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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]

Purpose: Different health state utility (HSU) instruments produce different utilities for the same individuals, thereby compromising the intended comparability of economic evaluations of health care interventions. When developing crosswalks, previous studies have indicated nonlinear relationships. This paper inquires into the degree of nonlinearity across the four most widely used HSU-instruments and proposes exchange rates that differ depending on the severity levels of the health state utility scale.Methods: Overall, 7933 respondents from six countries, 1760 in a non-diagnosed healthy group and 6173 in seven disease groups, reported their health states using four different instruments: EQ-5D-5L, SF-6D, HUI-3 and 15D. Quantile regressions investigate the degree of nonlinear relationships between these instruments. To compare the instruments across different disease severities, we split the health state utility scale into utility intervals with 0.2 successive decrements in utility starting from perfect health at 1.00. Exchange rates (ERs) are calculated as the mean utility difference between two utility intervals on one HSU-instrument divided by the difference in mean utility on another HSU-instrument.Results: Quantile regressions reveal significant nonlinear relationships across all four HSU-instruments. The degrees of nonlinearities differ, with a maximum degree of difference in the coefficients along the health state utility scale of 3.34 when SF-6D is regressed on EQ-5D. At the lower end of the health state utility scale, the exchange rate from SF-6D to EQ-5D is 2.11, whilst at the upper end it is 0.38.Conclusion: Comparisons at different utility levels illustrate the fallacy of using linear functions as crosswalks between HSU-instruments. The existence of nonlinear relationships between different HSU-instruments suggests that level-specific exchange rates should be used when converting a change in utility on the instrument used, onto a corresponding utility change had another instrument been used. Accounting for nonlinearities will increase the validity of the comparison for decision makers when faced with a choice between interventions whose calculations of QALY gains have been based on different HSU-instruments. [ABSTRACT FROM AUTHOR]

Background: Health care organizations need to be responsive to the needs of increasingly diverse patient populations. We compared the contents of six publicly available approaches to organizational responsiveness to diversity. The central questions addressed in this paper are: what are the most consistently recommended issues for health care organizations to address in order to be responsive to the needs of diverse groups that differ from the majority population? How much consensus is there between various approaches?Methods: We purposively sampled six approaches from the US, Australia and Europe and used qualitative textual analysis to categorize the content of each approach into domains (conceptually distinct topic areas) and, within each domain, into dimensions (operationalizations). The resulting classification framework was used for comparative analysis of the content of the six approaches.Results: We identified seven domains that were represented in most or all approaches: organizational commitment, empirical evidence on inequalities and needs, a competent and diverse workforce, ensuring access for all users, ensuring responsiveness in care provision, fostering patient and community participation, and actively promoting responsiveness. Variations in the operationalization of these domains related to different scopes, contexts and types of diversity. For example, approaches that focus on ethnic diversity mostly provide recommendations to handle cultural and language differences; approaches that take an intersectional approach and broaden their target population to vulnerable groups in a more general sense also pay attention to factors such as socio-economic status and gender.Conclusions: Despite differences in labeling, there is a broad consensus about what health care organizations need to do in order to be responsive to patient diversity. This opens the way to full scale implementation of organizational responsiveness in healthcare and structured evaluation of its effectiveness in improving patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Life expectancy (LE) and healthy life expectancy (HALE) are indicators measuring the national health level. GAP is the difference between them. This study systematically analyzed and projected LE, HALE, and GAP across global regions from 1995 to 2025.Methods: We obtained the data of 195 countries/regions on their LE, HALE, and influencing factors from 1995 to 2017. We compared the overall changes of LE, HALE, and GAP. Multiple linear regression analysis examined relationships among LE, HALE, GAP, and the associated factors. Using the Autoregressive Integrated Moving Average (ARIMA) model, we projected trends in LE, HALE, and GAP for 2017-2025.Results: During 1995-2017, LE, HALE, and their GAP in 195 countries/regions in the world showed overall increasing trends. Global average LE increased from 66.20 to 72.98 years, HALE from 57.59 to 63.25 years, and GAP from 8.62 to 9.72 years. LE and HALE in North America, Europe, and Australia were generally higher, while Africa had the lowest rates. Females' LE, HALE, and GAP were all higher than males', but females' growth rates of LE and HALE were lower. Different factors were included to project LE, HALE, and GAP, respectively, and prediction results showed that approximately 18% of the 195 countries/regions might achieve improved LE and HALE and lower GAP.Conclusions: LE, HALE will likely continue to increase in most of countries and regions worldwide in the future and GAP will further expand. While striving to improve LE and HALE, more attention needs be made to reduce GAP and improve quality of life. [ABSTRACT FROM AUTHOR]

