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Background: People with intellectual disabilities often present with unique challenges that make it more difficult to meet their palliative care needs. Aim: To define consensus norms for palliative care of people with intellectual disabilities in Europe. Design: Delphi study in four rounds: (1) a taskforce of 12 experts from seven European countries drafted the norms, based on available empirical knowledge and regional/national guidelines; (2) using an online survey, 34 experts from 18 European countries evaluated the draft norms, provided feedback and distributed the survey within their professional networks. Criteria for consensus were clearly defined; (3) modifications and recommendations were made by the taskforce; and (4) the European Association for Palliative Care reviewed and approved the final version. Setting and participants: Taskforce members: identified through international networking strategies. Expert panel: a purposive sample identified through taskforce members’ networks. Results: A total of 80 experts from 15 European countries evaluated 52 items within the following 13 norms: equity of access, communication, recognising the need for palliative care, assessment of total needs, symptom management, end-of-life decision making, involving those who matter, collaboration, support for family/carers, preparing for death, bereavement support, education/training and developing/managing services. None of the items scored less than 86% agreement, making a further round unnecessary. In light of respondents’ comments, several items were modified and one item was deleted. Conclusion: This White Paper presents the first guidance for clinical practice, policy and research related to palliative care for people with intellectual disabilities based on evidence and European consensus, setting a benchmark for changes in policy and practice. [ABSTRACT FROM AUTHOR]

Aim A discussion on how informatics knowledge and competencies can enable nursing to instantiate transition to integrated models of care. Background Costs of traditional models of care are no longer sustainable consequent to the spiralling incidence and costs of chronic illness. The international community looks towards technology-enabled solutions to support a shift towards integrated patient-centred models of care. Design Discussion paper. Data sources A search of the literature was performed dating from 2000-2015 and a purposeful data sample based on relevance to building the discussion was included. Discussion The holistic perspective of nursing knowledge can support and advance integrated healthcare models. Informatics skills are key for the profession to play a leadership role in design, implementation and operation of next generation health care. However, evidence suggests that nursing engagement with informatics strategic development for healthcare provision is currently variable. Implications for nursing A statistically significant need exists to progress health care towards integrated models of care. Strategic and tactical plans that are robustly pragmatic with nursing insights and expertise are an essential component to achieve effective healthcare provision. To avoid exclusion in the discourse dominated by management and technology experts, nursing leaders must develop and actively promote the advancement of nursing informatics skills. For knowledge in nursing practice to flourish in contemporary health care, nurse leaders will need to incorporate informatics for optimal translation and interpretation. Conclusion Defined nursing leadership roles informed by informatics are essential to generate concrete solutions sustaining nursing practice in integrated care models. [ABSTRACT FROM AUTHOR]

This paper investigates extrinsic motivation as a determinant of knowledge exchange among employees in sales teams. Applying a social network approach, we study different forms of knowledge‐exchange behaviors from the perspective of a focal employee and from the perspective of the dyad. From the focal employees' perspective, we disentangle knowledge seeking from knowledge providing, and argue that these two behaviors are affected differently by employees' extrinsic motivation. From the dyad perspective, we take similarity in motivation of tied‐to employees and reciprocity of exchange ties into account. To test our hypotheses, we apply exponential random graph models to data gathered from 138 employees in five different sales teams distributed across three companies in Central Europe. The results of our analysis from the focal employees' perspective show that extrinsically motivated employees generally engage in less knowledge exchange. The dyad perspective further highlights that sales employees proceed purposefully when they exchange knowledge with coworkers. For instance, two employees' relative levels of extrinsic motivation determine their willingness to engage in reciprocal knowledge exchange. We discuss the implications of our findings for research on the microfoundations of organizational knowledge management and draw conclusions concerning HRM practices used to foster extrinsic motivation, thereby affecting knowledge exchange. [ABSTRACT FROM AUTHOR]

Research demonstrates that relationships are key when working to support young people affected by sexual violence. Within these relationships, young people show a preference for non‐judgemental, flexible, consistent and informal support. Peer support – defined here as support provided by those with similar experiences – is however an uncharted area for assisting young people affected by sexual violence. This paper draws on interviews with 25 respondents with knowledge and experience of setting up, supervising and/or participating in peer support initiatives for young people impacted by different forms of sexual violence in Europe and North America. The article highlights how one form of peer support, peer or 'survivor' mentoring, can provide emotional and social support; create space for 'normality'; and give choices to young people. It outlines three unique dimensions to the support provided by peers more generally: relatability, credibility and translatability. The discussion reflects on what this might mean for traditional support provided by professionals. It also draws attention to the significance of recognising both the variety of experience and identity of young survivors of sexual trauma and the impact this may have on promoting relatability within relationships. [ABSTRACT FROM AUTHOR]

