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Objective. To describe health care resource utilization and costs for patients with advanced soft tissue sarcoma (STS) in the United Kingdom (UK), Spain, Germany, and France. Methods. Physicians abstracted data for adult patients with a diagnosis of advanced STS (other than Kaposi’s sarcoma or gastrointestinal stromal tumor) who received ≥1 lines of systemic therapy. Health care resource utilization related to advanced STS treatment was recorded; associated costs were estimated by applying unit costs. Results. A total of 130 physicians provided data for 807 patients (UK: 199; Spain: 203; Germany: 204; and France: 201). The site of care during active treatment varied based on differences in the health care systems of these four countries. Total mean per-patient health care cost in the UK was £19,457; in Spain, €26,814; in Germany, €20,468; and in France, €24,368. Advanced STS-related systemic treatment costs were driven primarily by drug acquisition and administration costs. Treatment-related costs increased during later lines of therapy for all countries except France, where they decreased after first-line therapy. Pain control and antiemetics were the most common supportive care medications. Conclusions. This study provides real-world data on resource utilization and estimated costs in advanced STS and could inform policymakers about treatment burden. [ABSTRACT FROM AUTHOR]

Introduction: Universal literature is a source of data to know diseases through history. Aims: Encourage readers to explore diseases and improve their health through literature. Methodology: The selected text is Oliver Twist for being the best known of Charles Dickens in his English and Spanish version. All the texts related to health are analyzed and the most representative ones are chosen, as well as those that are most repeated. A comparison is also made with the situation in Spain in those years. Results: The level of development of Great Britain was much higher than that of Spain. Technology had reached the countryside, the mines and the city. The epidemics, the health system, work accidents did not have many similarities due to the backwardness suffered by Spain. Conclusion: Literature serves to raise public awareness of the importance of health. Literature should be encouraged as an instrument for the prevention of diseases, even writers who describe diseases without knowing it. [ABSTRACT FROM AUTHOR]

Objective. To describe real-world treatment patterns and outcomes for patients with advanced soft tissue sarcoma (STS) not amenable to surgery or radiotherapy in the United Kingdom, Spain, Germany, and France. Methods. Physicians completed a web-based medical record abstraction for adult patients with advanced STS (other than Kaposi’s sarcoma or gastrointestinal stromal tumor) who received ≥1 line of systemic therapy. Clinical characteristics, treatments, tumor responses, and mortality data were recorded. Results. A total of 130 physicians provided data for 807 patients. Patients’ mean age at advanced STS diagnosis was 57.1 (±12.3) years; 59% were male. The most commonly identified histologic categories were leiomyosarcoma (28%), liposarcoma (13%), and rhabdomyosarcoma (11%). Overall, 57% of patients received only 1 line of therapy, 32% received 2 lines of therapy, and 11% received ≥3 lines of therapy. The most common first-line regimens were doxorubicin alone (41%), doxorubicin plus ifosfamide (19%), docetaxel plus gemcitabine (9%), paclitaxel alone (4%), and ifosfamide (4%). Median overall survival from start of treatment was estimated to be 17.6 months (95% confidence interval, 15.6–19.0 months). Conclusions. In real-world clinical practice, advanced STS is most commonly treated with older therapies in the United Kingdom, Spain, Germany, and France. New therapies that improve overall survival in advanced STS are needed. [ABSTRACT FROM AUTHOR]

Objective. To gain insight into clinical practice regarding referral, early diagnosis and other aspects of the management of patients with dcSSc in Europe and the USA. Methods. Semi-structured interviews were conducted with 84 rheumatologists (or internal medicine physicians) and 40 dermatologists in different countries (the UK, France, Germany, Italy, Spain and the USA). Physicians were asked to identify key steps in the patient pathway relating to patient presentation, diagnosis and referral, in addition to other treatment and follow-up processes. Results. The interviewed physicians reported that late presentation with dcSSc was common, with some patients presenting to primary care physicians after symptoms had persisted for up to 1 year. Awareness of dcSSc is reported to vary widely among primary care physicians. Final diagnosis, generally following guideline-based recommendations, was by rheumatologists in most cases (or internal medicine physicians in France) and they remained responsible for global patient management, with lesser involvement in diagnosis and management by dermatologists. Specialist centres were not well defined and did not exist in all countries. Conclusion. Patients and primary healthcare providers can be unaware of the symptoms of dcSSc, therefore presentation and referral to specialist care are often late. Thus, improved awareness among patients and primary care physicians is necessary to facilitate earlier referral and diagnosis. Once referred, more consistent use of the modified Rodnan skin score at diagnosis and follow-up may help to monitor disease progression. Furthermore, establishing specialist centres may help to promote such changes and improve patient care. [ABSTRACT FROM AUTHOR]

