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Haemophilia care has experienced unprecedented advances over the past 50 years, with the promise of a functional 'cure' being within reach in the not so distant future. This review outlines the challenges the haemophilia community in Europe has faced over the decades since the 1970s and how it has overcome them to steadily advance care. It will also look towards the future and anticipate the hurdles to accessing the next wave of innovation and apply how past experience can help reduce or eliminate these hurdles. The lessons we can learn from the past can inform not simply treatment decisions, but shape the policy, advocacy and access environment needed to make the future promise a reality. The future is bright, but only through active participation across the haemophilia community will we be able to achieve it. We need to work together, to ensure progress will not only be realized by those with haemophilia in Western Europe, but by all those with haemophilia and other inherited bleeding disorder throughout Europe. [ABSTRACT FROM AUTHOR]

Background: Questionnaire surveys have been undertaken worldwide to investigate practices and knowledge related to deep carious lesion (DCL) management in permanent teeth, and there is a lack of data in primary teeth. Aim: A cross‐sectional questionnaire survey was undertaken to describe the management strategies for DCL of vital primary teeth, focusing on the different caries removal techniques, among dentists practicing pediatric dentistry (DPPDs) in France. Their behavior was compared to members one registered to European Academy of Pediatric Dentistry (EAPD). Design: A questionnaire was electronically administrated (2018–2019) to members of the Collège des Enseignants en Odontologie Pédiatrique (CEOP), the Société Française d'Odontologie Pédiatrique (SFOP), and the EADP. Descriptive and statistical analyses were performed. Results: Response rate was, respectively, for CEOP, SFOP, and EAPD about 74%, 29%, and 15%. About half of the respondents (53%) would perform a complete caries removal into one step when 12% would indicate a stepwise technique: 68% of the DPPDs practicing in France would perform complete caries removal in one step when the preferred option in the other EAPD members was the selective excavation (44%) (P <.001). Conclusions: Complementary education of French dentists in the domain of caries management appears necessary regarding current recommendations. [ABSTRACT FROM AUTHOR]

Several studies have reported associations of hypertension with cancer, but not all results were conclusive. We examined the association of systolic (SBP) and diastolic (DBP) blood pressure with the development of incident cancer at all anatomical sites in the European Prospective Investigation into Cancer and Nutrition (EPIC). Hazard ratios (HRs) (95% confidence intervals) were estimated using multivariable Cox proportional hazards models, stratified by EPIC‐participating center and age at recruitment, and adjusted for sex, education, smoking, body mass index, physical activity, diabetes and dietary (in women also reproductive) factors. The study included 307,318 men and women, with an average follow‐up of 13.7 (standard deviation 4.4) years and 39,298 incident cancers. We confirmed the expected positive association with renal cell carcinoma: HR = 1.12 (1.08–1.17) per 10 mm Hg higher SBP and HR = 1.23 (1.14–1.32) for DBP. We additionally found positive associations for esophageal squamous cell carcinoma (SCC): HR = 1.16 (1.07–1.26) (SBP), HR = 1.31 (1.13–1.51) (DBP), weaker for head and neck cancers: HR = 1.08 (1.04–1.12) (SBP), HR = 1.09 (1.01–1.17) (DBP) and, similarly, for skin SCC, colon cancer, postmenopausal breast cancer and uterine adenocarcinoma (AC), but not for esophageal AC, lung SCC, lung AC or uterine endometroid cancer. We observed weak inverse associations of SBP with cervical SCC: HR = 0.91 (0.82–1.00) and lymphomas: HR = 0.97 (0.93–1.00). There were no consistent associations with cancers in other locations. Our results are largely compatible with published studies and support weak associations of blood pressure with cancers in specific locations and morphologies. What's new? Is there a link between high blood pressure and cancer? In this large, prospective study, the authors found that hypertension is indeed associated with a moderate increase in risk for several cancers, including renal, esophageal (only squamous cell carcinoma), head and neck, skin, colon, post‐menopausal breast cancer, and uterine cancer (only adenocarcinoma). These results may potentially enhance screening and risk assessment. Further research may also identify shared mechanisms for both hypertension and cancer, such as inflammation, lipid peroxidation, etc. [ABSTRACT FROM AUTHOR]

This article evaluates whether economic hardship affects social capital in Europe. Comparing 27 European countries, it evaluates the impact of personal experiences of economic hardship on engagement in voluntary associations as a cornerstone of civic and democratic life. Empirical analyses of the Eurobarometer data indicate that individual economic hardship has indeed a negative effect on associational volunteering in Europe. However, the result is qualified in two respects. First, it is found that the effect of individual economic hardship is contingent upon education. Second, this effect mostly refers to volunteering for associations providing solidarity goods (Putnam groups). These results have broader implications for understanding how economic hardship shapes the social capital within democratic societies. [ABSTRACT FROM AUTHOR]

This study investigates spatial variation in fertility in Europe. We analyse spatial variation in total fertility rates using small‐scale geographical data from 21 European countries for 2010 and investigate the role economic, sociocultural, and spatial factors play in regional fertility levels. We compare the performance of conventional ordinary least squares regression and multilevel modelling with that of different spatial regression models and show that the spatial approach is superior for modelling regional fertility variation. The analysis shows that fertility levels in a region are strongly related to gross domestic product per capita and the share of divorced individuals in the region, and fertility levels in neighbouring regions, supporting that all three realms of fertility determinants—economic, sociocultural, and spatial—are relevant for understanding modern fertility variation. [ABSTRACT FROM AUTHOR]

Heart failure (HF) is the major contributor to cardiovascular morbidity and mortality. Given its rising prevalence, the costs of HF care can be expected to increase. Multidisciplinary management of HF can improve quality of care and survival. However, specialized HF programmes are not widely available in most European countries. These circumstances underlie the suggestion of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) for the development of quality of care centres (QCCs). These are defined as health care institutions that provide multidisciplinary HF management at all levels of care (primary, secondary and tertiary), are accredited by the HFA/ESC and are implemented into existing health care systems. Their major goals are to unify and improve the quality of HF care, and to promote collaboration in education and research activities. Three types of QCC are suggested: community QCCs (primary care facilities able to provide non-invasive assessment and optimal therapy); specialized QCCs (district hospitals with intensive care units, able to provide cardiac catheterization and device implantation services), and advanced QCCs (national reference centres able to deliver advanced and innovative HF care and research). QCC accreditation will require compliance with general and specific HFA/ESC accreditation standards. General requirements include confirmation of the centre's existence, commitment to QCC implementation, and collaboration with other QCCs. Specific requirements include validation of the centre's level of care, service portfolio, facilities and equipment, management, human resources, process measures, quality indicators and outcome measures. Audit and recertification at 4-6-year intervals are also required. The implementation of QCCs will evolve gradually, following a pilot phase in selected countries. The present document summarizes the definition, major goals, development, classification and crucial aspects of the accreditation process of the HFA/ESC QCC Programme. [ABSTRACT FROM AUTHOR]

