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Background: The implementation science literature acknowledges a need for engagement of key stakeholders when designing, delivering and evaluating implementation work. To date, the literature reports minimal or focused stakeholder engagement, where stakeholders are engaged in either barrier identification and/or barrier prioritisation. This paper begins to answer calls from the literature for the development of tools and guidance to support comprehensive stakeholder engagement in implementation research and practice. The paper describes the systematic development of the Implementation‐STakeholder Engagement Model (I‐STEM) in the context of an international, large‐scale empirical implementation study (ImpleMentAll) aimed at evaluating the effectiveness of a tailored implementation toolkit. The I‐STEM is a sensitising tool that defines key considerations and activities for undertaking stakeholder engagement activities across an implementation process. Methods: In‐depth, semistructured interviews and observations were conducted with implementers who were tailoring implementation strategies to integrate and embed internet‐based cognitive behavioural therapy (iCBT) services in 12 routine mental health care organisations in nine countries in Europe and Australia. The analytical process was informed by principles of first‐ and third‐generation Grounded Theory, including constant comparative method. Results: We conducted 55 interviews and observed 19 implementation‐related activities (e.g., team meetings and technical support calls). The final outcome of our analysis is expressed in an initial version of the I‐STEM, consisting of five interrelated concepts: engagement objectives, stakeholder mapping, engagement approaches, engagement qualities and engagement outcomes. Engagement objectives are goals that implementers plan to achieve by working with stakeholders in the implementation process. Stakeholder mapping involves identifying a range of organisations, groups or people who may be instrumental in achieving the engagement objectives. Engagement approaches define the type of work that is undertaken with stakeholders to achieve the engagement objectives. Engagement qualities define the logistics of the engagement approach. Lastly, every engagement activity may result in a range of engagement outcomes. Conclusion: The I‐STEM represents potential avenues for substantial stakeholder engagement activity across key phases of an implementation process. It provides a conceptual model for the planning, delivery, evaluation and reporting of stakeholder engagement activities. The I‐STEM is nonprescriptive and highlights the importance of a flexible, iterative approach to stakeholder engagement. It is developmental and will require application and validation across a range of implementation activities. Patient or Public Contribution: Patient contribution to ImpleMentAll trial was facilitated by GAMIAN‐Europe at all stages—from grant development to dissemination. GAMIAN‐Europe brings together a wide variety of patient representation organisations (local, regional and national) from almost all European countries. GAMIAN‐Europe was involved in pilot testing the ItFits‐toolkit and provided their views on the various aspects, including stakeholder engagement. Patients were also represented in the external advisory board providing support and advice on the design, conduct and interpretation of the wider project, including the development of the ItFits‐toolkit. Trial registration: ClinicalTrials.gov NCT03652883. Retrospectively registered on 29 August 2018. [ABSTRACT FROM AUTHOR]

Objective: Recent public awareness of racial and ethnic disparities has again brought to light issues of diversity, equity, and inclusion in the eating disorders field. However, empirical information on racial and ethnic representation in eating disorders research is limited, making it difficult to understand where improvements are needed. Method: This study reviewed all studies including human participants published in the International Journal of Eating Disorders in 2000, 2010, and 2020. Differences in likelihood of reporting race and ethnicity were calculated based on study year, location, and diagnostic categories. Results: Out of 377 manuscripts, 45.2% reported information on the race and ethnicity of study participants. Studies conducted in the United States were more likely to report (128/173), and those conducted in Europe were less likely to report (5/61) on race and ethnicity than those conducted outside of those regions. Rates of reporting increased from 2000 to 2020. White participants made up approximately 70% of the samples that reported race and ethnicity data. Hispanic participants made up approximately 10% of samples reporting race and ethnicity. Participants from all other races and ethnicities made up less than 5% each. Discussion: Although rates of reporting race and ethnicity increased over time, most participants were White. Rates of reporting also differed by the geographical region, which may reflect variability in how information on race and ethnicity is collected across countries. More attention toward capturing the cultural background of research participants and more inclusivity in research are needed in the eating disorders field. [ABSTRACT FROM AUTHOR]

This paper investigates extrinsic motivation as a determinant of knowledge exchange among employees in sales teams. Applying a social network approach, we study different forms of knowledge‐exchange behaviors from the perspective of a focal employee and from the perspective of the dyad. From the focal employees' perspective, we disentangle knowledge seeking from knowledge providing, and argue that these two behaviors are affected differently by employees' extrinsic motivation. From the dyad perspective, we take similarity in motivation of tied‐to employees and reciprocity of exchange ties into account. To test our hypotheses, we apply exponential random graph models to data gathered from 138 employees in five different sales teams distributed across three companies in Central Europe. The results of our analysis from the focal employees' perspective show that extrinsically motivated employees generally engage in less knowledge exchange. The dyad perspective further highlights that sales employees proceed purposefully when they exchange knowledge with coworkers. For instance, two employees' relative levels of extrinsic motivation determine their willingness to engage in reciprocal knowledge exchange. We discuss the implications of our findings for research on the microfoundations of organizational knowledge management and draw conclusions concerning HRM practices used to foster extrinsic motivation, thereby affecting knowledge exchange. [ABSTRACT FROM AUTHOR]

Background: Learning Analytics (LA) is an emerging field concerned with measuring, collecting, and analysing data about learners and their contexts to gain insights into learning processes. As the technology of Learning Analytics is evolving, many systems are being implemented. In this context, it is essential to understand stakeholders' expectations of LA across Higher Education Institutions (HEIs) for large‐scale implementations that take their needs into account. Objectives: This study aims to contribute to knowledge about individual LA expectations of European higher education students. It may facilitate the strategy of stakeholder buy‐in, the transfer of LA insights across HEIs, and the development of international best practices and guidelines. Methods: To this end, the study employs a 'Student Expectations of Learning Analytics Questionnaire' (SELAQ) survey of 417 students at the Goethe University Frankfurt (Germany) Based on this data, Multiple Linear Regressions are applied to determine how these students position themselves compared to students from Madrid (Spain), Edinburgh (United Kingdom) and the Netherlands, where SELAQ had already been implemented at HEIs. Results and Conclusions: The results show that students' expectations at Goethe University Frankfurt are rather homogeneous regarding 'LA Ethics and Privacy' and 'LA Service Features'. Furthermore, we found that European students generally show a consistent pattern of expectations of LA with a high degree of similarity across the HEIs examined. European HEIs face challenges more similar than anticipated. The HEI experience with implementing LA can be more easily transferred to other HEIs, suggesting standardized LA rather than tailor‐made solutions designed from scratch. Lay Description: What is currently known about this topic: Implementing Learning Analytics is a promising but challenging task.SELAQ is a questionnaire that can be used to determine students' expectations of Learning Analytics.Several institutions in Europe applied SELAQ to implement Learning Analytics that meet the needs of their students. What this paper adds to this: This study applies SELAQ for the first time at a German university and compares the results to studies from the UK, Spain, and the Netherlands.The participating students at the German university show relatively homogeneous expectations of Learning Analytics.The expectations towards Learning Analytics of students across Europe are comparable. The implications of study findings for practitioners: Learning Analytics systems should be shared across institutions rather than being implemented separately as tailored solutions.More standardized or modular Learning Analytics systems are reasonable. [ABSTRACT FROM AUTHOR]

