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This article provides an update on the global cancer burden using the GLOBOCAN 2020 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer. Worldwide, an estimated 19.3 million new cancer cases (18.1 million excluding nonmelanoma skin cancer) and almost 10.0 million cancer deaths (9.9 million excluding nonmelanoma skin cancer) occurred in 2020. Female breast cancer has surpassed lung cancer as the most commonly diagnosed cancer, with an estimated 2.3 million new cases (11.7%), followed by lung (11.4%), colorectal (10.0 %), prostate (7.3%), and stomach (5.6%) cancers. Lung cancer remained the leading cause of cancer death, with an estimated 1.8 million deaths (18%), followed by colorectal (9.4%), liver (8.3%), stomach (7.7%), and female breast (6.9%) cancers. Overall incidence was from 2-fold to 3-fold higher in transitioned versus transitioning countries for both sexes, whereas mortality varied <2-fold for men and little for women. Death rates for female breast and cervical cancers, however, were considerably higher in transitioning versus transitioned countries (15.0 vs 12.8 per 100,000 and 12.4 vs 5.2 per 100,000, respectively). The global cancer burden is expected to be 28.4 million cases in 2040, a 47% rise from 2020, with a larger increase in transitioning (64% to 95%) versus transitioned (32% to 56%) countries due to demographic changes, although this may be further exacerbated by increasing risk factors associated with globalization and a growing economy. Efforts to build a sustainable infrastructure for the dissemination of cancer prevention measures and provision of cancer care in transitioning countries is critical for global cancer control., (© 2021 American Cancer Society.)

Population aging has forced policy makers in most developed countries to reform pension systems with the aim of maintaining or re-establishing financial sustainability. This usually involves cost-cutting measures like later pension eligibility ages and lower replacement rates. Such reforms face harsh trade-offs with the objective of providing adequate pensions. Social welfare and inequality have emerged as crucial concerns about recent pension reforms, stressing that the lack of "social sustainability" may undermine financial sustainability. This paper analyzes such trade-offs and may explain why support for pension reform has dwindled in Europe. The paper evaluates reform effects on financial sustainability, social welfare, and intra- and inter-generational equality in a rich unified framework with several dimensions of heterogeneity and various behavioral reactions. Our simulations shed light on the complex distributional effects of pension reform on different cohorts and societal groups. They show where policy tends to reform unequally and why reforms may fail to find voters' approval. [ABSTRACT FROM AUTHOR]

Objective: To provide a comprehensive picture of trends in parents' age and total fertility rate in selected most populous high-income countries from Europe and North America., Study Design: Data were retrieved from official statistics published by the United Nations, the World Bank, the European Union (EU), and by national health statistics offices., Results: Mean maternal age at birth showed increasing trends in all considered countries; in 2020, the highest mean age was observed in Italy (32.2) and Spain (32.3), and the lowest one in the USA (28.8). Mean maternal age at first birth also showed upward trends. In the 1990s, mean age at first birth ranged from 25.5 to 26.9 years, except for the USA where it was below 25 years. The countries with the highest average maternal age at first birth were Italy and Spain, reaching 31 years over the most recent years. Data on mean paternal age at birth were scant. In Germany (2019) it was 34.6 and in the USA (2014) 27.9 years. In Italy, mean paternal age increased from 34.2 in 2000 to 35.5 in 2018, in the UK from 30.7 in 1990 to 33.4 in 2017, and in Canada, a decrease was observed from 29.1 in 2006 to 28.3 in 2011. Finally, Sweden and the USA had the highest fertility rates, around two children in some years, while Italy and Spain had the lowest ones, with less than 1.5 children over the whole period., Conclusions: Monitoring of trends in reproductive factors is crucial to gain insight into society from a cultural and sociological point of view and to analyze the impact of these changes on reproductive health and related conditions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: International and migrant students face specific challenges which may impact their mental health, well-being and academic outcomes, and these may be gendered experiences. The purpose of this scoping review was to map the literature on the challenges, coping responses and supportive interventions for international and migrant students in academic nursing programs in major host countries, with a gender lens. Methods: We searched 10 databases to identify literature reporting on the challenges, coping responses and/or supportive interventions for international and migrant nursing students in college or university programs in Canada, the United-States, Australia, New Zealand or a European country. We included peer-reviewed research (any design), discussion papers and literature reviews. English, French and Spanish publications were considered and no time restrictions were applied. Drawing from existing frameworks, we critically assessed each paper and extracted information with a gender lens. Results: One hundred fourteen publications were included. Overall the literature mostly focused on international students, and among migrants, migration history/status and length of time in country were not considered with regards to challenges, coping or interventions. Females and males, respectively, were included in 69 and 59% of studies with student participants, while those students who identify as other genders/sexual orientations were not named or identified in any of the research. Several papers suggest that foreign-born nursing students face challenges associated with different cultural roles, norms and expectations for men and women. Other challenges included perceived discrimination due to wearing a hijab and being a 'foreign-born male nurse', and in general nursing being viewed as a feminine, low-status profession. Only two strategies, accessing support from family and other student mothers, used by women to cope with challenges, were identified. Supportive interventions considering gender were limited; these included matching students with support services' personnel by sex, involving male family members in admission and orientation processes, and using patient simulation as a method to prepare students for care-provision of patients of the opposite-sex. Conclusion: Future work in nursing higher education, especially regarding supportive interventions, needs to address the intersections of gender, gender identity/sexual orientation and foreign-born status, and also consider the complexity of migrant students' contexts. [ABSTRACT FROM AUTHOR]

This paper presents a comprehensive analysis and comparison of the existing literature on the phenomenon of non-marriage or staying unmarried in Asian countries such as China, Japan, South Korea, and Singapore, as well as European and American countries such as Spain and the US, and explores the trends, characteristics as well as reasons behind such a phenomenon. Through analysis, the present study found that there is a growing trend of postponed marriage and parenthood as well as an increasing proportion of individuals who exhibit no enthusiasm towards matrimony or parenthood in the aforementioned countries. To some extent, non-marriage or postponed marriage has become a prevalent trend in developed countries and even some developing countries. Japan, South Korea, and several developed countries in Europe and America have exhibited this phenomenon since the middle to late 20th century, with a relatively long history. The emergence of this phenomenon in China, Malaysia, the Philippines, and other developing countries in Asia, however, was relatively late, exhibiting a gradual development process. The current marriage landscape in China is characterized by a growing number of non-marriage individuals and a significant level of marital stability. In terms of reasons for staying unmarried, the marriage rates in the aforementioned countries can be attributed to various factors at macro, meso, and micro levels. In China, the phenomenon of non-marriage is closely associated with a range of factors, including diverse values and attitudes towards romance and marriage, marriage squeeze, education expansion, and the rise in females' economic and social status. The emphasis in future research should be placed on predicting the phenomenon of non-marriage, with a specific focus on exploring the reasons for advocating non-marriage, examining the internal mechanisms underlying this phenomenon, analyzing the consequences of non-marriage, and proposing corresponding countermeasures while establishing the public identity towards marriage. [ABSTRACT FROM AUTHOR]

