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Objectives: The main objective of this study is to examine the relationship between health and an early exit from paid employment in the Finnish, Polish, and Spanish populations. The authors have addressed the following 3 issues: who chooses not to work according to gender patterns, whether the health status is a determinant of being non-employed, and what diseases are associated with being non-employed.Material and Methods: The studied material consists of data from the Collaborative Research on Ageing in Europe (COURAGE in Europe) project. The analysis was based on a sample of 5868 individuals, including 1214 from Finland, 2152 from Poland and 2532 from Spain. In the paper, these data were complemented with the results of the PArticipation To Healthy Workplaces And inclusive Strategies in the Work Sector (PATHWAYS) project.Results: The results of the study revealed that self-rated health was a strong predictor of being non-employed for different reasons. Chronic diseases, such as arthritis, angina, diabetes, chronic obstructive pulmonary disease, depression and hypertension, were typically associated with an increased risk of being non-employed due to health problems and early retirement. Women more frequently reported arthritis and depression, while a higher proportion of men suffered from angina and diabetes.Conclusions: The results obtained by the authors highlight the importance of evaluating gender patterns in work cessation and, at the same time, the importance of gender-focused actions in terms of preventing withdrawal from the labor market. In principle, all chronic diseases have some impact on participation in the labor market. It is worth noting, however, that each of them affects workforce participation in a different manner, depending on the specific disease, country and gender. For this reason, tailored support to every individual's needs is highly recommended. Int J Occup Med Environ Health. 2020;33(3):365-84. [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]

Accessible summary In the Western world, many people who have mental health problems experience poor physical health. Research suggests that those with mental illness often have difficulties in accessing health care services, reporting that when they do, their physical health needs are often overlooked., Nurses are expected to deliver safe and effective care that meets the needs of service users. In order to help mental health nurses address physical health care needs, changes to nurse education, supported by government policy, have been made in the United Kingdom. Despite these changes, mental health nurses still feel less confident and prepared to address physical health needs of service users. However, this same problem is also reported by nurses throughout Europe and in other Western countries, who have undergone different training and education programmes., This paper discusses important factors affecting the mental health nurses' ability to deliver physical care and how they impact on confidence and competence., The paper concludes by highlighting the role of the mental health nurse being key in addressing the physical health needs of those in their care, and how this will only be realized when education and practice provide sufficient opportunity for them to develop and maintain their knowledge and skills., Abstract In the Western world, there is increasing concern regarding the ability of health care professionals to meet the physical health care needs of those diagnosed with mental illness. This discussion paper seeks to explore some of the issues facing mental health nurses in delivering care to those who have both mental and physical illness. Criticism of the National Health Service for failing to meet the physical health needs of people with serious mental illness has generated a number of political strategies aimed at addressing inequalities between mental and physical health care, a consequence being a change in pre-registration nurse education. It is envisaged that such changes will enable all nurses to deliver safe, effective care to service users, with adult and mental health nurses being more adept at meeting both the mental and physical health needs of those in their care. The impact of three key areas identified within the literature will be considered: the impact of co-existing physical and mental illness; the role of mental health nurses and perceptions of service users re physical health care; and education, training and learning from others in the Western world. In conclusion, the complexities of delivering such care will be addressed. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to scope potential and gaps in European cohort studies with focus on brain ageing and neurodegeneration. Design/methodology/approach -- Combined and augmented two scoping exercises conducted for European Union Joint Programme on Neurodegenerative Diseases (JPND) and the Alzheimer Society UK. Findings -- In total, 106 cohorts initially identified with a further 52 found on second sweep. Strengths include gender balance, diversity of measures and much detail on health and health behaviours, and lifecourse representation. Major gaps identified were the oldest old, non-Caucasians, people in Eastern Europe, migrant populations, rural residents and people in long-term care. Quality of life, psychosocial and environmental factors were limited. Relatively few cohorts are population representative. Analytical methods for combining studies and longitudinal analysis require careful consideration. Research limitations/implications -- European studies and published information only. Practical implications -- Collaboration across disciplines and studies, greater dissemination of methods and findings will improve knowledge about cognitive and functional decline in current and future older populations. Social implications -- Better understanding of brain ageing and the dementia syndrome will improve investment decisions for primary, secondary and tertiary prevention. Originality/value -- Building on the work of JPND and the Alzheimer Society is the first study of the scope and limitations of current cohorts in Europe. It is designed to help researchers and policy makers in their planning. [ABSTRACT FROM AUTHOR]

We provide original, international evidence documenting that self-assessed health (SAH) is a leading health indicator, that is, a significant predictor of future changes in health conditions, in a large sample of Europeans aged above 50 and living in 13 different countries. We find that, after controlling for attrition bias, lagged SAH is significantly and negatively correlated with changes in the number of chronic diseases, net of the correlations with levels, and changes in sociodemographic factors and health styles, country and regional health system effects, and declared symptoms. Illness-specific estimates document that lagged SAH significantly correlates with arthritis, cholesterol, and lung diseases (and weakly so with ulcer, hypertension, and cataracts) and has a significant correlation with the probability of contracting cancer. Interpretations and policy implications of our findings are discussed in the paper. [ABSTRACT FROM AUTHOR]

Background and objective The spread of self-care holds the promise of containing chronic illness burden. Falling within the framework of a FP7 collaborative research project, this paper reports the views of key informants from six countries regarding who the main stakeholders are at different levels in the support system for self-care for patients with chronic illness ( SSSC) and how they accomplish their role and collaborate. Methods 90 Interviews with purposefully selected key informants from Bulgaria, Greece, the Netherlands, Norway, Spain and United Kingdom were conducted. Interviews involved government and local authorities, politicians, academics, health professionals and private sector representatives. Interviewers followed an expert opinion-based guide. Analysis involved a cross-country examination with thematic analysis and framework method techniques. Results Key informants described the ideal SSSC as inclusive, interdependent and patient-centred. The following main stakeholders in SSSC were identified: patients, governments, health-care professionals, associations, private companies and the media. In the current SSSCs, collaboration among stakeholders within and across different levels was said to be lacking. Patients were seen as playing a passive subordinate role based on the following: their own attitudes; the paternalistic and medicalized attitudes of the health-care professionals; their misrepresentation by patient associations; and their exposure to the damaging influences of media and industries. Conclusions Making SSSC patient-centred constitutes the greatest challenge for European authorities. Strategies must be revised for promoting patient participation. They should undergo changes so as to promote industry and media social responsibility and patient association advocacy capacity. [ABSTRACT FROM AUTHOR]

