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The COVID-19 pandemic has changed life in Europe and globally. The pandemic affects both individuals and the broader society across many domains, including physical and psychological health, the economy and general welfare. The measures taken to counteract the pandemic have significantly altered daily life and, along with the threat of contracting the coronavirus and uncertainties surrounding future developments, created a complex system of stressors with a negative impact on public mental health. This paper aims to outline the ESTSS strategy to address mental health issues related to COVID-19 and focuses on (1) trauma-informed policies, (2) capacity building, (3) collaborative research and (4) knowledge-exchange. To facilitate implementation of a trauma-informed approach and appropriate measures, ESTSS has developed a toolkit of recommendations on mental health and psychosocial assistance to be provided during the different phases of crisis and its aftermath. To promote capacity building, ESTSS offers a certification programme based on a curriculum in psychotraumatology and corresponding on-line training to the European community of mental health professionals. To assure evidence-based approaches and methods tailored to current circumstances, ESTSS has initiated a pan-European research project with international cooperation aimed at studying the mental health consequences of the pandemic, with a focus on psychological trauma and other stress-related reactions. To foster knowledge-exchange, the European Journal of Psychotraumatology (EJPT), the official journal of ESTSS, is publishing a special issue on COVID-19. [ABSTRACT FROM AUTHOR]

The paper by ESMO “The current and future role of the medical oncologist in the professional care for cancer patients: a position paper by the European Society for Medical Oncology (ESMO)” conveys some important key messages for the whole oncology community. A working group (WG) involving 21 oncology and related societies would like to comment on the ESMO position paper from a multidisciplinary perspective. The letter focuses on the concept of multidisciplinarity and how collaboration is the ideal situation for the best care of patients: the guidance to the patient must be given in accordance with agreements based on the outcome of discussions within the multidisciplinary team. The commentary therefore wants to highlight those statements that the working group shares and supports, identifying the common ground from where to start a constructive dialogue. [ABSTRACT FROM AUTHOR]

Background: Maintaining a physically active lifestyle is a determinant factor of a healthy life and personal happiness. Meanwhile, physical inactivity remains a significant issue, resulting in negative consequences for public health. Objectives: This paper investigates the relationships between physical activity, physical inactivity, a healthy life, life expectancy, and personal happiness in European Union (EU) countries. Methods: This empirical study uses an artificial neural network and cluster analysis to analyze and interpret data from 27 EU countries. Artificial neural network analysis enables the assessment of the relationships between physical activity and inactivity, a healthy life, and personal happiness, while cluster analysis identifies groups of EU countries based on physical activity, healthy life, and personal happiness indicators. Results: The results show significant positive links between physical activity and improvements in healthy living and personal happiness. Conclusions: This study highlights considerable variations among EU countries regarding the levels of physical activity, healthy living, and personal happiness, emphasizing the importance of promoting physical activity to enhance public health and overall well-being. The findings suggest the need to develop customized policies that address country-specific factors and promote an active lifestyle. [ABSTRACT FROM AUTHOR]

The article offers information on the award received by Professor Michael Hebbert from the University of Manchester for his paper "Re-enclosure of the urban picturesque: green-space transformations in postmodern urbanism" as the Best Published Paper 2008 from the Association of European Schools of Planning (AESOP). His appreciated paper is one of a series of essays which focuses on the reconsolidation of urban design while his other works emphasize public health, collective memory, highway design and street architecture and the fundamental concepts of urbanism. The AESOP prize, which started in 1995, is intended to honor deserving scholars and professionals who have exemplary works in the planning field and publishing in planning journals in Europe.

The Health Silk Road plays a crucial role in the Belt and Road Initiative, and comprehending the health status within the participating countries is fundamental for fostering cooperation in public health. This paper collected five health indicators to represent the health status of the Belt and Road countries. Employing spatial statistics, the spatial patterns of health indicators and the associations with influencing factors were investigated. The utilized spatial statistics encompass spatial autocorrelation methods, geographical detector and spatial lag model. The results revealed obvious disparities and significant positive spatial autocorrelation of health indicators within the Belt and Road countries. Specifically, countries in Sub-Saharan Africa exhibited significant clustering of limited health indicators, while countries in Europe and Central Asia demonstrated significant clustering of robust health indicators. Furthermore, the health indicators exhibited significant spatial heterogeneity and association with the influencing factors. Universal health coverage, household air pollution, and the prevalence of undernourishment emerge as influential factors affecting health indicators. Overall, our findings highlighted complex influencing factors that contributed to the profound health inequalities across the Belt and Road countries. These factors should be duly considered in public health collaborations within the Belt and Road Initiative., (© 2024. The Author(s).)

Coastal areas have long been attractive places to live, work, and recreate and remain so even in the face of growing threats from global environmental change. At any moment, a significant portion of the human population is exposed to both positive and negative health effects associated with coastal locations. Some locations may be "hotspots" of concern for human health due to ongoing climatic and other changes, accentuating the need for better understanding of coastal environment-human health linkages. This paper describes how environmental and health data could be combined to create a coastal environmental and human health observing system. While largely based on information from the US and Europe, the concept should be relevant to almost any coastal area. If implemented, a coastal health observing system would connect a variety of human health data and environmental observations for individuals and communities, and where possible cohorts. Health data would be derived from questionnaires and other personal sources, clinical examinations, electronic health records, wearable devices, and syndromic surveillance, plus information on vulnerability and health-relevant community characteristics, and social media observations. Environmental data sources would include weather and climate, beach and coastal conditions, sentinel species, occurrences of harmful organisms and substances, seafood safety advisories, and distribution, proximity, and characteristics of health-promoting green and blue spaces. Where available, information on supporting resources could be added. Establishment of a linked network of coastal health observatories could provide powerful tools for understanding the positive and negative health effects of coastal living, lead to better health protections and enhanced wellbeing, and provide significant benefits to coastal residents, including the historically disadvantaged, as well as the military, hospitals and emergency departments, academic medical, public health, and environmental health programs, and others. Early networks could provide best practices and lessons learned to assist later entries., Competing Interests: The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Sandifer.)

