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Immigrant minority (IM) languages have a significant presence in certain European regions. Nonetheless, these languages are not usually included in the school curriculum. This paper aims to analyse the studies published between 2010 and 2020 considering IM languages in multilingual European education contexts. The method included a search of academic papers published in the databases ERIC, Web of Science and Scopus, which yielded 42 studies. The studies were analysed by considering: (1) the demographic characteristics of the countries where the studies were conducted, (2) the sociolinguistic or psycholinguistic focus of the papers in relation to the European country, and (3) the characteristics of the bi-multilingual education programme including IM languages. The results indicate that: (1) the demographic characteristics of the country are not strictly related to the number of studies published, (2) most studies have a sociolinguistic approach even though many studies analyse both sociolinguistic and psycholinguistic factors, and (3) only seven multilingual education programmes including IM languages were described in these papers. We conclude that there is a lack of research focusing on IM languages in educational settings and discuss how addressing these gaps could create opportunities for building equitable multilingual communities in Europe.

Background: Learning Analytics (LA) is an emerging field concerned with measuring, collecting, and analysing data about learners and their contexts to gain insights into learning processes. As the technology of Learning Analytics is evolving, many systems are being implemented. In this context, it is essential to understand stakeholders' expectations of LA across Higher Education Institutions (HEIs) for large-scale implementations that take their needs into account. Objectives: This study aims to contribute to knowledge about individual LA expectations of European higher education students. It may facilitate the strategy of stakeholder buy-in, the transfer of LA insights across HEIs, and the development of international best practices and guidelines. Methods: To this end, the study employs a 'Student Expectations of Learning Analytics Questionnaire' (SELAQ) survey of 417 students at the Goethe University Frankfurt (Germany) Based on this data, Multiple Linear Regressions are applied to determine how these students position themselves compared to students from Madrid (Spain), Edinburgh (United Kingdom) and the Netherlands, where SELAQ had already been implemented at HEIs. Results and Conclusions: The results show that students' expectations at Goethe University Frankfurt are rather homogeneous regarding 'LA Ethics and Privacy' and 'LA Service Features'. Furthermore, we found that European students generally show a consistent pattern of expectations of LA with a high degree of similarity across the HEIs examined. European HEIs face challenges more similar than anticipated. The HEI experience with implementing LA can be more easily transferred to other HEIs, suggesting standardized LA rather than tailor-made solutions designed from scratch.

This study aims to conduct a bibliometric analysis of the literature on sports nutrition as recovery published between 1964 and 2022. This study illustrates the structure and trends in sports nutrition publications by using scientific mapping and analyzing publication performance. This study identified the contributions of authors, journals, countries, and widely cited articles. While there was no massive expansion in the first year of publication, the results show that high growth emerged in the 2010s. Several countries have made significant contributions to recovery research in sports nutrition. European countries account for the majority of publications on this subject. Latin American and Asian countries are also keeping an eye on the study's growth. Another finding is that various multidisciplinary publishers publish articles about sports nutrition. The International Journal of Sports Nutrition and Exercise Metabolism, on the other hand, is the journal that publishes the most articles. Burke L.M. has established himself as a prolific writer in this field, producing many documents and total citations. Several keywords have large nodes associated with their frequency of occurrence. The keyword relationship provides information about the relationship between keywords frequently appearing in one study. Visualizations of research trends are presented to provide an up-to-date reference guide for academics, revealing critical research gaps and potential research avenues for future studies to advance the discipline's consolidation.

As the ecosystem of actors communicating science has become more complex, there is a need to understand the motivations and deterrents of those involved in the communication of science, technology and health topics. This article reports on a survey of 465 communication actors based in seven European countries. The findings suggest strong commonalities between role and country, with personal enthusiasm a key motivator, and from a theoretical perspective, these motivations can be viewed as relatively pragmatic. More variation was found between countries and roles in barriers to communication, though these suggest a perception that institutions do not value this work.

Purpose: Adapting the Health Promotion School (HPS) approach to context specifics is acknowledged as being essential for implementation and achieving optimal effectiveness. This study aims to explore implementation variations on seven HPS spectra (such as top-down to bottom-up involvement of stakeholders) on which implementation of the HPS approach can vary, and the factors that relate to navigation on these spectra. Design/methodology/approach: In 2020, fourteen HPS researchers and professionals from ten European countries participated in semi-structured interviews. Findings: Navigation variations on the HPS spectra occurred throughout most spectra. Further, a tendency was found towards spectrum extremes of addressing multiple core-components, implementing non-disruptive Health Promotion (HP) programmes, and evaluating the HPS approach through an action-oriented research approach. Important general factors were resources, staff capacity and time available to staff members for implementing the HPS approach. Some spectra required more specific factors like organisational skills, leadership or a certain level of democracy. Practical implications: The implementation of the HPS approach should be supported by implementation strategies addressing the spectrum-specific factors, but more generic factors such as staff capacity, resources and the level of democracy should also be considered. Originality/value: This study explores navigation variations throughout HPS spectra rather than the HPS approach in general. It also nuances implementation diversity across and within different European contexts.

Identifying illicit behavior in survey research is inherently problematic, since self-reports are untrustworthy. We argue that fraudulent interviewers can, however, be identified through statistical deviance of the distributional parameters of their interviews. We document that a high proportion of the variation in the data is due to the interviewer. In addition, we show that the incidence of interviewer-induced anomalies is strongly associated with the perceived level of corruption across the countries participating in the European Social Survey 2010. The major implication of the findings is that the data from some countries cannot be used fruitfully for cross-national comparative research.