Multimorbidity, the concurrence of several chronic conditions, is a rising concern that increases the years lived with disability and poses a burden on healthcare systems. Little is known on how it interacts with socioeconomic deprivation, previously associated with poor health-related outcomes. We aimed to characterize the association between multimorbidity and these outcomes and how this relationship may change with socioeconomic development of regions. 55,915 individuals interviewed in 2017 were drawn from the Survey of Health, Ageing and Retirement in Europe, a population-based study. A Latent Class Analysis was conducted to fit multimorbidity patterns based on 16 self-reported conditions. Physical limitation, quality-of-life and healthcare utilization outcomes were regressed on those patterns adjusting for additional covariates. Those analyses were then extended to assess whether such associations varied with the region socioeconomic status. We identified six different patterns, labelled according to their more predominant chronic conditions. After the "healthy" class, the "metabolic" and the "osteoarticular" classes had the best outcomes involving limitations and the lowest healthcare utilization. The "neuro-affective-ulcer" and the "several conditions" classes yielded the highest probabilities of physical limitation, whereas the "cardiovascular" group had the highest probability of hospitalization. The association of multimorbidity over physical limitations appeared to be stronger when living in a deprived region, especially for metabolic and osteoarticular conditions, whereas no major effect differences were found for healthcare use. Multimorbidity groups do differentiate in terms of limitation and healthcare utilization. Such differences are exacerbated with socioeconomic inequities between regions even within Europe. [ABSTRACT FROM AUTHOR]

Background: Chronic conditions, especially pain conditions, have a very significant impact on quality of life and on workplaces. Workplace interventions for chronic conditions are heterogenous, multidimensional, and sometimes poorly evidenced. The Joint Action for Chronic Disease Plus (CHRODIS Plus), including The CHRODIS Plus Workbox on Employment and Chronic Conditions (CPWEC), aimed to combat this, prevent chronic disease and multimorbidity, and influence policy in Europe. However, the supporting evidence behind CHRODIS Plus has not been formally assessed. Methods: A scoping review was carried out; Embase, MEDLINE, and CINAHL were searched for literature related to CHRODIS Plus and pain. Title and abstract and full-text screening were carried out in duplicate and independently. Additionally, CHRODIS Plus authors were approached for unpublished data. Secondly, the search was broadened to CHRODIS Plus and pain-causing conditions. Grey literature was also searched. Appropriateness appraisal was derived from the Trial Forge Guidance. Systematic reviews, on which CPWEC was based, were appraised using the A Measurement Tool to Assess systematic Reviews (AMSTAR) 2 tool. Results: The initial search yielded two results, of which zero were suitable to be included in the scoping review. The second, broader search revealed 14 results; however, none were deemed suitable for inclusion. AMSTAR 2 scores revealed that the three systematic reviews influencing CPWEC were of varying quality (from critically low to moderate). Conclusions: CPWEC is based on heterogenous reviews of varying quality. However, comparable tools are designed using alternative forms of evidence. Further research evaluating the post-implementation efficacy of the tool is needed. [ABSTRACT FROM AUTHOR]

Background: Although there is evidence that tailored implementation strategies can be effective, there is little evidence on which methods of tailoring improve the effect. We designed and evaluated five tailored programs (TPs) each consisting of various strategies. The aim of this study was to examine (a) how determinants of practice prioritized in the design phase of the TPs were perceived by health care professionals who had been exposed to the TPs and whether they suggested other important determinants of practice and (b) how professionals used the offered strategies and whether they suggested other strategies that might have been more effective.Methods: We conducted a mixed-method process evaluation linked to five cluster-randomized trials carried out in five European countries to implement recommendations for five chronic conditions in primary care settings. The five TPs used a total of 28 strategies which aimed to address 38 determinants of practice. Interviews of professionals in the intervention groups and a survey of professionals in the intervention and control groups were performed. Data collection was conducted by each research team in the respective national language. The interview data were first analyzed inductively by each research team, and subsequently, a meta-synthesis was conducted. The survey was analyzed descriptively.Results: We conducted 71 interviews; 125 professionals completed the survey. The survey showed that 76 % (n = 29) of targeted determinants of practice were perceived as relevant and 95 % (n = 36) as being modified by the implementation interventions by 66 to 100 % of professionals. On average, 47 % of professionals reported using the strategies and 51 % considered them helpful, albeit with substantial variance between countries and strategies. In the interviews, 89 determinants of practice were identified, of which 70 % (n = 62) had been identified and 45 % (n = 40) had been prioritized in the design phase. The interviewees suggested 65 additional strategies, of which 54 % (n = 35) had been identified and 20 % (n = 13) had been prioritized, but not selected in the final programs.Conclusions: This study largely confirmed the perceived relevance of the targeted determinants of practice. This contrasts with the fact that no impact of the trials on the implementation of the recommendations could be observed. The findings suggest that better methods for prioritization of determinants and strategies are needed.Trial Registration: Each of the five trials was registered separately in recognized trial registries. Details are given in the respective trial outcome papers. [ABSTRACT FROM AUTHOR]

Background: Stanford's Chronic Disease Self-Management Program (CDSMP) stands out as having a large evidence-base and being broadly disseminated across various countries. To date, neither evidence nor practice exists of its systematic adaptation into a German-speaking context. The objective of this paper is to describe the systematic German adaptation and implementation process of the CDSMP (2010-2014), report the language-specific adaptation of Franco-Canadian CDSMP for the French-speaking part of Switzerland and report findings from the initial evaluation process.Methods: Multiple research methods were integrated to explore the perspective of workshop attendees, combining a longitudinal quantitative survey with self-report questionnaires, qualitative focus groups, and interviews. The evaluation process was conducted in for both the German and French adapted versions to gain insights into participants' experiences in the program and to evaluate its impact. Perceived self-efficacy was measured using the German version of the Self-Efficacy for Managing Chronic Disease 6-Item Scale (SES6G).Results: Two hundred seventy eight people attending 35 workshops in Switzerland and Austria participated in the study. The study participants were receptive to the program content, peer-led approach and found principal methods useful, yet the structured approach did not address all their needs or expectations. Both short and long-term impact on self-efficacy were observed following the workshop participation (albeit with a minor decrease at 6-months). Participants reported positive impacts on aspects of coping and self-care, but limited effects on healthcare service utilization.Conclusions: Our findings suggest that the process for cross-border adaptation was effective, and that the CDSMP can successfully be implemented in diverse healthcare and community settings. The adapted CDSMP can be considered an asset for supporting self-management in both German-and French-speaking central European countries. It could have meaningful, wide-ranging implications for chronic illness care and primary prevention and potentially tertiary prevention of chronic disease. Further investigations are needed to tailor the program for better access to vulnerable and disadvantaged groups who might benefit the most, in terms of facilitating their health literacy in chronic illness. [ABSTRACT FROM AUTHOR]

Successful management of health conditions in older population is determined by strategic involvement of a professional team of careers and by empowering patients and their caregivers to take over a central role and responsibility in the daily management of condition. Identifying, structuring and ranking the most important needs related to these aspects could pave the way for improved strategies in designing systems and technological solutions supporting user empowerment. This paper presents the preliminary results of a study aiming to elicit these needs. Healthcare professionals, working together in the European and Innovation Partnership on Active and Healthy Ageing (EIP-AHA) initiative, have defined a set of needs and factors that have been organized in two hierarchies around the concepts of patient activation and proactive and prepared care team, defined in the Chronic Care Model. The two hierarchies have been mapped, by a team of experts in computer science, with technologies and solutions that could facilitate the achievement of the identified needs. [ABSTRACT FROM AUTHOR]

