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The economic, social, and health costs of mental distress are increasingly burdening individuals and societies in Europe. Yet, overmedicalization of mild symptoms is also well documented. This accumulates in more pressures and demands on health care systems. In this article, I explore how the process of help seeking in mental distress might be shaped by health system design and functioning in one of the South European societies—Spain. Employing Bourdieu's theoretical lens, in-depth interviews with health care providers and users of services are analyzed. I reveal how the logic of the mental health care field, which is reinforced by the market, the state, and the media, may result in medicalization of mild distress while severe mental illness remains undertreated. I also show how mental help-seeking practices could gradually influence the functioning of the treatment system. Nevertheless, points of resistance to medicalization can also be identified. [ABSTRACT FROM AUTHOR]

Background The study assessed awareness and use of heated tobacco products (HTPs) and factors that influenced these issues among cigarette smokers from six European countries in 2016 (Wave 1) and 2018 (Wave 2). Methods A survey was conducted among a nationally representative sample of cigarette smokers aged 18 years or older from Germany, Greece, Hungary, Poland, Romania and Spain in 2016 (N  = 6011) and 2018 (N  = 6027; 53% of smokers from the previous wave were retained, regardless of smoking status and dropouts were replaced by a replenishment sample of smokers). Data were collected through face-to-face interviews. Estimates were produced using weighted data. The study presents the cross-sectional results. Results Awareness of HTPs increased from 8% to 17% between the two waves. At Wave 1, 1.1% of the smokers declared having used HTPs at least once during their lifetime; and at Wave 2, this increased to 1.9% (around 1% or less in four countries, except for Greece and Romania where it was around 4%). Factors associated with HTPs use among those who had ever heard about these products at Wave 1 were country of residence, being a daily cigarette smoker and ever use of electronic cigarettes. At Wave 2, ever use of HTPs was significantly higher among those who had tried to quit smoking combustible cigarettes in the last 12 months, had tried electronic cigarettes during lifetime and perceived HTPs as less dangerous than combustible cigarettes; the country of residence was also associated with HTPs use. Conclusion This study offers insights into the behaviours and perceptions of European adult smokers regarding HTPs, an important emerging issue in the field of tobacco control. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore how communication in neonatal intensive care units (NICUs) between immigrant mothers and nurses take place without having a common language, and how these mothers experience their NICU stay. Background: Admission of infants to NICU affects both parents and infants. Immigrant mothers constitute a vulnerable hospital population in need of culturally, linguistically and individually tailored information. Design and methods: The study had a qualitative design reported according to the COREQ criteria. Eight mothers who spoke neither Scandinavian nor English went through individual semi‐structured interviews. Six mother–nurse interactions were observed, and eight nurses' experiences were explored through focus‐group interviews. All interviews were audio recorded and transcribed verbatim. The analysis was thematic and hermeneutic in character. Results: Interpreters were present during the consultations with the physicians, but rarely during the daily nurse‐mother interactions. Nurses focused on daily routines, infant care guidance and mother–infant attachment. The mothers learned through demonstrations and hands‐on guidance. Language barriers made it difficult to assess the mothers' understanding, but the mothers expressed that they felt adequately included in the care of their infant and well informed and guided. Even so, both mothers and nurses expressed desire to use interpreters more regularly. The pictorial communication boards available lacked important vocabulary needed in neonatal nursing contexts and their use furthermore interrupted the mother–nurse conversation. Conclusion: Body language, simple words, guesswork, trial and error characterised the nurse–mother interaction. The nurses adopted various communication strategies to help the mothers understand and give them a voice. Competent interpreters were used during meetings with physicians, but not during daily bedside guidance and information giving by nurses. Relevance to clinical practice: Knowledge of immigrant mothers' and nurses' communication strategies and how both parties think, feel and act to overcome communication problem is necessary to improve clinical practice and reduce communication barriers. [ABSTRACT FROM AUTHOR]

In this article, we apply narrative dialogism and new materialism to health research. We examine how material↔semiotic environments (MSEs) affect the rehabilitation process of Patrick, a man who exercised with the aim to recover from spinal cord injury. The MSEs are considered embedded subcases within the overall holistic case of Patrick. Three MSEs were identified: the hospital gym, the personal gym, and the adapted gym. These are examined using the analytical lens of assemblages. First, the mutually affecting components of each MSE are described. Second, a larger environmental assemblage is identified, which is termed exercise-is-restitution assemblage. This composite assemblage illuminates the associations between the three MSEs, and reveals how restitution resonated across time and space. The article contributes to the literature by reconceptualizing restitution. It highlights the importance of the materiality of health-related narratives, and it reveals the potential of MSE for transforming rehabilitation and improving exercise promotion and maintenance. [ABSTRACT FROM AUTHOR]

Elite soccer clubs across Europe spend ever-increasing sums of money on transfers and salaries for world-class players. Consequently, clubs' talent identification and development processes for junior players have become more professionalised. Based on a holistic ecological approach, this study presents an analysis of talent identification practices across some of the most productive soccer academies in Europe (N = 11). Data were collected via semi-structured interviews with 11 heads of academy recruitment from clubs in the "big five" European leagues. Clubs were purposively sampled based on their player productivity ranking. Interviews ranged from 52:26 minutes to 114:06 minutes in length (m = 87:53 ± 20.10 minutes). This study argues that holistic ecological approaches the environments were characterised through the interplay of factors that ranged from high-level internal to international level relationships. This resulted in the identification and recruitment of players from local and international environments. The purpose of recruitment was suggested to have a dual purpose: recruitment of players for the first team; recruitment of players for further development/monitoring and/or selling to another club. [ABSTRACT FROM AUTHOR]

Copyright of European Journal of Social Work is the property of Routledge 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.)

Objective: This study aimed to explore whether positive impacts were sustained and unanticipated ripple effects had occurred four years after the implementation of interventions to improve cross‐cultural communication in primary care. Background: Sustaining the implementation of change using complex interventions is challenging. The EU‐funded "RESTORE" study implemented guidelines and training on cross‐cultural communication in five Primary Care sites in Europe, combining implementation theory (Normalisation Process Theory) with participatory methodology (participatory learning and action—PLA). There were positive impacts on knowledge, skills and clinical routines. Design, setting and participants: Four of the five original sites (England, Ireland, Greece, The Netherlands) were available for this qualitative follow‐up study. The study population (N = 44) was primary healthcare staff and migrants, most of whom had participated in RESTORE. Intervention; main outcome measures: PLA‐style focus groups and interviews explored routine practice during consultations with migrants. Etic cards based on the effects of RESTORE stimulated the discussion. Deductive framework analysis was performed in each country followed by comparative data analysis and synthesis. Results: Changes in knowledge, attitudes and behaviour with regard to consultations with migrants were sustained and migrants felt empowered by their participation in RESTORE. There were ongoing concerns about macro level factors, like the political climate and financial policies, negatively affecting migrant healthcare. Conclusion: There were sustained effects in clinical settings, and additional unanticipated positive ripple effects, due in part, from the participatory approach employed. [ABSTRACT FROM AUTHOR]