Education holds promise as a vehicle for sustainable global development and human capacity development, as reflected in the Sustainable Development Goals set by the United Nations. International education has become a prominent feature in contemporary times on the educational landscape as students become increasingly mobile in pursuit of their right to education. This study investigates the key factors that motivate international students to undertake better quality education at higher education (university) level, particularly in Europe, and the underlying gender preferences for study destinations within the framework of push-pull factors. The study collected responses of 288 individuals from 84 countries who had undertaken some form of education in Europe through the European Commission-funded Erasmus Mundus (EM) Scholarship. Responses were collected through an online platform, Survey Monkey. Outcomes of the study revealed that Germany, United Kingdom, Sweden, Netherlands, and Spain are the most popular destinations for pursuing higher education in Europe. The United Kingdom is the most preferred destination for female students while Germany is the most preferred destination for male students, with slight changes for other countries. Key motivating factors for international education were found to be scholarship opportunity, better quality of education, and availability of the relevant study program. The least influencing factors were found to be the commonality of language, suitable environment (eg climate, temperature), geographical proximity, the scope of migration, and social cost.

This article explores how higher education institutions (HEIs) internationalize, employing information on the internationalization activities (IA), context and organizational characteristics of 431 HEIs from 33 European countries. A latent cluster analysis identifies three distinct clusters of HEIs with distinct portfolios of IA: "basic, academic and entrepreneurial." The "basic" portfolio includes the most common IA, whereas IA requiring larger organizational capacity are rare. The "entrepreneurial" portfolio distinguishes from the "academic" portfolio as it also includes IA aimed to attract resources. We explore what contextual and organizational traits characterize HEIs with different IA portfolios. Small HEIs tend to display a "basic" portfolio, without national variations. On the contrary, strong national variations exist in the frequency of "academic" and "entrepreneurial" portfolios, which strongly relate to the actual and potential importance of tuition fees as a source of revenues.

What is the significance of regulations of job contracts and wages when it comes to young people's access to labour market? This is an issue that has attracted and continues to attract a great deal of interest in both research and politics. Proposals for deregulated employment protection and reduced entry-level pay recur regularly in public debate. In our view it is incomprehensible how sectors of the labour market that are dominated by jobs with low productivity and unstable employment conditions could be expected to offer a permanent solution for the large group of young people who are currently finding it difficult to enter the labour market and reach an acceptable standard of living. Instead, the responses to the challenges facing young people in the labour market could involve training in the form of apprenticeships rather than more insecure jobs and/or lower pay. Essentially, our starting point is that apprenticeship training could provide a more accurate response to the challenges facing young people in working life. This response would not involve the costs in terms of increased social polarisation and increased social risks that may follow in the wake of an increasingly deregulated labour market.

The academic profession has been long recognized as a pivotal source of belief and identity alongside the discipline and the institution of belonging. However, the ways in which academics as a professional group organize themselves towards common objectives that possibly transcend systems, institutions and disciplines, has not been explored so far. Therefore, the goal of this article is investigate how academics organize themselves in the pursuit of their professional, scientific and scholarly interests outside the university setting and across national higher education systems. We address this question by studying European academic associations. Drawing from World Polity Theory, studies on Professions and Professionalism, as well as on Interest Groups, we derive expectations as to the growth in number of academic associations and their aims. Based on the analysis of 324 associations, our findings show that assuming that the founding of academic associations is related primarily to the emergence or presence of international organizations needs to be revisited, as foundations appear to be affected by other contingent events as well. As to their aims, there is more variety than usually posited and five types of academic associations can be identified. We discuss the implications of on-going European integration in higher education and research from theory and policy perspectives.

In this article institutional and structural factors relating to access to education are assessed. First, the macro frameworks of institutional regulation that exert influence on the educational trajectories of young Europeans are demonstrated. Based on different aspects of these frameworks and drawing from extant research, the article presents a typology of education systems that provide varying levels of access to and accessibility of education in Finland, France, Germany, Italy, Poland, the Netherlands, Slovenia, and the United Kingdom. Second, using survey data (N = 6,366) it analyzes the impact of gender and parental education on young people's educational aspirations and early labor-market entry across the countries.

Many of the current policy debates in Europe focus on what kind of "knowledge economy" or "knowledge society" would be best in the future if it is to combine both economic competitiveness and social cohesion. Should European economies move increasingly towards the so-called Anglo-Saxon model of flexible labour markets and high employment rates--with the increasing income inequalities that attend them--or would some new form of the European Social Model be more appropriate for Europe's traditional concerns with matching economic competitiveness with social cohesion? This article explores the different models of the "knowledge economy/society" which can be identified in the European Union and how different models of Lifelong Learning support these. The analysis is confined to western European member states, and some of their major OECD competitor states, since it is too early yet to identify knowledge economies in the transformation states of central and Eastern Europe. Whereas traditional political economy approaches typically present dualistic theories relating to the Anglo-Saxon and Social Market models, the author now identifies at least three major models of the knowledge economy/society in Europe, roughly corresponding to different geographical/cultural regions, and that these are indeed supported by different models of Lifelong Learning. Only one of these can be said to combine the concerns of economic competitiveness and social cohesion. (Contains 8 figures and 1 note.)