The article analyzes how those young Spanish people (aged between 25 and 35) with a university degree, migrated to the United Kingdom and Chile between 2010 and 2014, build their adaptive processes in both countries. These processes are complex and they depend on a range of factors, such as the skills of migrants regarding the language of the arrival country, their habituation to the climate of such country, the social position they acquire after migration, their interaction with the local population, the images they construct about their society of origin, and the level of integration in the new social spaces they access, etc.. Depending on all these factors, multiple possible adaptation paths of migrants can be configured. These paths are systematized here by means of a three-dimensional analytical model that distinguishes among nostalgic, converse and cosmopolitan ways of adaptation. Such model is used to examine how university skilled migrants construct, deconstruct and reconstruct their adaptive strategies in the UK and Chile, two different socio-economic and cultural contexts. Firstly, in the UK, the adaptive processes reveal a more versatile character, showing adaptation paths of young Spanish immigrants that are classified, respectively, as nostalgic, converse and cosmopolitan. However, those young Spanish people settled in Chile manifest greatly affected by the high degree of privatization of problems and public services existing in this country, in which it is broadly assumed that the costs of such problems and services have to be individually paid. This causes that these young migrants, faced to this very difficult situation that is so hard to understand and accept by them, develop adaptation processes mainly characterized by the nostalgia for their origin society and the idealization of the return. [ABSTRACT FROM AUTHOR]

Background: To more accurately quantify the potential impact of the neighbourhood environment on adults' physical activity (PA), it is important to compare environment-PA associations between periods of the day or week when adults are more versus less likely to be in their neighbourhood and utilise its PA resources. We examined whether, among adults from 10 countries, associations between objectively-assessed neighbourhood environment attributes and moderate-to-vigorous physical activity (MVPA) varied by time of the day and day of the week. The secondary aim was to examine whether such associations varied by employment status, gender and city. Methods: This cross-sectional study included 6,712 adults from 14 cities across 10 countries with ≥1 day of valid accelerometer-assessed MVPA and complete information on socio-demographic and objectively-assessed environmental characteristics within 0.5 and 1 km street-network buffers around the home. Accelerometer measures (MVPA min/h) were created for six time periods from early morning until late evening/night, for weekdays and weekend days separately. Associations were estimated using generalized additive mixed models. Results: Time of the day, day of week, gender and employment status were significant moderators of environment-MVPA associations. Land use mix was positively associated with MVPA in women who were employed and in men irrespective of their employment status. The positive associations between MVPA and net residential density, intersection density and land use mix were stronger in the mornings of weekdays and the afternoon/evening periods of both weekdays and weekend days. Associations between number of parks and MVPA were stronger in the mornings and afternoon/evenings irrespective of day of the week. Public transport density showed consistent positive associations with MVPA during weekends, while stronger effects on weekdays were observed in the morning and early evenings. Conclusions: This study suggests that space and time constraints in adults' daily activities are important factors that determine the impact of neighbourhood attributes on PA. Consideration of time-specific associations is important to better characterise the magnitude of the effects of the neighbourhood environment on PA. Future research will need to examine the contribution of built environment characteristics of areas surrounding other types of daily life centres (e.g., workplaces) to explaining adults' PA at specific times of the day. [ABSTRACT FROM AUTHOR]

Introduction. During the 2014–2016 West-African Ebola virus disease (EVD) outbreak, some HCWs from Western countries became infected despite proper equipment and training on EVD infection prevention and control (IPC) standards. Despite their high awareness toward EVD, some of them could not recall the transmission routes. We explored these incidents by recalling the stories of infected Western HCWs who had no known directly exposures to blood/bodily fluids from EVD patients. Methodology. We carried out conventional and unconventional literature searches through the web using the keyword “Ebola” looking for interviews and reports released by the infected HCWs and/or the healthcare organizations. Results. We identified fourteen HCWs, some infected outside West Africa and some even classified at low EVD risk. None of them recalled accidents, unintentional exposures, or any IPC violation. Infection transmission was thus inexplicable through the acknowledged transmission routes. Conclusions. We formulated two hypotheses: inapparent exposures to blood/bodily fluids or transmission due to asymptomatic/mildly symptomatic carriers. This study is in no way intended to be critical with the healthcare organizations which, thanks to their interventions, put an end to a large EVD outbreak that threatened the regional and world populations. [ABSTRACT FROM AUTHOR]

Background: Even though addressing lifestyle problems is a major recommendation in most guidelines for the treatment of hypertension (HTN), alcohol problems are not routinely addressed in the management of hypertension in primary health care. Methods: Internet based survey of 3081 primary care physicians, recruited via the mailing lists of associations for general practitioners (GPs) in France, Germany, Italy, Spain and the UK. Clinical practice, attitudes, knowledge, education and training were assessed. Logistic regression to predict screening, brief intervention and treatment for alcohol dependence in the management of hypertension were assessed. Results: Overall, about one third of the interviewed GPs reported sufficient screening in cases with HTN (34.0 %, 95 % confidence interval (CI):32.1-35.8 %). One out of five GPs screened and delivered brief interventions in HTN patients with hazardous consumption (22.2 %, 95 % CI: 20.6-23.8 %) and about one in 13 GPs provided treatment for HTN patients with alcohol dependence other than advice or brief intervention (7.8 %, 95 % CI: 6.8-8.9 %). Post-graduate training and belief in their effectiveness predicted interventions. There were marked differences between countries. Conclusions: While current interventions were overall low, marked differences between countries indicate that current practices could be improved. Education and post-graduate training seems to be key in improving clinical practice of including interventions for problematic alcohol consumption and alcohol dependence in primary health care. [ABSTRACT FROM AUTHOR]