Access to universal healthcare is a normative expectation of citizens in European welfare states. As part of a comparative study of healthcare in diverse European neighbourhoods, we met women who described failures of the public healthcare system, together with gratitude for that system. Challenges to European welfare states of ageing populations, the retraction of resources available for healthcare, and globalised migration streams have been linked to xenophobic 'welfarist' attempts to restrict access to services for new arrivals and those seen as failing to contribute sufficiently. Stories of healthcare systems' failure to treat symptoms, pain, and suffering in a timely and caring fashion came from eight women of non-European migrant backgrounds as part of a wider interview study in four European cities (Birmingham, Uppsala, Lisbon, Bremen). These accounts suggest that a normative aspect of welfare provision has been reproduced – that is, the expression of gratitude – despite inadequate services. Where welfarist attitudes to migration meet normative aspects of healthcare, suffering may be compounded by an expectation of gratitude. The regrettable unmet healthcare need of the eight women whose cases are presented suggests that other marginalised healthcare users may also be under-served in apparently universal healthcare systems. [ABSTRACT FROM AUTHOR]

Longitudinal studies of caregiver burden when caring for persons with dementia living at home are sparse. The aim of the study was to identify factors associated with caregiver burden and predicting increased burden related to caregivers, persons with dementia and formal care. Data were collected through interviews with 1223 caregivers in eight European countries. Bivariate and multivariate regression analyses were performed. Factors associated with caregiver burden included extensive informal care provision, decreased well-being and reduced quality of life for the caregiver and reduced cognition, decreased quality of life, severe neuropsychiatric symptoms and depression in the person with dementia and caregivers' negative experience of quality of care. Factors predicting an increased burden were diminished caregiver well-being, severe neuropsychiatric symptoms of the person with dementia and caregivers' negative perception of quality of care. The knowledge gained in this study may be useful in developing more adequate service systems and interventions to improve dementia care. [ABSTRACT FROM AUTHOR]

Background: There has been an increase in children growing up in non-traditional families, such as single-parent and blended families. Children from such families have a higher prevalence of obesity and poorer health outcomes, but research on the relationship with obesogenic behaviours is limited. Objectives: Therefore, the aim of this study was to investigate whether there are associations between family structures and obesogenic behaviours and related family rules in European children and adolescents. Methods: The sample included 7664 children (mean age ± SD: 10.9 ± 2.9) from 4923 families who were participants of the multi-centre I.Family study (2013/2014) conducted in 8 European countries. Family structure was assessed by a detailed interview on kinship and household. Obesogenic behaviours (screen time, sleep duration, consumption of sugar-sweetened beverages (SSBs)) and family rules (rules for computer and television, bedtime routine, availability of SSBs during meals) were determined by standardized questionnaires. Multilevel mixed-effects linear and logistic regression models were used to model the associations of family structure with obesogenic behaviours and family rules. Sex, age, parental education level, number of children and adults in the household and BMI z-score were covariates in the models. Two-parent biological families were set as the reference category. Results: Children from single-parent families were less likely to have family rules regarding screen time (OR: 0.62, 95% CI: 0.40–0.94, p = 0.026) with higher reported hours of screen time per week (β = 2.70 h/week, 95% CI: 1.39–4.00, p < 0.001). The frequency of weekly SSB consumption differed by family structure in a sex-specific manner: girls from single-parent (β = 3.19 frequency/week, 95% CI: 0.91–5.47, p = 0.006) and boys from blended/adoptive families (β = 3.01 frequency/week, 95% CI: 0.99–5.03, p = 0.004) consumed more SSBs. Sleep duration, bedtime routines and availability of SSBs during meals did not differ between children from these family structures. Parental education did not modify any of these associations. Conclusions: Parents in non-traditional family structures appear to experience more difficulties in restricting screen time and the intake of SSBs in their children than parents in traditional two-parent family structures. Our findings therefore suggest that additional support and effective strategies for parents in non-traditional families may help to reduce obesogenic behaviours in children from such family types. [ABSTRACT FROM AUTHOR]

Background Forty-three out of 53 of the WHO European Member States have set up political and institutional mechanisms to implement the United Nations (UN) 2030 Agenda for Sustainable Development. This includes governance and institutional mechanisms, engaging stakeholders, identifying targets and indicators, setting governmental and sectoral priorities for action and reporting progress regularly. Still, growing evidence suggests that there is room for advancing implementation of some of the Sustainable Development Goals (SDGs) and targets at a higher pace in the WHO European Region. This article proposes the E4A approach to support WHO European Member States in their efforts to achieve the health-related SDG targets. Methods The E4A approach was developed through a 2-year, multi-stage process, starting with the endorsement of the SDG Roadmap by all WHO European Member States in 2017. This approach resulted from a mix of qualitative methods: a semi-structured desk review of existing committal documents and tools; in-country policy dialogs, interviews and reports; joint UN missions and discussion among multi-lateral organizations; consultation with an advisory group of academics and health policy experts across countries. Results The E—engage—functions as the driver and pace-maker; the 4 As—assess, align, accelerate and account—serve as building blocks composed of policies, processes, activities and interventions operating in continuous and synchronized action. Each of the building blocks is an essential part of the approach that can be applied across geographic and institutional levels. Conclusion While the E4A approach is being finalized, this article aims to generate debate and input to further refine and test this approach from a public health and user perspective. [ABSTRACT FROM AUTHOR]

Resilience is seen as a key organisational capability for sustainability in the current turbulent environment. At the same time, for organisations to be more sustainable and resilient, the delivery of innovative responses to the market through continuous change and improvement is necessary. If small and medium enterprises (SMEs) account for over 70% of the world's production, and there is a growing mandate to create sustainable SMEs, then instilling, developing and implementing change capabilities is paramount in making progress towards sustainability and resilience. Therefore, this article aims to demonstrate that change management process capability is fundamental to creating resilience in SMEs. This study is based on a multiple case study methodology through semi-structured, face-to-face interviews with 232 senior managers in 37 manufacturing SMEs across Europe. This article demonstrates that sustainability and resilience in SMEs will be enhanced by (1) ability to embrace organisational and people dimensions as well as operational aspects of change management, and (2) paying attention to long-term planning and external communication to drive change proactively. This article builds a bridge between the theoretical starting point, the results of empirical research and the usability of the presented findings in practice in order to contribute to the development of more resilient SMEs. [ABSTRACT FROM AUTHOR]

Background: General Practice (GP) seems to be perceived as less attractive throughout Europe. Most of the policies on the subject focused on negative factors. An EGPRN research team from eight participating countries was created in order to clarify the positive factors involved in appeals and retention in GP throughout Europe. The objective was to explore the positive factors supporting the satisfaction of General Practitioners (GPs) in clinical practice throughout Europe. Method: Qualitative study, employing face-to-face interviews and focus groups using a phenomenological approach. The setting was primary care in eight European countries: France, Belgium, Germany, Slovenia, Bulgaria, Finland, Poland and Israel. A thematic qualitative analysis was performed following the process described by Braun and Clarke. Codebooks were generated in each country. After translation and back translation of these codebooks, the team clarified and compared the codes and constructed one international codebook used for further coding. Results: A purposive sample of 183 GPs, providing primary care to patients in their daily clinical practice, was interviewed across eight countries. The international codebook included 31 interpretative codes and six themes. Five positive themes were common among all the countries involved across Europe: the GP as a person, special skills needed in practice, doctor-patient relationship, freedom in the practice and supportive factors for work-life balance. One theme was not found in Poland or Slovenia: teaching and learning. Conclusion: This study identified positive factors which give GPs job satisfaction in their clinical practice. This description focused on the human needs of a GP. They need to have freedom to choose their working environment and to organize their practice to suit themselves. In addition, they need to have access to professional education so they can develop specific skills for General Practice, and also strengthen doctor-patient relationships. Stakeholders should consider these factors when seeking to increase the GP workforce. [ABSTRACT FROM AUTHOR]

Copyright of European Journal of Social Work is the property of Routledge 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.)