A discussion of costs for students attending higher education institutions in nine European countries (Austria, Belgium, Denmark, Finland, France, Germany, Netherlands, Sweden, United Kingdom) looks at average expenditures of American students, sources and conditions of public support for foreign students, requirements for student academic progress, and relative affordability for Americans in those countries. (MSE)

Background: The practice of palliative sedation continues to raise ethical questions among people, which in turn leads to its varied acceptance and practice across regions. As part of the Palliative Sedation European Union (EU) project, the aim of the present study was to determine the perceptions of palliative care experts regarding the practice of palliative sedation in eight European countries (The Netherlands, Belgium, Germany, UK, Italy, Spain, Hungary, and Romania). Methods: A specifically designed survey, including questions on the most frequently used medications for palliative sedation, their availability per countries and settings, and the barriers and facilitators to the appropriate practice of palliative sedation was sent to expert clinicians involved and knowledgeable in palliative care in the indicated countries. A purposive sampling strategy was used to select at least 18 participating clinicians per consortium country. Descriptive statistical analysis was conducted on the survey data. Results: Of the 208 expert clinicians invited to participate, 124 participants completed the survey. Midazolam was perceived to be the most frequently used benzodiazepine in all eight countries. 86% and 89% of expert clinicians in Germany and Italy, respectively, perceived midazolam was used "almost always", while in Hungary and Romania only about 50% or less of the respondents perceived this. Levomepromazine was the neuroleptic most frequently perceived to be used for palliative sedation in the Netherlands, Spain, Germany, and the United Kingdom. Between 38- 86% of all eight countries´ expert clinicians believed that opioid medications were "almost always" used during palliative sedation. The perceived use of IV hydration and artificial nutrition "almost always" was generally low, while the country where both IV hydration and artificial nutrition were considered to be "very often" given by a third of the expert clinicians, was in Hungary, with 36% and 27%, respectively. Conclusions: Our study provides insight about the differences in the perceived practice of medication during palliative sedation between eight European countries. In countries where palliative care services have been established longer perceptions regarding medication use during palliative sedation were more in line with the recommended European guidelines than in Central and Eastern European countries like Romania and Hungary. [ABSTRACT FROM AUTHOR]

Participation and accessibility issues faced by gamers with multi-sensory disabilities are themes yet to be fully understood by accessible technology researchers. In this work, we examine the personal experiences and perceptions of individuals with deafblindness who play games despite their disability, as well as the reasons that lead some of them to stop playing games. We conducted 60 semi-structured interviews with individuals living with deafblindness in five European countries: United Kingdom, Germany, Netherlands, Greece and Sweden. Participants stated that reasons for playing games included them being a fun and entertaining hobby, for socialization and meeting others, or for occupying the mind. Reasons for stop playing games included essentially accessibility issues, followed by high cognitive demand, changes in gaming experience due their disability, financial reasons, or because the accessible version of a specific game was not considered as fun as the original one. We identified that a considerable number of individuals with deafblindness enjoy playing casual mobile games such as Wordfeud and Sudoku as a pastime activity. Despite challenging accessibility issues, games provide meaningful social interactions to players with deafblindness. Finally, we introduce a set of user-driven recommendations for making digital games more accessible to players with a diverse combination of sensory abilities. Digital games were considered a fun and entertaining hobby by participants with deafblindness. Furthermore, participants play games for socialization and meeting others, or for occupying the mind. Digital games provide meaningful social interactions and past time to persons with deafblindness. On top of accessibility implications, our findings draw attention to the importance of the social element of gaming for persons with deafblindness. Based on interviews, we introduce a set of user-driven recommendations for making digital games more accessible to players with a diverse combination of sensory abilities. [ABSTRACT FROM AUTHOR]

Epidemiological evidence suggests that regular physical activity (PA) positively impacts individuals' mental health (MH). The PA-MH relationship may be critical among immigrants owing to psycho-social-cultural influences. This scoping review of 61 studies employed a holistic bio-psycho-socio-cultural framework to thoroughly investigate the complex relationship between PA (across life domains) and immigrants' MH in Western countries. A systematic search of five electronic databases (Medline, PubMed, Embase, PsycINFO and Anthropology Plus) was conducted to locate relevant articles. No limitations were applied to study design, age, gender, home country, MH condition or PA type. A bio-psycho-socio-cultural-informed conceptual model guided the analysis of the multi-domain PA-MH relationship. Immigrant PA-MH studies were conducted and reported most commonly in the USA (38%), Australia (18%), and Canada (11%). Overall, PA was positively related to MH. Each domain-specific PA appeared to be associated with unique MH-promoting pathways/mechanisms. Leisure-related PA may support MH by enhancing self-agency and minimizing risky behaviors, whilst travel- and domestic-related PA may promote self-accomplishment and physical engagement. Ethnic sports appeared to enhance resilience. Occupational-related PA was associated with either positive or negative MH, depending on the type of occupation. A bio-psycho-socio-cultural-informed model is required to gain an encompassing and integrated understanding of immigrants' health. The first iteration of such a model is presented here, along with an illustration of how the model may be used to deepen analysis and understanding of the multi-domain PA-MH relationship among immigrants and inform public health planners and practitioners. [ABSTRACT FROM AUTHOR]

Background In Europe, more than 15 million people live with heart failure (HF). It imposes an enormous social, organizational and economic burden. As a reaction to impending impact on healthcare provision, different country-specific structures for HF-care have been established. The aim of this report is to provide an overview and compare the HF-care approaches of Germany, Ireland, the Netherlands and the UK, and to open the possibility of learning from each other's experience. Methods A mixed methods approach was implemented that included a literature analysis, interviews and questionnaires with HF-patients and caregivers, and expert interviews with representatives from healthcare, health service research and medical informatics. Results The models of HF-care in all countries analyzed are based on the European Society of Cardiology guidelines for diagnosis and treatment of HF. Even though the HF-models differed in design and implementation in practice, key challenges were similar: (i) unequal distribution of care between urban and rural areas, (ii) long waiting times, (iii) unequal access to and provision of healthcare services, (iv) information and communication gaps and (v) inadequate implementation and financing of digital applications. Conclusion Although promising approaches exist to structure and improve HF-care, across the four countries, implementation was reluctant to embrace novel methods. A lack of financial resources and insufficient digitalization making it difficult to adopt new concepts. Integration of HF-nurses seems to be an effective way of improving current models of HF-care. Digital solutions offer further opportunities to overcome communication and coordination gaps and to strengthen self-management skills. [ABSTRACT FROM AUTHOR]