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

Background: Formative assessments are vital for supporting learning and performance but are also considered to increase the workload of teachers. As self‐assessments in higher education are increasingly facilitated via digital learning environments allowing to offer direct feedback and tracking students' digital learning behaviour these constraints might be reduced. Yet, learning analytics do not make sufficient use of data on assessments. Aims: This exploratory case study uses learning analytics methods for investigating students' engagement with self‐assessments and how this relates to performance in the final exam and self‐reported self‐testing strategies. Materials & Methods: The research study has been conducted at a European university in a twelve‐weeks course of a Bachelor's program in Economic and Business Education including nenroll = 159 participants. During the semester, students were offered nine self‐assessments each including three to eight tasks plus one mid‐term and one exam‐preparation self‐assessment including all prior self‐assessments tasks. The self‐assessment interaction data for each student included: the results of the last self‐assessment attempt, the number of processed self‐assessment tasks, and the time spent on the last self‐assessment attempt, the total self‐assessment attempts, and the first as well as last access of each self‐assessment. Data analytics included unsupervised machine learning and process mining approaches. Results: Findings indicate that students use the self‐assessments predominantly before summative assessments. Two distinct clusters based on engagement with self‐assessments could be identified and engagement was positively related to performance in the final exam. The findings from learning analytics data were also indicated by students' self‐reported use of self‐testing strategies. Discussion: With the help of multiple data from self‐reports, formal exams, and a learning analytics system, the findings provided multiple perspectives on the use of self‐assessments and their relationships with course performance. These findings call for applying assessment analytics and related frameworks in learning analytics as well as providing learners with related adaptive feedback. Conclusion: Future research might investigate different (self‐report) variables for clustering, other student cohorts or self‐assessment forms. Lay Description: What is already known about this topic: Formative assessments are vital for supporting learning and performance.Learning analytics do not make sufficient use of data on assessments. What this paper adds: Students use the self‐assessments predominantly prior to summative assessments.Engagement with self‐assessments was positively related to performance in the final exam. Implications for practice and/or policy: Findings call for applying assessment analytics and implementing related learning analytics frameworks for supporting learning processes and performance.Pedagogically oriented assessment analytics may provide multiple benefits for learners, teachers, schools, and other involved stakeholders. [ABSTRACT FROM AUTHOR]

This paper investigates different uses of the Journal Impact Factor (JIF) in national journal rankings and discusses the merits of supplementing metrics with expert assessment. Our focus is national journal rankings used as evidence to support decisions about the distribution of institutional funding or career advancement. The seven countries under comparison are China, Denmark, Finland, Italy, Norway, Poland, and Turkey—and the region of Flanders in Belgium. With the exception of Italy, top‐tier journals used in national rankings include those classified at the highest level, or according to tier, or points implemented. A total of 3,565 (75.8%) out of 4,701 unique top‐tier journals were identified as having a JIF, with 55.7% belonging to the first Journal Impact Factor quartile. Journal rankings in China, Flanders, Poland, and Turkey classify journals with a JIF as being top‐tier, but only when they are in the first quartile of the Average Journal Impact Factor Percentile. Journal rankings that result from expert assessment in Denmark, Finland, and Norway regularly classify journals as top‐tier outside the first quartile, particularly in the social sciences and humanities. We conclude that experts, when tasked with metric‐informed journal rankings, take into account quality dimensions that are not covered by JIFs. [ABSTRACT FROM AUTHOR]

Background: Parents play a central role in the treatment of childhood stuttering. Addressing parental attitudes toward stuttering is helpful therapeutically. The extent to which differences in attitudes toward stuttering exist on the basis of sex, geographical region and parental status (e.g., parent of a stuttering child, parent of a nonstuttering child, nonparent) is unclear. Many studies investigating such factors have used the Public Opinion Survey of Human Attributes–Stuttering (POSHA–S) questionnaire. A large POSHA–S database has collected responses from over 20 000 people from 49 countries. Aims: The aim of this study was to use the POSHA‐S database to examine the extent to which the following variables influence attitudes toward stuttering: (a) parents' sex (mothers vs. fathers), (b) geographic region (Middle East vs. Europe and North America), (c) parents' children (stuttering vs. nonstuttering) and (d) parental status (parents versus nonparents). Methods & Procedures: Data used in this study were extracted from selected, relevant studies that administered the POSHA–S to respondents. The Overall Stuttering Scores were compared on the basis of sex and parent status (i.e., mothers and fathers; nonparent women and men) and were then compared within and across the two geographical areas. Group comparisons were performed using analysis of variance followed by independent t tests, and Cohen's d was calculated to determine effect sizes. Outcomes & Results: Statistically significant differences were observed upon the basis of geographical region. In general, male parents and nonparents tend to have more positive stuttering attitudes among the Middle Eastern samples while female parents and nonparents tend to show more positive attitudes in European and North American samples in the POSHA–S database. Effect sizes were small for all comparisons. Conclusions & Implications: The effect of geographic region and culture may predict sex‐based differences among mothers' and fathers' attitudes toward stuttering; however, the clinical significance is unclear. Additional research is needed to better understand how children who stutter are affected by their parents' attitudes toward stuttering. What this paper adds: What is already known on this subject: The research clearly indicates that attitudes toward stuttering vary according to geographical region. Less clear is whether mothers and fathers from geographically diverse backgrounds hold different attitudes toward stuttering and the extent to which parental status (being a parent, parent of a child who stutters or nonparent) affects attitudes toward stuttering. What this study adds: This study's findings confirm that geographical differences do influence attitudes toward stuttering. Male parents and nonparents tend to have equal or more positive attitudes toward stuttering in Middle Eastern samples, whereas non‐Middle Eastern female parents and nonparents tend to show hold more positive attitudes. What are the clinical implications of this work?: In addition to being culturally sensitive when working with parents of children who stutter, clinicians should also consider that mothers and fathers may have some differences in attitudes and behaviours toward their child's stuttering. These differences should be considered when designing treatment plans. It should also be noted that, despite statistical significance, the effect sizes in this study were low, suggesting that further research as well as close collaboration with parents of children who stutter is warranted. [ABSTRACT FROM AUTHOR]

Background: Cesarean birth (CB) rates have increased over recent years with concerns over differences between these rates in migrant communities compared with the rates among women in their receiving country. This review aimed at summarizing the available literature regarding the incidence of CB among migrants in Europe. Methods: A systematic search of four electronic databases was carried out, including CINAHL, MEDLINE, Scopus, and Maternity and Infant Care. Identified studies were screened and their quality assessed. Meta‐analysis was undertaken using Rev Man 5.4 where sufficient data were available. Otherwise, data were synthesized narratively. Results: From the 435 records identified in searches, 21 papers were included. Analysis shows that overall CB rates were significantly lower for Syrian refugee women compared with women in their receiving country (Turkey) and higher for Iranian migrants than women in their host country. Emergency CB rates were significantly higher for migrant women from "Sub Saharan Africa" and the "South East Asia, Asia and Pacific" region than rates in the receiving country. Statistical significance was not found between other populations. Conclusions: This review highlights differences between CB rates in certain migrant groups in comparison with women native to their host country, which merits further investigation for potential explanations. We also identified a need to standardize definitions and population groupings to enable more meaningful analysis. This review also highlights a substantial lack of data on CB rates between different population groups that could negatively impact the provision of care. [ABSTRACT FROM AUTHOR]

Background: Despite technological innovations and continuous improvement in evidence‐based treatments, mortality in the intensive care unit (ICU) remains high. Consequently, a large group of family members may be in need of, and could benefit from, bereavement follow‐up support. Aims and Objectives: To explore the elements, organization, and evaluation of ICU bereavement services in European countries. Specific objectives were to investigate: (a) the model of bereavement follow‐up services (elements of support), (b) the workforce model (organization of staff), and (c) the evaluation model (evaluation strategies). Design: This was a cross‐sectional survey of conference delegates. Methods: A paper‐and‐pen questionnaire, including a cover letter assuring the respondents of anonymity and confidentiality, was distributed to 250 delegates during the opening ceremony of the 2017 European federation of Critical Care Nurses associations Congress in Belfast. The questionnaire was developed from a previously validated tool describing bereavement care practices in ICUs, including questions about the content and organization of bereavement follow‐up services. Frequencies were calculated using yes/no questions, and content analysis was applied in additional free‐text comments. Results: We received 85 responses from publicly employed nurses, mainly in mixed adult ICUs. Respondents were 48 (56.5%) bedside nurses, and the remaining respondents represented clinical nurse specialists, researchers, managers, or academic nurses. Bereavement follow up had existed for about 1 to 15 years. Important follow‐up elements were: viewing the deceased in the unit, 77 (90.6%); providing follow‐up information, 67 (79.8%); sending a letter of sympathy, 17 (20%); and calling the family to arrange a meeting, 27 (31%). Conclusions: Bereavement follow up is common but variable in European ICUs. We recommend the development, implementation, and evaluation of evidence‐based, but culture‐specific, bereavement follow‐up guidelines for European ICUs. Relevance to Clinical Practice: More critical care nurses are realizing the need for bereavement follow‐up guidelines. This paper provides an overview of common elements that might be considered. WHAT IS KNOWN ABOUT THIS TOPICMany families experience the death of a loved one in intensive care unit (ICU).Bereavement services are offered at some ICUs.WHAT THIS PAPER ADDSBereavement services are not systematically offered in European ICUs.Culture‐specific guidelines are needed for bereavement follow up in ICUs.Common elements of bereavement services have been identified, for example, viewing the deceased in the unit, providing follow‐up information, sending a letter of sympathy, and calling the family to arrange a meeting.Consequences of bereavement in ICU have been discussed, for example, prolonged or complicated grief and lack of closure in the bereaved. [ABSTRACT FROM AUTHOR]