Background: The International Classification of Headache Disorders lists different subtypes of medication overuse headache (MOH), according to the medication overused. The aim of this study is to evaluate whether the different subtypes correspond to clinically distinguishable phenotypes in a large population. Method: This descriptive cross‐sectional observational study included 660 patients with MOH referred to headache centers in Europe and Latin America as a part of the COMOESTAS project. Information about clinical features was collected with structured patient interviews and with self‐administered questionnaires for measuring disability, anxiety, and depression. Results: Female/male ratio, body mass index, marital status, and level of education were similar among in subjects enrolled in the 5 centers. The mean age was higher among subjects overusing triptans (T‐MOH) with respect to subjects overusing simple analgesic (A‐MOH). Duration of headache before chronification was longer in T‐MOH (19.2 ± 11.9 years) and in subjects overusing ergotamines (E‐MOH, 17.8 ± 11.7 years) with respect to the A‐MOH group (13.1 ± 10.9; P < .001 and P = .017, respectively) and in T‐MOH with respect multiple drug classes (M‐MOH, 14.9 ± 11.7; P = .030). Migraine Disability Assessment (MIDAS) score was significantly lower in E‐MOH group (33.6 ± 41.6), while T‐MOH group (56.8 ± 40.6) had a significant lower MIDAS score with respect to M‐MOH (67.2 ± 62.5; P = .016 and P = .037, respectively). Prevalence of depression and anxiety was lower in patients overusing T with respect to other groups of patients (χ2  = 10.953, P = .027 and χ2 = 25.725, P < .001, respectively). Conclusion: In this study on a large and very well characterized population of MOH, we describe the distinctive clinical characteristics of MOH subtypes. These findings contribute to more clearly define the clinical picture of a poorly delineated headache disorder. They also provide some insights in the possible trajectories leading to this highly disabling chronic headache, that is classified as a secondary form, but whose occurrence is entirely dependent on an underlying primary headache. [ABSTRACT FROM AUTHOR]

Research misconduct has been a threat to Chinese biomedical research. Despite many publications dealing with research integrity in China, little empirical data is available concerning Chinese biomedical researchers' perceptions of research integrity and misconduct. To learn more about this issue, we interviewed Chinese biomedical researchers in Europe to investigate their perceptions of this issue. Semi-structured interviews were conducted with 25 participants until data saturation was reached. The findings indicate that certain aspects of research integrity need elaboration among Chinese biomedical researchers. Participants had a vague understanding of general concepts related to research integrity. Data fabrication, data falsification and plagiarism were perceived as the most severe deviance. Inappropriate authorship (especially gift authorship) and ghost writing were regarded as the most prevalent types of research misconduct in Chinese biomedical research. The harms of certain practices, such as inappropriate authorship, salami publication and multiple submission, were not well recognized. Attitudes toward research misconduct were divided. The current scientific evaluation system, pressures of promotion, motives for fame and other factors were perceived as the main reasons for research misconduct. Participants suggested various measures in addition to existing safeguards to improve research integrity in Chinese biomedical research. [ABSTRACT FROM AUTHOR]

The diversification of caregiving arrangements in European societies has drawn attention to the factors that condition the use of care by older people. Social and family relations appear as a key factor, mainly to be related to the availability and accessibility to potential informal caregivers. Recent studies evidenced that geographical proximity and a larger social network increase the probability of receiving informal support in old age. However, the ways in which interpersonal relationships are associated with the use of formal care, as well as the cross‐country variability of this association, have been barely explored. Using a sample of 37,708 individuals aged 65 and over from Wave 6 of the Survey of Health, Ageing and Retirement in Europe (SHARE), this study examines to what extent the characteristics of older people's social networks predict the use of three types of home care; formal, informal, or combined, exploring the cross‐European convergences and divergences. Binomial logistic regressions are conducted to compare four macro‐regions in continental Europe (northern countries: Denmark and Sweden; western countries: Austria, Belgium, France, Germany, Switzerland, and Luxembourg; southern countries: Italy, Spain, Greece, and Portugal; and eastern countries: Poland, Czech Republic, Slovenia, Estonia, and Croatia). The structure, availability, and accessibility to the members of the social network are the major predictors of the receipt of informal care everywhere. Regional divergences are observed regarding to formal care, alone or combined with informal caregivers. [ABSTRACT FROM AUTHOR]

The study aimed to investigate the role of social activities, social networks as well as socioeconomic status (SES) in influencing some aspects of cognitive functioning (immediate and delayed verbal recall tests and semantic verbal fluency) in elderly people over time. This analysis was conducted on a sample of 31,954 healthy elderly people (58% female, mean age 65.54 ± 9.74) interviewed in both the fourth and sixth waves of the Survey on Health, Aging and Retirement in Europe (SHARE), in 2011 and 2015. A structural equation model with measurement component was used to assess the relationship between cognitive function, social life and SES over time. Multilevel ordinal logistic regression was applied to explain satisfaction with social network in relation to different types of social network across countries. Being equipped with good cognitive skills did not seem to be predictive of their maintenance over time (latent coefficient = 0.24, p value = 0.34). On the contrary, the subject's social and participatory life, understood as satisfying one's social network and engaging in diversified non-professional social activities, seemed to play a crucial role in the maintenance of cognitive functions in the elderly (latent coefficient = 3.5, p value = 0.03). This research suggests that a socially active and participatory lifestyle mitigates the effects of the physiological process of brain aging. [ABSTRACT FROM AUTHOR]

Background: Whilst many health systems offer a range of urgent and emergency care services to deal with the need for unscheduled care, these can be problematic to navigate. Objective: To explore how lay people make sense of urgent care provision and processes. Design: Qualitative study, incorporating citizen panels and longitudinal semi‐structured qualitative interviews. Setting and Participants: Two citizens' panels, comprising purposively selected public populations—a group of regular users and a group of potentially marginalized users of urgent and emergency care. Semi‐structured interviews were conducted with 100 people, purposively sampled to include those over 75, aged 18‐26 years, and from East/Central Europe. A sub‐sample of 41 people received a second interview at +6‐12 months. Framework analysis was thematic and comparative, moving through coding to narrative and interpretive summaries. Findings and Discussion: Participants narratives illuminated considerable uncertainty and confusion regarding urgent and emergency care provision which in part could be traced to the contingent nature of urgent and emergency care need. Accounts of emergency care provision were underpinned by strong moral positioning of appropriate help‐seeking, demarcating legitimate service use that echoed policy rhetoric, but did not necessarily translate into individual behaviour. People struggled to make sense of urgent care provision making navigating "appropriate" use problematic. Conclusions: The focus on help‐seeking behaviour, rather than sense‐making, makes it difficult to move beyond the polarization of "appropriate" and "inappropriate" service use. A deeper analysis of sense‐making might shift the focus of attention and allow us to intervene to reshape understandings before this point. [ABSTRACT FROM AUTHOR]

