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BACKGROUND: People with spinal cord injuries (SCI) are underrepresented in the labour force. OBJECTIVE: To examine the meaning of employment, as it is understood in the context of participation and integration in society, among persons with SCI in six European countries. We ask how SCI relates to employment, for the functions of employment, alternatives to employment, and its obstacles. METHOD: Semi-structured interviews were conducted with 74 persons and qualitatively analysed using a grounded theory approach. RESULTS: Employment was ranked as very important independent of the participants current employment status. We identified three main functions of employment: 1) employment contributes to the creation of personal and collective identity and social recognition; 2) employment enables structuring of time and distracts from impairment and pain; 3) employment is as an important social arena that facilitates interaction with other people. Voluntary work and domestic work did not fully replace the social functions of employment, nor correspond to the design of the disability compensation systems. CONCLUSION: This study illustrates the high value of employment and a need to pay more attention to a broader range of productive work. It also reveals the interdependencies between employment status and income mediated by the disability compensation schemes. [ABSTRACT FROM AUTHOR]

Aim: The overall goal of this study was to explore internationally educated nurses’ perceptions of the English language and nursing communication skill requirements in a Canadian bridging education program. Background: The increased global mobility of nurses creates a need to address the educational needs of migrating nurses. A large percentage of these nurses require additional language and professional education. New research is needed that would represent an in ‐ depth analysis of their educational experiences associated with learning academic English and Canadian nursing communication. Introduction: Developing proficiency with a new language has been documented as posing challenges for new immigrants. Since language proficiency is a key requirement of Canadian nursing regulatory bodies, previously unrecognized barriers such as attitudes and beliefs about required English language and nursing communication competency which may hinder their ability to meet local practice standards need to be explored. Method: Using a grounded theory study design, narratives from 22 participants from the Philippines, Nigeria and Europe enrolled in bridging education were collected and analysed. Results: The participants identified the incongruence in professional norms between Canada and their home country as a major challenge. The major themes identified included cultural dissonance, academic literacy challenges and skepticism regarding unexpected communication competency requirements. Discussion: The participants possessed varying degrees of comprehension and acceptance of new educational and professional regulatory requirements. A certain degree of culture shock, which may be associated with frustration and disillusionment, is a typical and anticipated aspect of the immigration process. Their perceptions need to be recognized and accommodated when assisting internationally educated nurses to integrate into the Canadian practice culture. Limitations of the study: Any generalizations to other host countries need to be made cautiously. Conclusion and implications for nursing policy: Clear communication from regulators about English language and nursing communication requirements during the pre ‐ arrival period is recommended. If bridging education is required, these programs need to be designed to address English language competency and nursing communication skills of non ‐ native English speakers. [ABSTRACT FROM AUTHOR]

Background: We know little about how procurement of a high-risk medical device (HRMD) affects clinical practice and outcomes. In health systems in high-income countries, and specifically those that maintain a national arthroplasty registry, procurement decisions are frequently guided by long-term clinical results, with the goal of ensuring at least standard quality of HRMDs. But in countries like Mexico, decision-making is often dominated by lowest acquisition price. We set out to study the impact of procurement for orthopaedic HRMDs on clinical procedures and outcomes.Methods: We based our qualitative study on 59 in-depth interviews with stakeholders from Mexico, Switzerland, Germany, and UK: orthopaedic specialists, government officials, other experts, and social security system managers or administrators. We took a healthcare delivery approach to capturing and comparing factors that affected the regulations of HRMDs and procurement processes, and to understanding connections between procurement and clinical practice.Results: Our findings demonstrate for procurement processes that the three European countries compared to Mexico don't have similar concerns with regards to their procurement processes. Deficiencies of procurement regulations and practices identified from representatives in Mexico were almost absent in European countries. We identified three areas of deficiency: 1) HRMD regulations based on insufficiently robust clinical evidence (mainly noted by European countries); 2) Follow-up on Health Technology Assessments is inadequate (noted by Mexico) and methodology not always good enough (noted by European countries); and, 3) Lowest-acquisition price often guides procurement decisions and thus may not align with needs of clinical procedures (noted by Mexico and some European countries).Conclusions: Procurement processes for orthopaedic HRMDs may have an impact on clinical procedures and outcomes. A favourable approach is one where orthopaedic specialists are parties to the procurement process, and post-market surveillance data informs decision-making. Actors in the procurement process can improve their impact on clinical procedures and outcomes by developing specific strategies that better align the needs of both, procurement and clinical procedures. [ABSTRACT FROM AUTHOR]

Background The current study sought to examine the diagnostic overlap in DSM- IV and DSM-5 alcohol use disorder ( AUD) and determine the clinical correlates of changing diagnostic status across the 2 classification systems. Methods DSM- IV and DSM-5 definitions of AUD were compared using cross-national community survey data in 9 low-, middle-, and high-income countries. Participants were 31,367 respondents to surveys in the World Health Organization's World Mental Health Survey Initiative. The Composite International Diagnostic Interview, version 3.0, was used to derive DSM- IV and DSM-5 lifetime diagnoses of AUD. Clinical characteristics, also assessed in the surveys, included lifetime DSM- IV anxiety; mood and drug use disorders; lifetime suicidal ideation, plan, and attempt; general functional impairment; and psychological distress. Results Compared with DSM- IV AUD (12.3%, SE = 0.3%), the DSM-5 definition yielded slightly lower prevalence estimates (10.8%, SE = 0.2%). Almost one-third ( n = 802) of all DSM- IV abuse cases switched to subthreshold according to DSM-5 and one-quarter ( n = 467) of all DSM- IV diagnostic orphans switched to mild AUD according to DSM-5. New cases of DSM-5 AUD were largely similar to those who maintained their AUD across both classifications. Similarly, new DSM-5 noncases were similar to those who were subthreshold across both classifications. The exception to this was with regard to the prevalence of any lifetime drug use disorder. Conclusions In this large cross-national community sample, the prevalence of DSM-5 lifetime AUD was only slightly lower than the prevalence of DSM- IV lifetime AUD. Nonetheless, there was considerable diagnostic switching, with a large number of people inconsistently identified across the 2 DSM classifications. [ABSTRACT FROM AUTHOR]