The starting point of this contribution is the potential risk to health and performance from the combination of elite sporting careers with the pursuit of education. In European sport science and politics, structural measures to promote dual careers in elite sports have been discussed increasingly of late. In addition to organisational measures, there are calls for educational-psychological intervention programmes supporting the successful management of dual careers at the individual level. This paper presents an appropriate intervention programme and its evaluation: stress-resistance training for elite athletes (SRT-EA). It comprises 10 units, each lasting 90 minutes. It is intended for athletes and aims to improve their resistance to chronic stress. The evaluation was carried out in a quasi-experimental design, with three points of measurement (baseline, immediately after, and three months after) and two non-randomised groups: an intervention group (n = 128) and an untreated control group (n = 117). Participants were between 13 and 20 years of age (53.5% male) and represented various Olympic sports. Outcome variables were assessed with questionnaires. Significant short- and mid-term intervention effects were explored. The intervention increased stress-related knowledge, general self-efficacy, and stress sensitivity. Chronic stress level, stress symptoms, and stress reactivity were reduced. In line with the intention of the intervention, the results showed short- and mid-term, small to medium-sized effects. Accordingly, separate measurements at the end of the intervention and three months later showed mostly positive subjective experiences. Thus, the results reinforce the hope that educational-psychological stress-management interventions can support dual careers. [ABSTRACT FROM PUBLISHER]

Objective: The objective of this paper is to describe the data collected by the CBVCT services from the Community‐based testing (COBATEST) network, from 2014 to 2016, in order to provide an insight into community‐based voluntary counselling and testing (CBVCT) services’ testing activity in Europe. Methods: A descriptive analysis of HIV testing activity in CBVCT services that are using the COBATEST tools was performed for the period 2014–2016. Results: During the study period, a total of 30 329 HIV tests were performed on 27 934 individuals, of which 1.8% were reactive. Of these reactive tests, 75.8% had a confirmatory test, 92.2% of those were confirmed as positive, and 90.38% of the confirmed positives were linked to care. The total number of tests performed over the study period increased 19.31%. The proportion of confirmatory tests increased from 63.0% to 90.0% and proportion linked to care increased from 84.1% to 93.8%. Most of the tested individuals were men (70.6%), aged between 21 and 35 years (58.5%) and non‐foreign born (68.1%). A high proportion of individuals tested were men who have sex with men (MSM; 42.2%). The percentage of reactive screening tests was particularly high among transgender people (8.37%) and among male sex workers (6.38%). Repeat testers had a higher percentage of reactive tests (2.02%) than those tested for first time (1.1%). Conclusions: These results prove the feasibility of collecting standardized data from CBVCT services in different countries across Europe and demonstrate the usefulness of such data. [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives: Online modified Delphi (OMD) panel approaches can be used to engage large and diverse groups of clinical experts and stakeholders in developing health services performance measures. Such approaches are increasing in popularity among health researchers. However, information about their acceptability to participating experts and stakeholders is lacking but important to determine before recommending widespread use of online approaches. Therefore, the objective of this paper is to explore acceptability of the OMD panel approach from the participants' perspective. Method: We use data from participants in three OMD panels designed to develop performance measures for use in arthritis research and quality improvement efforts. At the end of each online panel, we surveyed clinical experts and stakeholders who shared their experiences with the OMD process by answering 13 close-ended questions using 7-point Likert-type scales. A mean of 5 or higher on a given question was treated as an indication of acceptability. Results: Ninety-eight clinical experts and stakeholders (92% participation rate) answered survey questions about the online process. They considered the OMD panel approach to be acceptable, particularly the ease of using the online system (mean = 5.3, standard deviation = 1.3) and the understanding gained from online discussions (mean = 5.2, standard deviation = 1.0). Participants also felt that participation in the Delphi study was interesting (mean = 5.6, standard deviation =1.1). Conclusion: These findings illustrate likely acceptability and a potential for a more widespread use of OMD panel approaches by stakeholders in developing health services performance measures. [ABSTRACT FROM AUTHOR]

In the past decade, policy‐makers in science have been concerned with harmonizing research integrity standards across Europe. These standards are encapsulated in the European Code of Conduct for Research Integrity. Yet, almost every European country today has its own national‐level code of conduct for research integrity. In this study we document in detail how national‐level codes diverge on almost all aspects concerning research integrity—except for what constitutes egregious misconduct. Besides allowing for potentially unfair responses to joint misconduct by international collaborations, we argue that the divergences raise questions about the envisaged self‐regulatory function of the codes of conduct. [ABSTRACT FROM AUTHOR]

The Wound‐QoL assesses the impact of chronic wounds on patients' health‐related quality of life (HRQoL). A 17‐item and a shortened 14‐item version are available. The Wound‐QoL‐17 has been validated for multiple languages. For the Wound‐QoL‐14, psychometric properties beyond internal consistency were lacking. We aimed to validate both Wound‐QoL versions for international samples representing a broad range of European countries, including countries for which validation data had yet been pending. Patients with chronic wounds of any aetiology or location were recruited in Austria, Lithuania, the Netherlands, Poland, Slovakia, Spain, Switzerland and Ukraine. Psychometric properties were determined for both Wound‐QoL versions for the overall sample and, if feasible, country‐wise. We included 305 patients (age 68.5 years; 52.8% males). Internal consistency was high in both Wound‐QoL‐17 (Cronbach's α: 0.820–0.933) and Wound‐QoL‐14 (0.779–0.925). Test–retest reliability was moderate to good (intraclass correlation coefficient: 0.618–0.808). For Wound‐QoL‐17 and Wound‐QoL‐14, convergent validity analyses showed highest correlations with global HRQoL rating (r = 0.765; r = 0.751) and DLQI total score (r = 0.684; r = 0.681). Regarding clinical data, correlations were largest with odour (r = −0.371; r = −0.388) and wound size (r = 0.381; r = 0.383). Country‐wise results were similar. Both Wound‐QoL versions are valid to assess HRQoL of patients with chronic wounds. Due to its psychometric properties and brevity, the Wound‐QoL‐14 might be preferrable in clinical practice where time is rare. The availability of various language versions allows for the use of this questionnaire in international studies and in clinical practice when foreign language patients are being treated. [ABSTRACT FROM AUTHOR]

Background Diet quality indices add an important dimension to dietary assessment. The aim of this systematic review was to: (i) identify and describe the attributes and applications of diet quality indices developed for use or used in paediatric populations; (ii) describe associations between these diet quality indices and health-related variables in paediatric populations; and (iii) identify factors that are associated with diet quality in paediatric populations worldwide. Methods Studies were identified by searching electronic databases for relevant papers from 1980 to October 2013 using keywords. Inclusion criteria were original studies that utilised a quantitative measure of diet quality in children and adolescents aged 0-18 years. Results One hundred and nineteen studies met the inclusion criteria, from which 80 different diet quality indices were identified. The majority of studies had >1000 participants and were of acceptable quality. Of the 56 studies that investigated health-related outcomes, weight status was the most researched. Europe produced the most number of diet quality indices ( n = 27 indices). Of the 119 studies, seven intervention studies were identified. Paediatric diet quality indices were found to be associated with environmental, behavioural and maternal factors. Conclusions The use of diet quality indices in paediatric populations is a rapidly expanding area of research in diverse populations internationally. In economically disadvantaged countries, diet quality indices may be predictive of child growth. However, prospective cohort, intervention and validation studies are required to draw stronger conclusions concerning risk of future disease in paediatric populations in general. [ABSTRACT FROM AUTHOR]