Smoke-Free School Policies (SFSP) are primarily designed to ensure educational spaces remain free of second-hand smoke, whilst contributing to a reduction in adolescent smoking by challenging the practice per se. Evidence regarding the latter goal is inconclusive, however, with most studies suggesting SFSPs are ineffective in reducing smoking prevalence. A dearth of qualitative research limits our understanding of why this inefficacy persists and how it might be addressed. This paper addresses this lacuna through a critical discursive analysis of data from 56 focus groups, generated with adolescents across 17 schools in seven European cities. It reveals that, while smoking is banned on school premises in most European countries, young people experience wide variation in implementation. Despite this, participants framed SFSPs in remarkably similar ways. Among young people most likely to smoke, representations of SFSPs often undermined their efficacy, leading to the displacement of smoking (outside the school grounds) rather than a reduction in prevalence. We argue that, policy effectiveness could be improved if schools worked collaboratively with students to develop positive collective beliefs and understandings about SFSPs, but caution realism about the potentially limited power of schools to reduce adolescent smoking prevalence. [ABSTRACT FROM AUTHOR]

Background: People with dementia are often marginalized and excluded from influence, also in relation to dementia research. There is, however, a growing requirement for inclusion through Patient and Public Involvement (PPI), but there is still limited knowledge on how researchers can fully benefit from the involvement of people with dementia in the development and testing of psychosocial interventions. This paper describes the results of a pan‐European consultation with people with dementia, synthesizing their views on outcomes of psychosocial interventions. Objective: To involve people with dementia in establishing what are meaningful outcomes when participating in psychosocial interventions. Setting and participants: Consultations took place at four divergent sites across Europe, involving twenty‐five people with dementia from nine European countries. Methods: The methods used for the consultation were developed through an iterative process involving people with dementia. Data from the consultation were analysed from a thematic analysis approach. Results: The results suggested that people with dementia wish to participate in interventions that enhance their well‐being, confidence, health, social participation and human rights. This highlights a need for improvements in psychosocial research to capture these outcomes. Discussion and conclusions: Involving people with dementia in discussions of psychosocial interventions has enhanced our understanding about meaningful outcome measures in research and methods of data collection. This study suggests that new outcome measures in psychosocial research are needed where concepts of positive psychology and social health can guide innovation and outcome measurement. [ABSTRACT FROM AUTHOR]

Objective Tobacco companies have made extensive efforts to build alliances against comprehensive smoke-free legislation. This article analyses the interaction between actors who opposed the development of the European Council Recommendation on smoke-free environments. Methods Drawing on data from 200 policy documents and 32 semistructured interviews and using qualitative textual analysis and organisational network analysis, opponents' positions on, and responses to, the policy initiative, strategies to oppose the policy, and efforts to build alliances were investigated. Results The non-binding nature of the policy, scientific evidence and clear political will to adopt EU-wide measures combined to limit the intensity of commercial sector opposition to the comprehensive EU smoke-free policy. Most tobacco companies, led by the Confederation of European Community Cigarette Manufacturers (CECCM), voiced reservations against the proposal, criticised the policy process and fought flanking measures on product regulation. However, some companies focused on instigating harm reduction debates. These divergent approaches and the reluctance of other commercial actors to demonstrate solidarity with the tobacco sector prevented the establishment of a cohesive commercial sector alliance. Conclusions The comparatively limited opposition to EU smoke-free policy contrasts with previous accounts of tobacco industry resistance to tobacco control. While context-specific factors can partially explain these differences, the paper indicates that the sector's diminished credibility and lack of unity hampered political engagement and alliance building. Industry efforts to emphasise the benefits of smokeless tobacco during smoke-free policy debates highlight the potential of harm reduction as a gateway for tobacco companies to re-enter the political arena. [ABSTRACT FROM AUTHOR]

Purpose: People with mental disorders experience higher rates of disability and mortality disproportionately than the general population. Until recently, psychiatric palliative care (PPC) for people with serious mental illness (SMI) was not explored as a treatment option. This paper aims to explore the feasibility of PPC as a supportive care model for people with serious mental illness. Design/methodology/approach: Fifteen health-care professionals' in the USA and Europe participated in semi-structured phone interviews regarding PPC for people with SMI. The Qualitative Analysis Guide of Leuven (QUAGOL) was used to conduct thematic analysis of the data. Findings: PPC was identified as a supportive care model that could improve quality of life and enhance patient autonomy for people with SMI. While PPC was endorsed as a possible new standard of care, it is imperative that the model be piloted to determine its efficacy as a viable treatment option among adults. Originality/value: There are limited studies that investigate the perceptions of health professionals' regarding the use of PPC as a treatment option for people with SMI. [ABSTRACT FROM AUTHOR]

The social work profession in Albania is relatively young and social services in the country continue to develop. But over the past three decades, Albania has experienced significant growth and transformation in its social work education programmes. Nevertheless, there is very little published work on the Albanian social work education system and its implementation on the ground. Currently, the main sources of social work graduates are three Schools of Social Work in Tirana, Shkodra, and Elbasan. Programmes at the bachelor's and master's level all incorporate policy, research, and practice education. The social work curriculum, originally transplanted from the United States, has gone through reforms following the Bologna process and continues to be revised to meet local needs. Drawing from a multi-country study of the social service workforce in southeast Europe, this paper presents baseline data on social work education in Albania. 62 participants were interviewed using semi-structured interviews, case stories, and focus group discussions with consensus-building exercises. The findings highlight both the opportunities and challenges of this relatively young profession in Albania. Besides increasing understandings of social work education in Albania, this research adds to emerging regional and global themes in the development of social work education and practice. [ABSTRACT FROM AUTHOR]

