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This paper describes a study of doctors and the education of doctors in Germany, Italy and the UK and the changing location of accounting practices and expertise. In these countries there have been coercive reform attempts to get doctors to accept increased financial responsibility and pay greater attention to costs and budgets.suggested that Finnish doctors have willingly adopted accounting practices as part of their legitimated competencies and have become a hybrid profession. This paper address the question of whether that is a valid generalisation in Germany, Italy or the UK. The key focus of the paper is on the education and training of doctors, which should have altered if hybridisation has occurred. The finding is that there is no evidence from the countries studied that accounting has become incorporated into the formal education of doctors. While there were management and accounting training courses for doctors these were only available for those in or aiming for clinico-managerial positions. This does not support the argument that medicine has become a hybridised profession, but it does support the case for polarisation. These changes are absorbed or managed by an emergent sub-group, the medical manager. [ABSTRACT FROM AUTHOR]

ABSTRACT European labour markets have undergone several important innovations over the last three decades. Most countries have reformed their labour markets since the mid-1990s, with the liberalization of fixed-term contracts and temporary work agencies being the common elements to such reforms. This paper investigates the existence of a change in the dynamic behaviour of the aggregate employment for major European Union countries - France, Germany, Italy and Spain. According to our results, partial labour market reforms have made the response of the aggregate employment to output shocks larger and quite comparable to that found for the UK - the most flexible labour market in Europe since the Thatcher reforms. [ABSTRACT FROM AUTHOR]

Aim: To explore nurses' and nurse assistants' experiences of providing end‐of‐life care during the COVID‐19 pandemic in Austria, Germany and Northern Italy. Design: A qualitative explorative interview study. Method: Data were collected between August and December 2020 and analysed using content analysis. Healthcare professionals (nurses (n = 30), nurse coordinators (n = 6) and nurse assistants (n = 5)) from hospitals (n = 32) and long‐term care facilities (n = 9) in Austria, Germany and Northern Italy were interviewed for this study. Results: Five main categories were identified as follows: (i) end‐of‐life care involves love and duty, (ii) last wishes and dignity of the patient, (iii) communication with the family, (iv) organizational and religious aspects and (v) personal emotions. Results indicate that more training and guidelines are needed to prepare nurses and nurse assistants for end‐of‐life care during pandemics. Public contribution: This research can help prepare nurses and nurse assistants for end‐of‐life care in pandemics and will be of value for improving the institutional and government health policies. Furthermore, it can be of value in preparing training for healthcare professionals patient–relatives. [ABSTRACT FROM AUTHOR]

Abstract: The goal of this paper is to examine the importance of permanent and transitory shocks using a more efficient trend-cycle decomposition of the real exchange rate series. Our main contribution is that in measuring the impact of shocks, we not only impose common trend restrictions but also common cycle restrictions. We later confirm, through a post sample forecasting exercise, the efficiency gains from imposing common cycle restrictions. Our results indicate that permanent shocks are responsible for the bulk of the real exchange rate variations for Japan, Italy, Germany, France, and the UK vis-à-vis the US dollar over short horizons. For Canada, however, transitory shocks are dominant over the short horizon. In sum, while for Japan, France, and Italy, around 15% of the variation in real exchange rate is due to transitory shocks, for Canada, Germany and the UK, over 25% of the variations over the short horizon are due to transitory shocks. Thus, we claim that the role of transitory shocks should not be ignored. [Copyright &y& Elsevier]

The effects of productivity on the parameters of the species–area curve were investigated in this paper using two data sets on terrestrial plant communities: (1) one including 48 plots in 12 experimental sites on ploughed, formerly cultivated fields in the Siena region, Italy, and (2) one including 40 plots in hay meadows in the Bremen region, Germany. In both regions, species presence of vascular plants was recorded in nested plots ranging in size from 0.004 to 256 m2 and 0.001 to 1000 m2, respectively. Productivity was estimated as dry standing biomass. In the Siena data set, species richness showed a humped-back relation to biomass in the plot sizes up to 1 m2. For the larger plot sizes, no significant correlations were found. In the Bremen data set, positive relation between species number and biomass was observed at the smallest spatial scale (0.001 m2), whereas the relation disappeared or tended to be negative for the larger plot sizes. In general, the slopes z of the log species–log area curves (SAC) were negatively related to biomass in both data sets, while the intercept c increased with biomass in the Siena data set and was unrelated to biomass in the Bremen data set. The relationship between c and z was negative in the Siena data set and positive in the Bremen data set. The above results differed somewhat depending on which plot sizes were considered for the calculation of the SAC. Literature data confirmed that there are no clear patterns in the inter-correlations between productivity, small scale and large scale species richness. Sites differing in productivity and in the slopes and intercepts of SAC may thus give rise to different species richness–productivity relationships. There can be one possible relation between species richness and biomass at one spatial scale (e.g. humped-back) and another type of relation, even opposite, at another spatial scale. This suggests that the properties of species–area curves do not respond in a uniform way to the changes in productivity, but depend on the type of habitat or plant community and its particular properties. The parameter of the SAC can then hardly be used as scale-independent parameter to investigate the effects of ecological factors, such as productivity, on species richness. The lack of clear patterns in the relations between small scale and large scale species richness implies that the predictions of the species-pool hypothesis may fail when applied to plot sizes as dealt with in this study. [ABSTRACT FROM AUTHOR]