Innovative actions are local initiatives which leverage the interactions between the ocean and human health to reduce the risks and enhance the benefits for the stakeholders and the natural environment. These initiatives can have strong positive effects on human health and wellbeing as well as on the marine environment. We analysed 150 such innovative actions in Europe. Using a combined case study and survey approach, innovative actions were identified using interviews and content analysis of websites and compiled into a database. Quantitative data were analysed according to the Drivers, Pressures, State, Impact and Response (DPSIR) framework, guided by selected in-depth interviews. Overall, the innovative actions provided a positive impact on the health of both the ocean and humans through increasing food provision, water quality and tourism opportunities; and addressing environmental issues such as commercial fish stock depletion, pollution and climate change. Innovative actions contributed to meeting various targets of the Sustainable Development Goals (SDGs) 3, 13 and 14. These actions played a potential role ahead of and alongside policy. Some of the innovative actions may have potential to be put in place elsewhere. Such up-scaling would need to be adapted to local circumstances and could be facilitated by an innovative action exchange platform. [ABSTRACT FROM AUTHOR]

The author comments on a study by S. H. Woolf, published in the issue about life expectancy in the U.S. She discusses some caveats on the comparisons presented by Woolf in discussing methodology and data, three of the four causes that Woolf notes are causing midlife mortality to rise in the U.S., and results that do not make a lack of higher education causal in the higher mortality rates for those without a four-year college degree.

Background The Policy Evaluation Network proposes a consolidated approach to measure comparable health indicators across European health surveillance systems to evaluate effectiveness of policy action. Methods In a stepwise approach, questionnaire items used by the systems for measuring diet and physical activity data to describe health indicators were identified based on their validity, reliability, and suitability to monitor achievement of health recommendations. They were collated to unified questionnaire modules and discussed bilaterally with representatives of these systems to explore barriers and facilitators for implementation. Also, establishment of a methodological competence platform was proposed, in which the surveillance and monitoring systems agree on the priorities and common quality standards for the harmonization process and to coordinate the integration of questionnaire modules into existing systems. Results In total, seven questionnaire modules were developed, of which two diet and two physical activity modules were proposed for implementation. Each module allows measurement of data reflecting only partial aspects of national and WHO recommendations related to diet and physical activity. Main barriers were the requirements of systems to monitor temporal trends and to minimize costs. Main facilitator for implementation was the systems' use of questionnaire items that were comparable to the unified modules. Representatives agreed to participate in a methodological competence platform. Conclusion We successfully took first steps in the realization of the roadmap towards a harmonization of European surveillance by introducing unified questionnaire modules allowing the collection of comparable health indicators and by initiating the establishment of a competence platform to guide this process. [ABSTRACT FROM AUTHOR]

Eurostat's official Healthy Life Years (HLY) estimates are based on European Union Statistics on Income and Living Conditions (EU-SILC) cross-sectional data. As EU-SILC has a rotational sample design, the largest part of the samples are longitudinal, health-related attrition constituting a potential source of bias of these estimates. Bland-Altman plots assessing the agreement between pairs of HLY based on total and new rotational, representative samples demonstrated no significant, systematic attrition-related bias. However, the wide limits of agreement indicate considerable uncertainty, larger than accounted for in the confidence intervals of HLY estimates. [ABSTRACT FROM AUTHOR]