This paper reports on a study undertaken to determine what progress has been made in the uptake and impact of the CompHP Core Competencies on Health Promotion practice, education and training in Europe since their publication in 2011. The study used a purposive sample comprising health promoters who had contributed to the development of the CompHP Competencies was augmented by snowball sampling across European Health Promotion practitioners. An online survey tool was employed to elicit information on respondents' attitudes to the Competencies, levels of current and intended use, and opinions on their impact. A total of 81 responses were received from 25 European countries. Findings on factors considered likely to influence the use of the Competencies were generally positive, as were respondents' attitudes to them. However, only 53% of respondents reported that the CompHP Competencies were used in their country and 54% that they used them in their practice. The Competencies were most frequently used in Health Promotion education, where their impact was also most apparent. A lack of support and recognition of the Competencies by key organizations and stakeholders at country level emerges as a potentially critical factor influencing their uptake and use. The survey findings provide an insight into the uptake and impact of the CompHP Core Competencies to date and begin to address the gap in empirical evidence on the use and impact of Health Promotion competencies. However, further research is required to explore the factors influencing implementation of the CompHP Core Competencies at a country level. [ABSTRACT FROM AUTHOR]

This paper reports on qualitative data from the Actifcare study investigating experiences, attitudes, barriers and facilitators concerning access to and use of formal care. A total of 85 semi‐structured in‐depth interviews were conducted in eight European countries. Results were analysed with a deductive content analysis, first within country and then integrated in a cross‐national analysis. Overall, analysis of the in‐depth interviews revealed two major themes with five subcategories. The results can be summarised in an optimal pathway for access to dementia care. This pathway includes fixed factors such as disease‐related factors and system‐related factors. In addition there are personal factors that are subject to change such as attitudes towards care. An important finding consisted of the necessity of having sufficient information about the disease and available care and having a key contact person to guide you through the process of finding suitable care while monitoring your needs. In addition, it is important to involve your social network as they can take on care‐giving tasks. It is helpful to have a diagnosis (in most countries). Concerning decision‐making, the person closest to the person with dementia is in the majority of cases the one who makes the ultimate decision to access and use services and he/she should therefore be supported in this process. These results provide insight into the factors that influence the pathway to formal care use and help professionals to enhance access to formal dementia care by focusing on factors that can be modified. [ABSTRACT FROM AUTHOR]

Background: Alcohol dependence (AD) in Europe is prevalent and causes considerable health burden. Recognition by general practitioners (GPs) and provision of or referral to treatment may contribute to reduce this burden. This paper studied AD prevalence in varying European primary care settings and examined who received treatment. Methods: In a cross-sectional multi-centre study in six European countries, 358 general practitioners assessed 13,003 primary care patients between January 2013 and January 2014, of which 8,476 patients were interviewed, collecting information on socio-demographics, physical and mental problems, and on alcohol use, problems and treatment. AD diagnoses were determined by GPs' clinical judgement and a standardized interview. A wide definition for AD treatment included individual and group interventions provided by different health professionals. Descriptive as well as inferential statistics were employed. Results: AD was prevalent among patients in European primary health care settings (8.7 %, 95 % confidence interval (CI): 8.1-9.3 %). Treatment rates were low (22.3 % of all AD cases, 95 % CI: 19.4-25.2 %). For both prevalence and treatment utilization, considerable country variations were observed. AD was associated with a number of socio-economic disadvantages (e.g. higher unemployment rate) and higher physical (e.g., liver disease, hypertension) and mental comorbidities (e.g., depression, anxiety). Liver problems, mental distress and daily amount of alcohol used were higher among treated versus untreated male patients with AD. Conclusion: A minority of people identified as having AD received treatment, showing heavier drinking patterns and a higher level of co-morbidity. Different types of treatment, depending on severity of AD, should be considered. [ABSTRACT FROM AUTHOR]

As the world prepares to commemorate the centenary of the First World War, it is timely to discuss meaningful learning activities that students of nursing could be engaged in to encourage them to reflect on the nurse's role then and now. Several films and television series about the war and featuring nursing have already been aired. No doubt there will be many more stories to come. Such stories have the potential to do more than eulogise nursing for students and practitioners. Stories, such as The crimson field, have potential to stimulate serious contemplation about values and cultural practices that have remained constant or have changed and to assist students to develop and articulate values that will be fitting for contemporary practice. Recently, excerpts from the series were examined with a group of nursing students and key learnings were found. These are shared in this paper for the benefit of educators planning to utilise public discourse as triggers to engage nursing students in discussions about nursing values, nursing history and representations of the profession. [ABSTRACT FROM AUTHOR]