Background Palliative sedation is a commonly accepted medical practice. This study aims to clarify how palliative sedation is regulated in various countries and whether this may impact its practice. Methods An online survey requesting regulations on palliative sedation was conducted in Belgium, Germany, Hungary, Italy, The Netherlands, Spain, Romania and the UK. Purposive sampling strategy was used to identify clinicians from different medical fields and legal experts for each country. Regulations were analyzed using the principles of the European Association for Palliative Care Framework on palliative sedation. Country reports describing how palliative sedation is regulated were elaborated. Results One hundred and thirty-nine out of 223 (62%) participants identified 31 laws and other regulations affecting palliative sedation. In Spain, 12 regional laws recognize palliative sedation as a right of the patient at the end of life when there are refractory symptoms. In Italy, the law of informed consent and advance directives specifically recognizes the doctor can use deep sedation when there are refractory symptoms. There are also general medical laws that, while not explicitly referring to palliative sedation, regulate sedation-related principles: the obligation of doctors to honour advance directives, informed consent, the decision-making process and the obligation to document the whole process. In Germany, the Netherlands and the UK, palliative sedation is also regulated through professional guidelines that are binding as good practice with legal significance. Conclusions Palliative sedation is considered in the general law of medical practice, in laws regarding the patient's autonomy, and through professional guidelines. [ABSTRACT FROM AUTHOR]

The aim of the present study was to examine parental experiences of homeschooling during the COVID-19 pandemic in families with or without a child with a mental health condition across Europe. The study included 6720 parents recruited through schools, patient organizations and social media platforms (2002 parents with a child with a mental health condition and 4718 without) from seven European countries: the UK (n = 508), Sweden (n = 1436), Spain (n = 1491), Belgium (n = 508), the Netherlands (n = 324), Germany (n = 1662) and Italy (n = 794). Many parents reported negative effects of homeschooling for themselves and their child, and many found homeschooling to be of poor quality, with insufficient support from schools. In most countries, contact with teachers was limited, leaving parents with primary responsibility for managing homeschooling. Parents also reported increased levels of stress, worry, social isolation, and domestic conflict. A small number of parents reported increased parental alcohol/drug use. Some differences were found between countries and some negative experiences were more common in families with a child with a mental health condition. However, differences between countries and between families with and without a mental health condition were generally small, indicating that many parents across countries reported negative experiences. Some parents also reported positive experiences of homeschooling. The adverse effects of homeschooling will likely have a long-term impact and contribute to increased inequalities. Given that school closures may be less effective than other interventions, policymakers need to carefully consider the negative consequences of homeschooling during additional waves of the COVID-19 pandemic and future pandemics. [ABSTRACT FROM AUTHOR]

Many researchers and practitioners consider ethnic segregation in neighbourhoods or schools detrimental to migrants' acculturation in host societies. Empirically, however, segregation is a 'mixed bag' and its effects depend crucially on the investigated acculturation domain (e.g., negative for language skills, positive for well‐being). As most prior studies have focused on a restricted spectrum of acculturation, a comprehensive assessment within one single study is needed to establish comparability across different acculturation domains. Among over 8000 immigrant‐background students from four countries, we investigated the association of classroom segregation, defined as opportunities for contact with natives and other migrants, with a broad spectrum of acculturation (academic, attitude‐related, identity‐related, social, health‐related, and psychological criteria). Some findings were consistent (e.g., academic acculturation), some were contrary to prior research (e.g., social acculturation). In sum, our results shed light on the 'mixed bag' of segregation and contribute to the understanding of a crucial social issue. [ABSTRACT FROM AUTHOR]

Despite efforts to reduce adolescent smoking via minimum age-of-sale legislation, many young people continue to access tobacco through a mix of social and commercial sources. Little is known about the roles of habitus, capital, and social topographies in shaping under-age access to tobacco. This article draws on Bourdieu's theory of practice and data generated from 56 focus groups with 14- to 19-year-olds across seven European cities to answer the question "via what sources and by what means do adolescents obtain tobacco?" We find that adolescents use a range of personal capitals (social, cultural, and economic) to access tobacco, with the specific constitution and deployment of these capitals varying according to the regularities of different fields. Since adolescents access tobacco via culturally embedded practices, attempts to curtail this access are more likely to be effective if they are multi-pronged, culturally informed, and attuned to the lived experiences of adolescent smokers. [ABSTRACT FROM AUTHOR]

Background To stop the spread of the new coronavirus disease in 2019 (COVID-19), many countries had completely locked down. This lockdown restricted the everyday life of the affected residents and changed their mobility pattern, but its effects on sleep pattern were largely unknown. Methods Here, utilizing one of the largest crowdsourced database (Sleep as Android), we analyzed the sleep pattern of 25 217 users with 1 352 513 sleep records between 1 January and 29 April 2020 in the US and 16 European countries (Germany, UK, Spain, France, Italy, The Netherlands, Belgium, Hungary, Denmark, Finland, Norway, Czech, Sweden, Austria, Poland and Switzerland) with more than 100 records in all days of 2020. Results During the COVID-19 pandemic, the sleeping pattern before and after the country-level lockdown largely differed. The subjects increased their sleep duration by an average of 11.3 to 18.6 min on weekday nights, except Denmark (4.9 min) and Finland (7.1 min). In addition, subjects form all 16 European countries delayed their sleep onset from 10.7 min (Sweden) to 29.6 min (Austria). Conclusion During the COVID-19 pandemic, residents in the US and 16 European countries delayed their bedtime and slept longer than usual. [ABSTRACT FROM AUTHOR]

