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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]

Aims: To perform temporal validation of a risk prediction model for breast cancer‐related lymphoedema in the European population. Design: Temporal validation of a previously developed prediction model using a new retrospective cohort of women who had undergone axillary lymph node dissection between June 2018 and June 2020. Methods: We reviewed clinical records to identify women who did and did not develop lymphoedema within 2 years of surgery and to gather data regarding the variables included in the prediction model. The model was calibrated by calculating Spearman's correlation between observed and expected cases. Its accuracy in discriminating between patients who did versus did not develop lymphoedema was assessed by calculating the area under the receiver operating characteristic curve (AUC). Results: The validation cohort comprised 154 women, 41 of whom developed lymphoedema within 2 years of surgery. The value of Spearman's coefficient indicated a strong correlation between observed and expected cases. Sensitivity of the model was higher than in the derivation cohort, as was the value of the AUC. Conclusion: The model shows a good capacity to discriminate women at risk of lymphoedema and may therefore help in developing improved care pathways for individual patients. Implications for the Profession and/or Patient Care: Identifying risk factors for lymphoedema secondary to breast cancer treatment is vital given its impact on women's physical and emotional well‐being. Impact: What problem did the study address? Risk of BCRL. What were the main findings? The prediction model has a good capacity to discriminate women at risk of lymphoedema. Where and on whom will the research have an impact? In clinical practice with women at risk of BCRL. Reporting Method: STROBE checklist. What Does this Paper Contribute to the Wider Global Clinical Community?: It presents a validated risk prediction model for BCRL. No Patient or Public Contribution: There was no patient or public contribution in the conduct of this study. [ABSTRACT FROM AUTHOR]

The top 100 most cited papers in social work journals in 2000–09 were recently listed in a British Journal of Social Work paper by Hodge, Lacasse and Benson. The citations of these 100 papers in a two-year period (2007–09) were identified and a further manual web-based search was conducted to identify some key features of the citing sources. Descriptive statistics are presented on language of publication and national location of citing authors, as well as type of citing source. Bivariate analysis was conducted of the national location of cited journal by national location of citing first author. This analysis shows a strong tendency towards within-country citation in both the UK and USA, providing some evidence of intellectual chauvinism amongst social work academics and, more specifically, evidence of a Great Atlantic Divide. [ABSTRACT FROM PUBLISHER]

Although leisure constraints that individuals have to cope with can negatively affect their social inclusion and satisfaction with life, little research has addressed the link between these variables. Therefore, the current paper examined the moderator role of leisure constraints on the relationship between satisfaction with life and leisure constraints among adults living in five different European countries. The respondents were 1,382 women and 877 men adults. The findings of analysis revealed that all factors used in the study accounted for 15% of the variance in satisfaction with life and social inclusion had a significant and positive impact on satisfaction with life. As a result, it can be said that leisure constraints had a moderating effect on the relationship between satisfaction with life and social inclusion. The present research study recommends that social inclusion should be encouraged through decreasing to leisure constraints to increase the life satisfaction. [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]

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]

Background: Childhood myopia represents a global concern with increasing prevalence in recent decades. Lifestyle factors significantly impact myopia. Aim: To evaluate lifestyle factors in myopic children from a metropolitan area in Europe. Methods: This was a descriptive study including myopic subjects aged 4–18 years. Patient demographic and clinical data were collected, including cycloplegic refraction in spherical equivalent refraction (SER) and axial length (AL). In addition, a questionnaire on lifestyle factors was conducted between September 2022 and April 2023. Results: A total of 321 myopic children were included, aged 10.72 ± 3.05 years, of whom 51.4% were boys, with SER −2.25 ± 1.9 D and AL 24.54 ± 0.98 mm. The mean age of myopia onset was 7.69 ± 3.05 years. A total of 59.8% had family history of myopia. Those children who had <2 h/day of screen time (on weekdays) presented SER −2 ± 1.91 D, compared to those who had >2 h/day, SER: −2.50 ±1.88 D (p = 0.009). Children who spent <2 h/day doing near work after school were less myopic compared to those who spent >2 h/day (SER: −1.75 ± 1.83 vs. SER: −2.75 ± 1.82, respectively, p = 0.03). However, no significant association was observed between SER and AL and time spent outdoors nor between SER and AL and academic performance (p > 0.05). Conclusions: Screen time and near-work time appear to be lifestyle factors related to myopia. [ABSTRACT FROM AUTHOR]

The present paper examines cross-national differences in the utilisation of work-family resources at the organisational level and the relationships between these resources and work-to-home interference ( WHI) and satisfaction with work-family balance ( SWFB) among professional and non-professional service sector employees in five Western European countries. Further, it explores cross-national variations in the gap between professionals and non-professionals with respect to both outcome variables. Professional service sector employees were consistently found to experience higher levels of WHI and lower levels of SWFB. The use of organisational work-family resources differed across welfare state regimes and levels of national gender equality. It was highest in Sweden and the Netherlands and lowest in Portugal. A family-supportive supervisor and a family-supportive organisational culture differentially affected WHI of professional and non-professional workers, with a family-supportive supervisor being more beneficial to non-professionals and a family-supportive organisational culture being more beneficial to professional employees. Finally, the gap between professionals and non-professionals was also found to vary across countries for WHI but not for SWFB. It was significantly larger in the UK and in Sweden than in the other three countries. [ABSTRACT FROM AUTHOR]

Summary What is known and Objective: Economic evaluation is used to assess the value for money of medicines and inform pharmaceutical pricing/reimbursement decisions in many countries. This paper aims to report on estimates of the value for money of medicines in Europe. Methods: Estimated cost-utilities were derived from studies included in the Tufts Medical Center Cost-Effectiveness Analysis Registry between 2000 and 2007. For each study, the following variables were examined: publication year, target population, intervention type, country of patient sample, disease classification, prevention stage, funding source, study perspective, discounting, sensitivity analysis, incremental cost-utility ratio (ICUR) and methodological quality. Results and Discussion: Six hundred and eight ICURs were reported in 231 cost-utility analyses. Around 17·1% of ratios related to medicines that were more effective and less expensive than the comparator; 76·5% related to medicines that improved outcomes, but increased costs; and 6·4% related to medicines that were less effective and more expensive than the comparator. The median ratio was 12 238 € per quality-adjusted life year (QALY). Using threshold values of 20 000 and 50 000 € per QALY, the probability that medicines provided value for money was 58% and 81%, respectively. Preventive medicines studied provided more value for money than curative medicines ( P = 0·002). Studies sponsored by industry generated more favourable results than studies sponsored from other sources ( P < 0·001). However, no association was observed between the funding source and the methodological quality of economic evaluations. What is new and Conclusion: The evidence base suggests that the majority of medicines provided value for money. Such information informs policy decisions relating to the allocation of scarce health care resources in Europe. [ABSTRACT FROM AUTHOR]