Copyright of International Social Security Review is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The role of future forests in global biogeochemical cycles will depend on how different tree species respond to climate. Interpreting the response of forest growth to climate change requires an understanding of the temporal and spatial patterns of seasonal climatic influences on the growth of common tree species. We constructed a new network of 310 tree‐ring width chronologies from three common tree species (Quercus robur, Pinus sylvestris and Fagus sylvatica) collected for different ecological, management and climate purposes in the south Baltic Sea region at the border of three bioclimatic zones (temperate continental, oceanic, southern boreal). The major climate factors (temperature, precipitation, drought) affecting tree growth at monthly and seasonal scales were identified. Our analysis documents that 20th century Scots pine and deciduous species growth is generally controlled by different climate parameters, and that summer moisture availability is increasingly important for the growth of deciduous species examined. We report changes in the influence of winter climate variables over the last decades, where a decreasing influence of late winter temperature on deciduous tree growth and an increasing influence of winter temperature on Scots pine growth was found. By comparing climate–growth responses for the 1943–1972 and 1973–2002 periods and characterizing site‐level growth response stability, a descriptive application of spatial segregation analysis distinguished sites with stable responses to dominant climate parameters (northeast of the study region), and sites that collectively showed unstable responses to winter climate (southeast of the study region). The findings presented here highlight the temporally unstable and nonuniform responses of tree growth to climate variability, and that there are geographical coherent regions where these changes are similar. Considering continued climate change in the future, our results provide important regional perspectives on recent broad‐scale climate–growth relationships for trees across the temperate to boreal forest transition around the south Baltic Sea. [ABSTRACT FROM AUTHOR]

Objectives: Despite the availability of HIV testing guidelines to facilitate prompt diagnosis, late HIV diagnosis remains high across Europe. The study synthesizes recent evidence on HIV testing strategies adopted in health care settings in the European Union/European Economic Area (EU/EEA). Methods: Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines were followed and systematic searches were run in five databases (2010–2017) to identify studies describing HIV testing interventions in health care settings in the EU/EEA. The grey literature was searched for unpublished studies (2014–2017). Two reviewers independently performed study selection, data extraction and critical appraisal. Results: One hundred and thirty intervention and/or feasibility studies on HIV testing in health care settings were identified. Interventions included testing provision (n = 94), campaigns (n = 14) and education and training for staff and patients (n = 20). HIV test coverage achieved through testing provision varied: 2.9–94% in primary care compared to 3.9–66% in emergency departments. HIV test positivity was lower in emergency departments (0–1.3%) and antenatal services (0–0.05%) than in other hospital departments (e.g. inpatients: 0–5.3%). Indicator condition testing programmes increased HIV test coverage from 3.9–72% before to 12–85% after their implementation, with most studies reporting a 10–20% increase. There were 51 feasibility and/or acceptability studies that demonstrated that HIV testing interventions were generally acceptable to patients and providers in health care settings (e.g. general practitioner testing acceptable: 77–93%). Conclusions: This review has identified several strategies that could be adopted to achieve high HIV testing coverage across a variety of health care settings and populations in the EU/EEA. Very few studies compared the intervention under investigation to a baseline, but, where this was assessed, data suggested increases in testing. [ABSTRACT FROM AUTHOR]

The EuroSIDA study was initiated in 1994 and follows adult people living with HIV (PLHIV) in 100 collaborating clinics across 35 countries covering all European regions, Israel and Argentina. The study aims to study the long‐term virological, immunological and clinical outcomes of PLHIV and to monitor temporal changes and regional differences in outcomes across Europe. Annually collected data include basic demographic characteristics, information on AIDS‐ and non‐AIDS‐related clinical events, and details about antiretroviral therapy (ART), hepatitis C treatment and other medications, in addition to a range of laboratory values. The summer 2016 data set held data from a total of 23 071 individuals contributing 174 481 person‐years of follow‐up, while EuroSIDA's unique plasma repository held over 160 000 samples. Over the past 25 years, close to 300 articles have been published in peer‐reviewed journals (h‐index 52), covering a range of scientific focus areas, including monitoring of clinical and virological outcomes, ART uptake, efficacy and adverse events, the influence of hepatitis virus coinfection, variation in the quality of HIV care and management across settings and regions, and biomarker research. Recognizing that there remain unresolved issues in the clinical care and management of PLHIV in Europe, EuroSIDA was one of the cohorts to found The International Cohort Consortium of Infectious Disease (RESPOND) cohort consortium on infectious diseases in 2017. In celebration of the EuroSIDA study's 25th anniversary, this article aims to summarize key scientific findings and outline current and future scientific focus areas. [ABSTRACT FROM AUTHOR]

Among the traits whose relevance for plant invasions has recently been suggested are genome size (the amount of nuclear DNA) and ploidy level. So far, research on the role of genome size in invasiveness has been mostly based on indirect evidence by comparing species with different genome sizes, but how karyological traits influence competition at the intraspecific level remains unknown. We addressed these questions in a common‐garden experiment evaluating the outcome of direct intraspecific competition among 20 populations of Phragmites australis, represented by clones collected in North America and Europe, and differing in their status (native and invasive), genome size (small and large), and ploidy levels (tetraploid, hexaploid, or octoploid). Each clone was planted in competition with one of the others in all possible combinations with three replicates in 45‐L pots. Upon harvest, the identity of 21 shoots sampled per pot was revealed by flow cytometry and DNA analysis. Differences in performance were examined using relative proportions of shoots of each clone, ratios of their aboveground biomass, and relative yield total (RYT). The performance of the clones in competition primarily depended on the clone status (native vs. invasive). Measured in terms of shoot number or aboveground biomass, the strongest signal observed was that North American native clones always lost in competition to the other two groups. In addition, North American native clones were suppressed by European natives to a similar degree as by North American invasives. North American invasive clones had the largest average shoot biomass, but only by a limited, nonsignificant difference due to genome size. There was no effect of ploidy on competition. Since the North American invaders of European origin are able to outcompete the native North American clones, we suggest that their high competitiveness acts as an important driver in the early stages of their invasion. [ABSTRACT FROM AUTHOR]

