Search

Aims: The European Society of Cardiology (ESC) guidelines state that heart failure nurse specialists (heart-failure nurses) with specific competences are essential for a successful heart-failure-management programme. Thus, the Heart Failure Association (HFA) of the ESC developed the heart failure nurse curriculum (HFA curriculum). Several ESC member states developed cardiovascular education programmes to enable nurses to deliver high specialist care, but little is known of whether these curricula are in line with the HFA curriculum. Therefore, this paper describes the extent to which cardiovascular education programmes in Belgium, The Netherlands and Germany correspond to the HFA curriculum. Methods and results: A case study approach was adopted to obtain an in-depth understanding of the programme contents in relation to the HFA curriculum. For this purpose, representatives of the educational programmes and/or delegates of the national cardiovascular nursing organization shared their educational curricula. All of the studied cardiovascular education programmes aim to provide heart failure and/or cardiovascular nurses with essential competences for implementation of evidence based and guideline derived care. However, every cardiovascular education programme has a different focus/area of attention. Cardiovascular education in Belgium discusses aspects of all core-learning objectives of the HFA curriculum and emphasizes mostly knowledge aspects of these. Learning objectives in cardiovascular education in The Netherlands focus on chronic diseases in general and on learning objectives concerning patient education, support in self-care and management of device and pharmacological therapy. Cardiovascular education in Germany discusses most learning objectives; however, not all learning objectives receive equal attention. Conclusions: Although local cardiovascular education programmes adopt certain aspects of the HF curriculum, the curriculum as a whole is not adopted. [ABSTRACT FROM AUTHOR]

Background: Our aim, within the collaborative study SPHERE (Strengthening Public Health Research in Europe), was to produce a bibliometric overview of public health research literature for Europe. Methods: A search strategy ('filter') was designed to interrogate the Science Citation Index (SCI) and the Social Science Citation Index (SSCI) databases for research articles published between 01/01/1995 and 31/12/2004 in any language. We analysed output for country by population, Gross Domestic Product (GDP), burden of disease using DALYs, and language. Results: Overlap between the two databases SCl and SSCI was 35%. 210433 publications were identified after duplicates were removed, a world total of about 20000 per year. Approximately 7000 papers per year were produced in Europe and 9400 by the USA. Thirteen of 28 individual European countries produced more than 100 public health papers per year. Publications per capita were highest in northern European countries. In multiple regression analyses, GDP was a modest predictor (r² = 0.53, P< 0.02) of publications for European countries, while population size and disability adjusted life years were not significantly related. Smaller countries and lower producers of public health research were more likely to collaborate with other countries. Of the publications, 3.5% were published in a non-English language, with German the most common. Conclusion: There is marked variation in public health publication by country in Europe. Eastern and southern European countries appear to under-invest in public health research compared with northern European countries and compared to relative health need. [ABSTRACT FROM AUTHOR]

The paper presents the main conclusions and recommendations derived from the EVIDOS project, which is supported by the European Commission within the 5th Framework Programme. EVIDOS aims at evaluating state of the art neutron dosimetry techniques in representative workplaces of the nuclear industry with complex mixed neutron-photon radiation fields. This analysis complements a series of individual papers which present detailed results and it summarises the main findings from a practical point of view. Conclusions and recommendations are given concerning characterisation of radiation fields, methods to derive radiation protection quantities and dosemeter results. [ABSTRACT FROM AUTHOR]

This paper studies the sustainability of fiscal policy for selected Euro-area countries. We focus on those countries that either have a high debt to GDP ratio (Italy) or have recently violated the Maastricht treaty by permitting more than three percent of the deficit to GDP ratio (France, Germany, and Portugal). We apply an approach developed by Bohn who proposes to study whether the primary surplus to GDP ratio is a positive function of the debt to GDP ratio which does not need arbitrary discount rates that other approaches have to assume. By controlling for the impact of other variables in this process, we can show that for the above mentioned countries fiscal policy shows evidence for sustainability, although the three percent rule of the Maastricht treaty might temporarily be violated. We also compare our results from the Euro-area countries to results obtained for the US fiscal policy. [ABSTRACT FROM AUTHOR]

This paper considers the role that the journals system plays in supporting scientific productivity: a critical issue for publishers, librarians and research managers at a time of considerable upheaval in scholarly communication, notably the rise of open access models. The survey findings presented here support the unfashionable view that reader open access is something of a non-issue for the two author communities studied: corresponding authors in immunology and microbiology. Other issues, notably how financial and human resources are organised and deployed appear to be much more serious issues for biomedical researchers. The key policy implication of this work is that Europe could improve its research performance by listening more carefully to its scientists and harnessing those resources more effectively. [ABSTRACT FROM AUTHOR]

In recent years, various democracies have faced the problem of nondemocratic political parties. In response, some have adopted the practice of the party ban. The main focus in existing jurisprudence has been on the external activities of these parties. In determining whether a political party is nondemocratic, attention has centered on the party's goals and practices. This judicial practice, manifest in different European constitutional courts as well as the European Court of Human Rights, is problematic. It often ignores an essential element in political parties, namely, their internal structures. This paper argues that political parties must be democratic not only externally, in their goals, but also democratic internally, in their organizational practices. The very interdependence between political parties and democracies should promote the parties' adherence not only to democratic goals and activities but also to democratic internal structures. This paper further argues that such internal democracy must be mandatory, and that, in rare cases, there is valid justification for banning political parties that lack internal democracy. [ABSTRACT FROM PUBLISHER]