The health benefits of physical activity and a healthy diet are well known, yet large proportions of modern societies do not meet recommended guidelines for these behaviours. Intervention programmes aimed at changing activity and eating behaviours, ranging from individual-level approaches to community-wide campaigns in effects on physical activity, diet and weight loss (Norman et al. ). A first step in healthy behaviour promotion aimed at behaviour change is to identify the health problems of a population that are serious and/or prevalent enough to justify spending time, money and other resources (Brug et al. ). Many behaviour change interventions aim to tackle obesity, the prevalence of which is still rising in many European countries, which is positively associated with chronic diseases affecting the health and wellbeing of Western populations. But other common risk factors for chronic disease, such as high intakes of salt or saturated fatty acids, are also the targets of health intervention programmes in a number of European countries. This paper provides examples of intervention programmes, conducted by government and other organisations, from eight European countries that aim to change behaviour in relation to diet and physical activity. It summarises the outcomes of a workshop held during a meeting of the European Nutrition Foundations ( ENF) Network in London, UK, on 25 June 2012. [ABSTRACT FROM AUTHOR]

Disparities in access to health care also extend to the end-of-life care. Despite the general principle that palliative care is equitably available for all in need, it remains underutilised by certain groups in the community. Ethnic minorities, older people and patients with non-cancer diseases are found to be at a greatest risk for underutilisation of palliative care. Barriers to access palliative care by these groups in the community are complex and often overlapping. To overcome these barriers, there is a need to take action on many fronts. This paper discusses these barriers and provides an overview of the strategies that have been implemented to address these issues. [ABSTRACT FROM AUTHOR]

Abstract: The aim of this paper is to examine educational inequalities in the risk of non-employment among people with illnesses and how they vary between European countries with different welfare state characteristics. In doing so, the paper adds to the growing literature on welfare states and social inequalities in health by studying the often overlooked ‘sickness’-dimension of health, namely employment behaviour among people with illnesses. We use European Union Statistics on Income and Living Conditions (EU-SILC) data from 2005 covering 26 European countries linked to country characteristics derived from Eurostat and OECD that include spending on active labour market policies, benefit generosity, income inequality, and employment protection. Using multilevel techniques we find that comprehensive welfare states have lower absolute and relative social inequalities in sickness, as well as more favourable general rates of non-employment. Hence, regarding sickness, welfare resources appear to trump welfare disincentives. [Copyright &y& Elsevier]

INTRODUCTION Having a chronic disease either caused or worsened by tobacco smoking does not always translate into quitting smoking. Although smoking cessation is one of the most cost-effective medical interventions, it remains poorly implemented in healthcare settings. The aim was to examine whether smokers with chronic and respiratory diseases were more likely to receive support to quit smoking by a healthcare provider or make a quit attempt than smokers without these diseases. METHODS This population-based study included a sample of 6011 adult smokers in six European countries. The participants were interviewed face-to-face and asked questions on sociodemographic characteristics, current diagnoses for chronic diseases, healthcare visits in the last 12 months and, if so, whether they had received any support to quit smoking. Questions on smoking behavior included nicotine dependence, motivation to quit smoking and quit attempts in the last 12 months. The results are presented as weighted percentages with 95% confidence intervals (CI) and as adjusted odds ratios with 95% CI based on logistic regression analyses. RESULTS Smokers with chronic respiratory disease, those aged 55 years and older, as well as those with one or more chronic diseases were more likely to receive smoking cessation advice from a healthcare professional. Making a quit attempt in the last year was related to younger age, high educational level, higher motivation to quit, lower nicotine dependence and having received advice to quit from a healthcare professional but not with having chronic diseases. There were significant differences between countries with smokers in Romania consistently reporting more support to quit as well as quit attempts. CONCLUSIONS Although smokers with respiratory disease did indeed receive smoking cessation support more often than smokers without disease, many smokers did not receive any advice or support to quit during a healthcare visit. [ABSTRACT FROM AUTHOR]

Health policy in Europe is at a crossroads. Longstanding challenges, such as persisting social and geographical inequalities, ageing populations, and rising burdens of chronic diseases, are being compounded by new, global threats, such as pandemic infl uenza and crises in the world's fi nancial markets. Signifi cant improvement in the health of Europe's population has been driven by factors both inside and outside the health sector. Key obstacles to improving population health in Europe result from underlying failures to overcome political and economic issues, including those shaping healthcare fi nancing and delivery systems. How can the public health community respond to these challenges? This paper discusses three examples of how power and politics have shaped the world in which public health works. The focus on individual risk factors diverts attention from underlying determinants, such as the dominance of the market in healthcare, and the political decision to favour a rapid transition from communism in the 1990s. Effective public health policy requires addressing these political forces, seeking to understand the dominant paradigms, how they have been defi ned and shaped, and how they might be changed. Their effects are often subtle but powerful, shaping the language that is used, the assumptions that are made, and the rules that are implied. We can formulate key policy options to help improve health outcomes by reshaping the critical forces that affect public health risk factors among those populations currently most burdened by signifi cant disease in Europe today. [ABSTRACT FROM AUTHOR]

summary objective the proportion of elderly people in the population has been increasing during the last few decades. in 1995, 16% of the middle european population was older than 65 years, and through the year 2010 this value should increase to 22%. german investigations have shown that 1/3 of the population older than 65 years suffers from 3-4 chronic diseases, 98% of the population older than 80 years from one chronic disease. thus, the number of old patients admitted to icus is increasing. the aim of the following paper was to evaluate the treatment and outcome of very old patients (over 85 years) at a medical icu of a general hospital over an 18month period. results and outcome 739 patients were admitted to the icu during the study period, 40 (5.3%) older than 85 years. at admission the apache ii score ranked between 6 and 38. indications were mainly cardial (23), metabolic (7), gastrointestinal (4), outside cpr (4) and acute respiratory failure (2). eleven patients had been mechanical ventilated (1-8d/mean 2.7d), 6 patients received a cardiac pacemaker, 5 underwent endoscopical interventions, 4 thrombolysis (ami, 100mg alteplase "front loaded"), 2 patients ptca/iabp and one female patient acbg. duration of stay was 4.0d (overall 5.6), mortality 28% (overall 14.8%). conclusion comorbidity and mortality were higher in patients older than 85 years compared to all patients. six months after the icu stay, 22 patients (57.5%) were still alive with good quality of life. despite higher mortality, very old patients benefit from icu stay and interventions. zusammenfassung der anteil älterer personen in der gesamtbevölkerung nimmt seit jahrzehnten zu. waren 1995 noch 16% der bevölkerung mitteleuropas über 65 jahre alt, so werden es im jahr 2010 bereits 22% sein. deutschen untersuchungen nach leidet 1/3 aller über 65-jährigen an 3-4 chronischen erkrankungen, 98% aller über 80-jährigen an mindestens einer chronischen erkrankung. dadurch nimmt auch der anteil älterer patienten an der intensivstation zu. ziel folgender arbeit war es, behandlung und outcome sehr alter, über 85-jähriger patienten einer medizinischen intensivstation über den zeitraum von 18 monaten zu dokumentieren. 739 patienten wurden an der intensivstation aufgenommen, 40 (5,3%) älter als 85 jahre. der apache-ii-score betrug zum aufnahmezeitpunkt 6-38 punkte. indikationen zur aufnahme waren hauptsächlich kardiale ursachen (23), metabolisch (7), gastrointestinal (4) auswärtig durchgeführte cpr (4) und akute exacerbation bei copd (2). 11 patienten mussten invasiv beatmet werden (1-8d/durchschnitt 2,7d), 6 patienten erhielten ein schrittmachersystem, bei 5 patienten war eine endoskopische intervention indiziert, 4-mal eine systemische thrombolyse wegen akuten myokardinfarkts, 2 patienten wurden einer perkutanen koronarintervention unter intraaortalem ballonpumpenschutz unterzogen und eine patientin nach aortokoronarer bypassoperation übernommen. die durchschnittliche aufenthaltsdauer lag bei 4,0 tagen (overall 5,6), die mortalität bei 28% (overall 14,8%). komorbidität und mortalität sind bei den sehr alten patienten naturgemäß wesentlich höher im vergleich zu den anderen patienten. 6 monate nach ihrem intensivaufenthalt befanden sich 22 (57,5%) der patienten am leben. trotz höherer mortalität profitieren auch sehr alte patienten von intensivmedizinischen maßnahmen. [ABSTRACT FROM AUTHOR]

