all. Additionally participants listed the 20 leading causes of death for their UAs from the Eurostat 65. Results were compiled to inform indicator selection for the main data collection phase. Results: Responses were received for 25 of 28 eligible UAs. Of the 29 proposed indicators, 55.1% (n = 16) were accepted without change, 24.1% (n = 7) were re-allocated to other data collection tools and 17.2% (n = 5) were accepted after a modification of the EURO-URHIS 2 definition. Discussion: This scoping exercise and piloting phase for the 'existing data tool' for the project was useful and informative. It provided detailed information on what could be collected, and an opportunity to modify indicator definitions to maximize response rates. These results are only applicable to those UAs returning results and cannot be generalized. Detailed interrogation of definitions is essential to this sort of data collection, and the process described was designed with cross-national comparability in mind. [ABSTRACT FROM AUTHOR]

Background: Freedom from discrimination is one of the key principles in a human rights-based approach to maternal and newborn health. Objective: To review the published evidence on discrimination against Romani women in maternity care in Europe, and on interventions to address this. Search strategy: A systematic search of eight electronic databases was undertaken in 2015 using the terms "Roma" and "maternity care". A broad search for grey literature included the websites of relevant agencies. Data extraction and synthesis: Standardised data extraction tables were utilised, quality was formally assessed and a line of argument synthesis was developed and tested against the data from the grey literature. Results: Nine hundred papers were identified; three qualitative studies and seven sources of grey literature met the review criteria. These revealed that many Romani women encounter barriers to accessing maternity care. Even when they are able to access care, they can experience discriminatory mistreatment on the basis of their ethnicity, economic status, place of residence or language. The grey literature revealed some health professionals held underlying negative beliefs about Romani women. There were no published research studies examining the effectiveness of interventions to address discrimination against Romani women and their infants in Europe. The Roma Health Mediation Programme is a promising intervention identified in the grey literature. Conclusions: There is evidence of discrimination against Romani women in maternity care in Europe. Interventions to address discrimination against childbearing Romani women and underlying health provider prejudice are urgently needed, alongside analysis of factors predicting the success or failure of such initiatives. [ABSTRACT FROM AUTHOR]

In the past decade, policy‐makers in science have been concerned with harmonizing research integrity standards across Europe. These standards are encapsulated in the European Code of Conduct for Research Integrity. Yet, almost every European country today has its own national‐level code of conduct for research integrity. In this study we document in detail how national‐level codes diverge on almost all aspects concerning research integrity—except for what constitutes egregious misconduct. Besides allowing for potentially unfair responses to joint misconduct by international collaborations, we argue that the divergences raise questions about the envisaged self‐regulatory function of the codes of conduct. [ABSTRACT FROM AUTHOR]

Background: During the COVID-19 pandemic, effective contact tracing was recognized as a crucial public health response to mitigate the spread of SARS-CoV-2 and reduce COVID-19-related morbidity and mortality, particularly before widespread vaccination. The World Health Organization (WHO) recommended implementing active surveillance strategies to trace and quarantine contacts of confirmed or suspected COVID-19 cases. Methods: A detailed review and analysis of the COVID-19 contact tracing responses was conducted in five European countries and territories, between March 2021 and August 2022. The countries and territories were selected to ensure geographical representation across the WHO European Region and applied a mixed-methods approach of in-depth interviews with various stakeholders across different administrative levels to identify good practices in COVID-19 contact tracing. The interviews covered 12 themes, including methods and procedures for COVID-19 contact tracing, information technology, quality assurance and key performance indicators. Results: The findings demonstrate that the policy approach, digitalization capabilities and implementation approach varied in the countries and territories and were dynamic throughout the pandemic. The analysis revealed that some practices were applicable across all countries and territories, while others were context-specific, catering to each country's and territory's unique needs. The study highlighted a need for all countries to institutionalize contact tracing as an essential function of existing health systems, to digitalize contact tracing practices and processes, and to build and retain contact tracing capacities for better pandemic preparedness. Conclusion: The lessons related to COVID-19 contact tracing should be utilized to strengthen future outbreak response operations as part of epidemic and pandemic preparedness. [ABSTRACT FROM AUTHOR]