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Background The incidence of renal replacement therapy (RRT) in the general population ≥75 years of age varies considerably between countries and regions in Europe. Our aim was to study characteristics and survival of elderly RRT patients and to find explanations for differences in RRT incidence. Methods Patients ≥75 years of age at the onset of RRT in 2010–2013 from 29 national or regional registries providing data to the European Renal Association–European Dialysis and Transplant Association Registry were included. Chi-square and Mann–Whitney U tests were used to assess variation in patient characteristics and linear regression was used to study the association between RRT incidence and various factors. Kaplan–Meier curves and Cox regression were employed for survival analyses. Results The mean annual incidence of RRT in the age group ≥75 years of age ranged from 157 to 924 per million age-related population. The median age at the start of RRT was higher and comorbidities were less common in areas with higher RRT incidence, but overall the association between patient characteristics and RRT incidence was weak. The unadjusted survival was lower in high-incidence areas due to an older age at onset of RRT, but the adjusted survival was similar [relative risk 1.00 (95% confidence interval, 0.97–1.03)] in patients from low- and high-incidence areas. Conclusions Variation in the incidence of RRT among the elderly across European countries and regions is remarkable and could not be explained by the available data. However, the survival of patients in low- and high-incidence areas was remarkably similar. [ABSTRACT FROM AUTHOR]

Unintended pregnancy is a public health concern throughout Europe. There is no common definition and no standard way to measure unintended pregnancy. Identifying unintended births is difficult and prevalence estimates vary depending on how and when the question is asked. Abortion rates are not a proxy and are themselves notoriously inaccurate. An estimated 34% (in Western Europe) to 54% (in Eastern Europe) of pregnancies are unintended. The determinants of unintended pregnancy are the length of the reproductive span and exposure to the risk of conception; the desired number of children and contraceptive use and effectiveness. The age of sexual debut fell during the 20th century in Europe to between 15 and 18 years of age. Mean age at first birth for women is now over 30 years in most European countries and most couples want no more than two children. Thus most couples must use contraception perfectly for many years in order to avoid unintended pregnancy. Use of effective contraception is high throughout most of Europe but there is scope, through better provision of sexual health services, better formal sex education and better training of providers, to increase the uptake of the most effective contraceptives and improve use of all methods. For individual women unintended pregnancy can be a disaster and recourse to induced abortion should be freely available. [ABSTRACT FROM AUTHOR]

Background We have encountered repeated cases of recessive lethal generalized severe (Herlitz-type) junctional epidermolysis bullosa ( JEB gen sev) in infants born to Hungarian Roma parents residing in a small region of Hungary. Objectives To identify the disease-causing mutation and to investigate the genetic background of its unique carrier group. Methods The LAMB3 gene was analysed in peripheral-blood genomic DNA samples, and the pathological consequences of the lethal defect were confirmed by cutaneous LAMB3 cDNA sequencing. A median joining haplotype network within the Y chromosome H1a-M82 haplogroup of individuals from the community was constructed, and LAMB3 single-nucleotide polymorphism ( SNP) patterns were also determined. Results An unconventional intronic splice-site mutation ( LAMB3, c.1133-22G>A) was identified. Thirty of 64 voluntarily screened Roma from the closed community carried the mutation, but none of the 306 Roma from other regions of the country did. The age of the mutation was estimated to be 548 ± 222 years. Within the last year, more patients with JEB gen sev carrying the same unusual mutation have been identified in three unrelated families, all immigrants from the Balkans. Two were compound heterozygous newborns, in Germany and Italy, and one homozygous newborn died in France. Only the French family recognized their Roma background. LAMB3 SNP haplotyping confirmed the link between the apparently unrelated Hungarian, German and Italian male cases, but could not verify the same background in the female newborn from France. Conclusions The estimated age of the mutation corresponds to the time period when Roma were wandering in the Balkans. [ABSTRACT FROM AUTHOR]