Adapting and providing quality services for people as they age is a common challenge across Europe. The perspective of older people is fundamental in a person-centred care approach. Expanding research at the European level that explicitly includes their views can offer a relevant contribution to the development of evidence-based guidelines that can be shared in education and training across health and social care professions. This study aimed to identify common meaningful dimensions of professional competence in health and social care emphasised by older people from six countries in different regions of Europe according to their experiences. A qualitative approach was chosen with a total of 95 semi-structured interviews conducted in Austria, Finland, Lithuania, Portugal, Turkey and UK, following a common topic guide. Participants in this study were aged 60 and above, and recruitment considered age, gender, level of education and living arrangements. Results identified a set of universal skills and practices that according to older people, health and social care professionals should meet. Competences at the interpersonal level were central in older people's discourses, and its core dimensions are anchored in relational, communication and socio-emotional skills of professionals. These findings reinforce the aspiration of establishing best practices in care that relies on the harmonisation of a competence framework that can be shared in the training and education of health and social care professionals across Europe and that voices older people's preferences, expectations and needs. [ABSTRACT FROM AUTHOR]

Background Mental health problems are a risk factor for loss of paid employment. This study investigates (i) the relation between depressive symptoms and different involuntary pathways of labour force exit and (ii) explores gender and geographical differences in this relation. Methods The study population consisted of 5263 individuals in paid employment aged between 50 years and the country-specific retirement age from 11 European countries participating in the longitudinal Survey of Health, Ageing and Retirement in Europe (SHARE). Self-reported depressive symptoms at baseline were assessed using the EURO-D. Employment status was derived from interviews after 2 and 4 years. Cox proportional hazards regression analyses were used to investigate the association between depressive symptoms and labour force exit via disability benefit and unemployment. Population attributable fractions (PAFs) were calculated to estimate the contribution of depressive symptoms to these pathways of labour force exit. Results Both men and women with a EURO-D score ≥4 had a >2-fold increased risk of a disability benefit (HR: 2.46, 95%CI 1.68–3.60) after adjustment for demographics and work-related characteristics. Among men depressive symptoms elevated the risk of becoming unemployed at follow-up (HR 1.55; 95%CI: 0.94–2.57). The PAF was 0.18 for disability benefit and 0.04 for unemployment, and varied across European regions. Conclusions Individuals with depressive symptoms are at increased risk of losing paid employment, which in turn may aggravate their symptoms. Targeting depressive symptoms with public health and occupational policies should be considered to reduce the burden of mental diseases in Europe. [ABSTRACT FROM AUTHOR]

Purpose: Previous research has suggested that individuals are mostly prone to loneliness in their later years of life because of exposure to several risk factors typical of old age. The current study aims to examine possible demographic, health and social determinants of loneliness among older adults in Europe.Methods: Data on a nationally representative sample of 5074 Europeans aged ≥ 65 years were drawn from the first wave of the Survey of Health, Aging and Retirement in Europe (SHARE, 2004/2005). Frequency of feelings of loneliness was examined according to adverse health conditions, stressful life events and social isolation indicators.Results: Female gender, older age, lower socioeconomic status, living unpartnered, being childless and having no activity involvement were significantly associated with frequent feelings of loneliness (p < 0.001). The proportion of the respondents who declared enduring loneliness most of the time compared with none of the time was significantly higher among Southern Europeans relative to their Northern counterparts (p < 0.001). Recent departure of offspring from the parental nest was a significant predictor of loneliness in both the second (ORs = 2.08; 95% CI 1.24-3.48) and the third (ORs = 1.75; 95% CI 1.03-2.96) multiple regression models.Conclusion: In this sample of older Europeans, several demographic characteristics, specific adverse health conditions, stressful life events and social isolation indicators were associated with feelings of loneliness. Policy initiatives for the alleviation of loneliness in older age should therefore aim at improving psychosocial and health-related difficulties faced by this population. [ABSTRACT FROM AUTHOR]

New technology has made pornography increasingly accessible to young people, and a growing evidence base has identified a relationship between viewing pornography and violent or abusive behavior in young men. This article reports findings from a large survey of 4,564 young people aged 14 to 17 in five European countries which illuminate the relationship between regular viewing of online pornography, sexual coercion and abuse and the sending and receiving of sexual images and messages, known as “sexting.” In addition to the survey, which was completed in schools, 91 interviews were undertaken with young people who had direct experience of interpersonal violence and abuse in their own relationships. Rates for regularly viewing online pornography were very much higher among boys and most had chosen to watch pornography. Boys’ perpetration of sexual coercion and abuse was significantly associated with regular viewing of online pornography. Viewing online pornography was also associated with a significantly increased probability of having sent sexual images/messages for boys in nearly all countries. In addition, boys who regularly watched online pornography were significantly more likely to hold negative gender attitudes. The qualitative interviews illustrated that, although sexting is normalized and perceived positively by most young people, it has the potential to reproduce sexist features of pornography such as control and humiliation. Sex and relationships education should aim to promote a critical understanding of pornography among young people that recognizes its abusive and gendered values. [ABSTRACT FROM AUTHOR]

Background This study aimed to assess cross-sectional and prospective relationships between vigorous physical activity (VPA) and the risk of major chronic diseases among European older adults. Methods Participants were 37 524 older adults who responded to the fourth (in 2011) and fifth (in 2013) wave of the SHARE project, from 13 European countries. Participants answered interview questions about the presence of chronic conditions and VPA. The cross-sectional and prospective association between PA and the number of chronic diseases was assessed using logistic regression models. Results Among men and women, the prevalence of chronic diseases was significantly lower among those who reported VPA once a week or more than once a week. For men, VPA once a week was prospectively related with lower odds of heart attack, chronic lung disease, Parkinson's disease and Alzheimer's disease. VPA more than once a week was prospectively related with lower odds of having all chronic diseases. Women who engaged in VPA once a week presented lower odds of having chronic diseases, except for hypertension, high blood cholesterol and cancer. For VPA more than once a week, cancer was the only disease not associated with physical activity. Conclusion VPA is associated with reduced risk of chronic diseases in men and women. Even the practice of VPA once a week seems to be sufficient to reduce risks of chronic diseases. [ABSTRACT FROM AUTHOR]

Purpose: Evidence is limited on implementation of secondary prevention guidelines for coronary heart disease (CHD) in clinical practice and variations between younger and elder patients. We investigated the control of cardiovascular risk factors in German patients with CHD enrolled in the European-wide EUROASPIRE IV survey, stratified by younger (18-69 years) and older (70-79 years) age groups.Method: Eligible subjects were identified via the hospitals’ patient information system and invited to attend a study visit 6 months to 3 years after hospitalization for CHD (myocardial infarction, ischemia, angioplasty/stent, coronary bypass grafting). Information on lifestyle and medication was collected by interview.Results: Five hundred thirty-six patients were recruited in 2012-2013 (median age 69 years [IQR 62-74 years], 18% female, 44% ≥ 70 years of age, median time between index hospitalization and study visit 1.8 [1.1-2.5] years). Proportion of CHD patients receiving recommended drug therapy was 89% for platelet inhibitors (younger vs. older patients 93 vs. 84%, p < 0.01), 83% for statins (83 vs. 85%, p = 0.9), and 83% for beta-blockers (87 vs. 79%, p = 0.02). Uncontrolled blood pressure was observed in 45% (40 vs. 50%, p = 0.02), LDL cholesterol levels > 2.5 mmol/l in 53% (56 vs. 49%, p = 0.1), and HbA1c levels > 7% in diabetic patients in 39% (45 vs. 32%, p = 0.1). Eighty-five percent were overweight (86 vs. 85%, p = 0.8), 37% were obese (41 vs. 31%, p = 0.01), and 10% reported currently smoking (17 vs. 3%, p < 0.01).Conclusion: Although most CHD patients received the drug classes recommended by guidelines, treatment goals were frequently not achieved. Elderly subjects had a less favorable pattern, which may reflect multi-morbidity and weaker identification with treatment targets. National CHD prevention strategies should focus not only on enhancing lifestyle modifications and reaching treatment targets, but also on highlighting the different needs in older individuals. [ABSTRACT FROM AUTHOR]