Health care in prison and particularly the health care of older prisoners are increasingly important topics due to the growth of the ageing prisoner population. The aim of this paper is to gain insight into the approaches used in the provision of equivalent health care to ageing prisoners and to confront the intuitive definition of equivalent care and the practical and ethical challenges that have been experienced by individuals working in this field. Forty interviews took place with experts working in the prison setting from three Western European countries to discover their views on prison health care. Experts indicated that the provision of equivalent care in prison is difficult mostly due to four factors: variability of care in different prisons, gatekeeper systems, lack of personnel, and delays in providing access. This lack of equivalence can be fixed by allocating adequate budgets and developing standards for health care in prison. [ABSTRACT FROM AUTHOR]

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

Introduction: The World Health Organization identified health to be the most important social goal and the 1978 Declaration of Alma Ata placed primary health care central to its attainment and the UN Sustainable Development Goals (SDGs) as the template. The Astana Declaration called on a change of focus in primary care, from treatment of specific diseases to the prevention and inclusion of both scientific and traditional knowledge. Such objectives require public–private partnerships in providing health care, including traditional and complementary medicine systems such as naturopathy that align. However, there is limited understanding of global regulatory frameworks and officially recognized training for naturopathy. Materials and Methods: This descriptive study employs an adapted mixed-methods explanatory framework to examine naturopathy regulation and education. Analysis merges data arising from a descriptive policy analysis of regulation from 36 countries and survey analysis from 65 naturopathic organizations from 29 countries. Results: Four types of workforce regulation were identified within 107 countries where naturopathy was practiced—statutory registration or occupational licensing, coregulation, negative licensing, and voluntary certification. No form of naturopathic regulation was most common. Higher graduate/postgraduate education and access to a broader range of practices were more frequently reported in countries where naturopathy is statutory regulated. Government audits were more frequently reported where naturopathy was statutory regulated or coregulated. Discussion: Naturopathic philosophy and practice align with primary health care goals outlined in the Declaration of Astana. The naturopathic workforce represents an untapped health care resource with a demonstrated track record of translating these aspirational goals into practice. However, naturopathy remains inconsistently regulated globally, serving as a significant barrier to partnering with other health system actors to attain the health-related SDGs. Workforce regulation for the naturopathic profession offers increased standards, reduced risks, integrative health workforce planning, and assistance to countries toward achieving the promise of the Declaration of Astana. [ABSTRACT FROM AUTHOR]

Background The material practices which researchers use in research partnerships may enable or constrain the nature of engagement with stakeholder groups. Participatory learning and action ( PLA) research approaches show promise, but there has been no detailed analysis of stakeholders' and researchers' experiences of PLA techniques for data generation and co-analysis. Objectives To explore stakeholders' and researchers' experiences of PLA techniques for data generation and co-analysis. Design The EU RESTORE implementation science project employed a participatory approach to investigate and support the implementation of guidelines and training initiatives ( GTIs) to enhance communication in cross-cultural primary care consultations. We developed a purposeful sample of 78 stakeholders (migrants, general practice staff, community interpreters, service providers, service planners) from primary care settings in Austria, England, Greece, Ireland and The Netherlands. We used speed evaluations and participatory evaluations to explore their experiences of two PLA techniques-Commentary Charts and Direct Ranking-which were intended to generate data for co-analysis by stakeholders about the GTIs under analysis. We evaluated 16 RESTORE researchers' experiences using interviews. We conducted thematic and content analysis of all evaluation data. Results PLA Commentary Charts and Direct Ranking techniques, with their visual, verbal and tangible nature and inherent analytical capabilities, were found to be powerful tools for involving stakeholders in a collaborative analysis of GTIs. Stakeholders had few negative experiences and numerous multifaceted positive experiences of meaningful engagement, which resonated with researchers' accounts. Conclusion PLA techniques and approaches are valuable as material practices in health research partnerships. [ABSTRACT FROM AUTHOR]

Introduction: Clinical supervisors allow trainees to fail during clinical situations when trainee learning outweighs concerns for patient safety. Trainees perceive failure as both educationally valuable and emotionally draining; however, the nuance of supervised failures has not been researched from the trainee perspective. This study explored trainees' awareness and their experience of failure and allowed failure to understand those events in‐depth. Methods: We interviewed 15 postgraduate trainees from nine teaching sites in Europe and Canada. Participants were a purposive sample, representing 1–10 years of clinical training in various specialties. Consistent with constructivist grounded theory, data collection and analysis were iterative, supporting theoretical sampling to explore themes. Results: Trainees reported that failure was a common, valuable, and emotional experience. They perceived that supervisors allowed failure, but they reported never having it explicitly confirmed or discussed. Therefore, trainees tried to make sense of these events on their own. If they interpreted a failure as allowed by the supervisor, trainees sought to ascertain supervisory intentions. They described situations where they judged supervisor's intentions to be constructive or destructive. Discussion: Our results confirm that trainees perceive their failures as valuable learning opportunities. In the absence of explicit conversations with supervisors, trainees tried to make sense of failures themselves. When trainees judge that they have been allowed to fail, their interpretation of the event is coloured by their attribution of supervisor intentions. Perceived intentions might impact the educational benefit of the experience. In order to support trainees' sense‐making, we suggest that supervisory conversations during and after failure events should use more explicit language to discuss failures and explain supervisory intentions. Residents' interpretation of being allowed to fail is shown to be colored by attributions of supervisor intention, thereby influencing what is learned from failure and emphasizing the importance of explicit conversation. [ABSTRACT FROM AUTHOR]