The use of economic instruments within environmental policy has become a challenging topic for policymakers, governments and scholars. Environmental taxes have emerged as a prevailing preference in developed countries to promote sustainability. Recently, a particular focus has been given to waste generation and disposal, shifting the attention from greenhouse gases to another important source of environmental pollution. This paper investigates the effect of national environmental taxes and policies on industrial waste. A fixed effects model is used for 34 countries across Europe from 2004 to 2022. The results suggest that environmental taxes and energy policies reduce industrial (hazardous and non-hazardous) waste. However, environmental tax reforms should take into consideration the deterioration in environmental quality, the increase in economic costs and undesirable social consequences. [ABSTRACT FROM AUTHOR]

Whereas there are recent papers on the effect of robot adoption on employment and wages, there is no evidence on how robots affect non‐monetary working conditions. We explore the impact of robot adoption on several domains of non‐monetary working conditions in Europe over the period 1995–2005 combining information from the World Robotics Survey and the European Working Conditions Survey. In order to deal with the possible endogeneity of robot deployment, we employ an instrumental variables strategy, using the robot exposure by sector in other developed countries as an instrument. Our results indicate that robotization has a negative impact on the quality of work in the dimension of work intensity and no relevant impact on the domains of physical environment or skills and discretion. [ABSTRACT FROM AUTHOR]

This paper explores the characteristics and inter-relationships of tax systems in the OECD countries over the period 2014–2020, i.e., from a relatively consolidated economic period until the end of the first year of the COVID-19 pandemic. A predictable tax system is essential for the proper functioning of the economy. One of our two main research objectives was to develop a composite indicator for taxation, consisting of tax rates and tax administration time. This composite indicator was then tested using multivariate statistical methods. Our second research objective was to explore the correlation between tax rates, tax burden indicators and macroeconomic indicators over the period 2014–2020, focusing on three years, 2014, 2019 and 2020. An important criterion for the choice of the study years was that 2014 was considered the first overall year of recovery from the crisis, 2019 the last year before the COVID-19 pandemic, and 2020 the first year affected by the pandemic. We investigated the significant differences between the composite indicator categories and the tax burden macroeconomic indicators, and examined and tested correlations between the variables under study (tax rates, tax burden and macroeconomic variables). We found that the amount of working time spent on tax administration is decreasing, presumably due to the increasingly digitalised environment, but this trend has been slightly interrupted by the pandemic. Furthermore, we found that countries with more complex tax systems with a high tax burden perform worse on certain macroeconomic indicators, mainly in southern Europe from a geographical perspective; however, these potentially more burdensome, higher-rate tax systems of more developed countries do not put these countries at a competitive disadvantage. This reflects on the fact that these countries rely on the monetarist school rather than the Keynesian school, a fact which was also compared and considered in our paper. [ABSTRACT FROM AUTHOR]

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Offshore financial centers are almost never the final destination of the foreign direct investments (FDI) they receive. A large portion of these investments are phantom FDI, which ultimately flow to third countries or return back to the source country in a process called round‐tripping. This paper develops a model in which onshore countries compete internationally with tax instruments to attract capital from abroad, in the presence of an offshore financial center that encourages phantom FDI. We show that the presence of offshore financial centers is beneficial to technologically advanced countries, whereas it is detrimental to others. Finally, we use this framework to analyze the effectiveness of Controlled Foreign Company (CFC) rules against profit shifting recently implemented in Europe and the associated loss of tax base. [ABSTRACT FROM AUTHOR]

Abstract: This scoping review focuses on the views of informal caregivers regarding the division of care responsibilities between citizens, governments and professionals and the question of to what extent professionals take these views into account during collaboration with them. In Europe, the normative discourse on informal care has changed. Retreating governments and decreasing residential care increase the need to enhance the collaboration between informal caregivers and professionals. Professionals are assumed to adequately address the needs and wishes of informal caregivers, but little is known about informal caregivers’ views on the division of care responsibilities. We performed a scoping review and searched for relevant studies published between 2000 and September 1, 2016 in seven databases. Thirteen papers were included, all published in Western countries. Most included papers described research with a qualitative research design. Based on the opinion of informal caregivers, we conclude that professionals do not seem to explicitly take into account the views of informal caregivers about the division of responsibilities during their collaboration with them. Roles of the informal caregivers and professionals are not always discussed and the division of responsibilities sometimes seems unclear. Acknowledging the role and expertise of informal caregivers seems to facilitate good collaboration, as well as attitudes such as professionals being open and honest, proactive and compassionate. Inflexible structures and services hinder good collaboration. Asking informal caregivers what their opinion is about the division of responsibilities could improve clarity about the care that is given by both informal caregivers and professionals and could improve their collaboration. Educational programs in social work, health and allied health professions should put more emphasis on this specific characteristic of collaboration. [ABSTRACT FROM AUTHOR]

The new information age and the phenomena of digitalization and automation make investments in research and development (R&D) indispensable for economic and social progress. Meanwhile, increased inequality within countries and its effects on advanced countries is one of the consequences of the recent turbulences in the global economy. These two dynamics open debates around the still-unresolved nature of the relationship between innovation and inequality. This paper contrasts postulates from the existing theory and relevant empirical evidence to argue that the analysis of the positive and complex co-evolution of inequality reduction and technological progress in Europe implies a recombination of factors that highlights institutions as the backbone of the relationship. The results of this analysis based on time series / cross-section regressions with panel data from a sample of 20 European countries for the period 1995–2017 show the relevance of structural and institutional aspects within the region, while two sets of countries evince a dissimilar European behavior in the relationship under study. According to our findings, it is plausible to argue the existence of a virtuous circle defined by the combination of social protection contributions with innovation policies that certainly help settle the controversial relationship between innovation and inequality. [ABSTRACT FROM AUTHOR]

Although black (Rattus rattus) and brown (Rattus norvegicus) rats are among the most widespread synanthropic wild rodents, there is a surprising scarcity of knowledge about their ecology in the urban ecosystem. In particular, relatively few studies have investigated their helminth species diversity in such habitat. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guideline to synthesize the existing published literature regarding the helminth fauna of urban rats in developed countries (North America, Europe, Australia, New Zealand and Japan). We aimed at describing the species diversity and richness of urban rat helminths, the species prevalence and associations, the methods of investigation, the pathological changes observed in the hosts, the risk factors of infection and the public health significance of rat-borne helminthiases. Twenty-three scientific papers published between 1946 and 2019 were reviewed, half of them were conducted in Europe. Twenty-five helminth species and eight genera were described from the liver, digestive tract, lungs and muscles of urban rats. The most commonly reported parasite was Calodium hepaticum. Prevalence and risk factors of helminth infection in urban rats varied greatly between studies. Observed pathological findings in the rat host were generally minor, except for C. hepaticum. Several rat helminths can parasitize humans and are therefore of public health significance. The lack of references to identification keys and the rare use of molecular tools for species confirmation represent the main limitation of these studies. Knowledge gap on this topic and the needs for future research are discussed. [ABSTRACT FROM AUTHOR]