Universities are accused of being left‐wing bastions, unwelcoming to conservative and right‐wing professors. However, we know little about the political orientation of professors in comparison to other professionals, which would be the right comparison group if we want to know whether universities are potentially hostile environments to conservatives. Examining culturally and economically oriented political orientations in Europe, it is demonstrated that professors are more liberal and left‐leaning than other professionals. However, there is no greater homogeneity of political orientations among the professoriate relative to other specific professions, suggesting that there is a diversity of opinions which is similar to what professionals would find in other occupations. One exception concerns attitudes towards immigration, on which professors have more liberal orientations and comparatively low residual variance around that more liberal mean. Importantly, the difference between professors and other professionals is not so clear within graduates from the social sciences, but emerges more clearly among graduates with a medical, STEM, economics or law degree. An important political cleavage exists between professionals and managers, a group of similar social standing. [ABSTRACT FROM AUTHOR]

This article compares the use of referendums across political regimes over time in Europe. It does so on the basis of a new typology that differentiates between policy domains and degrees of abstraction. The analysis shows different patterns in referendum use between authoritarian regimes, countries in transition and democracies. In addition to the variation in policy domains, the findings indicate different institutional features within the polity types: the process of initiation, the turnout in referendums and the rate of approval. The empirical evidence draws on an original dataset of 620 referendums organised at national level in Europe between 1793 and 2017. [ABSTRACT FROM AUTHOR]

Multiple paternity (MP) increases offspring's genetic variability, which could be linked to invasive species' evolvability in novel distribution ranges. Shifts in MP can be adaptive, with greater MP in harsher/colder environments or towards the end of the reproductive season, but climate could also affect MP indirectly via its effect on reproductive life histories. We tested these hypotheses by genotyping N = 2,903 offspring from N = 306 broods of two closely related livebearing fishes, Gambusia holbrooki and Gambusia affinis. We sampled pregnant females across latitudinal gradients in their invasive ranges in Europe and China, and found more sires per brood and a greater reproductive skew towards northern sampling sites. Moreover, examining monthly sampling from two G. affinis populations, we found MP rates to vary across the reproductive season in a northern Chinese, but not in a southern Chinese population. While our results confirm an increase of MP in harsher/more unpredictable environments, path analysis indicated that, in both cases, the effects of climate are likely to be indirect, mediated by altered life histories. In both species, which rank amongst the 100 most invasive species worldwide, higher MP at the northern edge of their distribution probably increases their invasive potential and favours range expansions, especially in light of the predicted temperature increases due to global climate changes. [ABSTRACT FROM AUTHOR]

Summary: Although substantial efforts have been made to investigate about the composition of the microbiota, fungi that constitute the mycobiota play a pivotal role in maintaining microbial communities and physiological processes in the body. Here, we conducted an international survey focusing on laboratory's current procedures regarding their goals and practices of mycobiota characterisation using NGS. A questionnaire was proposed to laboratories affiliated to working groups from ECMM (NGS study group) and ESCMID (ESGHAMI and EFISG study groups). Twenty‐six questionnaires from 18 countries were received. The use of NGS to characterise the mycobiota was not in routine for most of the laboratories (N = 23, 82%), and the main reason of using NGS was primary to understand the pathophysiology of a dysbiosis (N = 20), to contribute to a diagnosis (N = 16) or to implement a therapeutic strategy (N = 12). Other reported reasons were to evaluate the exposome (environmental studies) (N = 10) or to investigate epidemics (N = 8). Sputum is the main sample studied, and cystic fibrosis represents a major disease studied via the analysis of pulmonary microbiota. No consensus has emerged for the choice of the targets with 18S, ITS1 and ITS2 used alternatively among the laboratories. Other answers are detailed in the manuscript. We report a photography of mycobiota analysis that may become a major tool in the near future. We can draw some conclusions on the diversity of approaches within the answers of the 27 laboratories and underline the need for standardisation. [ABSTRACT FROM AUTHOR]

In view of globally increasing flood losses, a significantly improved and more efficient flood risk management and adaptation policy are needed. One prerequisite is reliable risk assessments on the continental scale. Flood loss modeling and risk assessments for Europe are until now based on regional approaches using deterministic depth‐damage functions. Uncertainties associated with the risk estimation are hardly known. To reduce these shortcomings, we present a novel, consistent approach for probabilistic flood loss modeling for Europe, based on the upscaling of the Bayesian Network Flood Loss Estimation MOdel for the private sector, BN‐FLEMOps. The model is applied on the mesoscale in the whole of Europe and can be adapted to regional situations. BN‐FLEMOps is validated in three case studies in Italy, Austria, and Germany. The officially reported loss figures of the past flood events are within the 95% quantile range of the probabilistic loss estimation, for all three case studies. In the Italian, Austrian, and German case studies, the median loss estimate shows an overestimation by 28% (2.1 million euro) and 305% (5.8 million euro) and an underestimation by 43% (104 million euro), respectively. In two of the three case studies, the performance of the model improved, when updated with empirical damage data from the area of interest. This approach represents a step forward in European wide flood risk modeling, since it delivers consistent flood loss estimates and inherently provides uncertainty information. Further validation and tests with respect to adapting the model to different European regions are recommended. Plain Language Summary: We present a novel, probabilistic approach to calculate flood losses for residential buildings in Europe. We show how the approach can be applied to the European scale and which data sets are required for the calculation. The validity of the approach is proven on the basis of three historic flood events in Italy, Austria, and Germany. This approach which delivers consistent flood loss estimates including uncertainty information supports more efficient flood risk management and adaptation policy in Europe. Key Points: For the first time, a consistent approach for probabilistic flood loss modeling for residential buildings in Europe is presentedThe approach is validated for three case studies of varying spatial scale in Germany, Italy, and AustriaBN‐FLEMOps can be adapted to individual regions in Europe using an updating approach with empirical data from the target region [ABSTRACT FROM AUTHOR]