Aims: To explore caregivers' needs and problems in three European countries and associate the clusters of caregivers' needs with their sociodemographic characteristics. Design: A qualitative focused mixed methods design was used. Methods: In total, 52 caregivers of heart failure (HF) people were interviewed in three European countries between March 2017 and December 2018. Transcripts were analysed using the seven‐phase method of the exploratory multidimensional analysis according to Fraire with Reinert lexical classes findings were organized in dendrograms. Mayring's content analysis was also performed. Results: Three clusters of caregivers were identified: spouses, adult children and non‐family members. Caregivers not only provide HF patients with vital unpaid support for their physical and emotional needs, but they are continually trying to cope with their social isolation and deteriorating health. Conclusions: Informal caregiving emerged as a complex process influenced by various sociodemographic factors. Gender, relationship type and economic status are the important factors to be considered planning to develop approaches to address the needs of caregivers serving people with heart failure. Impact A comprehensive understanding of the nature of informal caregiving of individuals with heart failure, the complexity of the real‐world sociodemographic and cultural factors is warranted. The use of the EMDA method gave us the possibility of processing large masses of qualitative data through rapid, complex calculations. In detail, AATD allowed us to study in deep the significant fuzziness of what caregivers expressed and to analyse the content of the entire interviews and to produce global knowledge by using multi‐dimensional statistical methods to grasp the fundamental sense of the interviews, beyond the simple words. Three clusters were identified in the samples, including spouses, adult children and non‐family members. This study demonstrated that some sociodemographic characteristics could lead to everyday needs. Therefore, these demographic characteristics should be considered in developing targeted interventions. The research was conducted in Europe, but the technique shown can be replicated everywhere. The findings not only impact nursing but can be extended to all those stakeholders who concur with a public health educational mission. Patient or Public Contribution: Carers were involved in this study after the discharge of their loved ones or at the time of the outpatient visit. They were involved after they had been observed in their dynamics of involvement in caring of the familiars or friends with heart failure. [ABSTRACT FROM AUTHOR]

Objective: To investigate and summarize the literature on the validation of International Classification of Functioning, Disability and Health (ICF) core sets from 2001 to 2019 and explore what research methods have been used when validating ICF core sets. Methods: The current study is a scoping review using a structured literature search. Results: In total, 66 scientific articles were included, of which 23 ICF core sets were validated. Most validation studies were conducted in Europe using a quantitative methodology and were validated from the perspective of patients. Analysis methods differed considerably between the studies, and most ICF core sets were validated only once for a single target population or from a single perspective. The comprehensive core sets were validated more often than the brief core sets, and core sets for stroke and low back pain were validated most often. Conclusion: The results of the current study show that only 66% of the existing ICF core sets are validated. Many of the validation studies are conducted in a European context and from a single perspective. More validation studies of ICF core sets from the perspective of both patients and professionals are needed. ICF core sets aim to facilitate assessments in clinical settings and research. Validation studies indicate in general that the ICF core sets are valid and relevant for patients and professionals in the specific areas explored and thus can be used in rehabilitation settings. To improve the quality of ICF core sets, more validation studies are needed for ICF core sets not yet tested and for ICF core sets that have been validated only in one study or for one specific population or target group. [ABSTRACT FROM AUTHOR]

Studies show that older migrants have poorer health than native populations in Western Europe. To date, little systematic research has explored the differences between men and women within older populations with migration backgrounds. This article examines gender-specific aspects and mediating mechanisms of self-reported health among older migrants from Turkey. Using a mixed method approach, data and results from a quantitative survey and a qualitative study conducted in Berlin, Germany, are analysed and integrated at the interpretive level. Standardised face-to-face interviews were carried out with the help of a network approach with 194 older migrants from Turkey (93 women, 101 men, mean age: 68). Potential mediators showing significant gender differences are included in a parallel multiple mediation analysis. The documentary method is used to analyse 11 semi-structured narrative interviews with first-generation labour migrants from Turkey. Women reported significantly worse subjective health than men (c = 0.443, bCI [0.165–0.736]), conveyed through greater functional limitations (ab = 0.183, bCI [0.056–0.321]) and emotional loneliness (ab = 0.057, bCI [0.008–0.128]). Respondents to the qualitative study perceived that women age earlier and have poorer health due to the burden of performing a greater variety of social roles. Higher levels of emotional loneliness among women could be caused by their experiences of negatively assessed partnerships. Our results show that as a group, older female migrants have an elevated health vulnerability. A broader scientific foundation regarding gender differences in the health of older migrants and their causes is needed to promote gender-sensitive prevention and care for this group. [ABSTRACT FROM AUTHOR]