Introduction: the ACMEplus project aims to devise a standardised system for measuring case-mix and outcome in older patients admitted to hospitals in different parts of Europe for primarily 'medical' (i.e. not surgical or psychiatric) reasons. As a first step in this project, a systematic review was carried out to identify factors which had a significant influence on outcome in such patients. Methods: the systematic search used Medline 1966-2000, Cinahl 1982-2000, Web of Science 1981-2000, reference lists of relevant papers and a hand search of Age and Ageing 1974-2000. A six-category grading system was devised to classify the 313 identified papers with regard to their relevance to the ACMEplus project, study design and power. The analysis of the 14 'category 1' papers is presented. Results: the main areas of assessment of case-mix were function, cognition, depression, illness severity, nutrition, social elements, aspects of diagnosis and demographic details. Statistically significant predictors, for the four outcome measures, listed below were: i. For length of stay: functional status score, illness severity, cognitive score, poor nutrition, comorbidity score, diagnosis or presenting illness, polypharmacy, age and gender. ii. For mortality: functional status score, illness severity, cognitive score, comorbidity score, diagnosis or presenting illness, polypharmacy, age and gender. iii. For discharge destination: functional status score, cognitive score, diagnosis or presenting illness and age. iv. For readmission rate: functional status score, illness severity, co-morbidity, polypharmacy, diagnosis or presenting illness and age. Conclusions: factors affecting outcome in older medical patients are complex. When looking at outcomes of hospital admission in older people it is important not just to look at routinely available statistics such as age, gender and diagnosis but also to take into account multifaceted aspects such as functional status and cognitive function. [ABSTRACT FROM AUTHOR]

The article comments on the papers that evaluated the smoking prevention project in Europe. Jackie Green, professor at Leeds Metropolitan University, said that the papers made a valuable contribution to the people's understanding of smoking in adolescence. Lilian Lechner, professor at Open University of the Netherlands, commented that the papers mentioned goals, objectives, and methods without describing them.

This paper discusses the work of the EUHPID Project to develop a European Health Promotion Monitoring System based on a common set of health promotion indicators. The Project has established three working groups to progress this task -- health promotion policy and practice-driven, data-driven and theory-driven. The work of the latter group is reviewed in particular. EUHPID has taken a systems theory approach in order to develop a model as a common frame of reference and a rational basis for the selection, organization and interpretation of health promotion indicators. After reviewing the strengths and weaknesses of those health promotion models currently proposed for indicator development, the paper proposes a general systems model of health development, and specific analytical, socio-ecological models related to public health and health promotion. These are described and discussed in detail. Taking the Ottawa Charter as the preferred framework for health promotion, the socio-ecological model for health promotion adopts its five action areas to form five types of systems. The structure and processes for each of these five systems are proposed to form the basis of a classification system for health promotion indicators. The paper goes on to illustrate such a system with reference to indicators in the workplace setting. The EUHPID Consortium suggest that their socio-ecological model could become a common reference point for the public health field generally, and offer an invitation to interested readers to contribute to this development. [ABSTRACT FROM AUTHOR]

In this paper it is argued that imperfect competition should be given more attention by agricultural economists as the characteristics of food markets in Europe (and elsewhere) suggest that these markets are more typically oligopolistic. Particularly important in this regard is the growing market power of food retailers in many European countries. The analysis of imperfect competition should not be confined to those solely interested in competition policy issues but should also be the concern of economists who undertake applied policy analysis more generally. [ABSTRACT FROM AUTHOR]

This paper discusses the current Labour government's industrial policy—as most recently reflected in its document on manufacturing strategy—in the context of industrial policy in the UK over the last 50 years and the form that it has taken elsewhere in Europe. It concludes that the thematic priorities for UK industrial policy in the 1960s—international competitiveness, innovation, competition, and skills—continue to be the key themes of UK policy today. The paper presents data that illustrate the gaps that exist in key indicators of performance between the UK and its main economic competitors. The difference between the 1960s and the 2000s is that there are new instruments of policy. Two areas in particular are focused on—competition policy and technology policy—and an attempt is made to assess the likely effectiveness of these new instruments. The paper concludes that the international evidence base for these new approaches is reasonably robust but that it is still too soon to tell if they are having the hoped‐for impact on the performance of the UK economy. [ABSTRACT FROM PUBLISHER]

In this paper, we study the changes in corporate valuations induced by the adoption of the euro as the common currency in Europe. We use corporate-level data from seventeen European countries, of which eleven adopted the euro. We show that the introduction of the euro has increased Tobin's Q-ratios by 17.1% in the euro-area countries that previously had weak currencies. Part of the increase in corporate valuations is explained by the decrease in interest rates and by the decrease in the cost of equity. The increases in Tobin's Q are larger for firms that would be harmed by currency devaluations. [ABSTRACT FROM AUTHOR]

A conference paper about the asylum system and refugee paradigm in Europe is presented. It explains the internal dimension and external dimension of the European asylum system and how the European Union is moving towards a more systematic approach to handling asylum. It discusses the challenges of European states in defining the refugee paradigm, as well as their fear of the legal obligations when considering someone a refugee.

A conference paper about the need for the establishment of transparent and liberal asylum and immigration policies in Europe is presented. It explains the consequences of the absence of immigration policies in Europe, which include making it a continent of immigration from a continent of emigration. It discusses long-term objectives that can be fulfilled when liberal and well-defined immigration policies are created in Europe.

A conference paper about the asylum system in Europe is presented. It discusses the asylum policy of the European Union (EU), with its members setting several targets including the creation of a uniform status for refugees and a common asylum procedure, and limitations on asylum seekers' secondary movements. It explains the role of EU as the intermediary between the international system and member states with regards to asylum responsibilities.

A conference paper about the challenge of European identity, as well as the nature of asylum and migration in a pluralistic and open society is presented. It highlights how a common European identity is affected by several factors which include language, religion, political values, and institutional and administrative integration. It explains why restricting the numbers of foreigners will not be adopted or considered as a measure to create a common European identity.