The nutritional adequacy of human milk (HM) from vegan/vegetarian mothers has been a matter of debate, and a variety of recommendations regarding the eligibility of these mothers as human milk donors exists. According to the latest evidence, HM from vegans/vegetarians is similar in its composition to that from omnivores, however, some differences may be observed regarding vitamin B12 and omega‐3 fatty acids concentrations. Maternal supplementation of these compounds has been proven effective in increasing their HM concentration. With this survey, we aimed to explore the practices currently in use in European human milk banks (HMBs) regarding potential donors following vegan/vegetarian diets. The online survey was distributed to European HMBs between January and July 2022. A total of 188 HMBs were contacted, and 118 replied (response rate 63%). Vegan and vegetarian mothers were recommended supplements of vitamin B12 to be accepted as donors in 27% and 26% of HMBs, respectively. Additional omega‐3 fatty acid supplementation was required in 8% HMBs. In the remaining HMBs, these mothers were either systematically excluded or included regardless of supplementation. The dosage of the recommended supplements was extremely variable. Fifty‐one percent of HMBs were following recommendations to guide their practice, national or local recommendations mainly. Great variability in European HMBs practices towards potential donors following vegan/vegetarian diets exists. Some of these practices can result in loss of donors and/or in potential nutritional deficiencies. Standardised evidence‐based recommendations on this issue and their implementation in daily HMB practice are needed. Key messages: There is significant variability among the practices of European human milk banks towards donors following a vegan or vegetarian diet.The majority of human milk banks follow no guidelines or local guidelines, rather than international ones.Some of the practices currently in use can result in the loss of potential donors and/or nutritional deficiencies for mothers, their babies, and potentially for recipients of donor human milk.Evidence‐based recommendations regarding the inclusion of these mothers in human milk donation and nutritional counselling are needed. [ABSTRACT FROM AUTHOR]

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

Objective To assess the participation of European urology residents in urological laparoscopy, their training patterns and facilities available in European Urology Departments., Materials and Methods A survey, consisting of 23 questions concerning laparoscopic training, was published online as well as distributed on paper, during the Annual European Association of Urology Congress in 2012., Exposure to laparoscopic procedures, acquired laparoscopic experience, training patterns, training facilities and motivation were evaluated., Data was analysed with descriptive statistics., Results In all, 219 European urology residents answered the survey., Conventional laparoscopy was available in 74% of the respondents' departments, while robotic surgery was available in 17% of the departments., Of the respondents, 27% were first surgeons and 43% were assistants in conventional laparoscopic procedures. Only 23% of the residents rated their laparoscopic experience as at least 'satisfactory'; 32% of the residents did not attend any course or fellowship on laparoscopy., Dry laboratory was the most frequent setting for training (33%), although 42% of the respondents did not have access to any type of laparoscopic laboratory., The motivation to perform laparoscopy was rated as 'high' or 'very high' by 77% of the respondents, and 81% considered a post-residency fellowship in laparoscopy., Conclusions Urological laparoscopy is available in most European training institutions, with residents playing an active role in the procedure. However, most of them consider their laparoscopic experience to be poor., Moreover, the availability of training facilities and participation in laparoscopy courses and fellowships are low and should be encouraged. [ABSTRACT FROM AUTHOR]

Aims: We measured the association between a history of incarceration and HIV positivity among people who inject drugs (PWID) across Europe. Design, Setting and Participants: This was a cross-sectional, multi-site, multi-year propensity-score matched analysis conducted in Europe. Participants comprised community-recruited PWID who reported a recent injection (within the last 12 months). Measurements: Data on incarceration history, demographics, substance use, sexual behavior and harm reduction service use originated from cross-sectional studies among PWID in Europe. Our primary outcome was HIV status. Generalized linear mixed models and propensity-score matching were used to compare HIV status between ever- and never-incarcerated PWID. Findings: Among 43 807 PWID from 82 studies surveyed (in 22 sites and 13 countries), 58.7% reported having ever been in prison and 7.16% (n = 3099) tested HIV-positive. Incarceration was associated with 30% higher odds of HIV infection [adjusted odds ratio (aOR) = 1.32, 95% confidence interval (CI) = 1.09-1.59]; the association between a history of incarceration and HIV infection was strongest among PWID, with the lowest estimated propensity-score for having a history of incarceration (aOR = 1.78, 95% CI = 1.47-2.16). Additionally, mainly injecting cocaine and/or opioids (aOR = 2.16, 95% CI = 1.33-3.53), increased duration of injecting drugs (per 8 years aOR = 1.31, 95% CI = 1.16-1.48), ever sharing needles/syringes (aOR = 1.91, 95% CI = 1.59-2.28) and increased income inequality among the general population (measured by the Gini index, aOR = 1.34, 95% CI = 1.18-1.51) were associated with a higher odds of HIV infection. Older age (per 8 years aOR = 0.84, 95% CI = 0.76-0.94), male sex (aOR = 0.77, 95% CI = 0.65-0.91) and reporting pharmacies as the main source of clean syringes (aOR = 0.72, 95% CI = 0.59-0.88) were associated with lower odds of HIV positivity. Conclusions: A history of incarceration appears to be independently associated with HIV infection among people who inject drugs (PWID) in Europe, with a stronger effect among PWID with lower probability of incarceration. [ABSTRACT FROM AUTHOR]

Slater et al. (2018. Singing it for "us": Team passion displayed during national anthems is associated with subsequent success. European Journal of Sport Science, 18(4), 541–549. https://doi.org/10.1080/17461391.2018.1431311) found that the perceived level of team passion displayed during (pre-match) national anthems at UEFA Euro 2016 predicted team performance during the match. Teams that displayed greater passion conceded fewer goals and team passion predicted the likelihood of victory during the knockout (but not group) stages. Here, we replicate Slater et al. using a larger sample of matches from the FIFA World Cup (n = 415), and apply more appropriate analyses, and control for potential confounds. We also extend the original study to consider additional performance-related outcome variables (fouls, bookings, and possession). We find no evidence that anthem passion was a reliable predictor of performance outcomes (i.e. match outcome, goals scored/conceded, fouls, bookings, possession) in competitive international soccer matches. HIGHLIGHTS Failing to replicate previous research, we find no evidence that the amount of collective passion displayed by a team during the national anthem predicts performance outcomes in soccer matches. Collective passion was unrelated to goals scored, goals conceded, match outcome, fouls, possession, and expected goals. The effect of passion on these outcomes was not moderated by the stage of competition. The reported null effects may be because verbal and non-verbal behaviours during the national anthem are poor signals of collective passion. [ABSTRACT FROM AUTHOR]

In 2022, Europe experienced unprecedented citizen mobilizations to help Ukrainian refugees. Based on two parallel lines of scholarship, we examined individual prosocial dispositions and superordinate identities related to intentions to help Ukrainians. Employing a French‐speaking student sample in Belgium (N = 374), in Study 1, we showed that dispositional prosociality and European identification were both positively related to intentions to help Ukrainians. An interaction qualified these main effects, so that highly prosocial European identifiers were particularly willing to help. With a nationwide quota sample of the French‐speaking population in Belgium (N = 371), in Study 2, we identified two processes mediating the relationship of dispositional prosociality and European identification with intentions to help Ukrainians. On the one hand, dispositional prosociality was positively related to empathy with Ukrainians, which in turn predicted participants' helping intentions. On the other hand, European identification was positively related to both empathy and identity fusion with Ukrainians, which further predicted participants' helping intentions. Overall, these findings suggest that individual prosocial dispositions and superordinate identities represent two cumulative pathways to intergroup helping. Concluding, we discuss common and specific processes related to intentions to help Ukrainians, compared with other refugee groups. [ABSTRACT FROM AUTHOR]

