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Background: Since the outbreak of the COVID-19 pandemic, the excess mortality P-score has gained prominence as a measure of pandemic burden. The P-score indicates the percentage by which observed deaths deviate from expected deaths. As the P-score is regularly used to compare excess mortality between countries, questions arise regarding the age dependency of the measure. In this paper we present formal and empirical results on the population structure bias of the P-score with a special focus on cross-country comparisons during the COVID-19 pandemic in Europe. Methods: P-scores were calculated for European countries for 2021, 2022, and 2023 using data from the 2024 revision of the United Nations' World Population Prospects and the HMDs Short Term Mortality Fluctuations data series. The expected deaths for 2021, 2022, and 2023 were estimated using a Lee–Carter forecast model assuming pre-pandemic conditions. P-score differences between countries were decomposed using a Kitagawa-type decomposition into excess-mortality and structural components. To investigate the sensitivity of P-score cross-country rankings to differences in population structure we calculated the rank-correlation between age-standardized and classical P-scores. Results: The P-score is an average of age-specific percent excess deaths weighted by the age-distribution of expected deaths. It can be shown that the effect of differences in the distribution of deaths only plays a marginal role in a European comparison. In most cases, the excess mortality effect is the dominant effect. P-score rankings among European countries during the COVID-19 pandemic are similar under both age-standardized and classical P-scores. Conclusions: Although the P-score formally depends on the age-distribution of expected deaths, this structural component only plays a minor role in a European comparison, as the distribution of deaths across the continent is similar. Thus, the P-score is suitable as a measure of excess mortality in a European comparison, as it mainly reflects the differences in excess mortality. However, this finding should not be extrapolated to global comparisons, where countries could have very different death distributions. In situations were P-score comparisons are biased age-standardization can be applied as a solution. [ABSTRACT FROM AUTHOR]

Cosmopolitanism, which is often defined as openness to other cultures and individuals, is significant for understanding processes of stratification in contemporary, globalised societies that are home to increasingly diverse populations. In this paper, we broaden the perspective on cosmopolitanism to include cultural, interpersonal, and political dimensions. We test the associations between these types of cosmopolitanism and three types of correlates: socio-demographic characteristics, personal exposure to other cultures, and exposure to other cultures via various media. We analyse data from nine European countries that differ in the characteristics of their population, cultural traditions, and political models. Results indicate that differences between respondents in the nine countries are better explained by individual characteristics than by country characteristics. Furthermore, it is mainly personal and mediated exposure to other cultures, rather than socio-demographic variables, that play a significant role in influencing respondents' cosmopolitan tendencies. [ABSTRACT FROM AUTHOR]

Recent research has suggested a decline in alcohol use among students, however, only a few papers offer to explain why adolescents are drinking less. According to ESPAD, adolescents' alcohol use is decreasing in Europe, but only Hungary shows an increasing trend. The paper aims to give explanation for the opposite trends. The analysis is based on a cross-national dataset, ESPAD in 2003 and 2019, involving 25 countries (N = 157,790). The background variables cover family, school, leisure time, risk behaviors. Chi-square tests, logit explanatory model, KHB method were applied. In Hungary and in countries with decline the strongest relation with current alcohol use was found for internet use, going out, parental control, daily smoking, and alcohol intake. In countries with decline and in Hungary, stronger parental control, going out less often, smoking less may contribute to a declining trend while a more widespread internet use may contribute to an increasing trend. Hungary shows the same pattern as the countries with decline, so other factors such as a lack of alcohol policy, permissive attitudes, media representation, health awareness may be behind the different trends. Future research should be directed toward providing further explanations for the opposite trends. [ABSTRACT FROM AUTHOR]

Background: Minimally invasive approaches to the hip joint for total hip arthroplasty such as the DAA ("Direct Anterior Approach with bikini incision") are increasingly utilized. According to the literature, this approach is more muscle-sparing, results in less postoperative pain, and achieves higher patient satisfaction. The existence of postoperative lymphedema after hip arthroplasty is hardly considered. The aim of this paper is to contribute to the evaluation of the different access methods related to postoperative lymphedema and their functional outcomes. Methods: This is a prospective non-randomized study at an orthopedic specialist clinic in Northern Europe. The surgeons that performed the arthroplasties are high-volume surgeons in private practice affiliated to the clinic. The study included 188 patients with primary hip arthroplasty in a 1:1 ratio (DAA: standard accesses (posterior, transgluteal, and anterolateral access)). Epidemiologic data, Harris Hip Score, Oxford Hip Score, European Quality of Life 5, and Visual Analog Scale were collected preoperatively on admission day, 3rd and 5th postoperative day, and follow-up after 1 year. Furthermore, the range of motion, gait, and ability to climb stairs, as well as the presence of hypesthesia were assessed. To evaluate the edema situation, both legs were measured on the 3rd and 5th postoperative day. The prescription of manual lymphatic drainage and remaining swelling conditions 1 year postoperatively were recorded. Results: For each group, 94 patients with a mean age of 61.7 years (DAA 60.7 and standard access 62.6) were included. All but one patient in the DAA group showed postoperative lymphedema (n: 93/94; 98.9%). In the standard surgery group, only n: 37/94 (39.4%) showed swelling symptoms requiring treatment. After 1 year, lymphedema persisted in 20 patients in the DAA group and 0 patients in the standard-OR group. Hypesthesia at the ventral thigh persisted in 16/94 (= 17%) patients of the DAA group versus 0/94 patients of the standard group after 12 months. Of these 16 cases, 10 had concomitant edema (62.5%). The DAA showed better results than the standard accesses in terms of Oxford Hip Score (p < 0.05) and ability to climb stairs (p < 0.05). In contrast, the Visual Analog Scale and patient quality of life results showed no significant difference (p > 0.05). Conclusion: The present study demonstrated the increased incidence of postoperative lymphedema in patients operated on via DAA access using a Bikini-type skin incision. In the follow-up, significantly more hypesthesia of the ventral thigh occurred in the DAA group. Otherwise, the DAA proved to be superior to the standard approaches from a functional point of view at short-term follow-up. Future research is needed to compare the horizontally oblique to the longitudinal oblique skin incision technique in direct anterior hip surgery regarding the above-mentioned adverse effects found in this study. [ABSTRACT FROM AUTHOR]

Simple Summary: Patients with advanced non-small cell lung cancer (NSCLC) with epidermal growth factor receptor gene (EGFR) Exon 20 insertion mutations (Exon20ins) used to have poor outcomes after the failure of platinum-based therapies. Amivantamab, a drug that targets two proteins involved in NSCLC (EGFR/MET), was developed and studied in the CHRYSALIS clinical trial. This paper summarizes an analysis comparing outcomes for amivantamab from CHRYSALIS to the outcomes for a mix of treatments that were used in real-world clinical practice (real-world physician's choice [RWPC]). RWPC data were collected from hospitals across Europe in the CATERPILLAR real-world evidence (RWE) study. The outcomes of 114 patients from CHRYSALIS were compared to 55 lines of treatment (LOTs) from CATERPILLAR-RWE, accounting for differences in patient characteristics between the two populations. Overall, the results show that amivantamab was at least twice as good as RWPC for platinum pre-treated patients in terms of tumor response and survival rates. Patients with advanced non-small cell lung cancer (NSCLC) with epidermal growth factor receptor gene (EGFR) Exon 20 insertions (Exon20ins) at the second line and beyond (2L+) have an unmet need for new treatment. Amivantamab, a bispecific EGFR- and MET-targeted antibody, demonstrated efficacy in this setting in the phase 1b, open-label CHRYSALIS trial (NCT02609776). The primary objective was to compare the efficacy of amivantamab to the choices made by real-world physicians (RWPC) using an external control cohort from the real-world evidence (RWE) chart review study, CATERPILLAR-RWE. Adjustment was conducted to address differences in prognostic variables between cohorts using inverse probability weighting (IPW) and covariate adjustments based on multivariable regression. In total, 114 patients from CHRYSALIS were compared for 55 lines of therapy from CATERPILLAR-RWE. Baseline characteristics were comparable between the amivantamab and IPW-weighted RWPC cohorts. For amivantamab versus RWPC using IPW adjustment, the response rate ratio for the overall response was 2.14 (p = 0.0181), and the progression-free survival (PFS), time-to-next-treatment (TTNT) and overall survival (OS) hazard ratios (HRs) were 0.42 (p < 0.0001), 0.47 (p = 0.0063) and 0.48 (p = 0.0207), respectively. These analyses provide evidence of clinical and statistical benefits across multiple outcomes and adjustment methods, of amivantamab in platinum pre-treated patients with advanced NSCLC harboring EGFR Exon20ins. These results confirm earlier comparisons versus pooled national registry data. [ABSTRACT FROM AUTHOR]