Purpose Return to work is a complex and challenging process which takes various forms in different contexts. The aim of this study is to explore and compare cross-country differences in stakeholders' experiences and views on actors, policies and practices relevant for return to work after long-term sickness absence. The comparative exploration is done in six countries with various legislative backgrounds, welfare and social dialogue systems. Methods Using a purposive sample, six multidisciplinary stakeholders group discussions were conducted in six countries: Belgium, Estonia, Ireland, Italy, Romania and Slovakia. A total of 51 individuals comprised of social partners, policymakers or representatives of public bodies and patient associations participated. An interpretative phenomenological analysis was employed to derive the most important themes in the discussions. Results Five major themes emerged from the group discussions. A graphic model is proposed to emphasize the variety of frameworks and processes across countries. Conclusions The core part of the return to work process is the dynamic relation between legislation, stakeholders and practices, which is influenced by broader national and societal factors. The cross-country variation in legislations, stakeholders and practices can be understood as a continuum, from low to high structuring, development and comprehensiveness. Although social dialogue appears to have a role in return to work process with variation across countries, it is not always on top of the agenda of social partners. [ABSTRACT FROM AUTHOR]

One in ten adults in Europe have chronic insomnia, which is characterised by frequent and persistent difficulties initiating and/or maintaining sleep and daily functioning impairments. Regional differences in practices and access to healthcare services lead to variable clinical care across Europe. Typically, a patient with chronic insomnia (a) will usually present to a primary care physician; (b) will not be offered cognitive behavioural therapy for insomnia—the recommended first-line treatment; (c) will instead receive sleep hygiene recommendations and eventually pharmacotherapy to manage their long-term condition; and (d) will use medications such as GABA receptor agonists for longer than the approved duration. Available evidence suggests that patients in Europe have multiple unmet needs, and actions for clearer diagnosis of chronic insomnia and effective management of this condition are long overdue. In this article, we provide an update on the clinical management of chronic insomnia in Europe. Old and new treatments are summarised with information on indications, contraindications, precautions, warnings, and side effects. Challenges of treating chronic insomnia in European healthcare systems, considering patients' perspectives and preferences are presented and discussed. Finally, suggestions are provided—with healthcare providers and healthcare policy makers in mind—for strategies to achieve the optimal clinical management. [ABSTRACT FROM AUTHOR]

The article offers information on chronic disease research in Europe. One study presented a comparison between social networks and the self-assessed health status of elderly people in Italy and Spain. Another paper focused on the relationship between depression and mortality from coronary heart disease, investigating the extent to which it is explained by factors such as social class and health behaviors.

The COVID-19 pandemic has created challenges in providing medical care for people with health conditions other than COVID-19. The study aims to assess the prevalence of older adults' reportage of decline in health relative to pre-pandemic and to identify its determinants. The study is based on the Survey of Health, Ageing and Retirement in Europe (SHARE) data collected during the pandemic. It comprised 51,778 people in twenty-seven European countries and Israel. Participants were asked about changes in their health status relative to pre-pandemic. Bivariate analysis and logistic regression were used to identify factors associated with worsening of health. Nine percent of people (average age 70 years) reported a worsening of health relative to pre-pandemic. A logistic regression revealed a significant relation of the probability of a downturn in health to forgoing, postponing, or being denied an appointment for medical care. Multiple chronic illnesses, developing COVID-19, having at least one form of psychosocial distress, higher age, and lower economic capacity were also found significantly related to the probability of a decline in health. Older adults' comprehensive health needs must be addressed even when healthcare services are under strain due to pandemic outbreaks. Policymakers should attend to the healthcare needs of people whose vulnerability to the pandemic is amplified by chronic health conditions and low socioeconomic status. Public healthcare systems may experience a massive rebound of demand for health care, a challenge that should be mitigated by delivery of healthcare services and the provision of the financial resources that they need. [ABSTRACT FROM AUTHOR]

Using data from the COVID-19 questionnaire of the Survey of Health, Ageing and Retirement in Europe (SHARE), we investigate the time patterns of precautionary health behaviours of individuals aged 50 years and above during the summer of 2020, an easing phase of the COVID-19 pandemic in Europe. We also examine how these health behaviours differ by the presence of chronic conditions such as hypertension, high cholesterol level, heart disease, diabetes or chronic bronchitis, which can be considered as risk factors for COVID-19. Our results suggest that while on average, people became less precautious during the analysed time period, this is less so for those who are at higher risk. We also document large regional differences in precautionary health behaviours and show that higher-risk individuals are on average more cautious in all regions. We conclude that people adjusted their health behaviours in line with the generally understood risk of the COVID-19 disease. At the same time, our results also point out divergences in the level of willingness to take different precautionary steps. [ABSTRACT FROM AUTHOR]

With life expectancy increasing for the general population, public health promotion activities should be a priority to aim at a reduction of the burden and costs of hospitalization, disability, and lifelong treatment. This study aimed to explore the influence of parameters pertaining to different aspects of well-being, including physical and mental health and cognitive functioning, on self-perceived health, a predictor of chronic disease prevalence and mortality. We used data from the Survey of Health, Aging and Retirement in Europe (SHARE) project gathered between 2013 and 2017, obtaining a sample of 96,902 participants (63.23 ± 6.77 years). We found a strong association between the self-perceived health rating and not only physical health aspects but also mental health and cognitive functioning. In particular, BMI, chronic diseases and medications, muscle strength, and mobility issues had a strong effect on self-perceived health, as also did the quality of life, depression, and verbal fluency, while other aspects, such as individual characteristics, limitations in daily activities, and pain, among others only had a small effect. These results show that public health and prevention interventions should prioritize the targeting of all aspects of well-being and not only of physical health, acknowledging self-perceived health rating as a simple tool that could help provide a complete overview of psycho-physical well-being and functional status. [ABSTRACT FROM AUTHOR]