BACKGROUND: Upper extremity function (UEF) is often compromised in multiple sclerosis (MS), although its importance is regularly underrecognized relative to ambulation. We explored the concurrent presence of impairment in UEF and ambulation by examining various aspects of UEF across different levels of ambulation. METHODS: The cohort consisted of 247 patients with clinically definite MS or clinically isolated syndrome according to the revised 2010 McDonald criteria. The Nine-Hole Peg Test and the Expanded Disability Status Scale were used to stratify patients into clinically different subgroups. For UEF, cerebellar function (finger-to-nose test), pyramidal function (pronator drift test), and the ability to perform a task of activities of daily living (drinking- from-cup test) were examined. Patient-reported limitations of UEF in daily life were assessed using the Arm Function in Multiple Sclerosis Questionnaire. RESULTS: Patients in more severely impaired ambulation groups displayed poorer performance on all UEF measures. Although most patients had normal to mild (n = 147) or moderate (n = 46) ambulatory impairment, 87.7% exhibited some level of UEF impairment as defined using the Nine-Hole Peg Test. Most patients had mild UEF impairment (n = 174), accounting for the largest proportion in all ambulation groups (51.9%-77.8%). CONCLUSIONS: A distinct pattern of impairment was found for ambulation and multiple aspects of UEF. Independent assessment of multiple aspects of disability may be helpful in treatment decision-making and could support the development of rehabilitation strategies that specifically target UEF impairment [ABSTRACT FROM AUTHOR]

Objectives: To identify social network profiles using Latent Profile Analysis (LPA), to study the relationships of these profiles with health markers, mental health, quality of life, and cognitive functioning, and to compare profiles across European regions. Methods: 27,272 participants from the Wave 8 of the SHARE project, aged 65 or older (M = 74.95, SD = 7.17) from Europe. Statistical analyses included LPAs followed by MANOVAs to compare the profiles and the health markers. Results: Five profiles were identified: family, friends, spouse, diverse, and others. A no network group was also added. The prevalence of the specific profiles differed across European regions. Individuals with no network and those categorized into the others profile presented the worst health outcomes. Discussion: The "friends" network is more protective toward cognitive functioning and physical health and the "spouse" and "family" ones are more protective toward mental health. The variability according to European regions is discussed. [ABSTRACT FROM AUTHOR]

Background: Studies revealed unidirectional associations between frailty and medication‐related problems (MRPs) among older adults. Less is known about the association between frailty and the risk of MRPs. We aimed to assess the bi‐directional association between frailty and the risk of MRPs in community‐dwelling older adults in five European countries. Methods: Participants were 1785 older adults in the population‐based Urban Health Centres Europe project. Repeated assessments were collected at baseline and one‐year follow‐up, including frailty, the risk of MRPs, and covariates. Linear regression analyses were conducted to examine the unidirectional associations. A cross‐lagged panel modeling was used to assess bi‐directional associations. Results: The unidirectional association between frailty at baseline and the risk of MRPs at follow‐up remained statistically significant after adjusting for covariates (β = 0.10, 95%CI:0.08, 0.13). The association between the risk of MRPs at baseline and frailty at follow‐up shows similar trends. The bi‐directional association was comparable with reported unidirectional associations, with a stronger effect from frailty at baseline to the risk of MRPs at follow‐up than reversed path (Wald test for comparing lagged effects: p < 0.05). Conclusion: This longitudinal study suggests that a cycle may exist where older adults with higher frailty levels are more likely to have a higher risk of MRPs, which in turn contributes to developing a higher level of frailty. Further research is needed to validate our findings and explore underlying pathways. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the experienced barriers of care for treatment-seeking trans individuals (TSTG) in three large European clinics. Methods: An online follow-up questionnaire was filled out by 307 TSTG individuals as part of the research protocol of the European Network for the Investigation of Gender Incongruence (ENIGI). Data was collected during follow-up in 2017/2018, around 5 years after participants had their initial clinical appointments in Ghent (Belgium), Amsterdam (the Netherlands), or Hamburg (Germany). Background characteristics, country, treatment characteristics and mental health were analyzed in relation to experienced barriers of care (EBOC, measured though agreement with statements). Results: The majority of participants reported various EBOC, oftentimes more than one. The most-frequently reported EBOCs pertained to the lack of family and friends' support (28.7%, n = 88) and travel time and costs (27.7%, n = 85), whereas around one-fifth felt hindered by treatment protocols. Also, a significant share expressed the feeling that they had to convince their provider they needed care and/or express their wish in such way to increase their likelihood of receiving care. A higher number of EBOCs reported was associated with more mental health problems, lower income and female gender. Conclusions: A substantial number of TSTG individuals within three European health care systems experiences EBOCs. EBOCs relate to both personal and systemic characteristics. These findings can help health care providers and centers to improve care. More research must be done to better understand the diversity among TSTG individuals and the corresponding barriers experienced. Supplemental data for this article is available online at https://doi.org/10.1080/26895269.2021.1964409 [ABSTRACT FROM AUTHOR]

Older adults tend to have multiple comorbidities and specific needs that require timely assistance. The information on percentage and characteristics of older adults that self-refer to physiotherapy is scarce, thus our objective is to characterise them in terms of socio-demographic aspects and health conditions across 15 European Countries. Individuals aged 65 years and over from the first wave of the European Health Interview Survey across 15 European Countries was used. The information retrieved for analysis was: sex, age, country, education' levels, income, self-perception of health, health conditions, and visits on their own behalf to a physiotherapist. The sample comprised 39,922 older adults, aged 75.6 (7.8) years old, and of which 60.5% were women. The percentage of self-referral to physiotherapy varied between 3.3 and 29.9% across countries. Older adults reporting osteoarthritis, neck pain, low back pain or stroke were associated with higher rates of self-referral. Our study shows that a small percentage of older adults self-refer to physiotherapy and confirmed higher income and higher education' levels are associated with direct access/self-referral to physiotherapy, suggesting the need to improve public health systems, health insurance and campaigns promoting physiotherapy targeting older adults and their careers. [ABSTRACT FROM AUTHOR]

Background: Psychosis rates are higher among some migrant groups. We hypothesized that psychosis in migrants is associated with cumulative social disadvantage during different phases of migration. Methods: We used data from the EUropean Network of National Schizophrenia Networks studying Gene-Environment Interactions (EU-GEI) case–control study. We defined a set of three indicators of social disadvantage for each phase: pre-migration, migration and post-migration. We examined whether social disadvantage in the pre- and post-migration phases, migration adversities, and mismatch between achievements and expectations differed between first-generation migrants with first-episode psychosis and healthy first-generation migrants, and tested whether this accounted for differences in odds of psychosis in multivariable logistic regression models. Results: In total, 249 cases and 219 controls were assessed. Pre-migration (OR 1.61, 95% CI 1.06–2.44, p = 0.027) and post-migration social disadvantages (OR 1.89, 95% CI 1.02–3.51, p = 0.044), along with expectations/achievements mismatch (OR 1.14, 95% CI 1.03–1.26, p = 0.014) were all significantly associated with psychosis. Migration adversities (OR 1.18, 95% CI 0.672–2.06, p = 0.568) were not significantly related to the outcome. Finally, we found a dose–response effect between the number of adversities across all phases and odds of psychosis (⩾6: OR 14.09, 95% CI 2.06–96.47, p = 0.007). Conclusions: The cumulative effect of social disadvantages before, during and after migration was associated with increased odds of psychosis in migrants, independently of ethnicity or length of stay in the country of arrival. Public health initiatives that address the social disadvantages that many migrants face during the whole migration process and post-migration psychological support may reduce the excess of psychosis in migrants. [ABSTRACT FROM AUTHOR]

