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An editorial is presented in which the editor refers to the articles ‘SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe' and ‘SCORE2-OP risk prediction algorithms: estimating incident cardiovascular event risk in older persons in four geographical risk regions'. Topics of discussion includes reason to understand the risk and its calculation.

Aims: Conflicting results have been reported regarding the effect of beta-blockers on first-registered heart rhythm in out-of-hospital cardiac arrest (OHCA). We aimed to establish whether the use of beta-blockers influences first-registered rhythm in OHCA.Methods and Results: We included patients with OHCA of presumed cardiac cause from two large independent OHCA-registries from Denmark and the Netherlands. Beta-blocker use was defined as exposure to either non-selective beta-blockers, β1-selective beta-blockers, or α-β-dual-receptor blockers within 90 days prior to OHCA. We calculated odds ratios (ORs) for the association of beta-blockers with first-registered heart rhythm using multivariable logistic regression. We identified 23 834 OHCA-patients in Denmark and 1584 in the Netherlands: 7022 (29.5%) and 519 (32.8%) were treated with beta-blockers, respectively. Use of non-selective beta-blockers, but not β1-selective blockers, was more often associated with non-shockable rhythm than no use of beta-blockers [Denmark: OR 1.93, 95% confidence interval (CI) 1.48-2.52; the Netherlands: OR 2.52, 95% CI 1.15-5.49]. Non-selective beta-blocker use was associated with higher proportion of pulseless electrical activity (PEA) than of shockable rhythm (OR 2.38, 95% CI 1.01-5.65); the association with asystole was of similar magnitude, although not statistically significant compared with shockable rhythm (OR 2.34, 95% CI 0.89-6.18; data on PEA and asystole were only available in the Netherlands). Use of α-β-dual-receptor blockers was significantly associated with non-shockable rhythm in Denmark (OR 1.21; 95% CI 1.03-1.42) and not significantly in the Netherlands (OR 1.37; 95% CI 0.61-3.07).Conclusion: Non-selective beta-blockers, but not β1-selective beta-blockers, are associated with non-shockable rhythm in OHCA. [ABSTRACT FROM AUTHOR]

Purpose To describe: (i) patterns of self-employment and social welfare provisions for self-employed and salaried workers in several European countries; (ii) work-related outcomes after cancer in self-employed people and to compare these with the work-related outcomes of salaried survivors within each sample; and (iii) work-related outcomes for self-employed cancer survivors across countries. Methods Data from 11 samples from seven European countries were included. All samples had cross-sectional survey data on work outcomes in self-employed and salaried cancer survivors who were working at time of diagnosis (n = 22–261 self-employed/101–1871 salaried). The samples included different cancers and assessed different outcomes at different times post-diagnosis. Results Fewer self-employed cancer survivors took time off work due to cancer compared to salaried survivors. More self-employed than salaried survivors worked post-diagnosis in almost all countries. Among those working at the time of survey, self-employed survivors had made a larger reduction in working hours compared to pre-diagnosis, but they still worked more hours per week post-diagnosis than salaried survivors. The self-employed had received less financial compensation when absent from work post-cancer, and more self-employed, than salaried, survivors reported a negative financial change due to the cancer. There were differences between self-employed and salaried survivors in physical job demands, work ability and quality-of-life but the direction and magnitude of the differences differed across countries. Conclusion Despite sample differences, self-employed survivors more often continued working during treatment and had, in general, worse financial outcomes than salaried cancer survivors. Other work-related outcomes differed in different directions across countries. [ABSTRACT FROM AUTHOR]

Self-employment-the so-called flexible layer of the economy-has gained importance following the 2007-2008 global economic and financial crisis. In Europe, the self-employed now comprise on average 15% of workers [Eurostat, Labour market and Labour force survey (LFS) statistics, 2016]. Around one-third of self-employed people also provide jobs for others [European Commission, Fact Sheet. 2015 Employment and Social Developments in Europe Review: frequently asked questions, 2016]. Moreover, this group of workers adapts quickly to changing circumstances. In the UK, for instance, recent growth in self-employment is considered to have made an important contribution to labour market recovery [Hatfield, Self-employment in Europe. London, Institute of Public Policy Research, 2015]. Across the European Union self-employment is viewed as a key enabler of sustainable economic growth and, reflecting this, the Europe 2020 strategy encourages member states both to promote self-employment and to remove measures that discourage it [Library of the European Parliament, Self-employment and social security. Effects on innovation and economic growth, 2013]. [ABSTRACT FROM AUTHOR]

A new species of Fusarium, Fusarium langsethiae, is described, illustrated and discussed. This species is isolated from kernels of oats, wheat and barley in several European countries. Morphologically, the species resembles Fusarium poae. It is differentiated from F. poae by slower growth, less aerial mycelium and absence of odour; its napiform or globose conidia are borne in the aerial mycelium on the agar surface on often bent phialides which exhibit sometimes more than one opening, whereas those of F. poae are produced on straight monophialides mostly in the aerial mycelium. No sporodochial conidia are formed by F. langsethiae even under near-UV light (nUV). Based on morphological characters, the species is placed in the section Sporotrichiella. [Copyright &y& Elsevier]

The article focuses on the study depicting the methylisothiazolinone (MI) epidemic in Europe. It mentions that MI lead to epidemic of allergic contact dermatitis. It offers information on test of Mi at the Department of Dermatovenerology. Information on multiple contact allergies among patients is presented.

European defence policy offers opportunities for spending more and better where better achieves more from existing resources. Increased defence spending needs to be justified by the threats to Europe which have to be identified and defined. Higher defence expenditure usually focuses on inputs rather than final outputs in the form of greater peace, protection, security and the safety of a nation's citizens. The task is to show the opportunities for applying economic analysis to the complexities of European defence policy and collaborative defence projects. Economic efficiency criteria identify the contribution of final outputs, substitution and competition to the formulation of European defence policy, but the final outcomes are likely to be determined by military-political factors rather than economic efficiency criteria. The paper provides a critique of European defence policy. [ABSTRACT FROM AUTHOR]

