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Interest in higher education institutions (HEIs) as instruments for development has increased in recent years. The main objective of this paper is to address the contribution of HEIs to development through their missions, models, and challenges. With this purpose, we perform a historical analysis and characterise higher-education systems through the perspective of university models and missions, noticing relevant aspects regarding the evolution of this institution over time, as well as the transformations undergone. We also consider the main challenges that current higher education systems face in the 21st century. As methodological approaches, we carry out a literature review complemented by a comparative analysis based on data from the higher education systems of ten European countries. The findings show that HEIs can contribute to development through their missions, which are related to the models of higher education. Their first mission (teaching) contributes to improving human capital and attracting highly qualified people to their regions; the second mission (research) improves scientific knowledge which can foster innovative activities; and the third mission (community service) acts as a link between research and business, including patents, business incubators, and collaboration agreements. We also conclude that the challenges of higher education in the 21st century can be categorised essentially in three main areas: (1) globalisation and massification of higher education, as well as the internationalisation of HEIs' missions and diversification of the educational supply to attract new students; (2) new technologies related to the digitalisation of teaching and distance learning; and (3) higher education entrepreneurship, showing the importance of university-company relationships. This paper provides a global setting for a reflection on the role of HEIs in the 21st century, given their connection with society and the need for a more effective contribution to socio-economic development.

This study explores the relation between risk of job automation and participation in adult education and training (AET) and examines variation in that relation across welfare regimes distinguishing between situational and institutional barriers. Using microdata of PIAAC, we analyze participation in formal or nonformal AET for job-related reasons in relation to the risk of automation of the respondents' occupation after controlling for main sociodemographic characteristics. Logistic regression models are run on respondents from 14 European countries representing different welfare regimes: Denmark, Norway, and Sweden (Scandinavian countries); Italy, Greece, and Spain (Southern European); Czech Republic, Slovakia, and Poland (Central and Eastern Europe), Belgium, France, and Germany (Continental); and United Kingdom and Ireland (Anglo-Saxon countries). Our findings confirm that workers in occupations at high risk of automation were found to be consistently less likely to participate in job-related AET, quite irrespective of welfare regime. [The paper was presented at XIII Conferenza Espanet Italia--Il welfare state di fronte alle sfide globali (Venezia, 17 September 2020).]

This study aims to identify the literacy skills of individuals whose highest level of education was in the field 'teacher training and educational sciences'. The study sample comprised 10,618 individuals in the field of teacher training and educational sciences, selected from 31 countries (participating in the International Adult Skills Assessment Programme during the 2014-2015 survey) using a multi-stage sampling method. The study employed multi-level latent class analysis and three-step analysis in order to determine both the number of multi-level latent classes of educators' literacy scores as well as the selected independent variables' success in predicting those latent classes. The analysis revealed that educators in Germany constituted the group with the highest literacy skills while educators from Singapore comprised the group with the lowest literacy skills. [This study was presented at the 9th International Congress of Educational Research. Ordu University, Ordu, Turkey.]

Framing has previously been studied in the field of pandemic preparedness and global health governance and influenza pandemics have usually been framed in terms of security and evidence-based medicine on a global scale. This paper is based on the pandemic preparedness plans, published after 2009, from eight European countries. We study how pandemic preparedness is framed and how pandemic influenza in general is narrated in the plans. All plans contain references to ‘uncertainty’, ‘pandemic phases’, ‘risk management’, ‘vulnerability’ and ‘surveillance’. These themes were all framed differently in the studied plans. The preparedness plans in the member states diverge in ways that will challenge the ambition of the European Union to make the pandemic preparedness plans interoperable and to co-ordinate the member states during future pandemics. [ABSTRACT FROM PUBLISHER]