The first European Union Survey on Violence against Women (EU-VAW) released in 2014 revealed the unexpected result indicating that the world's most egalitarian countries have relatively high rates of Intimate Partner Violence Against Women (IPVAW). This phenomenon, referred to as the "Nordic Paradox," revived a heated, intermittently ongoing discussion dating back four decades where several competing hypotheses about the relationship between gender inequality and IPVAW have been proposed, but no consensus has been reached. The main aim of this paper is to revisit the most important of such hypotheses proposed in the last four decades, while proposing a new one that could potentially throw some light on understanding the "Nordic Paradox." Multilevel linear regression models are estimated using data from the EU-VAW survey conducted in 2012, and an alternative operationalization of the Gender Equality Index (GEI) (our measure of gender equality). We did not find any significant effect of gender equality on IPVAW repetition. However, we found that higher country-level status of women and men go together with less IPVAW, with a larger effect of women's status in economic domains compared to the impact of men's economic status, and a larger effect of men's overall status. These findings support the Marxist feminist hypothesis, stating that women's absolute status in the economic and labor domain is critical in lessening IPVAW, as women's real and potential access to resources is key for leaving a violent relationship. At the same time, our results support the "male privilege protection" hypothesis, which states that gains in women's status in certain domains—such as in the economic sphere considering our results for the European Union—would not suppose a threat to men, allowing ameliorative effects. In contrast, if the overall status of men is threatened, backlash effects would be triggered. [ABSTRACT FROM AUTHOR]

Nowadays, China increasingly sees education as a critical component of becoming a world emerging power. Since 2015, China has implemented its new education strategy, named the "World first-class universities and world first-class disciplines" project. In this context, the university's internal governance has become a critical factor for the Chinese standards to construct world first-class universities. The Chinese government has published a series of related documents to enhance university autonomy and improve external conditions with university governance's mechanism reform. The paper firstly discusses the research statutes and proposes the analytical framework based on the stakeholder theory and quadrilateral model. Secondly, it presents the history and progress of the university's internal governance in China and Europe and summarizes their experiences and characteristics. Thirdly, it discusses the similarities and differences between Europe and China in the universities' internal governance, which focuses on the internal governance framework and the power distribution. In this way, the university budget and finance, teacher's appointment and promotion, enrollment power, curriculum design, research, and even the housing and equipment assignment are all analyzed. Finally, it summarizes China and Europe's internal governance models with the key factors and prominent features in the different models. It also discusses the common issues that the universities are facing in internal governance. [ABSTRACT FROM AUTHOR]

Copyright of Industry / Industrija is the property of Economics Institute 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.)

Is there only one type of successful entrepreneurial ecosystem? This paper applies qualitative comparative analysis to identify and analyse configurations of regional entrepreneurial ecosystems in Europe. We test two rivalling causal logics: a completeness logic stating that all entrepreneurial ecosystem elements need to be present and the weakest link is the most important constraint, and a substitutability logic arguing that elements are substitutable. High entrepreneurship outputs can be realised with different entrepreneurial ecosystem configurations. However, focusing on regions with the highest entrepreneurship outputs, our results point at the importance of a complete entrepreneurial ecosystem. [ABSTRACT FROM AUTHOR]

Copyright of European Journal of Social Work is the property of Routledge 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.)

Jewish heritage tourism is a relatively new form of niche tourism which appeared in Europe in the 1990s, because of a renewed understanding of cultural and historical values of Jewish heritage. By its inclusion in tourism, Jewish heritage has become a visible component in destinations, which has led to the renovation of synagogues, opening of Jewish museums, organization of festivals, and also to the gentrification of neglected Jewish quarters in many European cities. The goal of this paper is to analyse the most common methods, selection of stakeholders, elements, research locations and spatial scope used in studies of Jewish heritage tourism. The analysis includes 28 scientific papers from databases and focuses on the research methods used in those papers. The results show that the most common methods used in studies of Jewish heritage tourism are content analysis and interviews. These methods have proven to be suitable for determining the state and representation of Jewish heritage in each destination, while for a higher level of integration of Jewish heritage in tourism, other methods are more appropriate. [ABSTRACT FROM AUTHOR]

International comparative planning studies is a growing field of planning research that enjoys increasing recognition. In Europe in particular, various approaches have emerged over recent decades that can be considered established in the scholarly literature. However, a closer look at the literature reveals some weaknesses, particularly against the background of the methodological quality criteria of social science comparative research. For example, explanatory comparisons are rare in comparative planning studies. Often, case study research designs are chosen, while large N studies and qualitative comparative analysis (QCA) are still rarely used. This paper summarises these weaknesses and points out avenues for further development. English title: How can we best compare different planning systems? [ABSTRACT FROM AUTHOR]

Copyright of International Journal of Action Research is the property of Verlag Barbara Budrich GmbH 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.)

This systematic study aims at analyzing the differences between the approach of the European healthcare systems to the pharmaceutical market and the American one. This paper highlights the opportunities and the limitations given by the application of managed entry agreements (MEAs) in European countries as opposed to the American market, which does not regulate pharmaceutical prices. Data were collected from the Organisation for Economic Co-operation and Development (OECD), the European Medicines Agency, and the national healthcare agencies of US and European countries. A literature review was undertaken in PubMed, Scopus, MEDLINE, and Google for a period ten years (2010–2019). The period 2020–2021 was considered to compare health expenditure before and after the SARS-CoV-2 pandemic. Scarce information from national agencies has been given in terms of MEAs related to the COVID-19 pandemic. The comparison between the United States approach and the European one shows the importance of a market access regulation to reduce the cost of therapies, increasing the efficiency of national healthcare systems and the advantages in terms of quality and accessibility to the final users: patients. Nevertheless, it seems that the golden age of MEAs for Europe was during the examined period. Except for Italy, countries will move to other forms of reimbursements to obtain higher benefits, reducing the costs of an inefficient implementation and outcomes in the medium term. [ABSTRACT FROM AUTHOR]