The paper analyzes bank performance in the context of the integrated European Union market and its member countries. First, the paper investigates the technical efficiency of banks in each country sample using a Data Envelopment Analysis (DEA) model incorporating only banking variables. Then, a second DEA model is defined incorporating environmental factors together with banking variables in order to standardize the country-specific environmental conditions. Based on these models, the paper systematically analyzes the efficiency position for each of the European banking industry if average banks decide to operate in any other country. The results indicate that adverse (advantageous) environmental conditions are a positive (negative) factor for the home banking industry and being technically efficient appears to be a significant deterrence to foreign competition. [ABSTRACT FROM AUTHOR]

William Osler was the greatest physician of his time. Specialists reading his textbooks agreed that in their own specialities he was accurate and illuminating. His grasp of dermatology was particularly striking and skin changes are prominent in five of the syndromes named after him and in at least 100 of his papers. This paper describes how his early training in dermatology under Tilbury Fox in London and Hebra in Vienna combined with his unusual personal qualities to enable him to make massive contributions to a wide variety of dermatological topics. These include smallpox, cutaneous tuberculosis, nail growth, leprosy, scleroderma, pigmentation and purpuric eruptions as well as the more obvious hereditary haemorrhagic telangiectasia, angio-neurotic oedema and Osler’s nodes. [ABSTRACT FROM AUTHOR]

The authors introduce the issue, themed From Data to Public Health Actions, which features work conducted by the Population Health Information Research Infrastructure (PHIRI). Topics discussed include an overview of PHIRI, essential pillars covered by PHIRI to support strong and resilient HIS and research for evidence-based policy making across Europe, and role of PHIRI in the implementation of the European Health Data Space (EHDS).

At Europe's most congested airports demand for take-off and landing slots has exceeded the available supply for many years. Yet, in the face of persistent growth in air traffic activities, these airports have achieved remarkable increases in their capacities to handle flights, despite retaining the same basic infrastructures. This paper investigates this growth of capacity as a 'problem centred innovating system', in which the roles of procedural change and co-operation between teams are highlighted. 'System evolution' is also observed, as over time new agents with different knowledge bases have been brought into 'the system' to assist with the search for additional capacity. [ABSTRACT FROM AUTHOR]

In a rapidly globalizing economy, and particularly in the face of a process of economic integration such as that occurring in the EU, regions forge an increasing number of linkages with other locations within and across national boundaries through the local technological development efforts of multinational corporations (MNCs). By using a database of patents granted to the largest firms by the US Patent and Trademark Office (USPTO), we have shown in previous research that the pattern of MNC networks for innovation conforms to an internal (within national boundaries) hierarchy of regional centres. In this paper the hypothesis of the combined significance of cumulativeness and incremental change in innovation is examined by testing the extent of continuity in the sectoral composition of technological profiles of different EU regional centres between the I970s and the 1990s. The results provide support for our hypothesis that a geographical hierarchy of regional locations can be established also across national boundaries within the EU. It is shown that the core European regions can be divided into two kinds—those in which MNCs have consolidated areas of traditional specialisation for the regions in question, and those in which there has been a shift towards (and a relative growth of) the development of fields of high technological opportunities. [ABSTRACT FROM AUTHOR]

Facing the considerable variation in the computation of disability-adjusted life years (DALY) in the numerous updates of the Global Burden of Disease (GBD) study and many independent studies, the European burden of disease network (burden-eu) launched a series of systematic literature reviews (SLR) to explore the key assumptions used in the European burden of disease (BoD) studies. The SLR will provide an overview of the existing BoD studies and the computational variations used and will also help identifying ways to harmonize the approaches enhancing the comparability of BoD estimates. The SLR was split in four parallel reviews: noncommunicable diseases (NCDs), communicable diseases (CDs), injuries and risk factors. For the first three, the search strategy included terms describing the population (GBD area ‘‘European region’’) and the BoD measures (years lived with disability, years of life lost, and DALYs). We included studies published between January 1990 and April 2020, without language restrictions. The search strategy was run in PubMed, Web of Science, Cochrane, and Embase. OpenGrey, OAIster, CABDirect, WHO and targeted public health agency websites were screened for grey literature. In addition, burden-eu members were asked to supplement the list of publications with any material available within their national public health institutes. Data extraction focused on methodological information. The title, abstract and full-text screening resulted in the final inclusion of 165 papers regarding NCDs, 189 with CDs, and 124 papers regarding injuries. The final list includes peer-reviewed articles and reports showing a variability in data sources used (e.g. patient medical records, disease registries, insurance claims sources) and model assumptions (e.g. use of multi-morbidity adjustments, use of disability weights). Further data extraction and analysis is in process, and will be presented during the workshop. [ABSTRACT FROM AUTHOR]

Over the past 20 years, Europe has deregulated many industries, protected consumer welfare, and created strongly independent regulators. These policies represent a stark departure from historical traditions in continental Europe. How and why did this turnaround happen? We build a political economy model of market regulation and we compare the design of national and supra-national regulators. We show that countries in a single market willingly promote a supranational regulator that enforces free markets beyond the preferences of any individual country. We test and confirm the predictions of the model. European institutions are indeed more independent and enforce competition more strongly than any individual country ever did. Countries with ex-ante weaker institutions benefit more from the delegation of competition policy to the EU level. [ABSTRACT FROM AUTHOR]

This paper aims to develop and empirically test a model which examines the relationships between academics' social capital and their engagement in technology and knowledge transfer via entrepreneurial and traditional activity. Social capital is assessed through individuals' orientation, desire, and willingness to work with others. The data gathered from academics at four different European universities are used to test the proposed relationships by performing structural equation modeling. Overall, our findings reveal that academics' social capital is significantly related to their engagement in technology and knowledge transfer. Being oriented to teamwork stimulates academics' desire to participate in interdisciplinary projects with industry and partially stimulates multidisciplinary research. Both interdisciplinary projects with industry and multidisciplinary research are positively related to industry interactions, which are significantly related to academics' further engagement in patenting, business activity, and scientific publishing. [ABSTRACT FROM AUTHOR]