Background: Informal caregivers are essential figures for maintaining frail elderly at home. Providing informal care can affect the informal caregivers' physical and psychological health and labour market participation capabilities. They need support to prevent caregiver burden. A variety of existing support measures can help the caregiver care for the elderly at home, but with some limitations. The objective of this review was to explore the experiences of informal caregivers caring for elderly in the community with the use of supportive policy measures in Belgium and compare these to the experiences in other European countries.Methods: An empirical qualitative case study research was conducted in five European countries (Belgium, The Netherlands, Luxembourg, France and Germany). Semi-structured interviews were conducted with informal caregivers and their dependent elderly. Interview data from the different cases were analysed. In particular data from Belgium was compared to data from the cases abroad.Results: Formal services (e.g. home care) were reported to have the largest impact on allowing the caregiver to care for the dependent elderly at home. One of the key issues in Belgium is the lack of timely access to reliable information about formal and informal services in order to proactively support the informal caregiver. Compared to the other countries, informal caregivers in Belgium expressed more difficulties in accessing support measures and navigating through the health system. In the other countries information seemed to be given more timely when home care was provided via care packages.Conclusion: To support the informal caregiver, who is the key person to support the frail elderly, fragmentation of information regarding supportive policy measures is an important issue of concern. [ABSTRACT FROM AUTHOR]

Background: A high amount of sedentary time has been proposed as a risk factor for various health outcomes in adults. While the evidence is less clear in children and adolescents, monitoring sedentary time is important to understand the prevalence rates and how this behaviour varies over time and by place. This systematic literature review aims to provide an overview of existing cross-European studies on sedentary time in children (0-12y) and adolescents (13-18y), to describe the variation in population levels of sedentary time, and to discuss the impact of assessment methods. Methods: Six literature databases were searched (PubMed, EMBASE, CINAHL, PsycINFO, SportDiscus and OpenGrey), followed by backward- and forward tracking and searching authors' and experts' literature databases. Included articles were observational studies reporting on levels of sedentary time in the general population of children and/or adolescents in at least two European countries. Population levels were reported separately for children and adolescents. Data were reviewed, extracted and assessed by two researchers, with disagreements being resolved by a third researcher. The review protocol is published under registration number CRD42014013379 in the PROSPERO database. Results: Forty-two eligible articles were identified, most were cross-sectional (n = 38). The number of included European countries per article ranged from 2 to 36. Levels of sedentary time were observed to be higher in East-European countries compared to the rest of Europe. There was a large variation in assessment methods and reported outcome variables. The majority of articles used a child-specific questionnaire (60 %). Other methods included accelerometers, parental questionnaires or interviews and ecological momentary assessment tools. Television time was reported as outcome variable in 57 % of included articles (ranging from a mean value of 1 h to 2.7 h in children and 1.3 h to 4.4 h in adolescents), total sedentary time in 24 % (ranging from a mean value of 192 min to 552 min in children and from 268 min to 506 min in adolescents). Conclusion: A substantial number of published studies report on levels of sedentary time in children and adolescents across European countries, but there was a large variation in assessment methods. Questionnaires (child specific) were used most often, but they mostly measured specific screen-based activities and did not assess total sedentary time. There is a need for harmonisation and standardisation of objective and subjective methods to assess sedentary time in children and adolescents to enable comparison across countries. [ABSTRACT FROM AUTHOR]

Objective To examine (1) the impact of pictorial cigarette warning labels on changes in self-reported warning label responses: warning salience, cognitive responses, forgoing cigarettes and avoiding warnings, and (2) whether these changes differed by smokers' educational level. Methods Longitudinal data of smokers from two survey waves of the International Tobacco Control (ITC) Europe Surveys were used. In France and the UK, pictorial warning labels were implemented on the back of cigarette packages between the two survey waves. In Germany and the Netherlands, the text warning labels did not change. Findings Warning salience decreased between the surveys in France (OR=0.81, p=0.046) and showed a non-significant increase in the UK (OR=1.30, p=0.058), cognitive responses increased in the UK (OR=1.34, p<0.001) and decreased in France (OR=0.70, p=0.002), forgoing cigarettes increased in the UK (OR=1.65, p<0.001) and decreased in France (OR=0.83, p=0.047), and avoiding warnings increased in France (OR=2.93, p<0.001) and the UK (OR=2.19, p<0.001). Warning salience and cognitive responses decreased in Germany and the Netherlands, forgoing did not change in these countries and avoidance increased in Germany. In general, these changes in warning label responses did not differ by education. However, in the UK, avoidance increased especially among low (OR=2.25, p=0.001) and moderate educated smokers (OR=3.21, p<0.001). Conclusions The warning labels implemented in France in 2010 and in the UK in 2008 with pictures on one side of the cigarette package did not succeed in increasing warning salience, but did increase avoidance. The labels did not increase educational inequalities among continuing smokers. [ABSTRACT FROM AUTHOR]

This study examines the connection of love styles with relationship satisfaction on the basis of cross-cultural research, including Bosnia, Germany, Romania, Russia, and German immigrants from Russia and Turkey. Love styles include romantic love, friendship love, game-playing love, possessive love, altruistic love, and pragmatic love. The validation of the measurement model across cultural groups was successful because partial measurement invariance was secured, which allows for the application of correlation, regression, and path analysis. Results indicate that the effects of love styles on relationship satisfaction were consistent across cultures with the exception of game-playing love that negatively predicted relationship satisfaction for Germans, Romanians, and Turkish migrants but not for Bosnians, Russians, and Russian migrants. In addition, cultural variation occurred with respect to the strength of the associations. The implications of these findings are discussed in relation to universality and cultural relativity. In general, the effect of love styles on well-being turned out to be manifold. [ABSTRACT FROM AUTHOR]

People who have visual impairments exceed 250 million persons worldwide and represent an important cohort of museum visitors. However, they experience many constraints to participation in daily life. Few studies analyse the accessibility of museums to visitors with visual impairments, and many are confined to a single museum and to a small set of strategies for improving accessibility. This article aims to identify a broad set of strategies to increase the accessibility of museums to visitors with visual impairments and analyse the accessibility of museums in four European cities. Conclusions and implications for policy-makers and museum managers, designed to promote the creation of inclusive museums, are presented. [ABSTRACT FROM PUBLISHER]

Aims: Alcohol dependence is associated with high rates of co-occurring disorders which impact health-related quality of life (HRQoL) and add to the cost-of-illness. This study investigated the burden of alcohol dependence and associated co-occurring conditions on health and productivity. Methods: A cross-sectional surveywas conducted in eight European countries. Physicians (Psychiatrists and General Practitioners) completed patient record forms, which included assessment of cooccurring conditions, and patients completed matching self-completion forms. Drinking risk level (DRL) was calculated and the relationship between DRL, co-occurring conditions, work productivity, hospitalisations and rehabilitation stays was explored. Results: Data were collected for 2979 alcohol-dependent patients (mean age 48.8 ± 13.6 years; 70% male). In total, 77% of patients suffered from moderate-to-severe co-occurring psychiatric and/or somatic conditions. High DRL was significantly associated with depression, greater work productivity losses, increased hospitalisations and rehabilitation stays. Co-occurring conditions were significantly associated with poorer HRQoL and decreased work productivity, with a statistical trend towards an increased frequency of rehabilitation stays. Conclusions: Alcohol-dependent patients manifest high rates of co-occurring psychiatric and somatic conditions, which are associated with impaired work productivity and HRQoL. The continued burden of illness observed in these already-diagnosed patients suggests an unmet need in both primary and secondary care. [ABSTRACT FROM AUTHOR]