The urgent need to mitigate greenhouse gas (GHG) emissions has prompted the exploration of various strategies, including the adaptation of carbon farming practices, to achieve sustainability in agricultural systems. In this research, we assess the viability of carbon farming practices for organic vegetable growing in Europe. The study explores the potential benefits of these practices, including GHG emissions' mitigation and improved soil health, biodiversity, and ecosystem services, while also acknowledging the need for further research to optimize implementation strategies and foster widespread adoption. However, the suitability and effectiveness of carbon farming practices in organic vegetable production systems remain uncertain. The analysis considers the measurement and estimation methods employed to assess changes in soil carbon stocks and the potential environmental and economic implications for farmers. Despite a substantial body of data demonstrating the sustainable attributes of carbon farming and its multifaceted advantages, a degree of hesitancy persists. Considering this, we propose undertaking a concise strengths, weaknesses, opportunities, and threats (SWOT) analysis to evaluate multiple aspects of carbon farming. The findings reveal that carbon farming practices can be viable and advantageous in organic vegetable production. Carbon farming practices, such as cover cropping, reduced tillage, compost application, and agroforestry, can significantly enhance the sustainability of organic farming systems. Implementing these practices can mitigate greenhouse gas emissions, improve soil health and fertility, and promote biodiversity conservation. Farmer education and support, policy measures, and continued research are crucial for maximizing the potential of these practices for a sustainable future. These practices also contribute to developing climate-friendly agricultural systems, promoting environmental resilience, and reducing the ecological footprint of organic vegetable production. However, further research is needed to optimize implementation strategies, address site-specific challenges, and foster widespread adoption of carbon farming practices in organic vegetable production. [ABSTRACT FROM AUTHOR]

Background Few large-scale, comparative studies have examined both the positive mental well-being outcomes of work–life balance and the broader socio-economic context by which it is shaped. Therefore, the aim of this study was to investigate the association between work–life balance and work engagement across a wide range of European welfare states, as well as to examine whether work – life balance varies across European countries and whether this variance can be explained by welfare regime, controlling for individual-level factors. Methods This study utilized data from the 2015 European Working Conditions Survey. In total, 35 401 workers from 30 European countries could be classified into the adopted welfare regime typology. Work engagement was measured using an ultra-short version of the Utrecht Work Engagement Scale, and work–life balance with a question on the fit between working hours and family or social commitments. Due to the hierarchical structure of the data, multilevel regression models were applied. Results A statistically significant positive association between work–life balance and work engagement across the European workforce was found. Between-country variance in work–life balance was demonstrated and this can in part be explained by welfare regime. Conclusions While it has long been recognized that occupational stress and work-related mental health problems are shaped by the socio-economic context and thus regarded as public health concerns in Europe, our results suggest that this applies to well-being at work and related support factors as well. [ABSTRACT FROM AUTHOR]

Elymus repens (L.) Gould), Cirsium arvense (L.) Scop. and Sonchus arvensis L. are important arable creeping perennial weeds in Europe. These are clonal plants with subterranean reproductive organs (E. repens, rhizomes, the two dicots, horizontal creeping roots) sprouting from ramets. We tested the sprouting ability and early growth of ramet sprouts at temperatures typical for Nordic autumn climate and with different preconditions of the mother plant (time in autumn, mother plant age, climate change experiences of the mother plants (two experiments)). The species reacted differently, with S. arvensis not sprouting at all, and C. arvense ramets sprouting at higher temperatures than those of E. repens, which sprouted at all tested temperatures. Plant age affected only the ramet sprout biomass of E. repens. Climate change during mother plant growth only affected C. arvense, with the highest above-ground biomass of the sprouted ramets at an elevated temperature and ambient CO2. Testing earlier in autumn showed more sprouting and biomass for C. arvense and E. repens than testing later in the season. The observed temperature responses confirmed more and bigger sprouts with higher autumn temperatures. Controlling the sprouted ramets in autumn is easier for E. repens than for C. arvensis. Due to their low/no sprouting ability in autumn, the ramets of S. arvensis cannot be controlled in autumn. [ABSTRACT FROM AUTHOR]

In this paper, we assess the development of financial participation schemes, employee share ownership and profit‐sharing in selected European countries and the degree to which they are correlated with strategic human resource management, and industrial relations, that is collective bargaining, unionization and works councils, and national context. This study adds a more dynamic perspective to the literature on the incidence of financial participation by using a longitudinal approach rarely found before. Our hypotheses are based on the theoretical frameworks of strategic human resource management (HRM), industrial relations and institutional approach. We use data drawn from the waves of the Cranet surveys on Human Resource Management: 1999/2000, 2005/06, 2010/11 and 2015/16. We find that both time and national location are important. The national context matters in particularly for profit‐sharing and less for employee share ownership. For both forms of financial participation, the country regulative context is also more important than industrial relations factors and HRM strategies. In general, industrial relation factors gain importance over time and become more important than the HRM strategy for employee share ownership (ESO) but not for profit‐sharing (PS). In general, over the whole period, commitment HRM is more important for the incidence of ESO and PS than control HRM, but the relative importance of these strategies varies per year. [ABSTRACT FROM AUTHOR]

Barley is an important crop grown annually on about 55 Mha and intensively cultivated in Europe. In central and north-western Europe, spring and winter barley can be grown in similar environments which creates suitable conditions for the development of barley pathogens, including Blumeria graminis f. sp. hordei, the causal agent of powdery mildew. Apart from pesticide application, it can be controlled by inexpensive and environmentally-friendly genetic resistance. In this contribution, results of the resistance gene identification in 58 barley cultivars to powdery mildew are presented. In 56 of them their resistances were postulated and in two hybrid cultivars a recently developed method of gene identification was used. In total, 18 known resistance genes were found and several unknown genes were detected. In spring barley, a gene of durable resistance mlo is still predominant. MlVe found in winter SU Celly was the only new resistance gene recorded in barley cultivars registered in the Czech Republic in this time span. Since 2001 eight new genes of specific resistance have been identified in cultivars registered in the country and their response under field conditions is discussed, including the corresponding responses of the pathogen population due to directional selection. Different strategies for breeding spring and winter barley are recommended. [ABSTRACT FROM AUTHOR]