Increasing wage inequality, strong labour market divides and welfare retrenchment are widely believed to result in more polarised public opinion towards the welfare state. The present study examined if attitudes towards workfare policies have become more polarised in Europe over recent decades. To achieve this aim, the study analysed public opinion data from the European Value Study (EVS) from 23 European countries in the years 1990–2008, using multi‐level regression analysis. It is found that individuals who are most affected by workfare – the unemployed, the poor and the young – most strongly oppose workfare concepts. Against expectations, there was no evidence of an increasing polarisation of attitudes in Europe. Attitudinal cleavages based on employment status, income and education have remained stable. Differences between age groups have even dissolved because younger cohorts increasingly favour strict workfare policies. The results suggest that warnings of increasing social conflicts and an erosion of solidarity in European societies are exaggerated. [ABSTRACT FROM AUTHOR]

This study focuses on the northward shift of homogeneous agro‐climate zones in Europe analyzed for the observed past and projected climate conditions for the next decades. Statistical cluster analysis is used to derive eight main agro‐climatic zones driven by two agro‐meteorological indicators, namely, active temperature sum and thermal growing season length. The northward shift of homogeneous agro‐climate zones and the corresponding change of crop growth suitability are analyzed together with the change of exposure of crops to temperature‐related climate extremes during the growing season. Gradual warming over Europe has contributed to a lengthening of the growing season and an increased active temperature accumulation, accompanied by more frequent occurrence of warm extreme climate events. Using a set of five high‐resolution regional climate scenarios, we calculate that a major part of Europe will be affected by further northward climate zone migration. In the next decades, the migration of agro‐climatic zones in Eastern Europe may reach twice the velocity observed during the period 1975–2016. Several regions of the Mediterranean may lose suitability to grow specific crops in favor of northern European regions. This indicator‐based assessment suggests that the potential advantages of the lengthening of the thermal growing season in northern and eastern Europe are often outbalanced by the risk of late frost and increased risk of early spring and summer heat waves. Key Points: Agro‐climate zones in eastern Europe have experienced a northward migration velocity of 100 km per 10 years over the past 40 yearsNorthward migration of agro‐climate zones in Europe may be up to two times faster in next decadesNegative impacts of heat stress are expected to nonlinearly increase in large parts of southern and southeastern Europe [ABSTRACT FROM AUTHOR]

Deprived housing is recognized as a source of poor health, but there is still little evidence of a causal relationship between housing and health. While existing literature identifies neighborhood effects and the individual dwelling as factors which affect health, it does not offer a joint examination of these factors. Moreover, endogeneity is a concern in analyses of both problems. Thus far, studies addressing endogeneity have done so through experimental design or instrumental variables. The first approach suffers from problems of external validity and the latter from the lack of reliable instruments. We therefore adopt an alternative strategy which considers both sources of endogeneity in order to identify the effects of housing on health by estimating fixed‐effect models. We reveal how housing problems affect health depending on living conditions and socioeconomic status. Our results therefore indicate that living in poor housing is an important short‐term socioeconomic determinant that directly affects health. [ABSTRACT FROM AUTHOR]

Copyright of Policy Studies Journal is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The burden of paediatric Hepatitis C virus (HCV) infection across Europe is unknown, as are current policies regarding monitoring and treatment. This collaborative study aimed to collect aggregate data to characterise the population of ≤18‐year‐olds with HCV infection in specialist follow up in a 12‐month period (2016) across the PENTAHep European consortium, and investigate current policies around monitoring and treatment. A cross‐sectional, web‐based survey was distributed in April 2017 to 50 paediatricians in 19 European countries, covering patients' profile, and monitoring and treatment practices. Responses were received from 38/50 clinicians collectively caring for 663 children with chronic HCV infection of whom three‐quarters were aged ≥6 years and 90% vertically infected. HCV genotype 1 was the most common (n 380; 57.3%), followed by genotype 3, 4 and 2. Seventeen children (3%) with chronic HCV infection were diagnosed with cirrhosis, and six were reported to have received liver transplantation for HCV‐related liver disease. The majority (n 425; 64.1%) of the European children with HCV infection remained treatment‐naive in 2016. Age affected clinicians' attitudes towards treatment; 94% reported being willing to use direct‐acting antivirals, if available, in adolescents (aged ≥11 years), 78% in children aged 6‐10 and 42% in those 3‐5 years of age (Pearson correlation coefficient −0.98; P 0.0001). This survey provides the largest characterisation of the population of children in clinical follow‐up for chronic HCV infection in Europe, alongside important contextual information on their management and treatment. Discussion is needed around strategies and criteria for use of direct‐acting antivirals in these children. [ABSTRACT FROM AUTHOR]

In the last two decades Europe experienced a series of high‐impact heat extremes. We here assess observed trends in temperature extremes at ECA&D stations in Europe. We demonstrate that on average across Europe the number of days with extreme heat and heat stress has more than tripled and hot extremes have warmed by 2.3 °C from 1950–2018. Over Central Europe, the warming exceeds the corresponding summer mean warming by 50%. Days with extreme cold temperatures have decreased by a factor of 2–3 and warmed by more than 3 °C, regionally substantially more than winter mean temperatures. Cold and hot extremes have warmed at about 94% of stations, a climate change signal that cannot be explained by internal variability. The clearest climate change signal can be detected in maximum heat stress. EURO‐CORDEX RCMs broadly capture observed trends but the majority underestimates the warming of hot extremes and overestimates the warming of cold extremes. Key Points: We detect a clear climate change signal in extreme heat, heat stress, and cold over Europe that cannot be explained by internal variabilityOn average across Europe, days with extreme heat and heat stress have tripled and days with extreme cold more than halved from 1950–2018Hot and cold extremes warmed significantly more than the corresponding seasonal mean in Central Europe, by 2.3 and >3 °C, respectively [ABSTRACT FROM AUTHOR]

This article investigates whether income inequality leads to political polarization and provides new evidence that an increase in the Gini coefficient at the local level increases the probability of supporting a political party at the extreme left and right of the ideological distribution. Using individual data for 25 European countries from 2002 to 2014, I find that increasing inequality leads on average to more support for left‐wing parties. I also find that increasing inequality leads to more support for far‐right parties among older individuals. Support for far‐right parties seems to be driven by rising anti‐immigrant sentiments. The results are robust to different specifications, including an instrumental variable that addresses the endogeneity of income inequality. [ABSTRACT FROM AUTHOR]