Food insecurity is the limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire foods in socially acceptable ways. The study presents a comparison of the principal determinants of individual food insecurity in Europe and other Continents, with particular regard to gender, since the literature clearly states the importance of women in the administration of food in the household. The study of gender related differences in food insecurity is particularly important in Europe, since women experience food insecurity at a larger extent than men, but with a variability related to the geographical distribution and with complex relationships with economic and social drivers. Using a large international sample of individual level data, that allows the analysis for developed Countries for the first time, and the first experiential measure of food insecurity comparable at the global level, the paper analyses the principal determinants of gender differences in food insecurity. In order to verify if women's vulnerability in food insecurity is moderated by specific factors, the modelling approach allows gender to vary by education, poverty, place of residence. The results suggest that the driver that could most mitigate women disadvantage is education: people with a university degree present a lower probability of experiencing food insecurity, both for men and for women. On the contrary, familial characteristics, such as the number of children in the household, present a higher impact on women's food insecurity than on men's. [ABSTRACT FROM AUTHOR]

The demographic shift experienced by developed countries inevitably results in a change in intergenerational relations. However, despite some attempts to evaluate intergenerational balance in quantitative terms, there is still a significant literature gap in this respect. This paper aims to propose a conceptual and empirical framework to measure intergenerational balance in a cross-country perspective which can serve for the comparative assessment of the outcomes of various policies. It addresses the research question in which countries selected generations are privileged over others in socio-economic terms. Our empirical study includes the investigation of the (relative) situation of different generations as well as comparisons of gender differences in terms of studied welfare state performance across generations to examine whether gender equality in some generations is more promoted than in others. As a criterion, we employ multivariate statistical analysis methods to group 25 European countries into clusters using the intergenerational balance in terms of poverty, income, housing, labour market, education and health. We distinguish four patterns in this respect: 'Supporting young', 'Supporting adult', 'Discriminating against elderly' and 'Supporting elderly'. Our findings reveal that shifting the perspective from inputs to outcomes and including gender perspective gives a somewhat different picture of Europe in terms of intergenerational balance. [ABSTRACT FROM AUTHOR]

This paper analyses the effect of mortality rates (under-five and adult mortality) and population growth on the population ageing in a pooled sample of nine lower and upper middle European countries. Therefore, the main goal of this research is to investigate the ageing process of the population in the context of mortality mechanisms (under five and adult mortality) and of population growth in nine European LUMIs. The analysis is implemented in terms of Pooled least squares with cross-section fixed effects methodology. The novelty used within this research is White two-way cluster standard errors & covariance. This study is based on a database from the World Bank and UN covering the period 1995-2019. The expected results are making available quantitative analysis and insights in the context of mechanisms between the ageing process of population, mortality and population growth across these European LUMIs. Results are consistent with the notion that the increasing ageing process within these countries may be a consequence of the negative impact of population growth and from the influence of adult mortality for both sexes. The research results confirm the presence of solid ties of the mechanism between mortality, population growth and population ageing. Therefore, a clear point was provided that mortality acceleration will depend primarily on the level of population growth., Competing Interests: The authors have declared that no competing interests exist.

Diabetic macular edema (DME) remains the major cause of preventable blindness in the working-age population in developed countries, and screening programs are extremely important in the management of this complication of diabetic retinopathy. The introduction of modern imaging modalities and technological advances have facilitated both the early detection and the follow-up of patients with DME, particularly optical coherence tomography angiography and artificial intelligence. Intravitreal therapy is the gold standard treatment for DME, but not all patients respond equally to this therapy, and sometimes it is not easy to apply treatment protocols correctly; for these reasons, clinical practice results may differ from those of clinical trials in terms of vision gain. One approach has been to implement new treatment regimens, such as treat and extend, and new molecules and therapeutic targets are constantly being developed. The main goal of this review paper is to describe the current treatment options and management strategies for DME in Europe and to provide a brief oversight of the novel therapeutic options on the horizon. [ABSTRACT FROM AUTHOR]

Biotherapeutics dominate the pipelines of pharmaceutical companies across the world today with products ranging from hormones, immune-modulators, monoclonal antibodies (mAbs), blood coagulation factors, enzymes and vaccines. However, they are considerably more expensive than their small molecule counterparts (pharmaceuticals) and as a result their contribution to the already unacceptably high healthcare costs in the developed economies (Europe, United States, Japan, Canada and South Korea) has been in the limelight in the last decade. This has resulted in the rise of biosimilars, seen as the affordable versions of innovator biotherapeutics. As the developed economies form the majority of the global sales of biotherapeutics, they are an attractive market for the biosimilars as well. Regulatory considerations for approval of biosimilars in these jurisdictions is likely to have a major impact on the adoption of biosimilars. In this paper, we offer a perspective on this topic while focusing on the developed markets. This article summarizes the main regulatory requirements for approval of biosimilars in Europe, United States, Japan, Canada, and South Korea. An overview on current biosimilars status and market in the aforesaid countries has also been included., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background. Obesity is a key public health problem. The advancement of gut microbiota research sheds new light on this field. This article aims to present the research trends in global intestinal microbiota studies within the domain of obesity research. Methods. Bibliographic information of the publications on intestinal microbiota and obesity was retrieved from the Scopus database, and then analyzed by using bibliometric approaches. Results. A total of 3,446 references were retrieved; the data indicated a steady growth and an exponential increase in publication numbers. The references were written in 23 different languages (93.8% in English). A number of 3,056 English journal papers were included in the further analyses. Among the 940 journals, the most prolific ones were PLOS ONE, Scientific Reports, and British Journal of Nutrition. North America and Europe were the highest publication output areas. The US (995 publications) ranked first in the number of publications, followed by the China (243 publications) and France (242 publications). The publication numbers were significantly correlated with gross domestic product (GDP), human development index (HDI), and population number (PN). International collaboration analysis also shows that most of the collaborations are among developed countries. Discussion. This comprehensive bibliometric study indicates that gut microbiota is a significant topic in the obesity research. The structured information may be helpful in understanding research trends, and locating research hot spots and gaps in this domain. [ABSTRACT FROM AUTHOR]