Background: Although shoulder arthroplasty is less common than knee or hip arthroplasty, the number of procedures being performed is increasing rapidly. The treatment effect is a simple method to measure outcome of joint replacement. The method was applied to measure results of total hip/knee arthroplasty but not yet for shoulder arthroplasty.Methods: Included were patients with unilateral cuff arthropathy (Hamada grades > = 2) treated with reversed total shoulder arthroplasty (RSA) in this prospective multicenter study. The patients were assessed with the ASES questionnaire. The treatment effects (TE) was calculated for each patient. TE = score reduction/baseline score. A positive TE means amelioration, TE = 0 unchanged, and a negative TE means worse. The primary aim was to calculate the TE's for RSA at 6, 12, 24, and 60 months postoperatively. The secondary aim was to analyze the influence of confounders (preoperative Hamada grade, age, gender, dominance, side of the affected shoulder, general co-morbidities measured using ASA grade).Results: Two hundred three patients were included for this analysis of whom 183 patients had a complete 2 year follow up. Two years postoperatively the mean ASES score augmented significant from 20.5 to 78.7 (p < 0.001). The 2 year TE's ranged from 1 to 0.09. We had no patient with a negative TE. A higher Hamada grade was associated with better TE's (Hamada grade 4+ vs. 2, p-value 0.042). For age and dominant side there were weak associations where those aged 80+ and dominant side had better TE's. The patients with higher ASA grade had lower TE's (ASA grade 4+ vs. 1, p-value 0.013). The mean TE's were 0.77 at 6-months, 0.81 at 1 year, 0.76 at 2 years and 0.73 at 5 years.Conclusions: The outcome for reverse shoulder arthroplasty can be measured with the treatment effect method; the 2 years TE's vary from 1 to 0.09. The mean treatment effects change little in the first five postoperative years (from 0.73 to 0.81). The confounders for better TE's were: higher severity of cuff arthropathy (Hamada grade 3, 4 and 5), less co-morbidities (ASA Grade 1), higher age (80+) and dominant side. Gender did not influence the 2-year TE's.Trial Registration: Comité intercantonal d'éthique (Jura, Fribourg, Neuchâtel), number 01/2008, 24.09.2008. [ABSTRACT FROM AUTHOR]

Background Forty-three out of 53 of the WHO European Member States have set up political and institutional mechanisms to implement the United Nations (UN) 2030 Agenda for Sustainable Development. This includes governance and institutional mechanisms, engaging stakeholders, identifying targets and indicators, setting governmental and sectoral priorities for action and reporting progress regularly. Still, growing evidence suggests that there is room for advancing implementation of some of the Sustainable Development Goals (SDGs) and targets at a higher pace in the WHO European Region. This article proposes the E4A approach to support WHO European Member States in their efforts to achieve the health-related SDG targets. Methods The E4A approach was developed through a 2-year, multi-stage process, starting with the endorsement of the SDG Roadmap by all WHO European Member States in 2017. This approach resulted from a mix of qualitative methods: a semi-structured desk review of existing committal documents and tools; in-country policy dialogs, interviews and reports; joint UN missions and discussion among multi-lateral organizations; consultation with an advisory group of academics and health policy experts across countries. Results The E—engage—functions as the driver and pace-maker; the 4 As—assess, align, accelerate and account—serve as building blocks composed of policies, processes, activities and interventions operating in continuous and synchronized action. Each of the building blocks is an essential part of the approach that can be applied across geographic and institutional levels. Conclusion While the E4A approach is being finalized, this article aims to generate debate and input to further refine and test this approach from a public health and user perspective. [ABSTRACT FROM AUTHOR]