The unprecedented geopolitical shift resulting from Brexit reflects deep socioeconomic fault lines within and beyond the UK. In many ways foreshadowing the US presidential election of Donald Trump, Brexit brought to the surface and gave a public voice to socio-economic divisions that were deeply embedded, sometimes illogical, but until now had either been ignored or hushed out of 'respectable' public debate. This Discussion Forum emanates from a spontaneous seminar organized 2 days after the Brexit vote on June 25, 2016 as part of the SASE conference held in University of California-Berkeley and followed by an open call for papers by Socio-Economic Review. The papers here draw attention to the origins of the Brexit vote in deep-seated socio-economic divisions (O'Reilly), widening differences in economic performance across sectors and regions of the UK (Froud, Sukhdev and Williams) and the growth of poor quality jobs (Warhurst). Meanwhile, the political dynamics of the Brexit vote were also shaped by the fractured nature of UK business elites (Morgan), divisions between locals and cosmopolitans (Grey) and creative but muddled actions of elites that arguably generated consequences they themselves failed to fully anticipate (Wood and Wright). From the perspective of Europe, Brexit reflects a history of dysfunctional economic policy in Europe that prioritized market competition in ways that neglected and ultimately undermined solidarity (Boyer). Here, Brexit reflects a political strategy to both renationalize and recommodify solidarity in the face of fears over migration, and which are likely to have major consequences for social solidarity in Europe more generally (Frerichs and Sankari). However, Brexit is unlikely to provide a durable social and political solution to the wider tensions between globalization and democracy, which also affect all countries throughout Europe (Rona-Tas). Ultimately, the Brexit vote underlines social divisions that combine class inequalities with regional ones, not just in Britain but throughout Europe (Le Galés). [ABSTRACT FROM AUTHOR]

Various examples of complementary currencies have recently emerged in Europe in response to the impact of the 2007 financial crisis. They have been variously labelled as social, local and alternative money but their economic meaning has still to be discussed. On the one hand, they have been hailed as innovative tools for socioterritorial policies with a focus on localist, anti-globalist and anti-capitalist values. On the other, the emphasis on the value of currencies as instruments of alternative territorial development runs the risk of overshadowing issues concerning the specific features of such projects. The first part of this paper puts forward an interpretation of the current situation as a crisis of the liquidity principle and suggests that the principle of clearing instead represents the primary point of reference for any institutional arrangement aimed at restoring a balanced relationship between lenders and borrowers. A critical review of known European complementary monetary circuits is followed by examination of the Sardex clearing system. The paper then goes on to argue by means of a stock-flow consistent model that complementary monetary circuits can serve to stabilise local economic systems. In particular, a local clearing union for local exchanges has the effect of stabilising the profits of firms while attenuating the impact of the credit crunch at same time. [ABSTRACT FROM AUTHOR]

Context/problem: Comparative analysis of relative and absolute mortality differentials between socioeconomic groups are now available. These show consistently increasing relative increases in mortality differentials but complex trends in absolute mortality differentials. Objective: This paper provides an analysis of relative and absolute trends in mortality by cause of death and socioeconomic group (SEG) from 1984 to 2008 among men and active women aged 30-64 years in Ireland and compares these results with recent European and US studies to give an overview of trends. Methods: This paper uses mortality data from the Irish Central Statistics Office from 1984 to 2008 to calculate standardized death rates by age, sex, socioeconomic status and cause of death showing trends in SEG inequalities in mortality in Ireland. These show which specific causes of death are driving all-cause mortality trends. Results: SEG differentials in all-cause mortality among men and women have been increasing since the 1980s. Some of this increase reflects larger falls in cardiovascular causes among advantaged groups, but the trend is largely accounted for by increasing inequalities in mortality in digestive, neoplasm and external causes of deaths. Conclusions: These findings are in line with international findings that show that socioeconomic differentials in digestive, neoplasm and external cause deaths are driving general socioeconomic differentials in all-cause mortality. External cause deaths may have been influenced by levels of economic activity, particularly in construction, during the economic boom among manual workers. Furthermore, deaths from digestive diseases during the 1990s and 2000s may well be the result of increases in liver disease associated with excessive alcohol consumption. [ABSTRACT FROM AUTHOR]

The European Urban Health Indicators System Project Part 2 (EURO-URHIS 2) is a cross-national study that was implemented in Europe. It consists of four data collection tools that were specifically developed to collect health data at an urban level. This paper reviews some of the methodological constraints in adapting the EURO-URHIS 2 study in Ho Chi Minh City, Vietnam. No attempt to extend the original study beyond Europe has been reported before. Cultural, political, economic and social differences create specific obstacles as well as challenges. This paper sets out how these challenges were addressed, examining key aspects of the methodology, including study design, translation of the questionnaire and data collection. It was found that the EURO-URHIS 2 adult data collection tool methodology could not be replicated in Vietnam. A lack of basic infrastructure and population registers led to significant changes being made to the sampling and survey administration. It was recommended that the Expanded Programme on Immunization (EPI) was used as the replacement method. Despite the limitations in using the EPI method, the overall strengths and benefits were found to address methodological issues and the resource poor setting. [ABSTRACT FROM AUTHOR]

Europe's debt crisis resembles historical episodes of outright default on domestic public debt about which little research exists. This paper proposes a theory of domestic sovereign default based on distributional incentives affecting the welfare of risk-averse debt and nondebtholders. A utilitarian government cannot sustain debt if default is costless. If default is costly, debt with default risk is sustainable, and debt falls as the concentration of debt ownership rises. A government favoring bond holders can also sustain debt, with debt rising as ownership becomes more concentrated. These results are robust to adding foreign investors, redistributive taxes, or a second asset. [ABSTRACT FROM AUTHOR]