Purpose: Scholarly interest in interorganizational learning (IOL) has spiked in the past decade because of its potential to absorb, transfer and create valuable knowledge for enhanced innovative performance and sustained competitive advantage. However, only a handful of review studies exists on the topic. The evolution of IOL has not been studied explicitly and there is a lack of understanding of the field trends. To fill this gap, this paper aims to comprehensively review the literature on IOL and map its evolution and trends using bibliometric techniques. In particular, the authors use visualization of science mapping freeware to systematize the findings and interpret the results. Design/methodology/approach: The authors synthesize the findings using "evaluative bibliometric techniques" to identify the quality and quantity indicators of the IOL research and use "relational bibliometric techniques" to determine the structural indicators of the IOL field such as the intellectual foundations and emerging research themes of IOL research. Findings: Through an analysis of 208 journal publications obtained from the Scopus database, the authors determine the leading authors, countries, highly cited papers and their contributions to the IOL literature. By identifying the key hotspots, intellectual foundations and emerging trends of IOL, the authors provide promising avenues in IOL research. Originality/value: To the best of the knowledge, this study is the first to systematically review the IOL literature and provide future research directions.

Purpose: The paper identifies, outlines, and categorises establishment and operational factors that contribute to successful agricultural on-farm demonstration. Design/Methodology/approach: The paper is based on a literature review on demonstration activities and meta-analysis of 24 original case study reports from 12 European countries. Findings: Based on a combination of deductive and inductive analysis, the success determinants are classified into nine critical success factors deemed important in designing an on-farm demonstration event (the 'Nine Ps'): Purpose, Problem, Place, Personnel, Positioning, Programme, Process, Practicalities, Post-event engagement. Each factor ('what') is framed in terms of success principles to provide a guide to its enactment ('how'). Practical implications: The results of the analysis can serve as a practical decision-support tool for organisers and evaluators of on-farm demonstration events. Theoretical implications: The paper broadens the perspective on the character, interlinkages, and relative importance of the factors underlying demonstration and their successful application within the agricultural knowledge and innovation system. Originality/Value: The paper addresses the deficit of comprehensive empirical studies investigating on-farm demonstrations by offering a rich research-based analysis of the factors and principles underlying their successful implementation.

This article maps the scientific production and the contents associated with the sustainable development goals and their integration with universities during the past 21 years. Although many of the topics related to sustainable development goals (SDGs) have been addressed in different studies for decades, it is since 2015 onwards that they gained greater prominence due to the inclusion of higher education as an important actor in the fulfillment of the 2030 agenda and the United Nations SDGs. For the purpose of this paper, a bibliometric analysis of 871 papers, 535 documents in Scopus, and 336 in Web of Science (WoS) from 1998 to 2019 was performed, and the Bibliometrix analysis tool was used. The objective of this mapping is to answer the following research question: Is the integration of the Sustainable Development Goals and Universities a field of study? An analysis of the network of collaborators and trend topics in Scopus and WoS allows us to identify the concurrence and relationships of some keywords, such as sustainable development, sustainability and planning, and some background words, such as humans and global health. In another analysis, the word "higher education" is related to change. This article suggests that the integration of the Sustainable Development Goals in Universities is becoming a field of study under exploration, with a peak of production in 2016 and that has remained stable in the last three years, but thanks to the leading role assigned to Universities, intellectual production should increase in the following years.

This paper presents a compilation of personal reflections from 66 contributors on the impact of, and responses to, COVID-19 in accounting education in 45 different countries around the world. It reveals a commonality of issues, and a variability in responses, many positive outcomes, including the creation of opportunities to realign learning and teaching strategies away from the comfort of traditional formats, but many more that are negative, primarily relating to the impact on faculty and student health and well-being, and the accompanying stress. It identifies issues that need to be addressed in the recovery and redesign stages of the management of this crisis, and it sets a new research agenda for studies in accounting education.

For over two decades now, the application of Citizen Science to Education has been evolving, and fundamental topics, such as the drivers of motivation to participate in Citizen Science projects, are still under discussion. Some recent developments, though, like the use of Artificial Intelligence to support data collection and validation, seem to point to a clear-cut divergence from the mainstream research path. The objective of this paper is to summarise the development trajectory of research on Citizen Science in Education so far, and then shed light on its future development, to help researchers direct their efforts towards the most promising open questions in this field. We achieved these objectives by using the lens of the Affordance-Actualisation theory and the Main Path Analysis method.