Background. Job satisfaction of family physicians (FPs) is vitally important not only for the well-being of physicians but also for the quality of health services. Coordination of care is one of the core dimensions of strong primary care. However, studies focused on the association between care coordination and the job satisfaction of FPs is scarce. Objectives. To explore whether the factors influencing the job satisfaction of FPs differ in countries with different strengths of coordination. Material and methods. A cross-sectional study was conducted among FPs in ten European countries which were divided into three groups in terms of care coordination. An online questionnaire was disseminated by e-mail to groups of FPs. Socio-demographic, working conditions and workload features were included as independent variables. Job satisfaction as the outcome variable was measured with one question. The Chi-square test was used for comparative analysis. Results. 278 FPs (72% of the targeted sample size) participated. The job satisfaction of FPs in strong and medium-level care coordination groups was higher than their counterparts in the weak-level care coordination group (p < 0.001). No association was found between the socio-demographics and workload features with job satisfaction. Only the non-existence of a gate-keeping system was associated with the increased job satisfaction of FPs in the medium-level care coordination group (p = 0.01). Conclusions. Primary health care is responsible for the coordination of care within the gigantic healthcare system, and FPs play a role in guiding patients. Studying the association between care coordination and the job satisfaction of FPs might help to build better healthcare systems. The gate-keeping system deserves special attention in this research area. [ABSTRACT FROM AUTHOR]

Background. The problem of the ageing population has resulted in attitudes towards aging in different age groups becoming a subject of increased academic interest. Objectives. To provide comparative characteristics of the prevalence of manifestations of gerontological ageism among university students in five European countries. Material and methods. The sample consisted of university students (n = 2493) aged 18–25 from Belarus (n = 827), Russia (n = 528), Poland (n = 798), Lithuania (n = 223) and Ukraine (n = 117). The prevalence of gerontological ageism among respondents was evaluated according to the Fraboni Ageism Scale. Results. The prevalence and manifestations of gerontological ageism vary depending on the country. The maximum total indicator, displaying the highest overall level of ageism, was noted among Belarusian students, the minimum – in Lithuania (p < 0.05). The final indicators of gerontological ageism were found to be the following: the level of age discrimination and negative emotional attitude towards the elderly was increased in one fifth of the respondents in all five groups. The observation found the level of ageism averaging at 60%, evenly distributed in all groups. The predominant attitudes towards older people were found to be neutral or positive (84.6%). Conclusions. The manifestations of ageism are international in nature and can explain 20% of the total variety of answers characterising the differences in ranked attributes and degree of ageism. The total indicator showed the highest degree of gerontological ageism among students in Belarus, the lowest – among those in Lithuania, with levels of gerontological ageism among students in Russia, Poland and Ukraine distributed in between. [ABSTRACT FROM AUTHOR]

Oral Medicine is a young dental specialty born almost a century ago and deals with orofacial conditions not directly attributable to the most prevalent tooth pathologies such as dental caries or periodontal diseases. Presentations may reflect local disease or orofacial manifestations of more widespread pathology affecting other parts of the body. Due to its recency as a distinct discipline and to heterogeneous global settings, Oral Medicine has not yet achieved a shared scope and definition, as well as a recognized status across the globe. The current report presents survey data gathered from Oral Medicine practitioners in Europe and Australia and aimed to identify practitioner characteristics including demographics, training, clinical and research activity. As expected, Oral Medicine clinical practice commonly deals with conditions such as immune‐mediated disorders, potentially malignant disorders, oral mucosal infections and chronic pain disorders, but geographical heterogeneities are observed. The present data, representative of current clinical practice, are valuable in order to understand the evolution of Oral Medicine as a distinct discipline and should be taken into consideration in order to create or update postgraduate training curricula able to meet the needs of future practitioners and the communities they serve. [ABSTRACT FROM AUTHOR]

Objectives. Grandparents play an important role in looking after grandchildren, although intensive grandparental childcare varies considerably across Europe. Few studies have explicitly investigated the extent to which such cross-national variations are associated with national level differences in individual demographic and socio-economic distributions along with contextual-structural and cultural factors (e.g., variations in female labor force participation, childcare provision, and cultural attitudes). Methods. We used multilevel models to examine associations between intensive grandparental childcare and contextual-structural and cultural factors, after controlling for grandparent, parent, and child characteristics using nationally representative data from the Survey of Health, Ageing and Retirement in Europe. Results. Even controlling for cross-national differences in demographic and socio-economic distributions, contextual-structural factors play an important role in explaining grandparental childcare variations in Europe. In particular, higher levels of intensive grandparental childcare are found in countries with low labor force participation among younger and older women, and low formal childcare provision, where mothers in paid work largely rely on grandparental support on an almost daily basis. Discussion. Encouraging older women to remain in paid work is likely to have an impact on grandchild care which in turn may affect mothers' employment, particularly in Southern European countries where there is little formal childcare. [ABSTRACT FROM AUTHOR]

Introduction: In addition to the functional aspects of healthcare integration, an understanding of its normative aspects is needed. This study explores the importance of values underpinning integrated, people-centred health services, and examines similarities and differences among the values prioritised by actors across Europe. Methods: Explorative cross-sectional design with quantitative analysis. A questionnaire of 18 values was conducted across Europe. A total of 1,013 respondents indicated the importance of each of the values on a nine-point scale and selected three most important values. Respondents were clustered in four actor groups, and countries in four European sub-regions. Results: The importance scores of values ranged from 7.62 to 8.55 on a nine-point scale. Statistically significant differences among actor groups were found for ten values. Statistically significant differences across European sub-regions were found for six values. Our analysis revealed two clusters of values: 'people related' and 'governance and organisation'. Discussion and conclusion: The study found that all 18 values in the set are considered important by the respondents. Additionally, it revealed distinctions in emphasis among the values prioritised by actor groups and across sub-regions. The study uncovered two clusters of values that contribute to a conceptually based definition of integrated, people-centred health services. [ABSTRACT FROM AUTHOR]