Background: Prevention of HIV transmission is fundamental to ending the HIV epidemic. Pre‐exposure prophylaxis (PrEP) with oral tenofovir‐emtricitabine (TDF‐FTC) is an established HIV‐prevention method; however, most PrEP services in Europe have been targeted at men who have sex with men (MSM). A survey in 2021 by Women Against Viruses in Europe (WAVE) showed considerable variation in PrEP access and guidance for women throughout Europe. WAVE therefore commissioned this systematic review to provide insight into PrEP provision and barriers to uptake for women in Europe. Methods: PubMed, Embase, and Scopus were searched for studies (January 2013–May 2021) that reported on actual (e.g., efficacy and safety) or hypothetical (e.g., awareness, barriers, PrEP impact models) use of oral PrEP involving women (including cis, transgender, pregnant, migrant, and breastfeeding women). Search terms included HIV, pre‐exposure prophylaxis (specifically TDF‐FTC), and women. Studies performed outside of the World Health Organization European region were excluded. Results: The search identified 4716 unique citations, and 45 peer‐reviewed articles (44 studies) were included. The majority of these studies (34/44 [77%]) included recipients or potential recipients of PrEP, representing 4699 women (243 transgender women). However, few studies were women focused (4/34 [12%]) or took place outside of Western Europe (3/34 [9%]). Across the three clinical studies that reported women‐specific outcomes (60 transgender women, 13 pregnant, and 19 cis women), no breakthrough infections were recorded during the use of PrEP. Lack of awareness of PrEP, low self‐estimation of HIV acquisition risk, concerns about stigma, lack of protection against other sexually transmitted infections, and PrEP interaction with hormones (for transgender women) were identified as barriers to use. The remaining studies examined healthcare professionals' perceptions of PrEP (9/44 [20%]), asked for public opinion (2/44 [5%]), or modelled the potential of PrEP for HIV prevention (1/44 [2%]). Conclusions: This review revealed a notable lack of literature on PrEP for cis and transgender women in Europe. This is synonymous with a lack of PrEP provision for women in this region. Barriers to PrEP uptake are complex and rooted in institutional and societal stigma, which must be addressed at policy level. HIV prevention with PrEP is not 'one size fits all' and requires a nuanced gender‐responsive approach. Further research into the use of PrEP in cis, pregnant, breastfeeding, and transgender women is essential if we are to stop HIV transmission by 2030. [ABSTRACT FROM AUTHOR]

Objectives To assess the efficacy of comprehensive geriatric assessment ( CGA) in prevention of delirium after hip fracture. Design Systematic review and metaanalysis. Setting Ward based models on geriatrics wards and visiting team based models on orthopaedics wards were included. Participants Four trials (three European, one U.S.; 973 participants) were identified. Two assessed ward-based, and two assessed team-based interventions. Measurements MEDLINE, EMBASE, CINAHL and Psyc INFO databases; Clinicaltrials.gov; and the Central Register of Controlled Trials were searched. Reference lists from full-text articles were reviewed. Incidence of delirium was the primary outcome. Length of stay, delirium severity, institutionalization, long-term cognition and mortality were predefined secondary outcomes. Duration of delirium was included as a post hoc outcome. Results There was a significant reduction in delirium overall (relative risk ( RR) = 0.81, 95% confidence interval ( CI) = 0.69-0.94) in the intervention group. Post hoc subgroup analysis found this effect to be preserved in the team-based intervention group ( RR = 0.77, 95% CI = 0.61-0.98) but not the ward-based group. No significant effect was observed on any secondary outcome. Conclusion There was a reduction in the incidence of delirium after hip fracture with CGA. This is in keeping with results of non-randomized controlled trials and trials in other populations. Team-based interventions appeared superior in contrast to the Ellis CGA paper, but it is likely that heterogeneity in interventions and population studied affected this. [ABSTRACT FROM AUTHOR]

Background: The prevalence of obesity has risen in recent decades and reached epidemic proportions worldwide. The proportion of those living with obesity is also increasing in nursing homes. This could impact the nursing care required, equipment and facilities provided, and morbidity in these settings. Limited evidence exists on clinical consequences of obesity in nursing home residents and their care. Objective: Therefore, the aim was to examine the rate and associated factors of obesity (BMI ≥30; class I (BMI 30.0–34.9 kg/m2), class II (BMI 35.0–39.9 kg/m2), and class III (BMI >40.0 kg/m2)) amongst older nursing home residents in European countries. Methods: We analysed data from 21,836 people who reside in nursing homes in Austria, the Netherlands, and the United Kingdom. They participated in the "International Prevalence Measurement of Care Quality", a cross sectional study between 2016 and 2019, where trained nurses interviewed the residents, reviewed care records, and conducted clinical examinations. A tested and standardised questionnaire comprised questions on demographic data, measured BMI, medical diagnosis according to ICD‐10, and care dependency. Descriptive and logistic regression analyses were performed. Results: Obesity rates were highest in Austria (17.1%) and lowest in the UK (13.0%) (p =.006). Residents with obesity were younger and less likely to be care dependent or living with dementia and had more often diabetes mellitus, endocrine, metabolic, and skin diseases compared to residents without obesity (p <.05). Most obese residents had obesity class I. Therefore, two subgroups were built (class I vs. class II + III). Residents with obesity class II + III were more frequently care dependent for mobility, getting dressed and undressed, and personal hygiene compared to residents with class I (p <.05). Conclusions: This study identified several factors that are associated with obesity amongst older nursing home residents in selected European countries. Implications for practice: The division into obesity classes is important for planning targeted care according to the individual needs of nursing home residents. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to investigate the impact of the 2021 European Society of Cardiology (ESC) guideline changes in left bundle branch block (LBBB) definition on cardiac resynchronization therapy (CRT) patient selection and outcomes. Methods: The MUG (Maastricht, Utrecht, Groningen) registry, consisting of consecutive patients implanted with a CRT device between 2001 and 2015 was studied. For this study, patients with baseline sinus rhythm and QRS duration ≥ 130ms were eligible. Patients were classified according to ESC 2013 and 2021 guideline LBBB definitions and QRS duration. Endpoints were heart transplantation, LVAD implantation or mortality (HTx/LVAD/mortality) and echocardiographic response (LVESV reduction ≥15%). Results: The analyses included 1.202, typical CRT patients. The ESC 2021 definition resulted in considerably less LBBB diagnoses compared to the 2013 definition (31.6% vs. 80.9%, respectively). Applying the 2013 definition resulted in significant separation of the Kaplan–Meier curves of HTx/LVAD/mortality (p <.0001). A significantly higher echocardiographic response rate was found in the LBBB compared to the non‐LBBB group using the 2013 definition. These differences in HTx/LVAD/mortality and echocardiographic response were not found when applying the 2021 definition. Conclusion: The ESC 2021 LBBB definition leads to a considerably lower percentage of patients with baseline LBBB then the ESC 2013 definition. This does not lead to better differentiation of CRT responders, nor does this lead to a stronger association with clinical outcomes after CRT. In fact, stratification according to the 2021 definition is not associated with a difference in clinical or echocardiographic outcome, implying that the guideline changes may negatively influence CRT implantation practice with a weakened recommendation in patients that will benefit from CRT. [ABSTRACT FROM AUTHOR]

Background and Aims: Excessive cannabis use may lead to lower educational attainment. However, this association may be due to confounders and reverse causality. We tested the potential causal relationship between cannabis use disorder (CUD) or life‐time cannabis use (LCU) and educational attainment. Design: Bidirectional two‐sample Mendelian randomization (MR) study was conducted. Our primary method was inverse‐variance weighted (IVW) MR, with a series of sensitivity analyses. Multivariable MR (MVMR) was performed to estimate any direct effect independent of intelligence, smoking initiation or attention deficit hyperactivity disorder (ADHD). Setting and participants: European ancestry individuals. The sample sizes of the genome‐wide association study ranged from 55 374 to 632 802 participants. Measurements Genetic variants of CUD, LCU or educational attainment. Findings Using univariable MR, we found evidence of a potential causal effect of genetic liability to CUD on a lower educational attainment [MR, 95% confidence interval (CI)inverse variance weighted (IVW) = −1.2 month (−1.9 month, −0.5 month); P = 0.0008]. However, we found no evidence of an effect of genetic liability to LCU on educational attainment [MR, 95% CIIVW = 0.5 month (−1.5 month, 2.6 month), P = 0.6032]. Reverse direction analysis suggested that genetic liability to higher educational attainment had a potential causal effect on lower risk of CUD [odds ratio (OR), 95% CIIVW = 0.39 (0.29, 0.52), P = 1.69 × 10−10]. We also found evidence of potential causal effect from genetic liability to higher educational attainment to higher risk of LCU [OR, 95% CIIVW = 1.35 (1.11, 1.66), P = 0.0033]. Conclusions: Genetic liability to cannabis use disorder may lead to lower educational attainment. Genetic liability to higher educational attainment may also lead to higher life‐time cannabis use risk and lower cannabis use disorder risk. However, the bidirectional effect between cannabis use disorder and educational attainment may be due to shared risk factors (e.g. attention‐deficit hyperactivity disorder). [ABSTRACT FROM AUTHOR]