Background. Two separate multinational surveys of oncologists and patients with cancer were conducted to assess the awareness and use of biomarkers in clinical practice. These data explore the self-reported and physician-assessed levels of patient cancer literacy and factors affecting physicians' choice to use biomarkers in treatment decisions. Patients and Methods. Interviews were conducted via telephone with patientsand online with physicians. Physicians had 3-35 years of experience; were treating more than 15 patients/ month; and specialized in breast, lung, or colorectal cancer. Patients had received treatment for breast, lung, or colorectal cancer within the previous 5 years. Results. Interviews with 895 physicians and 811 patients were completed. Most patients and physicians reported that patients understood that a tumor could be tested to determine what treatment would be most effective (78% and 73%, respectively) and that patients would be willing to participate in a personalized treatment plan. Whereas 85% of patients felt that they understood their treatment when it was explained to them, only 23% of doctors felt that their patients were always fully informed. Most physicians (90%) reported using biomarkers; among the 10% not performing biomarker analysis, the most cited obstacles were local availability, speed of obtaining results, and cost. Conclusion. These data demonstrate wide global use of biomarker testing but with regional variations reflecting cultural and local practice. Self-reported and physician-assessed cancer literacy, although generally high, highlighted important regional variations and the need to provide patients with additional information. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this evaluation was to obtain views from general practitioners (GPs) who piloted the electronic risk assessment tools (eRATs) for suspected lung or colorectal cancer. We wanted to find out whether GPs were able to integrate these tools into their everyday practice. We were also keen to identify facilitators and barriers to their more widespread use. Background: Cancer remains one of UK's biggest health problems, in terms of morbidity and mortality. Comparative European data show that five-year survival figures for many cancers are lower in the United Kingdom than in comparable European countries. eRATs are intended to aid recognition of symptoms of lung and colorectal cancers in patients aged 40 years and over. Methods: This was a qualitative study; telephone interviews were conducted with 23 GPs who piloted the eRATs. A systematic qualitative analysis was applied to the data. The normalisation process model was used after data collection. This theory-driven conceptual framework was used to examine the operationalisation of this intervention in Primary Care. Findings: Electronic decision-support tools appear to be useful additions to the resources available to GPs in order to assist them with recognizing potential cancer symptoms. However, the tools need to be refined in order to integrate them into GP practice. The tools raised GPs' awareness about cancer because of the prompt facility of the software, although this also raised the potential of 'prompt fatigue'. GPs constantly receive alerts via their clinical system, particularly related to the Quality and Outcomes Framework. The integration of eRATs into routine practice could be engendered by improvement to the training packages that accompany them, and by its delivery via a platform compatible with all GP clinical systems. [ABSTRACT FROM AUTHOR]

How do national institutional contexts mediate the global? This article aims to answer this question by analyzing screen translation—the translation of audiovisual materials like movies and television programs—in four European countries: France, Italy, the Netherlands, and Poland. A cross-national, multi-method research project combining interviews, ethnography, and a small survey found considerable cross-national differences in translation norms and practices, sometimes leading to very different translated versions of the same product. The analysis shows how differences between national translation fields are produced and perpetuated by the interplay of institutional factors on four interdependent levels: technology, and the organizational, national, and transnational fields. On each level, various institutions are influential in shaping nationally specific translation norms and practices by producing institutional constraints or imposing specific meanings. I propose a model that explains the persistence of national translation systems—not only from the logics of specific institutions, fields, or levels—but by the feedback loops and interdependencies between institutions on various levels. This analysis has implications for the sociological understanding of globalization, the production of culture and media, cross-national comparative research, as well as institutional theory and the role of translation in sociological practice. [ABSTRACT FROM AUTHOR]

The role of union status, or whether people are married, cohabiting or single, is seldom considered in welfare state research. This perspective, however, is important, since many welfare state policies focus on marriage and do not apply to unmarried cohabitants. This lack of legal regulation may render cohabitants vulnerable in moments when state support is needed. Since cohabitation levels are increasing across Europe, understanding the role of union status in welfare state policies is increasingly important. By analysing data from the European Social Survey and a self-constructed policy database, we answer three questions: (1) How many couples live in cohabitation across 12 European countries today? (2) Which rights do they have in different policy areas? and (3) How many couples, therefore, are covered or fall outside the scope of policies in their country? We find that cohabitation is often, but not always, more strongly regulated in countries with high cohabitation levels, leaving more cohabitants legally unprotected in some countries than in others. [ABSTRACT FROM AUTHOR]

This article summarizes previous employment histories and studies associations between types of histories and quality of life in older ages. Retrospective information from the Survey of Health, Ageing and Retirement in Europe (SHARE) was used and the occupational situation for each age between 30 and 65 of 4,808 men and 4,907 women aged 65 or older in Europe was considered. Similar histories were regrouped using sequence analyses, and multi-level modelling was applied to study associations with quality of life. To avoid reverse causality, individuals with poor health prior to or during their working life were excluded. Men's employment histories were dominated by long periods of paid employment that ended in retirement (‘regular’ histories). Women's histories were more diverse and also involved domestic work, either preceding regular careers (‘mixed’ histories) or dominating working life (‘home-maker’ histories). The highest quality of life was found among women with mixed histories and among men with regular histories and late retirement. In contrast, retirement between 55 and 60 (but not earlier) and regular histories ending in unemployment or domestic work (for men only) were related to lower quality of life, as well as home-maker histories in the case of women. Findings remain significant after controlling for social position, partnership and parental history, as well as income in older ages. Results point to the importance of continuous employment for health and wellbeing, not only during the working life, but also after labour market exit. [ABSTRACT FROM PUBLISHER]