Physical activity (PA) is an important health-promoting behavior from which adolescents with long-term illnesses or disabilities (LTID) can benefit. It is important to monitor differences across countries in adherence with PA recommendations for health. The aim of this study was to compare PA levels among 15 European countries after disaggregating data by disability. Data from pupils (mean age= 13.6 years, SD = 1.64) participating in the 2013/2014 Health Behavior in School-aged Children study were analyzed to compare adolescents without LTID, with LTID, and with LTID that affects their participation (affected LTID). Logistic regression models adjusted for age and family affluence, stratified by gender and country group with PA recommendations for health as the outcome variable. With the data pooled, 15% (n = 9,372) of adolescents reported having LTID and 4% (n = 2,566) having affected LTID. Overall, fewer boys with LTID met PA recommendations for health than boys without LTID, although it was not statistically significant either at the national levels or for girls. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to explore caregiver and family quality of life in families with children with autism spectrum disorder (ASD). To better understand the experience of caregivers and families of children with ASD, a family systems perspective using constructs from a psychosocial adjustment model of disability (i.e., role impact as the independent variable and relationship satisfaction and mastery as mediator variables) was studied to explain caregiver and family quality of life. Method: Hayes' PROCESS macro was used to determine the variance of caregiver and family quality of life accounted for by the predictor variables. Results: The results indicated that the models explained 52.3% of the variance in caregiver quality of life and 44.4% of the variance in family quality of life. Conclusions: The findings of this study expand the current literature on caregivers of children with ASD, and the important variables to consider related to caregiver quality of life and family quality of life. Implications for rehabilitation research (e.g., increased need for a focus on family variables across research agendas) and practice (e.g., increase need for family-oriented interventions) are discussed. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to explore mentoring competence in nursing student mentors during clinical practice by identifying different mentor profiles and connections between different competence areas among five European countries and Japan. Methods: The study implemented a cross‐sectional design in Finland, Italy, Lithuania, Slovenia, Spain, and Japan during 2016 and 2019. In total, 6208 mentors were invited, and 1862 participated from 58 healthcare organizations. The data were collected with a survey questionnaire by including background question items with the Mentor Competence Instrument. K‐clustering and structural equation modeling were used for data analysis. Results: Four mentor profiles, A (43%), B (30%), C (18%), and D (9%), were identified according to the seven mentoring competence areas with high statistical significance (p < 0.001). Higher mentoring competence (mean >3.50) was observed among Finnish, Lithuanian, and Slovenian mentors with university education in nursing, older ages, more work experience, and previous education in mentoring. Lower competence (mean <2.49) was observed among Japanese and Italian mentors with diplomas in nursing, younger ages, less work experience, and no previous education in mentoring. Conclusion: Mentoring requires motivated, highly competent mentors since mentoring is a critical aspect of nursing education. Mentoring roles should be given to nurses with higher education and mentoring training. Younger, less experienced nurses without formal mentoring training may need support from senior nurses when performing mentoring roles and could also facilitate a more balanced workload between patient care and mentoring for senior nurses. [ABSTRACT FROM AUTHOR]

Purpose: Several guidelines for the use of patient-reported outcomes (PROs) in clinical studies have been published in the past decade. This review primarily aimed to compare the number and compliance with selected PRO-specific criteria for reporting of clinical studies in Europe using PROs published in 2008 and 2018. Secondarily, to describe the study designs, PRO instruments used, patient groups studied, and countries where the clinical studies were conducted. Methods: A literature search was conducted in MEDLINE to identify eligible publications. To assess the number of publications, all abstracts were screened for eligibility by pairs of reviewers. Compliance with PRO-specific criteria and other key characteristics was assessed in a random sample of 150 eligible full-text publications from each year. Randomized controlled trials (RCTs) were assessed according to the full CONSORT-PRO checklist. Results: The search identified 1692 publications in 2008 and 4290 in 2018. After screening of abstracts, 1240 from 2008 and 2869 from 2018 were clinical studies using PROs. By full-text review, the proportion of studies discussing PRO-specific limitations and implications was higher in 2018 than in 2008, but there were no differences in the other selected PRO-specific criteria. In 2018, a higher proportion of studies were longitudinal/cohort studies, included ≥ 300 patients, and used electronic administration of PRO than in 2008. The most common patient groups studied were those with cancer or diseases of the musculoskeletal system or connective tissue. Conclusion: The number of clinical studies from Europe using PROs was higher in 2018 than in 2008, but there was little difference in compliance with the PRO-specific criteria. The studies varied in terms of study design and PRO instruments used in both publication years. [ABSTRACT FROM AUTHOR]

Adequate follow-up in celiac disease is important to improve dietary compliance and treat disease-related symptoms and possible complications. However, data on the follow-up of celiac children is scarce. We aimed to assess current pediatric celiac follow-up practices across Europe. Pediatricians and pediatric gastroenterologists from 35 countries in Europe, Israel, Turkey, and Russia completed an anonymous survey which comprised a 52-item questionnaire developed by the ESPGHAN Special Interest Group on Celiac Disease. A total of 911 physicians, the majority of whom exclusively worked in pediatric care (83%) and academic institutions (60%), completed the questionnaire. Mean age and mean experience with celiac care were 48.7 years (± 10.6) and 15.7 years (± 9.9), respectively. The vast majority (≥ 92%) always assessed anthropometry, dietary adherence, and tissue-transglutaminase IgA-antibodies at every visit, with the first visit being between 3 and 6 months after diagnosis. Other parameters (% always tested) were as follows: complete blood count (60%), iron status (48%), liver enzymes (42%), thyroid function (38%), and vitamin D (26%). Quality of life was never assessed by 35% of the responding physicians. Transition to adult care was mostly completed via a written transition report (37%) or no formal transition at all (27%). Conclusions: Follow-up of celiac children and adolescents in Europe may be improved, especially regarding a more rational use of (laboratory) tests, dietary and QoL assessment, and transition to adult care. Evidence-based advice from international scientific societies is needed. What is Known: • Follow-up in celiac disease is important to treat disease-related symptoms, improve dietary compliance, and prevent possible complications. • There is a lack of consensus about the appropriate follow-up. What is New: • Almost all European physicians assess anthropometry, tissue-transglutaminase IgA-antibodies, and dietary adherence at every visit, but there are large variations in other follow-up aspects. • Follow-up could be improved by a more rational use of (laboratory) tests, increased intention to dietary compliance, and quality of life together with transition programs to adult care. [ABSTRACT FROM AUTHOR]

Aim: The target of this work is to support the thesis that pharmaceutical companies' testing phase would be treated like any other form of production in a globalization process, that is to say, a specific phase of pharmaceutical research and development (R&D) could be localized where the cost of clinical evidence is lower. Subject and methods: Considering Europe, an empirical analysis in order to support the main hypothesis is performed. Taking trials of phases II and III, funded by Industry (dependent variable) and the main macroeconomic features (independent variables) of each nation into account, the empirical work is implemented via regression analysis on panel data (2000-2007). The sample analyzed considers EU-27 plus the candidate states-Croatia, the Former Yugoslav Republic of Macedonia, Turkey-as well as Norway, Switzerland and Iceland. Results: Results suggest the appropriateness of this process since clinical research is clearly affected by economic conditions, regardless of the scientific purpose. Conclusion: The conclusions regard the policy maker's point of view, that is to say, how national competitiveness could be increased on the European market of human experimentation. [ABSTRACT FROM AUTHOR]