Aim: To develop and validate models based on logistic regression and artificial intelligence for prognostic prediction of molar survival in periodontally affected patients. Materials and Methods: Clinical and radiographic data from four different centres across four continents (two in Europe, one in the United States, and one in China) including 515 patients and 3157 molars were collected and used to train and test different types of machine‐learning algorithms for their prognostic ability of molar loss over 10 years. The following models were trained: logistic regression, support vector machine, K‐nearest neighbours, decision tree, random forest, artificial neural network, gradient boosting, and naive Bayes. In addition, different models were aggregated by means of the ensembled stacking method. The primary outcome of the study was related to the prediction of overall molar loss (MLO) in patients after active periodontal treatment. Results: The general performance in the external validation settings (aggregating three cohorts) revealed that the ensembled model, which combined neural network and logistic regression, showed the best performance among the different models for the prediction of MLO with an area under the curve (AUC) = 0.726. The neural network model showed the best AUC of 0.724 for the prediction of periodontitis‐related molar loss. In addition, the ensembled model showed the best calibration performance. Conclusions: Through a multi‐centre collaboration, both prognostic models for the prediction of molar loss were developed and externally validated. The ensembled model showed the best performance in terms of both discrimination and validation, and it is made freely available to clinicians for widespread use in clinical practice. [ABSTRACT FROM AUTHOR]

This study investigates how the effect of employee stock ownership on financial performance may hinge on the diverse cultural and societal contexts of European countries. Based on agency and national culture theories, we hypothesize that the positive relationship between employee stock ownership and return on assets (ROA) is stronger in those nations with lower uncertainty avoidance and higher social trust. Using a multisource, time‐lagged, large‐scale dataset of 1,741 firms from 21 countries in Europe, our multilevel, random coefficient modeling analysis found evidence for these hypotheses, suggesting that uncertainty avoidance and social trust serve as important contextual cues in predicting the linkage between employee stock ownership and financial performance. Our supplemental analysis with distinction between the managerial and nonmanagerial employee stock ownership further indicates managerial employee stock ownership has a direct positive effect on ROA. Although nonmanagerial employee stock ownership had a nonsignificant association with ROA, the relationship was positive and significant when uncertainty avoidance was low and social trust was high. This research contributes to the existing literature by illuminating some of the contextual influences altering the effectiveness of employee stock ownership. Our findings also offer practical suggestions for effectively using employee stock ownership. [ABSTRACT FROM AUTHOR]

Can older managers overcome stereotypes relating age to low competence? We integrate the literature on age and cognitive ability with research on innovation to explore whether—and if so, when—employees' age harms performance and promotability appraisals made by their supervisors. Multisource, time‐lag data from 305 project managers indicate that the negative stereotypes can be explained through decreased innovative behavior. However, older employees are not always seen as poorer performers with less potential to be promoted due to their reduced innovative behavior. Rather, interdepartmental collaboration moderates these effects. Specifically, older employees with low interdepartmental collaboration are less innovative and receive worse performance and promotability appraisals than younger employees, but the "age handicap" vanishes when older employees collaborate with members of other departments. Organizations should foster formal or informal collaboration among units to prevent negative consequences of an aging workforce. [ABSTRACT FROM AUTHOR]

Purpose: We examined the association between social distancing and trouble sleeping during the COVID‐19 outbreak in adults 65+, and underlying potential mechanisms. Methods: We used data from the extensive Survey of Health, Aging, and Retirement in Europe (SHARE). Logistic regression analysis tested the direct and indirect associations between social distancing and trouble sleeping during the pandemic, the mediation effect of depression, and the moderating‐mediation effects of perceived economic status and employment status. Findings Social distancing was associated with a higher probability of sleeping problems, partially mediated by depression and moderated by employment status and perceived economic status. Depression had a greater effect on trouble sleeping among those unemployed and those who perceived their economic status as difficult or partially difficult. Conclusion: COVID‐19 policy of lockdowns and physical distancing has negative consequences on sleeping and the development of depressive symptoms among older adults. Clinical and policy relevance: Clinicians should be aware of sleep problems in older adults during the pandemic and after, and try to reduce depressive symptoms. Policymakers should determine future policies and regulations that encourage employment among older adults and improve their economic resilience during pandemics. [ABSTRACT FROM AUTHOR]

This article studies the impact of employment law on de facto labour market segmentation for 22 European countries from 1991 to 2014. Applying the concept of legal segmentation, the authors distinguish between the standard‐setting (protective), privileging and equalizing functions of employment law and use descriptive and multivariate statistics to indicate their effects on overall employment, and male and female standard and non‐standard employment. High privileging, in combination with high standard‐setting, is found to favour male standard employment and female non‐standard employment, while the equalizing function, aimed at improving the protection of women and other marginalized groups, actually increases male non‐standard employment. [ABSTRACT FROM AUTHOR]

Summary: Background: Living in single parent and blended families or as an only child—compared to living in two‐parent biological families or with siblings, respectively—is associated with a higher body mass index (BMI) in cross‐sectional studies. However, longitudinal research addressing the children's BMI in this context is scarce. Further, little is known about the association between family structure and metabolic health. Objectives: This study aimed at investigating the association between both aspects of family structure with BMI and a metabolic score (MetS). Methods: Cross‐sectional data from 7804 children participating in the European multi‐center I.Family study (2013/2014) and longitudinal data from 5621 children who also participated previously in the IDEFICS study (2007–2010) were used. Family structure was assessed by a detailed interview. BMI z‐score and the MetS were based on measured anthropometry, blood pressure, high‐density lipoprotein, blood glucose, and triglycerides. Linear regressions were performed to model associations between family structure with BMI and MetS. Results: Children from single‐parent families had higher BMI z‐scores in the cross‐sectional (β = 0.09, 95% confidence interval [CI]: 0.001 to 0.18) and longitudinal analyses compared to those from two‐parent families. Cross‐sectionally, the number of siblings was associated with lower BMI z‐scores (β = −0.07, 95% CI: −0.10 to −0.03) and lower MetS (β = −0.14, 95% CI: −0.26 to −0.01). Longitudinally, only children between baseline and follow‐up had higher BMI z‐scores at follow‐up (β = 0.07, 95% CI: 0.01 to 0.14) compared to stable siblings. Conclusion: Obesity prevention measures should focus on single‐parent households and families with an only child. [ABSTRACT FROM AUTHOR]

In this multilevel study, the authors investigate the influence of country‐level formal institutions and workgroup behavior on foreign subsidiary employees' participation in employee stock ownership plans (ESOPs). Based on the perspectives of bounded rationality, transaction cost theory, and psychological ownership, the authors argue that weak formal institutions restrain multinational enterprises from effectively implementing ESOPs due to reduced employee participation. However, the authors expect that workgroup behavior—more specifically, the participation of the workgroup's members and superiors in ESOPs—has a positive influence on employees' ESOP participation. Furthermore, the authors analyze whether cross‐level effects of institutions and workgroup behavior function as substitutes or complements. They empirically examine the ESOP participation of 185,291 foreign subsidiary employees in 28 countries. The results confirm the hypotheses about direct effects of weak institutions and workgroup behavior and additionally provide support for a complementary relationship between institutions and workgroup behavior. [ABSTRACT FROM AUTHOR]

Background: Non‐pharmacologic interventions might be effective to reduce the incidence of delirium in pediatric intensive care units (PICU). Aim: To explore expert opinions and generate informed consensus decisions regarding the content of a non‐pharmacologic delirium bundle to manage delirium in PICU patients. Study design: A two‐round online Delphi study was conducted from February to April 2021. PICU experts (nurses, physicians, researchers, physical therapists, play specialists, and occupational therapists) located in Europe, North America, South America, Asia, and Australia participated. Results: We developed a questionnaire based on the outcomes of a comprehensive literature search in the domains: 1) cognition support; 2) sleep support; and 3) physical activity support. Under these domains, we listed 11 strategies to promote support with 61 interventions. Participants rated the feasibility of each intervention on a 9‐point Likert scale (ranging from 1 strongly disagree to 9 strongly agree). A disagreement index and panel median were calculated to determine the level of agreement among experts. In the second round, participants reassessed the revised statements and ranked the interventions in each domain in order of importance for age groups: 0–2, 3–5, and 6–18 years of age. During the first Delphi round, 53 of 74 (72%) questionnaires were completed, and in the second round 45 of 74 (61%) were completed. Five of the highest ranked interventions across the age groups were: 1) developing a daily routine, 2) adjusting light exposure according to the time of day, 3) scheduling time for sleep, 4) providing eyeglasses and hearing aids if appropriate, 5) encouraging parental presence. Conclusions: Based on expert consensus, we developed an age‐specific non‐pharmacologic delirium bundle of interventions to manage delirium in PICU patients. Relevance to Clinical Practice: An age‐specific Non‐Pharmacological Delirium bundle is now ready to be tested in the PICU and will hopefully reduce pediatric delirium. [ABSTRACT FROM AUTHOR]