Background: Effective linkage to specialist care following screening is crucial for secondary prevention of chronic viral hepatitis-related consequences. Methods: To explore the frequency of referral of patients to secondary care from the health services involved in screening and to gather information on the services responsible for the provision of post-test counselling and contact tracing, four online surveys were conducted among general practitioners (GP), and experts working in sexual health services (SHS), antenatal care (ANC) and specialist secondary care in Germany, Hungary, Italy, The Netherlands, Spain and the UK. Results: Overall, 60% of GPs report referring all patients to specialist care. Although 67% of specialists commonly receive patients referred by GPs, specialists in Germany rarely or never receive patients from ANC or from centres testing injecting drug users; and specialists in the Netherlands, Hungary and Germany rarely receive patients from SHS. Gastroenterologists/hepatologists are the professionals mainly responsible for the provision of counselling following a positive diagnosis of viral hepatitis according to two-thirds of specialists, 14% of SHS providers and 11% of ANC providers. Almost half of ANC providers (45%) stated that gynaecologists are the professionals responsible for the provision of counselling to positive pregnant women; among SHS providers, only 14% identified SHS as the services responsible. Conclusion: Our findings suggest the existence of complex/ineffective referral practices or that opportunities to screen risk groups are missed. Recommendations clarifying the services responsible at each step of the referral pathway are needed in order to increase the success of screening programmes. [ABSTRACT FROM AUTHOR]

The article discusses research which examined link between tumor necrosis factor ligand superfamily member 4 gene (TNFSF4) rs844648 polymorphism and systemic sclerosis (SS)-related calcinosis. Topics explored include the prevalence of calcinosis in patients with SS, the observed increase in OX40L serum levels in early-onset SS patients, and brief details about the genotyping and meta-analysis of data performed.

Acetylsalicylic acid is a frequently used medication worldwide. It is not used in pediatrics due its association with Reye syndrome. However, in case of pediatric intoxication, children are more fragile to salicylate poisoning because of their reduced ability of buffer the acid stress. Intoxication leads to a decoupling of oxidative phosphorylation and subsequently to a loss in mitochondrial function. Symptoms of poisoning are diverse; eventually they can lead to the death of the patient. Governmental websites of various EU countries were searched for legal information on acetylsalicylic acid availability in pharmacies and non-pharmacy stores. Various EU countries permit prescription-free sales of acetylsalicylic acid in pharmacies and non-pharmacy stores. In Sweden acetylsalicylic acid 500 mg may be sold in a maximum package size of 20 tablets or effervescent tablets in a non-pharmacy. In the UK a maximum of 16 tablets of acetylsalicylic acid 325 mg is allowed to sell in non-pharmacies. In Ireland acetylsalicylic acid is classified as S2 medication. Subsequently, acetylsalicylic acid is allowed to be sold prescription-free in pharmacies and non-pharmacy stores. In the Netherlands acetylsalicylic acid may only be sold in drug stores or pharmacies. A maximum of 24 tablets of 500 mg is allowed to purchase in a drug store. Several countries in the European Union are permitted to offer acetylsalicylic acid prescription-free in pharmacies and non-pharmacy stores without legal guidance on the storage position within the store. Further research is needed to investigate whether acetylsalicylic acid is located directly accessible to young children within the stores in EU countries which permit prescription-free sales of acetylsalicylic acid. [ABSTRACT FROM AUTHOR]

Background: Osteoarthritis (OA) is the most common cause of disability in the elderly. Clinical frailty is associated with high mortality, but few studies have explored the relationship between OA and frailty. The objective of this study was to consider the association between OA and frailty/pre-frailty in an elderly population comprised of six European cohorts participating in the EPOSA project.Methods: Longitudinal study using baseline data and first follow-up waves, from EPOSA; 2,455 individuals aged 65-85 years were recruited from pre-existing population-based cohorts in Germany, Italy, the Netherlands, Spain, Sweden and the United Kingdom. Data were collected on clinical OA at any site (hand, knee or hip), based on the clinical classification criteria developed by the American College of Rheumatology (ACR). Frailty was defined according to Fried's criteria. The covariates considered were age, gender, educational level, obesity and country. We used multinomial logistic regression to analyse the associations between OA, frailty/pre-frailty and other covariates.Results: The overall prevalence of clinical OA at any site was 30.4 % (95 % CI:28.6-32.2); frailty was present in 10.2 % (95 % CI:9.0-11.4) and pre-frailty in 51.0 % (95 % CI:49.0-53.0). The odds of frailty was 2.96 (95 % CI:2.11-4.16) and pre-frailty 1.54 (95 % CI:1.24-1.91) as high among OA individuals than those without OA. The association remained when Knee OA, hip OA or hand OA were considered separately, and was stronger in those with increasing number of joints.Conclusions: Clinical OA is associated with frailty and pre-frailty in older adults in European countries. This association might be considered when designing appropriate intervention strategies for OA management. [ABSTRACT FROM AUTHOR]