The article aims to understand how governments across Europe have modified the regulation of the delivery of cash‐for‐care schemes (CfCs) to dependent older people since the beginning of the century. In our terminology, the regulation of the CfCs delivery defines the norms, rules, and practices that public actors adopt to manage how beneficiaries can use the benefits. To discuss the regulation of CfCs delivery, we employ an original framework that take three analytical dimensions into account: the degrees of freedom in benefits' utilization ("CfCs utilization" dimension), the provision of information/orientation/advices/counselling to older people and families ("professional support" dimension), and the relationship between the delivery of CfCs and the delivery of the other publicly funded long‐term care inputs ("care system" dimension). The analysis adopts a comparative perspective, looking at six countries—Italy, Austria, the Netherlands, France, Germany, and England. Among various findings, the main one consists in showing that there has been a shared and increased interest in consolidating the regulation of CfCs delivery. This trend has been mostly directed towards the new policy aim of strengthening the professional support, a goal underestimated in the past, when this dimension was not a major topic of both debate and practice concerning CfCs across Europe. [ABSTRACT FROM AUTHOR]

Resource allocation has been a main policy issue in cash‐for‐care schemes (CfCs) for older people in Europe since their inception. It regards how publicly funded care benefits and services are distributed among older people. The raising pressures of an ageing population and the tensions on the financial sustainability of welfare regimes in place have further exacerbated the relevance of this topic over the recent years. Nevertheless, comparative research so far has overlooked changes in resource allocation in CfCs over time. This article contributes to fill this gap, exploring changes in resource allocation of CfCs for older people in a sample of European countries—Austria, England, France, Germany, Italy, and The Netherlands—since the early '90s (or since the introduction of the scheme). It examines three analytical dimensions: (a) The mix of public services and benefits provided to older people (CfCs, community services in kind, residential care); (b) the level of CfCs coverage; and (c) its generosity. A combined view of these dimensions leads to the discussion of two dilemmas: How to allocate the resources devoted to CfCs in the light of the trade‐off between its coverage and intensity? And, within the whole long‐term care system, how to allocate resources between CfCs and services in kind? [ABSTRACT FROM AUTHOR]

Geographical Indications (GIs) are increasingly important instruments of agricultural and food regulations and are growing as contentious issues in trade negotiations and disputes. GIs can improve welfare but they can also be a protectionist instrument. The EU has the most GIs in the world, but they are concentrated in the south of the EU. Even excluding wine, there are seven times more food GIs per capita in the southern EU Member States than in other EU Member States. This note discusses several factors which may explain the geographic concentration of GIs in the south of the EU. [ABSTRACT FROM AUTHOR]

Temperature and precipitation are the most important factors responsible for agricultural productivity variations. In 2018 spring/summer growing season, Europe experienced concurrent anomalies of both. Drought conditions in central and northern Europe caused yield reductions up to 50% for the main crops, yet wet conditions in southern Europe saw yield gains up to 34%, both with respect to the previous 5‐year mean. Based on the analysis of documentary and natural proxy‐based seasonal paleoclimate reconstructions for the past half millennium, we show that the 2018 combination of climatic anomalies in Europe was unique. The water seesaw, a marked dipole of negative water anomalies in central Europe and positive ones in southern Europe, distinguished 2018 from the five previous similar droughts since 1976. Model simulations reproduce the 2018 European water seesaw in only 4 years out of 875 years in historical runs and projections. Future projections under the RCP8.5 scenario show that 2018‐like temperature and rainfall conditions, favorable to crop growth, will occur less frequent in southern Europe. In contrast, in central Europe high‐end emission scenario climate projections show that droughts as intense as 2018 could become a common occurrence as early as 2043. While integrated European and global agricultural markets limited agro‐economic shocks caused by 2018's extremes, there is an urgent need for adaptation strategies for European agriculture to consider futures without the benefits of any water seesaw. Key Points: Unique concurrent spring and summer climatic anomalies affected Europe in 20182018‐like droughts could become a common occurrence as early as 2043Climate change adaptation strategies for agriculture in Europe cannot count on recurrent water seesaws [ABSTRACT FROM AUTHOR]

An accurate diagnosis of β‐lactam (BL) allergy can reduce patient morbidity and mortality. Our aim was to investigate the availability of BL reagents, their use and test procedures in different parts of Europe, as well as any differences in the diagnostic workups for evaluating subjects with BL hypersensitivity. A survey was emailed to all members of the EAACI Drug Allergy Interest Group (DAIG) between February and April 2016, and the questionnaire was meant to study the management of suspected BL hypersensitivity. The questionnaire was emailed to 82 DAIG centres and answered by 57. Amoxicillin alone or combined to clavulanic acid were the most commonly involved BL except in the Danish centre, where penicillin V was the most frequently suspected BL. All centres performed an allergy workup in subjects with histories of hypersensitivity to BL: 53 centres (93%) followed DAIG guidelines, two national guidelines and two local guidelines. However, there were deviations from DAIG recommendations concerning allergy tests, especially drug provocation tests. A significant heterogeneity exists in current practice not only among countries, but also among centres within the same country. This suggests the need to re‐evaluate, update and standardize protocols on the management of patients with suspected BL allergy. [ABSTRACT FROM AUTHOR]

Fog plays a major role in many ecological aspects and it influences human life in various ways. In this study, a temporally highly resolved and spatially explicit analysis of variations in fog occurrence was conducted for Europe and links to general weather conditions were investigated. To this end, a high‐resolution fog product based on Meteosat Second Generation data was developed. Characteristic fog distributions were identified by applying a Self Organizing Map approach to the dataset. It was found that the resulting fog patterns are primarily determined by terrain characteristics. Simultaneous occurrences between these patterns and the predominant general weather situations were analyzed. The results show that the general weather situations can be categorized into three main groups, each responsible for the formation of a different group of fog patterns. Additionally, distinct regional differences could be identified in the diurnal and annual fog frequency cycles and the derived region‐specific frequency variations were used to draw conclusions about the fog types prevailing in these regions. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the study was to establish a methodology for evaluating the hepatitis C continuum of care in HIV/hepatitis C virus (HCV)‐coinfected individuals and to characterize the continuum in Europe on 1 January 2015, prior to widespread access to direct‐acting antiviral (DAA) therapy. Methods: Stages included in the continuum were as follows: anti‐HCV antibody positive, HCV RNA tested, currently HCV RNA positive, ever HCV RNA positive, ever received HCV treatment, completed HCV treatment, follow‐up HCV RNA test, and cure. Sustained virological response (SVR) could only be assessed for those with a follow‐up HCV RNA test and was defined as a negative HCV RNA result measured > 12 or 24 weeks after stopping treatment. Results: Numbers and percentages for the stages of the HCV continuum of care were as follows: anti‐HCV positive (n = 5173), HCV RNA tested (4207 of 5173; 81.3%), currently HCV RNA positive (3179 of 5173; 61.5%), ever HCV RNA positive (n = 3876), initiated HCV treatment (1693 of 3876; 43.7%), completed HCV treatment (1598 of 3876; 41.2%), follow‐up HCV RNA test to allow SVR assessment (1195 of 3876; 30.8%), and cure (629 of 3876; 16.2%). The proportion that achieved SVR was 52.6% (629 of 1195). There were significant differences between regions at each stage of the continuum (P < 0.0001). Conclusions: In the proposed HCV continuum of care for HIV/HCV‐coinfected individuals, we found major gaps at all stages, with almost 20% of anti‐HCV‐positive individuals having no documented HCV RNA test and a low proportion achieving SVR, in the pre‐DAA era. [ABSTRACT FROM AUTHOR]