This paper unveils a new resource for macroeconomic research: a long-run dataset covering disaggregated bank credit for 17 advanced economies since 1870. The new data show that the share of mortgages on banks' balance sheets doubled in the course of the twentieth century, driven by a sharp rise of mortgage lending to households. Household debt to asset ratios have risen substantially in many countries. Financial stability risks have been increasingly linked to real estate lending booms, which are typically followed by deeper recessions and slower recoveries. Housing finance has come to play a central role in the modern macroeconomy. [ABSTRACT FROM AUTHOR]

Europe's financial structure has become strongly bank-based-far more so than in other economies. We document that an increase in the size of the banking system relative to equity and private bond markets is associated with more systemic risk and lower economic growth, particularly during housing market crises. We argue that these two phenomena arise owing to an amplification mechanism, by which banks overextend and misallocate credit when asset prices rise, and ration it when they drop. The paper concludes by discussing policy solutions to Europe's 'bank bias', which include reducing regulatory favouritism towards banks, while simultaneously supporting the development of securities markets. [ABSTRACT FROM AUTHOR]

Tropospheric ozone is an air pollutant that poses a public health problem in Europe. Climate change could increase the formation of ozone. Applying past and predicted annual total (all-cause) mortality data and modeled daily ozone concentrations, we performed a nationwide health impact assessment estimating annual ozone-related (attributable) deaths in Austria. Different approaches were compared. Estimates were based on maximal 1-h averages of ozone. Until the decade from 2045 till 2055, more people will die in Austria because of the demographic trends. Therefore, more deaths will also be attributable to ozone. Higher greenhouse gas emission scenarios (e.g. Representative Concentration Pathway RCP8.5 compared to RCP2.6) will lead to more ozone-related deaths, mostly due to the national emission of ozone precursors (a difference of 250–340 cases per year, depending on the model), but to a lesser extent because of global climate change. Increases in attributable deaths will be affected mostly by national, not global mitigation measures. National emission reduction will certainly have a strong and beneficial effect on local atmospheric chemistry, air quality, and public health. [ABSTRACT FROM AUTHOR]

If Rome was for centuries the centre of power and influence for Christendom and the European world of learning associated with it, Brussels can claim to be such a twofold centre in the late twentieth century. The radical pluralism and postmodernist orientations which are now part of the Enlightenment legacy becloud the point that a new uniformity of belief and outlook -- mercenary rather than spiritual -- furnishes the context for most educational policy-making in European countries. Far from calling for a return to a patriarchal past, the paper attempts to sketch an understanding of education as a universally defensible practice, while addressing the challenges of both postmodernism and the new uniformity. [ABSTRACT FROM AUTHOR]

This article contributes to two debates about international relations (IR) as a discipline: first, how global is IR, and how is it structured? Second, what is the state of theory in IR? We conducted (co-) citation analyses of both Web of Science (WoS) and—for the first time— non-WoS publications from Europe, North America, Latin America, Africa, and Asia. With regard to the first question, we find that global IR resembles a core–periphery structure as a "hub and spoke" system whereby transatlantic core nodes are interconnected to each other and to some periphery nodes, while the periphery nodes are connected to the core but not to each other. IR scholarship in the periphery quotes the transatlantic theory cluster but is not linked to each other, not even in the same region. Knowledge produced in the periphery has to go through the transatlantic core in order to be recognized globally. As to the transatlantic core, we identify two major (co-) citation clusters: one committed to IR theory-building across issue areas from a variety of perspectives and the other focused on security studies with a strong emphasis on quantitative methods. With regard to the second question, global IR hangs together through references to the IR theory cluster consisting of North American and European authors who appear to define what IR theory is. Scholars in the periphery refer to this transatlantic IR theory cluster when engaging in theory-building. IR theories have become rather diverse and pluralistic, even in the core. While scholars still refer to the big "isms," they use them around the globe in a synthesizing manner. [ABSTRACT FROM AUTHOR]

Background As digitalization is progressively permeating all aspects of society, how can be it fruitfully employed to sustain the public health goals of quality, accessibility, efficiency and equity in health care and prevention? In this paper, we reflect on the potential of applying digital tools to public health and discuss some key challenges. Methods We first define 'digitalization' in its broader sense, as well as applied to public health. We then build a conceptual framework where key public health domains are associated to available digital technologies in a matrix that help to identify digital features that bolster public health action. We also provide illustrative data and evidence on the application of digital solutions on selected public health areas. In the second part, we identify the strategic pillars for a successful European strategy for public health digitalization and we outline how the approach being pursued by the European Public Health Association (EUPHA) applies to digital health. Results From a public health perspective, digitalization is being touted as providing several potential benefits and advantages, including support for the transition from cure to prevention, helping to put people and patients at the center of care delivery, supporting patient empowerment and making healthcare system more efficient, safer and cheaper. These benefits are enabled through the following features of digital technologies: (i) Personalization and precision; (ii) Automation; (iii) Prediction; (iv) Data analytics and (v) Interaction. Conclusion A successful European strategy for public health digitalization should integrate the following pillars: political commitment, normative frameworks, technical infrastructure, targeted economic investments, education, research, monitoring and evaluation. EUPHA acknowledges digitalization is an asset for public health and is working both to promote the culture of "public health digitalization", as well as to enable its planning, implementation and evaluation at the research, practice and policy level. [ABSTRACT FROM AUTHOR]