Aim: To evaluate how researchers in the field of Public Health (PH) use graphical representations in the context of a scientific meeting. Subjects and methods: We evaluated 159 graphs contained in the oral presentations given at the 2006 European Conference on Public Health. An ad-hoc data extraction form was developed on the basis of the available literature to evaluate type and characteristics of the graphs (e.g. format of axes, scales, legend, use of colours, presence of distortions). Principal component analysis (PCA) was performed to identify latent variables. Results: We found that the majority of graphs were simple univariate displays such as bar diagrams (59.1%), and linear graphs (18.2%). Distortions were present in about 1 out of 3 graphs and they were less common in graphs made by researchers from northern and western European countries than in graphs made by researchers from other countries. Two factors emerged from PCA: clarity of the graph and appropriate use of colours. Conclusion: The ability of PH researchers to fully exploit the visual potential of graphs appeared limited. Clarity and use of colours characterised use of graphics in oral presentations. [ABSTRACT FROM AUTHOR]

Do organizational controls facilitate or hinder employees' trust in their organization? We addressed this question through a mixed-methods design using three studies. Based on a literature review and an open-response survey study (Study 1), we developed a theoretical model proposing that organizational control is positively related to employees' trust in their organization, and that this relationship is mediated by procedural fairness and organizational prestige. This mediated model was tested and supported in a quantitative survey of 582 European managers and professional employees from a range of organizations (Study 2). A complementary, qualitative interview-based study (Study 3) confirmed that well-implemented controls facilitate trust in the organization; however, poorly implemented control systems that are inconsistent, overly rigid, or incentivize untrustworthy behavior can undermine trust in the organization. [ABSTRACT FROM AUTHOR]

Background: The selection of quality indicators demonstrating the efficiency and relevance of nursing practice in patient outcomes in the intensive care unit remains a challenge. Aim: The aim of this study was to develop a set of potential quality indicators to quantify nursing care provided to critically ill patients through a consensus method. Design: This was a three‐phase study including a European survey of intensive care unit (ICU) nurses (phase one) followed by a two‐phase face‐to‐face consensus meeting of experts from Cyprus. Method: Two distinct panels of experts were asked to rate each quality indicator using a 4‐point Likert scale in phases one and two. The level of consensus was set at 60%. In phase three, scores of the content validity index for items and scales were considered for the final selection of quality indicators. Results: The phase one survey included 139 ICU nurses from 13 European countries, and phases two and three included seven ICU experts from Cyprus. "Consensus in" was achieved for 12 items at the end of phase two. Three of the quality indicators were significantly different by country: (a) falls (P =.006), (b) accidental removal of nasogastric tube (P <.001), and (c) accidental removal of intravascular catheters (P <.001). Only falls was significantly correlated with higher academic qualifications of the participants (P =.002). Conclusions: Fifteen items have been identified as potential indicators for adult ICU nursing quality. These need to be prospectively studied to determine the extent to which they can accurately capture nursing care quality in this setting. Relevance to clinical practice: The study provides a set of relevant quality indicators. A nursing set for the ICU may serve as the basis for nursing management and facilitate the strategy dedicated to the vision of health care quality assurance. [ABSTRACT FROM AUTHOR]

Occupational health risk selfperception among nurses is linked to professional time management and well-being. In contrast, most of the activities done during personal time seem to have a visibly low effect on the subjects. The importance of time management in nurses' regular work shifts and the relevance of harmonizing personal and family life with each professional's particular circumstances are highlighted. [ABSTRACT FROM AUTHOR]

Background: Service provision is a key domain to assess national-level palliative care development. Three editions of the European Association for Palliative Care (EAPC) Atlas of Palliative Care monitored the changes in service provision across Europe since 2005. Aim: To study European trends of specialized service provision at home care teams, hospital support teams, and inpatient palliative care services between 2005 and 2019. Design: Secondary analysis was conducted drawing from databases on the number of specialized services in 2005, 2012, and 2019. Ratios of services per 100,000 inhabitants and increase rates on number of services for three periods were calculated. Analysis of variance (ANOVA) analyses were conducted to determine significant changes and chi-square to identify countries accounting for the variance. Income-level and sub-regional ANOVA analysis were undertaken. Setting: 51 countries. Results: Forty-two countries (82%) increased the number of specialized services between 2005 and 2019 with changes for home care teams (104% increase-rate), inpatient services (82%), and hospital support teams (48%). High-income countries showed significant increase in all types of services (p < 0.001), while low-to-middle-income countries showed significant increase only for inpatient services. Central–Eastern European countries showed significant improvement in home care teams and inpatient services, while Western countries showed significant improvement in hospital support and home care teams. Home care was the most prominent service in Western Europe. Conclusion: Specialized service provision increased throughout Europe, yet ratios per 100,000 inhabitants fell below the EAPC recommendations. Western Europe ratios' achieved half of the suggested services, while Central–Eastern countries achieved only a fourth. High-income countries and Western European countries account for the major increase. Central–Eastern Europe and low-to-middle-income countries reported little increase on specialized service provision. [ABSTRACT FROM AUTHOR]

Objective: As adolescent cancer patients may suffer from infertility following treatment, fertility counselling is essential. Our aim was to explore the current situation in four European countries in terms of (I) education about the risk for infertility, (II) counselling on fertility preservation, (III) patients' knowledge on fertility, (IV) sufficiency of information and (V) uptake of cryopreservation. Methods: In total, 113 patients (13–20 years) at 11 study centres completed a self‐report questionnaire three and six months after cancer diagnosis. Multivariate logistic regression was used to estimate odds ratios (OR) with 95% confidence intervals (CI). Results: As many as 80.2% of participants reported having received education about the risk for infertility prior to treatment, 73.2% recalled counselling on fertility preservation. Only 52.3% stated they felt sufficiently informed to make a decision. Inability to recall counselling on fertility preservation (OR = 0.03, CI: 0.00–0.47) and female gender (OR = 0.11, CI: 0.03–0.48) was associated with lower use of cryopreservation, whereas older age was associated with higher use. Conclusion: Fertility counselling was available to a relatively high proportion of patients, and it did influence the utilisation of cryopreservation. However, many patients did not feel sufficiently informed. Further improvement is needed to enable adolescent cancer patients to make an informed decision on fertility preservation. [ABSTRACT FROM AUTHOR]