Background: Although the effects of individual-level factors on wellbeing change following work exit have been identified, the role of welfare-state variables at the country level has yet to be investigated.Methods: Data on 8037 respondents aged 50 years and over in 16 European countries were drawn from the Survey of Health, Ageing and Retirement in Europe (SHARE) and the English Longitudinal Study of Ageing (ELSA). We employed multilevel models to assess determinants of change in wellbeing following work exit, using CASP-12 change scores. After adjusting for institutionally defined route and timing of work exit, in addition to other individual-level variables, we tested country-level variables including welfare-state regime and measures of disaggregated welfare spending to determine their associations with wellbeing change and the proportion of between-country variance explained.Results: Individuals whose exit from paid work was involuntary or diverged from the typical retirement age experienced declines in wellbeing. Country effects accounted for 7% of overall variance in wellbeing change. Individuals residing in countries with a Mediterranean welfare regime experienced more negative changes in wellbeing, with a difference of -2.15 (-3.23, -1.06) CASP-12 points compared with those in Bismarckian welfare states. Welfare regime explained 62% of between-country variance. National per-capita expenditure on non-healthcare in-kind benefits (services) was associated with more positive wellbeing outcomes.Conclusions: National expenditure on in-kind benefits, particularly non-healthcare services, is associated with more favourable wellbeing change outcomes following work exit in early old age. Welfare-state effects explain the majority of between-country differences in change in wellbeing. [ABSTRACT FROM AUTHOR]

This article aims to investigate the impact of using 2 measures of socio-economic status on the analysis of how informal care and home care use are distributed among older people living in the community. Using data from the Survey of Health, Ageing and Retirement in Europe for 14 European countries, we estimate differences in corrected concentration indices for use of informal care and home care, using equivalised household net income and equivalised net worth (as a proxy for wealth). We also calculate horizontal inequity indices using both measures of socio-economic status and accounting for differences in need. The findings show that using wealth as a ranking variable results, as a rule, in a less pro-poor inequality of use for both informal and home care. Once differences in need are controlled for (horizontal inequity), wealth still results in a less pro-poor distribution for informal care, in comparison with income, whereas the opposite is observed for home care. Possible explanations for these differences and research and policy implications are discussed. [ABSTRACT FROM AUTHOR]

In recent years, population health research has focused on understanding the determinants of later-life health. Two strands of that work have focused on (1) international comparisons of later-life health and (2) assessing the early-life origins of disease and disability and the importance of life course processes. However, the less frequently examined intersection of these approaches remains an important frontier. The present study contributes to the integration of these approaches. We use the Health and Retirement Study family of data sets and a cohort dynamic approach to compare functional health trajectories across 12 high-income countries and to examine the role of life course processes and cohort dynamics in contributing to variation in those trajectories. We find substantial international variation in functional health trajectories and an important role of cohort dynamics in generating that variation, with younger cohorts often less healthy at comparable ages than the older cohorts they are replacing. We further find evidence of heterogeneous effects of life course processes on health trajectories. The results have important implications for future trends in morbidity and mortality as well as public policy. [ABSTRACT FROM AUTHOR]

Objective: Patient-physician discordance in global assessment of disease activity concerns one-third of patients, but what does it reflect? We aimed to assess patient-physician discordance in psoriatic arthritis (PsA) and patient-reported domains of health (physical and psychological) associated with discordance.Methods: We analyzed the PsAID (Psoriatic Arthritis Impact of Disease), a cross-sectional, multicenter European study of patients with PsA according to expert opinion. Patient global assessment (PGA) and physician global assessment (PhGA) were rated on a 0-10 numeric rating scale. Discordance was defined as the difference (PGA-PhGA) and as the absolute difference |PGA-PhGA| ≥3 points. Determinants of PGA-PhGA were assessed by a stepwise multivariate linear regression among 12 physical and psychological aspects of impact: pain, skin problems, fatigue, ability to work/leisure, functional incapacity, feeling of discomfort, sleep disturbance, anxiety/fear, coping, embarrassment/shame, social participation, and depressive affects.Results: In 460 patients (mean ± SD age 50.6 ± 12.9 years, 52.2% female, mean ± SD disease duration 9.5 ± 9.5 years, mean ± SD Disease Activity Index for Psoriatic Arthritis score 30.8 ± 32.4, and 40.4% undergoing treatment with biologic agents), the mean ± SD PGA was higher than the mean PhGA, with a mean absolute difference of 1.9 ± 1.8 points. Discordance defined by |PGA-PhGA| ≥3 of 10 concerned 134 patients (29.1%), and 115 patients (85.8% of the patients with discordance) had PGA>PhGA. Higher fatigue (β = 0.14), lower self-perceived coping (β = 0.23), and impaired social participation (β = 0.16) were independently associated with a higher difference (PGA-PhGA).Conclusion: Discordance concerned 29.1% of these patient/physician dyads, mainly by PGA>PhGA. Factors associated with discordance were psychological rather than physical domains of health. Discordance was more frequent in patients in remission, indicating more work is needed on the patient perspective regarding disease activity. [ABSTRACT FROM AUTHOR]