Purpose: Unclear labeling has been recognized as an important cause of look-alike medication errors. Little is known about which labeling practices are currently used in European hospitals. The aim of this article is to obtain an overview of the labeling practices for parenteral medications, in relation to national guidelines, in the Netherlands, Germany, and the UK. Methods: An online survey was conducted using the Qualtrics® software. The survey was distributed to hospital pharmacists in the Netherlands, Germany, and the UK. The results were downloaded from Qualtrics and exported to Microsoft Excel. Data were categorized into groups and analyzed descriptively. Results: In total, 104 responses were received. The response rate was 63% (n = 48) in the Netherlands and 11% (n = 41) for Germany; for the UK, 15 responses were received. In general almost 90% of the respondents followed the National guidelines concerning labeling of pharmacy-prepared parenteral products. The use of label enhancement techniques was relatively low in all countries. On average, the use of "Tall Man" lettering was 19%, the use of color coding was 29%, and the use of a barcode on the label was 27%. Conclusion: Label-enhancement methods for parenteral medication in hospital pharmacies do not seem to be widely implemented and acknowledged in European hospitals, but response rates were limited for two countries. Greater standardization in conjunction with research for evidence-based enhancement techniques is needed to guide improvement in labeling practices across Europe. [ABSTRACT FROM AUTHOR]

The actions that individuals take to proactively craft their jobs are important to help create more meaningful and personally enriching work experiences. But do these proactive behaviors have implications beyond working life? Inspired by the suggestion that individuals aim for a meaningful life we examine whether on days when individuals craft their jobs, they are more likely to craft non-work activities. It also seems likely that characteristics of the home environment moderate these cross-domain relationships. We suggest that crafting crosses domains particularly when individuals gain resources through high autonomy and high workload at home. We partly supported our model through a daily diary study, in which 139 service sector employees from six European countries (Belgium, Denmark, Germany, Netherlands, Spain, UK) reported their experiences twice a day for five consecutive workdays. Home autonomy and home workload strengthened the positive relationship between seeking resources at work and at home. Moreover, home autonomy strengthened the positive association between seeking challenges at work and at home, and the negative relation between reducing demands at work and at home. These findings suggest that the beneficial implications of job crafting transcend life boundaries thereby providing advice for how individuals can experience greater meaning in their lives. [ABSTRACT FROM AUTHOR]

Aim: To explore the differences in perceived patient safety culture in cancer nurses working in Estonia, Germany, the Netherlands, and the United Kingdom. Design: An exploratory cross‐sectional survey. Methods: In 2018, 393 cancer nurses completed the 12 dimensions of the Hospital Survey on Patient Safety Culture. Results: The mean score for the overall patient safety grade was 61.3. The highest rated dimension was "teamwork within units" while "staffing" was the lowest in all four countries. Nurses in the Netherlands and in the United Kingdom, scored higher on "communication openness", the "frequency of events reported", and "non‐punitive response to errors", than nurses from Estonia or Germany. We found statistically significant differences between the countries for the association between five of the 12 dimensions with the overall patient safety grade: overall perception of patient safety, communication openness, staffing, handoffs and transitions and non‐punitive response to errors. Conclusion: Patient safety culture, as reported by cancer nurses, varies between European countries and contextual factors, such as recognition of the nursing role and education have an impact on it. Cancer nurses' role in promoting patient safety is a key concern and requires better recognition on a European and global level. Impact: Cancer Nursing Societies in any country can use these data as an indication on how to improve patient care in their country. Recognition of cancer nursing as a distinct specialty in nursing will help to improve patient safety. [ABSTRACT FROM AUTHOR]

This article puts contemporary debates about the relationship between immigration policy and the welfare state in historical perspective. Relying on new historical data, the article examines the relationship between immigration policy and social policy in Western Europe in the late 19th and early 20th centuries, when the modern welfare state emerged. Germany already had comparably strict immigration policies when the German Empire introduced the world's first national social insurances in the 1880s. Denmark, another early social-policy adopter, also pursued restrictive immigration policies early on. Almost all other countries in Western Europe started out with more liberal immigration policies than Germany's and Denmark's, but then adopted more restrictive immigration policies and more generous social policies concurrently. There are two exceptions, Belgium and Italy, which are discussed in the article. [ABSTRACT FROM AUTHOR]

Purpose: To report the vitamin D status in adults from seven European countries and to identify behavioural correlates.Methods: In total, 1075 eligible adult men and women from Ireland, Netherlands, Spain, Greece, UK, Poland and Germany, were included in the study.Results: Vitamin D deficiency and insufficiency, defined as 25-hydroxy vitamin D3 (25-OHD3) concentration of <30 and 30-49.9 nmol/L, respectively, were observed in 3.3 and 30.6% of the participants. The highest prevalence of vitamin D deficiency was found in the UK and the lowest in the Netherlands (8.2 vs. 1.1%, P < 0.05). In addition, the prevalence of vitamin D insufficiency was higher in females compared with males (36.6 vs. 22.6%, P < 0.001), in winter compared with summer months (39.3 vs. 25.0%, P < 0.05) and in younger compared with older participants (36.0 vs. 24.4%, P < 0.05). Positive dose-response associations were also observed between 25-OHD3 concentrations and dietary vitamin D intake from foods and supplements, as well as with physical activity (PA) levels. Vitamin D intakes of ≥5 μg/day from foods and ≥5 μg/day from supplements, as well as engagement in ≥30 min/day of moderate- and vigorous-intensity PA were associated with higher odds (P < 0.05) for maintaining sufficient (≥50 nmol/L) 25-OHD3 concentrations.Conclusions: The prevalence of vitamin D deficiency varied considerably among European adults. Dietary intakes of ≥10 μg/day of vitamin D from foods and/or supplements and at least 30 min/day of moderate- and vigorous-intensity PA were the minimum thresholds associated with vitamin D sufficiency. [ABSTRACT FROM AUTHOR]