Background: Pediatric influenza causes significant morbidity annually, resulting in an increased economic burden. Therefore, we aimed to summarize existing literature regarding the costs of pediatric influenza in Europe, paying particular attention to the direct and indirect costs considered in the economic evaluations. Knowing health and social costs of childhood influenza is essential to support value‐based health decisions to implement effective immunization strategies. Methods: We searched three databases for articles published to September 3, 2021. Eligible studies were those reporting the economic burden of influenza in the pediatric and youth population in European countries written in English language. Results: Overall, 2225 records were screened, and 9 articles were included. Costs estimates are different across countries and in the age groups considered. Direct costs per episode, whose major expense driver are hospitalizations and pediatric examinations, range from about €74 in Italy to €252 in Germany. Important variations are observed based on age, with the youngest group absorbing in some cases double the resources of the older ones such as (in Italy, in France and in Germany). Regarding indirect costs, workdays lost by parents resulted in higher costs for children <2 years and 2–5 years than those >5 years of age and their economic impact was variable reaching €251 per week in Germany. Conclusion: Evidence obtained in our review strengthened the awareness about the economic impact, in terms of direct and indirect costs, of pediatric influenza requiring, as a priority action in Europe, the implementation of influenza vaccination policies in this target population. [ABSTRACT FROM AUTHOR]

This article analyses wage differentials between permanent and temporary workers in the 25-40 age bracket using the 2010 European Union Statistics on Income and Living Conditions (EU-SILC) wave data for France, Germany and Italy. Applying a Recentered Influence Function (RIF) regression and a reweighting estimation technique, we investigate the contribution of personal and job characteristics to wage differentials across the wage distribution. Results point to a large unexplained component of the wage gap across the whole distribution in Italy, while this component is weaker in France among highly paid employees and insignificant in Germany. These findings highlight potential policy considerations and areas for future research. [ABSTRACT FROM AUTHOR]

The quantity and frequency of alcohol consumption are crucial both in risk assessment as well as epidemiological and clinical research. Using the Munich Composite International Diagnostic Interview (M-CIDI), drinking amounts have been assessed in numerous large-scale studies. However, the accuracy of this assessment has rarely been evaluated. This study evaluates the relevance of drink categories and pouring sizes, and the factors used to convert actual drinks into standard drinks. We compare the M-CIDI to alternative drink assessment instruments and empirically validate drink categories using a general population sample ( n = 3165 from Germany), primary care samples ( n = 322 from Italy, n = 1189 from Germany), and a non-representative set of k = 22503 alcoholic beverages sold in Germany in 2010-2016. The M-CIDI supplement sheet displays more categories than other instruments (AUDIT, TLFB, WHO-CIDI). Beer, wine, and spirits represent the most prevalent categories in the samples. The suggested standard drink conversion factors were inconsistent for different pouring sizes of the same drink and, to a smaller extent, across drink categories. For the use in Germany and Italy, we propose the limiting of drink categories and pouring sizes, and a revision of the proposed standard drinks. We further suggest corresponding examinations and revisions in other cultures. [ABSTRACT FROM AUTHOR]

ABSTRACT In this research, we explore the market potential of a domestic agricultural product, the early potato, in two countries, Italy and Germany. We conducted two parallel marketing studies aimed at revealing the most desirable characteristics for the commercialization of this product in each of the two markets, and made comparisons among consumers' attitudes for several attributes (country of origin, carbon footprint, production method, ethical certification and packaging). Motivation for this study is the declining market share of the domestic early potato, considered an important crop in both countries, due to the competition from abroad. A focal aspect of this research is the recent public interest for social justice, traditionally reserved for products imported from developing countries, with respect to ethical products made in developed countries. The possibility for Italian and German early potatoes to regain important market shares depends on the ability to differentiate their potatoes from potatoes supplied by competing extra-European countries. [JEL Classifications: Q13; Q18]. [ABSTRACT FROM AUTHOR]