This paper addresses the issue of integrated care services as a current challenge for primary health care in Europe. It is focused on an operational definition of integrated care and documents its relevance to the recent declaration of the World Health Organization regarding primary health care. The paper also reports on experiences gained and lessons learned in Greece, a country where initial attempts towards integration of public health into primary care are currently unfolding. Additionally, it discusses the limited involvement of patients, families, and communities in health care, as well as relative absence of advocacy and care coordination at a policy level. The need for training stakeholders to define and promote integrated care is highlighted as an essential component of translating new concepts into concrete health care actions. Finally, when discussing development and implementation of a well-coordinated and integrated primary health care system, the paper provides ideas for further consideration. The present report is anticipated to open the dialogue between health care professionals, stakeholders, policy makers, and the public towards the integration of health services in contemporary Europe. [ABSTRACT FROM AUTHOR]

Objectives: (i) To determine the current state of online grocery shopping, including individuals' motivations for shopping for groceries online and types of foods purchased; and (ii) to identify the potential promise and pitfalls that online grocery shopping may offer in relation to food and beverage purchases. Design: PubMed, ABI/INFORM and Google Scholar were searched to identify published research. Setting: To be included, studies must have been published between 2007 and 2017 in English, based in the USA or Europe (including the UK), and focused on: (i) motivations for online grocery shopping; (ii) the cognitive/psychosocial domain; and (iii) the community or neighbourhood food environment domain. Subjects: Our search yielded twenty-four relevant papers. Results: Findings indicate that online grocery shopping can be a double-edged sword. While it has the potential to increase healthy choices via reduced unhealthy impulse purchases, nutrition labelling strategies, and as a method to overcome food access limitations among individuals with limited access to a brick-and-mortar store, it also has the potential to increase unhealthy choices due to reasons such as consumers' hesitance to purchase fresh produce online. Conclusions: Additional research is needed to determine the most effective ways to positively engage customers to use online grocery shopping to make healthier choices. [ABSTRACT FROM AUTHOR]

COVID-19 represents the greatest health crisis in recent human history. To date, it is still difficult to estimate its impact on mortality. This paper investigates the excess crude mortality in 27 European countries. The differences between the values observed in 2020 and 2021 with those predicted by a joinpoint regression model were evaluated. A multi-regression analysis was implemented to assess the relationship between health variables and excess mortality. Europe experienced a marked and surprising (S-value > 52) increase in crude mortality during 2020 (Δ% = +10.0%, 95% CI: [2.5; 18.7]) and 2021 (Δ% = +12.1%, 95% CI: [4.3; 21.2]). The difference between average excesses of Eastern and Western countries was not surprising (S < 2) and had little relevance (ΔE-W = −2.4, 95% CI: [−2; 7]) during 2020 but was more pronounced (S = 15, ΔE-W = +17.2, 95% CI: [11.0; 23.5]) during 2021. Excess crude mortality increased in 2021 (Δ% = +65%, 95% CI: [12.6; 118], S = 5.9). Evidence has been found for a surprising and marked negative linear relationship between COVID-19 vaccinations and excess mortality ("2021 excess mortality = A + BX4", with "A = 58 ± 7, S = 28" and "B = −0.65 ± 0.10, S = 22, Radj2 = 0.65, 95% CI: [0.38; 0.82]). In light of the current literature, these findings provide solid evidence of the substantial role of COVID-19 in the unexpected and marked excess mortality recorded in Europe. COVID-19 vaccinations have appeared to be one of the main determinants for reducing mortality. Future research should explore these aspects in more detail. [ABSTRACT FROM AUTHOR]

choactive substances” (NPS) as substances for abuse that are not under the control of the 1961 Convention on Narcotic Drugs or the 1971 Convention on Psychotropic Substances, but may constitute The definition of a group of different substances, which have been developing very rapidly since 2000 and are difficult to identify due to frequent changes in pharmacological and toxicological properties.The health risk assessment of consumers has been insufficiently researched.The use of NPS is reaching epidemic proportions worldwide and poses an increasing danger to the individual and public health. There are several basic groups of NPS, according to their chemical composition and pharmacological properties. All NPS cannot be safely differentiated according to these groups, and their effects, potency and risk profile are not similar to the substances from which they are derived. The highest percentage of abused NPS is from the group of synthetic cathinones and synthetic cannabinoids. Clinicaly, NPS abuse is categorized as acute intoxications, which is more common, because NPS is most often used on certain occasions (outings, musical events) or as an addiction. Acute intoxications with different types of NPS are severe, with numerous mental and physical symptoms, often life-threatening and with fatal outcomes. Adequate diagnosis is uncertain, diagnostic laboratory tests for drugs are generally not applicable to NPS. Symptomatic internal medicine and psychiatric therapy are used in the treatment because there are no specific antidotes, except for the group of synthetic opioids, (naltrexone). Patients with more serious complications are taken care of in intensive care units. Addiction to certain types of NPS is diagnosed and treated according to the principles of treatment of addiction to already known drugs. Methods: The paper presents an overview of available foreign and domestic literature and experiences of various authors on the topic of NPS from the previous 10 years, as well as the latest reports of regulatory bodies in the USA and Europe, in charge of monitoring epidemiological data on NPS. Topic: The main goal of the paper is to draw the attention of the professional public to the problem of the epidemic wave of new psychoactive substances in the world, as well as significant amounts of knowledge and experience and developing new strategies for registration, monitoring, diagnosis and treatment of abuses and dependence on these substances. Conclusion: These facts impose the need to raise the vigilance of the health and legal system according to the presence of NPS on the market and the prevalence of use in the population, their health risks, as well as connecting with European organizations for monitoring NPS and developing new strategies for their control and prevention. [ABSTRACT FROM AUTHOR]

Background Parents' reluctance to vaccinate their children undermines the effectiveness of vaccination programmes in Western Europe. There is anecdotal evidence suggesting a connection between the rise of political populism and vaccine hesitancy. Methods This paper analyses national-level data to examine the link between political populism and vaccine hesitancy in Western Europe. Political populism is operationalised as the percentage of people in a country who voted for populist parties in the 2014 European Parliament elections. Vaccine hesitancy is operationalised as the percentage of people in a country who believe that vaccines are not important, safe and effective according to data from the Vaccine Confidence Project (2015). Results There is a highly significant positive association between the percentage of people in a country who voted for populist parties and who believe that vaccines are not important (R = 0.7923, P = 0.007) and effective (R = 0.7222, P = 0.0035). The percentage of people who think vaccines are unsafe just misses being significant at the 5% level (R = 0.5027, P = 0.0669). Conclusions Vaccine hesitancy and political populism are driven by similar dynamics: a profound distrust in elites and experts. It is necessary for public health scholars and actors to work to build trust with parents that are reluctant to vaccinate their children, but there are limits to this strategy. The more general popular distrust of elites and experts which informs vaccine hesitancy will be difficult to resolve unless its underlying causes—the political disenfranchisement and economic marginalisation of large parts of the Western European population—are also addressed. [ABSTRACT FROM AUTHOR]