This article intended to compare the discrimination perceived, respectively, by Muslim and non-Muslim immigrants in Europe, and investigate its determinants. Data covered six European Social Surveys and fourteen countries. The study found that the perception of being discriminated against is much more widespread among Muslim immigrants. The paper also found vast demo-socioeconomic heterogeneities between Muslim and non-Muslim immigrants. Consequently, the hypothesis was advanced that those heterogeneities were responsible for the discrimination differential between the two groups. In order to test this hypothesis, the present study used a statistical decomposition model rather than the procedures usually employed to analyse perceived discrimination. It emerged that demo-socioeconomic dissimilarities (in age, education, unemployment, income etc.) between Muslim and non-Muslim immigrants do not explain their gap in perceived discrimination. Nor is the gap eliminated by controlling for the host country's features, economic conditions and native hostility included. Instead, it emerged that identical individual traits—such as second generation, age, and income—are accompanied by opposite outcomes of perceived discrimination in the two groups. These divergent outcomes, in turn, are associated with deep-rooted characteristics of the immigrants' cultural identity. These findings suggest that these characteristics can be more impactful than the immigrants' socioeconomic status and the host country's features and that, ultimately, immigrants' shared in-group values play a more prominent role in the discrimination perceived by ethnic-religious groups than usually assumed by current literature. [ABSTRACT FROM AUTHOR]

This paper presents a comparative analysis of various capacity mechanisms that are either in force or under approval in key countries/regions in Europe and the US. A detailed analysis on the necessities that led to the establishment of the capacity mechanisms, along with various fundamental technical and operational features associated with the design and operation of different capacity mechanisms, mainly in Europe (Italy, France, Germany, Belgium, Poland, Great Britain, Ireland, Cyprus) and complementarily in the US (PJM, New England), are presented. This analysis is complemented by a real-life application regarding the long-term capacity remuneration mechanism that is expected to be established in Greece in the near future. A detailed simulation of the envisaged capacity mechanism auctions under differentiated scenarios has been performed, regarding the future Greek power system operating conditions during the forthcoming decade (2022–2031). Test results illustrate that the outcome of the auctions is heavily dependent on the future energy generation mix and the market participants' bidding strategy. Whereas, the total cost that will have to be undertaken by the electricity supply companies and, ultimately, by the end-consumers for the financing of the proposed capacity mechanism lies in the range of 5.5–8.7 €/MWh for the entire study period. [ABSTRACT FROM AUTHOR]

There has been a strong degree of interest over the last 30 years towards immigrant segregation in Europe. This paper aims to contribute towards the existing body of research by extending the multi-scalar analysis of patterns of immigrant residential segregation into a coherent international comparative study of cities of different sizes. We investigate the patterns of immigrant-native segregation at different geographical scales, along with their correlates, in more than a hundred cities in 2011 across Germany, Spain, Sweden, the Netherlands, and the United Kingdom. Our findings suggest that cities in the UK are the most highly segregated in Europe. The positions of the other countries in the 'European segregation ranking' depend upon the considered immigrant group and spatial scale. The national context is consistently the most important factor in understanding segregation at multiple spatial scales. However, even while taking into account the national contexts, the structural-ecological factors remain important predictors of segregation patterns in Europe. [ABSTRACT FROM AUTHOR]

This paper investigates different uses of the Journal Impact Factor (JIF) in national journal rankings and discusses the merits of supplementing metrics with expert assessment. Our focus is national journal rankings used as evidence to support decisions about the distribution of institutional funding or career advancement. The seven countries under comparison are China, Denmark, Finland, Italy, Norway, Poland, and Turkey—and the region of Flanders in Belgium. With the exception of Italy, top‐tier journals used in national rankings include those classified at the highest level, or according to tier, or points implemented. A total of 3,565 (75.8%) out of 4,701 unique top‐tier journals were identified as having a JIF, with 55.7% belonging to the first Journal Impact Factor quartile. Journal rankings in China, Flanders, Poland, and Turkey classify journals with a JIF as being top‐tier, but only when they are in the first quartile of the Average Journal Impact Factor Percentile. Journal rankings that result from expert assessment in Denmark, Finland, and Norway regularly classify journals as top‐tier outside the first quartile, particularly in the social sciences and humanities. We conclude that experts, when tasked with metric‐informed journal rankings, take into account quality dimensions that are not covered by JIFs. [ABSTRACT FROM AUTHOR]

Background: No data on healthcare utilisation and associated costs for the many rare entities of children's interstitial lung diseases (chILD) exist. This paper portrays healthcare utilisation structures among individuals with chILD, provides a pan-European estimate of a 3-month interval per-capita costs and delineates crucial cost drivers.Methods: Based on longitudinal healthcare resource utilisation pattern of 445 children included in the Kids Lung Register diagnosed with chILD across 10 European countries, we delineated direct medical and non-medical costs of care per 3-month interval. Country-specific utilisation patterns were assessed with a children-tailored modification of the validated FIMA questionnaire and valued by German unit costs. Costs of care and their drivers were subsequently identified via gamma-distributed generalised linear regression models.Results: During the 3 months prior to inclusion into the registry (baseline), the rate of hospital admissions and inpatient days was high. Unadjusted direct medical per capita costs (€19 818) exceeded indirect (€1 907) and direct non-medical costs (€1 125) by far. Country-specific total costs ranged from €8 713 in Italy to €28 788 in Poland. Highest expenses were caused by the disease categories 'diffuse parenchymal lung disease (DPLD)-diffuse developmental disorders' (€45 536) and 'DPLD-unclear in the non-neonate' (€47 011). During a follow-up time of up to 5 years, direct medical costs dropped, whereas indirect costs and non-medical costs remained stable.Conclusions: This is the first prospective, longitudinal study analysing healthcare resource utilisation and costs for chILD across different European countries. Our results indicate that chILD is associated with high utilisation of healthcare services, placing a substantial economic burden on health systems. [ABSTRACT FROM AUTHOR]

Copyright of Frühmittelalterliche Studien is the property of De Gruyter 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.)

Objectives Research among older adults reveals that the loss of core network members is a risk factor for loneliness. Still, it is not clear whether all such losses induce similar levels of loneliness, particularly as network members are distributed at varied geographic distances. Neither is it clear whether tie addition—the other ubiquitous aspect of network turnover in later life—offsets the loneliness that arises from different network loss scenarios. Methods This paper scrutinized core network losses across multiple relationship–distance scenarios. We used the fourth and sixth waves of data from the Survey of Health, Ageing, and Retirement in Europe and estimated fixed-effect models. Results The loss of a child from a core network increases feelings of loneliness across variant distances, especially when not complemented by additional connections. Losing relatives or nonkin core connections in proximity (within 1 km and 5 km radius, respectively) is also associated with increased loneliness, yet such effects are also largely mitigated by the addition of new core network members. Discussion The relationship between core network member losses and loneliness can significantly differ based on the nature of the lost connection and its geographic distance. Active rebalancing of one's core network following losses and proactive network expansion can serve as pivotal strategies to prevent loneliness for the aging population. [ABSTRACT FROM AUTHOR]

Introduction: Due to the Covid-19 pandemic, making more use of remote medical solutions has been advertised. The purpose of this study was to assess the willingness of orthopedic trauma patients to conduct an online video consultation (OVC) during the coronavirus pandemic compared to before. Methods: A survey amongst orthopedic and trauma outpatients from three European trauma centers was conducted via paper-based questionnaires, composed of participants' demographics and five open and closed questions between June and November 2019 and between April and July 2020 during Covid-19. The main outcome was the difference between the cohorts regarding the willingness to use an OVC, reasons for and against usage as well as advantages and disadvantages. Sub-analysis was performed for gender, participants' occupation and three age groups (≤ 30 years; 31–55 years; > 55 years). Results: 1400 participants (780 preCovid-19 and 620 Covid-19) were included. There was no difference in willingness to conduct an OVC between the cohorts (57.6% versus 63.9%; p = 0.053). The highest disposition towards an OVC in both cohorts was seen in patients below 30 years of age, followed by 31–55 years and over 55 years. Women were significantly more likely in the Covid-19-group than in the preCovid-19-group to conduct an OVC (p = 0.032). Use of the OVC for "personal questions to the physician" was more often stated in the Covid-19-cohort (p = 0.007). "No danger of an infection" (p = 0.001) and "availability from anywhere" (p = 0.032) as advantages of an OVC were more often stated in the Covid-19-cohort. "No direct contact with the doctor" (p = 0.001) and "relationship to the doctor could change" (p = 0.024) as disadvantages of the OVC were less often stated in the Covid-19-cohort. Conclusion: The majority of the assessed outpatients would use an OVC. Fear of infections have increased, and direct physical contact is less important since the Covid-19 pandemic, but have not increased the disposition for an OVC significantly. [ABSTRACT FROM AUTHOR]