Background Relationship status is an important factor associated with condomless anal intercourse (CAI) amongst men who have sex with men (MSM). Methods A multi-centre bio-behavioural survey with MSM was conducted in 13 European cities (n = 4901) exploring factors associated with CAI via bivariate and multivariate multilevel logistic regression analyses. Results Likelihood of CAI with casual partners was associated with being 'out' to a majority (AOR = 1.19;95% CI 1,1.42); knowing their HIV status (AOR = 1.86; 95% CI 1.25,2.76); using substances (1–2 AOR = 1.39; 95% CI 1.16,1.63, 2+ AOR = 1.81; 95% CI 1.35,2.42); being older (AOR = 0.98; 95% CI 0.97,0.99); successful sero-communication (AOR = 0.79; 95% CI 0.67,0.94); and, not having a recent HIV test (AOR = 0.78; 95% CI 0.66,0.92). CAI with steady partners was associated with successful sero-communication (AOR = 2.72; 95% CI 2.72,3.66); not having a recent HIV test (AOR = 1.26; 95% CI 1.09,1.46), and; being older (AOR = 0.99; 95% CI 0.98,0.99). Conclusions Understandings of partner type and/or relationship status in relation to CAI amongst MSM can potentially play an important role in the development of culturally appropriate HIV/STI prevention and risk-reduction efforts targeting at-risk MSM. Our results speak to the need to consider segmented and tailored public health and health promotion initiatives for MSM with differing CAI behaviours and relationship profiles. [ABSTRACT FROM AUTHOR]

Purpose: To test the impact of a nudge strategy (dish of the day strategy) and the factors associated with vegetable dish choice, upon food selection by European adolescents in a real foodservice setting. Methods: A cross-sectional quasi-experimental study was implemented in restaurants in four European countries: Denmark, France, Italy and United Kingdom. In total, 360 individuals aged 12–19 years were allocated into control or intervention groups, and asked to select from meat-based, fish-based, or vegetable-based meals. All three dishes were identically presented in appearance (balls with similar size and weight) and with the same sauce (tomato sauce) and side dishes (pasta and salad). In the intervention condition, the vegetable-based option was presented as the "dish of the day" and numbers of dishes chosen by each group were compared using the Pearson chi-square test. Multivariate logistic regression analysis was run to assess associations between choice of vegetable-based dish and its potential associated factors (adherence to Mediterranean diet, food neophobia, attitudes towards nudging for vegetables, food choice questionnaire, human values scale, social norms and self-estimated health, country, gender and belonging to control or intervention groups). All analyses were run in SPSS 22.0. Results: The nudging strategy (dish of the day) did not show a difference on the choice of the vegetable-based option among adolescents tested (p = 0.80 for Denmark and France and p = 0.69 and p = 0.53 for Italy and UK, respectively). However, natural dimension of food choice questionnaire, social norms and attitudes towards vegetable nudging were all positively associated with the choice of the vegetable-based dish. Being male was negatively associated with choosing the vegetable-based dish. Conclusions: The "dish of the day" strategy did not work under the study conditions. Choice of the vegetable-based dish was predicted by natural dimension, social norms, gender and attitudes towards vegetable nudging. An understanding of factors related to choosing vegetable based dishes is necessary for the development and implementation of public policy interventions aiming to increase the consumption of vegetables among adolescents. [ABSTRACT FROM AUTHOR]

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Purpose: This study illustrates the huge untapped potential of quantifying the impact of culture in making meaningful comparisons across groups. Our focus is on cross‐national differences in nurses' reports of their relations with physicians, and how the measurement of this complex construct and the evaluation of true differences are related to dimensions of national culture. Design: We examine across 14 European countries the association between indices of national culture from the seminal work of Hofstede and 39,435 nurses' ratings of their relations with physicians. Multilevel confirmatory factor analysis was used to evaluate strong factorial invariance across countries and to examine the influence of power distance and masculinity. Findings: There was wide variation across countries in nurses' reports of their relations with physicians. Strong factorial invariance was shown for a one‐factor model, which confirmed that across countries the seven survey items measure a common factor of physician‐nurse relations. This model showed no country bias for any of the seven survey items, which suggests that differences across countries reflect true differences. These true differences were significantly associated with variation in country values of power distance, which showed a significant negative correlation with physician–nurse relations. Conclusions: Continuously pursuing a better understanding of characteristics that impact the studied indicators, such as national culture, is elementary to better understand the construct under study. In this application, country values of power distance negatively impacted nurse‐reported relations with physicians, which strongly varied across countries. Clinical Relevance: Better nurse‐reported relations between nurses and physicians link to higher nurse job satisfaction, lower emotional exhaustion, better nurse‐perceived quality of care, and lower patient mortality. The Practice Environment Scale of the Nursing Work Index is an excellent instrument to characterize variation in working relations between nurses and physicians as well as physicians' professional posture towards nurses. [ABSTRACT FROM AUTHOR]

Nursing education will play an important role in further advancing healthcare transformation in the future. The aim of this study was to assess and compare nursing education and self-reported professional competence among nursing students graduating with a bachelor's degree from higher education institutions in Europe. Data were collected using the Nurse Professional Competence Scale including 88 items and eight competence areas. In total, 752 nursing students at 11 higher education institutions in Europe participated in the study, with a response rate of 88.7%. The highest measured mean scores were found in the competence areas 'Value-based nursing care' and 'Medical technical care' and the lowest were found in 'Legislation in nursing and safety planning' and 'Education and supervision of staff and students'. Nursing students in central Europe scored significantly higher on seven out of the eight competence areas than nursing students in northern and southern Europe. In order to standardize and further develop nursing education in Europe, the assessment of nursing-related competences is of crucial importance. [ABSTRACT FROM AUTHOR]

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

Background: Understanding how nursing students in European countries perceive their future professional role is an important step in creating awareness of the diversity and similarities between countries. Investigating nursing students' perceptions of their future profession could help in the design of education and the retention of nurses. Aim: To compare nursing students' perceptions of the professional nurse's role between Belarus, Lithuania, Poland and Sweden. Method: A cross‐sectional design was implemented. The study used two scales of the Professional Nursing Image Survey, which has questions about 10 skills and abilities and 14 functions and duties of a nurse. Results: A total of 392 final‐year nursing students in four countries participated in the study. Statistically significant differences were found between countries in terms of all 10 skills and abilities and in the distribution of responses concerning functions and duties of a nurse. Conclusions: Nursing students in Belarus, Lithuania, Poland and Sweden perceive differently the role of a nurse in terms of some functions and responsibilities. This may influence the adaptation of nurses who enjoy freedom of movement among the countries. Implications for nursing policy: The knowledge gained in this study could be beneficial in improving nursing education, as it could illuminate the discrepancy between educational goals and students' perceptions of their future professional role. [ABSTRACT FROM AUTHOR]

Purpose: Previous research has suggested that individuals are mostly prone to loneliness in their later years of life because of exposure to several risk factors typical of old age. The current study aims to examine possible demographic, health and social determinants of loneliness among older adults in Europe.Methods: Data on a nationally representative sample of 5074 Europeans aged ≥ 65 years were drawn from the first wave of the Survey of Health, Aging and Retirement in Europe (SHARE, 2004/2005). Frequency of feelings of loneliness was examined according to adverse health conditions, stressful life events and social isolation indicators.Results: Female gender, older age, lower socioeconomic status, living unpartnered, being childless and having no activity involvement were significantly associated with frequent feelings of loneliness (p < 0.001). The proportion of the respondents who declared enduring loneliness most of the time compared with none of the time was significantly higher among Southern Europeans relative to their Northern counterparts (p < 0.001). Recent departure of offspring from the parental nest was a significant predictor of loneliness in both the second (ORs = 2.08; 95% CI 1.24-3.48) and the third (ORs = 1.75; 95% CI 1.03-2.96) multiple regression models.Conclusion: In this sample of older Europeans, several demographic characteristics, specific adverse health conditions, stressful life events and social isolation indicators were associated with feelings of loneliness. Policy initiatives for the alleviation of loneliness in older age should therefore aim at improving psychosocial and health-related difficulties faced by this population. [ABSTRACT FROM AUTHOR]