Purpose To describe available and utilized formal care and service at home for persons with dementia, from diagnosis to end-of-life stage, in eight European countries. Design A descriptive cross-country design concerning eight European countries as a part of the European research project RightTimePlaceCare. Methods The research team in each country used a mapping system to collect country-specific information concerning dementia care and service system. The mapping system consists of 50 types of care and service activities. Sixteen of the 50 predefined activities concerning care and service at home were selected for this study and subdivided into three categories, following the stages of dementia. Findings Availability was reported to be higher than utilization, and the findings indicated more similarities than differences among the eight countries involved. Even though there were several available activities of 'basic care and services' and 'healthcare interventions,' they were utilized by few in most countries. Furthermore, 'specialized dementia care and services' were sparsely available and even more sparsely utilized in the participating countries. Conclusions The findings indicated that persons with dementia in Europe received formal care and service on a general, basic level but seldom adjusted to their specific needs. Clinical Relevance This study describes the gap between service provision and utilization enabling nurses to develop individually adjusted care plans for persons with dementia during the progress of the disease. The findings do not include matters of quality of care or how to best organize effective care and services. However, the activities of care and services presented here should shed light on what room there is for improvement when it comes to enabling persons with dementia to go on living at home. [ABSTRACT FROM AUTHOR]

Purpose: To test the feasibility of tools and procedures for a pan-European food consumption survey among children 0-10 years and to recommend one of two tested dietary assessment methods. Methods: Two pilot studies including 378 children were conducted in Belgium and the Czech Republic in the Pilot studies for Assessment of Nutrient intake and food Consumption among Kids in Europe. One protocol included a 3-day food diary which was checked with a parent, and data were entered afterwards using EPIC-Soft. The alternative protocol consisted of two non-consecutive 1-day food diaries followed by EPIC-Soft completion interviews. Both protocols included general and food propensity questionnaires and anthropometric measurements. The protocols were compared using evaluation questionnaires among the participating parents and study personnel. Results: The parents found the questionnaires and instructions for filling in the food diaries understandable. Food description and food quantification was evaluated as problematic by 29 and 15 % of the participants for the 3-day diaries versus 15 and 12 % for the 1-day diaries. The protocol with 1-day food diaries was evaluated as less burdensome by the parents and logistically more challenging by the interviewers. Conclusions: Both dietary assessment methods with related tools and administration protocols were evaluated as feasible. The administration protocol with two 1-day food diaries with completion interviews offers more advantages for the future pan-European survey in children 0-10 years. The positive evaluation of feasibility of tools and materials is an important step towards harmonised food consumption data at European level among the younger age groups. [ABSTRACT FROM AUTHOR]

Objective In Europe, volunteers have an important role in the delivery of palliative care. As part of the EU co-funded Europall project, 4 aspects of volunteering in palliative care were studied for 7 European countries (Belgium, England, France, Germany, the Netherlands, Poland, and Spain). These included (1) involvement of volunteers in palliative care, (2) organization of palliative care volunteering, (3) legal regulations concerning volunteering, and (4) education and training of palliative care volunteering. Design/Setting/Methods A literature search combined with an interview study. Information from the scientific literature, and country-specific policy documents were obtained and completed, along with data of consecutive semi-structured interviews with experts in the field of palliative care in the participating countries. Results In all countries, volunteers appeared to be involved in palliative care, yet their involvement across health care settings differed per country. England, for example, has the highest number of volunteers whereas Spain has the lowest number. Volunteering is embedded in law and regulations in all participating countries except for England and the Netherlands. In all participating countries, training programs are available and volunteers are organized, both on a national and a regional level. Conclusion This study provides a descriptive overview of volunteer work in palliative care in 7 European countries, with a focus on the organizational aspects. Further research should concentrate on the roles and responsibilities of volunteers in the care for the terminally ill in different European health systems. [ABSTRACT FROM AUTHOR]

Background: Kosovo represents a unique hotspot of biological and cultural diversity in Europe, which allows for interesting cross-cultural ethnobotanical studies. The aims of this study were twofold: 1) to document the state of traditional knowledge related to local (esp. wild) plant uses for food, medicine, and handicrafts in south Kosovo; and 2) to examine how communities of different ethnic groups in the region (Albanians, Bosniaks/Gorani, and Turks) relate to and value wild botanical taxa in their ecosystem. Methods: Field research was conducted in 10 villages belonging to the Prizren municipality and 4 villages belonging to the Dragash municipality, located in the Sharr Mountains in the southern part of Kosovo. Snowball sampling techniques were used to recruit 139 elderly informants (61 Albanians, 32 Bosniaks/Gorani and 46 Turks), for participation in semi-structured interviews regarding the use of the local flora for medicinal, food, and handicraft purposes. Results: Overall, we recorded the local uses of 114 species were used for medicinal purposes, 29 for food (wild food plants), and 20 in handicraft activities. The most important species used for medicinal purposes were Achillea millefolium L., Sambucus nigra L., Urtica dioica L., Tilia platyphyllos Scop. Hypericum perforatum L., Chamomilla recutita (L.) Rauschert, Thymus serpyllum L. and Vaccinium myrtillus L. Chamomilla recutita was the most highly valued of these species across the populations surveyed. Out of 114 taxa used for medicinal purposes, only 44 species are also included in the European Pharmacopoeia. The predominantly quoted botanical families were Rosaceae, Asteraceae, and Lamiaceae. Comparison of the data recorded among the Albanian, Bosniak/Gorani, and Turkish communities indicated a less herbophilic attitude of the Albanian populations, while most quoted taxa were quoted by all three communities, thus suggesting a hybrid character of the Kosovar plant knowledge. Conclusion: Cross-cultural ethnobiological studies are crucial in the Balkans not only for proposing ways of using plant natural resources, which could be exploited in sustainable local development projects (e.g. focusing on eco-tourism and small-scale trade of medicinal herbs, food niche and handicrafts products), but also for fostering collaboration and reconciliation among diverse ethnic and religious communities. [ABSTRACT FROM AUTHOR]

Aims To describe differences in caregiver burden and health-related quality of life of informal caregivers of people with dementia in eight European countries and assess changes after transition from home to institutional long-term care. Background Country differences in the experience of burden and health-related quality of life are rarely described. Design Prospective cohort study. Methods Data on burden and health-related quality of life were collected at baseline (conducted between November 2010-April 2012) and follow-up (after 3 months) using face-to-face interviews. Two groups of informal caregivers included those: (1) of people with dementia recently admitted to institutional long-term care facilities; and those (2) of people with dementia receiving home care. Statistical analyses focused on descriptive comparisons between groups and countries. Results Informal caregivers of about 2014 were interviewed. Informal caregivers of people with dementia at home experienced more burden compared with informal caregivers of recently institutionalised people with dementia. Almost no differences in health-related quality of life were found between groups. Large differences between countries on outcomes were found. Informal caregivers of people with dementia who made the transition to an institutional long-term care facility experienced a statistically significant decrease in burden and psychological distress at follow-up. Conclusion Cross-country differences may be related to differences in health and social care systems. Taking this into account, informal caregiver interventions need to be tailored to (country specific) contexts and (individual) needs. Findings highlight the positive impact of admission to institutional long-term care on informal caregiver well-being. [ABSTRACT FROM AUTHOR]