Background To address social inequalities in adolescent substance use and consequent disparities in health, it is important to identify the mechanisms of the association between substance use and academic performance. We study the role of health literacy (HL) in the association between academic performance and weekly smoking, monthly alcohol use and cannabis ever-use among adolescents in Europe. Methods SILNE-R school survey data, which was collected in 2016–17 with paper-and-pencil-method from Hanover (GE), Amersfoort (NL) and Tampere (FI), were used (N  = 5088, age 13–19). Health Literacy for School-aged Children instrument was used to assess students' HL. Logistic regression analyzed the association of substance use with academic performance and HL, separately and in the same model. Linear and multinomial logistic regression analyzed the association between academic performance and HL. Results Poor academic performance compared with high was associated with smoking [odds ratio (OR) 3.94, 95% confidence interval (CI) 2.83–5.49], alcohol use (OR: 2.94, 95% CI: 2.34–3.68) and cannabis use (OR: 2.56, 95% CI: 1.89–3.48). Poor HL was also associated with each substance use (with ORs of 2.32, 1.85 and 1.29). HL was positively associated with academic performance (β = 1.04, 95% CI: 0.89–1.20). The associations between academic performance and substance use were only slightly attenuated after controlling for HL. Conclusions Academic performance and HL were both determinants of substance use, confirming their role in tackling the disparities in substance use. However, HL did not demonstrably mediate the association between academic performance and substance use. A wider set of factors needs to be tackled to address emerging social inequalities in adolescent substance use. [ABSTRACT FROM AUTHOR]

Background: Acute respiratory infections (ARIs) accounted for an estimated 3.9 million deaths worldwide in 2015, of which 56% occurred in adults aged 60 years or older. We aimed to identify the cost of ARI management in older adults (≥50 years) in order to develop an evidence base to assist decision-making for resource allocation and inform clinical practice.Methods: We searched 8 electronic databases including Global Health, Medline and EMBASE for studies published between January 1, 2000 and December 31, 2021. Total management costs per patient per ARI episode were extracted and meta-analysis was conducted by World Health Organization (WHO) region and World Bank income level. All costs were converted and inflated to Euros (€) (2021 average exchange rate). The quality of included studies and the potential risk of bias were evaluated.Results: A total of 42 publications were identified for inclusion, reporting cost data for 8 082 752 ARI episodes in older adults across 20 countries from 2001 to 2021. The majority (86%) of studies involved high-income countries based in Europe, North America and Western Pacific. The mean cost per episode was €17 803.9 for inpatient management and €128.9 for outpatient management. Compared with costs reported for patients aged &lt;65 years, inpatient costs were €154.1, €7 018.8 and €8 295.6 higher for patients aged 65-74 years, 75-84 years and over 85 years. ARI management of at-risk patients with comorbid conditions and patients requiring higher level of care, incurred substantially higher costs for hospitalization: €735.9 and €1317.3 respectively.Conclusions: ARIs impose a substantial economic burden on health systems, governments, patients and societies. This study identified high ARI management costs in older adults, reinforcing calls for investment by global health players to quantify and address the scale of the challenge. There are large gaps in data availability from low-income countries, especially from South East Asia and Africa regions. [ABSTRACT FROM AUTHOR]

This paper analyzes whether and how work values differ between European Welfare states and change over time. We proceed in three steps: First, we show that—despite EU harmonization endeavors, for example, via the Europe 2020 strategy—work values still vary substantially between European countries and welfare regimes. Second, by analyzing data from the European Social Survey 2004 and 2010, we show how labor market policies, such as active and passive labor market policies, are associated with work values and how overall levels of work values changed over this period. Third, we discuss potential implications of the heterogeneity of work values for national as well as European labor market policy making. Altogether we are able to show that work values are substantially driven by the economic structure of a country and its labor market policy making. Key Practitioner MessageWork values vary substantially between European countries and welfare regimes.The change of work values is substantially driven by welfare state structures (both labor market policies implemented and industry share).Both European and national labor market policy making has to account for these different work values to be successful. [ABSTRACT FROM AUTHOR]

In this paper we carried out a comparative analysis of three alliances, namely Quercion petraea, Betonico-Quercion and Lathyro-Quercion, which span Central and Eastern European thermophilous oak forests. The main goal was to find out floristic and ecological differences as well as to assess specificities in the phytosociological and layer structure across the syntaxa in different regions of Europe. Cluster analysis was performed based on the Bray-Curtis distance matrix and the flexible beta algorithm. A phytoindication method was applied to determine ecological relationships. Variability in the phytosociological structure was studied by shares of species of different classes of vegetation. The layer structure features were investigated by comparing species with the highest constancy value within each layer. Analysis of the distribution boundaries of differentiating species allowed the geographical boundaries of the three identified syntaxa clusters to be delineated. In the phytosociological structure, the greatest differences were found in the proportion of species of Quercetea pubescentis and Brachypodio-Betuletea classes. The Central and Eastern European syntaxa groups were shown to be significantly different in the constancy-ranked series of major layer-forming species. [ABSTRACT FROM AUTHOR]

BACKGROUND: Appropriate body image self-perceptions provide a good help to increase the feeling of personal well-being, thus having an important impact on health. Universities, having an important role in shaping of the future workers, represent an important setting to approach health issues. OBJECTIVE: This study determined to what extent different types of students in higher education (four categories of students were created: "self-secure", "perfect", "destructive" and "apologetic") are likely to adopt different health risk behaviors. METHODS: A cross-sectional study in a sample of students from five European Universities in the 2016/2017 academic year was conducted. Based on the combination of body image perception and body mass index, four types of students were identified: "self-secure" (overweight students with a good self-esteem); "perfect" (underweight students with a good self-esteem); "destructive" (overweight students with a poor self-esteem); "apologetic" (underweight students with a poor self-esteem). RESULTS: The study reveals that the defined types of students differed in terms of risk behavior. When the control was included, the "self-secure" student type had a reduced likelihood of being on a diet (22.3%) and physically active (17.8%) than other students (p < 0.001). CONCLUSIONS: The results of this paper raise concerns about the future because the body dissatisfaction of the college student could be a big impact in long term whether at collective, personally or even professionally. [ABSTRACT FROM AUTHOR]

Objectives: This paper aims to estimate the percentage of European men who have sex with men (MSM) who may benefit from pre-exposure prophylaxis (PrEP), applying the three most widely used HIV risk indices for MSM (MSM Risk Index, Menza score, San Diego Early Test (SDET) score) and drawing on a large-scale multisite bio-behavioural survey (Sialon II).Methods: The Sialon II study was a bio-behavioural survey among MSM implemented in 13 European cities using either time-location sampling or respondent-driven sampling. Biological and behavioural data from 4901 MSM were collected. Only behavioural data of HIV-negative individuals were considered. Three widely used risk indices to assess HIV acquisition risk among MSM were used to estimate individual HIV risk scores and PrEP eligibility criteria.Results: 4219 HIV-negative MSM were considered. Regardless the HIV risk score used and the city, percentages of MSM eligible for PrEP were found to range between 5.19% and 73.84%. Overall, the MSM Risk Index and the Menza score yielded broadly similar percentages, whereas the SDET Index provided estimates constantly lower across all cities. Although all the three scores correlated positively (r>0.6), their concordance was highly variable (0.01Conclusion: Our findings showed the impact of different scoring systems on the estimation of the percentage of MSM who may benefit from PrEP in European cities. Although our primary aim was not to compare the performance of different HIV risk scores, data show that a considerable percentage of MSM in each city should be offered PrEP in order to reduce HIV infections. As PrEP is highly effective at preventing HIV among MSM, our findings provide useful, practical guidance for stakeholders in implementing PrEP at city level to tackle HIV infections in Europe. [ABSTRACT FROM AUTHOR]