This paper explores patterns in participation in adult education and training (AET) by comparing five countries with high participation rates (the Nordic countries and the Netherlands) with three countries with significantly lower participation rates (France, Poland and the Slovak Republic). Using PIAAC data the paper examines differences in the levels of demand for AET as well as variations in barriers to AET participation between the two groups of countries. The demand for AET is higher than the actual participation rate since it includes those who do not participate although they wish to. The demand for AET is substantially higher in countries with high participation rates. Further, the structure and level of barriers is quite similar in the two groups of countries. Countries with low AET participation rate do not have a higher proportion of individuals reporting barriers to AET participation; that they do not participate in AET although they wish to. In both groups of countries demand for AET is strongly associated with the individuals' educational level. The findings are discussed by drawing on previous studies on drivers of and barriers to participation in AET.

This paper argues that links between academia and other economic sectors are increasing, especially through intersectoral mobility of university graduates. Murray [(2010). "The Oncomouse that Roared: Hybrid Exchange Strategies as a Source of Distinction at the Boundary of Overlapping Institutions." "American Journal of Sociology" 116 (2): 341-388] has identified literature pointing both to blending and continuing co-existence of the academic and commercial worlds. Based on a European-wide study of PhD graduates in the social sciences and humanities (SSH), this paper considers the extent to which intersectoral mobility reflects blending. It finds that intersectoral communities of practice exist mainly in applied fields of knowledge. However, in many areas of the SSH, differences in institutional norms and values inhibit intersectoral mobility, particularly in mid-career stages.

Wood dust is an established carcinogen also linked to several non malignant respiratory disorders. A major limitation in research on wood dust and its health effects is the lack of (historical) quantitative estimates of occupational exposure for use in general population-based case-control or cohort studies. The present study aimed to develop a multinational quantitative Job Exposure Matrix (JEM) for wood dust exposure using exposure data from several Northern and Central European countries. For this, an occupational exposure database containing 12653 personal wood dust measurements collected between 1978 and 2007 in Denmark, Finland, France, The Netherlands, Norway, and the United Kingdom (UK) was established. Measurement data were adjusted for differences in inhalable dust sampling efficiency resulting from the use of different dust samplers and analysed using linear mixed effect regression with job codes (ISCO-88) and country treated as random effects. Fixed effects were the year of measurement, the expert assessment of exposure intensity (no, low, and high exposure) for every ISCO-88 job code from an existing wood dust JEM and sampling duration. The results of the models suggest that wood dust exposure has declined annually by approximately 8%. Substantial differences in exposure levels between countries were observed with the highest levels in the United Kingdom and the lowest in Denmark and Norway, albeit with similar job rankings across countries. The jobs with the highest predicted exposure are floor layers and tile setters, wood-products machine operators, and building construction labourers with geometric mean levels for the year 1997 between 1.7 and 1.9 mg/m3. The predicted exposure estimates by the model are compared with the results of wood dust measurement data reported in the literature. The model predicted estimates for full-shift exposures were used to develop a time-dependent quantitative JEM for exposure to wood dust that can be used to estimate exposure for participants of general population studies in Northern European countries on the health effects from occupational exposure to wood dust. [ABSTRACT FROM AUTHOR]

Context: Existing studies have explored the association between workplace training and wages suggesting that training participation may have a positive association with wages. However, we still know very little about whether this association varies between men and women. Through its potential positive association with wages, training may balance wage differences between men and women. In addition, the gender wage gap varies across the wage distribution. Differences in the association between training participation and wages for men and women across the earnings spectrum may offer an explanation as to why the discrepancy in female/male earnings is larger at some point of the wage distribution compared to others. Approach: Using data from the Programme for International Assessment of Adult Competencies (PIAAC) and unconditional quantile regression, this paper examines whether the association between workplace training and wages differs between men and women at different points of the wage distribution across 14 European countries. To partly control for endogeneity in training participation, detailed measures of cognitive skills have been included in the models. Findings: Findings show gender differences in the association between training and wages across the wage distribution. In most countries, results indicate larger training coefficients for women than men at the lower end of the wage spectrum whereas they are larger for men at the top. This pattern holds across most countries with the only exception of Liberal ones, where women benefit less than men across the entire wage spectrum. Conclusions: The findings of this work reveal that distributional variations in returns to workplace training follow a similar pattern across industrialized countries, despite their different institutional settings. Moreover, differences in training coefficients of men and women at different parts of the wage distribution suggest that training could reduce gender wage differences among low earners and potentially widen the gap in wages among individuals at the top of the wage distribution.