Innovative methods to manage frailty are critical to managing the needs of an ageing population. Evidence suggests there are opportunities to reverse or prevent frailty through early intervention. However, little is known about older adults’, families’ and practitioners’ beliefs about the malleability of frailty. This study examined European stakeholders’ accounts of the acceptability and feasibility of frailty screening and prevention to inform future intervention development. Semi-structured focus groups and individual interviews were conducted in three European Union countries (Italy, Poland and the United Kingdom) with key stakeholders – frail and non-frail older adults, family care-givers, and health and social care professionals. Thematic analysis identified four themes: synchronicity between the physical and the psychological in frailty, living with frailty in the social world, the need for a new kind of care, and screening for and preventing frailty. Findings emphasised the need for a holistic approach to frailty care and early intervention. Integrated care services and advocacy were important in the organisation of care. Central to all stakeholders was the significance of the psychological and social alongside the physical elements of frailty and frailty prevention. Support and care for older adults and their family care-givers needs to be accessible and co-ordinated. Interventions to prevent frailty must encompass a social dimension to help older adults maintain a sense of self while building physical and psychological resilience. [ABSTRACT FROM AUTHOR]

Background: Integrated palliative care aims at improving coordination of palliative care services around patients' anticipated needs. However, international comparisons of how integrated palliative care is implemented across four key domains of integrated care (content of care, patient flow, information logistics and availability of (human) resources and material) are lacking. Aim: To examine how integrated palliative care takes shape in practice across abovementioned key domains within several integrated palliative care initiatives in Europe. Design: Qualitative group interview design. Setting/participants: A total of 19 group interviews were conducted (2 in Belgium, 4 in the Netherlands, 4 in the United Kingdom, 4 in Germany and 5 in Hungary) with 142 healthcare professionals from several integrated palliative care initiatives in five European countries. The majority were nurses (n = 66; 46%) and physicians (n = 50; 35%). Results: The dominant strategy for fostering integrated palliative care is building core teams of palliative care specialists and extended professional networks based on personal relationships, shared norms, values and mutual trust, rather than developing standardised information exchange and referral pathways. Providing integrated palliative care with healthcare professionals in the wider professional community appears difficult, as a shared proactive multidisciplinary palliative care approach is lacking, and healthcare professionals often do not know palliative care professionals or services. Conclusion: Achieving better palliative care integration into regular healthcare and convincing the wider professional community is a difficult task that will take time and effort. Enhancing standardisation of palliative care into education, referral pathways and guidelines and standardised information exchange may be necessary. External authority (policy makers, insurance companies and professional bodies) may be needed to support integrated palliative care practices across settings. [ABSTRACT FROM AUTHOR]

No psychological research has been done investigating the experiences of adoption by sexual minorities living in Europe. This qualitative study is the first cross-national research within the European context giving the floor to LG (lesbian and gay) adoptive parents in order to explore the main challenges they encountered in the transition to adoptive parenthood. Sixty-two LG adoptive parents (16 lesbians and 46 gay men) living in Belgium (n = 14), France (n = 26), and Spain (n = 22) participated in this study. Semi-structured interviews were conducted in order to gather information about two key steps in the adoptive path: the decision making and the adoption process itself. Results revealed that while choosing to adopt, LG adoptive parents experienced numerous self-doubts and emotional conflicts driven by introjected heteronormative assumptions about family. During the adoption procedure, they were confronted with a large number of challenges and legal roadblocks connected to their sexual minority status. Exploring the experience of the first generation of LG adoptive parents in Europe provides insight into the great impact that the sociolegal context has on their lives. Findings suggest the necessity of promoting practice geared not only to fight discrimination but also to provide better support to LG people throughout the adoption process. [ABSTRACT FROM AUTHOR]

Background Pandemics of new and emerging infectious diseases are unpredictable, recurrent events that rapidly threaten global health and security. We aimed to identify public views regarding provision of information and consent to participate in primary and critical care clinical research during a future influenza-like illness pandemic. Methods Descriptive-interpretive qualitative study, using focus groups (n = 10) and semi-structured interviews (n = 16), with 80 members of the public (>18 years) in Belgium, Spain, Poland and the UK. Local qualitative researchers followed a scenario-based topic guide to collect data. Data were transcribed verbatim, translated into English and subject to framework analysis. Results Public understandings of pandemics were shaped by personal factors (illness during the previous H1N1 pandemic, experience of life-threatening illness) and social factors (historical references, media, public health information). Informants appreciated safeguards provided by ethically robust research procedures, but current enrolment procedures were seen as a barrier. They proposed simplified enrolment processes for higher risk research and consent waiver for certain types of low-risk research. Decision making about research participation was influenced by contextual, research and personal factors. Informants generally either carefully weighed up various approaches to research participation or responded instinctively. They supported the principle of using routinely collected, anonymized clinical biological samples for research without explicit consent, but regarded this as less acceptable if researchers were motivated primarily by commercial gain. Conclusions This bottom-up approach to ascertaining public views on pandemic clinical research has identified support for more proportionate research protection procedures for publically funded, low-risk studies. [ABSTRACT FROM AUTHOR]

What is known and objective Polypharmacy has a significant impact on patients' health with overall expenditure on over-the-counter (OTC) medicines representing a substantial burden in terms of cost of treatment. The aim of this study, which was conducted within the framework of a European Project funded by the European Union under the Seventh Framework Programme and was entitled OTC-SOCIOMED, was to report on possible determinants of patient behaviour regarding the consumption of medicines, and particularly OTCs, in the context of primary care. Methods A multicentre, cross-sectional study was designed and implemented in well-defined primary healthcare settings in Cyprus, the Czech Republic, France, Greece, Malta and Turkey. Patients completed a questionnaire constructed on the basis of the theory of planned behaviour (TPB), which was administered via face-to-face interviews. Results and discussion The percentage of patients who had consumed prescribed medicines over a 6-month period was consistently high, ranging from 79% in the Czech Republic and 82% in Turkey to 97% in Malta and 100% in Cyprus. Reported non-prescribed medicine consumption ranged from 33% in Turkey to 92% in the Czech Republic and 97% in Cyprus. TPB behavioural antecedents explained 43% of the variability of patients' intention to consume medicines in Malta and 24% in Greece, but only 3% in Turkey. Subjective norm was a significant predictor of the intention to consume medicines in all three countries (Greece, Malta and Turkey), whereas attitude towards consumption was a significant predictor of the expectation to consume medicines, if needed. What is new and conclusion This study shows that parameters such as patients' beliefs and influence from family and friends could be determining factors in explaining the high rates of medicine consumption. Factors that affect patients' behavioural intention towards medicine consumption may assist in the formulation of evidence-based policy proposals and inform initiatives and interventions aimed at increasing the appropriate use of medicines. [ABSTRACT FROM AUTHOR]