The paper "The impact and challenges of the Covid-19 for the Roma community in Europe" presents just a small part of the challenges that the Roma community are facing and how they were exacerbated by the apparition of the Covid-10 pandemic. Even before, the Roma people were a vulnerable group, having problems integrating because of the discrimination that brought forth other inequalities that they face in the society. Therefore, a special attention must be paid during this period of crisis in order to prevent further unreplaceable losses. [ABSTRACT FROM AUTHOR]

Background: The last 5-10 years have seen significant international momentum build around the field of health policy and systems research and analysis (HPSR + A). Strengthening post-graduate teaching is seen as central to the further development of this field in low- and middle-income countries. However, thus far, there has been little reflection on and documentation of what is taught in this field, how teaching is carried out, educators' challenges and what future teaching might look like.Methods: Contributing to such reflection and documentation, this paper reports on a situation analysis and inventory of HPSR + A post-graduate teaching conducted among the 11 African and European partners of the Consortium for Health Policy and Systems Analysis in Africa (CHEPSAA), a capacity development collaboration. A first questionnaire completed by the partners collected information on organisational teaching contexts, while a second collected information on 104 individual courses (more in-depth information was subsequently collected on 17 of the courses). The questionnaires yielded a mix of qualitative and quantitative data, which were analysed through counts, cross-tabulations, and the inductive grouping of material into themes. In addition, this paper draws information from internal reports on CHEPSAA's activities, as well as its external evaluation.Results: The analysis highlighted the fluid boundaries of HPSR + A and the range and variability of the courses addressing the field, the important, though not exclusive, role of schools of public health in teaching relevant material, large variations in the time investments required to complete courses, the diversity of student target audiences, the limited availability of distance and non-classroom learning activities, and the continued importance of old-fashioned teaching styles and activities.Conclusions: This paper argues that in order to improve post-graduate teaching and continue to build the field of HPSR + A, key questions need to be addressed around educational practice issues such as the time allocated for HPSR + A courses, teaching activities, and assessments, whether HPSR + A should be taught as a cross-cutting theme in post-graduate degrees or an area of specialisation, and the organisation of teaching given the multi-disciplinary nature of the field. It ends by describing some of CHEPSAA's key post-graduate teaching development activities and how these activities have addressed the key questions. [ABSTRACT FROM AUTHOR]

Background The aim was to evaluate the use of PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses), CONSORT (Consolidated Standards of Reporting Trials) and STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) methods in reviews, clinical trials and observational studies, respectively, which were published in European journals within the field of Public Health (PH). Methods Papers published between 2010 and 2013 in seven PH journals were evaluated. The presence of the words PRISMA, STROBE and CONSORT was considered in the search criteria. (Results In total, 2355 of 3456 retrieved articles were included: 1.5% appeared to follow the guidelines. The boundaries within which the criteria were applied are 0-100% for CONSORT, 0-0.6% for STROBE and 0-37% for PRISMA. Conclusions A strong heterogeneity in the application of guideline statements was observed. A common agreement among journals regarding research-reporting methodologies could improve the quality of PH research publishing. [ABSTRACT FROM AUTHOR]

Given the COVID-19 pandemic crisis that has deeply affected the health and well-being of people worldwide, the main objective of this paper was to explore the existing relationship between health, welfare, and population aging until the pandemic burst, on the basis of two distinctive groups of European Union (EU) countries, namely, the old and the new member states. The methodological endeavor was based on two advanced econometric techniques, namely, structural equation modelling and network analysis through Gaussian graphical models, applied for each group of EU countries, analyzed during the period of 1995-2017. The main results revealed significant differentiation among the new and old EU countries as follows: public health support was found to have a positive impact on healthy aging and well-being of older people, on other social determinants, and on people's perceived good and very good health; overall, significant influences were revealed in terms of the aging dimensions. The main implications of our findings relate to other researchers as a baseline comparison with the existing situation before the COVID-19 pandemic outbreak, but also to policymakers that have to rethink the public health allocations, both in old and new EU member states, in order to endorse the aging credentials, underpinning a successful and healthy integration of the elderly within all life dimensions.

The UK's response to COVID-19 has been widely criticized by scientists and the public. According to EuroMOMO, a European mortality monitoring initiative, the excess mortality that may be attributable to COVID-19 in England is one of the highest in Europe, second only to Spain. While critiqued from a public health perspective, much less attention is given to the implications of the pandemic outbreak for the right to health as defined under international human rights law and ratified by member states. Using the UK as a case study, we examine critically the extent to which the government's response to COVID-19 complied with the legal framework of the right to health. We review further key states' obligations on the right to health and assess its suitability in times of pandemic. Finally, we offer some recommendations for an update of the right to health. This paper adds to the body of literature on the right to health and human rights based-approaches to health., Competing Interests: Competing interests: None declared., (Copyright © 2020 Montel, Kapilashrami, Coleman, and Allemani.)

Background: Over recent years there have been several major terror attacks in cities across Europe. These attacks result in deaths, physical injuries, and pose long-term threats to mental health and wellbeing of large populations. Although psychologists have completed important work on mental health responses to disaster exposure including terrorist attacks, the mental health impacts of such attacks have been comparatively less examined in academic literature than the acute health response to physical injuries. This paper reflects on Southwark Council's pioneering public mental health response to the June 2017 terror attack at London Bridge and Borough Market. It aims to explore perceptions of the mental health impact of the incident by those living and working in the borough.Methods: A rapid qualitative evaluation informed by the logic underpinning Southwark Council's response was conducted. Seven formative interviews were undertaken with individuals involved in the response planning and/or delivery, enabling the evaluation team to establish the response's theoretical basis. Subsequently, nineteen semi-structured interviews with consenting Council employees, residents, business owners, and workers from the Borough were conducted to understand perceived mental health impacts of the attack and the success of the Council response. Thematic analysis of transcribed interviews was undertaken to evaluate the extent to which the response was implemented successfully.Results: Participants reported feeling the attack had a wide-reaching negative impact on the mental health of residents, those working in the borough and visitors who witnessed the attack. Delivering the response was a challenge and response visibility within the community was limited. Participants suggested a comprehensive systematic approach to health needs assessment informed by knowledge and relationships of key Council workers and community stakeholders is imperative when responding to terrorist incidents. Improved communication and working relationships between statutory organisations and community stakeholders would ensure community groups are better supported. Prioritising mental health needs of terror attack responders to mitigate persisting negative impacts was highlighted.Conclusions: This article highlights a potential public health approach and need for developing robust practical guidance in the aftermath of terror attacks. This approach has already influenced the response to the Christchurch mosque shooting in 2019. [ABSTRACT FROM AUTHOR]