Aim: To estimate health-related quality of life (HRQOL) in patients with Duchenne muscular dystrophy (DMD).Method: HRQOL was assessed using the Health Utilities Index Questionnaire (HUI) and the Pediatric Quality of Life Inventory (PedsQL) neuromuscular module version 3.0 online. Results were stratified by disease stage (early/late ambulatory/non-ambulatory) and caregivers' perceptions of patients' health and mental status.Results: A total of 770 patient-caregiver pairs (173 German, 122 Italian, 191 UK, and 284 USA) participated. Most caregivers (>84%) perceived their patients as happy/somewhat happy and in excellent/very good/good health, irrespective of current ambulatory class. In contrast, mean patient utility (reflecting public preferences: 0, dead; 1, perfect health) deteriorated with disease course, from 0.75 in early ambulatory males to 0.15 in the most severely affected patients. Mean patient PedsQL scores (0-100, higher score indicating better HRQOL) decreased from 80 to 57 across ambulatory classes.Interpretation: HRQOL in DMD, measured through public preferences, is substantially impaired in relation to the general population and significantly associated with disease progression. Still, most patients are perceived as happy and in good health by their caregivers, indicating that influential domains of HRQOL remain intact through the disease progression. Our findings emphasize the challenges in measuring HRQOL in a rare, progressive childhood condition such as DMD. [ABSTRACT FROM AUTHOR]

By analysing two countries that have recently undergone NPM reform at the municipal level (Germany and Italy), our investigation challenges two popular notions: (1) that an audit explosion occurs as a result of reform, and (2) that reform causes change, i.e., that actors within a changing institutional context automatically adapt. Our empirically-derived observations are of (1) an audit implosion, and (2) institutional, cultural, and political conditions that trump any automatic adaptation to change. Indeed, these conditions - not audit reform per se - can shape the process and determine the direction of change. Recalcitrance, the stubborn resistance to and defiance of authority or guidance, is an interesting characteristic of some institutions. German auditors illustrate this nicely; our Italian case study demonstrates a mandatory dismantling of institutional inertia. By analysing the causal relationship between public management reforms and auditing, our research highlights the factors that prevent auditors from adapting to contextual change and factors that render obedience. We test Power's audit explosion theory by operationalising it into five key components which are then evaluated within the landscapes of recent German and Italian municipal reform. [ABSTRACT FROM AUTHOR]

ACADEMIC EMERGENCY MEDICINE 2011; 18:1358-1370 © 2011 by the Society for Academic Emergency Medicine Abstract The maturation of emergency medicine (EM) as a specialty has coincided with dramatic increases in emergency department (ED) visit rates, both in the United States and around the world. ED crowding has become a public health problem where periodic supply and demand mismatches in ED and hospital resources cause long waiting times and delays in critical treatments. ED crowding has been associated with several negative clinical outcomes, including higher complication rates and mortality. This article describes emergency care systems and the extent of crowding across 15 countries outside of the United States: Australia, Canada, Denmark, Finland, France, Germany, Hong Kong, India, Iran, Italy, The Netherlands, Saudi Arabia, Catalonia (Spain), Sweden, and the United Kingdom. The authors are local emergency care leaders with knowledge of emergency care in their particular countries. Where available, data are provided about visit patterns in each country; however, for many of these countries, no national data are available on ED visits rates or crowding. For most of the countries included, there is both objective evidence of increases in ED visit rates and ED crowding and also subjective assessments of trends toward higher crowding in the ED. ED crowding appears to be worsening in many countries despite the presence of universal health coverage. Scandinavian countries with robust systems to manage acute care outside the ED do not report crowding is a major problem. The main cause for crowding identified by many authors is the boarding of admitted patients, similar to the United States. Many hospitals in these countries have implemented operational interventions to mitigate crowding in the ED, and some countries have imposed strict limits on ED length of stay (LOS), while others have no clear plan to mitigate crowding. An understanding of the causes and potential solutions implemented in these countries can provide a lens into how to mitigate ED crowding in the United States through health policy interventions and hospital operational changes. [ABSTRACT FROM AUTHOR]

In response to increasing care needs, the reform or development of long-term care (LTC) systems has become a prominent policy issue in all European countries. Cash-for-care schemes-allowances instead of services provided to dependents-represent a key policy aimed at ensuring choice, fostering family care, developing care markets, and containing costs. A detailed analysis of policy documents and regulations, together with a systematic review of existing studies, was used to investigate the differences among six European countries (Austria, France, Germany, Italy, the Netherlands, and Sweden). The rationale and evolution of their various cash-for-care schemes within the framework of their LTC systems also were explored. While most of the literature present cash-for-care schemes as a common trend in the reforms that began in the 1990s and often treat them separately from the overarching LTC policies, this article argues that the policy context, timing, and specific regulation of the new schemes have created different visions of care and care work that in turn have given rise to distinct LTC configurations. A new typology of long-term care configurations is proposed based on the inclusiveness of the system, the role of cash-for-care schemes and their specific regulations, as well as the views of informal care and the care work that they require. [ABSTRACT FROM AUTHOR]