The relatively small panel cointegration literature on the dynamics between FDI and income inequality predominantly finds that FDI will reduce income inequality in the long-run in developed countries. However, we point out an important technical oversight in the literature. Not accounting for cross-section dependence in panel data methodologies may yield unreliable results. Expanding on the work of Herzer and Nunnenkamp [(2013). Inward and outward FDI and income inequality: Evidence from Europe. Review of World Economics, 149(2), 395–422. https://doi.org/10.1007/s10290-013-0148-3], who pioneered the use of panel cointegration in the European context, we obtain different results when we account for cross-section dependence and employ economic procedures robust to it. Using a panel containing 16 OECD countries (1979–2017), 2 income inequality measures, and 4 FDI measures, we begin by showing strong evidence for the existence of cross-section dependence. Then, using second-generation econometric procedures, we do not find any evidence for a cointegrating relationship between inward FDI and income inequality. We do find evidence that outward FDI is cointegrated with income inequality; however, contrary to the main results of the literature, we find that it widens the income gap in the long-run. Additionally, our results support the view that fiscal policy is an important tool to reduce income inequality. [ABSTRACT FROM AUTHOR]

The ending of pregnancy is an issue that keeps attracting great attention even today, at the beginning of the 21st century. Since the 1970s, abortion legislation has moved steadily towards liberalization, especially in developed countries around the world. In Europe, only a few countries still prohibit abortion on request. Yet neither the current legislation nor the relevant case law of supreme and constitutional courts have brought about consensus on the justification thereof. An exceptionally delicate matter made so by a wealth of moral, ethical, philosophical, medical, religious, economic, legal and other aspects, abortion is a bone of contention in the general public and many an expert community. The reasoning provided in constitutional reviews of law is lambasted in equal measure by the pro-choice and the pro-life camps, the latter of which are felt in presence and influence despite the ever-growing liberalization. The paper primarily examines the matter of abortion in comparative and Croatian constitutional law and legislation from the perspective of human rights. [ABSTRACT FROM AUTHOR]

Background Diabetes is more prevalent among overweight/obese individuals, but has become a significant public health challenge among normal-weight populations. In this meta-analysis, we aimed to estimate diabetes/prediabetes incidence and its temporal trends by weight status. Methods PubMed, Embase, Web of Science, and Cochrane Library were searched until 8 December 2021. Prospective cohort studies reporting diabetes incidence by baseline body mass index (BMI) categories in adults were included. The median year of data collection was used to assess the temporal trends. Subgroup analyses and meta-regression were also performed. Results We included 94 studies involving 3.4 million adults from 22 countries. The pooled diabetes incidence in underweight, normal-weight, and overweight/obese adults was 4.5 (95% confidence interval (CI)=2.8-7.3), 2.7 (95% CI=2.2-3.3), and 10.5 (95% CI=9.3-11.8) per 1000 person-years, respectively. The diabetes incidence in low- and middle-income countries (LMICs) was higher than in high-income countries among normal-weight (5.8 vs 2.0 per 1000 person-years) or overweight/obese (15.9 vs 8.9 per 1000 person-years) adults. European and American regions had a higher diabetes incidence than the non-Western areas, regardless of weight status. Underweight diabetes incidence decreased significantly from 1995-2000 to 2005-2010. Diabetes incidence in normal-weight populations has increased continuously since 1985 by an estimated 36% every five years. In overweight/obese adults, diabetes incidence increased between 1985-1990 and 1995-2000, stabilised between 2000 and 2010, and spiked suddenly after 2010. Conclusions Diabetes incidence and its temporal trends differed by weight status. The continuous upward trend of diabetes incidence among overweight/obese individuals requires urgent attention, particularly in LMICs. Furthermore, diabetes among normal-weight individuals is becoming a significant public health problem. [ABSTRACT FROM AUTHOR]

Midlife, beginning at 40 years and extending to 65 years, a range that encompasses the late reproductive to late menopausal stages, is a unique time in women's lives, when hormonal and physical changes are often accompanied by psychological and social evolution. Access to sexual health and sexual well-being (SHSW) services, which include the prevention and management of sexually transmitted infections, contraception and the support of sexual function, pleasure and safety, is important for the health of midlife women, their relationships and community cohesion. The objective was to use the socio-ecological model to synthesise the barriers and enablers to SHSW services for midlife women in high-income countries. A systematic review of the enablers and barriers to women (including trans-gender and non-binary people) aged 40–65 years accessing SHSW services in high-income countries was undertaken. Four databases (PubMed, PsycINFO, Web of Science and Google Scholar) were searched for peer-reviewed publications. Findings were thematically extracted and reported in a narrative synthesis. Eighty-one studies were included; a minority specifically set out to study SHSW care for midlife women. The key barriers that emerged were the intersecting disadvantage of under-served groups, poor knowledge, about SHSW, and SHSW services, among women and their healthcare professionals (HCPs), and the over-arching effect of stigma, social connections and psychological factors on access to care. Enablers included intergenerational learning, interdisciplinary and one-stop women-only services, integration of SHSW into other services, peer support programmes, representation of minoritised midlife women working in SHSW, local and free facilities and financial incentives to access services for under-served groups. Efforts are needed to enhance education about SHSW and related services among midlife women and their healthcare providers. This increased education should be leveraged to improve research, public health messaging, interventions, policy development and access to comprehensive services, especially for midlife women from underserved groups. Plain language summary: Sexual health and sexual wellbeing services for midlife women in high income countries Midlife, beginning at 40 years and extending to 65 years, a range that encompasses the late reproductive to late menopausal stages, is a unique time in women's lives. Access to Sexual Health and Sexual Wellbeing (SHSW) services, which include the prevention and management of sexually transmitted infections, contraception and the support of sexual function, pleasure and safety, is important for the health of midlife women, their relationships and community cohesion. The objective of this systematic review was to use the socio-ecological model to synthesise the barriers and enablers to SHSW services for midlife women in high income countries. Eighty-one studies were included; a minority specifically set out to study SHSW care for midlife women. The key barriers that emerged were the intersecting disadvantage of under-served groups, poor knowledge, about SHSW, and SHSW services, among women and their HealthCare Professionals (HCPs), and the over-arching effect of stigma, social connections, and psychological factors on access to care. Enablers included intergenerational learning, interdisciplinary and one-stop women-only services, integration of SHSW into other services, peer support programmes, representation of minoritised midlife women working in SHSW, local and free facilities, and financial incentives for under-served groups to access services. The appetite for education about SHSW and SHSW services among midlife women and their HCPs should be capitalised upon, and utilised to improve research, public health messaging, interventions and access to holistic services, particularly for midlife women from under-served groups. [ABSTRACT FROM AUTHOR]

Objective: People who have limited access to dental care may present to non-dental health practitioners for dental treatment and advice. This review synthesised the available evidence regarding the use of non-dental health practitioners for oral health problems and the services provided by non-dental health practitioners to manage such presentations., Methods: PubMed and CINAHL databases were searched using key search terms to identify all relevant quantitative and qualitative English-language studies published between 1990 and March 2014. Snowballing techniques were then applied whereby the reference lists of retrieved articles were searched for other relevant citations. Grey literature was searched via Google using the same search terms to identify unpublished work and government reports., Results: Of the 43 papers which met the review criteria, 25 papers reported on the use of non-dental health practitioners for oral health problems and 18 on dental care education and training for non-dental health practitioners. Four reports were located from the grey literature on the involvement of non-dental health practitioners in the management of oral health care., Conclusions: The review of literature showed that both children and adults utilise non-dental health practitioners for oral health problems. Despite this, Emergency Department medical staff, medical practitioners and pharmacists generally lacked training and knowledge in the maragement of oral health. Services from non-dental health practitioners mainly focussed on children. The literature on education and training for non-dental health practitioners was limited.