Background: Many European citizens are seeking complementary and alternative medicine (CAM). These treatments are regulated very differently in the EU/EFTA countries. This may demonstrate differences in how risk associated with the use of CAM is perceived. Since most CAM treatments are practiced fairly similarly across Europe, differing risk understandings may influence patient safety for European CAM users. The overall aim of this article is thus to contribute to an overview and awareness of possible differing risk understandings in the field of CAM at a policymaking/structural level in Europe. Methods: The study is a re-analysis of data collected in the CAMbrella EU FP7 document and interview study on the regulation of CAM in 39 European countries. The 12 CAM modalities included in the CAMbrella study were ranked with regard to assumed risk potential depending on the number of countries limiting its practice to regulated professions. The 39 countries were ranked according to how many of the included CAM modalities they limit to be practiced by regulated professions. Results: Twelve of 39 countries generally understand the included CAM treatments to represent "high risk", 20 countries "low risk", while the remaining 7 countries understand CAM treatments as carrying "very little or no risk". The CAM modalities seen as carrying a risk high enough to warrant professional regulation in the highest number of countries are chiropractic, acupuncture, massage, homeopathy and osteopathy. The countries understanding most of the CAM modalities in the study as potentially high-risk treatments are with two exceptions (Portugal and Belgium) all concentrated in the southeastern region of Europe. Conclusion: The variation in regulation of CAM may represent a substantial lack of common risk understandings between health policymakers in Europe. We think the discrepancies in regulation are to a considerable degree also based on factors unrelated to patient risk. We argue that it is important for patient safety that policy makers across Europe address this confusing situation. This could be done by applying the WHO patient safety definitions and EU's policy to facilitate access to "safe and high-quality healthcare", and regulate CAM accordingly. [ABSTRACT FROM AUTHOR]

This study explores whether the plans of older workers on the cusp of retirement are in line with the active ageing agenda set by policy makers in Europe. The study was carried out in Italy, England, and the United States of America (USA). A total of 133 older workers who planned to retire within the next 10-12 months were interviewed (55 in England, 40 in Italy and 38 in the USA) between May 2014 and early 2015 using common semi-structured questions. Active Ageing Index dimensions were used to gauge the orientation of older people towards their retirement. The results of the study suggest that, with some differences, retirement plans of interviewees were substantially consistent with the active ageing perspective. However, some challenges were highlighted, including the need for governments to do more to promote genuine freedom of choice in relation to leaving the labour market, and to provide greater support for informal family carers. Findings also pointed to the need to measure active ageing in connection with individual wellbeing, e.g. by including indicators of leisure activities and by considering the re-weighting of employment and informal care dimensions. Companies could also provide more support during the retirement transition, with opportunities for maintained social connection with former colleagues, and help in making and fulfilling retirement plans. [ABSTRACT FROM AUTHOR]

Background Politicians in many countries have embraced the notion that health inequalities derive from socioeconomic inequalities, but European governments have for the most part failed to enact policies that would reduce underlying social inequalities. Methods Data are drawn from 84 in-depth interviews with policy-makers in four European countries between 2012 and 2015, qualitative content analysis of recent health inequalities policy documents, and secondary literature on the barriers to implementing evidence-based health inequalities policies. Results Institutional and political barriers are important barriers to effective policy. Both policy-making institutions and the ideas and practices associated with neoliberalism reinforce medical-individualist models of health, strengthen actors with material interests opposed to policies that would increase equity, and undermine policy action to tackle the fundamental causes of social (including health) inequalities. Conclusions Medicalizing inequality is more appealing to most politicians than tackling income and wage inequality head-on, but it results in framing the problem of social inequality in a way that makes it technically quite difficult to solve. Policy-makers should consider adopting more traditional programs of taxation, redistribution and labor market regulation in order to reduce both health inequalities and the underlying social inequalities. [ABSTRACT FROM AUTHOR]

Background: Patients with advanced diseases often experience deficient continuity of care. Although integrated palliative care promotes continuity of care, it is not clear how it can be optimized to improve continuity of care experiences. Aim: To examine how relational, informational and management continuity of care are experienced by patients with advanced diseases and their family caregivers receiving care from several integrated palliative care initiatives in five European countries. Design: We adopted a longitudinal qualitative study design including two interviews (interval 3 months) with patients and family caregivers focusing on how health care professionals responded to their needs. Interviews were audio-recorded and transcribed verbatim. Analysis involved a two-step qualitative content approach. Setting/participants: A total of 22 integrated palliative care initiatives (established local palliative care collaborations) were selected in Belgium, Germany, Hungary, the Netherlands and the United Kingdom. We recruited 152 patients (63% cancer, 24% chronic obstructive pulmonary disease, 13% heart failure; life expectancy <1 year; mean age 68 years, 56% female) and 92 family caregivers (mean age 61 years, 66% female). Results: Trusted relationships with a small number of key health care professionals to receive tailored care and easily access help were essential. Relational continuity was often deficient, especially with general practitioners. Although informational and management continuity was often lacking in care provision, collaborative integrated palliative care initiatives were related to consistent and coherent care. Conclusion: Patients and family caregivers most likely experience continuity of care by having a small number of trusted health care professionals who are available, provide multidisciplinary care and regularly transfer information to all health care professionals involved. Optimizing continuity of care requires further integration of integrated palliative care initiatives with other health care professionals involved in the patients’ care networks. [ABSTRACT FROM AUTHOR]

Assurance of transcript accuracy and quality in interview-based qualitative research is foundational for data accuracy and study validity. Based on our experience in a cross-cultural ethnographic study of women’s pelvic organ prolapse, we provide practical guidance to set up step-by-step interview transcription and translation protocols for team-based research on sensitive topics. Beginning with team decisions about level of detail in transcription, completeness, and accuracy, we operationalize the process of securing vendors to deliver the required quality of transcription and translation. We also share rubrics for assessing transcript quality and the team protocol for managing transcripts (assuring consistency of format, insertion of metadata, anonymization, and file labeling conventions) and procuring an acceptable initial translation of Spanish-language interviews. Accurate, complete, and systematically constructed transcripts in both source and target languages respond to the call for more transparency and reproducibility of scientific methods. [ABSTRACT FROM AUTHOR]

Background: With the present difficulties in the conservation of sardines in the North Atlantic, it is important to investigate the local ecological knowledge (LEK) of fishermen about the biology and ecology of these fish. The ethnoecological data of European pilchard provided by local fishermen can be of importance for the management and conservation of this fishery resource. Thus, the present study recorded the ethnoecological knowledge of S. pilchardus in the traditional fishing community of Peniche, Portugal. Methods: This study was based on 87 semi-structured interviews conducted randomly from June to September 2016 in Peniche. The interview script contained two main points: Profile of fishermen and LEK on European pilchard. The ethnoecological data of sardines were compared with the scientific literature following an emic-etic approach. Data collected also were also analysed following the union model of the different individual competences and carefully explored to guarantee the objectivity of the study. Results: The profile of the fishermen was investigated and measured. Respondents provided detailed informal data on the taxonomy, habitat, behaviour, migration, development, spawning and fat accumulation season of sardines that showed agreements with the biological data already published on the species. The main uses of sardines by fishermen, as well as beliefs and food taboos have also been mentioned by the local community. Conclusions: The generated ethnoecological data can be used to improve the management of this fishery resource through an adaptive framework among the actors involved, in addition to providing data that can be tested in further ecological studies. Therefore, this local knowledge may have the capacity to contribute to more effective conservation actions for sardines in Portugal. [ABSTRACT FROM AUTHOR]