Education is the core of the factors that improved people for a better lifestyle and increases the level of society' development. Quality education is one of the most vital goals of Sustainable Development Goals (SDGs) due to actualizing these factors. Using relational network data envelopment analysis (DEA), which have three interrelated substages, this current paper computes the educational economy efficiency of the Organisation for Economic Co-operation and Development (OECD) countries bearing in mind the characteristics related to SDGs. The contribution of our study is the use of a novel approach to computing the educational economy efficiency using relational network DEA with GAMS. Even though some interesting differences reveal in the efficiency of the countries, the findings show that countries with high-efficiency scores are clustered around countries like Latvia, Slovenia, and Korea.

Industrial relations and employment regulation are central elements of the national institutional framework shaping country-level differences in job quality. However, researchers are also interested in within-country variation by sector. International sector comparisons can shed light on the role of national institutions, individual employer approaches and workplace unions in shaping outcomes within a sector. This article uses qualitative data on pay and working time in the café industry in France, Norway and the UK to weigh the effects of institutions and employer differentiation on worker outcomes in a sector particularly challenging for union organisation. The findings identify the importance of national institutions for worker outcomes, and for shaping the scope at organisational level for employers and unions to make a difference. [ABSTRACT FROM AUTHOR]

In this paper, I examine whether generalized trust and education, as well as social security policies of welfare state institutions matter for cross-national differences in subjective well-being (SWB), because knowledge on this issue is still lacking. For this purpose I integrated the insights of two sociological theories: Social Function Production theory and Actor-Centred Institutionalism. Based on these theoretical notions we derived several hypotheses, which I tested using multilevel analysis of the data from the European Social Survey (2006), in a sample of 37,237 respondents from 22 European countries. My findings indicate that various extensiveness of social security policies matter for the level of SWB, and for the impact of education on SWB. I found negative impact of low education on SWB in all countries, except in Northern and Western European countries. This might suggest that social security policies of the latter countries have diminished the negative impact of low education on SWB. Moreover, my findings indicate positive relationship between individual education and generalized trust; as well as between generalized trust and SWB in countries with all five types of social security policies.

Higher education systems globally have seen major increases in women's participation and the overall trend in OECD countries has been a transition from the traditional male majority in enrolments to a substantial female majority. Prompted by a recent reversal of this trend, this paper explores gender differences in participation in higher education in 27 OECD countries between 1971 and 2015. While increased participation by women was thought to be part of the solution to persistent gender inequalities we argue that this is not an inevitable outcome. Our argument is based on an analysis of changes in the gender composition of the student population, using available secondary data. We explore how changing gender differentials are linked to the concurrent massification of HE, changing distribution of enrolments by field of study, changes in sex segregation by field, features of national education systems and wider social structural differences related to gender. Our analysis examines the complex interaction between discipline-specific levels of sex segregation and overall levels of gender parity. We argue that that sex segregation needs to be considered alongside women's long-standing higher participation rates to understand why the latter has not triggered a transformation in the gendered division of labour.