Dyadic coping (DC), how couples cope together to deal with a stressor like chronic illness, has received increased attention over the last three decades. The aim of the current study was to summarize the current state of research on DC in couples. We conducted a scoping review of qualitative, quantitative, and mixed-methods studies published between 1990 and 2020, assessing DC in couples during three decades. 5,705 studies were identified in three electronic databases and hand searches. We included 643 sources in this review (with a total of N = 112,923 study participants). Most studies were based in the global North, particularly in the US and Europe. Publication numbers increased constantly over time. A third of study designs were cross-sectional studies followed by qualitative and longitudinal studies. The most prolific DC research areas were related to DC and minor stressors and DC and major physical health stressors. Overall, DC has been established internationally as a highly relevant construct in many disciplines (clinical, social, developmental, personality psychology, social work, nursing etc.). To conclude, the review reveals that future studies should focus on predictors, trajectories, and the importance of very specific DC behaviors for personal and dyadic functioning. [ABSTRACT FROM AUTHOR]

Background:Prostate cancer is for many men a chronic disease with a long life expectancy after treatment. The impact of prostate cancer therapy on men has been well defined, however, explanation of the consequences of cancer treatment has not been modelled against the wider variables of long-term health-care provision. The aim of this study was to explore the parameters of unmet supportive care needs in men with prostate cancer in relation to the experience of nursing care.Methods:A survey was conducted among a volunteer sample of 1001 men with prostate cancer living in seven European countries.Results:At the time of the survey, 81% of the men had some unmet supportive care needs including psychological, sexual and health system and information needs. Logistic regression indicated that lack of post-treatment nursing care significantly predicted unmet need. Critically, men's contact with nurses and/or receipt of advice and support from nurses, for several different aspects of nursing care significantly had an impact on men's outcomes.Conclusion:Unmet need is related not only to disease and treatment factors but is also associated with the supportive care men received. Imperative to improving men's treatment outcomes is to also consider the access to nursing and the components of supportive care provided, especially after therapy. [ABSTRACT FROM AUTHOR]

Since the 1950s, life expectancy in Europe and the United States has improved at a steady pace, driven mostly by gains at older ages. However, these lives are punctuated by more chronic disease than ever before, contributing to substantial morbidity and disability. Using the Future Elderly Model, we simulate longevity and disability over the remaining lifetime for cohorts of older Europeans and Americans. We see that investment in both treatment and prevention for cancer, diabetes, and heart disease show tremendous promise for breaking Europe and the United States out of the expensive equilibrium we now find ourselves in as a result of demographic gains. [ABSTRACT FROM AUTHOR]

The political and economic turmoil that occurred in south-eastern Europe in the last decade of the twentieth century left a legacy of physical damage. This aspect of the conflict has received considerable coverage in the media. However, surprisingly less has been reported about the effects of that turmoil on the health of the people living in the region. In an attempt to identity and synthesize data on these effects, were carried out a systematic review and used the results to put together a searchable online database of documents, reports, and published material, the majority of which have not previously been easily accessible (http://www.lshtm.ac.uk/ecohost/see/index.php). The database covers the period from the early 1990s to 2003 and will be of considerable interest to policy-makers. It contains 762 items, many of them annotated and available for downloading. This paper synthesizes the main findings obtained from the material in the database and emphasizes the need for concerted action to improve the health of people in south-eastern Europe. Furthermore, we also recommend that agencies working in post-conflict situations should invest in developing and maintaining online databases that would be useful to others working in the area. [ABSTRACT FROM AUTHOR]

Purpose: The current study aims to examine the use of preventive and other health services among adults aged 50+ in eleven European countries. Methods: The data used were derived from 16,120 adults aged 50+ years participating in the Survey of Health, Ageing and Retirement in Europe (2004/05). Preventive Health Services Utilization score (PHSUs) and Health Care Services Utilization score (HCSUs) were assessed as a composite value from answers to 12 and 16 questions respectively, on a scale ranging from 0 to 100. Estimations were based on a complex study design. Results: Participants from Central European countries were found to have significantly higher mean PHSU and HCSU scores than their counterparts in Northern and Southern regions, (p < 0.05) and also exhibited a greater gap between the two scores (29.3, 95% CI: 28.6–30.1). Overall mean PHSU score was 39.9 (95% CI: 39.4–40.4) and mean HCSU score 12.4 (95% CI: 12.2–12.7). Women have a higher mean PHSUs and HCSUs (p < 0.001); as age increases, PHSUs falls and HCSUs rises (p < 0.001). Better educated participants appear to have higher mean PHSUs and HCSUs (p < 0.001). In addition, both of the above scores increase in the presence of chronic diseases (p < 0.001). Conclusion: Strong correlation is seen between comorbidity, increasing age, educational level, and retirement on the one hand, and increased use of health services on the other hand. The use of health services is a major issue with regard to public health policy formulation. [ABSTRACT FROM AUTHOR]

Annual influenza vaccination is recommended for children with chronic diseases. Studies on influenza vaccines, following controversies related to the 2009 H1N1 influenza, are scarce in Europe. Our aim was to evaluate the influenza vaccination coverage in such children in a French tertiary hospital. Secondary objectives were the evaluation of the influenza vaccination coverage trend and the identification of factors influencing the vaccination status. A prospective and descriptive study by questionnaire was performed at the end of 2017 in 402 French hospital outpatients with various underlying chronic diseases eligible to the influenza vaccination. The 2016–2017 vaccination coverage was 46.5%. Figures of 75% or greater were only found in patients with cystic fibrosis and sickle cell disease. CART analysis identified vaccination in the previous year, medical recommendation for vaccination, and maternal influenza vaccination as a child's decisive factors for being vaccinated. Conclusion: Influenza vaccination coverage remains insufficient in children receiving hospital follow-up for chronic diseases. Its implementation clearly depends on pediatricians' recommendation to vaccinate and on the type of chronic disease. What is Known: • Despite health policy recommendations, the rate of annual influenza vaccination in children with chronic diseases is low What is New: • Influenza vaccination coverage depends on the type of chronic disease and on the pediatricians' counseling to vaccine [ABSTRACT FROM AUTHOR]

The history of medical application of propolis (also known as bee glue) dates back to the times of ancient Greeks, Romans, Persians and Egyptians. Honey and other bee products, including propolis, occupy an important place in Polish folk medicine. Scientific research on propolis in Poland began in the early 1960s in Zabrze and continues until now. The aim of this review is to provide an overview of information on Polish research on propolis and its medical application with particular emphasis on studies concerning wound healing. Consequently, our goal is also to shed a new light on therapeutic potential of Polish propolis in order to support future research in the field. A systematic review of scientific literature on propolis and its medical application was performed by using the literature databases (PubMed, Web of Science, Google Scholar). We paid special attention to papers describing the effect of propolis on skin wound healing as well as to Polish contribution to research on propolis. Professor Stan Scheller was the first Polish scientist dealing with propolis and its medical potential. His legacy was continued by several research teams that studied the topic in various aspects. They analyzed propolis composition, its antioxidant, anti-inflammatory, antimicrobial, antiapoptotic and anticancer properties as well as its application in dentistry and wound treatment. Burn wound healing physiology after propolis administration was thoroughly studied on pig model, whereas research on patients proved the efficacy of propolis in chronic venous leg ulcer treatment. Polish scientists have made a significant contribution to the research on propolis, its biological properties and influence on wound healing. Propolis ointments can effectively accelerate the healing process and improve healing physiology, so they can be recommended as a promising topical medication for wound treatment in the future clinical and preclinical trials. Image 1 [ABSTRACT FROM AUTHOR]