The outbreak of COVID-19 in early 2020 created dangerous public health conditions which pressured governments and health systems to respond in a rapid and effective manner. However, this type of rapid response required many governments to bypass standing; bureaucratic structures of health sector administration and political governance to quickly take; essential measures against a rapidly evolving public health threat. Each government's particular; configuration of governmental and health system decision-making created specific structural and functional challenges to these necessary centrally developed and coordinated strategies. Most East Asian governments (except Japan) succeeded relatively quickly in centralizing essential disease control and treatment initiatives in a timely manner. In contrast, a number of European countries, especially those with predominantly tax-based financing and politically managed health delivery systems, had greater difficulty in escaping bureaucratic governance and management constraints. Drawing on data about these governments' early stage COVID-19 control experiences, this article suggests that structural changes will be necessary if low-performing governments are to better respond to a pandemic. This paper also summarizes other relatively successful strategies. By adopting such strategies, nations can help overcome structural bureaucratic and administrative obstacles in responding to further waves of COVID-19 or similar future pandemic events. [ABSTRACT FROM AUTHOR]

The paper measures environmental efficiency and productivity change to then carry out a decomposition analysis of an environmental efficiency index and a productivity change index. The paper includes a novel comparative assessment to determine the drivers of environmental efficiency and the sources of productivity change of the manufacturing sector in Europe, Asia and the whole world. We explore the capability to convert in an environmentally efficient way, selected inputs into desirable and undesirable outputs. Our estimation results of environmental efficiency confirm that Europe is ahead the world's average. Our analysis shows, however, a slowdown of Europe compared with the productivity growth of Asia. The latter shows a better performance in management capabilities, optimal resource allocation, and economies of scale. The analysis carried out in a second stage using the dynamic effects of the generalized method of moments also shows that the annual growth rate of manufacturing value added and manufacturing exports positively influence the level of environmental efficiency in both Asia and Europe. Therefore, the internationalization and extroversion of manufacturing can be crucial for sustainable development in Europe and Asia. • Benchmarking the strategy for sustainable development in Asia and Europe. • Decomposition of environmental efficiency indices and productivity change. • Effect of manufacturing value added and exports on environmental efficiency. • Benchmarking the manufacturing sector in Asia and Europe. • Showing Asia's best practices and European pillar of industrial restructuring. [ABSTRACT FROM AUTHOR]

The contribution of school curricula to public understanding and acceptance of evolution is still mostly unknown, due to the scarcity of studies that compare the learning goals present in different curricula. To overcome this lack of data we analysed 19 school curricula (18 European and one from Israel) to study the differences regarding the inclusion of learning goals targeting evolution understanding. We performed a quantitative content analysis using the Framework for the Assessment of school Curricula on the presence of Evolutionary concepts (FACE). For each country/region we analysed what this educational system considered the minimum evolution education a citizen should get. Our results reveal that: (i) the curricula include less than half of the learning goals considered important for scientific literacy in evolution; (ii) the most frequent learning goals address basic knowledge of evolution; (iii) learning goals related with the processes that drive evolution are often not included or rarely mentioned; (iv) evolution is most often not linked to its applications in everyday life. These results highlight the need to rethink evolution education across Europe. [ABSTRACT FROM AUTHOR]

Background The Nordic countries represent a unique case study for the COVID-19 pandemic due to socioeconomic and cultural similarities, high-quality comparable administrative register data and notable differences in mitigation policies during the pandemic. We aimed to compare weekly excess mortality in the Nordic countries across the three full pandemic years 2020–2022. Methods Using data on weekly all-cause mortality from official administrative registers in Denmark, Finland, Norway and Sweden, we employed time series regression models to assess mortality developments within each pandemic year, with the period 2010–2019 used as reference period. We then compared excess mortality across the countries in 2020–2022, taking differences in population size and age- and sex-distribution into account. Results were age- and sex-standardized to the Danish population of 2020. Robustness was examined with a variety of sensitivity analyses. Results While Sweden experienced excess mortality in 2020 [75 excess deaths per 100 000 population (95% prediction interval 29–122)], Denmark, Finland and Norway experienced excess mortality in 2022 [52 (14–90), 130 (83–177) and 88 (48–128), respectively]. Weekly death data reveal how mortality started to increase in mid-2021 in Denmark, Finland and Norway, and continued above the expected level through 2022. Conclusion Although the Nordic countries experienced relatively low pandemic excess mortality, the impact and timing of excess mortality differed substantially. These estimates—arguably the most accurate available for any region in capturing pandemic-related excess deaths—may inform future research and policy regarding the complex mortality dynamics in times of a health crisis such as the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background Type-2 diabetes (T2D) and hypertension (HTN) are two of the most prevalent non-communicable diseases (NCDs): they both cause a relevant number of premature deaths worldwide and heavily impact the national health systems. This study illustrates the impact of HTN and T2D in four European countries (Albania, Bulgaria, Greece and Spain) and compares their policies towards the monitoring and management of HTN and T2D and the prevention of NCDs as a whole. This analysis is conducted throughout the DigiCare4You Project (H2020)—which implements an innovative solution involving digital tools for the prevention and management of T2D and HTN. Methods The analysis is implemented through desk research, and it is enriched with additional information directly provided by the local coordinators in the four countries, by filling specific semi-structured forms. Results The countries exhibit significant differences in the prevalence of HTN and T2D and available policies and programs targeted to these two chronic conditions. Each country has implemented strategies for HTN and T2D, including prevention initiatives, therapeutic guidelines, educational programs and children's growth monitoring programs. However, patient education on proper disease management needs improvement in all countries, registries about patients affected by HTN and T2D are not always available, and not all countries promoted acts to contain the increasing rates of risk factors related to NCDs. Conclusions While political awareness of the risks associated with HTN, T2D and NCDs in general is growing, there is a collective need for countries to strengthen their policies for preventing and managing these chronic diseases. [ABSTRACT FROM AUTHOR]

In response to the COVID-19 outbreak, governments in European countries adopted a wide range of containment measures to prevent the spread of the virus. These measures led to unprecedented short-term economic loss for national economies, to which governments responded with support measures targeting both households and businesses. In this article, we argue that official statistics are a key source for robust comparisons of the economic impact of COVID-19 and subsequent support measures across countries. In particular, we use Eurostat's quarterly non-financial sector accounts and supplementary information provided by countries to estimate and compare the support received by households in 18 European countries. We focus our analysis on the second and third quarter of 2020, when national economies in Europe were impacted mostly by the containment measures. The results show some heterogeneity in the type and extent of support provided. Interestingly, while in some countries support interventions were far from making up for the loss of income, in others they far outweighed it. [ABSTRACT FROM AUTHOR]