Background: The Seven Countries Study in the 1960s showed very low mortality from coronary heart disease (CHD) in Japan, which was attributed to very low levels of total cholesterol. Studies of migrant Japanese to the USA in the 1970s documented increase in CHD rates, thus CHD mortality in Japan was expected to increase as their lifestyle became Westernized, yet CHD mortality has continued to decline since 1970. This study describes trends in CHD mortality and its risk factors since 1980 in Japan, contrasting those in other selected developed countries.Methods: We selected Australia, Canada, France, Japan, Spain, Sweden, the UK and the USA. CHD mortality between 1980 and 2007 was obtained from WHO Statistical Information System. National data on traditional risk factors during the same period were obtained from literature and national surveys.Results: Age-adjusted CHD mortality continuously declined between 1980 and 2007 in all these countries. The decline was accompanied by a constant fall in total cholesterol except Japan where total cholesterol continuously rose. In the birth cohort of individuals currently aged 50-69 years, levels of total cholesterol have been higher in Japan than in the USA, yet CHD mortality in Japan remained the lowest: >67% lower in men and > 75% lower in women compared with the USA. The direction and magnitude of changes in other risk factors were generally similar between Japan and the other countries.Conclusions: Decline in CHD mortality despite a continuous rise in total cholesterol is unique. The observation may suggest some protective factors unique to Japanese. [ABSTRACT FROM AUTHOR]

Radio and public service are often associated with information even though music programming has been part of public radio since its beginnings. The question is that not every audiovisual corporation shares the same notion of specialized music radio. Therefore, the aim of this article is to present a first exploratory approach by comparing the modus operandi of two public radio stations: iCat.cat and BBC Radio 6 Music. Within the framework of comparative media systems studies, we focus on studying the morning shows' playlists, as the flagship program of radio prime time and spearhead of the stations' programming policies. Obviously there are cultural differences between Catalonia and United Kingdom, nonetheless, we have chosen these stations because they both have similar approaches to a thematic conception that departs from commercial formula stations and operate under a programming strategy based on the so-called indie music. [ABSTRACT FROM AUTHOR]

Presumed consent is a legislative framework in which citizens must place their name on a national opt-out register, otherwise their consent for donating their organs will be presumed. The Welsh Assembly last year passed legislation to enable the introduction of presumed consent in Wales in 2015. The issue is currently being discussed in Northern Ireland, Scotland and the Republic of Ireland. However, there is scant evidence that presumed consent will be effective. Rather than legislating for consent of donors, we should be addressing the misgivings and misunderstandings of families to improve their consent rate, as has been done so successfully in Spain. National improvements in infrastructure in the UK have resulted in an outstanding 63% increase in deceased donation since 2007. If, now, family consent rates could be improved from the current 57% to Spanish levels of 85%, the UK's donation rate would be one of the best in the world. [ABSTRACT FROM AUTHOR]

Background Mutations in the CDKN2A and CDK4 genes predispose to melanoma. From three case-control studies of cutaneous melanoma, we estimated the prevalence and predictors of these mutations for people from regions with widely differing latitudes and melanoma incidence. Methods Population-based cases and controls from the United Kingdom (1586 cases, 499 controls) and Australia (596 early-onset cases, 476 controls), and a hospital-based series from Spain (747 cases, 109 controls), were screened for variants in all exons of CDKN2A and the p16INK4A binding domain of CDK4. Results The prevalence of mutations for people with melanoma was similar across regions: 2.3%, 2.5% and 2.0% for Australia, Spain and the United Kingdom respectively. The strongest predictors of carrying a mutation were having multiple primaries (odds ratio (OR) = 5.4, 95% confidence interval (CI: 2.5, 11.6) for 2 primaries and OR = 32.4 (95% CI: 14.7, 71.2) for 3 or more compared with 1 primary only); and family history (OR = 3.8; 95% CI:1.89, 7.5) for 1 affected first- or second-degree relative and OR = 23.2 (95% CI: 11.3, 47.6) for 2 or more compared with no affected relatives). Only 1.1% of melanoma cases with neither a family history nor multiple primaries had mutations. Conclusions There is a low probability (<2%) of detecting a germline CDKN2A mutation in people with melanoma except for those with a strong family history of melanoma (≥2 affected relatives, 25%), three or more primary melanomas (29%), or more than one primary melanoma who also have other affected relatives (27%). [ABSTRACT FROM AUTHOR]

PURPOSE: Environmental changes are potentially effective population-level physical activity (PA) promotion strategies. However, robust multisite evidence to guide international action for developing activity-supportive environments is lacking. We estimated pooled associations of perceived environmental attributes with objectively measured PA outcomes, between-site differences in such associations, and the extent to which perceived environmental attributes explain between-site differences in PA. METHODS: This was a cross-sectional study conducted in 16 cities located in Belgium, Brazil, Colombia, Czech Republic, Denmark, China, Mexico, New Zealand, Spain, United Kingdom, and United States of America. Participants were 6968 adults residing in administrative units stratified by socioeconomic status and transport-related walkability. Predictors were 10 perceived neighborhood environmental attributes. Outcome measures were accelerometry-assessed weekly minutes of moderate-to-vigorous PA (MVPA) and meeting the PA guidelines for cancer/weight gain prevention (420 min•wk-1 of MVPA). RESULTS: Most perceived neighborhood attributes were positively associated with the PA outcomes in the pooled, site-adjusted, single-predictor models. Associations were generalizable across geographical locations. Aesthetics and land use mix-access were significant predictors of both PA outcomes in the fully adjusted models. Environmental attributes accounted for within-site variability in MVPA, corresponding to an SD of 3 min•d-1 or 21 min•wk-1. Large between-site differences in PA outcomes were observed; 15.9%-16.8% of these differences were explained by perceived environmental attributes. All neighborhood attributes were associated with between-site differences in the total effects of the perceived environment on PA outcomes. CONCLUSIONS: Residents' perceptions of neighborhood attributes that facilitate walking were positively associated with objectively measured MVPA and meeting the guidelines for cancer/weight gain prevention at the within- and between-site levels. Associations were similar across study sites, lending support for international recommendations for designing PA-friendly built environments. [ABSTRACT FROM AUTHOR]