Aim To investigate agreement between: (1) expected reasons and actual reasons for admission of people with dementia according to informal caregivers; (2) scores on measurement instruments prior to admission and the actual reasons for admission according to informal caregivers. Background Timely admission of people with dementia is a crucial issue. Information is highly warranted on whether informal caregivers are capable of prior identification of causes of admission and, can thus be considered a reliable prospective source on causes of admission. Design A cohort study among informal caregivers of people with dementia who made a transition to institutional long-term care. Methods Qualitative data on the expected and actual reasons for admission were collected via open-ended questions at baseline and follow-up. Furthermore, at baseline, data were collected using measurement instruments to measure pre-admission characteristics. Interviews took place between November 2010-April 2012. After categorizing the answers, the agreement between the expected and actual reasons was calculated. Furthermore, bivariate associations were calculated between the actual reasons for admission and scores on corresponding measurement instruments. Results/Findings For most informal caregivers, there was agreement between their statements on the expected reason and the actual reason for admission. A third of the caregivers showed no conformity. Bivariate associations showed that there is also agreement between the actual reasons for admission and scores on corresponding measurement instruments. Conclusion Informal caregivers can be considered reliable sources of information regarding what causes the admission of a person with dementia. Professional care should anticipate informal caregivers' statements and collaborate with them to strive for timely and appropriate admission. [ABSTRACT FROM AUTHOR]

Background: Lowering energy (calorie) intake is essential in managing a healthy weight. One method of doing this is substituting sugar with low/no-calorie sweeteners. The safety of sweeteners has been debated, but little is known about how they are perceived by professionals responsible for weight management advice. We sought to explore dietitian perceptions of sweeteners and to identify the practical advice they provide about them. Methods: We collected data in France, Germany, Hungary, Portugal and the United Kingdom. We used face-toface interviews and a novel online tool designed to engage people with online content in a way that approximates everyday processes of making sense of information. Results: We identified four approaches to sweeteners that dietitians took: (1) sweeteners should not be used, (2) they should be limited and used primarily as a transitional product, (3) sweetener use was decided by the client and (4) sweeteners should be recommended or at least allowed. Where dietitians are reticent to recommend sweeteners this is because they feel it is important for consumers to reduce their attachment to sweet tastes and of evidence linking the consumption of sweeteners to increased appetite. There is also uncertainty about the possible negative health effects of sweeteners. Conclusions: Dietitians' perceptions about sweeteners are uncertain, ambivalent and divergent, sometimes explicitly being linked to fears about adverse health effects. Clear and authoritative guidance is required on scientific evidence around sweeteners as well as the ways in which they can be used in dietetic practice. [ABSTRACT FROM AUTHOR]

The Developmental Coordination Disorder Questionnaire (DCDQ'07) is a Canadian-English instrument recommended for screening children aged 5 to 15 years who are at risk for developmental coordination disorder. While a Canadian-French version of the DCDQ'07 presently exists, a European-French version does not. Aims. To produce a cross-cultural adaptation of the DCDQ'07 for use in areas of Europe where French is spoken and to test its cultural relevance in French-speaking Switzerland. Methods. Cross-cultural adaptation was done using established guidelines. Cultural relevance was analyzed with cognitive interviews of thirteen parents of children aged 5.0 to 14.6 years (mean age: 8.5 years, SD = 3.4), using think-aloud and probing techniques. Results. Cultural and linguistic differences were noted between the European-French, the Canadian-French, and the original versions of the DCDQ'07. Despite correct translation and expert committee review, cognitive interviews revealed that certain items of the European-French version were unclear or misinterpreted and further modifications were needed. Conclusions. After rewording items as a result of the outcomes of the cognitive interview, the European-French version of the DCDQ'07 is culturally appropriate for use in French-speaking Switzerland. Further studies are necessary to determine its psychometric properties. [ABSTRACT FROM AUTHOR]

The article focuses on a study which presents an economic assessment of aseptic compounding rooms in hospital pharmacies in five European countries. Topics discussed include the topics covered by the survey form used in the study, which include infrastructure cost, equipment cost and staff cost, and the characteristics of hospitals and workstations. Also mentioned are the total costs of environmental microbiological and preparation microbiological controls.

Immigration as a solution to staff and skill shortages in the health system is increasingly on the agenda in the European Union. This article highlights the related social and policy dilemmas by comparing a new destination country with an old destination country: Spain and the United Kingdom. After describing the challenges met by the United Kingdom, we ask how well-prepared Spain is to face the same issues. In particular, attention is paid to the occupational mobility of health workers after entry and to how immigration as a staffing solution poses new political and social challenges. Through a review of background information regarding the immigration of health workers in the two countries and the preliminary analysis of 15 exploratory interviews, we aim to identify the primary trends and key concerns for future analysis. Although our interviews only allow us to draw tentative conclusions, they do highlight emerging issues to be explored in the near future. Our conclusions show that many of the problems traditionally encountered in the United Kingdom are now emerging in Spain, suggesting scope for further collaboration among government, employers, and other stakeholders across the European Union. [ABSTRACT FROM AUTHOR]

Introduction: Socio-economic inequalities in health are large in urban areas; however, local municipal governments may plan, manage and provide services and policies which can reduce these. The objective of this study was to describe the beliefs and perceptions of public policymakers in a European city, Barcelona. They are the key actors in designing and implementing urban public policies. Methods: A qualitative research study describing policymakers' beliefs on health inequalities. The study population were twelve policymakers. These were politicians or officers from the city council. Informant profiles were selected using a theoretical sample. Semi-structured individual interviews were performed to collect the data and a thematic content analysis was carried out. Results: Politicians were aware of health inequalities in their city and identified diverse social causes. They viewed reducing inequalities as a priority for the city's government. Officers were less knowledgeable and described less efforts in addressing health inequalities. It was stated by some that reducing inequalities in non-health sectors helped to reduce health inequalities indirectly and there was some collaboration between two sectors. The most frequent barriers encountered when implementing policies were funding and the cities' limited authority. Conclusions: Officers and policymakers had different levels of awareness and access to information on health and its socials determinants. Officers referred to specific causes of health inequalities and policies which related to their sectors and politicians were more familiar with upstream determinants and policies. Some participants explained that policies and programmes needed to be evaluated and very little intersectoral action was said to be carried out. More efforts should be made to provide all policymakers with information on the social determinants of health inequalities. Research on health inequalities and policy should engage with policymakers and promote health as a cross cutting issue in the city council in liaison with the third sector. [ABSTRACT FROM AUTHOR]