Background: The 2008 financial crisis in Europe came abruptly and surprisingly. Many countries also suffered a second recession during the period 2010–2012. We examined the impact of the crisis on life satisfaction (LS) by country and individual socioeconomic level. Method: We used a representative sample from the European Social Survey (2002–2014) with data from 26 countries (N = 294,407). LS was measured with a single question with 11 response alternatives. Time from start of crisis (either 2008 or 2010-2012) was determined separately for each interview. Data were analyzed by multilevel analysis Results: There was a sharp decrease in LS in the beginning of the crisis in 2008, and another, but not so severe, decline in 2011, each of them of short duration. However, there was also a slight and progressive yearly decrease in LS that continued one to at least 3 years after either financial crisis that was independent of the effect of being unemployed. Associations varied considerably between countries. A negative decline after the financial crisis was especially evident among those in the most educated groups, and in those in the higher occupational levels. Conclusions: The 2008 financial crisis had a double effect on LS: (1) a sharp short-term decrease consistent with the Easterlin paradox; (2) a slighter long-term progressive decrease that was over and above the strong negative relationship with unemployment that lasted several years. The long-term decline in LS after the start of the financial crisis tended to occur especially in the higher socioeconomic groups. [ABSTRACT FROM AUTHOR]

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Background: As part of the ActifCare (ACcess to Timely Formal Care) project, we conducted expert interviews in eight European countries with policy and political decision makers, or representatives of relevant institutions, to determine their perspectives on access to formal care for people with dementia and their carers.Methods: Each ActifCare country (Germany, Ireland, Italy, The Netherlands, Norway, Portugal, Sweden, United Kingdom) conducted semi-structured interviews with 4-7 experts (total N = 38). The interview guide addressed the topics "Complexity and Continuity of Care", "Formal Services", and "Public Awareness". Country-specific analysis of interview transcripts used an inductive qualitative content analysis. Cross-national synthesis focused on similarities in themes across the ActifCare countries.Results: The analysis revealed ten common themes and two additional sub-themes across countries. Among others, the experts highlighted the need for a coordinating role and the necessity of information to address issues of complexity and continuity of care, demanded person-centred, tailored, and multidisciplinary formal services, and referred to education, mass media and campaigns as means to raise public awareness.Conclusions: Policy and political decision makers appear well acquainted with current discussions among both researchers and practitioners of possible approaches to improve access to dementia care. Experts described pragmatic, realistic strategies to influence dementia care. Suggested innovations concerned how to achieve improved dementia care, rather than transforming the nature of the services provided. Knowledge gained in these expert interviews may be useful to national decision makers when they consider reshaping the organisation of dementia care, and may thus help to develop best-practice strategies and recommendations. [ABSTRACT FROM AUTHOR]

The purpose of this research study was to examine the experiences of prosecutors in Athens, Greece, as they implement a restorative justice (RJ; mediation) model in cases of intimate partner violence (IPV). Greece recently enacted a new legislation related to domestic violence, part of the requirement is mediation. This study used semi-structured interviews with 15 public prosecutors at the courts of first instance and three interviews with facilitators of mediation process. The findings indicate widespread role confusion. Prosecutors’ experiences, professional positions, and views of RJ in adult cases of gendered violence were shaped by their legal training. That is, their perceptions reflected their work in an adversarial system. Their views were complex yet ultimately unreceptive and their practices failed the victims of IPV. The study report concluded with recommendations for the legislators and for better preparation of court actors. [ABSTRACT FROM AUTHOR]

This qualitative project is focused on the challenges that newcomer athletes revealed when they considered their earliest encounters with a receiving culture during general daily life. Conversational interviews with 24 national and international amateur newcomer athletes were subjected to interpretive thematic analysis and developed into a composite vignette. This vignette unearths three themes revealing hope (theme: opportunities abound); uncertainty and fear (theme: weighing the risks for the journey ahead); and anger, humiliation, and hardening (theme: public stonings). Understanding the fluidities within the vignette will permit practitioners to explore the uncertainties of acculturation and find entry points to support athlete acculturation. [ABSTRACT FROM PUBLISHER]

In the UK and Japan, there is concern regarding rising rates of annual new HIV infections among Men who have Sex with Men (MSM).Whilst in the UK and Europe, gay businesses are increasingly recognized as being important settings through which to deliver HIV prevention and health promotion interventions to target vulnerable populations; in Japan such settings-based approaches are relatively underdeveloped. This article draws on qualitative data from a recently completed study conducted to explore whether it is feasible, acceptable and desirable to build on the recent European Everywhere project for adaptation and implementation in Japan. A series of expert workshops were conducted in Tokyo, Nagoya and Osaka with intersectoral representatives from Japanese and UK non-governmental organizations (NGOs), gay businesses, universities and gay communities (n = 46). Further discussion groups and meetings were held with NGO members and researchers from the Japanese Ministry of Health, Labour and Welfare's Research Group on HIV Prevention Policy, Programme Implementation and Evaluation among MSM (n = 34). The results showed that it is desirable, feasible and acceptable to adapt and implement a Japanese version of Everywhere. Such a practical, policy-relevant, settings-based HIV prevention framework for gay businesses may help to facilitate the necessary scale up of prevention responses among MSM in Japan. Given the high degree of sexual mobility between countries in Asia, there is considerable potential for the Everywhere Project (or its Japanese variant) to be expanded and adapted to other countries within the Asia-Pacific region. [ABSTRACT FROM AUTHOR]

Background: Personalized medicine has the potential to allow patients to receive drugs specific to their individual disease, and to increase the efficiency of the healthcare system. There is currently no comprehensive overview of personalized medicine, and this research aims to provide an overview of the concept and definition of personalized medicine in nine European countries.Methods: A targeted literature review of selected health databases and grey literature was conducted to collate information regarding the definition, process, use, funding, impact and challenges associated with personalized medicine. In-depth qualitative interviews were carried out with experts with health technology assessment, clinical provisioning, payer, academic, economic and industry experience, and with patient organizations.Results: We identified a wide range of definitions of personalized medicine, with most studies referring to the use of diagnostics and individual biological information such as genetics and biomarkers. Few studies mentioned patients' needs, beliefs, behaviour, values, wishes, utilities, environment and circumstances, and there was little evidence in the literature for formal incorporation of patient preferences into the evaluation of new medicines. Most interviewees described approaches to stratification and segmentation of patients based on genetic markers or diagnostics, and few mentioned health-related quality of life.Conclusions: The published literature on personalized medicine is predominantly focused on patient stratification according to individual biological information. Although these approaches are important, incorporation of environmental factors and patients' preferences in decision making is also needed. In future, personalized medicine should move from treating diseases to managing patients, taking into account all individual factors. [ABSTRACT FROM AUTHOR]

How do public opinion signals affect political representatives' opinion formation? To date, we have only limited knowledge about this essential representative process. In this article, we theorize and examine the signaling strength of one type of societal signal: protest. We do so by means of an innovative experiment conducted among Belgian national and regional politicians. Elected officials were exposed to manipulated television news items covering a protest demonstration. Following Tilly's previously untested WUNC claim, four features of the event were manipulated: the demonstrators' worthiness, unity, numerical strength, and commitment. We argue that these protest features present elected officials with useful cues about what (a segment of) the public wants. We find that these cues affect elected officials' beliefs. The salience they attach to the protest issue, the position they take, and their intended actions all change as a consequence of exposure. The size of a protest event (numbers) and whether the protesters agree among themselves (unity) are the most persuasive protest factors. The effects of the protest signals come on top of strong receiver effects. We find no evidence that elected officials' predispositions moderate the effects of the protest features. [ABSTRACT FROM AUTHOR]