Aims and Objectives: This systematic review and meta‐analysis reports the seroprevalence of SARS‐CoV‐2 antibodies among nurses. Background: With a growing body of literature reporting the positive serology for SARS‐CoV‐2 antibodies among healthcare workers, it remains unclear whether staff at the point of direct patient care are more prone to developing and transmitting the virus. Given nurses make up the majority of the global health workforce, outbreaks among these workers could severely undermine a health system's capability to manage the pandemic. We aimed to summarise and report the seroprevalence of SARS‐CoV‐2 antibodies among nurses globally. Design: Systematic review and meta‐analyses. Methods: This systematic review was developed, undertaken and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guideline. We searched the electronic medical literature databases: MEDLINE; CINAHL; and EMBASE for studies reporting the seroprevalence of SARS‐CoV‐2 antibodies among nursing staff. Studies that reported nursing specific data were included in this review. Study quality was evaluated using the Joanna Briggs Institute checklist for studies reporting prevalence data. Studies were stratified according to the World Health Organisation region classifications, and results were presented using forest plots and summary prevalence and variance was estimated using a random effects model. Results: Our electronic search identified 1687 potential studies, of which 1148 were screened for eligibility after duplicates were removed, and 51 of the studies were included in our meta‐analysis. The overall seroprevalence of SARS‐CoV‐2 antibodies among nurses was estimated to be 8.1% (95% CI 6.9%–9.4%) among the 60,571 participants included in the studies. Seropositivity was highest in the African region (48.2%, 95% CI 39.2%–57.3%), followed by the European region (10.3%, 95% CI 8.0%–12.5%), the Region of the Americas (8.4%, 95% CI 6.0%–10.7%), the South‐East Asia region (3.0%, 95% CI 0.00%–6.5%) and the Western Pacific region (0.5%, 95% CI 0.0%–1.0%). Pooled estimates were unable to be calculated in the Eastern Mediterranean region due to insufficient studies. Conclusion: The seroprevalence of SARS‐CoV‐2 antibodies among nurses is comparable to other healthcare workers, and possibly similar to the general population. Early adoption and adherence to personal protective equipment and social distancing measures could explain these similarities, meaning the majority of staff contracted the virus through community transmission and not in a healthcare setting. Relevance to clinical practice: Fear and uncertainty have been features of this pandemic, including among nurses. This meta‐analysis should provide some comfort to nurses that risks are similar to community exposure when adequate PPE is available and there is an adherence to infection control measures. [ABSTRACT FROM AUTHOR]

The concept of 'patient involvement' is highlighted in healthcare. However, hindrances can prevent its implementation. This article explored how 'patient involvement' is understood and on what ideas this understanding is based through a critical textual analysis of the European document on patient involvement in health systems using a Fairclough-inspired critical discourse analysis. The findings showed that the document arose from a social discourse based on a mix of a neoliberal ideology, with a marketisation of care focusing on a cost-effective and evidence-based logic of care, and a humanistic ideology of patient involvement. It had the form of a normative, consensus-based standard, supported by European organisations. The document incorporated a visionary, well-intentioned abstract guide to promote patient involvement across European care contexts, however without addressing hindrances nor differences across the contexts in which it ought to be implemented. It raises questions about its usability, inviting further research into empirical applications. [ABSTRACT FROM AUTHOR]

This essay analyzes how public figures became accessories and what audiences gained from that accessorization. It argues that the development of three visual technologies—lithography, carte-de-visite photography, and the twinned impact of photojournalism and brand name commercial images—materially contributed to a solipsism of equivalence in the German consumer. Social and political celebrities became glamourous accessories to be appropriated metonymically, playfully, and temporarily, through a highly individualized pursuit of the self in consumerism and in ways that privileged the affect world of the spectators. Focusing on material culture, specifically in the form of lithographs, photographs and their albums, and celebrity-branded consumer goods, the essay examines the mediatization and expansion of consumerism that accompanied the economic upturn of the 1890s, as the ability to eat, wear, and otherwise consume celebrity-branded goods intensified the accessorization of celebrities, including politicians and other public figures. [ABSTRACT FROM AUTHOR]

The prevalence of type 2 diabetes mellitus (T2DM) is increasing worldwide, and physical activity (PA) is a suitable way of preventing and managing the disease. However, improving long‐term levels of PA in people with T2DM is a challenge and the best approach to rehabilitation in this regard is unknown. With the aim of outlining the existing knowledge regarding the maintenance of active lifestyles among people with T2DM after rehabilitation programs and gaining knowledge about options and challenges for their long‐term engagement in PA, a systematic review of original research articles assessing PA after rehabilitation programs was conducted. Two thousand two hundred and forty‐one articles were identified through PubMed or secondary sources and subjected to various inclusion criteria. Only articles published between the 1st of January 2000 and the 30th of June 2020 were considered. Additionally, the minimum time frame from intervention start to last PA assessment was 6 months and only articles based on interventions performed in Europe were included. The review was based on eighteen randomized controlled trials, four randomized trials without control, and four case studies. The 26 articles described 30 interventions that were categorized as personalized counseling, generalized teaching, supervised exercise, or a combination of personalized and generalized interventions. Statistical and narrative syntheses revealed no clear pattern regarding the effectiveness in eliciting maintained changes in PA. However, across categories, individual involvement, goal setting, social support, and the formation of habits are argued to be important components in sustaining PA and relieving challenges associated with the transition out of rehabilitation programs. [ABSTRACT FROM AUTHOR]

Aims: Liquid chromatography‐mass spectrometry (LC‐MS/MS) is an objective new technique to assess non‐adherence to medications. We used this method to study the prevalence, predictors and outcomes of non‐adherence in patients with heart failure with reduced left ventricular ejection fraction (HFrEF). Methods and results: This study included 1296 patients with HFrEF from BIOSTAT‐CHF, a study that aimed to optimise guideline‐recommended therapies. Angiotensin‐converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARBs), mineralocorticoid receptor antagonists, β‐blockers and loop diuretics were measured in a single spot urine sample at 9 months using LC‐MS/MS. The relationship between medication non‐adherence and the composite endpoint of all‐cause death or heart failure hospitalisation, over a median follow‐up of 21 months, was evaluated. Non‐adherence to at least one prescribed medication was observed in 45.9% of patients. The strongest predictor of non‐adherence was non‐adherence to any of the other medication classes (P < 0.0005). Regional differences within Europe were observed. On multivariable analyses, non‐adherence to ACEi/ARBs and β‐blockers was associated with an increased risk of the composite endpoint [hazard ratio (HR) 1.38, 95% confidence interval (CI) 1.09–1.95, P = 0.008 and HR 1.48, 95% CI 1.12–1.96, P = 0.006, respectively). Non‐adherence to β‐blockers was also associated with an increased risk of death (HR 2.48, 95% CI 1.67–3.68, P < 0.0005). Patients who were non‐adherent to loop diuretics were healthier and had a decreased risk of the composite endpoint (HR 0.69, 95% CI 0.51–0.93, P = 0.014). Non‐adherence to mineralocorticoid receptor antagonists was not related to any clinical outcome. Conclusion: Non‐adherence to medications, assessed by a single urine test, is common and predicts clinical outcomes in patients with HFrEF. [ABSTRACT FROM AUTHOR]