Although research has revealed a trend toward liberalization of attitudes toward homosexuality in Western countries, acceptance of homosexuality differs remarkably among individuals and across countries. We examine the roles of individual value priorities and of national laws regarding homosexuality and the interaction between them in explaining approval of homosexuality. Data are drawn from the European Social Survey and include representative national samples of 27 European countries in 2010. As hypothesized, individuals who prioritized openness to change and universalism values approved of homosexuality more, whereas those who prioritized conservation and power values exhibited more disapproval. Approval was greater in countries whose laws regarding homosexuality were more progressive. In addition, legal regulation of homosexuality moderated the associations of individual value priorities. In countries with more progressive laws, both the positive effect of openness to change values and the negative effect of conservation values on approval of homosexuality were weaker. However, the positive effect of universalism values and the negative effect of power values did not vary as a function of national laws regarding homosexuality. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Since 2004 the population of European migrant workers and their families living in the UK has increased. In 2012 a small qualitative pilot study was conducted involving interviews with eight health visiting professionals working in a Merseyside borough in the north west of England. Health visitors were asked about their perceptions of barriers to health and wellbeing faced by European migrant families and common challenges experienced in practice. Interviews were analysed thematically and interpreted using a constructivist approach. Multiple perceptions emerged regarding migrant families' barriers to health and wellbeing; housing; language; and health service access, knowledge and attitudes. Health visitors provided confirmation of their important role within the public health agenda, identifying vulnerability and challenging inequalities particularly among minority ethnic and lower socio-economic groups. This study highlights areas for future consideration by public health and other agencies, particularly wider determinants of health and barriers in accessing health, public and community services. However, further quantitative and qualitative research is needed to investigate the needs, inequalities, service use and barriers to health and wellbeing experienced by European migrants. [ABSTRACT FROM AUTHOR]

The number of people living with advanced cancer and chronic disease has increased worldwide. Many of these patients could benefit from palliative care, focusing on optimising the quality of life of patients and their families facing problems resulting from lifethreatening diseases. However, fragmentation and discontinuity of palliative care services often result in suboptimal palliative care. In order to overcome these problems, models using an integrated care approach are increasingly advocated in palliative care services. Although several models and definitions of Integrated Palliative Care (IPC) have been developed, the effects of integrated care are still under-investigated. Knowledge of the key components that constitute successful palliative care integration is still lacking. This mixed methods study will examine the experiences of patients, family caregivers and professional caregivers in order to provide insight into the mechanisms that constitute successful palliative care integration. Methods/Design Prospective multiple embedded case study. Three to five integrated palliative care initiatives will be selected in Belgium, Germany, Hungary, The Netherlands and the United Kingdom. Data collection will involve Social Network Analysis (SNA), a patient diary, semi-structured interviews, and questionnaires: Palliative care Outcome Scale (POS), Canhelp Lite, Caregiver Reaction Assessment (CRA). Patients and family caregivers will be followed in 4 consecutive contact moments over 3 months. The diary will be kept weekly by patients. One focus group per initiative will be conducted with professional caregivers. Interviews and focus groups will be tape recorded, transcribed and qualitatively analysed using NVivo 10. SPSS Statistics 20 will be used for statistical analysis. Discussion This study will provide valuable knowledge about barriers, opportunities and good practices in palliative care integration in the selected initiatives across countries. This knowledge can be used in the benchmark of integrated palliative care initiatives across Europe. It will add to the scientific evidence for IPC services internationally and will contribute to improvements in the quality of care and the quality of living and dying of severely ill patients and their relatives in Europe. [ABSTRACT FROM AUTHOR]

The article discusses research being done on the relation between long term exposure to air pollution and incidence of myocardial infarction and unstable angina. It references the study "Long Term Exposure to Ambient Air Pollution and Incidence of Acute Coronary Events: Prospective Cohort Study and Meta-Analysis in 11 European Cohorts From the ESCAPE Project," by Giulia Cesarone and colleagues published in a 2013 issue of "British Medical Journal."

A popular social discourse in the United States is that play is important for children's learning and that parental involvement maximizes play's learning potential. Past research has concluded that parents who hold this view of play are more likely to play with their children than those who do not. This study investigated the prevalence of this view among Euro-American and immigrant Latino parents of young children in order to illuminate the extent to which it uniquely and uniformly motivates parent-child play. Parents' models of play were assessed through interviews and naturalistic observations in a children's museum. Analysis revealed ethnic group differences in parent-child play that corresponded with parental beliefs about play. Within-group analysis, however, revealed diversity in the ways that these play behaviours and beliefs came together to comprise parents' models of play. Discussion focuses on the social nature of play, the dynamic nature of culture, and the issue of individual subject validity. Implications for the interpretation of parent-child play in early childhood settings are considered. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Beliefs related to illness constrain or facilitate health and wellbeing, and are of importance in how people understand and manage their illness. The aim of this study was to identify illness beliefs among individuals living with illness from a psychotic disorder. Data collected through two qualitative interview studies was secondary analysed by means of a method for directed content analysis. Beliefs of being different and odd, and of what constitutes 'normality', are prominent and constrain, in several respects, wellbeing among the individuals with psychotic illness. Beliefs about possible wellbeing are preferably related to existential, human desires of caretaking and responsibility for self and others. An awareness among mental healthcare staff that one does not hold the unequivocal truth about what is normal and healthy, is of importance. They need to ask questions about illness beliefs and not ignore or judge the answers received, but instead discuss them. Relationship-centred care, where a mutual dialogue occurs between the individual, the family and mental healthcare staff, is highlighted. [ABSTRACT FROM AUTHOR]

Background: poor physical performance (PP) is known to be associated with disability, lower quality of life and higher mortality rates. Knee and hip osteoarthritis (OA) might be expected to contribute to poor PP, through joint pain and restricted range of movement. Both clinical and self-reported OA are often used for large-scale community and epidemiological studies.Objective: to examine the relationships between hip and knee OA and PP in a large data set comprising cohorts from six European countries.Methods: a total of 2,942 men and women aged 65–85 years from the Germany, Italy, Netherlands, Spain, Sweden and the UK were recruited. Assessment included an interview and clinical assessment for OA. PP was determined from walking speed, chair rises and balance (range 0–12); low PP was defined as a score of ≤9.Results: the mean (SD) age was 74.2 (5.1) years. Rates of self-reported OA were much higher than clinical OA. Advanced age, female gender, lower educational attainment, abstinence from alcohol and higher body mass index were independently associated with low PP. Clinical knee OA, hip OA or both were associated with a higher risk of low PP; OR (95% CI) 2.93 (2.36, 3.64), 3.79 (2.49, 5.76) and 7.22 (3.63, 14.38), respectively, with relationships robust to adjustment for the confounders above as well as pain.Conclusion: lower limb OA at the hip and knee is associated with low PP, and for clinical diagnosis relationships are robust to adjustment for pain. Those at highest risk have clinical OA at both sites. [ABSTRACT FROM AUTHOR]