Aims and objectives To identify how nurse leaders view and experience the opportunities offered by one of the largest global nursing organisations Sigma Theta Tau International. Background Worldwide, nursing leadership is challenged with addressing the complex issues impacting on care delivery. International nursing organisations are a means to bring together individuals to promote leadership and scholarship for nursing practice to promote patient safety and quality care. The newly established all-England chapter of Sigma Theta Tau International is a recent addition to the society in terms of nurse leadership in Europe, as such faces challenges as it establishes its identity and seeks to interpret the organisational vision: to advance world health through nursing leadership and scholarship. Moving forward, members views were sought on the goals of the chapter and how they may be enacted. Design In July 2013, all chapter members at that time had been nominated on the basis of achievement in nurse leadership; all were invited to participate in an online survey. The online questionnaire contained a series of closed and open questions. Results Most respondents joined because they believed in the vision and networking opportunities Sigma Theta Tau International provides. Three themes were extracted from the data: the value of networking and communication, leadership and the development of culturally sensitive organisations and the need for shared scholarship for nursing practice. Conclusion Findings indicate the growth of effective leadership at all levels of nursing could be harnessed through successful collaboration and keen support for robust connections between practice and education to promote quality care. Relevance to clinical practice Whilst challenging, globalisation presents an opportunity for a nursing society such as Sigma Theta Tau International to work collaboratively to address healthcare issues. A nursing society that explores and resolves its own complex issues by actively promoting leadership and collaborative scholarship reveals a potential to empower the profession to share our collective solutions towards enhancing clinical practice. [ABSTRACT FROM AUTHOR]

The debate on age-segregated housing for older prisoners has seldom captured the perspectives of older prisoners and professionals (‘stakeholders’) working in a European prison setting. To address this gap in the research, 35 older prisoners from Switzerland and 40 stakeholders from three European countries (including Switzerland) were interviewed for the study. Data analysis was conducted thematically, and the validity of coding was established independently from the primary author. Interpretation of study results was agreed upon by all authors. Participants' opinions regarding age-segregated housing for older prisoners were split. An almost equal number of prisoners and stakeholders had similar arguments in favour of and against such living arrangements. The findings encompassed three major themes: ‘prisons should mirror society’ and thus age-mixed housing was preferable as it ensured generational exchange; a ‘separate unit within the prison’ would allow continuity of personal and other relationships and at the same time respond to older prisoners' specific health and environmental needs; finally, participants felt it was important to think critically about ‘the criteria’ for placing older prisoners in an age-segregated arrangement. We conclude that the debate on consolidated versus separate housing is bifurcated. Any push towards segregation based only on high prison violence and unvalidated context-specific information may result in unreliable public policy. [ABSTRACT FROM PUBLISHER]

Public care work organisations in Northern Europe often seek to increase their economic efficiency in ways that care workers criticise for reducing both their professional autonomy and the quality of care. Recently, the ideal of 'enterprising nursing' has emerged as a political belief according to which economic efficiency, care workers' autonomy and the quality of care can be improved in tandem by cultivating care workers' agential abilities. This article examines the reception of this belief among migrant care workers in Finland. Drawing on research interviews, the analysis demonstrates how migrant care workers may have difficulties in aligning themselves with the enterprising ideals but also in protesting them. Ethnicity, and the status of a migrant, can offer resources for both constructing enterprising subjectivities and reframing care workers' agency, and their organisational environment, in more critical terms. [ABSTRACT FROM AUTHOR]

Using data from the European Social Survey fielded in 2010/11, this study presents new evidence on retirement preferences in Europe. It investigates retirees' preferred and actual ages of retirement, focusing on the retirement window 1995–2011. Moreover, it reports on the prevalence of mismatch in the form of involuntary retirement (retiring earlier than preferred) and involuntary work (retiring later than preferred). The study identifies substantial shares of retirees who are affected by a mismatch between their preferred and actual ages of retirement. In the majority of the countries analysed, at least 30 per cent of retirees would have preferred to continue working past the age at which they retired, while in a number of countries sizeable shares of retirees report involuntary work. The risk factors for involuntary retirement include the experience of late-career job loss, unemployment, job exits for health reasons and, in the case of women, working in higher-status occupations. The risk factors for involuntary work include fatherhood and, in the case of women, part-time work. As a result of rising actual ages of retirement, the risk of involuntary retirement has decreased for more recent retirement cohorts, while due to pension reforms that have tightened eligibility rules for early retirement, men's risk of involuntary work has increased. However, involuntary retirement is still more prevalent than involuntary work. [ABSTRACT FROM PUBLISHER]

Background: Stakeholders are people with an interest in a topic. Internationally, stakeholder involvement in palliative care research and health technology assessment requires development. Stakeholder involvement adds value throughout research (from prioritising topics to disseminating findings). Philosophies and understandings about the best ways to involve stakeholders in research differ internationally. Stakeholder involvement took place in seven countries (England, Germany, Italy, Lithuania, the Netherlands, Norway and Poland). Findings informed a project that developed concepts and methods for health technology assessment and applied these to evaluate models of palliative care service delivery. Aims: To report on stakeholder involvement in the INTEGRATE-HTA project and how issues identified informed project development. Design: Using stakeholder consultation or a qualitative research design, as appropriate locally, stakeholders in seven countries acted as 'advisors' to aid researchers' decision making. Thematic analysis was used to identify key issues across countries. Setting/participants: A total of 132 stakeholders (82 professionals and 50 'lay' people) aged ≥18 participated in individual face-to-face or telephone interviews, consultation meetings or focus groups. Results: Different stakeholder involvement methods were used successfully to identify key issues in palliative care. A total of 23 issues common to three or more countries informed decisions about the intervention and comparator of interest, sub questions and specific assessments within the health technology assessment. Conclusion: Stakeholders, including patients and families undergoing palliative care, can inform project decision making using various involvement methods according to the local context. Researchers should consider local understandings about stakeholder involvement as views of appropriate and feasible methods vary. Methods for stakeholder involvement, especially consultation, need further development. [ABSTRACT FROM AUTHOR]

Background: Research on the costs of healthcare provision has so far focused on insurer costs rather than out-of-pocket costs. Out-of-pocket costs may be important to patients making medical decisions. Aim: To investigate the self-reported out-of-pocket costs associated with healthcare in the last year of life of older adults in Europe. Design: A post-death survey, part of the Survey of Health, Ageing, and Retirement in Europe, completed by proxy respondents in four waves from 2005 to 2012. Setting/participants: Proxy respondents for 2501 deceased adults of 55 years or over. Data from 13 European countries and four waves from 2005 to 2012 were used. Results: The proportion of people with out-of-pocket costs ranged from 21% to 96% in different European Union countries. Out-of-pocket costs ranged from 2% to 25% of median household income. Secondary and institutional care was most often the largest contributor to out-of-pocket costs, with care received in a care home being the most expensive type of care in 11 of 13 countries. Multilevel analyses showed that limitations in more than two activities of daily living (coefficient = 6.47, 95% confidence interval = 1.81–11.14) and a total hospitalization time of 3–6 months (coefficient = 14.66; 95% confidence interval = 0.97–28.35) or more than 6 months (coefficient = 31.01; 95% confidence interval = 11.98–50.15) were associated with higher out-of-pocket costs. In total, 24% of the variance on a country level remained unexplained. Conclusion: Variation in out-of-pocket costs for healthcare in the last year of life between European countries indicates that countries face different challenges in making healthcare in the last year of life affordable for all. [ABSTRACT FROM AUTHOR]