Background Resilience of national health systems in Europe remains a major concern in times of multiple crises and as more evidence is emerging relating to the indirect effects of the COVID-19 pandemic on health care utilization (HCU), resulting from de-prioritization of regular, non-pandemic healthcare services. Most extant studies focus on regional, disease specific or early pandemic HCU creating difficulties in comparing across multiple countries. We provide a comparatively broad definition of HCU across multiple countries, with potential to expand across regions and timeframes. Methods Using a cross-country federated research infrastructure (FRI), we examined HCU for acute cardiovascular events, elective surgeries and serious trauma. Aggregated data were used in forecast modelling to identify changes from predicted European age-standardized counts via fitted regressions (2017–19), compared against post-pandemic data. Results We found that elective surgeries were most affected, universally falling below predicted levels in 2020. For cardiovascular HCU, we found lower-than-expected cases in every region for heart attacks and displayed large sex differences. Serious trauma was the least impacted by the COVID-19 pandemic. Conclusion The strength of this study comes from the use of the European Population Health Information Research Infrastructure's (PHIRI) FRI, allowing for rapid analysis of regional differences to assess indirect impacts of events such as pandemics. There are marked differences in the capacity of services to return to normal in terms of elective surgery; additionally, we found considerable differences between men and women which requires further research on potential sex or gender patterns of HCU during crises. [ABSTRACT FROM AUTHOR]

This article analyses how educational and initial vocational training systems in Europe vary regarding the way in which they structure educational routes for pupils of different academic ability. The study uses cluster analysis to explore the degree of similarity between 25 European countries, including variables related to: stratification within compulsory education; vocational orientation; links between initial vocational education and the labour market; transitions from secondary education; stratification within tertiary education; and links between educational qualifications and labour market outcomes. I identify three clusters of countries that have distinct patterns of stratification. This article contributes to the literature on educational regimes and school-to-work transitions by adding countries from Central and Eastern Europe (CEE) and integrating multiple dimensions pertaining to the link between educational and social stratification. Thus, it develops a more encompassing representation of the architecture of educational pathways in different European countries. [ABSTRACT FROM AUTHOR]

Background: Premenstrual dysphoric disorder is a depressive disorder affecting 5%–8% of people with menstrual cycles. Despite evidence that facial emotion detection is altered in depressive disorders, with enhanced detection of negative emotions (negativity bias), minimal research exists on premenstrual dysphoric disorder. Objectives: The goal of this study was to investigate the effect of premenstrual dysphoric disorder symptoms and the premenstrual phase on accuracy and intensity at detection of facial emotions. Design: Cross-sectional quasi-experimental design. Method: The Facial Emotion Detection Task was administered to 72 individuals assigned female at birth with no premenstrual dysphoric disorder (n = 30), and provisional PMDD (n = 42), based on a retrospective Diagnostic and Statistical Manual of Mental Disorders—Fifth Edition -based measure of premenstrual dysphoric disorder. Facial emotion detection was examined both irrespective of menstrual cycle phase, and as a function of premenstrual phase (yes, no). The task used neutral-to-emotional facial expression morphs (15 images/morph). Participants indicated the emotion detected for each image within the progressive intensity morph. For all six basic emotions (sad, angry, fearful, happy, disgust, and surprise), two scores were calculated: accuracy of responses and the intensity within the morph at which the correct emotion was first detected (image number). Results: Individuals reporting moderate/severe symptoms of premenstrual dysphoric disorder had more accurate and earlier detection of disgust, regardless of cycle phase. In addition, those with provisional premenstrual dysphoric disorder detected sad emotions earlier. A premenstrual dysphoric disorder group × cycle phase interaction also emerged: individuals reporting premenstrual dysphoric disorder symptoms were more accurate at detecting facial emotions during the premenstrual phase compared to the rest of the cycle, with a large effect size for sad emotions. Conclusion: The findings suggest enhanced facial emotion processing in individuals reporting symptoms of premenstrual dysphoric disorder, particularly for sadness and disgust. However, replication is required with larger samples and prospective designs. This premenstrual dysphoric disorder premenstrual emotion detection advantage suggests an adaptive cognitive mechanism in premenstrual syndrome/premenstrual dysphoric disorder, and challenges stigma surrounding premenstrual experiences. Plain Language Summary: Women with Severe Premenstrual Syndrome or Probable Premenstrual Dysphoric Disorder are Better at Identifying Emotional Expressions on People's Faces, Especially During the Premenstrual Phase Premenstrual dysphoric disorder is a depressive disorder affecting women where they experience emotional and physical symptoms during the premenstrual phase (i.e. the week before one's period). It is a severe form of premenstrual syndrome. Research indicates that depression can affect facial emotion recognition. Accurately recognizing other people's emotions is an important skill that helps us develop social connections and keep ourselves and others safe. Quick recognition of facial emotions allows us to understand and support others, and quickly identify dangerous situations by recognizing other people's emotional responses. The goal of this study was to examine how premenstrual dysphoric disorder symptoms and the premenstrual phase may affect the ability of women to recognize and identify emotions on other people's faces. A total of 72 women (42 with premenstrual dysphoric disorder, 30 without premenstrual dysphoric disorder) completed the Facial Emotion Detection Task. This task measured how accurate and early the women were able to detect happiness, sadness, anger, fear, surprise, and disgust in faces. Women with moderate/severe symptoms of premenstrual dysphoric disorder had more accurate and earlier detection of disgust, regardless of where they were in their menstrual cycle. Women with premenstrual dysphoric disorder detected sad emotions earlier. Furthermore, women with premenstrual dysphoric disorder were more accurate at detecting facial emotions when they were tested in the premenstrual phase, and were especially more accurate in detecting sad emotions. The findings suggest that women with premenstrual dysphoric disorder are better at detecting facial emotions and show a premenstrual dysphoric disorder premenstrual emotion detection advantage. This tendency for women with premenstrual dysphoric disorder to better detect emotions in others, particularly when they are in the premenstrual cycle phase, would have benefits. As one of the first reports of a potentially beneficial effect of premenstrual syndrome for women, the findings may help decrease stigma associated with premenstrual dysphoric disorder and premenstrual syndrome. Further research is needed to replicate and extend these findings. [ABSTRACT FROM AUTHOR]

Simple Summary: This research delves into the realm of pancreatic cystic neoplasms (PCNs), specifically focusing on a subtype with a high malignancy potential that is known as intraductal papillary mucinous neoplasms (IPMNs). By analyzing data from 113 patients across two European medical centers, this study assesses the effectiveness of two key guidelines, the Fukuoka consensus guidelines and the European evidence-based guidelines, in diagnosing severe disease stages in IPMNs. The findings reveal comparable diagnostic accuracies between the guidelines, highlighting the importance of personalized patient care and the potential indicators for surgical intervention. This study underscores the need for continuous research to refine these guidelines to improve patient outcomes and deepen our understanding of PCNs. Through this research, the authors seek to contribute to more accurate diagnosis and treatment strategies, ultimately influencing the broader medical community's approach to managing these complex cystic formations in the pancreas. This study addresses the critical need for the accurate diagnosis and management of intraductal papillary mucinous neoplasms (IPMNs), which are pancreatic cystic neoplasm types holding a substantial potential for malignancy. It evaluates the diagnostic effectiveness of the Fukuoka consensus guidelines and the European evidence-based guidelines in detecting high-grade dysplasia/invasive carcinoma in IPMNs, utilizing a retrospective analysis of 113 patients from two European medical centers. The methods include a comparative analysis of clinical, radiological, and endoscopic ultrasonography data, alongside an assessment of guideline-driven diagnostic performance. The results demonstrate that both guidelines offer similar accuracy in identifying severe disease stages in IPMNs, with certain clinical markers—such as jaundice, solid mass presence, and an increase in CA 19-9 levels—being pivotal in predicting the need for surgical intervention. This study concludes that while both guidelines provide valuable frameworks for IPMN management, there is an inherent need for further research to refine these protocols and improve patient-specific treatment strategies. This research contributes to the ongoing discourse on optimizing diagnostic and treatment paradigms for pancreatic cystic neoplasms, aiming to enhance clinical outcomes and patient care in this challenging medical field. [ABSTRACT FROM AUTHOR]