The object of this study is project management under the changing conditions of the modern economy. The way the top management of the company affects the implementation of projects in various sectors and branches of production is an issue related to business development in general. An increasing number of enterprises use project tools to adjust production processes. To this end, in particular, it is advisable to use administrative management tools against the background of its improvement at the level of the company’s management. The logic of this study construction implies an emphasis on theoretical and experimental components. The theoretical foundations of the study include the identification of administrative management tools. The coverage of the experimental part is devoted to multifactorial regression analysis (the coefficient of determination is 0.715) of the influence of administrative management factors on the effectiveness of projects based on construction excavations. The interpretation of the research data confirms that the administrative management toolkit could be optimally used to establish high-quality project management. Based on the study of aspects of the relationship between administrative management and project management, the definition of administrative management and the project management system at modern enterprises is proposed. The study concluded that it is necessary to use those levers that are common in companies of industrialized countries of the world. Europe’s experience will be useful in spreading the practice of project management in enterprises of countries with transition economies. The results of the research could be used at enterprises of various sectors of industry, agriculture, and the service domain, in particular at construction enterprises that were chosen as the object of research [ABSTRACT FROM AUTHOR]

Background: Over the past half century the global tendency for improvements in longevity has been uneven across countries. This has resulted in widening of inter-country disparities in life expectancy. Moreover, the pattern of divergence appears to be driven in part by processes at the level of country groupings defined in geopolitical terms. A systematic quantitative analysis of this phenomenon has not been possible using demographic decomposition approaches as these have not been suitably adapted for this purpose. In this paper we present an elaboration of conventional decomposition techniques to provide a toolkit for analysis of the inter-country variance, and illustrate its use by analyzing trends in life expectancy in developed countries over a 40-year period. Methods: We analyze trends in the population-weighted variance of life expectancy at birth across 36 developed countries and three country groups over the period 1970-2010. We have modified existing decomposition approaches using the stepwise replacement algorithm to compute age components of changes in the total variance as well as variance between and within groups of Established Market Economies (EME), Central and Eastern Europe (CEE), and the Former Soviet Union (FSU). The method is generally applicable to the decomposition of temporal changes in any aggregate index based on a set of populations. Results: The divergence in life expectancy between developed countries has generally increased over the study period. This tendency dominated from the beginning of 1970s to the early 2000s, and reversed only after 2005. From 1970 to 2010, the total standard deviation of life expectancy increased from 2.0 to 5.6 years among men and from 1.0 to 3.6 years among women. This was determined by the between-group effects due to polarization between the EME and the FSU. The latter contrast was largely fueled by the long-term health crisis in Russia. With respect to age, the increase in the overall divergence was attributable to between-country differences in mortality changes at ages 15-64 years compared to those aged 65 and older. The within-group variance increased, especially among women. This change was mostly produced by growing mortality differences at ages 65 and older. Conclusions: From the early 1970s to the mid-2000s, the strong divergence in life expectancy across developed countries was largely determined by the between-group variance and mortality polarization linked to the East--West geopolitical division. [ABSTRACT FROM AUTHOR]

Recovery from the recent financial crisis and "great recession" has been slower than after previous recessions in most developed countries and areas, especially Europe. But Europe's growth problem is structural in character and started much earlier. This paper analyzes the structural causes of the European slow growth, evaluates the policies that Europe adopted to overcome it, and concludes that even with the appropriate policies, the prospects for accelerating growth in Europe will be difficult, especially in the context of the current US-China trade war. [ABSTRACT FROM AUTHOR]

Aim: This study aims to synthesize the factors associated with nurse emigration from lower and middle‐income countries. Design: Integrative review. Methods: An in‐depth search of registries and five databases yielded 9466 records. Using the PRISMA guidelines, 11 were chosen after screening by two authors independently. The mixed methods appraisal tool (MMAT) was used to assess the risk of bias. Results: The destination countries were Europe and North America, with an inclination for nurse migration of 14.3%–85%. Emigration factors were poor salary, working conditions, poor quality healthcare infrastructure; outdated healthcare technologies, lack of employment opportunities, younger age, relationship status (single), living environment, social pressure, urban residence, work experience, insecurity, high crime rates, political corruption and foreign language skills. Public Contribution: Healthcare authorities and nursing leaders must implement practical measures to minimize nurse emigration. [ABSTRACT FROM AUTHOR]

This paper is concerned with evaluating the impact of the Procurement Directive, 2009/81/EC, on defence offset in Europe. The aim of the Directive was to reduce the extent of Article 346 derogations based on offset. Indirect offset has disappeared, and while the evidence is patchy, direct offset appears to be declining. This gradual demise of offset is in line with the global trend, especially among advanced countries. Offset is increasingly becoming a developing country phenomenon. [ABSTRACT FROM AUTHOR]

Background: The databases of children's anthropometric parameters are often outdated, rarely representative and are not always available at an international level. Objectives: To present children's anthropometric parameters in six European countries that contributed to the Feel4Diabetes project and find country-specific differences. Design/Setting: The Feel4Diabetes study was performed between 2016 and 2018, targeting children in Belgium, Bulgaria, Finland, Greece, Hungary and Spain. The current study presents data from the baseline and the yearly follow-up anthropometric measurements. Subjects: In total, 20,832 measurements of children (48.7% boys) between 6 and 10 years of age were conducted. Main outcome measure: weight, height, BMI. Results: Belgian boys had the lowest body weight and height, while Greek boys had the highest body weight, and Finnish had the highest body height. The highest proportion of overweight (percentile above 85%) and obese boys (percentile above 95%) was in Greece, followed by Hungarian, Spanish, Bulgarian and Finnish boys. In contrast, Belgian boys had the lowest ratio in both categories. Among girls, Greece had the highest; Belgium had the lowest body weight; Finland was the highest in all age categories. The ratio in the overweight range was the highest in Greece, followed by Spanish, Bulgarian and Hungarian girls, who were second in the obese category. Finnish girls had lower and Belgian girls had the lowest ratio in both BMI categories. All the detailed data are presented in tables, and the trends are figures. Conclusions: Our study presents fresh and comparable anthropometric data of children between 6 and 10 years of age in six European countries, supporting the need for appropriate obesity prevention. [ABSTRACT FROM AUTHOR]