New technology has made pornography increasingly accessible to young people, and a growing evidence base has identified a relationship between viewing pornography and violent or abusive behavior in young men. This article reports findings from a large survey of 4,564 young people aged 14 to 17 in five European countries which illuminate the relationship between regular viewing of online pornography, sexual coercion and abuse and the sending and receiving of sexual images and messages, known as “sexting.” In addition to the survey, which was completed in schools, 91 interviews were undertaken with young people who had direct experience of interpersonal violence and abuse in their own relationships. Rates for regularly viewing online pornography were very much higher among boys and most had chosen to watch pornography. Boys’ perpetration of sexual coercion and abuse was significantly associated with regular viewing of online pornography. Viewing online pornography was also associated with a significantly increased probability of having sent sexual images/messages for boys in nearly all countries. In addition, boys who regularly watched online pornography were significantly more likely to hold negative gender attitudes. The qualitative interviews illustrated that, although sexting is normalized and perceived positively by most young people, it has the potential to reproduce sexist features of pornography such as control and humiliation. Sex and relationships education should aim to promote a critical understanding of pornography among young people that recognizes its abusive and gendered values. [ABSTRACT FROM AUTHOR]

The stigma associated with a diagnosis of mental illness is well known yet has not reduced significantly in recent years. Health professionals, including nurses, have been found to share similar negative attitudes towards people with labelled with mental illness as the general public. The low uptake of mental health nursing as a career option reflects these stigmatised views and is generally regarded as one of the least popular areas of in which to establish a nursing career. The aim of the current project was to examine nursing students' attitudes towards the concept of mental illness and mental health nursing across four European countries (Ireland, Finland, Norway and the Netherlands), and Australia, using the Opening Minds Scale and the Mental Health Nurse Education survey. The surveys were distributed to students prior to the commencement of the mental health theory component. Attitudes towards mental health nursing were generally favourable. Differences in opinion were evident in attitudes towards mental illness as a construct; with students from Australia and Ireland tending to have more positive attitudes than students from Finland, Norway and the Netherlands. The future quality of mental health services is dependent on attracting sufficient nurses with the desire, knowledge and attitudes to work in mental health settings. Understanding attitudes towards mental illness and mental health nursing is essential to achieving this aim. [ABSTRACT FROM AUTHOR]

ABSTRACT: Background: Gastric residual volume measurement is routinely used to evaluate the feeding tolerance and gastro‐oesophageal reflux in patients receiving enteral feeding therapy in the intensive care unit. However, little supportive evidence for this intervention is available as the usefulness of gastric residual volume measurements in patients receiving enteral feeding therapy in the intensive care is controversial. Aim: The aim of this study was to assess the practice of intensive care unit nurses related to gastric residual volume measurement in patients receiving enteral nutrition. Methods: A survey was conducted among a sample of intensive care unit nurses (n = 832) from four hospitals in Turkey (n = 182) and attendees of the Annual Congress of the Flemish Society for Critical Care Nurses in Flanders, Belgium (n = 650). The survey instrument was developed by the researchers based on the related literature. Results: A total of 480 nurses completed the questionnaire (response rate = 73%). Gastric residual volume is measured by 98·0% of respondents, with wide variations in the frequency of measuring. A 50–200 mL gastric residual volume is considered problematic by 45·5% (n = 183) of the participants, and only 18·4% (n = 81) reported their practice to be based on a current guideline. Strikingly, more experienced intensive care unit nurses appear to perform gastric residual volume measurements more commonly than their less experienced colleagues (p = 0·004), while the practice is more often reported to be performed in Belgium than in Turkey (p < 0·001). Conclusion: Gastric residual volume management could be improved by applying current evidence to daily nursing practice. Relevance to clinical practice: Our results show that increased awareness of these guidelines by nurses is needed to reduce inefficient use of working time and resources, streamline clinical practices and improve patient outcomes. Current gastric residual volume measurement guidelines and up‐to‐date, relevant training should be provided to nurses. [ABSTRACT FROM AUTHOR]

Abstract: Background: How a woman gives birth can affect her health‐related quality of life (HRQoL). This study explored HRQoL at 3 months postpartum in women with a history of one previous cesarean in three European countries. Methods: A prospective longitudinal survey, embedded within a cluster randomized trial in three countries, exploring women's postnatal HRQoL up to 3 months postpartum. The Short‐Form Six‐Dimensions (SF‐6D) was used to measure HRQoL, and multivariate analyses were used to examine the relationship with mode of birth. Results: Complete data were available from 880 women. Women with a spontaneous vaginal birth had the highest HRQoL scores, whereas women with an emergency repeat cesarean (P = .01) had the lowest. Postnatal readmission of the mother (P = .03), having public health insurance (P = .04), and a low antenatal HRQoL score (P < .01) contributes to poorer HRQoL scores. More specifically, women with a spontaneous vaginal birth had significantly higher HRQoL scores on the vitality dimension compared with women with an emergency repeat cesarean (P = .04). Conclusions: In women with low‐risk factors, repeat cesareans result in a poorer HRQoL compared with vaginal birth. When there are no contraindications for vaginal birth, women with a history of one previous cesarean should be encouraged to give birth vaginally rather than have an elective repeat cesarean. [ABSTRACT FROM AUTHOR]

Narratives are a pervasive form of discourse and a rich source for exploring a range of language and cognitive skills. The limited research base to date suggests that narratives generated using aided communication may be structurally simple, and that features of cohesion and reference may be lacking. This study reports on the analysis of narratives generated in interactions involving aided communication in response to short, silent, video vignettes depicting events with unintended or unexpected consequences. Two measures were applied to the data: the Narrative Scoring Scheme and the Narrative Analysis Profile. A total of 15 participants who used aided communication interacted with three different communication partners (peers, parents, professionals) relaying narratives about three video events. Their narratives were evaluated with reference to narratives of 15 peers with typical development in response to the same short videos and to the narratives that were interpreted by their communication partners. Overall, the narratives generated using aided communication were shorter and less complete than those of the speaking peers, but they incorporated many similar elements. Topic maintenance and inclusion of scene-setting elements were consistent strengths. Communication partners offered rich interpretations of aided narratives. Relative to the aided narratives, these interpreted narratives were typically structurally more complete and cohesive and many incorporated more elaborated semantic content. The data reinforce the robust value of narratives in interaction and their potential for showcasing language and communication achievements in aided communication. [ABSTRACT FROM PUBLISHER]