Sweden has been considered both pioneer and pariah in regard to its approach to the novel coronavirus SARS-CoV-2 and its pandemic disease, COVID-19. While much of Europe went into economic hibernation and rigid lockdown in the first wave of novel coronavirus infections in the spring of 2020, Sweden kept its borders, bars, restaurants, schools, gyms etc. open. Organised children’s sporting arrangements were also encouraged, on the basis that socialising and physical activity outweighed the risks posed by COVID-19 to children. Public transportation could still be freely used. Masks were not worn. This paper examines the often controversial tenets of the Swedish public health response to COVID-19, and how widely it has appealed to public health experts and officials in Europe and beyond. Debates within the country are also discussed. What it shows is that, despite rising levels of infection in a second wave in Europe and concessions that it might have even failed, the Swedish model is being adopted by stealth and admired from afar. [ABSTRACT FROM AUTHOR]

Background: Syndromic surveillance provides public health intelligence to aid in early warning and monitoring of public health impacts (e.g. seasonal influenza), or reassurance when an impact has not occurred. Using information collected during routine patient care, syndromic surveillance can be based on signs/symptoms/preliminary diagnoses. This approach makes syndromic surveillance much timelier than surveillance requiring laboratory confirmed diagnoses. The provision of healthcare services and patient access to them varies globally. However, emergency departments (EDs) exist worldwide, providing unscheduled urgent care to people in acute need. This provision of care makes ED syndromic surveillance (EDSyS) a potentially valuable tool for public health surveillance internationally. The objective of this study was to identify and describe the key characteristics of EDSyS systems that have been established and used globally.Methods: We systematically reviewed studies published in peer review journals and presented at International Society of Infectious Disease Surveillance conferences (up to and including 2017) to identify EDSyS systems which have been created and used for public health purposes. Search criteria developed to identify "emergency department" and "syndromic surveillance" were applied to NICE healthcare, Global Health and Scopus databases.Results: In total, 559 studies were identified as eligible for inclusion in the review, comprising 136 journal articles and 423 conference abstracts/papers. From these studies we identified 115 EDSyS systems in 15 different countries/territories across North America, Europe, Asia and Australasia. Systems ranged from local surveillance based on a single ED, to comprehensive national systems. National EDSyS systems were identified in 8 countries/territories: 2 reported inclusion of ≥85% of ED visits nationally (France and Taiwan).Conclusions: EDSyS provides a valuable tool for the identification and monitoring of trends in severe illness. Technological advances, particularly in the emergency care patient record, have enabled the evolution of EDSyS over time. EDSyS reporting has become closer to 'real-time', with automated, secure electronic extraction and analysis possible on a daily, or more frequent basis. The dissemination of methods employed and evidence of successful application to public health practice should be encouraged to support learning from best practice, enabling future improvement, harmonisation and collaboration between systems in future.Prospero Number: CRD42017069150 . [ABSTRACT FROM AUTHOR]

Female genital mutilation/cutting (FGM/C) is a rising issue in western societies as a consequence of international migration. Our paper presents demography-driven projections of female flows with FGM/C from each practicing country to each EU28 member state for the 3 sub-periods 2016-2020, 2021-2025, and 2026-2030, with the aim of supporting resource planning and policy making. According to our projections, the EU28 countries will receive a flow of around 400,000 female migrants between 2016 and 2020, and around 1.3 million female migrants between 2016 and 2030 from FGM/C practicing countries. About one-third of them, corresponding to an estimated 127,000 between 2016 and 2020, and more than 400,000 between 2016 and 2030 will have undergone FGM/C before migration. Among these female flows, slightly more than 20% is expected to be made up of girls aged 0-14. According to the expected age at arrival, 20% of these girls are expected to have already undergone FGM/C, while slightly less than 10% are to be considered potentially at risk of undergoing FGM/C after migration. As the number of women with FGM/C in Europe is expected to rise at quite a fast rate, it is important to act timely by designing targeted interventions and policies at the national and at the European level to assist cut women and protect children. Such measures are particularly compelling in France, Italy, Spain, UK, and Sweden that are expected to be the most affected countries by migration from FGM/C practicing countries. [ABSTRACT FROM AUTHOR]

Background: For better supporting the science-governance interface, the potential of health assessments appears underrated. Aims: To identify what various types of health assessment have in common; how they differ; which assessment(s) to apply for which purpose; and what needs and options there are for future joint development. Methods: This review is based on five types of health assessment: monitoring/surveillance/reporting, assessment of health impact, of health technology, of health systems performance, health-related economic assessment. The approach is exploratory and includes: applying an agreed set of comparative criteria; circulating and supplementing synoptic tables; and interpreting the results. Results: Two of the assessments deal with the question 'Where do we stand?', two others with variants of 'What if' questions. Economic Assessment can take place in combination with any of the others. The assessments involve both overall 'procedures' and a variety of 'methods' which inescapably reflect some subjective assumptions and decisions, e.g. on issue framing. Resources and assistance exist for all these assessments. The paper indicates which type of assessment is appropriate for what purpose. Conclusions: Although scientific soundness of health assessments is not trivial to secure, existing types of health assessment can be interpreted as a useful 'toolkit' for supporting governance. If current traces of 'silo' thinking can be overcome, the attainability of a more unified culture of health assessments increases and such assessments might more widely be recognized as a prime, 'tried and tested' way to voice Public Health knowledge and to support rational governance and policy-making. [ABSTRACT FROM AUTHOR]

Background: As digitalization is progressively permeating all aspects of society, how can be it fruitfully employed to sustain the public health goals of quality, accessibility, efficiency and equity in health care and prevention? In this paper, we reflect on the potential of applying digital tools to public health and discuss some key challenges., Methods: We first define 'digitalization' in its broader sense, as well as applied to public health. We then build a conceptual framework where key public health domains are associated to available digital technologies in a matrix that help to identify digital features that bolster public health action. We also provide illustrative data and evidence on the application of digital solutions on selected public health areas. In the second part, we identify the strategic pillars for a successful European strategy for public health digitalization and we outline how the approach being pursued by the European Public Health Association (EUPHA) applies to digital health., Results: From a public health perspective, digitalization is being touted as providing several potential benefits and advantages, including support for the transition from cure to prevention, helping to put people and patients at the center of care delivery, supporting patient empowerment and making healthcare system more efficient, safer and cheaper. These benefits are enabled through the following features of digital technologies: (i) Personalization and precision; (ii) Automation; (iii) Prediction; (iv) Data analytics and (v) Interaction., Conclusion: A successful European strategy for public health digitalization should integrate the following pillars: political commitment, normative frameworks, technical infrastructure, targeted economic investments, education, research, monitoring and evaluation. EUPHA acknowledges digitalization is an asset for public health and is working both to promote the culture of "public health digitalization", as well as to enable its planning, implementation and evaluation at the research, practice and policy level., (© The Author(s) 2019. Published by Oxford University Press on behalf of the European Public Health Association.)