Background: Health and social care systems face difficulties in managing multimorbidity, disease burden and complex needs in long‐term conditions such as Parkinson's disease. Objective: This study aimed to develop a European understanding of how health and social care professionals can collaborate with stakeholders from different organizations and sectors to enhance the management of Parkinson's disease in a community setting by identifying the existing gaps in this process and how people with Parkinson's disease and their family carers could benefit from these partnerships. Methods: A mixed‐methods sequential study was conducted in Denmark, Norway, Spain and the United Kingdom. The findings from the qualitative phase are presented. Individual semistructured interviews were analysed using Braun's and Clarke's thematic analysis. A meta‐ethnography approach was used to analyse and synthesize cross‐national findings. Results: A total of 41 healthcare professionals and 39 stakeholders from different disciplines and sectors were interviewed in the four countries. The participants acknowledged a lack of awareness of available resources and poor communication between the different support systems in the management of Parkinson's disease. To promote multiagency collaborations, the participants highlighted the need to organize services along the Parkinson's disease journey, patient involvement and strategic involvement of carers in organizing resources and Parkinson's disease care pathways. According to the participants, the benefits from multiagency partnerships could lead to an enhanced continuity of care and specialized knowledge, mobilization of resources in the community, personalized support and improved access to services. Conclusions: Policymakers are called upon to create formal structures that facilitate multisectoral collaborations to promote an integrated system of care for the management of Parkinson's disease in the community. To address this challenge, we propose five strategies showing how organizations can work together to optimize the use of resources and enhance the management of Parkinson's disease throughout the illness trajectory. Patient or Public Contribution: Patient and Public Involvement groups made up of stakeholders, healthcare professionals, patients with Parkinson's disease and family carers participated in the design of the study, the development of the interview guides and the validation of the findings. [ABSTRACT FROM AUTHOR]

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

Aim: Nurse leaders influence workplace culture; however, little is known about ethnic cultural influences on nurse leader development. This research aims to identify personal strategies promoting effective leadership by nurse leaders from European small island countries. Design: Descriptive qualitative study. Methods: In 2017, nineteen semi‐structured interviews with nurse leaders from England, Greece, Republic of Ireland and Malta explored leadership journeys, strategies employed to support their growth and development, and how cultural identity played a role. Transcripts were analysed using reflexive thematic analysis. Results: Four main themes and 12 subthemes captured the strategies and approaches of the nurse leaders: (1) Influences, (2) Communication, (3) Process and (4) Relationships. These findings reflect and validate the five transformational leadership practices of the Exemplary Leadership Model. While cultural island identity was discussed, there was a shared cultural identity within the role of "nurse leader" that spanned all islands. Patient or Public Contributions: Nineteen nurse leaders contributed to this study. [ABSTRACT FROM AUTHOR]

While previous synthesis research studies have found income inequality to be the most consistent predictor of crime at the cross-national level, recent comparative research studies in Europe have implied that the magnitudes of income inequality-crime association might be different in cross-national studies depending on sample composition. Employing a systematic review and meta-analysis, this study aimed to systematically estimate the strength and variability of income inequality-crime association in Europe across multiple published articles and to investigate the intervening role of regions in this relationship. Additional analyses were conducted to detect the regional differences within Europe using the official secondary data of 36 European countries. Income inequality in Europe had a small impact on crime (Mr =.171, k = 10), indicating that income inequality accounts for only 3% of the variance in crime outcomes. While the income inequality-crime association was significant in Eastern/Northern Europe, income inequality had little or no effect on crime in Western/Southern Europe. The small association between income inequality and crime in Europe may be due to the well-developed welfare system, which helps to buffer the adverse effects of being poor. This study's findings highlight the importance of incorporating geographic characteristics into cross-national research using purposive sampling techniques. [ABSTRACT FROM AUTHOR]

Background: Non‐pharmacologic interventions might be effective to reduce the incidence of delirium in pediatric intensive care units (PICU). Aim: To explore expert opinions and generate informed consensus decisions regarding the content of a non‐pharmacologic delirium bundle to manage delirium in PICU patients. Study design: A two‐round online Delphi study was conducted from February to April 2021. PICU experts (nurses, physicians, researchers, physical therapists, play specialists, and occupational therapists) located in Europe, North America, South America, Asia, and Australia participated. Results: We developed a questionnaire based on the outcomes of a comprehensive literature search in the domains: 1) cognition support; 2) sleep support; and 3) physical activity support. Under these domains, we listed 11 strategies to promote support with 61 interventions. Participants rated the feasibility of each intervention on a 9‐point Likert scale (ranging from 1 strongly disagree to 9 strongly agree). A disagreement index and panel median were calculated to determine the level of agreement among experts. In the second round, participants reassessed the revised statements and ranked the interventions in each domain in order of importance for age groups: 0–2, 3–5, and 6–18 years of age. During the first Delphi round, 53 of 74 (72%) questionnaires were completed, and in the second round 45 of 74 (61%) were completed. Five of the highest ranked interventions across the age groups were: 1) developing a daily routine, 2) adjusting light exposure according to the time of day, 3) scheduling time for sleep, 4) providing eyeglasses and hearing aids if appropriate, 5) encouraging parental presence. Conclusions: Based on expert consensus, we developed an age‐specific non‐pharmacologic delirium bundle of interventions to manage delirium in PICU patients. Relevance to Clinical Practice: An age‐specific Non‐Pharmacological Delirium bundle is now ready to be tested in the PICU and will hopefully reduce pediatric delirium. [ABSTRACT FROM AUTHOR]