Purpose: After regulatory restrictions for terfenadine and astemizole in '90s, only scarce evidence on proarrhythmic potential of antihistamines has been published. We evaluate the risk of ventricular tachyarrhythmia (VA) related to the use of individual antihistamines. Methods: A matched case-control study nested in a cohort of new users of antihistamines was conducted within the EU-funded ARITMO project. Data on 1997-2010 were retrieved from seven healthcare databases: AARHUS (Denmark), GEPARD (Germany), HSD and ERD (Italy), PHARMO and IPCI (Netherlands) and THIN (UK). Cases of VA were selected and up to 100 controls were matched to each case. The odds ratio (OR) of current use for individual antihistamines (AHs) was estimated using conditional logistic regression. Results: For agents largely used to prevent allergic symptoms, such as cetirizine, levocetirizine, loratadine, desloratadine and fexofenadine, we found no VA risk. A statistically significant, increased risk of VA was found only for current use of cyclizine in the pooled analysis (ORadj, 5.3; 3.6-7.6) and in THIN (ORadj, 5.3; 95% CI, 3.7-7.6), for dimetindene in GEPARD (ORadj, 3.9; 1.1-14.7) and for ebastine in GEPARD (ORadj, 3.3; 1.1-10.8) and PHARMO (ORadj, 4.6; 1.3-16.2). Conclusions: The risk of VA associated with a few specific antihistamines could be ascribable to heterogeneity in pattern of use or in receptor binding profile. [ABSTRACT FROM AUTHOR]

This study examined the inter-relationships of acculturative stressors experienced by Chinese international students. A sample of 463 Chinese students in six EU countries (UK, Germany, France, Netherlands, Spain and Belgium) responded to a web-based survey. The results showed that Chinese students in France suffered from bigger constraints in linguistic issues and dealing with life tasks than Chinese students in UK. Structural equation modeling (SEM) analysis revealed that language constraints and perceived cultural differences play a key role in influencing other stressors. The findings indicated that language constraints and perceived cultural differences accounted for 62% of the total variance of academic integration difficulty; language constraints accounted for 17% of the variance of problems in dealing with daily tasks; perceived cultural differences accounted for 56% of the variance of social integration difficulty; academic integration and problems in dealing with daily tasks explained 14% of the variance of homesickness. [ABSTRACT FROM AUTHOR]

The article presents a study on the impact of multimorbidity on the frequency of participation of older people in Europe in social leisure activities. Topics include the use of data from the European Project on Osteoarthritis (EPOSA), the concept of multimorbidity, and the individual and environmental factors that predict social leisure activity participation among the elderly. It also discusses the continuity theory of Robert Atchley.

Background: Strong primary care systems are believed to have an important role in dealing with healthcare challenges. Strengthening primary care systems is therefore a common policy goal for many countries. This study aims to investigate whether the Netherlands, the UK and Germany have strengthened their primary care systems in 2006-2012. Method: For this cross-sectional study, data from the International Health Policy surveys of the Commonwealth Fund in 2006, 2009 and 2012 were used. The surveys represent the experiences and perspectives of primary care physicians with their primary care system. The changes over time were researched in three areas: organization of primary care processes, use of IT in primary care and use of benchmarking and financial incentives for performance improvement. Results: Regarding organization of primary care processes, in all countries the use of supporting personnel in general practice increased, but at the same time practice accessibility decreased. IT services were most advanced in the UK. The UK and the Netherlands showed increased use of performance feedback information. German GPs were least satisfied with how their system works across the 2006-2012 timeframe. Conclusion: All three countries show trends towards stronger primary care systems, although in different areas. Coordination and comprehensive care through the assignment of assisting personnel and use of disease management programs improved in all countries. In the Netherlands and the UK, informational continuity is in part ensured through better IT services. All countries showed increasing difficulties upholding primary care accessibility. [ABSTRACT FROM AUTHOR]

Objective To examine (1) the impact of pictorial cigarette warning labels on changes in self-reported warning label responses: warning salience, cognitive responses, forgoing cigarettes and avoiding warnings, and (2) whether these changes differed by smokers' educational level. Methods Longitudinal data of smokers from two survey waves of the International Tobacco Control (ITC) Europe Surveys were used. In France and the UK, pictorial warning labels were implemented on the back of cigarette packages between the two survey waves. In Germany and the Netherlands, the text warning labels did not change. Findings Warning salience decreased between the surveys in France (OR=0.81, p=0.046) and showed a non-significant increase in the UK (OR=1.30, p=0.058), cognitive responses increased in the UK (OR=1.34, p<0.001) and decreased in France (OR=0.70, p=0.002), forgoing cigarettes increased in the UK (OR=1.65, p<0.001) and decreased in France (OR=0.83, p=0.047), and avoiding warnings increased in France (OR=2.93, p<0.001) and the UK (OR=2.19, p<0.001). Warning salience and cognitive responses decreased in Germany and the Netherlands, forgoing did not change in these countries and avoidance increased in Germany. In general, these changes in warning label responses did not differ by education. However, in the UK, avoidance increased especially among low (OR=2.25, p=0.001) and moderate educated smokers (OR=3.21, p<0.001). Conclusions The warning labels implemented in France in 2010 and in the UK in 2008 with pictures on one side of the cigarette package did not succeed in increasing warning salience, but did increase avoidance. The labels did not increase educational inequalities among continuing smokers. [ABSTRACT FROM AUTHOR]