Background: The prevalence of frailty at population-level is expected to increase in Europe, changing the focus of Public Health. Here, we report on the activities of the A3 Action Group, focusing on managing frailty and supporting healthy ageing at community level. Methods: A three-phased search strategy was used to select papers published between January 2016 and May 2018. In the third phase, the first manuscript draft was sent to all A3-Action Group members who were invited to suggest additional contributions to be included in the narrative review process. Results: A total of 56 papers were included in this report. The A3 Action Group developed three multidimensional tools predicting short⁻medium term adverse outcomes. Multiple factors were highlighted by the group as useful for healthcare planning: malnutrition, polypharmacy, impairment of physical function and social isolation were targeted to mitigate frailty and its consequences. Studies focused on the management of frailty highlighted that tailored interventions can improve physical performance and reduce adverse outcomes. Conclusions: This review shows the importance of taking a multifaceted approach when addressing frailty at community level. From a Public Health perspective, it is vital to identify factors that contribute to successful health and social care interventions and to the health systems sustainability.

Chikungunya virus (CHIKV) is a mosquito-borne infection that is emerging in temperate areas of Europe, following the expansion of one of its vector species, Aedes albopictus. Although CHIKV fever is a self-limiting disease, with a clinical syndrome often resolving within few days, it can also cause severe sequelae, including chronic polyarthralgia lasting up to 5 years. Additionally, CHIKV outbreaks may limit blood bank donations, adding economic burden on the health system. Public health authorities in Europe need to increase their preparedness against this emerging threat. Two large CHIKV outbreaks occurred in Italy in 2007 and 2017, with hundreds of cases and significant geographical spread. The aim of this paper is to review and compare the 2 Italian outbreaks in terms of available estimates of key epidemiological features, patient clinical presentation, virus and immunological characteristics, and public health response. Recommendations for public health and future directions for research are also discussed and highlighted. Key results: Both outbreaks started in small towns, but cases were also detected in nearby larger cities where transmission was limited to small clusters. The time spans between the first and the last symptom onsets were similar between the 2 outbreaks, and the delay from the symptom onset of the index case and the first case notified was considerable. Comparable infection and transmission rates were observed in laboratory. The basic reproductive number (R0) was estimated in the range of 1.8–6 (2007) and 1.5–2.6 (2017). Clinical characteristics were similar between outbreaks, and no acute complications were reported, though a higher frequency of ocular symptoms, myalgia, and rash was observed in 2017. Very little is known about the immune mediator profile of CHIKV-infected patients during the 2 outbreaks. Regarding public health responses, after the 2007 outbreak, the Italian Ministry of Health developed national guidelines to implement surveillance and good practices to prevent and control autochthonous transmission. However, only a few regional authorities implemented it, and the perception of outbreak risk and knowledge of clinical symptoms and transmission dynamics by general practitioners remained low. Major conclusions: Efforts should be devoted to developing suitable procedures for early detection of virus circulation in the population, possibly through the analysis of medical records in near real time. Increasing the awareness of CHIKV of general practitioners and public health officials through tailored education may be effective, especially in small coastal towns where the outbreak risk may be higher. A key element is also the shift of citizen awareness from considering Aedes mosquitoes not only as a nuisance problem but also as a public health one. We advocate the need of strengthening the surveillance and of promoting the active participation of the communities to prevent and contain future outbreaks. Author summary: In Europe, vector-borne diseases have been increasing during the last decades. CHIKV is an example of a neglected emerging disease transmitted by the alien mosquitoes Ae. albopictus that caused 2 large outbreaks in Italy in 2007 and 2017. It is important to compare the main epidemiological, clinical, virological, and immunological features, as well as the public health responses, to increase preparedness to face future outbreaks. [ABSTRACT FROM AUTHOR]

Broad terms such as Black, African, or Black African are entrenched in scientific writings although there is considerable diversity within African descent populations and such terms may be both offensive and inaccurate. This paper outlines the heterogeneity within African populations, and discusses the strengths and limitations of the term Black and related labels from epidemiological and public health perspectives in Europe and the USA. This paper calls for debate on appropriate terminologies for African descent populations and concludes with the proposals that (1) describing the population under consideration is of paramount importance (2) the word African origin or simply African is an appropriate and necessary prefix for an ethnic label, for example, African Caribbean or African Kenyan or African Surinamese (3) documents should define the ethnic labels (4) the label Black should be phased out except when used in political contexts. [ABSTRACT FROM AUTHOR]

This paper discusses the work of the EUHPID Project to develop a European Health Promotion Monitoring System based on a common set of health promotion indicators. The Project has established three working groups to progress this task -- health promotion policy and practice-driven, data-driven and theory-driven. The work of the latter group is reviewed in particular. EUHPID has taken a systems theory approach in order to develop a model as a common frame of reference and a rational basis for the selection, organization and interpretation of health promotion indicators. After reviewing the strengths and weaknesses of those health promotion models currently proposed for indicator development, the paper proposes a general systems model of health development, and specific analytical, socio-ecological models related to public health and health promotion. These are described and discussed in detail. Taking the Ottawa Charter as the preferred framework for health promotion, the socio-ecological model for health promotion adopts its five action areas to form five types of systems. The structure and processes for each of these five systems are proposed to form the basis of a classification system for health promotion indicators. The paper goes on to illustrate such a system with reference to indicators in the workplace setting. The EUHPID Consortium suggest that their socio-ecological model could become a common reference point for the public health field generally, and offer an invitation to interested readers to contribute to this development. [ABSTRACT FROM AUTHOR]

More than 100 leaders of European professional and lay bodies, representatives of the World Health Organisation, and health experts from governments and universities came together in 1998 to discuss and adopt a European Declaration on Epilepsy. As part of the Declaration, member States were urged to support the publication of a "White Paper" as a detailed public health statement on epilepsy in Europe. Consequently, in response to the European Declaration on Epilepsy, a number of experts and professional bodies from across Europe have been drawn together to produce the "European White Paper on Epilepsy."

The authors introduce the issue, themed From Data to Public Health Actions, which features work conducted by the Population Health Information Research Infrastructure (PHIRI). Topics discussed include an overview of PHIRI, essential pillars covered by PHIRI to support strong and resilient HIS and research for evidence-based policy making across Europe, and role of PHIRI in the implementation of the European Health Data Space (EHDS).