We provide a systematic country and age group comparison of the gender gap in several generic health indicators and more specific morbidity outcomes. Using data from the Survey of Health, Ageing and Retirement (SHARE), we examined the gender gap in the prevalence of poor self-rated health, chronic health conditions, activity limitations, multimorbidity, pain, heart attacks, diabetes, and depression in three age groups (50–64, 65–79, and 80+) based on linear probability models with and without adjustment for covariates. While women were typically disadvantaged regarding poor self-rated health, chronic health conditions, activity limitations, multimorbidity, pain, and depression, men had a higher prevalence of heart attacks and diabetes. However, the gender gap's magnitude and sometimes even its direction varied considerably with some age trends apparent. Regarding some health indicators, the gender gap tended to be higher in Southern and Eastern Europe than in Western and Northern Europe. All in all, the presence of a gender health gap cannot be regarded as a universal finding as the gap tended to widen, narrow or even reverse with age depending on the indicator and country. [ABSTRACT FROM AUTHOR]

It was highlighted that in the original article [1] Fig. 2 was incorrect and the link for the Additional File was missing. This Correction article provides the correct Fig. 2 and the Additional File with its link. The original file has been updated. [ABSTRACT FROM AUTHOR]

Increasing longevity, along with an aging population in Europe, has caused serious concerns about diet-related chronic diseases such as obesity, diabetes, cardiovascular diseases, and certain cancers. As recently noted during the coronavirus pandemic, regular exercise and a robust immune system complemented by adequate consumption of fruit and vegetables are recommended due to their known health benefits. Although the volume of fresh vegetable consumption in the EU is barely growing, demand for diversified, nutritious, and exotic vegetables has been increasing. Therefore, the European market for fresh Asian vegetables is expected to expand across the EU member states, and the introduction of new vegetables has enormous potential. We conducted this review to address the high number and wide range of Asian vegetable species with a commercial potential for introduction into the current European vegetable market. Many of them have not received any attention yet. Four Asian vegetables: (1) Korean ginseng sprout, (2) Korean cabbage, (3) Coastal hog fennel and (4) Japanese (Chinese or Korean) angelica tree, are further discussed. All of these vegetables possess several health benefits, are increasingly in demand, are easy to cultivate, and align with current trends of the European vegetable market, e.g., vegetables having a unique taste, higher value, are decorative and small. Introducing Asian vegetables will enhance the diversity of nutritious horticultural products in Europe, associated with all their respective consumption benefits. Future research on the Asian vegetable market within Europe is needed. In addition, experimental studies of Asian vegetables under practical conditions for their production in different European environments are required. Economic, social, and ecological aspects also ought to be considered. [ABSTRACT FROM AUTHOR]

Recent research in religiousness and health suggests that epidemiological forces can have opposed effects. Here we examine two forms of religiousness and their association with disease. We performed a cross-sectional study of 23,864 people aged 50+ included in wave 1 (2004–2005) of the Survey of Health, Ageing and Retirement in Europe and a longitudinal study including people from wave 1, who were followed up during 11 years. Results suggested that taking part in a religious organization was associated with lower odds of heart attack (OR 0.74, 95% CI 0.60, 0.90), stroke (OR 0.68, 95% CI 0.50, 0.95), and diabetes (OR 0.72, 95% CI 0.58, 0.90) and longitudinally associated with lower odds of cancer (OR 0.78, 95% CI 0.60, 1.00). Conversely, praying was longitudinally associated with higher odds of heart attack (OR 1.27, 95% CI 1.10, 1.48) and high cholesterol (OR 1.12, 95% CI 1.00, 1.26). The most religious people had lower odds of stroke, diabetes, and cancer than other respondents, and in the longitudinal model, people who only prayed had higher odds of heart attack than non-religious people. Our findings lend support to the hypothesis that restful religiousness (praying, taking part in a religious organization, and being religiously educated) was associated with lower odds of some diseases, whereas little evidence was present that crisis religiousness (praying only) was associated with higher odds of disease. [ABSTRACT FROM AUTHOR]

Aim: To provide reliable survival estimates for people with chronic heart failure and explain variation in survival by key factors including age at diagnosis, left ventricular ejection fraction, decade of diagnosis, and study setting.Methods and Results: We searched in relevant databases from inception to August 2018 for non-interventional studies reporting survival rates for patients with chronic or stable heart failure in any ambulatory setting. Across the 60 included studies, there was survival data for 1.5 million people with heart failure. In our random effects meta-analyses the pooled survival rates at 1 month, 1, 2, 5 and 10 years were 95.7% (95% confidence interval 94.3-96.9), 86.5% (85.4-87.6), 72.6% (67.0-76.6), 56.7% (54.0-59.4) and 34.9% (24.0-46.8), respectively. The 5-year survival rates improved between 1970-1979 and 2000-2009 across healthcare settings, from 29.1% (25.5-32.7) to 59.7% (54.7-64.6). Increasing age at diagnosis was significantly associated with a reduced survival time. Mortality was lowest in studies conducted in secondary care, where there were higher reported prescribing rates of key heart failure medications. There was significant heterogeneity among the included studies in terms of heart failure diagnostic criteria, participant co-morbidities, and treatment rates.Conclusion: These results can inform health policy and individual patient advanced care planning. Mortality associated with chronic heart failure remains high despite steady improvements in survival. There remains significant scope to improve prognosis through greater implementation of evidence-based treatments. Further research exploring the barriers and facilitators to treatment is recommended. [ABSTRACT FROM AUTHOR]

Many countries are experimenting with new models of care delivery involving enhanced integration and coordination of services to better meet the needs of those living with chronic illness. However, the available evidence on the relative value of different forms of integration remains uncertain. This paper will present the findings of a study undertaken in close collaboration with and co-funded by the European Observatory on Health Systems and Policies. It will provide an overview of strategies to chronic disease management that have been developed and/or implemented in five European countries (Denmark, England, France, Germany, Sweden) and Australia. It will also assess some of the contextual factors that enable or hinder implementation of strategies to address chronic illness. It illustrates the immense diversity among European countries in their approaches to address the rising burden of chronic disease. Approaches not only vary between but also within countries, and reflect to considerable degree the general approaches of health care financing and organisation taken. Thus, in many countries where strong primary care teams exist there has been a progressive shift in the management of many chronic diseases to nurse-led clinics in primary care, for example in England, Sweden and the Netherlands. The involvement of the non-medical profession in France or Germany is low, partly because of legal and professional restrictions on the deployment of nurses outside hospital. Instead, Germany has introduced dedicated disease management programmes which patients and providers can join voluntarily, while France is incentivising the formation of provider networks so as to improve coordination and multidisciplinary working along the continuum of care. The role of patient self-management is being acknowledged as a key component of effective chronic disease management in many countries; yet, systems that support self-management systematically remain relatively weak in many settings. The sustainability of chronic care models faces considerable challenges in all health care settings. These include administrative and financial obstacles to enhance the coordination and/or integration of health and social/community care services; under/mis-investment in suitable information systems; conflicting policies (e.g. pursuing activity-based funding vs. aiming to shift care into the community); a focus on cost reduction; and the potential impact of electoral cycles. An effective response to the rising burden of chronic disease requires a health system environment that allows for the development and implementation of structured approaches to chronic disease management. Experience suggests that systems that are characterised by fragmentation of health services are facing considerable challenges in the successful implementation of system-wide strategies to provide care for patients with chronic illness. [ABSTRACT FROM AUTHOR]