Based on the criteria and parameters considered decisive by the European Union for an effective self-regulation model in advertising, this work carries out a comparative analysis between the advertising self-regulation systems in the United Kingdom and Spain. Setting the British system as a benchmark due to its effectiveness, the main objective of the study is to identify the strengths and weaknesses of the Spanish system in terms of independence, effectiveness, funding and coverage. In line with the best practice model and in view of the results obtained, certain improvement tools are proposed within a framework of an independent and proactive body. [ABSTRACT FROM AUTHOR]

The article presents updates on building projects in health sciences libraries as of July 2014. These include projects at Al Maktoum Medical Library of Mohammed Bin Rashid at Academic Medical Center in Dubai, United Arab Emirates, Regional Library and Information Service at Dr. Steevens' Hospital in Dublin, Ireland, and Denmark Hill Campus Libraries at King's College London in Waterloo, London, England.

Simple Summary: Recent studies have mostly focused on the treatment of advanced mycosis fungoides and Sézary syndrome and less on the treatment of relapsed or refractory (R/R) cases of cutaneous T-cell lymphoma (CTCL). There is also a paucity of data on the treatment and outcomes of primary cutaneous anaplastic large cell lymphoma and other rare CTCL subtypes. This European observational study provided real-world data on the current treatments used in the management of CTCL across three lines of therapy. As a result, there was a significant level of heterogeneity in treatment types than expected by European guidelines. These findings highlight the lack of consensus in relapsed CTCL, as well as the urgent unmet treatment needs. The treatment pattern of cutaneous T-cell lymphoma (CTCL) remains diverse and patient-tailored. The objective of this study was to describe the treatment patterns and outcomes in CTCL patients who were refractory or had relapsed (R/R) after a systemic therapy. A retrospective chart review study was conducted at 27 sites in France, Germany, Italy, Spain and the United Kingdom (UK) of patients who received a first course of systemic therapy and relapsed or were refractory. Data were collected longitudinally from diagnosis to first-, second- and third-line therapy. The study included 157 patients, with a median follow-up of 3.2 years. In total, 151 proceeded to second-line and 90 to third-line therapy. In the first line (n = 147), patients were treated with diverse therapies, including single- and multi-agent chemotherapy in 67 (46%), retinoids in 39 (27%), interferon in 31 (21%), ECP in 4 (3%), corticosteroids in 3 (2%) and new biological agents in 3 (2%). In the second line, the use of chemotherapy and retinoids remained similar to the first line, while the use of new biologics increased slightly. In sharp contrast to the first line, combination chemotherapy was extremely diverse. In the third line, the use of chemotherapy remained high and diverse as in the second line. From the time of first R/R, the median PFS was 1.2 years and the median OS was 11.5 years. The presented real-world data on the current treatments used in the management of R/R CTCL in Europe demonstrate the significant heterogeneity of systemic therapies and combination therapies, as expected from the European guidelines. [ABSTRACT FROM AUTHOR]

A new methodology is presented for measuring, classifying and predicting the cycles of uncertainty that occur in temporary decision-making in the tourist accommodation market (apartments and hotels). Special attention is paid to the role of entropy and cycles in the process under the Adaptive Markets Hypothesis. The work scheme analyses random cycles from time to time, and in the frequency domain, the linear and nonlinear causality relationships between variables are studied. The period analysed is from January 2005 to December 2018; the following empirical results stand out: (1) On longer scales, the periodicity of the uncertainty of decision-making is between 6 and 12 months, respectively, for all the nationalities described. (2) The elasticity of demand for tourist apartments is approximately 1% due to changes in demand for tourist hotels. (3) The elasticity of the uncertainty factor is highly correlated with the country of origin of tourists visiting Spain. For example, it has been empirically shown that increases of 1% in uncertainty cause increases in the demand for apartments of 2.12% (worldwide), 3.05% (UK), 1.91% (Germany), 1.78% (France), 7.21% (Ireland), 3.61% (The Netherlands) respectively. This modelling has an explanatory capacity of 99% in all the models analysed. [ABSTRACT FROM AUTHOR]