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

In this paper we ask the question: why has capacity adequacy become a worry in developed countries in general, and Europe in particular, in recent years, and how serious is this problem? While the liberalisation process and the fast move to variable renewable energy sources play a role in this process, they are not the only causes. We discuss the extent to which regulators and policy makers are able to influence the evolution of the market and also consider the role of and challenges created by regional markets and cross-boarder integration. We conclude that policy makers can go into one of two directions. The first option is to ignore cross-border trading in their planning. While this would create security of supply for individual countries, it would come at the cost of very significant investment subsidies. The alternative is to rely on cross-border trade, an option which requires not only close cooperation and coordination, but also significant trust between the jurisdictions and institutions involved, to ensure sufficient capacity. The choice between these options is a political decision, to be made at the national and supranational levels, not by regulators, and even less by market participants. [ABSTRACT FROM AUTHOR]

International differences in technological activity are considered a fundamental factor in explaining differences in both levels and trends between countries' exports, imports, and income, especially among industrialized nations. This study examines the effects of innovation activity (measured by R&D expenditure and patent applications) and economic growth (GDP per capita) on trade openness (the ratio of imports plus exports to GDP) in 10 European countries from 1983 to 2018 using time series analysis. We also investigate the impact of the Lisbon and Europe 2020 strategies on trade openness. We use autoregressive distributed lag methodology and Granger causality tests based on the vector error correction model to conduct the analysis. The empirical findings indicate a strong long-run relationship among the variables in all the countries examined. In most countries, the long-run coefficients of R&D expenditure, patent applications, and GDP per capita are positive and statistically significant. In short-run dynamics, error correction models are well-defined and provide interesting results for each country. The effects of the Lisbon Strategy and Europe 2020 differ across the countries examined. Finally, the Granger causal relationships among the variables vary across countries. [ABSTRACT FROM AUTHOR]

Advocacy is one of the core functions of public health and is a key tool for achieving Sustainable Development Goals. Public health associations play a key role in advocating for the development and implementation of strategies to prevent diseases and promote health and well-being. This study aims to map out the focus of public health advocacy carried out by selected national public health associations over 4 years, between 2018 and 2021, in order to identify gaps and strengths and support associations and professionals in their advocacy efforts. Twelve national public health associations participated in the study. Official policy documents produced between 2018 and 2021 were collected and analysed. The title and summary of the policy documents were examined line by line and coded into the main subject categories and themes. A qualitative thematic analysis was conducted. Policies were assessed from global and regional perspectives. A total of 220 policy documents were analysed. Overall, the largest number of policy documents came from high-income countries and dealt with environmental health and communicable diseases, including COVID-19, with, however, important differences among regions. In the African region, public health advocacy focused mainly on strengthening health systems; Europe and South America were mostly concerned with communicable diseases and pandemic management; and North America and the Western Pacific regions focused primarily on climate change. Limited attention was paid to international health and health as a human right in all regions. Our study showed that, especially in high-income countries, public health associations actively engage in advocacy; however, more effort needs to be devoted to implementing a more international and intersectoral approach at the global level, anchored in health as a human right and aligned with the Sustainable Development Goals. [ABSTRACT FROM AUTHOR]

In the light of the current economic crisis, cross country collaboration represents an attractive opportunity for Transition Economies (TE) to pursue in order to counter the diminishing levels of economic growth and to obtain additional sources of revenue. One of the sources of economic growth, namely, investments in Information and Communication Technologies (ICT), have been shown to contribute reliably to the economic bottom-line in the context of the developed countries. Unlike their developed counterparts, however, TEs do not represent a homogenous group, and it is not clear how a given TE can identify a pool of the suitable collaborators in the area of investments in ICT, and then to determine the type of the collaborative projects to pursue. As a solution to this problem we suggest a methodological framework allowing for TEs, first, to determine an appropriate pool of possible partners, and then to determine an appropriate type of the collaborative effort. We focus on the subset of investments in ICT, namely, investments in Telecoms and illustrate the proposed framework in the context of Transition economies in Europe and the former Soviet Union. [ABSTRACT FROM AUTHOR]

Mapping large territories for earthquake-induced soil liquefaction hazard may sound like an oxymoron since soil liquefaction is by itself a spatially highly localized phenomenon. Thus, the zonation of liquefaction hazard at the continental scale (i.e. megazonation) is a truly hard facing challenge even if accepting a low level accuracy. Yet, the availability of a megazonation chart of liquefaction hazard could be useful to identify territories that in case of an earthquake may display this phenomenon of soil instability distinguishing them from the regions where soil liquefaction is not expected even in case of strong ground shaking. A representation of the spatial variability of liquefaction hazard potential within a single country is within reach considering the resolution and accuracy of geological and geotechnical information that is currently available in the most developed nations. The LIQUEFACT project fully addressed in a specific work package the problem of constructing georeferenced, earthquake-induced soil liquefaction hazard maps in continental Europe for various return periods. They were built using homogeneous datasets in Europe on the expected seismic hazard and on the geological, geomorphological, hydrogeological, shallow lithology and digital terrain information. A probabilistic prediction model based on a logistic regression for liquefaction occurrence was purposely developed using a set of optimal geospatial predictors (explanatory variables) which include the weighted-magnitude peak ground acceleration, the weighted-mean shear-wave velocity in the top 30 m (VS30) and the compound topographic index. The optimal geospatial descriptors were selected based on the Luco and Cornell methodology, namely on the criteria of efficiency, practicality and proficiency. To calibrate and successively validate the logistic regression, a database of liquefaction manifestations occurred in continental Europe was used. Although the level of accuracy provided by these models at a local scale is low, still the availability of continental charts of liquefaction hazard may help policy makers and administrators to prioritize which urbanized territories should be investigated further to assess the seismic risk of structures and infrastructures associated to the occurrence of soil liquefaction. [ABSTRACT FROM AUTHOR]

COBIT is a process-oriented IT governance framework. In the 2019 version, the framework offers a significantly redesigned approach to prioritise processes and set process target capability levels. The design phase is very important to achieve a governance system in future. Although there are several design factors defined in the design phase of COBIT 2019, these factors do not assess process suitability and value for the governance system. Thus, connections and continuity among processes are not taken into consideration enough. Therefore, the aim of the article is to suggest another design factor based on the interrelationships of processes in the COBIT framework represented by its information flows. The nature of the proposed innovation is described, and the analysis of process information flows and items is performed. The article also publishes several inconsistencies in COBIT 2019 documentation that have been identified in the process of research. The application of process information flows and items analysis has been illustrated in two case studies. We have identified new information that can be relevant to decision making in the design phase and discussed their importance for the planned governance system. The results could help to improve the quality of the design phase by providing additional information about the context of the processes designed to ensure the governance system. Implications for Central European audience: The implications for senior managers in the Central European region will be beneficial. Optimisation and effective use of information technologies is a prerequisite for achieving long-term competitiveness. COBIT is a best practice framework, and its implementation in companies is largely based on the specifics of each organisation. Therefore, it is important to pay close attention to the implementation phase of the application of COBIT. Framework application positively supports the holistic approach to management, resource optimisation, management based on responsibility and measurability. Today, these attributes of the organisation's management are emphasised not only in Central Europe but in developed countries in general. [ABSTRACT FROM AUTHOR]