Background: Non-medical use of benzodiazepines and Z-drugs is common; however, there is limited information available on the extent of harm related to this in Europe, as well as the relationship between misuse and availability.Aim: To describe presentations to the emergency department in Europe related to the recreational use of benzodiazepines and Z-drugs and compare regional differences in these presentations with legal drug sales of benzodiazepines and Z-drugs within each country.Methods: Emergency department presentations with recreational misuse of benzodiazepines and Z-drugs were obtained from the Euro-DEN dataset for the period from October 2013 to September 2015; data extracted included demographics, clinical features, reported coused drugs, and outcome data. Sales figures obtained by QuintilesIMS™ (Atlanta, Georgia) were used to compare regional differences in the proportion of benzodiazepines and Z-drugs in the emergency department presentations and legal drug sales across Europe.Results: Over the 2 years, there were 2119 presentations to the Euro-DEN project associated with recreational use of benzodiazepines and/or Z-drugs (19.3% of all Euro-DEN presentations). Presentations with 25 different benzodiazepines and Z-drugs were registered in all countries, most (1809/2340 registered benzodiazepines and Z-drugs, 77.3%) of which were prescription drugs. In 24.9%, the benzodiazepine was not specified. Where the benzodiazepine/Z-drug was known, the most frequently used benzodiazepines and Z-drugs were respectively clonazepam (29.5% of presentations), diazepam (19.9%), alprazolam (11.7%), and zopiclone (9.4%). The proportions of types of benzodiazepines/Z-drugs related to ED-presentations varied between countries. There was a moderate (Spain, UK, Switzerland) to high (France, Ireland, Norway) positive correlation between ED presentations and sales data (Spearman Row's correlation 0.66-0.80, p < 0.005), with higher correlation in countries with higher ED presentation rates.Conclusion: Presentations to the emergency department associated with the non-medical use of benzodiazepines and/or Z-drugs are common, with variation in the benzodiazepines and/or Z-drugs between countries. There was a moderate to high correlation with sales data, with higher correlation in countries with higher ED presentation rates. However, this is not the only explanation for the variation in non-medical use and in the harm associated with the non-medical use of benzodiazepines/Z-drugs. [ABSTRACT FROM AUTHOR]

Engagement with stakeholders is an essential part of the research process. This is particularly the case for early autism research with infant cohorts and their families, where a range of ethical issues are pertinent. Here, we report on a large survey of parents who have a child on the autism spectrum (n = 1040) which specifically probed attitudes to early autism research. The large majority of parents showed positive attitudes overall, and these were associated with greater access to services, higher service quality ratings and higher rates of intellectual disability among their children. Parents valued the scientific goals of research, but half of parents also reported that an intervention component would be an essential prerequisite for them to participate in research. If enrolled in a study, parents were positive about most commonly used measures though less favourably disposed towards brain scans for children. They valued direct contact with the research team and openness in data sharing. We interpret our findings in terms of lessons for the early autism research community and for stakeholder engagement projects. [Members of the COST ESSEA Working Groups contributed to the writing of this paper.]

The paper analyses which conditions may predict a better salary for people who got a PhD in social sciences and humanities (SS&H) in 13 European countries. Among the controlling variables, predictors are also: change of country of residence; percentage of time spent respectively in research and managerial activities; and impacts achieved during one's PhD programme. Findings, but also policy implications both for PhD programme planners and PhD candidates, are: some specific impacts such as having advised policy-makers, having released interviews to media and having managed and coordinated projects, all predict better salaries for PhD holders in SS&H, other things being equal. To move geographically out of one's country where PhD was awarded is also a good predictor of better wages, provided PhD holders do not swap sectors after attainment of PhD.

This paper, based on interviews conducted for the "Early Childhood Oral History Project," draws on oral life-history interviews with 14 prominent early childhood researchers who have been active since the 1970s within diverse European countries. A common theme across the interviews is the key role that collaborative research between academics and early childhood practitioners played in the construction of theories and innovative practices. The interviewees reflect on personal, social-political, epistemological and practical factors that underpinned their engagement in collaborative research, and the challenges they encountered. They give insight into the role practitioners played in the construction of education as a social-historical science--contextualised knowledge that is intrinsically related to ethics, values and innovation.