This article examines the relationship between health and volunteering in advanced age in a cross-national comparison. We used longitudinal data from five waves of the Survey of Health, Ageing and Retirement in Europe covering 13 European countries from 2004 to 2015 and employed dynamic random-effects probit models to study the consequences of declining health on voluntary work. Our results confirm that worsening health conditions (i.e., mobility limitations and depression) reduce the likelihood of volunteering, whereas chronic diseases do not. Most interestingly, we found important differences across countries: Worsening health reduces voluntary work participation, especially in contexts characterized by high rates of volunteering. Our findings have implications for policy makers and voluntary organizations that aim to encourage participation: Individual characteristics and contextual aspects must be taken into account, and people with health problems might need specific support through policies, recruitment, and retention even in contexts of overall high levels of volunteering. [ABSTRACT FROM AUTHOR]

Background: In the Central and Eastern European region, the British EQ-5D-3L value set is used commonly in quality of life (QoL) studies. Only Poland and Slovenia have country-specific weights. Our study aimed to investigate the impact of value set choice on the evaluation of 18 chronic conditions in Hungary.Methods: Patients' EQ-5D-3L index scores were calculated using the VAS-based Slovenian and European and the time-trade-off-based Polish and British value sets. We performed pairwise comparisons of mean index values by dimensions, diagnoses and age groups. We evaluated disease burden by comparing index values matched by age and gender in each condition with those of the general population of the CEE region in all four value sets.Results: Altogether, 2421 patients (55% female) were included in our sample with the average age of 55.87 years (SD = 17.75). The average Slovenian, European, Polish and British EQ-5D-3L scores were 0.598 (SD = 0.279), 0.661 (SD = 0.257), 0.770 (SD = 0.261) and 0.644 (SD = 0.279), respectively. We found highly significant differences in most diagnoses, with the greatest difference between the Polish and Slovenian index values in Parkinson's disease (0.265). Systematic pairwise comparison across all conditions and value sets revealed greatest differences between the time-trade-off (TTO) and VAS-based value sets as well as varying sensitivity of the disease burden evaluations of chronic disease conditions to the choice of value sets.Conclusions: Our results suggest that the choice of value set largely influences the health state utility results in chronic diseases, and might have a significant impact on health policy decisions. [ABSTRACT FROM AUTHOR]

Background: Increasing healthcare expenditures have triggered a trend from volume to value by linking patient outcome to costs. This concept first described as value-based healthcare (VBHC) by Michael Porter is especially applicable for chronic conditions. This article aims to explore the applicability of the VBHC framework to the chronic kidney disease (CKD) care area. Methods: The 4 dimensions of VBHC (measure value; set and communicate value benchmarking; coordinate care; payment to reward value-add) were explored for the CKD care area. Available data was reviewed focusing on CKD initiatives in Europe to assess to what extent each of the 4 dimensions of VBHC have been applied in practice. Results: Translating VBHC into value-based renal care (VBRC) seems to be initiated to a limited extent in European health systems. In most cases not all dimensions of VBHC have been utilized in the renal care initiatives. Conclusion: The translation of VBHC into VBRC is possible and even desirable if an optimal treatment pathway for CKD patients could be achieved. This would require an organizational change in health system set up and should include a strategy focusing on full care responsibility. The patient outcome perspective and health economic analysis need to be the centre of attention. [ABSTRACT FROM AUTHOR]

Background Inequalities in the distribution of self-reported health (SRH) have been widely reported. Its higher expressivity among women, elderly and least educated groups has been partly attributed to differences in their health perceptions. However, this subjectivity may be masking the burden of mental illness in these groups. Thus, we sought to understand if depression symptoms mediate inequalities in SRH. Methods SHARE waves 4 and 6, pertaining to Spain, Italy and Portugal, were used (n 2011 = 8517, n 2015 = 11 046). Inequalities in SRH were calculated, comparing the risk amongst education level, gender and age groups, adjusting for chronic diseases, functional limitations and country fixed effects. We then tested depression symptoms as mediators. Results Depression symptoms were associated with poor SRH (odds ratio (OR)2011 = 1.379, OR2015 = 1.384, P < 0.001). Their inclusion reduced the magnitude of the association between SRH and education, annulled the statistical significance for age, and reversed the gender effect. As expected, chronic diseases and functional limitations remained significant predictors of poor SRH. Conclusions Depression symptoms, together with chronic diseases and functional limitations, explain the poorer SRH of the least educated, female and older groups in the Southern European population. Therefore, tackling inequalities in SRH must require focusing on mental health issues, which disproportionately affect the most vulnerable groups. [ABSTRACT FROM AUTHOR]

Background This study aimed to assess cross-sectional and prospective relationships between vigorous physical activity (VPA) and the risk of major chronic diseases among European older adults. Methods Participants were 37 524 older adults who responded to the fourth (in 2011) and fifth (in 2013) wave of the SHARE project, from 13 European countries. Participants answered interview questions about the presence of chronic conditions and VPA. The cross-sectional and prospective association between PA and the number of chronic diseases was assessed using logistic regression models. Results Among men and women, the prevalence of chronic diseases was significantly lower among those who reported VPA once a week or more than once a week. For men, VPA once a week was prospectively related with lower odds of heart attack, chronic lung disease, Parkinson's disease and Alzheimer's disease. VPA more than once a week was prospectively related with lower odds of having all chronic diseases. Women who engaged in VPA once a week presented lower odds of having chronic diseases, except for hypertension, high blood cholesterol and cancer. For VPA more than once a week, cancer was the only disease not associated with physical activity. Conclusion VPA is associated with reduced risk of chronic diseases in men and women. Even the practice of VPA once a week seems to be sufficient to reduce risks of chronic diseases. [ABSTRACT FROM AUTHOR]

This study measured the prevalence of chronic venous disease (CVD, C1-C6), chronic venous insufficiency (C3-C6) in 23 countries. The possible influence of risk factors was assessed. Patient recruitment was carried out by general practitioners. Patient characteristics, prevalence of risk factors, and C-classification were recorded. We assessed differences in prevalence and risk factors between Asia (A), Eastern Europe (EE), Latin America (LA), and Western Europe (WE). A total of 99 359 patients were included. The prevalence of CVD (51.9% A, 70.18% EE, 68.11% LA, and 61.65% WE) was significantly (P < .001) lower in A. Risk factors such as age, obesity, smoking, having regular exercise, use of birth control pills, prolonged standing and sitting, and having a positive family history differ significantly between regions. After model-based probabilities corrected for risk factors, significant differences in the probability of having CVD were only found in the older age-group (>65 years). The lowest prevalence was noted in A. Chronic venous disease is very common and the prevalence varies between different geographical areas. After correcting for risk factors, these differences diminished. [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]