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

Background: Exposure of young people to alcohol advertising is a risk factor for underage drinking. This study assessed youth exposure to television alcohol advertising in the UK, the Netherlands and Germany, from December 2010 to May 2011. Methods: A negative binomial regression model predicted number of alcohol advertisements from the proportion of the television viewership in each age group. This allowed comparison of alcohol advertisement incidence for each youth age category relative to an adult reference category. Results: In the UK, those aged 10–15 years were significantly more exposed to alcohol advertisements per viewing hour than adults aged ≥25 years [incidence rate ratio (IRR) = 1.11; 95% confidence interval (95% CI): 1.06, 1.18; P < 0.01]; in the Netherlands, those aged 13–19 years were more exposed per viewing hour than adults aged ≥ 20 years (IRR = 1.29; 95% CI: 1.19, 1.39; P < 0.01). Conversely, in Germany, those aged 10–15 years were less exposed to alcohol advertisements than adults aged ≥25 years (IRR = 0.79; 95% CI: 0.73, 0.85; P < 0.01). In each country, young children (aged 4–9 years in the UK and Germany, 6–12 years in the Netherlands) were less exposed than adults. Conclusion: Adolescents in the UK and the Netherlands, but not Germany, had higher exposure to television alcohol advertising relative to adults than would be expected from their television viewing. Further work across a wider range of countries is needed to understand the relationship between national policies and youth exposure to alcohol advertising on television. [ABSTRACT FROM AUTHOR]

Objectives To measure changes in prevalence and predictors of home smoking bans (HSBs) among smokers in four European countries after the implementation of national smoke-free legislation. Design Two waves of the International Tobacco Control Policy Evaluation Project Europe Surveys, which is a prospective panel study. Pre- and post-legislation data were used from Ireland, France, Germany and the Netherlands. Two pre-legislation waves from the UK were used as control. Participants 4634 respondents from the intervention countries and 1080 from the control country completed both baseline and follow-up and were included in the present analyses. Methods Multiple logistic regression models to identify predictors of having or of adopting a total HSB, and Generalised Estimating Equation models to compare patterns of change after implementation of smoke-free legislation to a control country without such legislation. Results Most smokers had at least partial smoking restrictions in their home, but the proportions varied significantly between countries. After implementation of national smoke-free legislation, the proportion of smokers with a total HSB increased significantly in all four countries. Among continuing smokers, the number of cigarettes smoked per day either remained stable or decreased significantly. Multiple logistic regression models indicated that having a young child in the household and supporting smoking bans in bars were important correlates of having a pre-legislation HSB. Prospective predictors of imposing a HSB between survey waves were planning to quit smoking, supporting a total smoking ban in bars and the birth of a child. Generalised Estimating Equation models indicated that the change in total HSB in the intervention countries was greater than that in the control country. Conclusions The findings suggest that smoke-free legislation does not lead to more smoking in smokers' homes. On the contrary, our findings demonstrate that smoke-free legislation may stimulate smokers to establish total smoking bans in their homes. [ABSTRACT FROM AUTHOR]

Background: The European Commission requires tobacco products sold in the European Union to display standardized text health warnings. This article examines the effectiveness of the text health warnings among daily cigarette smokers in four Member States. Methods: Data were drawn from nationally representative samples of smokers from the International Tobacco Control Policy Evaluation Project surveys in France (2007), Germany (2007), the Netherlands (2008) and the UK (2006). We examined: (i) smokers’ ratings of the health warnings on warning salience, thoughts of harm and quitting and forgoing of cigarettes; (ii) impact of the warnings using a Labels Impact Index (LII), with higher scores signifying greater impact; and (iii) differences on the LII by demographic characteristics and smoking behaviour. Results: Scores on the LII differed significantly across countries. Scores were highest in France, lower in the UK, and lowest in Germany and the Netherlands. Across all countries, scores were significantly higher among low-income smokers, smokers who had made a quit attempt in the past year and smokers who smoked fewer cigarettes per day. Conclusion: The impact of the health warnings varies greatly across countries. Impact tended to be highest in countries with more comprehensive tobacco control programmes. Because the impact of the warnings was highest among smokers with the lowest socioeconomic status (SES), this research suggests that health warnings could be more effective among smokers from lower SES groups. Differences in warning label impact by SES should be further investigated. [ABSTRACT FROM PUBLISHER]

To estimate the proportion of nurses in Hungary who intend to change their profession or want to migrate abroad; to compare the proportion of nurses who intend to leave nursing in Hungary and in selected European countries; and to describe factors that predict nurses' intent to work in their current job another year. An exploratory research design with subsequent comparison was used, and a cross-sectional mail survey was implemented. Measures of intent to leave, to work another year as well as indicators of push and pull factors were identified and adopted from a literature review. One thousand nurses were randomly selected and mailed a questionnaire. Comparison was made with the results from the NEXT study. For statistical analyses, linear and logistic regression was used to predict nurses' intention to leave and proportional z-test for making comparisons. Nurses ( n = 754) responded the questionnaire. Approximately half of the sample did not consider changing to another health care job or leaving the profession. Compared with Hungary, the proportion of nurses who intended to leave nursing was significantly lower in Belgium and the Netherlands but was greater or the same in the rest of the European countries. Speaking a foreign language was the most significant predictor of working abroad for Hungarian nurses. Number of shifts, satisfaction with flexible scheduling and managerial support were all relevant predictors of working another year as a nurse. Both the intent to leave nursing and migrating abroad were prevalent issues in Hungary. Working conditions and social/managerial support were key factors identified as strong predictors of stay in the same job for another year. Compared with other European countries, Hungary was not in a worse position in the proportion of nurses wanting to leave nursing. All hospital managers and head nurses should be aware of their role in keeping nurses in the clinical practice and avoid staff nurses migration from the Hungarian health care system. [ABSTRACT FROM AUTHOR]

Economic thought has often regarded business cycles as asymmetric. This study examines the existence of asymmetries over the business cycle in seven European countries: France, Germany, Ireland, Italy, Luxembourg, The Netherlands and the United Kingdom. To analyse this issue, industrial production in these countries from 1957 to 1998 is examined, and quarterly contractions and expansions in this variable are compared. The results obtained with both parametric and non- parametric methods allow the existence of asymmetries in these countries to be questioned. [ABSTRACT FROM AUTHOR]