Implementation of the Global Strategy for Infant and Young Child Feeding varies widely among countries. Policymakers would benefit from insights into obstacles and enablers. Our aim was to explore the processes behind the development and implementation of national infant and young child feeding policies and monitoring systems in Europe. A qualitative study design was employed to analyze open text responses from six European countries (Croatia, Germany, Lithuania, Spain, Turkey and Ukraine) using inductive thematic analysis. Countries were selected based on their World Breastfeeding Trends Initiative scores on national policy and monitoring systems. The 33‐item online questionnaire was distributed to country representatives and completed by country teams. Key enablers and strengths included strong and continuous government commitment to infant and young child feeding, an operational national breastfeeding authority, a national and active monitoring and evaluation system, implementation of the International Code of Marketing of Breastmilk Substitutes in national legislation, the integration of skilled breastfeeding supporters, the implementation of the Baby‐friendly Hospital Initiative, and positive cultural norms and traditions supporting optimal infant and young child feeding. In some countries, UNICEF played a key role in funding and designing policies and monitoring systems. Weak government leadership, the strong influence of the industry, lack of adequate national legislation on the International Code and cultural norms which devalued breastfeeding were particularly noted as obstacles. Government commitment, funding and protection of optimal infant and young child feeding are essential to the implementation of strong national policies and monitoring systems. Key messages: Government commitment was essential to the implementation of strong policies and programs, adequate funding and legislation to protect breastfeeding.Cultural norms and traditions lay behind the prioritization of breastfeeding in some countries, while in others severe adversity led to an increased role for UNICEF which provided the framework and funding to establish strong policies and programs.The influence of the formula industry can undermine government priorities, health professional training and public opinion.This study provides lessons for policymakers who wish to protect, promote and support optimal infant and young child feeding. [ABSTRACT FROM AUTHOR]

Introduction: Post-stroke fatigue (PSF) is common and debilitating. However, while its effective management is a priority for clinicians and stroke survivors, there remains little evidence to provide guidance or underpin practice. Our aim, therefore, was to gain insights into the experiences of clinicians who routinely manage patients with fatigue. Method: Qualitative interview study. The target was to recruit a purposeful sample of approximately 20 participants with expertise in managing PSF and fatigue arising from other conditions. Maximum variation sampling was used to ensure a balance of participants across different settings. Data were analysed using a framework approach, iteratively developed and refined by including emergent themes. Results: We recruited 20 participants: nine occupational therapists (OTs), five physiotherapists, three nurses and three psychologists, which included three 'fatigue experts' from Europe and Australia. Analysis generated core themes around management and strategies used; these were similar regardless of professional background, clinical or geographical setting or condition treated. OTs felt a particular responsibility for fatigue management, although multidisciplinary teamwork was stressed by all. Conclusion: There are clear similarities in clinicians' experiences of managing PSF and fatigue across different conditions and also across professional groups. Clinicians rely predominantly on their own clinical knowledge for guidance. [ABSTRACT FROM AUTHOR]

Comparative European data using Second Generation Surveillance System (SGSS) are scarce among gay, bisexual and other men who have sex with men. This study evaluated the implementation of Sialon II, a bio-behavioural HIV research combined with targeted HIV prevention in 13 European cities conducted in collaboration with community partners. A mixed-methods process evaluation assessed the project's coverage, outputs, quality, challenges and opportunities for improvement. Data collected through structured questionnaire from 71 data collectors from community-based organisations and semi-structured interviews with 17 managers of participating gay venues were analysed. Overall implementation was successful, achieving 4901 valid behavioural questionnaires and obtaining 4716 biological samples. Challenges in conducting bio-behavioural research in gay venues related to strict research protocols and unfavourable characteristics of venues. Formative research, collaboration with community gay venues, and offering HIV prevention emerged as facilitators. Community researchers' training was crucial for fidelity to research protocols, increased trust amongst communities and enabled data collectors to effectively address practical problems in the field. Scientifically sound SGSS with community participation is feasible and allows for including 'hard-to-reach' populations. Prevention benefits include awareness raising, capacity building and sexual health promotion in gay venues. The findings are beneficial for epidemiological research among other HIV key populations. [ABSTRACT FROM AUTHOR]