We compared the level of attention capacity between adolescents from the center and south of Europe. The study included 627 European adolescents (54% girls), aged 12.5-17.5 years, who participated in the HELENA Study. The d2 Test of Attention was administered to assess attention capacity. The main results showed that adolescents from the south of Europe had significantly higher score in attention capacity compared with adolescents from central Europe (score + 8.1; 95%CI, 2.44-13.61) after adjustment for age, sex, socioeconomic indicators, body mass index, cardiorespiratory fitness and diet quality index (p = 0.012).Conclusion: Adolescents from the south of Europe had higher levels of attention capacity than their counterparts from central Europe independently of sociodemographic and health-related factors. These differences should be taken into account by educational institutions when promoting new approaches for putting into the practice student's capacities. What is Known? • Attention is a crucial capacity during adolescence. • Several health-related factors (i.e., physical activity, fitness or fatness) may influence attention capacity in adolescents. What is New? • Adolescents from the south of Europe had higher levels of attention capacity than their counterparts from the center, after accounting for socioeconomic factors, fitness, fatness and quality of diet. • These differences should be taken into account by educational institutions when promoting new approaches for putting into the practice student's capacities. [ABSTRACT FROM AUTHOR]

Early and reliable screening for oropharyngeal dysphagia (OD) symptoms in at-risk populations is important and a crucial first stage in effective OD management. The Eating Assessment Tool (EAT-10) is a commonly utilized screening and outcome measure. To date, studies using classic test theory methodologies report good psychometric properties, but the EAT-10 has not been evaluated using item response theory (e.g., Rasch analysis). The aim of this multisite study was to evaluate the internal consistency and structural validity and conduct a preliminary investigation of the cross-cultural validity of the EAT-10; floor and ceiling effects were also checked. Participants involved 636 patients deemed at risk of OD, from outpatient clinics in Spain, Turkey, Sweden, and Italy. The EAT-10 and videofluoroscopic and/or fiberoptic endoscopic evaluation of swallowing were used to confirm OD diagnosis. Patients with esophageal dysphagia were excluded to ensure a homogenous sample. Rasch analysis was used to investigate person and item fit statistics, response scale, dimensionality of the scale, differential item functioning (DIF), and floor and ceiling effect. The results indicate that the EAT-10 has significant weaknesses in structural validity and internal consistency. There are both item redundancy and lack of easy and difficult items. The thresholds of the rating scale categories were disordered and gender, confirmed OD, and language, and comorbid diagnosis showed DIF on a number of items. DIF analysis of language showed preliminary evidence of problems with cross-cultural validation, and the measure showed a clear floor effect. The authors recommend redevelopment of the EAT-10 using Rasch analysis. [ABSTRACT FROM AUTHOR]

Background: Patients with coronary artery disease can accumulate significant radiation dose through repeated exposures to coronary computed tomographic angiography, myocardial perfusion imaging with single photon emission computed tomography or positron emission tomography, and to invasive coronary angiography. Aim of the study was to audit radiation doses of coronary computed tomographic angiography, single photon emission computed tomography, positron emission tomography and invasive coronary angiography in patients enrolled in the prospective, randomized, multi-centre European study-EVINCI (Evaluation of Integrated Cardiac Imaging for the Detection and Characterization of Ischemic Heart Disease).Methods: We reviewed 1070 tests (476 coronary computed tomographic angiographies, 85 positron emission tomographies, 310 single photon emission computed tomographies, 199 invasive coronary angiographies) performed in 476 patients (mean age 60 ± 9 years, 60% males) enrolled in 12 centers of the EVINCI. The effective doses were calculated in milli-Sievert (mSv) as median, interquartile range (IQR) and coefficient of variation of the mean.Results: Coronary computed tomographic angiography (476 exams in 12 centers) median effective dose was 9.6 mSv (IQR = 13.2 mSv); single photon emission computed tomography (310 exams in 9 centers) effective dose was 9.3 (IQR = 2.8); positron emission tomography (85 in 3 centers) effective dose 1.8 (IQR = 1.6) and invasive coronary angiography (199 in 9 centers) effective dose 7.4 (IQR = 7.3). Inter-institutional variability was highest for invasive coronary angiography (100%) and coronary computed tomographic angiography (54%) and lowest for single photon emission computed tomography (20%). Intra-institutional variability was highest for invasive coronary angiography (121%) and coronary computed tomographic angiography (115%) and lowest for single photon emission computed tomography (14%).Conclusion: Coronary computed tomographic angiography and invasive coronary angiography doses vary substantially between and within centers. The variability in nuclear medicine procedures is substantially lower. The findings highlight the need to audit doses, to track cumulative exposures and to standardize doses for imaging techniques.Trial Registration: The study protocol is available at https://www.clinicaltrials.gov/ (ClinicalTrials.gov Identifier: NCT00979199 ). Information provided on September 16, 2009. [ABSTRACT FROM AUTHOR]