We estimate the distribution of COVID-19 mortality (measured as daily deaths) from the start of the pandemic until July 31st, 2022, for six European countries and the USA. We use the Pareto, the stretched exponential, the log-normal and the log-logistic distributions as well as mixtures of the log-normal and log-logistic distributions. The main results are that the Pareto does not describe well the data and that mixture distributions tend to offer a very good fit to the data. We also compute Value-at-Risk measures as well as mortality probabilities with our estimates. We also discuss the implications of our results and findings from the point of view of public health planning and modelling. [ABSTRACT FROM AUTHOR]

Health inequalities continue to exacerbate in the European Region, this underlines the need to strengthen the equity impact of public health policies. Nurses and midwives, professional groups that account for 61.8% of the practicing health professionals, work at the point of care, interdisciplinary and see the effects of health inequalities in their everyday work supporting communities and the environment where they are born, live, work and age. The government chief nursing and midwifery officer (GCNMOs) influence, provide policy advice and lead health systems planning and delivery of services. Further to this, it is increasingly being document that they participate in public health policy and inspire others to commit to the implementation of a new vision to strengthen equity impact on population health outcomes. In 2023, a series of discussions with GCNMOs, multidisciplinary researchers and experts, representing 35 of 53 countries in the WHO European Region explored the implications as to how GCNMOs can contribute to addressing the social determinants of health inequalities. Based on this dialogue, we provide a proposal of public health actions for health equity that will benefit from GCNMOs in delivering co-benefits for better health and inclusive growth. These actions can include equity-responsive health systems and health promotion, universal social protection, secure employment and healthy working conditions, environmental protection, education, decent housing, or urban planning among others. Unless governments facilitate the process where GCNMOs have clear mandates, sufficient authority, recognition, and support to engage in policy advocacy, governments will miss out on building fairer and healthier societies that are truly intersectoral and collaborative. [ABSTRACT FROM AUTHOR]

Tropospheric ozone is an air pollutant that poses a public health problem in Europe. Climate change could increase the formation of ozone. Applying past and predicted annual total (all-cause) mortality data and modeled daily ozone concentrations, we performed a nationwide health impact assessment estimating annual ozone-related (attributable) deaths in Austria. Different approaches were compared. Estimates were based on maximal 1-h averages of ozone. Until the decade from 2045 till 2055, more people will die in Austria because of the demographic trends. Therefore, more deaths will also be attributable to ozone. Higher greenhouse gas emission scenarios (e.g. Representative Concentration Pathway RCP8.5 compared to RCP2.6) will lead to more ozone-related deaths, mostly due to the national emission of ozone precursors (a difference of 250–340 cases per year, depending on the model), but to a lesser extent because of global climate change. Increases in attributable deaths will be affected mostly by national, not global mitigation measures. National emission reduction will certainly have a strong and beneficial effect on local atmospheric chemistry, air quality, and public health. [ABSTRACT FROM AUTHOR]

The role of evidence and expertise in policy-making has been of interest to public health professionals and political scientists alike. The public health community often sees its efforts as part of a linear knowledge transfer process and tends to blame itself for inadequate communication or translation of its arguments to policy-makers' language when its efforts fail. Political science, especially theories of the policy process, offer alternative perspectives to explain the success or failure of experts' preferred policy goals. This paper focuses on the concept of epistemic communities (groups of experts with a common policy goal derived from their shared knowledge) in policy-making, drawing on examples from the field of health technology assessment in Europe. By combining the parsimony and the central focus on experts of the linear knowledge transfer model with the recognition of complexity of political science, the epistemic communities concept provides a useful structure for the public health community to analyze its efforts to influence policy.

This paper presents the basic political science consensus on parties and their impact on policy, then turns to focus on the impact of the populist radical right (PRR) parties on policy, what PRR parties have done to implement their views and whether they make a difference. Three effects on policy were established: 1) they de-emphasize the issue, preferring to focus on migration, crime and security rather than health and welfare and 2) they prefer to pursue exclusionary policies. 3) it is not clear whether they increase or decrease benefits for the "native" populations they claim to represent. In short PRR parties make a difference whether to migrants or conservative governments, this party group matters.

The article provides updates on issues related to the European Public Health Association (EUPHA) as of October 2019. Topics covered include opportunity of the World Health Organization to renew its vision for health in Europe beyond 2020, a white paper published by the European Commission in March 2017 setting out five possible paths for the future of Europe, and EUPHA's statement on what European political parties are stating on health.

Background Family policies have been shown to affect men's and women's health throughout the European Union, though particularly in the case of women. This paper seeks to analyze this effect by creating two Synthetic Health Indicators (SHIs) differentiated by gender applying the P 2 distance method. We also aim to compare the results obtained by means of our SHI and the Self-rated health (SRH) indicator, as it is the most common indicator used to approach individuals' health. Methods The 2012 European Quality of Life Survey was used to construct the SHI. Dimensions such as physical health, mental health, psychosocial resources, the capacity of health services and community health status were included in our SHI. All proved to be relevant when measuring individuals' health. Results Gender health inequalities differed depending on the indicator used in each European country. When considering family policy, we found significant gender health gaps that favoured men in traditional countries, regardless of the indicator used (SHI or SRH). Moreover, with our SHI we found significant gender health inequalities in market-oriented and dual-earner countries that were not revealed by the SRH indicator, highlighting the fact that current equality policies are necessary but insufficient to overcome the gender health gap. Conclusions The SHI was more sensitive to gender differences and evidenced certain advantages compared to the SRH. The SHI includes a wide range of variables that incorporated large amounts of fresh information, allowing men and women to have a personalized design of their own health. [ABSTRACT FROM AUTHOR]

The evidence underpinning public health policy is often of low quality, leading to inconsistencies in recommended interventions. One example is the divergence in national policies across Europe for managing contacts of invasive meningococcal disease. Aiming to develop consistent guidance at the European level, a group of experts reviewed the literature and formulated recommendations. The group defined eight priority research questions, searched the literature, and formulated recommendations using GRADE methodology. Five of the research questions are discussed in this paper. After taking into account quality of evidence, benefit, harm, value, preference, burden on patient of the intervention, and resource implications, we made four strong recommendations and five weak recommendations for intervention. Strong recommendations related not only to one question with very low quality of evidence as well as to two questions with moderate to high quality of evidence. The weak recommendations related to two questions with low and very low quality of evidence but also to one question with moderate quality of evidence. GRADE methodology ensures a transparent process and explicit recognition of additional factors that should be considered when making recommendations for policy. This approach can be usefully applied to many areas of public health policy where evidence quality is often low. [ABSTRACT FROM AUTHOR]