Improving vaccination of the elderly is one of the most important challenges in the coming years, as it was for infant's decades ago. Insufficient vaccine uptake in the elderly can be considered a concern with regard to the burden of vaccine preventable diseases in this growing population. The purpose of this paper is to have an overview on the different steps involved in decision policy making from the regulatory agencies until people are vaccinated. Examples of different policies within European countries will be compared for influenza, streptococcal and zoster infections. For each step, key improvements to increase vaccine uptake in this specific population will be proposed. [ABSTRACT FROM AUTHOR]

No official data exist on the status of musculoskeletal (MSK) radiology in Europe. The Committee for National Societies conducted an international survey to understand the status of training, subspecialization, and local practice among the European Society of Musculoskeletal Radiology (ESSR) partner societies. This article reports the results of that survey. An online questionnaire was distributed to all 26 European national associations that act as official partner societies of the ESSR. The 24 questions were subdivided into six sections: society structure, relationship with the national radiological society, subspecialization, present radiology practice, MSK interventional procedures, and MSK ultrasound. The findings of our study show a lack of standardized training and/or accreditation methods in the field of MSK radiology at a national level. The European diploma in musculoskeletal radiology is directed to partly overcome this problem; however, this certification is still underrecognized. Using certification methods, a more homogeneous European landscape could be created in the future with a view to subspecialist training. MSK ultrasound and MSK interventional procedures should be performed by a health professional with a solid knowledge of the relevant imaging modalities and sufficient training in MSK radiology. Recognition of MSK radiology as an official subspecialty would make the field more attractive for younger colleagues as well as attracting the brightest and best, an important key to further development of both clinical and academic radiology. KEY POINTS: · Standardized training and/or accreditation methods in the field of MSK radiology is lacking at a national level.. · With certification methods, such as the European diploma in musculoskeletal radiology, a more homogeneous European landscape could be created in the future with a view to subspecialist training.. · Recognition of MSK radiology as an official subspecialty would make the field more attractive for younger colleagues as well as attracting the brightest and best, an important key to further development of both clinical and academic radiology.. [ABSTRACT FROM AUTHOR]

Purpose: Little is known about return to work (RTW) of cancer survivors (CSs) in Central and Southern Europe. This study investigates the RTW rate of Italian CSs, describes their sick leave (SL) pattern, and explores factors affecting their RTW process.Methods: A population-based cross-sectional survey involving CSs registered at the Cancer Registry of Reggio Emilia Province (Italy) was launched in July 2016. Eligibility was restricted to individuals with first diagnosis of cancer in 2012 (stages I-III), aged 20-59, and employed at the time of diagnosis.Results: Of the 266 individuals interviewed, 140 (52.6%) were reintegrated without difficulty, 113 (42.5%) returned to work with some difficulty, and 13 did not RTW (4.9%). The majority of CSs (56%) took SL for some periods during treatment. Age > 50 years and higher income seemed to facilitate RTW (RR = 0.65, 95% CI 0.49-0.88 and RR = 0.72, 95% CI 0.54-0.97, respectively), while being divorced acted as a barrier compared to being married (RR = 1.45, 95% CI 1.04-2.01). Individuals uncertain about the type of company they were working for reported greater difficulty in RTW (RR = 1.68, 95% CI 1.03-2.72). Individuals who had undergone chemotherapy and those perceiving physical limitations had a higher risk of difficulty in the RTW process (RR = 1.79, 95% CI 1.42-2.24 and RR = 1.59, 95% CI 1.25-2.02, respectively).Conclusions: Most CSs did RTW, with 2/3 combining work and treatment. However, almost half reported difficulty in RTW process. Factors affecting this process should be addressed throughout context-specific social and healthcare pathways aimed at preventing difficulties and potential job loss in this population. [ABSTRACT FROM AUTHOR]

Background: With climate change, heat waves are expected to become more frequent in the near future. Already, on average more than 25 000 "heat deaths" are estimated to occur in Europe every year. However, heat stress and heat illnesses arise not just when ambient temperatures are high. Physical exertion increases heat production within the organism many times over; if not enough heat is lost, there is a risk of exertional heat stress. This review article discusses contributing factors, at-risk groups, and the diagnosis and treatment of heat illnesses. Methods: A selective literature search was carried out on PubMed. Current guidelines and expert recommendations were also included. Results: Apart from muscular heat production (>70% of converted energy), there are other factors that singly or in combination can give rise to heat stress: clothing, climate/acclimatization, and individual factors. Through its insulating properties, clothing reduces the evaporation of sweat (the most effective physiological cooling mechanism). A sudden heat wave, or changing the climate zone (as with air travel), increases the risk of a heat-related health event. Overweight, low fitness level, acute infections, illness, dehydration, and other factors also reduce heat tolerance. In addition to children, older people are particularly at risk because of their reduced physiological adaptability, (multi-)morbidity, and intake of prescription drugs. A heat illness can progress suddenly to life-threatening heat stroke. Successful treatment depends on rapid diagnosis and cooling the body down as quickly as possible. The aim is to reduce core body temperature to <40 °C within 30 minutes. Conclusion: Immediately effective cooling interventions are the only causal treatment for heat stroke. Time once lost cannot be made up. Prevention (acclimatiza tion, reduced exposure, etc.) and terminating the heat stress in good time (e.g., stopping work) are better than any cure. [ABSTRACT FROM AUTHOR]

Introduction: Catheter ablation of atrial fibrillation (AF) has been recently shown to have an impact on the outcome of patients with heart failure and reduced LV ejection fraction (LVEF). We aimed to assess patients with reduced LVEF referred to catheter ablation of AF, and the efficacy and safety of this procedure compared with healthier patients. Methods: 2083 consecutive procedures of catheter ablation of AF in six centers were divided into two groups on the basis of LVEF (≤ vs >35%) and comparisons were performed regarding procedural safety and efficacy. Results: Only 51 (2.4%) of patients had low LVEF. Complication rate was comparable: 8.0% vs 6.9% (P = .760). Low LVEF patients are more frequently in persistent AF at the time of the procedure, have a higher degree of left atrial dilation, and higher CHA2DS2VASc score. The rate of atrial arrhythmia relapse post‐blanking period in the first 12 months was higher in the low LVEF group: 58.0% vs 37.6% (P < .001). During a median follow‐up of 14 months (IQR 5‐24), after adjusting for all baseline differences, AF duration, paroxysmal AF, CHA2DS2VASc score, BMI, and indexed LA volume were independent predictors of relapse. LVEF and LVEF ≤ 35% were not identified as predictors of relapse. Conclusions: Patients with reduced LVEF account for only a minority of patients undergoing catheter ablation of AF. However, ablation appears to be as safe as for the general population, and albeit the efficacy seems lower, this appears to be driven by other comorbidities or features, which are more frequent in this population. [ABSTRACT FROM AUTHOR]