Aims: The introduction of non-VKA oral anticoagulants (NOACs), which differ from the earlier vitamin K antagonist (VKA) treatments, has changed the approach to stroke prevention in atrial fibrillation (AF). GLORIA-AF is a prospective, global registry programme describing the selection of antithrombotic treatment in newly diagnosed AF patients at risk of stroke. It comprises three phases: Phase I, before the introduction of NOACs; Phase II, during the time of the introduction of dabigatran, the first NOAC; and Phase III, once NOACs have been established in clinical practice.Methods and Results: In Phase I, 1063 patients were eligible from the 1100 enrolled (54.3% male; median age 70 years); patients were from China (67.1%), Europe (EU; 27.4%), and the Middle East (ME; 5.6%). The majority of patients using VKAs had high stroke risk (CHA2DS2-VASc ≥ 2; 86.5%); 13.5% had moderate risk (CHA2DS2-VASc = 1). Vitamin K antagonist use was higher for persistent/permanent AF (47.7%) than that for paroxysmal (23.9%). Most patients in China were treated with antiplatelet agents (53.7%) vs. 27.1% in EU and 28.8% in ME. In China, 25.9% of patients had no antithrombotic therapy, vs. 8.6% in EU and 8.5% in ME.Conclusion: Phase I of GLORIA-AF shows that VKAs were mostly used in patients with persistent/permanent (vs. paroxysmal) AF and in those with high stroke risk. Furthermore, there were meaningful geographical differences in the use of VKA therapy in the era before the availability of NOACs, including a much lower use of VKAs in China, where most patients either received antiplatelet agents or no antithrombotic treatment. [ABSTRACT FROM AUTHOR]

Background: Cross-national comparisons of health in European countries provide crucial information to monitor health and disease within and between countries and to inform policy and research priorities. However, variations in estimates might occur when information from cross-national European surveys with different characteristics are used. We compared the prevalence of very good or good self-perceived health across 10 European countries according to three European surveys and investigated which survey characteristics contributed to differences in prevalence estimates. Methods: We used aggregate data from 2004 to 2005 of respondents aged 55-64 years from the European Union Statistics on Income and Living Conditions (EU-SILC), the Survey of Health, Ageing and Retirement in Europe (SHARE) and the European Social Survey (ESS). Across the surveys, self-perceived health was assessed by the same question with response options ranging from very good to very bad. Results: Despite a good correlation between the surveys (intraclass correlation coefficient: 0.77), significant differences were found in prevalence estimates of very good or good self-perceived health. The survey response, sample size and survey mode contributed statistically significantly to the differences between the surveys. Multilevel linear regression analyses, adjusted for survey characteristics, showed a higher prevalence for SHARE (+6.96, 95% CIs: 3.14 to 10.8) and a lower prevalence (-3.12; 95% CIs: -7.11 to 0.86) for ESS, with EU-SILC as the reference survey. Conclusion: Three important health surveys in Europe showed substantial differences for presence of very good or good self- perceived health. These differences limit the usefulness for direct comparisons across studies in health policies for Europe. [ABSTRACT FROM AUTHOR]

