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Aim: Children born very preterm require additional specialist care because of the health and developmental risks associated with preterm birth, but information on their health service use is sparse. We sought to describe the use of specialist services by children born very preterm in Europe.Method: We analysed data from the multi-regional, population-based Effective Perinatal Intensive Care in Europe (EPICE) cohort of births before 32 weeks' gestation in 11 European countries. Perinatal data were abstracted from medical records and parents completed a questionnaire at 2 years corrected age (4322 children; 2026 females, 2296 males; median gestational age 29wks, interquartile range [IQR] 27-31wks; median birthweight 1230g, IQR 970-1511g). We compared parent-reported use of specialist services by country, perinatal risk (based on gestational age, small for gestational age, and neonatal morbidities), maternal education, and birthplace.Results: Seventy-six per cent of the children had consulted at least one specialist, ranging across countries from 53.7% to 100%. Ophthalmologists (53.4%) and physiotherapists (48.0%) were most frequently consulted, but individual specialists varied greatly by country. Perinatal risk was associated with specialist use, but the gradient differed across countries. Children with more educated mothers had higher proportions of specialist use in three countries.Interpretation: Large variations in the use of specialist services across Europe were not explained by perinatal risk and raise questions about the strengths and limits of existing models of care.What This Paper Adds: Use of specialist services by children born very preterm varied across Europe. This variation was observed for types and number of specialists consulted. Perinatal risk was associated with specialist care, but did not explain country-level differences. In some countries, mothers' educational level affected use of specialist services. [ABSTRACT FROM AUTHOR]

Aim: To test the hypothesis that higher seizure burden in Dravet syndrome is associated with increased comorbidities and lower quality of life (QoL) in a large cohort of patients with Dravet syndrome and their caregivers in Europe.Method: An extensive survey of caregivers of patients with Dravet syndrome on experiences of diagnosis, seizure burden, management, social and financial impact, and health services use was administered online in 10 languages.Results: The survey received 584 unique responses from caregivers of paediatric (83%) and adult (17%) patients with Dravet syndrome (aged <1-48y). Despite broadly following current treatment guidance, less than 10% of patients were seizure free in the previous 3 months. Nearly all (99.6%) patients aged 5 years or older experienced at least one or more motor, speech, learning, or behavioural impairment. High seizure frequency was related to more reports of emergency treatment, comorbidities, and a lower QoL (as measured by the standardized instrument EQ-5D-5L). If not diagnosed at the first instance, the majority (83%) of adults, but less than 20% of 6- to 11-year-olds were diagnosed after 4 or more years.Interpretation: Patients with Dravet syndrome with the highest current seizure frequency suffer from more comorbidities and have a lower QoL. Therefore, more effective antiepileptic treatments are needed.What This Paper Adds: The survey captured about 15% of all patients with Dravet syndrome in Europe. Less than 10% of patients had current seizure freedom. Patients with a high current seizure burden have more comorbidities and lower quality of life. [ABSTRACT FROM AUTHOR]

This paper provides an original framework for the interpretation of innovative activity among European regions according to traditional ‘geographical’ spillovers and ‘relational’ spillovers. The focus is on two knowledge-based relational phenomena: participation in the same research networks (within the EU Fifth Framework Programme) and EPO co-patent applications. Using two econometric techniques, we investigate the factors that determine patenting activity, distinguishing structural features, geographical and relational spillovers. In this way, we are able to test whether hierarchical relationships based on a-spatial networks between geographically distant excellence centres prevail over diffusive patterns based on spatial contiguity. [ABSTRACT FROM AUTHOR]

Differential migration is a widespread, but poorly understood, phenomenon in birds. In this paper, we present the first detailed field study of differential migration in the Old World warbler (Sylviidae) family. We studied two chiffchaffPhylloscopus[collybita] semispecies: the common chiffchaffP.[c.]collybitaand the Iberian chiffchaffP.[c.]ibericus. Using data collected at several latitudes in Europe and Africa, we present convincing evidence for differential distance migration of sexes in chiffchaffs, with females moving further than males. Interestingly, while there was a pronounced gradient in the sex-ratios in Europe and North Africa (with an increasing proportion of females with declining latitude), no clear pattern was found south of the Sahara, where sex-ratios were more male-biased than predicted by a simple latitude model. This suggests that, amongst the chiffchaffs wintering in West Africa, a large proportion is composed by Iberian birds, and provides support to previous suggestions that Iberian chiffchaffs are long distance migrants. Results from detailed studies in Senegal also show that chiffchaffs display differential timing of spring migration, with males leaving the winter quarters considerably earlier than females. The results are discussed in the framework of the three main (non-mutually exclusive) hypotheses attempting to explain the latitudinal segregation of the sexes. Given the relative failure of standard comparative studies to discriminate between competing single-factor hypotheses to explain differential migration, it is argued that the chiffchaff species complex might be particularly suited to study this issue using a new approach suggested by: detailed (further) comparisons between closely related species (such as the common and the Iberian chiffchaffs) could help identifying the key factors to be incorporated into optimality models that can predict relative distance of migration of different sex or age classes. [ABSTRACT FROM AUTHOR]

Many epidemiological and clinical studies in Europe, especially in Eastern Europe and countries in transition, are of poor methodological quality because of lack of background knowledge in clinical epidemiology methods and study designs. The only way to improve the quality of epidemiological studies is to provide adequate undergraduate and/or postgraduate education for the health professionals and allied health professions. To facilitate this process, the European Federation of Neurological Societies (EFNS) Task Force on teaching of clinical epidemiology in Europe was set up in October 2000. Based on analyses of the current teaching and research activities in neuroepidemiology in Europe, this paper describes the Task Force recommendations aimed to improve these activities. [ABSTRACT FROM AUTHOR]