Numerous varieties of celery are grown in multiple countries to maintain supply, demand and availability for all seasons; thus, there is an expectation for a consistent product in terms of taste, flavour, and overall quality. Differences in climate, agronomy and soil composition will all contribute to inconsistencies. This study investigated the volatile and sensory profile of eight celery genotypes grown in the UK (2018) and Spain (2019). Headspace analysis determined the volatile composition of eight genotypes, followed by assessment of the sensory profile using a trained panel. Significant differences in the volatile composition and sensory profile were observed; genotype and geographical location both exerted influences. Two genotypes exhibited similar aroma composition and sensory profile in both locations, making them good candidates to drive breeding programmes aimed at producing varieties that consistently display these distinctive sensory properties. Celery samples harvested in the UK exhibited a higher proportion of sesquiterpenes and phthalides, whereas samples harvested in Spain expressed a higher aldehyde and ketone content. Studying the relationship between growing environment and genotype will provide information to guide growers in how to consistently produce a high-quality crop. [ABSTRACT FROM AUTHOR]

This paper examines the resistance to shocks (economic, political, outbreaks etc.) of the ecological footprint in EU-5 countries over the period 1961–2016. The aim of the study is to determine whether the ecological footprint tends to return to the average with advanced econometric analysis. Efforts to move towards carbon neutrality, which increased after the Paris Agreement, are important for the countries in our analysis. To achieve our aim, we primarily used traditional and one-break unit root tests, followed by the novel SOR unit root test, which considers both sharp and smooth breaks to achieve robust results. The econometric findings show that EF and its six components (i.e., carbon, cropland, grazing land, forest, built-up land and fishing grounds) all contain unit root except the built-up land footprint for Spain and the grazing land and forest footprint for the United Kingdom. Our study provides policymakers with important information for implementing policies to reduce environmental pollution and achieve the target of carbon neutrality. • This study applies SOR unit root test, which considers both sharp and smooth breaks. • The results confirm efforts to move towards carbon neutrality in EU-5 countries. • The study contemplates policy recommendations aimed to reach carbon neutrality. [ABSTRACT FROM AUTHOR]

There is an increasing demand to study the long-term effects of land use from both local farm and wider societal and environmental perspectives. This study applied an approach to evaluate both the financial profitability of arable, agroforestry, and tree-only systems and the wider societal benefits over a period of 30-60 years. The biophysical inputs and yields from the three systems were modelled for three case study sites in the United Kingdom, Spain, and Switzerland, using a tree and crop simulation model called Yield-SAFE. A bio-economic model called Farm-SAFE was then used to compare the financial (EAV F) and economic (or societal) equivalent annual values (EAV E) by including monetary values for five environmental externalities: carbon dioxide emissions, carbon sequestration, soil erosion by water, and nitrogen and phosphorus balances. Across the three case studies, arable farming generated higher farm incomes than the agroforestry or tree-only systems, but the arable systems also created the greatest environmental costs. By comparison the agroforestry and tree-only systems generated lower CO 2 emissions and sequestered more carbon. Applying monetary values to the environmental externalities meant that the EAV E of the agroforestry and tree-only systems were greater or similar to that for the arable system in the UK case study. In Spain, the slow predicted growth of the trees meant that, even after including the environmental externalities, the arable system created greater societal benefit than the agroforestry and tree-only systems. In Switzerland, including the environmental externalities increased the attraction of the tree-only system, but the high subsidies for arable and agroforestry systems meant that the EAV E for the agroforestry and arable systems were the most attractive from a farmer's perspective. A breakeven analysis was used to determine the environmental externality values at which the agroforestry and tree-only systems produced the same societal return as the arable system in each case study. In the UK, a carbon price of ₠16 (t CO 2)-1 allowed the EAV E of the agroforestry system to attain parity with the arable EAV E. In both the UK and Spain, an environmental nitrogen cost of ₠3-6 (kg N)-1 was sufficient for the EAV E of the agroforestry and tree-only systems to match those of arable farming. Because trees on farms provide "economies of multifunction" for environmental benefits, the breakeven values will be less if environmental benefits are considered together as packages. The described approach provides a method for governments and others to examine the cost effectiveness of new agri-environment measures. [ABSTRACT FROM AUTHOR]

• Effects of multi-zone heating systems in residential buildings are assessed. • Data obtained from 336 scenarios in Mediterranean climates are evaluated. • Results are evaluated under economic and energy criteria. This paper explores the effects of multi-zone heating systems in residential buildings in different Mediterranean climates. The aim is to evaluate their potential in residential sectors to provide a general basis from the results (from the energy and economic point of view). In addition, if feasible, a further detailed evaluation of this management strategy for optimising the energy use in residential buildings would also be carried out. To do so, the effects of two different zoning controls in different types of apartment, occupancy patterns, building characteristics and locations in Spain, have been assessed. Different combinations of these parameters have resulted in 336 different scenarios that have been dynamically simulated using Design Builder software. The obtained energy results have been analysed in detail. Moreover, an economic analysis of these results has also been carried out to evaluate the economic feasibility of these systems in residential buildings located in temperate climates. This has been calculated by evaluating the maximum investment that can be assumed in each scenario to achieve different payback periods (namely 10 and 20 years). The results obtained show that these systems could be a cost-effective strategy aimed at reducing the energy consumption in residential buildings, not only in cold climates, such as is shown in the literature (the majority of the studies found are located in the UK and northern countries), but also in more temperate climates, such as that of Spain. Savings of around 20% were obtained in the most usual scenarios in Spain (coherent with results obtained in previous studies in the UK found in the literature), showing that in several cases, the initial investment in zone-controlled systems could be paid off in less than ten years, especially in large apartments and the coldest weather conditions. [ABSTRACT FROM AUTHOR]