Background: The European population is aging. The main drivers of public spending on health care for people of 65 years and older are hospital admission and admission to long-term care facilities. High quality community care can be a cost-effective and quality solution to respond to the impact of ageing populations on health-care systems. It is unclear how well countries are equipped to provide affordable and quality community care. The aim of this article is to describe and compare community care delivery with care-dependent older people in Europe. Methods: This study is conducted within the European Union-financed IBenC project [Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of community care (FP7)] in which six European countries are involved. To compare the community care delivery with care-dependent older people in these countries, we performed a systematic comparison of macro indicators using metadata complemented with data from multinational surveys. Results: Data on the following dimensions are described and compared: population of the country, governmental expenditures on health, sources of community health services funding, governmental vision and regulation on community care, community care organisations and care professionals, eligibility criteria for and equity in receiving care and the involvement of informal care. Conclusion: Because of the variations in the European community care contexts, the growing demand for community care as a cost-effective and quality solution to the care burden of aging populations will have country-specific impacts. When learning from other countries' best practices, in addition to researchers, policy makers should take full account of local and national care contexts. [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]

Specific DNA repair genes/pathways may play a role in upper aerodigestive cancer susceptibility.DNA repair pathways are good candidates for upper aerodigestive tract cancer susceptibility because of their critical role in maintaining genome integrity. We have selected 13 pathways involved in DNA repair representing 212 autosomal genes. To assess the role of these pathways and their associated genes, two European data sets from the International Head and Neck Cancer Epidemiology consortium were pooled, totaling 1954 cases and 3121 controls, with documented demographic, lifetime alcohol and tobacco consumption information. We applied an innovative approach that tests single nucleotide polymorphism (SNP)-sets within DNA repair pathways and then within genes belonging to the significant pathways. We showed an association between the polymerase pathway and oral cavity/pharynx cancers (P-corrected = 4.45 × 10−2), explained entirely by the association with one SNP, rs1494961 (P = 2.65 × 10−4), a missense mutation V306I in the second exon of HELQ gene. We also found an association between the cell cycle regulation pathway and esophagus cancer (P-corrected = 1.48 × 10−2), explained by three SNPs located within or near CSNK1E gene: rs1534891 (P = 1.27 × 10−4), rs7289981 (P = 3.37 × 10−3) and rs13054361 (P = 4.09 × 10−3). As a first attempt to investigate pathway-level associations, our results suggest a role of specific DNA repair genes/pathways in specific upper aerodigestive tract cancer sites. [ABSTRACT FROM PUBLISHER]

Geographical inequalities in mortality across Europe may be influenced by migration between regions. The relationship between age- and sex-standardised death rates, 2008-2010, and population change resulting from migration 2000-2010, was analysed in 250 'Nomenclature of Statistical Territorial Units' (NUTS) level 2 regions in 26 European countries. Across Europe death rates were significantly higher in regions experiencing population loss. This association continued after adjustment for 2005 household income among all regions and Western regions but not among Eastern areas. This analysis suggests migration could contribute to Europe's persistent inequalities in mortality, and highlights the problems of Eastern regions with the highest death rates, lowest incomes and declining populations. [ABSTRACT FROM AUTHOR]

Multiple breast cancer susceptibility loci have been identified in genome-wide association studies (GWAS) in populations of European and Asian ancestry using array chips optimized for populations of European ancestry. It is important to examine whether these loci are associated with breast cancer risk in women of African ancestry. We evaluated 25 single nucleotide polymorphisms (SNPs) at 19 loci in a pooled case–control study of breast cancer, which included 1509 cases and 1383 controls. Cases and controls were enrolled in Nigeria, Barbados and the USA; all women were of African ancestry. We found significant associations for three SNPs, which were in the same direction and of similar magnitude as those reported in previous fine-mapping studies in women of African ancestry. The allelic odds ratios were 1.24 [95% confidence interval (CI): 1.04–1.47; P = 0.018] for the rs2981578-G allele (10q26/FGFR2), 1.34 (95% CI: 1.10–1.63; P = 0.0035) for the rs9397435-G allele (6q25) and 1.12 (95% CI: 1.00–1.25; P = 0.04) for the rs3104793-C allele (16q12). Although a significant association was observed for an additional index SNP (rs3817198), it was in the opposite direction to prior GWAS studies. In conclusion, this study highlights the complexity of applying current GWAS findings across racial/ethnic groups, as none of GWAS-identified index SNPs could be replicated in women of African ancestry. Further fine-mapping studies in women of African ancestry will be needed to reveal additional and causal variants for breast cancer. [ABSTRACT FROM AUTHOR]