Background Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the developed countries. The aim of this study was to evaluate the NAFLD prevalence in European adults and children/adolescents of the general population and specific subgroups. Method Search for all articles published between 01/1990-06/2019 reporting NAFLD prevalence from European countries. Results Nineteen studies with adults and 9 with children/adolescents were included. Pooled NAFLD prevalence in adults was 26.9%, being higher in studies using ultrasonography (27.2%) or fatty liver index (FLI) (30.1%) than liver biochemical tests (19.1%) and without differences between Mediterranean and non-Mediterranean countries or publication periods. Pooled NAFLD prevalence was higher in men than women (32.8% vs. 19.6%) and in patients with than those without metabolic syndrome (75.3% vs. 17.9%) or any of its components (always P<0.01). Ultrasound and FLI performed equally in estimating NAFLD prevalence in most subgroups. A higher prevalence was reported using FLI in obese and in diabetic patients, whereas a higher prevalence was observed with ultrasound in non-obese patients and in individuals without metabolic syndrome. NAFLD prevalence was 2.7% in unselected and 31.6% in obese/overweight children/adolescents. Conclusions NAFLD prevalence exceeds 25% in European adults, being higher in those with metabolic syndrome component(s)-related comorbidities. It remains low in unselected NAFLD population, but increased in overweight/obese European children/adolescents, particularly from Mediterranean countries. [ABSTRACT FROM AUTHOR]

Over the past decades, men's and women's time use in industrialized nations has changed dramatically, suggesting a gender revolution. Women increased their time in paid work and reduced time in unpaid activities, while men increased their time in unpaid work, but not enough to compensate for women's retreat. We investigate developments regarding men's and women's unpaid work across Europe and the United States, using time diary data from the mid‐1980s and onward. We find evidence for gender convergence in unpaid work over time, but different trends for housework and childcare. Gender convergence in housework primarily resulted from women reducing their time, whereas childcare time increased for both sexes, resulting in convergence only where men increased more than did women. Decomposition analyses show that trends in housework and childcare are explained by changes in behavior rather than compositional changes in population characteristics. Though level differences in unpaid work persist, our findings regarding trends support gender convergence in that they are general across country contexts that vary regarding policy and social norms about gender, family, and work. [ABSTRACT FROM AUTHOR]

Pharmaceutical products are believed to enhance the safety of living to cure or prevent diseases. This Pharmaceutical products, however it can cause serious disruptive impacts on living organisms, when they are dispersed throughout the environment by a different path. In the past few years, the difficult tasks for the pharmaceutical industries is adapting to the effect of pharmaceutical products on earth. Such natural wellbeing and protection issues made ready in building up a rightful regulatory regime for Environment Risk Assessment (ERA) of pharmaceutical products. The majority of regulatory improvements have been made in ERA for pharmaceutical products in developed countries such as the US, EU, Canada. Countries around the world and organizations such as OECD have developed procedures for ERA to achieve the main goal. Currently, there is an absence of specified guidance for ERA of pharmaceutical products in other countries around the world. However, in the future, they are supposed to have stringent guidelines and legislative specifications. This study seeks to acknowledge, compare, and contrast ERA embraced by developed countries such as Europe and the US. In this study, we have given an outline of the awareness of pharmaceuticals products on ERA and its environmental impacts. Hence, it is important to develop an Eco Pharmaco-Vigilance (EPV) framework for monitoring and collecting information, which will eliminate the possibility of medicinal products that reach the earth. Within this review article we compared about the ERA that developed countries like Europe and the US have adopted. [ABSTRACT FROM AUTHOR]

The science of event attribution has emerged to routinely answer the question whether and to what extent human-induced climate change altered the likelihood and intensity of recently observed extreme weather events. In Europe a pilot program to operationalize the method started in November 2019, highlighting the demand for timely information on the role of climate change when it is needed most: in the direct aftermath of an extreme event. Independent of whether studies are provided operationally or as academic studies, the necessity of good observational data and well-verified climate models imply most attributions are currently made for highly developed countries only. Current attribution assessments therefore provide very little information about those events and regions where the largest damages and socio-economic losses are incurred. Arguably, these larger damages signify a much greater need for information on how the likelihood and intensity of such high-impact events have been changing and are likely to change in a warmer world. In short, why do we not focus event attribution research efforts on the whole world, and particularly events in the developing world? The reasons are not just societal and political but also scientific. We simply cannot attribute these events in the same probabilistic framework employed in most studies today. We outline six focus areas to lessen these barriers, but we will not overcome them in the near future. [ABSTRACT FROM AUTHOR]

While we know that living alone is often associated w ith greater risk of financial hardship, we have limited knowledge on the possible link between the availability of public support and independent living. We use data from the 2 0 14 Health and Retirement Study and the 201 1-2015 Survey of Health, Ageing and Retirement in Europe to compare income and wealth profiles of the population aged 60 and above who are living alone in the United States and 19 European countries. We find that the likelihood of living alone is higher in generous welfare states, with social support and spending both positively associated with living alone. The relationship between personal resources and living alone has a smaller positive gradient in countries with robust welfare systems. The lack of adequate public support in less generous welfare states may constrain the ability of many low-income older adults with out a partner to continue living independently. [ABSTRACT FROM AUTHOR]

Objectives Increasing numbers of older adults cross-nationally are without children or partners in later life and therefore likely have greater reliance on nonkin (e.g. friends). This pattern may be particularly pronounced in country contexts that emphasize friendship. This article hypothesizes that those who lack kin (e.g. children, partners) and/or who live in countries with a stronger emphasis on friendship have more friends in their networks. Although these hypothesized patterns are consistent with interdisciplinary literatures, they have not been tested empirically and therefore remain overlooked in current "aging alone" narratives. Method This study combines individual-level data from the Survey of Health, Ageing, and Retirement in Europe (Wave 6) with nation-level data from the European Values Survey to estimate multilevel negative binomial models exploring number of friends among those aged more than 50 years who lack kin across 17 countries. Results Older adults who lack kin or whose kin are unavailable report more friends in their networks, particularly in countries with a higher percentage of people who believe that friends are "very important" in life. Discussion This article challenges dominating assumptions about "aging alone" that rely heavily on lack of family as an indicator of "alone." Future studies of "kinlessness" should consider the extent to which friendship is correlated with lack of kin, particularly in more socioeconomically developed countries. Previous research on "aging alone" may have overestimated risk in more privileged countries that already emphasize friendship, but underestimated risk in family-centered countries where "kinlessness" and alternative sources of support are less common. [ABSTRACT FROM AUTHOR]