We describe the outcomes in cancer patients during the initial outbreak of the COVID-19 in Europe from the retrospective, multi-center observational OnCovid study. We identified 204 cancer patients from eight centers in the United Kingdom, Italy, and Spain aged >18 (mean = 69) and diagnosed with COVID-19 between 26 February and 1 April 2020. A total of 127 (62%) were male, 184 (91%) had a diagnosis of solid malignancy, and 103 (51%) had non-metastatic disease. A total of 161 (79%) had >1 co-morbidity. A total of 141 (69%) patients had >1 COVID-19 complication. A total of 36 (19%) were escalated to high-dependency or intensive care. A total of 59 (29%) died, 53 (26%) were discharged, and 92 (45%) were in-hospital survivors. Mortality was higher in patients aged >65 (36% vs. 16%), in those with >2 co-morbidities (40% vs. 18%) and developing >1 complication from COVID-19 (38% vs. 4%, p = 0.004). Multi-variable analyses confirmed age > 65 and >2 co-morbidities to predict for patient mortality independent of tumor stage, active malignancy, or anticancer therapy. During the early outbreak of SARS-CoV-2 infection in Europe co-morbid burden and advancing age predicted for adverse disease course in cancer patients. The ongoing OnCovid study will allow us to compare risks and outcomes in cancer patients between the initial and later stages of the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

To conduct an economic analysis comparing the costs of managing adverse events (AEs) and treatment administration in patients with relapsed small cell lung cancer (SCLC) treated either with lurbinectedin or intravenous (IV) topotecan. Lurbinectedin demonstrated consistent cost savings in terms of both treatment administration and management of AEs in Spain and the UK. [Extracted from the article]

In this paper we investigate the feasibility and added value of using the seasonal hindcasts of the ECMWF System 4 as a hazard event set for European winter windstorms damage calculations. The windstorms are identified for every ensemble member and every year by an objective windstorm tracking algorithm. The damages are calculated directly from the obtained wind footprints via the open source natural catastrophe damage model CLIMADA for Germany, the UK, France and Spain and compared to the loss from ERA‐Interim. The results show that the ensembles of losses in System 4 nicely capture the inter‐annual loss variability of the reanalysis. Due to more than 1,500 years of "virtual reality" windstorm data from the hindcasts, the return levels of extreme losses can be estimated fairly accurately. Based on System 4, the losses in the scale of 1990 (January, February, March and December including the prominent windstorm Daria) represent a 20‐year event in Germany whereas they represent a 100‐year event for the UK. Thus, a considerably shorter return period compared to return periods calculated from ERA‐Interim alone. Further we investigate the link between the annual losses and large‐scale drivers derived from mean‐sea‐level‐pressure (MSLP) data in System 4. We can show that within System 4 there is a significant link between increased loss potentials for strongly positive North Atlantic Oscillation (NAO) phases for Germany and the UK as well as a reduced loss potential for Spain. The link between the other analysed indices is weak bar the East Atlantic (EA) pattern index. Thus, if the NAO in System 4 is correct we can assume that the windstorms in System 4 are useable. If this premise is given our study shows that the loss estimates and ultimately the return levels of losses from System 4 can be used in an operational way. The seasonal hindcasts of the ECMWF System 4 are used as a hazard event set for European winter windstorms loss calculations. The windstorms are identified for every ensemble member and every year by an objective windstorm tracking algorithm. The loss is calculated directly from the obtained wind footprints via the open source natural catastrophe damage model CLIMADA for Germany, the UK, France and Spain and compared to the loss from ERA‐Interim. Losses of the magnitude up to double the losses from 1990 are physically possible. [ABSTRACT FROM AUTHOR]

Background: Migraine is a distinct neurological disease that imposes a significant burden on patients, society, and the healthcare system. This study aimed to characterize the incremental burden of migraine in individuals who suffer from ≥4 monthly headache days (MHDs) by examining health-related quality of life (HRQoL), impairments to work productivity and daily activities, and healthcare resource utilization (HRU) in the EU5 (France, Germany, Italy, Spain, United Kingdom).Methods: This retrospective cross-sectional study used data from the 2016 National Health and Wellness Survey (NHWS; N = 80,600). Short-Form 36-Item Health Survey, version 2 (SF-36v2) physical and mental component summary scores (PCS and MCS), Short-form-6D (SF-6D), and EuroQoL (EQ-5D), impairments to work productivity and daily activities (Work Productivity and Activity Impairment Questionnaire (WPAI), and HRU were compared between migraine respondents suffering from ≥4 MHDs (n = 218) and non-migraine controls (n = 218) by propensity score matching using sociodemographic characteristics. Chi-square, T-tests, and Mann-Whitney tests were performed to determine significant differences between the groups after propensity score matching.Results: HRQoL was lower in migraine individuals suffering from ≥4 MHDs compared with non-migraine controls, with reduced SF-36v2 PCS (46.00 vs 50.51) and MCS (37.69 vs 44.82), SF-6D health state utility score (0.62 vs 0.71), and EQ-5D score (0.68 vs 0.81) (for all, p < 0.001). Respondents with migraine suffering from ≥4 MHDs also reported higher levels of absenteeism from work (14.43% vs 9.46%; p = 0.001), presenteeism (35.52% vs 20.97%), overall work impairment (38.70% vs 23.27%), and activity impairment (44.17% vs 27.75%) than non-migraine controls (for all, p < 0.001). Additionally, HRU was significantly higher for individuals with ≥4 MHDs compared to their matched controls. Consistently, migraine subgroups (4-7 MHDs, 8-14 MHDs and CM) had lower HRQoL, greater overall work and activity impairment, and higher HRU compared to non-migraine controls.Conclusions: Migraine of ≥4 MHDs was associated with poorer HRQoL, greater work productivity loss, and higher HRU compared with non-migraine controls. The findings of the study suggest that an unmet need exists among individuals suffering from ≥4 MHDs in the EU5 suggesting the need for effective prophylactic treatments to lessen the humanistic and economic burden of migraine. [ABSTRACT FROM AUTHOR]