With a clear emphasis on substantive political value that national legislatures are able to bring to the EU legislative process, this paper attempts to overcome skepticism about deepening national parliaments' direct involvement in the decision-making process at the European level. The role of national parliaments in advancing their subsidiarity concerns within European law-making may be strengthened through a more intensive political dialogue with the Commission, when the former acts not just as the 'guardians' of the subsidiarity principle (in the framework of the existing yellow and orange card schemes) but also as active contributors to the law-making process encouraging the Commission to leverage the so-called green card procedure. Complemented by the yellow and orange card provisions, it forms a three-element subsidiarity review mechanism perfectly capable of dealing with subsidiarity concerns of national parliaments at various stages of the EU law-making process, thus transforming the chambers from wardens into partners working together with the Commission to reshape EU legislative proposals for the sake of better regulation. [ABSTRACT FROM AUTHOR]

The article provides updates on issues related to the European Public Health Association (EUPHA) as of October 2019. Topics covered include opportunity of the World Health Organization to renew its vision for health in Europe beyond 2020, a white paper published by the European Commission in March 2017 setting out five possible paths for the future of Europe, and EUPHA's statement on what European political parties are stating on health.

Background Frailty is a common, multi-factorial, age-related syndrome commonly observed in people with diabetes. Although older diabetics are prone to adverse healthcare outcomes and diabetes increases the risk of developing frailty, little is known about the effects of frailty on diabetes. This paper examines the association between diabetes, frailty, and mortality in Europeans aged ≥50 years. Methods Data were included from The Survey of Health, Ageing and Retirement in Europe (SHARE) waves one and six. A participant's first interview was taken as the baseline and subsequent waves were used for mortality follow-up (time and cause). Frailty and pre-frailty were measured using established cut-offs using the Physical Phenotype (SHARE-FI) and a 55-item Frailty Index (FI-55). Kaplan-Meier survival analysis was used to assess the relationship between frailty and mortality in people with diabetes and significance tested using log-rank test. Cox regression was used to adjust for potential confounders (age, sex, education, income, employment, alcohol use, smoking, hypertension, hypercholesterolaemia, myocardial infarction, stroke, metastatic cancer, chronic lung disease, polypharmacy, self-perceived health and depression). Results Data from 8,954 diabetics aged 50-99 years were included with 1,598 deaths (17.8%). According to the SHARE-FI, 1,971 (22.0%) were frail, 4,183 (46.7%) pre-frail and 2,800 (31.3%) robust. According to the Kaplan-Meier log-rank test survival varied significantly across frailty strata according to both indexes (p<0.001). At 10-year follow-up, adjusting for confounders SHARE-FI frailty and pre-frailty were significantly associated with mortality, adjusted Hazard Ratio (HR) 2.19, (95% CI:1.66-2.89), and 1.38 (95% CI:1.09-1.74), respectively. Results were similar using the FI-55, HR for frailty 1.66 (95% CI:1.09-2.54). Causes of mortality were significantly different according to frailty status (p<0.05). Conclusion Frailty and pre-frailty are independent risk factors for mortality in diabetics. The identification of frailty is important for the risk-stratification and management of middle aged and older patients with diabetes and should be included in the routine assessment of these high-risk individuals. [ABSTRACT FROM AUTHOR]

Objectives IgA vasculitis (IgAV, formerly known as Henoch–Schönlein purpura) is the most common cause of systemic vasculitis in childhood. To date, there are no internationally agreed, evidence-based guidelines concerning the appropriate diagnosis and treatment of IgAV in children. Accordingly, treatment regimens differ widely. The European initiative SHARE (Single Hub and Access point for paediatric Rheumatology in Europe) aims to optimize care for children with rheumatic diseases. The aim therefore was to provide internationally agreed consensus recommendations for diagnosis and treatment for children with IgAV. Methods Recommendations were developed by a consensus process in accordance with the EULAR standard operating procedures. An extensive systematic literature review was performed, and evidence-based recommendations were extrapolated from the included papers. These were evaluated by a panel of 16 international experts via online surveys and subsequent consensus meeting, using nominal group technique. Recommendations were accepted when ⩾80% of experts agreed. Results In total, 7 recommendations for diagnosis and 19 for treatment of paediatric IgAV were accepted. Diagnostic recommendations included: appropriate use of skin and renal biopsy, renal work-up and imaging. Treatment recommendations included: the importance of appropriate analgesia and angiotensin-converting enzyme inhibitor use and non-renal indications for CS use, as well as a structured approach to treating IgAV nephritis, including appropriate use of CS and second-line agents in mild, moderate and severe disease along with use of angiotensin-converting enzyme inhibitors and maintenance therapy. Conclusion The SHARE initiative provides international, evidence-based recommendations for the diagnosis and treatment of IgAV that will facilitate improvement and uniformity of care. [ABSTRACT FROM AUTHOR]

Background This paper examines changes in substance use, and compares the resulting attributable burden of disease in the WHO European Region between 2010 and 2016. Methods Data for 2010 and 2016 on the number of deaths, years of life lost (YLL) and disability-adjusted life years (DALYs) lost were obtained by sex and country from the 2016 Global Burden of Disease (GBD) study. Exposure data for all substances except alcohol were obtained from the same study, while alcohol data were obtained from the WHO. Proportional changes were calculated for the WHO European Region as a whole to identify trends and for sub-regions to identify which regions contributed most to trends. Results In the WHO European Region in 2016, substance use caused 2.1 million deaths, 48.6 million YLL and 57.9 million DALYs lost, representing 22.4, 29.0 and 20.4% of all deaths, YLL and DALYs, respectively. The substance-attributable burden of disease was higher among men than women and highest in the eastern parts of the WHO European Region. Changes in the number of deaths, YLL and DALYs lost between 2010 and 2016 were almost uniformly downward, with the largest proportional changes observed for men. Exposure to tobacco, alcohol and illicit drugs also decreased uniformly. Conclusions Substance use and its attributable mortality and burden of disease have decreased in the WHO European Region since 2010. However, overall levels of substance use and the resulting burden of disease in the Region remain high compared with other regions of the world. [ABSTRACT FROM AUTHOR]