Many analyses of human populations have found that age-specific mortality rates increase faster across most of adulthood when overall mortality levels decline. This contradicts the relationship often expected from Williams' classic hypothesis about the effects of natural selection on the evolution of senescence. More likely, much of the within-species difference in actuarial aging is not due to variation in senescence, but to the strength of filters on the heterogeneity of frailty in older survivors. A challenge to this differential frailty hypothesis was recently posed by an analysis of life tables from historical European populations and traditional societies that reported variation in actuarial aging consistent with Williams' hypothesis after all. To investigate the challenge, we reconsidered those cases and aging measures. Here we show that the discrepancy depends on Ricklefs' aging rate measure, ω, which decreases as mortality levels drop because it is an index of mortality level itself, not the rate of increase in mortality with age. We also show unappreciated correspondence among the parameters of Gompertz-Makeham and Weibull survival models. Finally, we compare the relationships among mortality parameters of the traditional societies and the historical series, providing further suggestive evidence that differential heterogeneity has strong effects on actuarial aging. [ABSTRACT FROM AUTHOR]

Hypoxia inducible factor 1α (HIF 1α) plays a major role in the pleitropic response observed secondary to hypoxic conditions in tumors. Its expression in the tumor cells has been correlated to tumor aggressiveness and prognosis in squamous cell carcinoma (SCC) of the esophagus in Far Eastern population, but limited information is available on the prognostic role of HIF 1α in SCC of esophagus in European population. This information may help in choosing appropriate therapeutic strategies and possibly developing a monoclonal antibody with therapeutic potential targeting the HIF 1α. Tumor samples from 36 patients diagnosed with SCC of the esophagus were collected. Prepared tissue sections were stained with validated and specific monoclonal antibodies for HIF 1α and the expression was correlated with the disease pattern and survival. Out of 36 patients, 17 patients showed low and 19 high expression of HIF 1α. There was no difference in the disease-free and overall survival between these two groups ( P > 0.05, log rank test). Regression analysis showed that HIF 1α was not an independent prognostic factor for survival ( P > 0.05). HIF 1α did not show prognostic value in SCC of the esophagus in our study on European population, in agreement with previous studies. Novel strategies on the therapeutic manipulation of HIF 1α in cancer are to be explored further and may have a role to play in improving treatment outcome. [ABSTRACT FROM AUTHOR]

Lifespan variation adds to life expectancy by measuring the inequality surrounding age of death that a population faces. Countries that tackle premature mortality generally have decreasing lifespan variation but this is the first study to compare and statistically assess when and to what extent trends in lifespan variation have changed across Western Europe. Lifespan variation was measured using e+ and joinpoint regression analysed the timing and rate of change. Trends have been mostly downward with the recent exception of men in Scotland, Northern Ireland, Ireland and Finland where trends have flattened or show slight increases. Future research aimed at identifying the ages and causes of death, driving trends in these countries, is key to preventing increasing inequalities. [ABSTRACT FROM AUTHOR]