Background Global threats, such as the coronavirus disease 2019 (COVID-19) pandemic, have highlighted the critical importance of robust and well-functioning health information systems (HIS) in effectively addressing public health emergencies. To enhance the understanding and the functioning of such systems, it is crucial to perform HIS assessments. This article explores key gaps and identifies best practices in the COVID-19 HIS of eight European countries. Furthermore, it provides recommendations to strengthen European systems for better pandemic preparedness. Methods Assessments were carried out in eight European countries using an adapted version of the WHO support tool to strengthen HIS and the Joint Action on Health Information assessment tool. The assessments took place between January 2022 and April 2023. Results Four main themes emerged regarding the gaps and best practices identified in the various HIS: organizational, technical, legal and resources. The results of these assessments show different approaches implemented by countries to improve their HIS and respond to the demands of the pandemic. Conclusions It is imperative for countries to draw valuable insights from the COVID-19 pandemic and strengthen their HIS. This involves the adaptation or development of pandemic preparedness plans, strengthening legislative framework for data sharing and privacy protection, promotion of data standards and international definitions and implementation of a unique person identifier. Additionally, countries will have to act in this post-pandemic era and integrate the newly developed systems and innovations into existing structures, maintain and develop trust by citizens through transparent communication and engage in infodemic management and address resource gaps in the workforce. [ABSTRACT FROM AUTHOR]

Background Before the COVID-19 pandemic, a need for a uniform approach to health information (HI) knowledge in population health analysis across Europe was evident. The Population Health Information Research Infrastructure (PHIRI) emerged as a proactive initiative to strengthen European HI capacities. This article describes the achievements of PHIRI, highlighting its capacity-building activities and their contribution towards a sustainable strategy for the implementation of the European Health Data Space (EHDS). Methods PHIRI collaboration established a work package for skill-building activities in population health in partnership with other organizations. Activities included webinars, workshops, sessions, training schools and courses for researchers and public administration workers from Europe and beyond. The primary goal of the activities was to examine the impact of COVID-19 on European health systems at both local and national levels, including healthcare facilities and policymaking entities. Results Twelve activities were organized between October 2020 and the summer of 2023. In March 2023, the Spring School on Health Information was organized to share the knowledge achieved from PHIRI and other European Union-related projects. This event also validated the European Health Information Training Programme. Conclusions PHIRI's findings emphasized the importance of equipping the workforce with core HI skills to improve health systems' preparedness and resilience. Through this research, it is possible to propose a strategy for building capacity that emphasizes the importance of providing training in human-machine dynamics. This approach will contribute to the sustainable implementation of the EHDS. [ABSTRACT FROM AUTHOR]

Background Resilience of national health systems in Europe remains a major concern in times of multiple crises and as more evidence is emerging relating to the indirect effects of the COVID-19 pandemic on health care utilization (HCU), resulting from de-prioritization of regular, non-pandemic healthcare services. Most extant studies focus on regional, disease specific or early pandemic HCU creating difficulties in comparing across multiple countries. We provide a comparatively broad definition of HCU across multiple countries, with potential to expand across regions and timeframes. Methods Using a cross-country federated research infrastructure (FRI), we examined HCU for acute cardiovascular events, elective surgeries and serious trauma. Aggregated data were used in forecast modelling to identify changes from predicted European age-standardized counts via fitted regressions (2017–19), compared against post-pandemic data. Results We found that elective surgeries were most affected, universally falling below predicted levels in 2020. For cardiovascular HCU, we found lower-than-expected cases in every region for heart attacks and displayed large sex differences. Serious trauma was the least impacted by the COVID-19 pandemic. Conclusion The strength of this study comes from the use of the European Population Health Information Research Infrastructure's (PHIRI) FRI, allowing for rapid analysis of regional differences to assess indirect impacts of events such as pandemics. There are marked differences in the capacity of services to return to normal in terms of elective surgery; additionally, we found considerable differences between men and women which requires further research on potential sex or gender patterns of HCU during crises. [ABSTRACT FROM AUTHOR]

Alzheimer's disease (AD), breast cancer (BC) and prostate cancer (PC) continue to be high in the research and innovation agenda of the European Commission (EC). This is due to their exceptionally large burden to the national health systems, the profound economic effects of opportunity costs attributable to decreased working ability, premature mortality and the ever-increasing demand for both hospital and home-based medical care. Over the last two decades, the EC has been steadily increasing both the number of proposals being funded and the amounts of financial resources being allocated to these fields of research. This trend has continued throughout four consecutive science funding cycles, namely framework programme (FP)5, FP6, FP7 and Horizon 2020 (H2020). We performed a retrospective assessment of the outputs and outcomes of EC funding in AD, BC and PC research over the 1999–2019 period by means of selected indicators. These indicators were assessed for their ability to screen the past, present and future for an array of causal relationships and long-term trends in clinical, epidemiological and public health sphere, while considering also the broader socioeconomic impact of funded research on the society at large. This analysis shows that public–private partnerships with large industry and university-based consortia have led to some of the most impactful proposals being funded over the analysed time period. New pharmaceuticals, small molecules and monoclonal antibodies alike, along with screening and prevention, have been the most prominent sources of innovation in BC and PC, extending patients' survival and enhancing their quality of life. Unlike oncology, dementia drug development has been way less successful, with only minor improvements related to the quality of supportive medical care for symptoms and more sensitive diagnostics, without any ground-breaking disease-modifying treatment(s). Significant progresses in imaging diagnostics and nanotechnology have been largely driven by the participation of medical device industry multinational companies. Clinical trials funded by the EC were conducted, leading to the development of brand-new drug molecules featuring novel mechanisms of action. Some prominent cases of breakthrough discoveries serve as evidence for the European capability to generate cutting-edge technological innovation in biomedicine. Less productive areas of research may be reconsidered as priorities when shaping the new agenda for forthcoming science funding programmes. [ABSTRACT FROM AUTHOR]