Aliment Pharmacol Ther 2010; 32: 472–477 Background Data on drug treatment of abdominal cramping and pain are sparse. Aim To compare treatment of abdominal cramping and pain across countries worldwide. Methods A multi-national survey was conducted in the USA, Mexico, Brazil, Argentina, Germany, Belgium, Italy and the UK. In each country, approximately 210 people were interviewed on various aspects of drug treatment of their complaints. Results In total, 1717 participants were interviewed. Respondents from the Americas used more medication (approximately 90%) than those from Europe (approximately 70%). Over-the-counter remedies were much more used than prescription drugs (except for Mexico). Medication was mainly taken on demand to relieve a pain episode. In the Latin American countries, antispasmodics were most popular (up to 73%), in Germany antacids, and in the UK antacids and analgesics. Regarding expectations of treatment, ‘fast onset of action’ ranked the highest, followed by ‘highly effective’ and ‘well tolerated’. Conclusions A majority of people afflicted by abdominal cramping and pain use medication and take them on demand. Consequently, rapid onset of action is mentioned as most important. Antispasmodics are the class most frequently used with considerable variation from country to country. [ABSTRACT FROM AUTHOR]

Rapidly changing markets in the context of globalization call for increasingly frequent restructuring to sustain the competitiveness of individual firms. To meet this need while minimizing consequent job loss, the social partners in major European countries have devised a variety of decentralization mechanisms that enhance local-level flexibility without fundamentally calling into question the traditional national models of collective bargaining. Analysing the use of “opening clauses” in German industry agreements, France's firm-level “derogation agreements” and mandatory bargaining on “workforce planning”, and Italy's tripartite “territorial agreements”, the author concludes with a plea for a supranational framework to support socially sensitive restructuring across Europe. [ABSTRACT FROM AUTHOR]

The analysis of diversity across multiple scales is hampered by methodological difficulties resulting from the use of different sampling methods at different scales and by the application of different definitions of the communities to be sampled at different scales. It is our aim to analyse diversity in a nested hierarchy of scales by applying a formalized sampling concept used in population ecology when analysing population structure. This concept involved a precise definition of the sampled vegetation type by the presence of a target species, in our case Hornungia petraea. We compared separate indices of inventory diversity (i.e. number of species) and differentiation diversity (i.e. extent of change in species composition or dissimilarity) with indices derived from species accumulation curves and related diversity patterns to topographical plot characteristics such as area and distance. Ten plots were established systematically over a distance of 100 km each in the distribution centre of H. petraea in Italy (i.e. Marche and Umbria) and in a peripheral exclave in Germany (i.e. Thuringia and Saxony-Anhalt). We used a nested sampling design of 10 random subplots within plots and 10 systematically placed plots within regions. Internal α-diversity (species richness) and internal β-diversity (dissimilarity) were calculated on the basis of subplots, α-, β- and γ-diversity on the basis of plots in Italy and Germany. In addition, indices of inventory diversity and differentiation diversity were derived by fitting species accumulation curves to the Michaelis–Menten equation. There was no significant difference in the internal α-diversity between German and Italian plots but the α- and γ-diversity were higher in Italy than in Germany. In Germany, the internal β-diversity and β-diversity were lower than in Italy. The differentiation diversity increased with increasing scale from subplots over plots to regions. The same results were obtained by calculating species accumulation curves. Significant positive correlations were encountered between the internal α-diversity and α-diversity in both countries, while the internal β-diversity and internal α-diversity showed a correlation only for the Italian plots. Similarity decay was found for German plots with respect to inter-plot distance and for Italian plots with respect to altitudinal difference and to a smaller degree to distance between plots. The design chosen and the consistent analysis of species accumulation curves by the Michaelis–Menten equation yielded consistent results over different scales. The specific therophyte vegetation type in this study reflected diversity patterns also observed in other studies, e.g. a greater differentiation diversity in central than in peripheral habitats and a trend of increasing species richness towards lower altitudes. No asymptotic saturation of species richness between different scales was observed. Indications were found that the absolute level of inventory diversity at a particular scale and the completeness of the sampling procedure are the main clues for explaining the relationship between inventory and differentiation diversity at this particular scale. [ABSTRACT FROM AUTHOR]

Equal pay for men and women was a principle enshrined in the Treaty of Rome and was the subject of a European Directive in 1975. This investigation of progress towards equal pay in three member-states, Germany, Italy and the UK, reveals the importance of differences in employment structures and reward systems in determining relative pay for women. Differences in the structure and size of pay differentials among countries suggest that more attention needs to be paid to the general system of labour market regulation than to explicit equal-pay policies. Women would be more likely to benefit from a strategy of establishing labour standards and regulation than from equal-pay Directives which have little effect on the general practices and principles of pay determination. [ABSTRACT FROM AUTHOR]