In recent years, beverage establishments have grown in popularity among millions of people seeking leisure activities, nightlife attractions, and entertainment venues. Despite the prevalence of this well-established industry, beverage establishments have received little academic attention. The present study was designed to compare basic revenue management principles and characteristics with existing beverage establishments and suggest adaptations of those principles in the context of those beverage operations to optimize prices of their food and beverage products and entrance fees. This study involves a qualitative approach based on the interviews with 20 beverage operations managers from the United States and Europe. [ABSTRACT FROM AUTHOR]

The alignment of information systems with the business goals of an organisation, although a topic of great importance, is not always properly valued or taken into consideration. In general, managers have different opinions to chief information officers (CIOs) in relation to IS, especially with regard to their importance and value to the business and also in terms of investment needs. Here, we discuss and study new approaches to methods and tools for assessing the relative importance of each information system to business, focusing on the financial sector including banks and insurance companies. We suggest the introduction of new key indicators for better decision support and to identify investment priorities, and present results regarding the relative importance of each process to support the business strategy. The primary goal for the inherent research project is to analyse the main problems and difficulties encountered by IS and IT managers, featuring different players and how they relate. The main contributions of this work are the CRUDi framework as a tool to improve alignment between business and IS strategies and the CRUDi survey and its results qualifying the financial sector's opinion regarding the relative importance of processes and investments. [ABSTRACT FROM AUTHOR]

An effective response to the rising burden of chronic disease requires a health system environment that is conducive to implementing structured, integrated approaches to chronic disease prevention and management. This study presents some of the reported factors hindering the successful implementation of chronic care approaches in six European healthcare systems and focuses on processes to address these. We conducted 42 semi-structured interviews with key informants in Austria, Denmark, France, Germany, The Netherlands and Spain, representing the decision-maker, payer, provider and/or patient perspective. Despite differences among the healthcare systems studied, a shared set of barriers emerged. These included: (i) a continued focus on complications management and a failure to integrate risk minimisation and disease prevention along the spectrum of care; (ii) care fragmentation acting as a barrier to better coordination; (iii) a mismatch between intent, at national level, to enhance coordination and integration, and ability at regional or local level to translate these ambitions into practice; and (iv) a lack of structures suitable to promote proactive engagement with patients in the management of their own condition. Findings suggest successful implementation of chronic care across Europe will require cross-disciplinary collaboration, raising the profile of general practitioners and nurses, designing care explicitly around the needs of the patient, and the political will to carry forward these chronic care measures. [ABSTRACT FROM AUTHOR]

Background: European city councils are increasingly developing interventions against health inequalities. There is little knowledge about how they are perceived. This study describes and analyses good practices and challenges for local interventions on inequalities in health through the narratives of European city managers. Methods: A qualitative study was conducted. Each participating city (Amsterdam, Barcelona, Cluj-Napoca, Helsinki, Lisbon, London, Madrid, Rotterdam) selected interventions following these criteria: at least 6 months of implementation; an evaluation performed or foreseen; the reduction of health inequalities among their objectives, and only one of the interventions selected could be based on health care. Managers of these local interventions were interviewed following an outline. Eleven individual in-depth interviews describing nine local interventions were obtained. A thematic content analysis was performed. Results: One or more local interventions against health inequalities were identified in each city. Most relied on quantitative data and were linked to national strategies. Few interventions addressed socio-economic determinants. Health care, employment and education were the main determinants addressed. With variable depth, evidence-base, participation and intersectorality were regular components of the interventions. Half of them targeted the city and half some deprived neighbourhoods. Few interventions had been evaluated. Scarcity of funding and sustainability of the projects were the main perceived barriers by the managers. Conclusions: City intervention managers were familiar with health inequalities and concepts as intersectorality, participation and evidence-based action, but others such as socioeconomic aims, gradient approach, evaluation and sustainability were not so widely applied. Managers’ capacities and political leadership in governance for health should be reinforced. [ABSTRACT FROM PUBLISHER]

Background High-risk surgery patients may lose decision-making capacity as a result of surgical complications. Advance care planning prior to surgery may be beneficial, but remains controversial and is hindered by a lack of appropriate decision aids. This study sought to examine stakeholders' views on the appropriateness of using decision aids, in general, to support advance care planning among high-risk surgery populations and the design of such a decision aid. Methods Key informants were recruited through purposive and snowball sampling. Semi-structured interviews were conducted by phone until data collected reached theoretical saturation. Key informants were asked to discuss their thoughts about advance care planning and interventions to support advance care planning, particularly for this population. Researchers took de-identified notes that were analyzed for emerging concordant, discordant, and recurrent themes using interpretative phenomenological analysis. Results Key informants described the importance of initiating advance care planning preoperatively, despite potential challenges present in surgical settings. In general, decision aids were viewed as an appropriate approach to support advance care planning for this population. A recipe emerged from the data that outlines tools, ingredients, and tips for success that are needed to design an advance care planning decision aid for high-risk surgical settings. Conclusions Stakeholders supported incorporating advance care planning in high-risk surgical settings and endorsed the appropriateness of using decision aids to do so. Findings will inform the next stages of developing the first advance care planning decision aid for high-risk surgery patients. [ABSTRACT FROM AUTHOR]

The retrospectively recalled calendar of activities in the European Community Household Panel is a prime resource for cross-country analysis of unemployment experience. We investigate the reliability of these data and find that 26 % of unemployed respondents misreported retrospectively their unemployment status in the subsequent interview. We observe large differences across countries: While the conditional probability of consistent information is 96 % in the UK, it is just 51 % in Greece for a comparable individual. By analyzing long-term unemployment and unemployment persistence, we show that the results of cross-country comparisons are strongly affected by these data problems. [ABSTRACT FROM AUTHOR]

In Europe there is no common quality assurance framework for the delivery of guidance in higher education. Using a case study approach in four university career guidance services in England, France and Spain, this article aims to study how quality is implemented in university career guidance services in terms of strategy, standards and models, relationship with main stakeholders and quality assessment. The case study findings reveal that the services articulate their strategy and mission as dedication to providing a quality service. However, little objective assessment of programmes and procedures is actually being conducted. [ABSTRACT FROM PUBLISHER]