Background: Data from the Programme for the International Assessment of Adult Competencies (PIAAC) revealed that countries systematically differ in their respondents' literacy, numeracy, and problem solving in technology-rich environments skills; skill levels also vary by gender, age, level of education or migration background. Similarly, systematic differences have been documented with respect to adults' participation in education, which can be considered as a means to develop and maintain skills. From a psychological perspective, motivation to learn is considered a key factor associated with both skill development and participation in (further) education. In order to account for motivation when analyzing PIAAC data, four items from the PIAAC background questionnaire were recently compiled into a motivation-to-learn scale. This scale has been found to be invariant (i.e., showing full weak and partial strong measurement invariance) across 21 countries. Methods: This paper presents further analyses using multiple-group graded response models to scrutinize the validity of the motivation-to-learn scale for group comparisons. Results: Results indicate at least partial strong measurement invariance across gender, age groups, level of education, and migration background in most countries under study (all CFI > 0.95, all RMSEA < 0.08). Thus, the scale is suitable for comparing both means and associations across these groups. Conclusions:Results are discussed in light of country characteristics, challenges of measurement invariance testing, and potential future research using PIAAC data.

Although we do know that out-of-pocket healthcare expenditure is relatively high in Australia, little is known about what health conditions are associated with the highest out-of-pocket expenditure, and whether the cost of healthcare acts as a barrier to care for people with different chronic conditions. Cross-sectional analysis using linear and logistic regression models applied to the Commonwealth Fund international health policy survey of adults aged 18 years and over was conducted in 2013. Adults with asthma, emphysema and chronic obstructive pulmonary disease (COPD) had 109% higher household out-of-pocket healthcare expenditure than did those with no health condition (95% CI: 50-193%); and adults with depression, anxiety and other mental health conditions had 95% higher household out-of-pocket expenditure (95% CI: 33-187%). People with a chronic condition were also more likely to forego care because of cost. People with depression, anxiety and other mental health conditions had 7.65 times higher odds of skipping healthcare (95% CI: 4.13-14.20), and people with asthma, emphysema and chronic obstructive pulmonary disease had 6.16 times higher odds of skipping healthcare (95% CI: 3.30-11.50) than did people with no health condition. People with chronic health conditions in Canada, the United Kingdom, Germany, France, Norway, Sweden and Switzerland were all significantly less likely to skip healthcare because of cost than were people with a condition in Australia. The out-of-pocket cost of healthcare in Australia acts as a barrier to accessing treatment for people with chronic health conditions, with people with mental health conditions being likely to skip care. Attention should be given to the accessibility and affordability of mental health services in Australia. [ABSTRACT FROM AUTHOR]

When investigating the association between brain tumors and use of mobile telephones, accurate data on tumor position are essential, due to the highly localized absorption of energy in the human brain from the radio-frequency fields emitted. We used a point process model to investigate this association using information that included tumor localization data from the INTERPHONE Study (Australia, Canada, Denmark, Finland, France, Germany, Israel, Italy, Japan, New Zealand, Norway, Sweden, and the United Kingdom). Our main analysis included 792 regular mobile phone users diagnosed with a glioma between 2000 and 2004. Similar to earlier results, we found a statistically significant association between the intracranial distribution of gliomas and the self-reported location of the phone. When we accounted for the preferred side of the head not being exclusively used for all mobile phone calls, the results were similar. The association was independent of the cumulative call time and cumulative number of calls. However, our model used reported side of mobile phone use, which is potentially influenced by recall bias. The point process method provides an alternative to previously used epidemiologic research designs when one is including localization in the investigation of brain tumors and mobile phone use. [ABSTRACT FROM AUTHOR]

In this paper an analysis is carried out whether objective tests and subjective self-assessments in international large-scale studies yield similar results when looking at cross-national differences in the effects of skills on earnings, and skills patterns across countries, fields of study and gender. The findings indicate that subjective skills measures do not correlate well with objective measures of similar constructs when looking at cross-national differences. Countrywise associations between subjective skills measures and earnings do not correlate well with those found using objective skills measures. Moreover, cross-national differences in the level of subjective skills measures do not correlate well with cross-national differences in skill levels based on objective tests. Nor do gender differences found using subjective skills measures correlate with those found using objective skills measures. This does not mean that self-assessments cannot be used, but they need to be restricted to analysing within-country differences. Within countries, self-assessments do a good job in predicting skills differences across fields of study and also in predicting the effect of skills on earnings. When comparing gender differences in skills levels within countries, however, one needs to be aware that females tend to overestimate their skills levels in typical "female" domains like literacy.