Background: Welfare regimes in Europe modify individuals' socioeconomic trajectories over their life-course, and, ultimately, the link between socioeconomic circumstances (SECs) and health. This paper aimed to assess whether the associations between life-course SECs (early-life, young adult-life, middle-age and old-age) and risk of poor self-rated health (SRH) trajectories in old age are modified by welfare regimes (Scandinavian [SC], Bismarckian [BM], Southern European [SE], Eastern European [EE]).Methods: We used data from the longitudinal SHARE survey. Early-life SECs consisted of four indicators of living conditions at age 10. Young adult-life, middle-age, and old-age SECs indicators were education, main occupation and satisfaction with household income, respectively. The association of life-course SECs with poor SRH trajectories was analysed by confounder-adjusted multilevel logistic regression models stratified by welfare regime. We included 24 011 participants (3626 in SC, 10 256 in BM, 6891 in SE, 3238 in EE) aged 50 to 96 years from 13 European countries.Results: The risk of poor SRH increased gradually with early-life SECs from most advantaged to most disadvantaged. The addition of adult-life SECs differentially attenuated the association of early-life SECs and SRH at older age across regimes: education attenuated the association only in SC and SE regimes and occupation only in SC and BM regimes; satisfaction with household income attenuated the association across regimes.Conclusions: Early-life SECs have a long-lasting effect on SRH in all welfare regimes. Adult-life SECs attenuated this influence differently across welfare regimes. [ABSTRACT FROM AUTHOR]

Genetic variants disrupting DNA methylation at CpG dinucleotides (CpG-SNP) provide a set of known causal variants to serve as models to test fine-mapping methodology. We use 1716 CpG-SNPs to test three fine-mapping approaches (Bayesian imputation-based association mapping, Bayesian sparse linear mixed model, and the J-test), assessing the impact of imputation errors and the choice of reference panel by using both whole-genome sequence (WGS), and genotype array data on the same individuals (n = 1166). The choice of imputation reference panel had a strong effect on imputation accuracy, with the 1000 Genomes Project Phase 3 (1000G) reference panel (n = 2504 from 26 populations) giving a mean nonreference discordance rate between imputed and sequenced genotypes of 3.2% compared to 1.6% when using the Haplotype Reference Consortium (HRC) reference panel (n = 32,470 Europeans). These imputation errors had an impact on whether the CpG-SNP was included in the 95% credible set, with a difference of ~23% and ~7% between the WGS and the 1000G and HRC imputed datasets, respectively. All of the fine-mapping methods failed to reach the expected 95% coverage of the CpG-SNP. This is attributed to secondary cis genetic effects that are unable to be statistically separated from the CpG-SNP, and through a masking mechanism where the effect of the methylation disrupting allele at the CpG-SNP is hidden by the effect of a nearby SNP that has strong linkage disequilibrium with the CpG-SNP. The reduced accuracy in fine-mapping a known causal variant in a low-level biological trait with imputed genetic data has implications for the study of higher-order complex traits and disease. [ABSTRACT FROM AUTHOR]

The annual meeting of the European Association of Cardiovascular Imaging, EuroEcho-Imaging, was held in Milan, Italy, in December 2018. In the present paper, we report a summary of the 'Highlights' session. [ABSTRACT FROM AUTHOR]

Summary: Background: Photodynamic therapy (PDT) is an effective treatment for actinic keratosis (AK), particularly for patients with large areas of field cancerization. Among the approved protocols in Europe, the most widely used requires irradiation with the Aktilite CL 128 lamp. However, pain during irradiation and the suboptimal adaptability of the lamp relative to the treatment area are two limiting factors of this protocol. To overcome these limits, a new protocol (referred to as the Flexitheralight protocol) involving irradiation with a light‐emitting, fabric‐based device was developed. Objectives: This paper aims to assess the noninferiority, in terms of PDT efficacy for treating AK, of the Flexitheralight protocol compared with the conventional protocol, which requires irradiation with the Aktilite CL 128 lamp. Methods: A monocentric, randomized, controlled, phase II clinical study was performed. Twenty‐five patients with grade I–II AKs of the forehead and scalp were treated with methyl aminolaevulinate PDT in two symmetrical areas. One area was treated with the conventional protocol (n = 154 AKs), whereas the other area was treated with the Flexitheralight protocol (n = 156 AKs). The primary end‐point was the lesion complete response (CR) rate at 3 months (an absolute noninferiority margin of –10% was used). The secondary end‐points included patient‐reported pain at the end of the irradiation. Results: At 3 months, the lesion CR rate with the Flexitheralight protocol was noninferior to that obtained with the conventional protocol (66·0% vs. 59·1%, respectively; absolute difference, 6·9%; 95% confidence interval –0·6% to 14·5%). Patient‐reported pain was significantly lower with the Flexitheralight protocol than with the conventional protocol (mean ± SD: 0·4 ± 0·6 vs. 5·0 ± 2·6; P < 0·0001). Conclusions: The Flexitheralight protocol is noninferior in terms of efficacy and superior in terms of tolerability to the conventional protocol for treating AKs of the forehead and scalp. What's already known about this topic? Methyl aminolaevulinate photodynamic therapy (PDT) is an effective and noninvasive treatment for actinic keratosis (AK).Treatment‐associated pain is frequently experienced by patients treated with the conventional protocol, which requires irradiation with the Aktilite CL 128 lamp.PDT using daylight as the activating light source has been confirmed as equally effective and less painful than the conventional protocol, but it cannot be performed in all weather conditions. What does this study add? This study demonstrates that the Flexitheralight protocol, which can be performed in all weather conditions, is equally effective as the conventional PDT protocol for AK and is a less painful technique. Linked Comment:Morton. Br J Dermatol 2019; 180:703–704. Respond to this article Plain language summary available online [ABSTRACT FROM AUTHOR]