Background: Psychosocial factors shape the health of older adults through complex inter-relating pathways. Besides socioeconomic factors, time use activities may explain gender inequality in self-reported health. This study investigated the role of work-related and social time use activities as determinants of health in old age. Specifically, we analysed whether the impact of stress in terms of time pressure on health mediated the relationship between work-related time use activities (i.e. housework and paid work) on self-reported health. Methods: We applied structural equation models and a maximum-likelihood function to estimate the direct and indirect effects of psychosocial factors on health using pooled data from the Multinational Time Use Study on 11,168 men and 14,295 women aged 65+ from Italy, Spain, UK, France and the Netherlands. Results: The fit indices for the conceptual model indicated an acceptable fit for both men and women. The results showed that socioeconomic status (SES), demographic factors, stress and work-related time use activities after retirement had a significant direct influence on self-reported health among the elderly, but the magnitude of the effects varied by gender. Social activities had a positive impact on self-reported health but had no significant impact on stress among older men and women. The indirect standardized effects of work-related activities on self-reported health was statistically significant for housework (β = − 0.006; P < 0.001 among men and β = − 0.008; P < 0.001 among women) and paid work (β = 0.012; P < 0.01 among men and β = 0.000; P > 0.05 among women), which implied that the paths from paid work and housework on self-reported health via stress (mediator) was very weak because their indirect effects were close to zero. Conclusions: Our findings suggest that although stress in terms of time pressure has a direct negative effect on health, it does not indirectly influence the positive effects of work-related time use activities on self-reported health among elderly men and women. The results support the time availability hypothesis that the elderly may not have the same time pressure as younger adults after retirement. [ABSTRACT FROM AUTHOR]

Background: Agitation is a common feature of bipolar disorder and schizophrenia. Previous research indicates that specific symptoms impact caregiver burden in these conditions, but the impact of agitation on caregiver experience is poorly understood. The aim of this study was to characterise caregiver burden in providers of informal care for patients with bipolar disorder and schizophrenia who experience agitation. Methods: In total, 297 matched patient and caregiver surveys were collected across the UK, Germany and Spain between October 2016 and January 2017. To be eligible, caregivers needed to provide informal care to a patient with a diagnosis of bipolar disorder or schizophrenia with agitation managed in a community setting and participating in the patient survey. The caregiver survey captured information on demographics and their role in managing the patient’s agitation. Caregiver burden was assessed using the Involvement Evaluation Questionnaire. Descriptive analysis was conducted. Results: Caregivers provided 38.3 h (SD ± 40.34) a week of support to the patient with 20% providing 50 h or more. Most caregivers reported that they recognised an episode of agitation all of the time (44%, n = 130) or sometimes (40%, n = 119). Verbal de-escalation techniques (talking (80%, n = 239) and soothing (73%, n = 218) were the most commonly reported strategies used by caregivers during an episode of agitation; 14% (n = 43) reported resorting to physically restraining the patient. Caregivers supervised rescue medication administration regularly (41%, n = 69) or occasionally (49%, n = 82). Mean Involvement Evaluation Questionnaire score was 32.2 (± 15.27), equivalent to 28.4 (± 13.56) in Germany, 35.6 (± 16.55) in Spain and 33.3 (± 15.15) in the UK. Involvement Evaluation Questionnaire scores were higher for caregivers who reported hostile (41.7 ± 17.07) lack of control (40.3 ± 16.35) and violent (39.5 ± 16.40) patient behaviours when agitated. Over excitement (31.8 ± 15.05), restless (32.6 ± 14.77) and tense (32.9 ± 15.64) behaviours were associated with a lower Involvement Evaluation Questionnaire score. Conclusions: Caregivers are active participants in the recognition and management of agitation episodes. The substantial burden reported by these caregivers is impacted by factors including the number of hours of care provided, patient behaviours and country. These may be viable targets for effective interventions to reduce caregiver burden. [ABSTRACT FROM AUTHOR]

The article discusses the role of community and social networks in providing refugee aid for Eritreans and Syrians traveling to Europe to flee the violence of the Syrian War. It reports that research done of refugees traveling to Spain, Germany, or Great Britain have personal connections with people who have already successfully migrated to these countries.Topics include collective action, decision making, and finance.