Aims: The IATPAD (Improvement in Access to Treatment for People with Alcohol and Drug Related Problems) study explored barriers and facilitators to accessing alcohol and drug treatment services in eight European countries. Methods: Results from individual interviews and focus group discussions with 246 service users who had experienced alcohol and drug treatment in Bulgaria, Greece, Italy, Poland, Slovakia, Slovenia, Spain and Scotland are described. Thematic analysis was used to interpret the data. Results: The study identified a number of consistent facilitating factors and barriers across all eight European countries, despite different health care systems. The results suggest that five main factors were implicated in the help-seeking behaviour of the service users interviewed. These were: information, service organisation, staff attitudes, significant others and personal disposition. All these factors could be viewed as both facilitators and barriers. Conclusions: To enhance access to alcohol and drug treatment, local, non-stigmatising and available services are required alongside support from significant others which should increase motivation and skills of potential service users. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to estimate the differences in prevalence of multiple behavioral risk factors (MBRFs) for chronic diseases in European adults, from eleven North, Central and South European countries. Subjects and methods : We used data from 26,656 adults, aged 50+ years, participating in the Survey of Health, Ageing and Retirement in Europe (2004/05). Physical inactivity, high body weight, smoking and risky alcohol consumption were assessed and estimated based on sampling weights, controlling for socioeconomic characteristics. Results: 53.4 % of adults had 2+ MBRFs. Prevalence in the total sample was highest for physical inactivity (71.2 %) and lowest for smoking (18.1 %). The cluster of high body weight and physical inactivity had the highest prevalence of MBRFs (35.4 %), with higher prevalence in Southern Europe ( p < 0.05). Smoking and alcohol consumption presented the greatest degree of clustering (observed to expected ratio = 2.44). Spain and Greece had the highest prevalence of clustering 2+ MBRFs, whereas Southern European countries had a higher mean number of MBRFs, compared to North and Central European regions ( p < 0.05). Conclusion: Prevalence of MBRFs varied between countries, with Southern European countries engaging in more risky behaviors. Primary prevention programmes should be developed to reduce MBRFs in this population. [ABSTRACT FROM AUTHOR]

Background Child poverty rates are compared throughout Europe to monitor how countries are caring for their children. Child poverty reduction measures need to consider the importance of safe living environments for all children. In this study we investigate how European country-level economic disparity and housing conditions relate to one another, and whether they differentially correlate with child injury mortality. Methods We used an ecological, cross-sectional study design of 26 European countries of which 20 high-income and 6 upper-middle-income. Compositional characteristics of the home and its surroundings were extracted from the 2006 European Union Income Social Inclusion and Living Conditions Database ( n = 203 000). Mortality data of children aged 1-14 years were derived from the World Health Organization Mortality Database. The main outcome measure was age standardized cause-specific injury mortality rates analysed by income inequality and housing and neighbourhood conditions. Results Nine measures of housing and neighbourhood conditions highly differentiating European households at country level were clustered into three dimensions, labelled respectively housing, neighbourhood and economic household strain. Income inequality significantly and positively correlated with housing strain ( r = 0.62, P = 0.001) and household economic strain ( r = 0.42, P = 0.009) but not significantly with neighbourhood strain ( r = 0.34, P = 0.087). Child injury mortality rates correlated strongly with both country-level income inequality and housing strain, with very small age-specific differences. Conclusions In the European context housing, neighbourhood and household economic strains worsened with increasing levels of income inequality. Child injury mortality rates are strongly and positively associated with both income inequality and housing strain, suggesting that housing material conditions could play a role in the association between income inequality and child health. [ABSTRACT FROM AUTHOR]

Background Many individuals are subject to the physically and mentally detrimental effects of living in substandard housing and inadequate neighbourhoods. We propose that better physical neighbourhood quality can partially offset some of the negative effects of poor housing quality on psychological well-being. Methods Interviews and questionnaires were used to collect data in a cross-sectional study of housing quality, the state of the surrounding environment, and individual health and well-being for 5605 European adults from the Large Analysis and Review of European housing and health Status conducted by WHO in eight European cities. Multilevel random coefficient modelling was used to statistically analyse the main and interactive effects of housing quality and neighbourhood quality on psychological well-being. Socioeconomic status, employment status, gender and marital status were included as statistical controls. Results and conclusions Substandard housing quality and poor neighbourhood quality each contribute to lower psychological well-being. Furthermore better neighbourhood quality buffers against the negative effects of poor housing quality on psychological wellbeing. These results fill a gap in research concerning the ability of neighbourhood quality to amplify or attenuate housing quality impacts on well-being. [ABSTRACT FROM AUTHOR]

Background. Building on an earlier quantitative study which found that gay/ bisexual men from Central and Eastern Europe were at greater risk of sexual ill health following migration to the UK, the aim of this qualitative study is to explore how the process of migration itself may have influenced the migrants' sexual behaviour and attitudes. Methods. To address these questions, we conducted 17 in-depth interviews in London with gay/bisexual male migrants from Central and Eastern Europe, drawing on Fisher and Fisher's Information-Motivation-Behavioral Skills model as an interpretive framework. Results. We find that the sexual behaviours of our respondents have been significantly influenced by the process of migration itself. In particular, extricating themselves from the traditional systems of social control in their home societies and having greater access to gay venues in London resulted in their increased sexual activity, particularly in the first phase of migration. High-risk sexual behaviour was found to be a factor of sexual mixing, the use of commercial sex and perceptions of risk in the UK vis-á-vis Central and Eastern Europe, with each of these factors also influenced by the process of migration. Risk-prevention behaviour depended upon the possession of appropriate risk-prevention informa-tion, motivation to use condoms and appropriate behavioural skills, with the latter two factors in particular influenced by social mores in the home country and the UK. Conclusions. The interviews suggested a number of migration-related factors that increased the STI and HIV risk for these migrants. A number of potentially important policy recommendations stem from our analysis. [ABSTRACT FROM AUTHOR]

The aim of this article is to present the results of an international study on outreach approaches in the private domain in social work with a focus on moral dilemmas. The reason to start the study was to investigate if a trend in Dutch social work toward outreach approaches can be recognized in other European countries and what can be learned from other outreach practices. First, a definition of outreach approaches in the private domain was discussed. Next, data were collected by interviews with social workers in four different countries, executed by social work students and researchers. Although no evidence was found that outreach approaches in other countries than the Netherlands are increasing, many similarities were found in social workers' interpretation of their outreach work. All the interviewees emphasized that outreach approaches are intended for excluded people who are at risk or a risk and who are not in contact with social services. All workers stress the importance of gaining trust and staying in touch. A dilemma is that workers often find themselves between two fires. They tend to give priority to the relation with the client and accept that this can contradict rules of organizations or society. [ABSTRACT FROM AUTHOR]