Objectives: To update the 2012 European Society of Musculoskeletal Radiology (ESSR) clinical consensus guidelines for musculoskeletal ultrasound referral in Europe.Methods: Twenty-one musculoskeletal imaging experts from the ESSR participated in a consensus study based on a Delphic process. Two independent (non-voting) authors facilitated the procedure and resolved doubtful issues. Updated musculoskeletal ultrasound literature up to July 2017 was scored for shoulder, elbow, wrist/hand, hip, knee, and ankle/foot. Scoring of ultrasound elastography was included. The strength of the recommendation and level of evidence was scored by consensus greater than 67% or considered uncertain when the consensus was consensus less than 67%.Results: A total of 123 new papers were reviewed. No evidence change was found regarding the shoulder. There were no new relevant articles for the shoulder, 10 new articles for the elbow, 28 for the hand/wrist, 3 for the hip, 7 for the knee, and 4 for the ankle/foot. Four new evidence levels of A were determined, one for the hip (gluteal tendons tears), one for the knee (meniscal cysts), one for the ankle (ankle joint instability), and one for the foot (plantar plate tear). There was no level A evidence for elastography, although for Achilles tendinopathy and lateral epicondylitis evidence level was B with grade 3 indication.Conclusions: Four new areas of level A evidence were included in the guidelines. Elastography did not reach level A evidence. Whilst ultrasound is of increasing importance in musculoskeletal medical practice, the evidence for elastography remains moderate.Key Points: • Evidence and expert consensus shows an increase of musculoskeletal ultrasound indications. • Four new A evidence levels were found for the hip, knee, ankle, and foot. • There was no level A evidence for elastography. [ABSTRACT FROM AUTHOR]

Stable chest pain is a common clinical presentation that often requires further investigation using noninvasive or invasive testing, resulting in a resource-consuming problem worldwide. At onset of 2016, the National Institute for Health and Care Excellence (NICE) published an update on its guideline on chest pain. Three key changes to the 2010 version were provided by the new NICE guideline. First, the new guideline recommends that the previously proposed pretest probability risk score should no longer be used. Second, they also recommend that a calcium score of zero should no longer be used to rule out coronary artery disease (CAD) in patients with low pretest probability. Third, the new guideline recommends that all patients with new onset chest pain should be investigated with a coronary computed tomographic angiography (CTA) as a first-line investigation. However, in real world the impact of implementation of CTA for the evaluation of new onset chest pain remains to be evaluated, especially regarding its cost effectiveness. The aim of the present report was to discuss the results of the studies supporting new NICE guideline and its comparison with European and US guidelines. [ABSTRACT FROM AUTHOR]

This study investigates how flexibility in working hours affects retirement timing. It tests the assumption that decreasing weekly working hours delays retirement and extends working life. Using data from four waves of the Survey of Health, Ageing and Retirement in Europe (SHARE) and of the English Longitudinal Study of Ageing (ELSA), we analyze whether a shift from full-time to part-time work delays retirement. Results show that older workers who reduce their working hours retire earlier than those who stay in full-time employment. The effect is stronger in Central and Eastern Europe than in Scandinavian countries. No interaction effects for gender and work strain are found. We conclude that part-time work at the end of the career, as a means to extend working life, should be reevaluated. [ABSTRACT FROM AUTHOR]

Purpose: Chronic disease is often associated with a reduced energy level, which limits the capacity to work full-time. This study aims to investigate whether the construct work endurance is part of disability assessment in European countries and what assessment procedures are used. We defined work endurance as the ability to sustain working activities for a number of hours per day and per week. Materials and methods: We conducted a survey using two self-constructed questionnaires. We addressed 35 experts from 19 countries through the European Union of Medicine in Assurance and Social Security (EUMASS). We gathered descriptive data on various aspects of (the assessment of) work endurance. Results: Experts from 16 countries responded. In most countries work endurance is assessed. We found few professional guidelines specific for the assessment of work endurance. Both somatic and mental diseases may cause limited work endurance. Methods to assess work endurance vary, objective methods rating as most suitable. Almost half of the countries report controversies on the assessment of work endurance. Conclusions: Work endurance is recognised and assessed as an aspect of work disability assessment in Europe. However, controversies exist and evidence based guidelines, including reliable and valid methods to assess work endurance, are lacking. [ABSTRACT FROM AUTHOR]

Purpose: Return to work (RTW) of cancer survivors (CSs) fluctuates in different contexts. This systematic review searched for recent data on the RTW rate of CSs in Europe, investigating associated factors.Methods: Bibliographic search covered the period from January 2010 to February 2018, with no language restrictions. European population-based studies assessing RTW rate after cancer diagnosis were included. We excluded studies focusing on a specific cancer diagnosis.Results: Twelve observational studies were selected. The cohorts investigated included 280 to 46,720 individuals from Northwestern and Central Europe diagnosed with cancer from 1987 to 2010. The median interval between diagnosis and documented RTW was 2 years (0.2-23.4 years). RTW rates of CSs ranged from 39 to 77%. RTW of individuals employed at the time of diagnosis ranged from 60 to 92%, the latter registered in a sample with good prognosis. Personal factors, work-related factors, and cancer-related factors were all associated with RTW. Healthcare team interventions facilitated reintegration to work.Conclusions: Data from Mediterranean and Central European countries are urgently needed to understand whether RTW is an issue for CSs there as well and whether socio-rehabilitative interventions are required to mitigate the potential negative impact of cancer on individuals and society. [ABSTRACT FROM AUTHOR]

Abstract: Acid deposition arising from sulphur (S) and nitrogen (N) emissions from fossil fuel combustion and agriculture has contributed to the acidification of terrestrial ecosystems in many regions globally. However, in Europe and North America, S deposition has greatly decreased in recent decades due to emissions controls. In this study, we assessed the response of soil solution chemistry in mineral horizons of European forests to these changes. Trends in pH, acid neutralizing capacity (ANC), major ions, total aluminium (Altot) and dissolved organic carbon were determined for the period 1995–2012. Plots with at least 10 years of observations from the ICP Forests monitoring network were used. Trends were assessed for the upper mineral soil (10–20 cm, 104 plots) and subsoil (40–80 cm, 162 plots). There was a large decrease in the concentration of sulphate ( SO 4 2 −) in soil solution; over a 10‐year period (2000–2010), SO 4 2 − decreased by 52% at 10–20 cm and 40% at 40–80 cm. Nitrate was unchanged at 10–20 cm but decreased at 40–80 cm. The decrease in acid anions was accompanied by a large and significant decrease in the concentration of the nutrient base cations: calcium, magnesium and potassium (Bc = Ca2+ + Mg2+ + K+) and Altot over the entire dataset. The response of soil solution acidity was nonuniform. At 10–20 cm, ANC increased in acid‐sensitive soils (base saturation ≤10%) indicating a recovery, but ANC decreased in soils with base saturation >10%. At 40–80 cm, ANC remained unchanged in acid‐sensitive soils (base saturation ≤20%, pH CaCl 2 ≤ 4.5) and decreased in better‐buffered soils (base saturation >20%, pH CaCl 2 > 4.5). In addition, the molar ratio of Bc to Altot either did not change or decreased. The results suggest a long‐time lag between emission abatement and changes in soil solution acidity and underline the importance of long‐term monitoring in evaluating ecosystem response to decreases in deposition. [ABSTRACT FROM AUTHOR]