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

Implementation of the Global Strategy for Infant and Young Child Feeding varies widely among countries. Policymakers would benefit from insights into obstacles and enablers. Our aim was to explore the processes behind the development and implementation of national infant and young child feeding policies and monitoring systems in Europe. A qualitative study design was employed to analyze open text responses from six European countries (Croatia, Germany, Lithuania, Spain, Turkey and Ukraine) using inductive thematic analysis. Countries were selected based on their World Breastfeeding Trends Initiative scores on national policy and monitoring systems. The 33‐item online questionnaire was distributed to country representatives and completed by country teams. Key enablers and strengths included strong and continuous government commitment to infant and young child feeding, an operational national breastfeeding authority, a national and active monitoring and evaluation system, implementation of the International Code of Marketing of Breastmilk Substitutes in national legislation, the integration of skilled breastfeeding supporters, the implementation of the Baby‐friendly Hospital Initiative, and positive cultural norms and traditions supporting optimal infant and young child feeding. In some countries, UNICEF played a key role in funding and designing policies and monitoring systems. Weak government leadership, the strong influence of the industry, lack of adequate national legislation on the International Code and cultural norms which devalued breastfeeding were particularly noted as obstacles. Government commitment, funding and protection of optimal infant and young child feeding are essential to the implementation of strong national policies and monitoring systems. Key messages: Government commitment was essential to the implementation of strong policies and programs, adequate funding and legislation to protect breastfeeding.Cultural norms and traditions lay behind the prioritization of breastfeeding in some countries, while in others severe adversity led to an increased role for UNICEF which provided the framework and funding to establish strong policies and programs.The influence of the formula industry can undermine government priorities, health professional training and public opinion.This study provides lessons for policymakers who wish to protect, promote and support optimal infant and young child feeding. [ABSTRACT FROM AUTHOR]

Objective: Prevention of osteoarthritis (OA) remains important, as there are no disease‐modifying treatments. A personalized approach has the potential to better target prevention strategies. In the present study, we used recently identified genetic risk variants from genome‐wide association analysis for advanced OA to calculate polygenic risk scores (PRS) for knee and hip OA and assessed PRS performance in an independent population of older community‐dwelling adults. Methods: PRS were calculated in 12,093 individuals of European genetic descent ages ≥70 years who were enrolled in the Aspirin in Reducing Events in the Elderly trial. The outcome measure was knee and hip replacement (hospitalizations during the trial and self‐reported joint replacements before enrollment). PRS were considered as continuous (per SD) and categorical (low risk [0–20%], medium risk [21–80%], high risk [81–100%]) variables. Logistic regression was used to examine associations between PRS and risk of joint replacement, adjusted for age, sex, body mass index, and socioeconomic status. Results: Among the participants, 1,422 (11.8%) had knee replacements and 1,297 (10.7%) had hip replacements. PRS (per SD) were associated with a risk of knee replacement (odds ratio [OR] 1.13 [95% confidence interval (95% CI) 1.07–1.20]) and hip replacement (OR 1.23 [95% CI 1.16–1.30]). Participants with high PRS had an increased risk of knee replacement (OR 1.44 [95% CI 1.20–1.73]) and hip replacement (OR 1.88 [95% CI 1.56–2.26]), compared to those with low PRS. Associations were stronger for PRS and hip replacement risk in women than in men. Associations were similar in sensitivity analyses that examined joint replacements before and during the trial separately. Conclusion: PRS have the potential to improve prevention of severe knee and hip OA by providing a personalized approach and identifying individuals who may benefit from early intervention. [ABSTRACT FROM AUTHOR]

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Aim: This study aimed to identify the factors influencing the changes in the number of teeth present and the number of healthy or filled surfaces between two time points. Materials and Methods: Repeated cross‐sectional data from population‐based studies, namely the German Oral Health Studies (DMS‐III vs. DMS‐V), the Studies of Health in Pomerania (SHIP‐START‐0 vs. SHIP‐TREND‐0), and the Jönköping study (2003 vs. 2013), were analysed. Oaxaca decomposition models were constructed for the outcomes (number of teeth, number of healthy surfaces, and number of filled surfaces). Results: The number of teeth increased between examinations (DMS: +2.26 [adults], +4.92 [seniors], SHIP: +1.67, Jönköping: +0.96). Improvements in education and dental awareness brought a positive change in all outcomes. An increase in powered toothbrushing and inter‐dental cleaning had a great impact in DMS (adults: +0.25 tooth, +0.78 healthy surface, +0.38 filled surface; seniors: +1.19 teeth, 5.79 healthy surfaces, +0.48 filled surface). Inter‐dental cleaning decreased by 4% between SHIP‐START‐0 and SHIP‐TREND‐0, which negatively affected the outcomes. Conclusions: From this study, it can be concluded that education may be the most important factor having a direct and indirect effect on the outcomes. However, for better oral health, powered toothbrushing and inter‐dental cleaning should not be neglected. [ABSTRACT FROM AUTHOR]

Background: Countries vary in the number of qualified nurses employed in older adult services. Moreover, students' views of older people nursing as a career differ internationally. Studying future nurses and their career intentions for the field is warranted to meet the increased nurse workforce expectations in terms of quantity and competence. Aim: To analyse graduating nurse students' interest in older people nursing and the factors associated with it. Methods: A cross‐sectional multicountry survey design was applied. Data were collected between May 2018 and March 2019 from several educational institutions in Finland, Germany, Iceland, Ireland, Lithuania and Spain. Non‐probability convenience sampling was used to recruit graduating nurse students (n = 1796). The data were collected with a structured questionnaire comprising background factors and the Willingness sub‐scale (six items) of the Students' Interest in Nursing Older People Scale. Data were analysed using a linear mixed model including relevant background variables. Results: Overall, students' interest in older people nursing was low (score 20.5, on a 0‒100 scale). Among the studied countries, Spanish students scored the highest (38.8) and German students the lowest (3.6). Students' interest in older people nursing was associated with country (p <.001), the length of work experience (p =.006), plans for further study (p =.007), competence (p <.001) and the extent that nursing is valued by society (p <.001). The students who were most interested in older people nursing had higher self‐reported competence level (p <.001). Conclusion: In the studied sample of future nurse professionals, interest in older people nursing is low at a time when the field suffers from workforce shortage. As for quality workforce, it was promising that the students who considered working in the field also evaluated themselves as competent. Implications for practice: Multidimensional actions are required to promote interest in the field, including continued development of competence in both undergraduate education and workplaces, and investing in various career pathways to envisage potential opportunities. [ABSTRACT FROM AUTHOR]

Background and aims: Graph theoretic analysis of structural covariance networks (SCN) provides an assessment of brain organization that has not yet been applied to alcohol dependence (AD). We estimated whether SCN differences are present in adults with AD and heavy‐drinking adolescents at age 19 and age 14, prior to substantial exposure to alcohol. Design Cross‐sectional sample of adults and a cohort of adolescents. Correlation matrices for cortical thicknesses across 68 regions were summarized with graph theoretic metrics. Setting and participants: A total of 745 adults with AD and 979 non‐dependent controls from 24 sites curated by the Enhancing NeuroImaging Genetics through Meta Analysis (ENIGMA)–Addiction consortium, and 297 hazardous drinking adolescents and 594 controls at ages 19 and 14 from the IMAGEN study, all from Europe. Measurements Metrics of network segregation (modularity, clustering coefficient and local efficiency) and integration (average shortest path length and global efficiency). Findings The younger AD adults had lower network segregation and higher integration relative to non‐dependent controls. Compared with controls, the hazardous drinkers at age 19 showed lower modularity [area‐under‐the‐curve (AUC) difference = −0.0142, 95% confidence interval (CI) = −0.1333, 0.0092; P‐value = 0.017], clustering coefficient (AUC difference = −0.0164, 95% CI = −0.1456, 0.0043; P‐value = 0.008) and local efficiency (AUC difference = −0.0141, 95% CI = −0.0097, 0.0034; P‐value = 0.010), as well as lower average shortest path length (AUC difference = −0.0405, 95% CI = −0.0392, 0.0096; P‐value = 0.021) and higher global efficiency (AUC difference = 0.0044, 95% CI = −0.0011, 0.0043; P‐value = 0.023). The same pattern was present at age 14 with lower clustering coefficient (AUC difference = −0.0131, 95% CI = −0.1304, 0.0033; P‐value = 0.024), lower average shortest path length (AUC difference = −0.0362, 95% CI = −0.0334, 0.0118; P‐value = 0.019) and higher global efficiency (AUC difference = 0.0035, 95% CI = −0.0011, 0.0038; P‐value = 0.048). Conclusions: Cross‐sectional analyses indicate that a specific structural covariance network profile is an early marker of alcohol dependence in adults. Similar effects in a cohort of heavy‐drinking adolescents, observed at age 19 and prior to substantial alcohol exposure at age 14, suggest that this pattern may be a pre‐existing risk factor for problematic drinking. [ABSTRACT FROM AUTHOR]