Background: Incidence of first-episode psychosis (FEP) varies substantially across geographic regions. Phenotypes of subclinical psychosis (SP), such as psychotic-like experiences (PLEs) and schizotypy, present several similarities with psychosis. We aimed to examine whether SP measures varied across different sites and whether this variation was comparable with FEP incidence within the same areas. We further examined contribution of environmental and genetic factors to SP. Methods: We used data from 1497 controls recruited in 16 different sites across 6 countries. Factor scores for several psychopathological dimensions of schizotypy and PLEs were obtained using multidimensional item response theory models. Variation of these scores was assessed using multi-level regression analysis to estimate individual and between-sites variance adjusting for age, sex, education, migrant, employment and relational status, childhood adversity, and cannabis use. In the final model we added local FEP incidence as a second-level variable. Association with genetic liability was examined separately. Results: Schizotypy showed a large between-sites variation with up to 15% of variance attributable to site-level characteristics. Adding local FEP incidence to the model considerably reduced the between-sites unexplained schizotypy variance. PLEs did not show as much variation. Overall, SP was associated with younger age, migrant, unmarried, unemployed and less educated individuals, cannabis use, and childhood adversity. Both phenotypes were associated with genetic liability to schizophrenia. Conclusions: Schizotypy showed substantial between-sites variation, being more represented in areas where FEP incidence is higher. This supports the hypothesis that shared contextual factors shape the between-sites variation of psychosis across the spectrum. [ABSTRACT FROM AUTHOR]

Background: Performing cardiovascular and cancer screenings in target populations can reduce mortality. Visiting a General Practitioner (GP) once a year is related to an increased likelihood of preventive care. The aim of this study was to analyse the influence of visiting a GP in the last year on the delivery of preventive services based on sex and household income. Methods: Cross-sectional study using data collected from the European Health Interview Survey 2013–2015 of individuals aged 40–74 years from 29 European countries. The variables included: sociodemographic factors (age, sex, and household income (HHI) quintiles [HHI 1: lowest income, HHI 5: more affluent]), lifestyle factors, comorbidities, and preventive care services (cardiometabolic, influenza vaccination, and cancer screening). Descriptive statistics, bivariate analyses and multilevel models (level 1: citizen, level 2: country) were performed. Results: 242,212 subjects were included, 53.7% were female. The proportion of subjects who received any cardiometabolic screening (92.4%) was greater than cancer screening (colorectal cancer: 44.1%, gynaecologic cancer: 40.0%) and influenza vaccination. Individuals who visited a GP in the last year were more prone to receive preventive care services (cardiometabolic screening: adjusted OR (aOR): 7.78, 95% CI: 7.43–8.15; colorectal screening aOR: 1.87, 95% CI: 1.80–1.95; mammography aOR: 1.76, 95% CI: 1.69–1.83 and Pap smear test: aOR: 1.89, 95% CI:1.85–1.94). Among those who visited a GP in the last year, the highest ratios of cardiometabolic screening and cancer screening benefited those who were more affluent. Women underwent more blood pressure measurements than men regardless of the HHI. Men were more likely to undergo influenza vaccination than women regardless of the HHI. The highest differences between countries were observed for influenza vaccination, with a median odds ratio (MOR) of 6.36 (under 65 years with comorbidities) and 4.30 (over 65 years with comorbidities), followed by colorectal cancer screening with an MOR of 2.26. Conclusions: Greater adherence to preventive services was linked to individuals who had visited a GP at least once in the past year. Disparities were evident among those with lower household incomes who visited a GP. The most significant variability among countries was observed in influenza vaccination and colorectal cancer screening. [ABSTRACT FROM AUTHOR]

• Techno-economic comparative analysis is carried for parabolic trough collector and steam generating heat pumps with focus on industrial boundary conditions. • A novel comparative indicator based on solar fraction is introduced to compare the results to find economic strong hold of analysed technologies. • Parabolic trough collectors are an effective technology to reduce the emission in low to medium irradiation locations. • There is a significant potential of combining both technologies to leverage the advantages for fully decarbonised industrial systems. Industrial heat production is responsible for around 20% of total greenhouse gas emissions in Europe. To achieve the climate change goals defined in the Paris Climate Agreement, the EU commission has shifted its focus on sustainable means to generate heating. Moreover, global dependencies are leading to a re-organization of natural gas supplies. Therefore, there is a need for less vulnerable and less price-volatile solutions for heating. This paper focuses on two decarbonization technologies for industrial process heat supply: a) electricity-driven steam-generating high-temperature heat pumps (HTHP), a technology that is more efficient than fossil fuel boilers in generating steam, and b) solar parabolic trough collector (PTC), which can produce heat economically and at a minimal carbon footprint compared to other technologies. The main aim of this paper is to evaluate the levelized cost of heat (LCOH) of these technologies to fulfill a comparative techno-economic analysis. A maximum PTC collector's solar fraction limit (SF limit) is defined to indicate when the LCOH for these two technologies is equal. This allows for distinguishing between the economic stronghold of each technology. The evaluation is carried out through the annual energy simulations using TRNSYS and Excel spreadsheets for HTHPs, while TRNSED and OCTAVE are used for the solar thermal part. Boundary conditions for European geographical constraints have been applied to establish use cases for the analysis. The result shows that the design of a PTC system with optimal SF can reach cost parity with HTHP for most of the analyzed locations. The developed methodology serves as a valuable guide to quickly determine a preferred lower carbon heat solution, thus easing the decision-making for industries. [ABSTRACT FROM AUTHOR]

Objectives: Evaluate exposure and protection practices regarding dentomaxillofacial imaging among pediatric dentists in Europe and determine the effect of different clinician specific characteristics on their implementation. Methods: A cross-sectional study involving an electronic questionnaire addressed to paediatric dentists, participating in a seminar on dental radiology organized by the European Academy of Paediatric Dentistry. Participants were asked to respond to questions regarding dentomaxillofacial imaging in terms of applied radiation dose, adoption of radiation protection techniques, and different patterns of radiographic studying and exchange between patients and colleagues. Data analysis was performed and distribution of responses was tested using chi-square and Fisher's exact tests. Results: A total of 151 paediatric dentists, 119 females and 32 males, with a mean chronological age of 42.8 years (s.e. 11.3 years), successfully completed the questionnaire (response rate = 82%). Regardless of the type of radiograph, majority of respondents (68%), reported that they perform the radiographs themselves, while 21% reported that they refer the patients. Half of the respondents (51%), indicated requesting a small (localized) field of view (FOV) when referring for a cone beam computed tomography (CBCT) with only a small proportion (11%) reporting a large (maxillofacial) FOV. Thyroid collars and optimizing exposure settings were the most commonly reported patient protection measures used. Lastly, paediatric dentists have adopted the latest technological capacities for the study of dental images. Conclusions: Dentomaxillofacial imaging protection and exposure protocols used are common among paediatric dentists with none of their specific characteristics having a significant effect. [ABSTRACT FROM AUTHOR]