The article discusses the urban planning and extension of cities in Germany and Spain between 1848 and 1914, focusing particularly on how such improvements enhanced the perceptions and politics of place. Cities discussed include the Spanish cities of Barcelona, Madrid, and Valencia, as well as the German cities of Berlin, Munich, and Cologne. Topics include the influence of Paris, France city planner Georges-Eugène Haussmann on other European cities, the revolutions of 1848 and other uprisings, and photography of cityscapes.

The European Society of Cardiology (ESC) guidelines for management of atrial fibrillation (AF) recommend the use of CHA2DS2VASc risk score for assessment of thromboembolic (TE) risk, whereas the stratification of bleeding risk should be obtained by HAS-Bleed to balance the most appropriate anticoagulation (OAC) therapy. However, men with CHA2DS2VASc score= 1 and women with CHA2DS2VASc= 2, who are at intermediate TE risk, represent a grey zone where guidelines do not provide a definite OAC indication. Accordingly, implementation of risk stratification with echocardiography could be extremely useful. Both prospective and cross-sectional studies on transthoracic echocardiography (TTE) prediction of TE events and studies utilizing transoesophageal echocardiographic parameters as surrogate markers of TE events makes sustainable the hypothesis that echocardiography could improve TE prediction in non-valvular AF. Moreover, considering the close association of AF and stroke, all echo-Doppler parameters that have shown to predict AF onset and recurrence could be useful also to predict TE events in this clinical setting. Accordingly, EACVI AFib Echo Europe Registry has been designed as an observational, crosssectional study, with the aim of evaluating: (i) left atrial (LA) size and function together with left ventricular geometry, systolic and diastolic functions in paroxysmal, persistent, and permanent AF; (ii) relationships of structural/functional parameters with clinical TE and bleeding risk profile. By the AFib Echo Europe Registry, we expect to collect data on echocardiographic phenotype of patients with AF. The large data set accumulated will be useful to test the level of agreement of different echocardiographic measurements with the available risk scores. [ABSTRACT FROM AUTHOR]

Based on the storytelling tradition and analyses of conference material, this article provides an overview of the evolving Nordic Health Promotion Research Network (NHPRN) and its conferences over the last 20 years. The story goes from the planning of the first conference in Bergen, Norway, back in 1996 to the eighth conference in Jyväskylä, Finland, in 2016. There have been three phases of development. During the first phase, 1996–2007, the five first conferences were initiated and implemented by departments of public health in the Nordic countries. The World Health Organization (WHO) collaborative centres of Health Promotion in Bergen University and a group at Karolinska Institute, Department of Social Medicine, creating supportive environments for health in Stockholm played key roles in initiating and supporting NHPRN. During the second phase, 2007–2014, the network was strengthened and supported by the Nordic School of Public Health (NHV) in Gothenburg. The third phase started when NHV closed down in 2015 and networking activities were transferred to the European Office of WHO in Copenhagen. The Nordic Health Promotion Research Conference series has served several purposes and will continue to do so. They are important Nordic meeting places, stimulating Health Promotion research, as well as explicitly managing ongoing concerns in the international Health Promotion community. This is reflected in the shift of foci over time. The content of the conferences has been highly responsive to whatever challenges are particularly relevant at different points in time, while also contributing to developing Health Promotion as a discipline, given that every conference has built on the previous ones. [ABSTRACT FROM AUTHOR]

Contrast echocardiography is widely used in cardiology. It is applied to improve image quality, reader confidence and reproducibility both for assessing left ventricular (LV) structure and function at rest and for assessing global and regional function in stress echocardiography. The use of contrast in echocardiography has now extended beyond cardiac structure and function assessment to evaluation of perfusion both of the myocardium and of the intracardiac structures. Safety of contrast agents have now been addressed in large patient population and these studies clearly established its excellent safety profile. This document, based on clinical trials, randomized and multicentre studies and published clinical experience, has established clear recommendations for the use of contrast in various clinical conditions with evidence-based protocols. [ABSTRACT FROM AUTHOR]

Introduction: Data on management of atrial fibrillation (AF) in the Balkan Region are scarce. To capture the patterns in AF management in contemporary clinical practice in the Balkan countries a prospective survey was conducted between December 2014 and February 2015, and we report results pertinent to the use of non-vitamin K antagonist oral anticoagulants (NOACs).Methods: A 14-week prospective, multicenter survey of consecutive AF patients seen by cardiologists or internal medicine specialists was conducted in Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Montenegro, Romania, and Serbia (a total of about 50 million inhabitants).Results: Of 2712 enrolled patients, 2663 (98.2%) had complete data relevant to oral anticoagulant (OAC) use (mean age 69.1 ± 10.9 years, female 44.6%). Overall, OAC was used in 1960 patients (73.6%) of whom 338 (17.2%) received NOACs. Malignancy [odds ratio (OR), 95% confidence interval (CI) 2.06, 1.20-3.56], rhythm control (OR 1.64, 1.25-2.16), and treatment by cardiologists were independent predictors of NOAC use (OR 2.32, 1.51-3.54) [all p < 0.01)], whilst heart failure and valvular disease were negatively associated with NOAC use (both p < 0.01). Individual stroke and bleeding risk were not significantly associated with NOAC use on multivariate analysis.Conclusions: NOACs are increasingly used in AF patients in the Balkan Region, but NOAC use is predominantly guided by factors other than evidence-based decision-making (e.g., drug availability on the market or reimbursement policy). Efforts are needed to establish an evidence-based approach to OAC selection and to facilitate the optimal use of OAC, thus improving the outcomes in AF patients in this large region. [ABSTRACT FROM AUTHOR]