Background: Past research has focused on the relationship between mothers' and children's eating habits, although little is known about fathers as potential agents. The present study aimed to investigate the relationship between fathers' and children's fruit and vegetable (FV) intake in the context of fathers' education level and family income insecurity. Methods: Cross‐sectional analysis using baseline data from the multicentre Feel4Diabetes Study were collected in 2016. Participants were parent‐dyads (fathers, n = 10,038) and school children (n = 12,041) from six European countries. Socio‐demographic and dietary data were collected using questionnaires. Associations were assessed applying the multinomial logistic regression model. Results: Overall, European children have low FV intake, especially in Southern European countries (Greece, Spain and Hungary). Children with fathers consuming FV daily were more likely to consume fresh fruit (odds ratio [OR] = 2.75; 95% confidence interval [CI] = 1.95–3.88) and vegetables (OR = 2.55; 95% CI = 1.80–3.60) 1–2 times per day. After adjusting for paternal educational level and family income insecurity significant associations remained for fresh fruit (ORadj = 2.59; 95% CI = 1.82–3.69) and vegetables (ORadj = 1.98; 95% CI = 1.38–2.86). Country differences showed that fathers' educational level and income insecurity might be important factors worth considering for FV intake in Greece. Conclusions: The present study showed that fathers' FV intake was positively associated with children's daily intake of these foods. Implementation of future population‐based strategies promoting FV intake not only in mothers, but also in fathers could be an effective public health initiative to increase FV intake in children. Policy‐makers should give special attention to families dwelling in Southern European regions. Highlights: Fruit and vegetable (FV) intake is an essential component of a healthy diet with respect to overall health benefit effects, strengthening the immune system, and ensuring optimal growth and development in children.European children have low FV intake, especially in Southern European countries (Greece, Spain, and Hungary), and are not meeting the recommended FV intake of at least 400 g day–1.The present study showed that children with fathers consuming FV daily were more likely to consume fresh FVs 1–2 times per day.Implementation of future population‐based strategies promoting FV intake not only in mothers, but also in fathers could be an effective public health initiative to increase FV intake in children. Policy‐makers should give special attention to families dwelling in Southern European regions. [ABSTRACT FROM AUTHOR]

Many researchers and practitioners consider ethnic segregation in neighbourhoods or schools detrimental to migrants' acculturation in host societies. Empirically, however, segregation is a 'mixed bag' and its effects depend crucially on the investigated acculturation domain (e.g., negative for language skills, positive for well‐being). As most prior studies have focused on a restricted spectrum of acculturation, a comprehensive assessment within one single study is needed to establish comparability across different acculturation domains. Among over 8000 immigrant‐background students from four countries, we investigated the association of classroom segregation, defined as opportunities for contact with natives and other migrants, with a broad spectrum of acculturation (academic, attitude‐related, identity‐related, social, health‐related, and psychological criteria). Some findings were consistent (e.g., academic acculturation), some were contrary to prior research (e.g., social acculturation). In sum, our results shed light on the 'mixed bag' of segregation and contribute to the understanding of a crucial social issue. [ABSTRACT FROM AUTHOR]

Data about the regulatory approaches to donor human milk (DHM) in European countries are lacking. The aim of this study is to describe the various regulations of DHM within European countries, to assess its legislative context and its impact in relation to donor milk banking. We performed a cross‐sectional survey using a semistructured online questionnaire addressing 29 national European milk‐banking representatives from June 2020 to February 2021. Representatives of 26 national DHM services participated in this study. The legal classification and regulatory status of DHM were defined in 9 out of 26 areas of jurisdiction (35%) as either food product (n = 6), product of human origin according to a blood, tissue, cell regulation (n = 2), or medicinal product (n = 1). In the remainder, DHM remains unclassified. Most legislations did not provide a comprehensive framework concerning DHM and costs to cover milk bank operations were rarely reimbursed. In general, the lack of national legislative governance and the actual legislative regulations in place do not support the use of DHM in European countries. National medical guidelines for the use of DHM have been issued in only 11 countries. The current number and distribution of milk banks (n = 239) within participating countries may not provide an equitable access to DHM for eligible infants. These findings could guide stakeholders aiming to establish a regulatory framework for DHM. Key messages: There is a lack of a legislative framework concerning the use of donor human milk in the majority of European countries.Available national legislative frameworks differed widely with gaps in the regulation of safety and quality of donor human milk, protection of donors and recipients, and cost recovery.Despite clearly demonstrated benefits and unequivocal recommendations for the use of donor human milk there is a lack of national guidance in many European countries. [ABSTRACT FROM AUTHOR]

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

For measuring multilevel impact, we introduce the distributive h-indices, which balance two important components (breadth and strength) of multilevel impact at various citing levels. After exploring the theoretical properties of these indices, we studied two cases: 57 library and information science ( LIS) journals and social science research in 38 European countries/territories. Results reveal that there are approximate power-law relations between distributive h-indices and some underlying citation indicators, such as total citations, total citing entities, and the h-index. Distributive h-indices provide comprehensive measures for multilevel impact, and lead to a potential tool for citation analysis, particularly at aggregative levels. [ABSTRACT FROM AUTHOR]

Aims: To describe the mentoring competence of clinical practice nurse mentors and identify different mentor profiles. Design: Cross‐sectional research design, secondary analysis. Methods: An international, cross‐sectional study design was performed in five European countries. A total of 1 604 mentors from 33 healthcare organizations participated in the study between 2016–2019. The Mentors' Competence Instrument (MCI), which includes seven sub‐dimensions and 44 items, was used to collect data. K‐means cluster and binary regression analyses were performed to detect mentor profiles and determine how various factors affect competence, respectively. Results: The K‐means cluster analysis identified three distinct profiles: A (n = 926); B (n = 566); and C (n = 85). The profiles showed significantly different values (p <.001) across all seven areas of mentoring competence. In comparison with the other profiles, nurses in profile A were older, had more work experience and were more probably to have completed mentoring‐specific training. [ABSTRACT FROM AUTHOR]

The present study examined the relationships between emotional well‐being (positive and negative affect), sleep‐related variables (sleep quality, sleep duration, and change in sleep quality and duration compared to weeks before lockdown), and worrying about coronavirus disease (COVID‐19) challenges during the beginning of the outbreak in Europe. In addition, four different coping strategies were investigated. The study was conducted in Germany with data from 665 participants (53.8% female; 18–73 years), who completed an online questionnaire in April 2020. The results revealed that COVID‐19 worry was associated with impaired well‐being and sleep. Meaning‐ and problem‐focused coping were the most frequently used coping strategies, and showed positive associations with well‐being and sleep. Social and avoidance coping were associated with decreased well‐being and worse sleep outcomes. Three coping strategies showed moderating effects. People who worried more showed higher levels of positive affect when they used problem‐focused coping compared to those who did not. Similarly, highly worried participants showed lower levels of negative affect when they reported using meaning‐focused coping more often. In contrast, social coping increased the risk of high negative affect levels in worried participants. In conclusion, problem‐focused and meaning‐focused coping strategies seemed to be most effective in coping with COVID‐19 challenges. [ABSTRACT FROM AUTHOR]