Spatial and temporal patterns of trends in annual and seasonal precipitation over Germany during 1951–2013 were analysed using the ensemble empirical mode decomposition (EEMD) method. Three widely used and recognized high‐resolution observation‐based gridded precipitation products, the Climatic Research Unit (CRU) time‐series data, Global Precipitation Climatology Centre (GPCC) Full Data Reanalysis data and the EU‐FP6 project ENSEMBLES derived data set (EOBS), were used and compared. Comparison among different products showed that the CRU used a considerably lower number of gauge stations (maximum 36) in the construction of gridded product over Germany and should be used with great caution for other applications, and overall CRU presented less precipitation and smaller inter‐annual variability; GPCC and EOBS agreed well in the spatial and temporal distribution of seasonal and annual precipitation, as well as the identified trends. The spatiotemporal analysis of trends showed that trends in precipitation during 1951–2013 were, in most cases, highly nonlinear and varying over time. In particular, the spring, summer and autumn precipitation showed large variations in trends. Therefore, the assumption of linear trends on which previous studies were based is invalid. Annual precipitation showed increasing trends in over 66% of Germany (particularly northern and eastern Germany), and the magnitude of increasing trends were generally enhanced over time, e.g. GPCC showed that the average magnitude of increasing trends rose from 6.3% for the 1951–1980 period to 12% for the 1951–2013 period. There were considerable spatial and temporal variabilities in trends in seasonal precipitation totals over Germany. This study is among one of the first studies applying the EEMD method to a comprehensive analysis of time‐varying trends in precipitation over Germany, which is expected to improve our understanding of the complex and nonlinear regional climate system. Spatial and temporal patterns of the EEMD‐derived trend of the four seasonal precipitation totals (DJF, MAM, JJA, SON; the trend is presented as the percentage of the climatology mean during the whole period 1951–2013 for easy interpretation and comparison) from EOBS for five different periods, with ending years of 1980, 1990, 2000, 2010 and 2013. [ABSTRACT FROM AUTHOR]

The authors provide new evidence on youth earnings and labour market volatility, including flows into and out of employment, across Europe during the Great Recession. EU‐SILC data for the period 2004–13 reveal large disparities in volatility levels and trends across European countries. As expected, the Great Recession increased youth labour market volatility, offsetting the trends observed over the previous years of economic prosperity. A variance decomposition exercise points to greater exposure to worker turnover in southern Europe. Fixed effects regression on labour market institutions relates higher unemployment benefits and more stringent employment protection legislation to lower earnings and labour market volatility. [ABSTRACT FROM AUTHOR]

Aim: We use cluster analysis to delimit climatically and functionally distinct mammalian faunal clusters. These entities form regional species pools and are relevant to community assembly processes. Similar clusters can be differentiated in the fossil record, offering the potential for use as palaeoenvironmental proxies. Location: North America within W178°, W14°, N83°, N7° and Europe within W32°, E35°, N80°, N35°. Major taxa studied: 575 and 124 land mammal species from North America and Europe. Methods: K‐means clustering was used to subdivide North America and Europe into distinct faunas ranging in number from 3 (largest scale) to 21 (smallest scale). Each set of faunas was tested for significant differences in climate (mean annual precipitation, mean annual temperature) and functional traits (body mass, locomotion and diet). Results: In North America, climatic differentiation exists at the scale where mammals are divided into 11 or fewer distinct faunas and, in Europe, at the scale where there are five or fewer faunas. Functional trait differentiation in body mass occurs at a larger spatial scale in North America (8 distinct faunas), but locomotor differentiation is present at all spatial scales, and dietary differentiation is not present at any scale. No significant differentiation in any functional trait at any scale was found in Europe. Main conclusions: Faunal clusters can be constructed at any spatial scale, but clusters are climatically and functionally meaningful only at larger scales. Climatic (and environmental) differences and their associated functional trait specialisations are likely to be barriers to large‐scale mixing. We argue, therefore, that functionally and climatically distinct faunal clusters are the entities that form regional species pools for community assembly processes. In North America, there are eight such mammal pools, but only one in Europe. Since the functional traits in our study are observable in the fossil record, functional trait analysis can potentially be used to diagnose climatically distinct regions in the past. [ABSTRACT FROM AUTHOR]

Europe provides an interesting setting to explore the role that investment banks play in acquisitions because it is composed of countries with different legal regimes – the shareholder‐oriented common law regime in the UK/Ireland and the stakeholder‐oriented civil law regime in Continental Europe. Since investment banks are hired to act in the interests of shareholders, and due to differences in disclosure requirements, market transparency, accounting standards, and ownership between the UK and Continental Europe, I argue that investment banks are relatively more important in UK‐only acquisitions. My findings support this conjecture. [ABSTRACT FROM AUTHOR]

Why do some ethnic minority groups in Europe form ethnic minority parties (EMPs), while others work within established, mainstream parties? I argue that an ethnic minority group's historical background influences its political engagement strategies. I propose that native groups (those that inhabited the territory of the modern‐day state in which they reside prior to that state's establishment), groups with territorial attachment (historical concentration in particular regions of the state) and groups with historical experiences of autonomy are more likely to form successful parties. Groups perceiving themselves as native to their state and that have enjoyed autonomy are more likely to feel entitled to the unique form of representation provided by an EMP. I test my theoretical expectations on an original data set of elections in European states in the period 1990 to 2012, finding that the three historical variables working in conjunction exert a strong positive influence on EMP entry and success. [ABSTRACT FROM AUTHOR]