Aims: The aim of this study was to project educational inequalities in obesity and smoking prevalence to 2050 based on past obesity and smoking trends by education level. Methods: Data on obesity (body mass index ≥ 30) and smoking prevalence (current smokers) by education level (tertiary education and less than tertiary) from nationally representative cross-sectional surveys were collected for the following six countries participating in the Economics of Chronic Diseases project (EConDA): England, Finland, Lithuania, the Netherlands, Poland (obesity only) and Portugal (obesity only). A nonlinear multivariate regression model was fitted to the data to create longitudinal projections to 2050. Inequalities were measured with a prevalence ratio and a prevalence difference using projected obesity/smoking prevalence. Results: Educational inequalities in obesity prevalence are projected to increase in Finland, Lithuania and England for men, and in Lithuania and Poland for women, by 2050. Obesity prevalence is projected to increase faster among the more advantaged groups in England, Portugal, Finland and the Netherlands among women, and Portugal and the Netherlands among men, narrowing inequalities. In contrast to obesity, smoking prevalence is projected to continue declining in most of the countries studied. The decline is projected to be faster in relative terms among more advantaged groups; therefore, relative educational inequalities in smoking prevalence are projected to increase in all countries. Conclusions: Widening educational inequalities in obesity and smoking prevalence are expected in several European countries if current trends in obesity and smoking prevalence are unaltered. This will impact on inequalities in morbidity and mortality of associated diseases such as diabetes, coronary heart disease and chronic obstructive pulmonary disease. [ABSTRACT FROM AUTHOR]

The cumulative (dis)advantage hypothesis states that health disparities between education groups increase with age. The present study examined this hypothesis in a comparative analysis of the United States, the United Kingdom, the Netherlands, and Sweden. These countries offer sharp contrasts in the social conditions that may intensify or inhibit processes of cumulative (dis)advantage. Using harmonized panel data from the HRS, ELSA, and SHARE, the study applied Poisson multilevel regression models to trace changes in the number of chronic conditions and functional limitations of people aged 50-76 (N = 16,887 individuals; 71,154 observations). The four countries showed a clear gradient in levels of physical health and in the extent to which health trajectories were shaped by education. Across all ages and cohorts, health problems were most prevalent in the United States, less prevalent in the United Kingdom and the Netherlands, and least prevalent in Sweden. A similar cross-national gradient was found for the size of health gaps between education groups and for the extent to which these gaps widened with age. Gaps were largest in the United States, smaller in the United Kingdom and in the Netherlands, and smallest in Sweden. [ABSTRACT FROM AUTHOR]

More than 2 million people fleeing conflict, persecution, and poverty applied for asylum between 2015 and 2016 in the European Union. Due to this, medical practitioners in recipient countries may be facing a broader spectrum of conditions and unusual presentations not previously encountered, including a wide range of infections with pulmonary involvement. Tuberculosis is known to be more common in migrants and has been covered broadly in other publications. The scope of this review was to provide an overview of exotic infections with pulmonary involvement that could be encountered in refugees and migrants and to briefly describe their epidemiology, diagnosis, and management. As refugees and migrants travel from numerous countries and continents, it is important to be aware of the various organisms that might cause disease according to the country of origin. Some of these diseases are very rare and geographically restricted to certain regions, while others have a more cosmopolitan distribution. Also, the spectrum of severity of these infections can vary from very benign to severe and even life-threatening. We will also describe infectious and noninfectious complications that can be associated with HIV infection as some migrants might originate from high HIV prevalence countries in sub-Saharan Africa. As the diagnosis and treatment of these diseases can be challenging in certain situations, patients with suspected infection might require referral to specialized centers with experience in their management. Additionally, a brief description of noncommunicable pulmonary diseases will be provided. [ABSTRACT FROM AUTHOR]

An introduction is presented in which reports in the issue are discussed on topics including definitions of care coordination, chronic care management in transplant programs, and medical care in Scandinavia.

Aim: To report on the outcomes of the European project ENS4Care, which delivered evidence‐based guidelines enabling implementation of eHealth services in nursing and social care. Background: Within a policy context of efficiency, safety and quality in health care, this project brought together a diverse group of stakeholders from academia, industry, patient and professional organizations to lead the development of five eHealth guidelines in the areas of prevention, clinical practice, integrated care, advanced roles and nurse ePrescribing. Sources of evidence: Data were collected through a cross‐sectional, online, questionnaire survey of health professionals from 21 countries. Quantitative data were analysed using descriptive and summary statistics, while comments to open questions underwent a process of content analysis. Discussion: Representing an evidence‐based consensus statement, the five guidelines outline key steps and considerations for the deployment of eHealth services at different levels of enablement. Through analysis of the data, and sharing of best practices, common deployment processes and implementation lessons were identified. Conclusion: Findings reveal the richness, diversity and potential that eHealth holds for enabling the delivery of safer, more efficient and patient‐centred health care. Nurses and social care workers as the main proprietors of such practices hold the key to a healthier future for citizens across Europe. Implications for nursing and health policy: The preparation, agreement and dissemination of the ENS4Care guidelines will enable European Union leaders to diagnose the organizational changes needed and prescribe the development of new skills and roles in the workforce to meet the challenge of eHealth. Nurses and social care workers, with the right knowledge and skills will add considerable value and form an important link between technological innovation, health promotion and disease prevention. [ABSTRACT FROM AUTHOR]

Background: Previous studies examining physical and mental non-communicable diseases (NCDs) in Europe have so far largely either focused on limited numbers of countries or on fairly limited ranges of NCDs, with mental health in particular often being ignored. This article has three aims: (i) To provide a recent, comprehensive overview of a broad range of NCDs across a range of countries in all European regions; (ii) To give an overview of measures of physical and mental health in the new special rotating module in the European Social Survey (ESS); and (iii) To offer the first comprehensive comparison of estimates on physical and mental NCDs across European countries in this new promising data source. Methods: We use data from the 7th wave of the ESS. Results are presented separately for men and women. All results were age-standardized by weighting up or down the unstandardized (crude) prevalence rates for 5-year age groups in each country to a common standard. We present pooled estimates for the combined cross-national sample as well as country-specific results. Results: Overall, 74.1% of men and 79.7% of women reported at least one physical NCD. Across the 21 countries were observed that these percentages varied between 45.2% (for men in Hungary) and 91.6% (women in Finland). Serious depressive symptoms were reported by 10.2% of men and 18.8% of women, with percentages ranging between 6.2% (men in Ireland) and 30.9% (women in Portugal). Conclusions: A substantial share of Europeans experience the burden of NCDs, and the extent to which people report these conditions varies across countries. However, all physical and mental NCDs in this rotating module are reported by considerable percentages in each of the 21 country samples, which emphasizes that these conditions are not marginal phenomena but public health concerns. [ABSTRACT FROM AUTHOR]