Aprahamian, M. W., Walker, A. M., Williams, B., Bark, A., and Knights, B. 2007. On the application of models of European eel (Anguilla anguilla) production and escapement to the development of Eel Management Plans: the River Severn. – ICES Journal of Marine Science, 64: 1472–1482.The European eel stock has declined significantly since the 1980s, and the Eel Recovery Plan of the European Commission requires Member States to develop river basin Eel Management Plans (EMPs) that will achieve an escapement of silver eels that equals or exceeds 40% of the escapement biomass that would be produced in the absence of human activities. However, because silver eel escapement is not quantified within the UK, a modelling approach is required to estimate potential and actual escapement, and to assess the likely effects of management measures. We focus on two approaches developed in the UK, the Reference Condition Model (RCM) and the Scenario-based Model for Eel Populations (SMEP), and illustrate how such approaches can be used in EMPs using selected data from the River Severn. The RCM results indicate that the yellow eel population in the River Severn basin may be just 30–40% of the potential density indicated by reference conditions derived from a selection of rivers between the late 1970s and the early 1980s. The challenges of applying a model designed to be as realistic of eel production as possible, and the limited data on natural eel habitat and eel production in the Severn, preclude a SMEP analysis similar to that of the RCM, but simulations based on a simplified basin description and eel survey data from the early 1980s illustrate the potential of this model to assess compliance and test management scenarios. [ABSTRACT FROM PUBLISHER]

Background Widely recognized as a major public health threat globally, the rapid increase of antibiotic resistance in bacteria could soon render our most effective method to combat infections obsolete. Factors influencing the burden of resistance in human populations remain poorly described, though temperature is known to play an important role in mechanisms of bacterial growth and transmission. Methods Here, we present the first evidence that ambient temperatures may modulate the rate of increase of antibiotic resistance across Europe. Using a comprehensive dataset containing information across 28 countries, for 17 years (2000–2016), 3 common bacterial pathogens, and 4 antibiotic classes collectively representing over 4 million tested isolates, we show that antibiotic resistance has increased more rapidly in warmer regions over a period of nearly 2 decades. Results Specifically, we show that European countries with 10°C warmer ambient temperatures have experienced more rapid increases in antibiotic resistance to E. coli and K. pneumoniae over the 17-year period, ranging between 0.33%/year (95% CI 0.2, 0.5) and 1.2%/year (0.4, 1.9), even after accounting for recognized drivers of resistance including antibiotic consumption and population density. We found a decreasing relationship for S. aureus and methicillin of -0.4%/year (95% CI −0.7, 0.0), reflecting widespread declines in MRSA across Europe over the study period. Conclusion Our findings suggest that rising temperatures globally may hasten the spread of resistance and complicate efforts to mitigate it. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

To determine extant patterns of population genetic structure in common ash and gain insight into postglacial recolonization processes, we applied multilocus-based Bayesian approaches to data from 36 European populations genotyped at five nuclear microsatellite loci. We identified two contrasting patterns in terms of population genetic structure: (1) a large area from the British Isles to Lithuania throughout central Europe constituted effectively a single deme, whereas (2) strong genetic differentiation occurred over short distances in Sweden and southeastern Europe. Concomitant geographical variation was observed in estimates of allelic richness and genetic diversity, which were lowest in populations from southeastern Europe, that is, in regions close to putative ice age refuges, but high in western and central Europe, that is, in more recently recolonized areas. We suggest that in southeastern Europe, restricted postglacial gene flow caused by a rapid expansion of refuge populations in a mountainous topography is responsible for the observed strong genetic structure. In contrast, admixture of previously differentiated gene pools and high gene flow at the onset of postglacial recolonization of western and central Europe would have homogenized the genetic structure and raised the levels of genetic diversity above values in the refuges. [ABSTRACT FROM AUTHOR]

Focuses on the decline of the mortality rate of the population in Europe from the 17th to the 19th century. Role of insects in the transmission of diseases during the pre-decline era; Importance of studying diseases and their modes of transmission; Impact of the discovery of the role of insects in disease transmission on the mortality rate.

The article explores the level of public health research in Europe. It includes health research at organizational and population level. The level of public-health publications in the region is lower than the U.S. It is stated that is no standard description of funding for public health research in the region and is difficult to identify leadership of this matter at a national level.

The article presents abstracts of research on public health systems in Europe. They include "Population health in Ukraine: Consequences of a failing health system," "Effects of direct access to physiotherapy in the Netherlands in 2006," and "Out-of-pocket payments and financial burden of elderly with depressive symptoms across Europe."