Self-management interventions (SMIs) offer a promising approach to actively engage patients in the management of their chronic diseases. Within the scope of the COMPAR-EU project, our goal is to provide evidence-based recommendations for the utilisation and implementation of SMIs in the care of adult individuals with type 2 diabetes mellitus (T2DM). A multidisciplinary panel of experts, utilising a core outcome set (COS), identified critical outcomes and established effect thresholds for each outcome. The panel formulated recommendations using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach, a transparent and rigorous framework for developing and presenting the best available evidence for the formulation of recommendations. All recommendations are based on systematic reviews (SR) of the effects and of values and preferences, a contextual analysis, and a cost-effectiveness analysis. The COMPAR-EU panel is in favour of using SMIs rather than usual care (UC) alone (conditional, very low certainty of the evidence). Furthermore, the panel specifically is in favour of using ten selected SMIs, rather than UC alone (conditional, low certainty of the evidence), mostly encompassing education, self-monitoring, and behavioural techniques. The panel acknowledges that, for most SMIs, moderate resource requirements exist, and cost-effectiveness analyses do not distinctly favour either the SMI or UC. Additionally, it recognises that SMIs are likely to enhance equity, deeming them acceptable and feasible for implementation. [ABSTRACT FROM AUTHOR]

As millions of individuals flee conflict, persecution, and hardship in search of safety and better lives, destination states in Europe and North American have struggled to respond. Street-level theory provides an analytic lens for investigating these struggles and how they evolve on the ground through the informal practices of street-level organizations (SLOs), where the law and individuals meet. This introduction presents an overview of our special issue and its comparative, street-level approach to investigating how SLOs matter to policy, politics, and, ultimately, the lived experience of migrants and refugees. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to examine the Coronavirus disease 2019(COVID-19) vaccine policies disparities and effectiveness in Germany, Denmark and Bulgaria, with a view to providing lessons for global vaccination and response to possible outbreak risks. Methods: This study analyzed big data through public information on the official websites of the Ministries of Health of the European Union, Germany, Denmark and Bulgaria and the official websites of the World Health Organization. We systematically summarized the COVID-19 vaccine policies of the three countries, and selected the following six indicators for cross-cutting vaccination comparisons: COVID-19 vaccine doses administered per 100 people, COVID-19 vaccination rate, the share of people with fully vaccinated, the share of people only partly vaccinated, cumulative confirmed COVID-19 cases per million, cumulative confirmed COVID-19 deaths per million. Meanwhile, we selected the following four indicators for measuring the effectiveness of COVID-19 vaccine policy implementation: daily cases per million, daily deaths per million, the effective reproduction rate (Rt), the moving-average case fatality rate (CFR). Results: Although these three EU countries had the same start time for vaccination, and the COVID-19 vaccine supply was coordinated by the EU, there are still differences in vaccination priorities, vaccination types, and vaccine appointment methods. Compared to Germany and Denmark, Bulgaria had the least efficient vaccination efforts and the worst vaccination coverage, with a vaccination rate of just over 30% as of June 2023, and the maximum daily deaths per million since vaccination began in the country was more than three times that of the other two countries. From the perspective of implementation effect, vaccination has a certain effect on reducing infection rate and death rate, but the spread of new mutant strains obviously aggravates the severity of the epidemic and reduces the effectiveness of the vaccine. Among them, the spread of the Omicron mutant strain had the most serious impact on the three countries, showing an obvious epidemic peak. Conclusions: Expanding vaccination coverage has played a positive role in reducing COVID-19 infection and mortality rates and stabilizing Rt. Priority vaccination strategies targeting older people and at-risk groups have been shown to be effective in reducing COVID-19 case severity and mortality in the population. However, the emergence and spread of new variant strains, and the relaxation of epidemic prevention policies, still led to multiple outbreaks peaking. In addition, vaccine hesitancy, mistrust in government and ill-prepared health systems are hampering vaccination efforts. Among the notable ones are divergent types of responses to vaccine safety issue could fuel mistrust and hesitancy around vaccination. At this stage, it is also necessary to continue to include COVID-19 vaccination in priority vaccination plans and promote booster vaccination to prevent severe illness and death. Improving the fairness of vaccine distribution and reducing the degree of vaccine hesitancy are the focus of future vaccination work. [ABSTRACT FROM AUTHOR]

Background: It is unclear whether a hypothetical intervention targeting either psychosocial well-being or emotion-driven impulsiveness is more effective in reducing unhealthy food choices. Therefore, we aimed to compare the (separate) causal effects of psychosocial well-being and emotion-driven impulsiveness on European adolescents' sweet and fat propensity. Methods: We included 2,065 participants of the IDEFICS/I.Family cohort (mean age: 13.4) providing self-reported data on sweet propensity (score range: 0 to 68.4), fat propensity (range: 0 to 72.6), emotion-driven impulsiveness using the UPPS-P negative urgency subscale, and psychosocial well-being using the KINDLR Questionnaire. We estimated, separately, the average causal effects of psychosocial well-being and emotion-driven impulsiveness on sweet and fat propensity applying a semi-parametric doubly robust method (targeted maximum likelihood estimation). Further, we investigated a potential indirect effect of psychosocial well-being on sweet and fat propensity mediated via emotion-driven impulsiveness using a causal mediation analysis. Results: If all adolescents, hypothetically, had high levels of psychosocial well-being, compared to low levels, we estimated a decrease in average sweet propensity by 1.43 [95%-confidence interval: 0.25 to 2.61]. A smaller effect was estimated for fat propensity. Similarly, if all adolescents had high levels of emotion-driven impulsiveness, compared to low levels, average sweet propensity would be decreased by 2.07 [0.87 to 3.26] and average fat propensity by 1.85 [0.81 to 2.88]. The indirect effect of psychosocial well-being via emotion-driven impulsiveness was 0.61 [0.24 to 1.09] for average sweet propensity and 0.55 [0.13 to 0.86] for average fat propensity. Conclusions: An intervention targeting emotion-driven impulsiveness, compared to psychosocial well-being, would be marginally more effective in reducing sweet and fat propensity in adolescents. [ABSTRACT FROM AUTHOR]

Purpose: Achieving greater health and social care integration is a policy priority in many countries, but challenges remain. We focused on governance and accountability for integrated care and explored arrangements that shape more integrated delivery models or systems in Italy, the Netherlands and Scotland. We also examined how the COVID-19 pandemic affected existing governance arrangements. Design/methodology/approach: A case study approach involving document review and semi-structured interviews with 35 stakeholders in 10 study sites between February 2021 and April 2022. We used the Transparency, Accountability, Participation, Integrity and Capability (TAPIC) framework to guide our analytical enquiry. Findings: Study sites ranged from bottom-up voluntary agreements in the Netherlands to top-down mandated integration in Scotland. Interviews identified seven themes that were seen to have helped or hindered integration efforts locally. Participants described a disconnect between what national or regional governments aspire to achieve and their own efforts to implement this vision. This resulted in blurred, and sometimes contradictory, lines of accountability between the centre and local sites. Flexibility and time to allow for national policies to be adapted to local contexts, and engaged local leaders, were seen to be key to delivering the integration agenda. Health care, and in particular acute hospital care, was reported to dominate social care in terms of policies, resource allocation and national monitoring systems, thereby undermining better collaboration locally. The pandemic highlighted and exacerbated existing strengths and weaknesses but was not seen as a major disruptor to the overall vision for the health and social care system. Research limitations: We included a relatively small number of interviews per study site, limiting our ability to explore complexities within sites. Originality: This study highlights that governance is relatively neglected as a focus of attention in this context but addressing governance challenges is key for successful collaboration. [ABSTRACT FROM AUTHOR]

Blood donors are indispensable for enabling a myriad of medical procedures and treatments. We examined how public trust in the healthcare system and healthcare quality relate to individuals' likelihood of donating blood, using survey data from representative samples of 28 European countries (N = 27,868). Our preregistered analyses revealed that country-level public trust, but not healthcare quality, predicted individual propensity to donate blood. Notably, public trust decreased over time in many countries, while healthcare quality increased. Our results highlight the role of subjective perceptions of the healthcare system, rather than the objective state of healthcare, for blood donation behavior in Europe. [ABSTRACT FROM AUTHOR]