This paper empirically examines the impact of academic research on high-tech manufacturing growth of 28 Organisation for Economic Co-operation and Development (OECD) and emerging countries over the 1991-2005 period. A standard research and development (R&D) expenditure based measure is found to be too general to capture the input in high-tech research. To overcome this problem, a novel proxy for high-tech research investment--the supercomputer capacity--is proposed. Empirical evidence strongly supports this choice of variable. It is also found that academic R&D exerts a larger growth effect on high-tech output than its industry and government counterparts, but only the impact differential between academic and government R&D is statistically significant.

Background: Healthy life years have superseded life expectancy (LE) as the most important indicator for population health. The most common approach to separate the total number of life years into those spent in good and poor health is the Sullivan method which incorporates the health dimension to the classic period life table, thus transforming the LE indicator into the health expectancy (HE) indicator. However, life years derived from a period life table and health prevalence derived from survey data are based on different conceptual frameworks. Method: We modify the Sullivan method by combining the health prevalence data with the conceptually better fitting cross-sectional average length of life (CAL). We refer to this alternative HE indicator as the "cross-sectional average length of healthy life" (HCAL). We compare results from this alternative indicator with the conventional Sullivan approach for nine European countries. The analyses are based on EU-SILC data in three empirical applications, including the absolute and relative level of healthy life years, changes between 2008 and 2014, and the extent of the gender gap. Results: HCAL and conventional HE differ in each of these empirical applications. In general, HCAL provides larger gains in healthy life years in recent years, but at the same time greater declines in the proportion of healthy life years. Regarding the gender gap, HCAL provides a more favourable picture for women compared to conventional HE. Nonetheless, the extent of these differences between the indicators is only of minor extent. Conclusions: Albeit the differences between HE and HCAL are small, we found some empirical examples in which the two indicators led to different conclusions. It is important to note, however, that the measurement of health and the data quality are much more important for the healthy life years indicator than the choice of the variant of the Sullivan method. Nonetheless, we suggest to use HCAL in addition to HE whenever possible because it widens the spectrum of empirical analyses and serves for verification of results based on the highly sensitive HE indicator. [ABSTRACT FROM AUTHOR]

Background: Despite significant investments to support primary care internationally, income-based inequities in access to quality health care are present in many high-income countries. This study aims to determine whether low- and middle-income groups are more likely to report poor quality of primary care (PC) than high-income groups cross-nationally. Methods: The 2011 Commonwealth Fund Telephone Survey of Sicker Adults is a cross-sectional study across eleven countries. Respondents were recruited from randomly selected households. We used data from surveys conducted in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, the United Kingdom, and the United States. We identified all questions relating to primary care performance, and categorized these into five dimensions: 1) access to care, 2) coordination 3) patient-centered care, and 4) technical quality of care. We used logistic regression with low and middle-income as the comparison groups and high-income as the referent. Results: Fourteen thousand two hundred sixty-two respondents provided income data. Countries varied considerably in their extent of income disparity. Overall, 24.7% were categorized as low- and 13.9% as high-income. The odds of reporting poor access to care were higher for low- and middle-income than high-income respondents in Canada, New Zealand and the US. Similar results were found for Sweden and Norway on coordination; the opposite trend favoring the low- and middle-income groups was found in New Zealand, United Kingdom, and the United States. The odds of reporting poor patient-centered care were higher for low-income than high-income respondents in the Netherlands, Norway, and the US; in Australia, this was true for low- and middle-income respondents. On technical quality of care, the odds of reporting poor care were higher for the low- and middle-income comparisons in Canada and Norway; in Germany, the odds were higher for low-income respondents only. The odds of reporting poor technical quality of care were higher for high-income than low-income respondents in the Netherlands. Conclusion: Inequities in quality PC for low and middle income groups exist on at least one dimension in all countries, including some that in theory provide universal access. More research is needed to fully understand equity in the PC sector. [ABSTRACT FROM AUTHOR]