In the past four decades, high-income countries have seen a thorough socio-economic restructuring with important implications for the jobs of many workers, including health- and safety-related aspects. Much attention has been paid to psychosocial risks related to intrinsic features of contemporary work tasks, while the occupational health and safety consequences of 'new' conditions and relations of employment have remained neglected. This relative neglect is unjustified given the disrupting nature of many contemporary forms of employment. In this commentary, I introduce the concept of 'employment quality' as a novel approach towards measuring employment-related OHS risks. Employment quality involves a 'typological approach' towards employment arrangements, identifying five employment types in European labour markets, showing a distinct profile in terms of health-related employment characteristics. Moreover, these types align with segmented labour market theory, have a clear socio-economic profile, and show strong associations with workers' self-reported health. [ABSTRACT FROM AUTHOR]

Objective: The main goal of this study was to determine the knowledge and beliefs of otorhinolaryngologists in a secondary setting in selected economically advanced European countries concerning severe hearing loss, hearing aids, and cochlear implants (CIs). Secondary goals of the study looked into the information sources of the otorhinolaryngologists and into key topics of importance for these professionals. In Europe, many adults, who could benefit from a CI, do not have one despite their availability via national health care systems. This lack of coverage might be due, in part, to the knowledge and beliefs of otorhinolaryngologists.Methods: Otorhinolaryngologists in a secondary setting in Germany, England, France, Austria, and Sweden were emailed a custom-made questionnaire on their knowledge and beliefs regarding hearing loss and its treatments. Results were presented in relative frequencies (%) according to each nation.Results: Two-hundred and forty otorhinolaryngologists responded (50 from each nation except Sweden). Each nation regarded rehabilitation and hearing preservation as particularly important in CIs. National and international conferences and conversations with colleagues were much more popular methods of keeping abreast of medical issues than other information sources such as online media or company information.Conclusion: The otorhinolaryngologists of the surveyed nations share many common beliefs about hearing loss, hearing aids, and CIs, although some national variation in opinion is present. The otorhinolaryngologists of each nation are knowledgeable, but could still benefit from an increased knowledge and awareness of hearing loss treatment modalities. [ABSTRACT FROM AUTHOR]

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Objective: Concerns about differences in registration practices across countries have limited the use of routine data for international very preterm birth (VPT) rate comparisons.Design: Population-based study.Setting: Twenty-seven European countries, the United States, Canada and Japan in 2010.Population: A total of 9 376 252 singleton births.Method: We requested aggregated gestational age data on live births, stillbirths and terminations of pregnancy (TOP) before 32 weeks of gestation, and information on registration practices for these births. We compared VPT rates and assessed the impact of births at 22-23 weeks of gestation, and different criteria for inclusion of stillbirths and TOP on country rates and rankings.Main Outcome Measures: Singleton very preterm birth rate, defined as singleton stillbirths and live births before 32 completed weeks of gestation per 1000 total births, excluding TOP if identifiable in the data source.Results: Rates varied from 5.7 to 15.7 per 1000 total births and 4.0 to 11.9 per 1000 live births. Country registration practices were related to percentage of births at 22-23 weeks of gestation (between 1% and 23% of very preterm births) and stillbirths (between 6% and 40% of very preterm births). After excluding births at 22-23 weeks, rate variations remained high and with a few exceptions, country rankings were unchanged.Conclusions: International comparisons of very preterm birth rates using routine data should exclude births at 22-23 weeks of gestation and terminations of pregnancy. The persistent large rate variations after these exclusions warrant continued surveillance of VPT rates at 24 weeks and over in high-income countries.Tweetable Abstract: International comparisons of VPT rates should exclude births at 22-23 weeks of gestation and terminations of pregnancy. [ABSTRACT FROM AUTHOR]

Background: In recent years, high-cost medicines have increasingly been challenging the public health budget in all countries including high-income economies. In this context, this study aims to survey, analyze and compare prices of medicines that likely contribute to high expenditure for the public payers in high-income countries.Methods: We chose the following 16 European countries: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Hungary, Ireland, Italy, the Netherlands, Portugal, Sweden, Slovakia, Spain and United Kingdom. The ex-factory price data of 30 medicines in these countries were collected in national databases accessible through the Pharmaceutical Price Information (PPI) service of Gesundheit Österreich GmbH (Austrian Public Health Institute).Results: The ex-factory prices (median) per unit (e.g. per tablet, vial) ranged from 10.67 cent (levodopa + decarboxylase inhibitor) to 17,000 euro (ipilimumab). A total of 53% of the medicines surveyed had a unit ex-factory price (median) above 200 Euro. For two thirds of the medicines, price differences between the highest-priced country and lowest-priced country ranged between 25 and 100%; the remaining medicines, mainly low-priced medicines, had higher price differential, up to 251%. Medicines with unit prices of a few euros or less were medicines for the treatment of diseases in the nervous system (anti-depressants, medicines to treat Parkinson and for the management of neuropathic pain), of obstructive airway diseases and cardio-vascular medicines (lipid modifying agents). High-priced medicines were particularly cancer medicines.Conclusion: Medicine prices of Greece, Hungary, Slovakia and UK were frequently at the lower end, German and Swedish, as well as Danish and Irish prices at the upper end. For high-priced medicines, actual paid prices are likely to be lower due to confidential discounts and similar funding arrangements between industry and public payers. Pricing authorities refer to the higher undiscounted prices when they use price data from other countries for their pricing decisions. [ABSTRACT FROM AUTHOR]

Background: Funding models influence provision and development of palliative care services. As palliative care integrates into mainstream health care provision, opportunities to develop funding mechanisms arise. However, little has been reported on what funding models exist or how we can learn from them. Aim: To assess national models and methods for financing and reimbursing palliative care. Design: Initial literature scoping yielded limited evidence on the subject as national policy documents are difficult to identify, access and interpret. We undertook expert consultations to appraise national models of palliative care financing in England, Germany, Hungary, Republic of Ireland, New Zealand, The Netherlands, Norway, Poland, Spain, Sweden, Switzerland, the United States and Wales. These represent different levels of service development and a variety of funding mechanisms. Results: Funding mechanisms reflect country-specific context and local variations in care provision. Patterns emerging include the following: • Provider payment is rarely linked to population need and often perpetuates existing inequitable patterns in service provision. • Funding is frequently characterised as a mixed system of charitable, public and private payers. • The basis on which providers are paid for services rarely reflects individual care input or patient needs. Conclusion: Funding mechanisms need to be well understood and used with caution to ensure best practice and minimise perverse incentives. Before we can conduct cross-national comparisons of costs and impact of palliative care, we need to understand the funding and policy context for palliative care in each country of interest. [ABSTRACT FROM AUTHOR]