Background: The European Low-Grade Glioma network indicated a need to better understand common practices regarding the managing of diffuse low-grade gliomas. This area has experienced great advances in recent years. Method: A general survey on the managing of diffuse low-grade gliomas was answered by 21 centres in 11 European countries. Here we focused on specific questions regarding perioperative and intraoperative cognitive assessments. Results: More centres referred to the same speech and language therapist and/or neuropsychologist across all assessments; a core of assessment tools was routinely used across centres; fluency tasks were commonly used in the perioperative stages, and object naming during surgery; tasks that tapped on attention, executive functions, visuospatial awareness, calculation and emotions were sparsely administered; preoperative assessments were performed 1 month or 1 week before surgery; timing for postoperative assessments varied; finally, more centres recommended early rehabilitation, whenever needed. Conclusions: There is an emerging trend towards following similar practices for the management of low-grade gliomas in Europe. Our results are descriptive and formalise current discussions in our group. Also, they contribute towards the development of a European assessment protocol. [ABSTRACT FROM AUTHOR]

The article presents 2016 European Guidelines on cardiovascular disease (CVD) prevention in clinical practice by Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. Topics discussed include assessment of total CVD risk, measurement of preclinical vascular damage and treatment of patients for cancer.

This study investigates whether older workers have adapted their preferred retirement age to the pension reforms aimed at extending working life. Based on data from Eurobarometer and the European Social Survey in 12 European countries, the analysis shows that future pensioners have indeed increased their preferred retirement age and adjusted to the new credo of late retirement. However, the strength of the increase was found to vary between different groups of older workers: It is much stronger for the higher-educated than for the lower-educated. This finding supports recent concerns regarding the reemergence of social inequality in the retirement process. [ABSTRACT FROM AUTHOR]

The article proposes a synthesis of the major historical works on nineteenth-century European borders. Founded on an original methodological approach, the article advances a rethinking of the concept of 'territoriality' traditionally attributed to the rise of modern nation-states. The innovative method adopted is based on combining the focus on spatiality in recent historiography - especially in global history - with the categories and the ethnographic method developed within the border-studies field. The analysis is conducted in two directions. The first focuses on 'borders', specifically on some bordercreation processes developing throughout the European continent. The second is more centred on European 'borderlands', conceived as trans-state and trans-national regions, mainly linked to the space's well-established social practices, familial and economic networks and religious experience. On the one hand, the article highlights how nineteenth-century borders were not simply the product of an institutional decision performed by emerging nation-states, but also the result of an interactive dialectic between state institutions and social actors inhabiting the borderlands. On the other, it shows how the borderlands as cross-border territorial entities continued to exist alongside the new territorial state limits, helping shape a more complex European spatiality than traditionally stated. [ABSTRACT FROM AUTHOR]

Dissolved organic carbon (DOC) in surface waters is connected to DOC in soil solution through hydrological pathways. Therefore, it is expected that long-term dynamics of DOC in surface waters reflect DOC trends in soil solution. However, a multitude of site studies have failed so far to establish consistent trends in soil solution DOC, whereas increasing concentrations in European surface waters over the past decades appear to be the norm, possibly as a result of recovery from acidification. The objectives of this study were therefore to understand the long-term trends of soil solution DOC from a large number of European forests (ICP Forests Level II plots) and determine their main physicochemical and biological controls. We applied trend analysis at two levels: (1) to the entire European dataset and (2) to the individual time series and related trends with plot characteristics, i.e., soil and vegetation properties, soil solution chemistry and atmospheric deposition loads. Analyses of the entire dataset showed an overall increasing trend in DOC concentrations in the organic layers, but, at individual plots and depths, there was no clear overall trend in soil solution DOC. The rate change in soil solution DOC ranged between -16.8 and =23%yr-1 (medianD C0.4%yr-1/across Europe. The non-significant trends (40 %) outnumbered the increasing (35 %) and decreasing trends (25 %) across the 97 ICP Forests Level II sites. By means of multivariate statistics, we found increasing trends in DOC concentrations with increasing mean nitrate (NO3-/deposition and increasing trends in DOC concentrations with decreasing mean sulfate (SO42-/deposition, with the magnitude of these relationships depending on plot deposition history. While the attribution of increasing trends in DOC to the reduction of SO42- deposition could be confirmed in low to medium N deposition areas, in agreement with observations in surface waters, this was not the case in high N deposition areas. In conclusion, longterm trends of soil solution DOC reflected the interactions between controls acting at local (soil and vegetation properties) and regional (atmospheric deposition of SO42- and inorganic N) scales. [ABSTRACT FROM AUTHOR]

Objectives: To study the responsiveness of a combined power Doppler and greyscale ultrasound (PDUS) score for assessing synovitis in biologic-naïve patients with rheumatoid arthritis (RA) starting abatacept plus methotrexate (MTX).Methods: In this open-label, multicentre, single-arm study, patients with RA (MTX inadequate responders) received intravenous abatacept (∼10 mg/kg) plus MTX for 24 weeks. A composite PDUS synovitis score, developed by the Outcome Measures in Rheumatology-European League Against Rheumatism (OMERACT-EULAR)-Ultrasound Task Force, was used to evaluate individual joints. The maximal score of each joint was added into a Global OMERACT-EULAR Synovitis Score (GLOESS) for bilateral metacarpophalangeal joints (MCPs) 2-5 (primary objective). The value of GLOESS containing other joint sets was explored, along with clinical efficacy.Results: Eighty-nine patients completed the 24-week treatment period. The earliest PDUS sign of improvement in synovitis was at week 1 (mean change in GLOESS (MCPs 2-5): -0.7 (95% CIs -1.2 to -0.1)), with continuous improvement to week 24. Early improvement was observed in the component scores (power Doppler signal at week 1, synovial hyperplasia at week 2, joint effusion at week 4). Comparable changes were observed for 22 paired joints and minimal joint subsets. Mean Disease Activity Score 28 (C reactive protein) was significantly reduced from weeks 1 to 24, reaching clinical meaningful improvement (change ≥1.2) at week 8.Conclusions: In this first international prospective study, the composite PDUS score is responsive to abatacept. GLOESS demonstrated the rapid onset of action of abatacept, regardless of the number of joints examined. Ultrasound is an objective tool to monitor patients with RA under treatment.Trial Registration Number: NCT00767325. [ABSTRACT FROM AUTHOR]