Background: Although relevant for health policy, so far only little is known about the extent to which persons avoid dental attendance because of associated costs.Objectives: To examine the cost-relatedness of dental non-attendance in various older adulthood populations.Material and Methods: Secondary analyses were conducted of data from wave 1 of the Survey of Health, Ageing, and Retirement in Europe (SHARE), which includes unique information on recent dental non-attendance and care foregone due to costs by persons aged 50+ from eleven European countries and Israel. Multivariate logistic regression analysis was used to detect differences in the extent to which dental non-attendance is attributable to associated costs.Results: The study sample comprised 13 935 persons who did not access dental care within the past year. Levels of cost-related non-attendance differed between the twelve examined countries, ranging from 6.8% in Israel to 0.5% in Austria. Cost-related non-attendance was 47% less likely among persons with good as compared to compromised chewing ability (Odds Ratio: 0.53; 95% CI: 0.43-0.66). Cost-related non-attendance was 33% less likely among persons with tertiary as compared to (pre-) primary educational attainment (Odds Ratio: 0.67; 95% CI: 0.47-0.96). Cost-related dental non-attendance was significantly more likely among persons with low levels of general health (Odds Ratio for lowest vs. highest level of general health: 3.05; 95% CI: 1.88-4.95).Conclusions: The findings of the present study suggest that a relatively small proportion of dental non-attendance in older adulthood is cost-related. For specific population subgroups in various countries, however, dental care costs may still pose a relevant barrier to dental care. [ABSTRACT FROM AUTHOR]

Purpose: Osteoarthritis (OA) has been shown to be associated with decreased physical function, which may impact upon a person's self-rated health (SRH). Only a few studies have examined the association between OA and SRH in the general population, but to date none have used a clinical definition of OA. The objectives are: (1) To examine the cross-sectional association between clinical OA and fair-to-poor SRH in the general population; (2) To examine whether this association differs between countries; (3) To examine whether physical function is a mediator in the association between clinical OA and SRH.Methods: Baseline data of the European Project on OSteoArthritis (EPOSA) were used, which includes pre-harmonized data from six European cohort studies (n = 2709). Clinical OA was defined according to the American College of Rheumatology criteria. SRH was assessed using one question: How is your health in general? Physical function was assessed using the Western Ontario and McMaster Universities OA Index and Australian/Canadian OA Hand Index.Results: The prevalence of fair-to-poor SRH ranged from 19.8 % in the United Kingdom to 63.5 % in Italy. Although country differences in the strength of the associations were observed, clinical OA of the hip, knee and hand were significantly associated with fair-to-poor SRH in five out of six European countries. In most countries and at most sites, the association between clinical OA and fair-to-poor SRH was partly or fully mediated by physical function.Conclusions: Clinical OA at different sites was related to fair-to-poor SRH in the general population. Most associations were (partly) mediated by physical functioning, indicating that deteriorating physical function in patients with OA should be a point of attention in patient care. [ABSTRACT FROM AUTHOR]

The purpose of this European Heart Rhythm (EHRA) Scientific Initiatives Committee EP Wire Survey was to assess 'real-world' practice in the management of patients with atrial fibrillation (AF) and chronic kidney disease (CKD) in the European Eelectrophysiology centres. Of 41 responding centres, 39 (95.1%) and 37 (90.2%) routinely evaluated renal function in AF patients at first presentation and during follow-up, respectively, but 13 centres (31.7%) re-assessed advanced CKD only at ≥1-year intervals. While the use of oral anticoagulants (OACs) in mild-to-moderate CKD patients was mostly guided by individual patient stroke risk, 31% of the centres used no therapy, or aspirin or the left appendage occlusion in patients with advanced CKD and HAS-BLED ≥ 3. Vitamin K antagonists (VKAs) were preferred in patients with severe CKD or under renal replacement therapy (RRT), any non-VKA in patients with mild CKD, and apixaban in patients with moderate CKD. Rhythm control was preferred in patients with mild-to-moderate CKD (48.7% of centres), and rate control in patients with severe CKD (51.2% of centres). In 20 centres (48.8%), AF ablation was not performed in advanced CKD patients. Most centres performed AF ablation on OAC, but heparin bridging was still used in >10% of centres. Our survey has shown that the importance of renal function monitoring in AF patients is well recognized in clinical practice. In patients with mild-to-moderate CKD, AF is mostly managed according to the guideline recommendations, but more data are needed to guide the management of AF in patients with severe CKD or RRT. [ABSTRACT FROM AUTHOR]

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