There has been much discussion recently that better healthcare systems lead to increased service access and utilisation. However, there are still concerns raised among the refugee and immigrant communities about barriers to access and utilisation of primary healthcare services in the UK. This study aimed to explore with refugee and immigrant community health champions (CHCs) their perceptions about such barriers based on feedback in their own discussions with fellow refugees, asylum-seekers and immigrants in the West Midlands, UK. A total of 42 refugees and immigrants were recruited. Qualitative design-focused group discussions were conducted among purposively selected participants. These discussions were conducted between May and September 2019, and data were analysed using thematic analysis. The barriers to service access and utilisation are categorised into four themes: (i) knowledge about health issues that most affected refugees and immigrants; (ii) community indications of factors that obstructed service access; (iii) challenges in identifying local teams involved in service provision; and (iv) accurate knowledge about the different teams and their roles in facilitating access. This study higlighted that the levels of service access and utilisation would depend on the competence and effectiveness of the health system. Urgency and seriousness of individuals' healthcare needs were the factors that were perceived to strongly influence refugees and immigrants to seek and utilise local services. We identified a number of potential barriers and challenges to service access and utilisation that should be overcome if primary healthcare service is to be planned and delivered effectively, efficiently and equitably in the West Midlands. [ABSTRACT FROM AUTHOR]

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Aims and objectives: To explore how communication in neonatal intensive care units (NICUs) between immigrant mothers and nurses take place without having a common language, and how these mothers experience their NICU stay. Background: Admission of infants to NICU affects both parents and infants. Immigrant mothers constitute a vulnerable hospital population in need of culturally, linguistically and individually tailored information. Design and methods: The study had a qualitative design reported according to the COREQ criteria. Eight mothers who spoke neither Scandinavian nor English went through individual semi‐structured interviews. Six mother–nurse interactions were observed, and eight nurses' experiences were explored through focus‐group interviews. All interviews were audio recorded and transcribed verbatim. The analysis was thematic and hermeneutic in character. Results: Interpreters were present during the consultations with the physicians, but rarely during the daily nurse‐mother interactions. Nurses focused on daily routines, infant care guidance and mother–infant attachment. The mothers learned through demonstrations and hands‐on guidance. Language barriers made it difficult to assess the mothers' understanding, but the mothers expressed that they felt adequately included in the care of their infant and well informed and guided. Even so, both mothers and nurses expressed desire to use interpreters more regularly. The pictorial communication boards available lacked important vocabulary needed in neonatal nursing contexts and their use furthermore interrupted the mother–nurse conversation. Conclusion: Body language, simple words, guesswork, trial and error characterised the nurse–mother interaction. The nurses adopted various communication strategies to help the mothers understand and give them a voice. Competent interpreters were used during meetings with physicians, but not during daily bedside guidance and information giving by nurses. Relevance to clinical practice: Knowledge of immigrant mothers' and nurses' communication strategies and how both parties think, feel and act to overcome communication problem is necessary to improve clinical practice and reduce communication barriers. [ABSTRACT FROM AUTHOR]

Elite soccer clubs across Europe spend ever-increasing sums of money on transfers and salaries for world-class players. Consequently, clubs' talent identification and development processes for junior players have become more professionalised. Based on a holistic ecological approach, this study presents an analysis of talent identification practices across some of the most productive soccer academies in Europe (N = 11). Data were collected via semi-structured interviews with 11 heads of academy recruitment from clubs in the "big five" European leagues. Clubs were purposively sampled based on their player productivity ranking. Interviews ranged from 52:26 minutes to 114:06 minutes in length (m = 87:53 ± 20.10 minutes). This study argues that holistic ecological approaches the environments were characterised through the interplay of factors that ranged from high-level internal to international level relationships. This resulted in the identification and recruitment of players from local and international environments. The purpose of recruitment was suggested to have a dual purpose: recruitment of players for the first team; recruitment of players for further development/monitoring and/or selling to another club. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: General Practice (GP) seems to be perceived as less attractive throughout Europe. Most of the policies on the subject focused on negative factors. An EGPRN research team from eight participating countries was created in order to clarify the positive factors involved in appeals and retention in GP throughout Europe. The objective was to explore the positive factors supporting the satisfaction of General Practitioners (GPs) in clinical practice throughout Europe. Method: Qualitative study, employing face-to-face interviews and focus groups using a phenomenological approach. The setting was primary care in eight European countries: France, Belgium, Germany, Slovenia, Bulgaria, Finland, Poland and Israel. A thematic qualitative analysis was performed following the process described by Braun and Clarke. Codebooks were generated in each country. After translation and back translation of these codebooks, the team clarified and compared the codes and constructed one international codebook used for further coding. Results: A purposive sample of 183 GPs, providing primary care to patients in their daily clinical practice, was interviewed across eight countries. The international codebook included 31 interpretative codes and six themes. Five positive themes were common among all the countries involved across Europe: the GP as a person, special skills needed in practice, doctor-patient relationship, freedom in the practice and supportive factors for work-life balance. One theme was not found in Poland or Slovenia: teaching and learning. Conclusion: This study identified positive factors which give GPs job satisfaction in their clinical practice. This description focused on the human needs of a GP. They need to have freedom to choose their working environment and to organize their practice to suit themselves. In addition, they need to have access to professional education so they can develop specific skills for General Practice, and also strengthen doctor-patient relationships. Stakeholders should consider these factors when seeking to increase the GP workforce. [ABSTRACT FROM AUTHOR]