Background This article of the International Epidemiological Association commissioned paper series stocktakes the population health and status of epidemiology in 21 of the 53 countries of the WHO European Region. By United Nations geographical classification, these countries belong to Eastern Europe, Western Asia and South-Central Asia.Methods Published data were used to describe population health indicators and risk factors. Epidemiological training and research was assessed based on author knowledge, information searches and E-mail survey of experts. Bibliometric analyses determined epidemiological publication outputs.Results Between-country differences in life expectancy, amount and profile of disease burden and prevalence of risk factors are marked. Epidemiological training is affected by ongoing structural reforms of educational systems. Training is advanced in Israel and several Eastern European countries. Epidemiological research is mainly university-based in most countries, but predominantly conducted by governmental research institutes in several countries of the former Soviet Union. Funding is generally external and limited, partially due to competition from and prioritization of biomedical research. Multiple relevant professional societies exist, especially in Poland, the Czech Republic and Hungary. Few of the region’s 39 epidemiological academic journals have international currency. The number of epidemiological publications per population is highest for Israel and lowest for South-Central Asian countries.Conclusions Epidemiological capacity will continue to be heterogeneous across the region and depend more on countries’ individual historical, social, political and economic conditions and contexts than their epidemiologists’ successive efforts. National and international research funding, and within- and between-country collaborations should be enhanced, especially for South-Central Asian countries. [ABSTRACT FROM AUTHOR]

An introduction to the journal is presented which discusses topics related to the Sustainable Development Goals (SDG) set by the United Nations (UN) and featured within the issue, including the SDG framework for action, the health-related SDG in Europe, and the political aspects of the SDG.

This paper provides a first outline of the European Network of Health Economic Evaluation Databases (EURO NHEED) project. The project is funded by the European Commission and will implement, in 7 European centres based in France, Germany, Italy, The Netherlands, Spain, Sweden and the United Kingdom, databases on the economic evaluation of healthcare interventions. The network will be based on two existing and well-established resources, namely the UK’s NHS Economic Evaluation Database (NHS EED), and France’s Connaissances et Décision en ÉConomie de la Santé (CODECS) database. EURO NHEED will initially cover 17 European countries and will provide its users with bibliographic records, detailing the main characteristics of all included studies. In addition, structured abstracts will be provided for articles identified as full economic evaluations (cost-benefit, cost-effectiveness or cost-utility), which will offer a detailed critique of the findings and the methodology used. These databases will be accessible free of charge on the Internet. The EURO NHEED project is the first attempt to develop such a resource on a multi-national basis. The project will bring together Health Economists and Information Scientists from the European Union and beyond and is anticipated to facilitate a number of benefits and advances in the field of Health Economics. These include harmonisation and increased understanding of the theory and methodology of economic evaluation in healthcare, the interpretation of the generalisability of studies to target settings, and the influence of healthcare system variations among the European countries. The project will therefore advance the state of the art in collecting, summarising, critiquing and disseminating economic evaluations of healthcare conducted within Europe. [ABSTRACT FROM AUTHOR]

Background: A large proportion of European children, adults and older adults do not engage in sufficient physical activity (PA). Understanding individual and contextual factors associated with PA behaviours is essential for the identification and implementation of effective preventative environments, policies, and programmes that can promote an active lifestyle across life course and can potentially improve health. The current paper intends to provide 1) a multi-disciplinary, Pan-European and life course view of key determinants of PA behaviours and 2) a proposal of how these factors may cluster., Methods: After gathering a list of 183 potential PA behaviours-associated factors and a consensus meeting to unify/consolidate terminology, a concept mapping software was used to collate European experts' views of 106 identified factors for youth (<19 years), adults (19-64 years), and older adults (≥65 years). The analysis evaluated common trends in the clustering of factors and the ratings of the distinct factors' expected modifiability and population-level impact on PA behaviours across the life course. Priority for research was also assessed for each cluster., Results: The concept mapping resulted in six distinct clusters, broadly merged in two themes: 1) the 'Person', which included clusters 'Intra-Personal Context and Wellbeing' and 'Family and Social Economic Status' (42 % of all factors) and 2) the 'Society', which included the remaining four clusters 'Policy and Provision', 'Cultural Context and Media', 'Social Support and Modelling', and 'Supportive Environment' (58 % of all factors). Overall, 25 factors were rated as the most impactful on PA behaviours across the life course and being the most modifiable. They were mostly situated in the 'Intra-Personal Context and Wellbeing' cluster. Furthermore, 16 of them were rated as top priority for research., Conclusions: The current framework provides a preliminary overview of factors which may account for PA behaviour across the life course and are most relevant to the European community. These insights could potentially be a foundation for future Pan-European research on how these factors might interact with each other, and assist policy makers to identify appropriate interventions to maximize PA behaviours and thus the health of European citizens.

The persistence of socioeconomic inequalities in health, despite all that has been done to reduce social and economic inequalities in many European countries, is one of the great disappointments of public health. In this paper, I summarize the results of a series of studies into the explanation of variations and trends in inequalities in mortality in three European regions: the Nordic countries with their puzzlingly large inequalities in mortality, Southern European countries with their miraculously small inequalities in mortality and Central & Eastern European countries in which inequalities in mortality have disastrously exploded since the early 1990 s. The results of these studies show that inequalities in mortality are remarkably variable and dynamic, which suggests that it may be possible to reduce them if we exploit the entry-points for policy that these studies have also identified, such as poverty, smoking, excessive alcohol consumption and lack of access to health care. At the same time, another lesson is that health inequalities are influenced in sometimes unexpected ways by factors that are not under our control, and that we cannot expect to eliminate these health inequalities soon. [ABSTRACT FROM AUTHOR]

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E-cigarette use has become increasingly popular, especially among the young. Its long-term influence upon health is unknown. Aim of this review has been to present the current state of knowledge about the impact of e-cigarette use on health, with an emphasis on Central and Eastern Europe. During the preparation of this narrative review, the literature on e-cigarettes available within the network PubMed was retrieved and examined. In the final review, 64 research papers were included. We specifically assessed the construction and operation of the e-cigarette as well as the chemical composition of the e-liquid; the impact that vapor arising from the use of e-cigarette explored in experimental models in vitro; and short-term effects of use of e-cigarettes on users' health. Among the substances inhaled by the e-smoker, there are several harmful products, such as: formaldehyde, acetaldehyde, acroleine, propanal, nicotine, acetone, o-methyl-benzaldehyde, carcinogenic nitrosamines. Results from experimental animal studies indicate the negative impact of e-cigarette exposure on test models, such as ascytotoxicity, oxidative stress, inflammation, airway hyper reactivity, airway remodeling, mucin production, apoptosis, and emphysematous changes. The short-term impact of e-cigarettes on human health has been studied mostly in experimental setting. Available evidence shows that the use of e-cigarettes may result in acute lung function responses (e.g., increase in impedance, peripheral airway flow resistance) and induce oxidative stress. Based on the current available evidence, e-cigarette use is associated with harmful biologic responses, although it may be less harmful than traditional cigarettes. Int J Occup Med Environ Health 2017;30(3):329-344. [ABSTRACT FROM AUTHOR]