More than 68.5 million people were forced to move from their countries, according to the UN Refugee Agency, UNHCR, in 2018. Forced displacements are caused by poverty, war, and lack of safety. Since 2015, Europe has been experiencing a so‐called refugee crisis that calls European values and policies into question. Beyond data, there are the experiences of those who are on the move. The number of people arriving on the continent has made integration a decisive topic. This research aims to discover the portrayal of refugees and migrants in media. This goal includes the challenge of making European media evaluate their work to improve the treatment given to complex subjects such as migration. This article is the result of research derived from the project Refugees Reporting in 2017, coordinated by the Europe Region of the World Association for Christian Communistories ancation and the Churches' Commission for Migrants in Europe. [ABSTRACT FROM AUTHOR]

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Over the past decade the European Commission has been developing plans to address environmental problems caused by a growing volume of waste from electrical and electronic products. It has recently published a series of proposals for a draft Directive. Using a recognized analytical framework, this paper evaluates arguments for and against these proposals in the light of responses from stakeholder interest groups. It assesses the strong criticisms voiced by some industry representatives and the reservations of environmental and consumer organizations. The paper concludes that the proposed legislation, if refined and implemented effectively, would represent a highly significant advance in environmental policy, as waste-related environmental costs would be internalized into the price of electrical and electronic products. Sustainable product design could thereby be promoted. [ABSTRACT FROM AUTHOR]

Despite the strong impetus given to environmental education since 1988, at both the national and European policy levels, initiatives havenot had any significant or long-term impact on the curriculum of schools. Schools in Europe, as in many other countries in the world, struggle to introduce this innovative form of education into the mainstream curriculum. Research appears to suggest that the existing curriculum culture and structures of schooling conflict with the nature and principles of environmental education. The focus of this paper is an action research project funded by DGXI of the European Community and the European Educational Regional Partnership. The project attempted to stimulate curriculum change in environmental education at the school level. It aimed to not only initiate but also find ways of sustaining development in this area. This research takes on board the curriculum challenge posed by the existing school system and explores the changes required for rooting environmental education within the curriculum of European schools. Five years after the pilot study was carried out, the paper reviews how successful it was in attaining sustainable curriculum policy and development in environmental education. Copyright (c) 1999 John Wiley & Sons, Ltd and ERP Environment. [ABSTRACT FROM AUTHOR]

As an introduction to the special issue on European floodplain forests, this paper reviews the fundamental hydrological and geomorphological controls on floodplain biodiversity and river-forest interactions. The role of the energy/slope gradient and channel conditions (including number of channels) can be seen as critical in determining the nature and dynamics of floodplain woodland and biodiversity. These factors also control the processing of materials and nutrients in forested floodplains. The biogeochemistry of floodplain forests is complicated by multi-dimensional interactions between substrate, hydrology and vegetation which include longitudinal interactions (e.g. between channels and banks and live and dead-water zones). All of these factorscomplicate the application of the river continuum concept as do natural variations caused by geomorphological inheritance and multiple channels. The distribution and status of European floodplain woodlands and the history of floodplain forests in the British Isles are briefly outlined. Lastly the paper considers the possibilities for the partial afforestation of some British Floodplains and the potential environmental benefits. [ABSTRACT FROM AUTHOR]

Plant communities of trampled soil dominated by plants characterizedby the C4-assimilation syndrome were investigated in Europe. These species, belonging to genera such as Chamaesyce, Amaranthus, Eleusine,Eragrostis and Setaria, are thermophilous, late-germinating, prostrate herbs or grasses. The centre of their distribution is in the (Sub)Tropics. A syntaxonomic revision or the phytosociological material from Europe (incl. the Macaronesian Archipelago) revealed three alliances: the Euphorbion prostratae from Spain, the Polycarpo-Eleusinion indicae from Italy, and Slovenian and Croatian Istria, and the Eragrostio-Polygonion arenastri from temperate regions of Europe. The latter two syntaxa are described as new. All three alliances belong to the order Eragrostietalia (class Stellarietea mediae). Vicarious (ecologically analogous) communities occur also in southern Africa, eastern Asia and North America. The communities studied in the present paper are considered to be an impoverished form of highly diversified trampled plant communities typical of (sub)tropical areas. [ABSTRACT FROM AUTHOR]

Evapotranspiration plays an essential role in estimating water balance, runoff and effective precipitation. To determine historical and projected water availability for Europe, we contribute high‐resolution (1 km) estimates of monthly and annual potential evapotranspiration (ET0) and actual evapotranspiration (AET0). In the ET0 calculation, the monthly and annual heat index I and annual α parameter were estimated following the Thornthwaite method, and AET0 was calculated using the Budyko approach. The variables were estimated for a climate normal period that largely precedes an anthropogenic warming signal (1961–1990), and for two CMIP5 multi‐model future projections (2011–2040 and 2041–2070). We project widespread and relatively uniform ET0 increases of around 50–100 mm by the 2020s and 75–125 mm by the 2050s for most of Europe. These values imply important changes that may affect runoff and groundwater recharge. AET0 was identified as important driver of water availability with more regional variability. Spatial mapping of changes relative to the normal baseline imply that all except northern parts of Europe are vulnerable to water deficits, with pronounced decrease expected in southern Europe. We provide high‐resolution maps and data as an important tool for future natural resources management and climate change mitigation planning. [ABSTRACT FROM AUTHOR]

Abstract: These conversations between Toni Negri and Sandro Mezzadra (November 2014–October 2015) focus on the politics of Mediterranean boundaries and situate migratory movements across the Mediterranean in the geopolitical context of the Eastern and Southern shore. Looking at the proliferation of wars around the Mediterranean region and reflecting on the legacy of the Arab Uprisings, Mezzadra and Negri revisit the concept of the “autonomy of migration” and critically interrogate its possible contribution to the field of migration and in terms of the current refugee crisis. [ABSTRACT FROM AUTHOR]

Abstract: Party politics and electoral research generally assume that party members are loyal voters. This article first assesses the empirical basis for this assumption before providing individual‐level explanations for defection. It combines prominent theories from party politics and electoral behaviour research and argues that internal disagreement and external pressure can each bring about disloyal voting. The hypotheses are motivated with multi‐country European survey data and tested on two sets of party‐level national surveys. The results show, first, that, on average, 8 per cent of European party members cast a defecting vote in the last election, and second, that dissatisfaction with the leadership is the strongest predictor of defection. Additionally, internal ideological disagreement is associated with higher probabilities of defection, whereas the effects of pull factors in the form of contentious policies are rather limited. These findings emphasise the importance of testing scientific assumptions and the potential significance of party leadership contests. [ABSTRACT FROM AUTHOR]