Aim: The aim of the present study was to describe the association between primary healthcare (PHC) nurses' perceived stress and organizational culture and climate in a team context. Design: A descriptive, cross-sectional correlation study. Methods: 29 teams in 18 PHC centers situated in one Lithuanian county participated in the study. A total of 187 nurses completed the Expanded Nursing Stress Scale, while 344 healthcare professionals (including nurses) responded to the Organizational Social Context questionnaire. Results: Absolute values of Spearman's rho correlation coefficients between 0.19-0.24 (p < 0.01) were found when examining the association of nurses' stress with organizational culture and climate across PHC teams. Whether the culture was resistant or proficient seemed to have associations with some of the stress factors experienced by nurses. Additionally, how the whole team reported stress or functionality in their organizational climate seemed to be associated with perceived stress of nurses. Conclusion: Investigating the organizational culture and climate experienced by PHC teams may help identify manageable problems and decrease stress experienced by nurses. The study also allows the possibility of nursing scholars using the study's designs and instruments for further investigation of teams. [ABSTRACT FROM AUTHOR]

Background: Whilst many health systems offer a range of urgent and emergency care services to deal with the need for unscheduled care, these can be problematic to navigate. Objective: To explore how lay people make sense of urgent care provision and processes. Design: Qualitative study, incorporating citizen panels and longitudinal semi‐structured qualitative interviews. Setting and Participants: Two citizens' panels, comprising purposively selected public populations—a group of regular users and a group of potentially marginalized users of urgent and emergency care. Semi‐structured interviews were conducted with 100 people, purposively sampled to include those over 75, aged 18‐26 years, and from East/Central Europe. A sub‐sample of 41 people received a second interview at +6‐12 months. Framework analysis was thematic and comparative, moving through coding to narrative and interpretive summaries. Findings and Discussion: Participants narratives illuminated considerable uncertainty and confusion regarding urgent and emergency care provision which in part could be traced to the contingent nature of urgent and emergency care need. Accounts of emergency care provision were underpinned by strong moral positioning of appropriate help‐seeking, demarcating legitimate service use that echoed policy rhetoric, but did not necessarily translate into individual behaviour. People struggled to make sense of urgent care provision making navigating "appropriate" use problematic. Conclusions: The focus on help‐seeking behaviour, rather than sense‐making, makes it difficult to move beyond the polarization of "appropriate" and "inappropriate" service use. A deeper analysis of sense‐making might shift the focus of attention and allow us to intervene to reshape understandings before this point. [ABSTRACT FROM AUTHOR]

Purpose: Children with hypoplastic left heart syndrome (HLHS) experience numerous vulnerabilities during transitions from hospital to home during their first year of life. This paper examines the parents' responses to the situations they experience during the initial interstage transition as described through illness blogs. Design and methods: A qualitative descriptive design through inductive theme development using thematic analysis was performed for this study. Text data were used from publically available blogs written by parents of HLHS children on their feelings and experiences during transitions between hospital‐ and home‐care during the interstage period. Results: Six blogs were analyzed. Overall, the lack of difference in normalcy for these parents and their families was apparent. Major themes included: thoughts and feelings when discharged from the hospital, difficulties with hospital readmissions, protecting their child from infection, and developing a support system. Conclusions: Parents looked forward to going home and learned all they could about properly caring for their child before going home. They were disappointed and frustrated when returning to the hospital for either emergency or scheduled admissions and were not prepared to see their child in the intensive care unit environment again. Many parents isolated themselves and avoided the hospital as much as possible to avoid their child developing an infection. All parents had support systems through family and/or friends and found an unexpected sense of support through their blog families. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this evaluation was to obtain views from general practitioners (GPs) who piloted the electronic risk assessment tools (eRATs) for suspected lung or colorectal cancer. We wanted to find out whether GPs were able to integrate these tools into their everyday practice. We were also keen to identify facilitators and barriers to their more widespread use. Background: Cancer remains one of UK's biggest health problems, in terms of morbidity and mortality. Comparative European data show that five-year survival figures for many cancers are lower in the United Kingdom than in comparable European countries. eRATs are intended to aid recognition of symptoms of lung and colorectal cancers in patients aged 40 years and over. Methods: This was a qualitative study; telephone interviews were conducted with 23 GPs who piloted the eRATs. A systematic qualitative analysis was applied to the data. The normalisation process model was used after data collection. This theory-driven conceptual framework was used to examine the operationalisation of this intervention in Primary Care. Findings: Electronic decision-support tools appear to be useful additions to the resources available to GPs in order to assist them with recognizing potential cancer symptoms. However, the tools need to be refined in order to integrate them into GP practice. The tools raised GPs' awareness about cancer because of the prompt facility of the software, although this also raised the potential of 'prompt fatigue'. GPs constantly receive alerts via their clinical system, particularly related to the Quality and Outcomes Framework. The integration of eRATs into routine practice could be engendered by improvement to the training packages that accompany them, and by its delivery via a platform compatible with all GP clinical systems. [ABSTRACT FROM AUTHOR]