Vocabulary learning reflects the language experiences of the child, both in typical and atypical development, although the vocabulary development of children who use aided communication may differ from children who use natural speech. This study compared the performance of children using aided communication with that of peers using natural speech on two measures of vocabulary knowledge: comprehension of graphic symbols and labeling of common objects. There were 92 participants not considered intellectually disabled in the aided group. The reference group consisted of 60 participants without known disorders. The comprehension task consisted of 63 items presented individually in each participant’s graphic system, together with four colored line drawings. Participants were required to indicate which drawing corresponded to the symbol. In the expressive labelling task, 20 common objects presented in drawings had to be named. Both groups indicated the correct drawing for most of the items in the comprehension tasks, with a small advantage for the reference group. The reference group named most objects quickly and accurately, demonstrating that the objects were common and easily named. The aided language group named the majority correctly and in addition used a variety of naming strategies; they required more time than the reference group. The results give insights into lexical processing in aided communication and may have implications for aided language intervention. [ABSTRACT FROM PUBLISHER]

Purpose To develop and perform reliability and validity assessments of the international Multidimensional Nursing Generations Questionnaire. Background There are three generations of nurses in the European workforce. There is little research on the characteristics of these generations and the ways in which to manage them professionally, and no instrument has yet been developed to measure these aspects specifically. Methods With results from previous studies, 69 nursing generations-oriented items were created in English, translated into Italian and Finnish, and pretested to form the basis of an instrument that was tested between September and October 2014 on a sample of Finnish and Italian nurses ( n = 1302) using principal component analysis and Cronbach's alpha. Results Fifty-four items and eight components (Cronbach's α range: 0.61-0.81) were identified in the instrument: (1) conflicts between generations; (2) patient safety view; (3) relationships between generations; (4) working as a multigenerational team; (5) orientation to change; (6) presenteeism and job propensity; (7) intention to leave, and (8) flexibility and availability. Conclusions The instrument showed acceptable preliminary psychometric properties and satisfactory internal consistency. Implications for nursing management The Multidimensional Nursing Generations Questionnaire is a useful tool to measure the characteristics of different generations of nurses and to develop management strategies tailored to those generations. [ABSTRACT FROM AUTHOR]

Purpose: There are limited data on the contribution of fortified foods and nutritional supplements to intakes of vitamin D in young children. Our objective was to examine the intake, adequacy, risk of excessive intake and sources of dietary vitamin D. Methods: The nationally representative cross-sectional dietary survey of young children (aged 1-4 years) ( n 500) was used to evaluate vitamin D intake and quantify the contribution of the base diet, fortified foods and nutritional supplements to total intake. Results: Median (IQR) intakes of vitamin D were generally low in this young population, ranging from 2.0 (1.9) to 2.5 (4.9) µg/day. Ninety-three and 78 % of children had intakes below 10 and 5 µg/day, respectively. While vitamin D supplement users (17 %) had the highest intakes [6.7 (6.4) µg/day] ( P < 0.001), 74 % had intakes below 10 µg/day. Vitamin D-fortified foods, consumed by 77 % of children [2.2 (2.0) µg/day], made nutritionally significant contributions to intake [0.8 (1.6) µg/day], particularly in younger children [1.5 (4.6) µg/day]. Children who did not use nutritional supplements or fortified foods had significantly ( P < 0.001) lower intakes of vitamin D than the other groups [1.0 (0.8) µg/day]. Our analyses show the importance of milk and yoghurt, meat and fortified ready-to-eat cereals as sources of vitamin D in this age group. The use of nutritional supplements or fortified foods at current levels does not represent a risk of intakes exceeding the European Food Safety Authority (EFSA) tolerable upper intake level (UL) (50 µg/day), as intakes did not exceed or even approach the UL (P95: 22 % of UL). Conclusion: Intakes of vitamin D in preschool children in Ireland are generally low. Nutritional supplements and fortified foods make significant contributions to intakes of vitamin D, without risk of unacceptably high intakes. Though supplements are effective in raising intakes of vitamin D in users, uptake is low (17 %). Food fortification may represent a suitable public health approach to increasing vitamin D intakes. The national food consumption data of Irish preschool children provide the ideal starting point for modelling of fortification scenarios to identify which foods and levels of addition will ensure effective and safe increases in vitamin D intake. [ABSTRACT FROM AUTHOR]

Evidence on the association between mode of delivery and asthma at school age is inconclusive. We assessed the associations between specific modes of delivery and asthma in children from 9 European birth cohorts that enrolled participants between 1996 and 2006. Cohort-specific crude and adjusted risk ratios for asthma at ages 5-9 years were calculated using Poisson regression models and pooled. A sensitivity analysis was carried out in children born at term to reduce confounding due to perinatal factors. The study included 67,613 participants. Cohort-specific rates of cesarean delivery varied from 9.4% to 37.5%. Cesarean delivery, as opposed to vaginal delivery, was associated with an increased risk of asthma (adjusted risk ratio (aRR) = 1.22, 95% confidence interval (CI): 1.02,1.46). Compared with spontaneous vaginal delivery, the adjusted risk ratio was 1.33 (95% CI: 1.02,1.75) for elective cesarean delivery, 1.07 (95% CI: 0.94, 1.22) for emergency cesarean delivery, and 0.97 (95% CI: 0.84, 1.12) for operative vaginal delivery. In children born at term, the associations were strengthened only for elective cesarean delivery (aRR = 1.49, 95% CI: 1.13, 1.97). The large sample size allowed analysis of the associations between specific modes of delivery and asthma at school age. The increased risk of asthma associated with elective cesarean delivery, especially among children born at term, is relevant in counteracting the increasing use of this procedure, which is often performed without a clear medical indication. [ABSTRACT FROM AUTHOR]

Objective The objective was to determine the effect of frailty on risk of 30-day mortality in nonseverely disabled older patients with acute heart failure ( AHF) attended in emergency departments ( EDs). Methodology The Frailty- AHF Study is a retrospective analysis of a multicenter, observational, prospective, cohort study (Older- AHF Register). This study included consecutive patients ≥ 65 years of age without severe functional dependence or dementia attended for AHF in three Spanish EDs for 4 months. Frailty was defined by frailty phenotype as the presence of three or more domains. Baseline and episode characteristics and 30-day mortality were collected in all the patients. Results A total of 465 patients with a mean (± SD) age of 82 (±7) years were included, 283 (61.0%) being female and 225 (51.3%) with severe comorbidity (Charlson index ≥ 3). Frailty was present in 169 (36.3%). The rate of 30-day mortality was 7.3%. Frailty adjusted for potential confounding factors was an independent factor associated with 30-day mortality (adjusted hazard ratio = 2.5; 95% confidence interval = 1.0 to 6.0; p = 0.047). Conclusion The presence of frailty is an independent risk factor of 30-day mortality in nonsevere dependent older patients attended with AHF in EDs. [ABSTRACT FROM AUTHOR]