Background: Stroke prevention in dialysis-dependent patients with atrial fibrillation (AF) is an unresolved clinical dilemma. Indeed, no randomized controlled trial evaluating the efficacy and safety of oral anticoagulants in this population, has been conducted so far. Observational research on the use of warfarin in patients on dialysis has shown conflicting results. This uncertainty is mirrored by the wide variations in warfarin prescription patterns across centers. We sought to evaluate the association between the use of vitamin K antagonists (VKAs) and mortality among hemodialysis patient with AF and to assess potential factors affecting the risk-benefit profile of warfarin in this population.Methods: A total of 91,987 patients registered in the European Clinical Dialysis Database® system from January 2004 to January 2015. Of which, 9,238 patients were identified with a diagnosis of AF. After excluding ineligible patients, a 1:1 propensity score matched cohort of 1,324 warfarin users and non-users were assembled.Results: VKA use was associated with both increased 90-day survival (hazard ratio, HR 0.47, p < 0.01) and 6-year survival (HR 0.76, p < 0.01); however, a trend indicated a stronger early benefit (p for time-interaction <0.01). Moderation analysis showed that patients' age and clinical history of stroke strongly influenced warfarin-related benefits on survival.Conclusion: VKA may provide an early survival benefit; however, this is partially offset later during the follow-up. In addition, heterogeneous risk-benefit profiles were observed among subgroups of dialysis-dependent patients with AF, further emphasizing the complexities of tailoring stroke prevention strategies in this population. [ABSTRACT FROM AUTHOR]

Pharmacotherapy directed toward reducing body weight may provide benefits for both curbing obesity and lowering the risk of obesity-associated comorbidities; however, many weight loss medications have been withdrawn from the market because of serious adverse effects. Examples include pulmonary hypertension (aminorex), cardiovascular toxicity, e.g. flenfluramine-induced valvopathy, stroke [phenylpropanolamine ( PPA)], excess non-fatal cardiovascular events (sibutramine), and neuro-psychiatric issues (rimonabant; approved in Europe, but not in the USA). This negative experience has helped mould the current drug development and approval process for new anti-obesity drugs. Differences between the US Food and Drug Administration ( FDA) and the European Medicines Agency, however, in perceptions of risk-benefit considerations for individual drugs have resulted in discrepancies in approval and/or withdrawal of weight-reducing medications. Thus, two drugs recently approved by the FDA, i.e. lorcaserin and phentermine + topiramate extended release, are not available in Europe. In contrast, naltrexone sustained release ( SR)/bupropion SR received FDA approval, and liraglutide 3.0 mg was recently approved in both the USA and Europe. Regulatory strategies adopted by the FDA to manage the potential for uncommon but potentially serious post-marketing toxicity include: (i) risk evaluation and mitigation strategy programmes; (ii) stipulating post-marketing safety trials; (iii) considering responder rates and limiting cumulative exposure by discontinuation if weight loss is not attained within a reasonable timeframe; and (iv) requiring large cardiovascular outcome trials before or after approval. We chronicle the adverse effects of anti-obesity pharmacotherapy and consider how the history of high-profile toxicity issues has shaped the current regulatory landscape for new and future weight-reducing drugs. [ABSTRACT FROM AUTHOR]

The main aim was to gain structured insight into the use of musculoskeletal ultrasonography (MSUS) in routine rheumatology practices in Central and Eastern European (CEE) countries. In a cross-sectional, observational, international, multicenter survey, a questionnaire was sent to investigational sites in CEE countries. Data on all subsequent routine MSUS examinations, site characteristics, MSUS equipment, and investigators were collected over 6 months or up to 100 examinations per center. A total of 95 physicians at 44 sites in 9 countries provided information on a total of 2810 MSUS examinations. The most frequent diagnoses were rheumatoid arthritis (RA) and spondyloarthritis (34.8 and 14.9 % of cases, respectively). Mean number of joints examined was 6.8. MSUS was most frequently performed for diagnostic purposes (58 %), particularly in patients with undifferentiated arthritis, suspected soft tissue disorders, or osteoarthritis (73.0-85.3 %). In RA patients, 56.3 % of examinations were conducted to monitor disease activity. Nearly all investigations (99 %) had clinical implications, while the results of 78.6 % of examinations (51.6-99.0 %) were deemed useful for patient education. This first standardized multicountry survey performed in CEEs provided a structured documentation of the routine MSUS use in participating countries. The majority of MSUS examinations were performed for diagnostic purposes, whereas one-third was conducted to monitor disease activity in RA. A majority of examinations had an impact on clinical decision making and were also found to be useful for patient education. [ABSTRACT FROM AUTHOR]

This consensus guideline discusses the electrocardiographic phenomenon of beat-to-beat QT interval variability (QTV) on surface electrocardiograms. The text covers measurement principles, physiological basis, and clinical value of QTV. Technical considerations include QT interval measurement and the relation between QTV and heart rate variability. Research frontiers of QTV include understanding of QTV physiology, systematic evaluation of the link between QTV and direct measures of neural activity, modelling of the QTV dependence on the variability of other physiological variables, distinction between QTV and general T wave shape variability, and assessing of the QTV utility for guiding therapy. Increased QTV appears to be a risk marker of arrhythmic and cardiovascular death. It remains to be established whether it can guide therapy alone or in combination with other risk factors. QT interval variability has a possible role in non-invasive assessment of tonic sympathetic activity. [ABSTRACT FROM AUTHOR]

Aims: To assess physicians' adherence to guideline-recommended medications for the treatment of chronic heart failure (CHF) with reduced ejection fraction.Methods and Results: QUALIFY is an international prospective observational longitudinal survey of 7092 CHF outpatients recruited 1-15 months after hospitalization for heart failure from September 2013 to December 2014 in 547 centres in 36 countries. We constructed a five-class guideline adherence score for angiotensin converting enzyme inhibitors (ACEIs), beta-blockers, angiotensin receptor blockers (ARBs), mineralocorticoid receptor antagonists, and ivabradine. The adherence score was good in 67%, moderate in 25%, and poor in 8% of patients. Adherence was lower in women than men but there were differences in age (65.7 ± 12.5 years women vs. 62.2 ± 12.4 years men, P < 0.001) and the proportion of women at ≥50% target dose of beta-blockers was lower in those >67 years (median) (11% vs. 16.2%, P = 0.005). Geographic variations were observed with lower adherence scores in Central/Eastern European countries. The proportion of patients at target dose and ≥50% of target dose was low (27.9% and 63.3% for ACEIs, 14.8% and 51.8% for beta-blockers, 6.9% and 39.5% for ARBs, and 6.9% and 39.5% for ivabradine, respectively). It was also lower in patients most recently hospitalized (<6  vs. ≥6 months) except for beta-blockers.Conclusion: This international survey shows that adherence to guideline-recommended medications is relatively satisfactory but the dosage of recommended CHF medications is usually suboptimal. Action plans aimed at improving adherence to guidelines are required. [ABSTRACT FROM AUTHOR]