Background Family policies have been shown to affect men's and women's health throughout the European Union, though particularly in the case of women. This paper seeks to analyze this effect by creating two Synthetic Health Indicators (SHIs) differentiated by gender applying the P 2 distance method. We also aim to compare the results obtained by means of our SHI and the Self-rated health (SRH) indicator, as it is the most common indicator used to approach individuals' health. Methods The 2012 European Quality of Life Survey was used to construct the SHI. Dimensions such as physical health, mental health, psychosocial resources, the capacity of health services and community health status were included in our SHI. All proved to be relevant when measuring individuals' health. Results Gender health inequalities differed depending on the indicator used in each European country. When considering family policy, we found significant gender health gaps that favoured men in traditional countries, regardless of the indicator used (SHI or SRH). Moreover, with our SHI we found significant gender health inequalities in market-oriented and dual-earner countries that were not revealed by the SRH indicator, highlighting the fact that current equality policies are necessary but insufficient to overcome the gender health gap. Conclusions The SHI was more sensitive to gender differences and evidenced certain advantages compared to the SRH. The SHI includes a wide range of variables that incorporated large amounts of fresh information, allowing men and women to have a personalized design of their own health. [ABSTRACT FROM AUTHOR]

Objectives The European Single Hub and Access point for paediatric Rheumatology in Europe initiative aimed to optimize care for children with rheumatic diseases. Kawasaki disease (KD) is the most common cause of acquired heart disease in children and an important cause of long-term cardiac disease into adulthood. Prompt diagnosis and treatment of KD is difficult due to the heterogeneity of the disease but is crucial for improving outcome. To date, there are no European internationally agreed, evidence-based guidelines concerning the diagnosis and treatment of KD in children. Accordingly, treatment regimens differ widely. The aim of this study is to provide consensus-based, European-wide evidence-informed recommendations for diagnosis and treatment of children with KD. Methods Recommendations were developed using the EULAR's standard operating procedures. An extensive systematic literature search was performed, and evidence-based recommendations were extrapolated from the included papers. These were evaluated by a panel of international experts via online surveys and subsequently discussed in three consensus meetings, using nominal group technique. Recommendations were accepted when ⩾80% agreed. Results In total, 17 recommendations for diagnosis and 14 for treatment of KD in children were accepted. Diagnostic recommendations included laboratory and imaging workup for complete as well as incomplete KD. Treatment recommendations included the importance of early treatment in both complete and incomplete KD, use of intravenous immunoglobulin, aspirin, corticosteroids for high-risk cases, and other treatment options for those with resistant disease. Conclusion The Single Hub and Access point for paediatric Rheumatology in Europe initiative provides international evidence-based recommendations for diagnosing and treating KD in children, facilitating improvement and uniformity of care. [ABSTRACT FROM AUTHOR]

Aim This paper briefly reviews the history of alcohol policy development in Europe leading to the current consensus in the health field on strategic priorities. There is a review of recent policy developments in selected European countries, both EU and non-EU members. Methods Narrative review of published journal articles, publications from WHO, and other health organisations and government publications. Results The implementation of the WHO policy priorities has been variable across Europe. At EU level, there has been a recent pattern of trade considerations taking priority over health and a disinvestment in alcohol research and advocacy. Among EU member states new implementation of WHO strategies have been limited to a few smaller countries and regions. In Russia, there have been considerable falls in mortality following the introduction of controls on price, availability and marketing. Conclusion The implementation of WHO strategy at national level in Europe is highly dependent on the local political circumstances. Where there is concern about alcohol harm and political will, the WHO strategic priorities have been highly influential. In order to build public and political support for prevention, alcohol policy advocates should ensure that there is good data on trends within age, gender, and income groups and develops policies to respond to these trends. The concept of proportionate universalism, where interventions are understood to have a broad population effect but the effect is greater on the groups most in need, may be more useful than the traditional alcohol policy field conceptualisations of whole population and targeted measures. [ABSTRACT FROM AUTHOR]

This paper presents the methodology, programme logic and conceptual framework that drove the evaluation of the Fifth Phase of the WHO European Healthy Cities Network. Towards the end of the phase, 99 cities were designated progressively through the life of the phase (2009-14). The paper establishes the values, systems and aspirations that these cities sign up for, as foundations for the selection of methodology. We assert that a realist synthesis methodology, driven by a wide range of qualitative and quantitative methods, is the most appropriate perspective to address the wide geopolitical, demographic, population and health diversities of these cities. The paper outlines the rationale for a structured multiple case study approach, the deployment of a comprehensive questionnaire, data mining through existing databases including Eurostat and analysis of management information generation tools used throughout the period. Response rates were considered extremely high for this type of research. Non-response analyses are described, which show that data are representative for cities across the spectrum of diversity. This paper provides a foundation for further analysis on specific areas of interest presented in this supplement. [ABSTRACT FROM AUTHOR]

Intractable policy controversies like migrant integration often involve a high level of politicization. This paper looks specifically at how and why politicization changes research-policy dialogues, involving both the structure of these dialogues and how they affect policy-making and knowledge production. Migrant integration policy (in five EU countries and at EU level) is taken as a case study. Bringing together theories on knowledge utilization, knowledge production and the structure of research-policy relations (dialogue structures), our analysis shows that a process of 'politicization of science' goes hand in hand with a process of 'scientification of politics'. Research-policy dialogues continue in the context of politicization, but in a fundamentally different way. Different sorts of institutional dialogues between research and policy emerge that do justice to political primacy, knowledge utilization becomes more symbolic but not less important, and knowledge production tends to become more fragmented in the context of politicization. [ABSTRACT FROM AUTHOR]