Abstract: Dissatisfaction with the economic situation and perceived governmental inefficacy in regard to the financial crisis has spawned a widespread feeling of political distrust across Europe. This distrust has been translated into protests against institutional authority that aims at either expanding democratic procedures or supporting xenophobic and populist measures. This research uses European Social Survey data to compare exclusive and inclusive protesters with regard to a number of personal and social values, attitudes toward democratic principles, and different life conditions and socio‐economic resources. It also considers contextual factors to investigate how different protesters' profiles are interwoven with socio‐economic conditions. The results of a multilevel latent profile analysis show that exclusive and inclusive protesters, despite sharing similar levels of political distrust, differ with regard to key values and political attitudes, and these differences are related to individual and collective living conditions. We argue that unfavourable living conditions play a non‐negligible role in increasing the probability of easy (i.e., populist) scapegoat political attitudes. Further support for this hypothesis is provided by the cross‐country analysis, which shows that higher levels of exclusive protest are present in countries that were characterized by worse living conditions before the economic crisis. [ABSTRACT FROM AUTHOR]

ABSTRACT: During the last decades, the effects of global warming have become apparent also in Europe, causing relevant impacts in many sectors. Under projected future global warming, such a tendency can be expected to persist until the end of this century and beyond. Identifying which climate‐related impacts are likely to increase, and by how much, is an important element of any effective strategy for managing future climate risks. This study investigates whether energy demand for cooling and heating buildings can be expected to increase or decrease under climate change. Two indicators of weather‐related energy consumption for heating and cooling buildings are considered: heating degree‐days (HDD) and cooling degree‐days (CDD). The evolution of these indicators has been analysed based on 11 high‐resolution bias‐adjusted EURO‐CORDEX simulations for two emission representative concentration pathways (RCP4.5 and RCP8.5). Both indicators have been validated over the period 1981–2010 using an independent data set that contains more than 4000 station data, showing very high correlation over most of Europe. Trends of HDD and CDD from 1981 to 2100, together with their uncertainties, are analysed. For both RCPs, all simulations project a significant decrease for HDD, especially over Scandinavia and European Russia, and an increase of CDD which peaks over the Mediterranean region and the Balkans. Overall, degree‐day trends do not show remarkable differences if population weighting is applied. If a constant population scenario is considered, the decrease in HDD will outbalance the increase in CDD in the 21st century over most of Europe. Thus the related energy demand (expressed as Energy Degree‐days, EDD) is expected to decrease. If, however, population projections over the 21st century are included in the calculations, it is shown that despite the persisting warming, EDD will increase over northern Europe, the Baltic countries, Great Britain, Ireland, Benelux, the Alps, Spain, and Cyprus, resulting in an overall increase in EDD over Europe. [ABSTRACT FROM AUTHOR]

A burgeoning comparative literature has identified the centrality of childcare policy and provision in promoting parental, and specifically maternal, participation in paid employment across countries. This literature has focused on the importance of macro- level institutional arrangements, with a special emphasis on variation in availability of, and access to, formal early childhood education and care services. However, there has been limited comparative exploration of what this means in practice at the micro- level: the everyday challenges parents face when attempting to navigate the childcare system and the labour market simultaneously. Taking inspiration from human geography literature on the concept of 'space- time fixity', we present cross- national findings on the logistical challenges of arranging childcare. Evidence is drawn from interviews with parent- and childcare- related organizations in six European countries: Germany, Hungary, Italy, Slovenia, Sweden and the UK. Our research provides a richer understanding of childcare availability than would a sole focus on formal childcare services, by elucidating the difficulties parents face in organizing access to these services, which can be a challenge to some extent even in contexts where childcare services are comprehensive and affordable. [ABSTRACT FROM AUTHOR]

This article assesses the influence of populist parties on two central aspects of democracy - participation and representation. In line with traditional theories on populism and democracy, we argue that populist parties have a positive effect on electoral turnout and the equality of participation. This effect, however, is moderated by the party's role in government or opposition as well as their host-ideology, i.e. left, centre or right. We argue that populist parties also have a positive effect on substantive representation, but that this effect is strongly dependent on their host-ideology. We test these arguments with lagged dependent variable models using data from 31 European countries from 1990 until 2014. We find mixed support for our theoretical expectations. [ABSTRACT FROM AUTHOR]

In the first international study of this kind, we analyze the capital structure of 364 nongovernmental development organizations ( NGDOs) from three different countries: Belgium, Spain, and the United Kingdom. We observe lower debt ratio values in the United Kingdom, and significant differences between countries were found by testing an econometric model with the five classical determinants of leverage, considering total debt and both long- and short-term debt. We find support for the pecking order theory, and we broadly discuss some possible reasons for the obtained differences. [ABSTRACT FROM AUTHOR]

Rationale, Aims, and Objectives Pharmaceutical care involves patient-centred pharmacist activity to improve medicines management by patients. The implementation of this service in a comprehensive manner, however, requires considerable organisation and effort, and indeed, it is often not fully implemented in care settings. The main objective was to assess how pharmaceutical care provision within community pharmacy has evolved over time in Europe. Method A cross-sectional questionnaire-based survey of community pharmacies, using a modified version of the Behavioural Pharmaceutical Care Scale (BPCS) was conducted in late 2012/early 2013 within 16 European countries and compared with an earlier assessment conducted in 2006. Results The provision of comprehensive pharmaceutical care has slightly improved in all European countries that participated in both editions of this survey (n = 8) with progress being made particularly in Denmark and Switzerland. Moreover, there was a wider country uptake, indicating spread of the concept. However, due to a number of limitations, the results should be interpreted with caution. Using combined data from participating countries, the provision of pharmaceutical care was positively correlated with the participation of the community pharmacists in patient-centred activities, routine use of pharmacy software with access to clinical data, participation in multidisciplinary team meetings, and having specialized education. Conclusions The present study demonstrated a slight evolution in self-reported provision of pharmaceutical care by community pharmacists across Europe, as measured by the BPCS. The slow progress suggests a range of barriers, which are preventing pharmacists moving beyond traditional roles. Support from professional bodies and more patient-centred community pharmacy contracts, including remuneration for pharmaceutical care services, are likely to be required if quicker progress is to be made in the future. [ABSTRACT FROM AUTHOR]