Most published studies, regarding students' participation in drinking games (DGs), originate from the United States of America (USA). This study extends research to the United Kingdom (UK) and countries of mainland Europe. University students from five countries completed an anonymous online questionnaire which included measures of the frequency of DG participation, along with types, contexts and motives for participation. Responses are compared by the gender, and country of domicile of the participants. The study is based on the results of the questionnaire administered to 306 Social Work students from five universities/countries of which 72.2% are females, with a mean age of 22.6 years. This included students in Austria, Germany, the Netherlands, the UK and the USA. A high proportion of students, irrespective of gender, or country of domicile, stated that they participated in DGs. To 'meet people' and 'to get drunk' are the most important reasons stated for DG participation. Less benign motives, to 'control others' or 'get other people drunk', are reported as 'not important'. The most common types of DGs were consumption and team DGs. The pre-partying involved in DGs and associated consequences show important targets in alcohol harm minimization interventions. Harm minimization/public health messages regarding safer drinking need to recognize that younger students often feel they are immortal and do not fully appreciate risks and adverse effects of DGs and drink to have fun and be sociable. [ABSTRACT FROM AUTHOR]

This article presents a study which examined how attitudes to maternal employment at different stages of child rearing vary across and within eight nations in the European Union: Great Britain, Germany, Austria, the Netherlands, Sweden, Ireland, Italy and Spain, using data from the 1994 International Social Survey Programme. The prevalence of married women in the labor force undermines the traditional gender division of labor, whereby men are responsible for the public sphere of paid work and women are confined to the private sphere of home life. Increasingly women, even those with small children, are in paid employment. Women are now expected to contribute to the family income, but they are also expected to place family needs first. Based on the results of the study, cohort, education and women's labor force participation all have a marked effect on attitudes to maternal employment, with support for mothers working associated with more recent cohorts, higher education and the labor force participation of women or the wives/partners of men. Women's employment status has a stronger effect on the attitudes of men than of women. One unexpected and interesting finding was the dramatic effect that the labor force participation of women has on women's attitudes to maternal employment in the Netherlands. Austria is the only country where endorsement of maternal employment is consistently suppressed by its relatively conservative gender-role attitudes. Meanwhile, Ireland and Spain are very comparable with Germany in having low support of mothers working when the youngest child is of school age.

Green parties achieved a major breakthrough in the 1989 European elections. Who voted green in these elections? This first comprehensive comparative analysis of the green voter in Europe reveals, that, as expected, green voting is more common among the young, well-educated, and middle class, and green voters also tend to be left-wing, post-materialist and concerned about the environment and arms limitation. But these stereotypical attributes of greenness closely apply to the German and Dutch Greens only: green voters in other countries comply far less, if at all, with this socio-demographic profile. The one pervasive predictor is environmental concern, which is dominant in Britain, France, Belgium and Ireland. It is rather less important in Germany and the Netherlands where post-materialism and a left-wing orientation are more prevalent instead. The basis of green voting is thus rather less narrow than previously thought. The sharper delineation of support for the German Greens has contributed to a relatively stable green vote in the past, but the potential for attracting other sectors of the electorate are clearly very limited. Green parties in most other countries appear to be able to attract votes from a wider spectrum of the population but the commitment of these voters is likely to be far more volatile. [ABSTRACT FROM AUTHOR]

Background: Venous thromboembolism (VTE, including deep vein thrombosis [DVT] and pulmonary embolism [PE]) has an annual incidence rate of 104–183 per 100,000 person-years. After a VTE episode, the two-year recurrence rate is about 17%. Consequently, effective and safe anticoagulation is paramount. Edoxaban is a direct oral anticoagulant (DOAC) approved VTE treatment. Current safety and efficacy data are derived from clinical trials, and information about treatment durations beyond 12 months are not available. Methods: ETNA-VTE-Europe is an 18-month prospective, single-arm, non-interventional, multinational post-authorisation safety study. Approximately 310 sites across eight European countries (Austria, Belgium, Germany, Ireland, Italy, the Netherlands, Switzerland and the United Kingdom) will participate in the study, with the intention to represent the regional distributions of centres, healthcare settings and specialties. An estimated cohort of 2700 patients will be recruited, the only enrolment criteria being acute symptomatic VTE, no participation in an interventional study, and treating physician decision to prescribe edoxaban independently from the registry. Data from patient medical records and/or telephone interviews will be collected at baseline, 1, 3, 6, 12 and 18 months. The primary objective is to evaluate the 18-month rate of symptomatic VTE recurrence in patients with VTE treated with edoxaban outside a clinical trial. The co-primary objective is to evaluate the real-world rates of bleeding and adverse drug reactions. Secondary outcomes include rates of other patient-relevant safety events, adherence to and discontinuation of edoxaban. Furthermore, 12-month ETNA-VTE-Europe data will be considered in the context of those for patients receiving different anticoagulants in the PREFER in VTE registry and Hokusai-VTE clinical trial. Conclusions: ETNA-VTE-Europe will allow the safety and effectiveness of edoxaban to be evaluated over an extended period in acute symptomatic VTE patients encountered in routine clinical practice. Findings will be informative for European practitioners prescribing edoxaban as part of real-world VTE treatment/prevention. Trial registration: ClinicalTrials.gov Identifier: NCT02943993. [ABSTRACT FROM AUTHOR]

The article highlights the approach of Ireland-based wind power company, Airtricity, in wiring up the coastline of Europe. On the issue that when the wind does not blow, the current does not flow, the company has come up with a novel solution, a subsea electricity grid connecting offshore wind farms all around the coasts of Europe. With wind farms far enough apart to be in different weather systems, it will always be windy somewhere around the grid. Currently, the company is proposing to build a huge wind farm in the southern North Sea, to supply electricity to Great Britain, Netherlands, and Germany.