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Background: International and migrant students face specific challenges which may impact their mental health, well-being and academic outcomes, and these may be gendered experiences. The purpose of this scoping review was to map the literature on the challenges, coping responses and supportive interventions for international and migrant students in academic nursing programs in major host countries, with a gender lens. Methods: We searched 10 databases to identify literature reporting on the challenges, coping responses and/or supportive interventions for international and migrant nursing students in college or university programs in Canada, the United-States, Australia, New Zealand or a European country. We included peer-reviewed research (any design), discussion papers and literature reviews. English, French and Spanish publications were considered and no time restrictions were applied. Drawing from existing frameworks, we critically assessed each paper and extracted information with a gender lens. Results: One hundred fourteen publications were included. Overall the literature mostly focused on international students, and among migrants, migration history/status and length of time in country were not considered with regards to challenges, coping or interventions. Females and males, respectively, were included in 69 and 59% of studies with student participants, while those students who identify as other genders/sexual orientations were not named or identified in any of the research. Several papers suggest that foreign-born nursing students face challenges associated with different cultural roles, norms and expectations for men and women. Other challenges included perceived discrimination due to wearing a hijab and being a 'foreign-born male nurse', and in general nursing being viewed as a feminine, low-status profession. Only two strategies, accessing support from family and other student mothers, used by women to cope with challenges, were identified. Supportive interventions considering gender were limited; these included matching students with support services' personnel by sex, involving male family members in admission and orientation processes, and using patient simulation as a method to prepare students for care-provision of patients of the opposite-sex. Conclusion: Future work in nursing higher education, especially regarding supportive interventions, needs to address the intersections of gender, gender identity/sexual orientation and foreign-born status, and also consider the complexity of migrant students' contexts. [ABSTRACT FROM AUTHOR]

The EU COST Action 15111 collaboration on myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) aims to assess current research and identify knowledge gaps in Europe. Presently, our purpose is to map the effects of non-pharmacological therapies (NPTs) for ME/CFS, and what patients find important in the treatment process. A scoping mixed methods literature review of European studies identified 16 papers fulfiling our inclusion criteria. The quantitative and qualitative studies were synthesized separately in tables. Additionally, extracts from the qualitative studies were subjected to translational analysis. Effect studies addressed cognitive behavioural therapy (CBT, n = 4), multimodal rehabilitation (n = 2) and activity-pacing (n = 2). CBT reduced fatigue scores more than usual care or waiting list controls. The effects of rehabilitation and activity-pacing were inconsistent. The contents, assessment methods and effects of rehabilitation and activity pacing studies varied. For patients, health professionals' recognition of ME/CFS and support were crucial, but they expressed ambiguous experiences of what the NPTs entail. Methodological differences make comparisons across NPTs impossible, and from a patient perspective the relevance of the specific contents of NPTs are unclear. Future well-designed studies should focus on developing NPTs tailored to patients' concerns and evaluation tools reflecting what is essential for patients. [ABSTRACT FROM AUTHOR]

Aims and objectives: To examine the effectiveness of cognitive interventions after general anaesthesia to improve cognitive functioning. Background: The number of surgical procedures performed worldwide is large and growing. Postoperative cognitive dysfunction is a common complication associated with poor postoperative outcomes. A variety of cognitive interventions have been developed to maintain or improve cognitive function in one or more cognitive domains. Cognitive interventions have shown to be effective in healthy older populations, those with mild cognitive impairment, and those with heart failure. The impact of cognitive interventions in surgical patients after general anaesthesia is a relatively new focus of research and is therefore less well established. Methods: Seven bibliographic databases were searched in relation to 'surgery' and 'cognitive interventions'; no date or language limits were imposed. Studies including adult patients who were scheduled for, or who had undergone surgery under general anaesthesia, had a baseline cognitive assessment using a validated measurement, and had engaged with any cognition‐based intervention were included. Full‐text review for inclusion, quality assessment and data extraction were undertaken independently by two authors. This study is reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta‐Analyses guidelines. Results: A total of 550 papers were identified for possible inclusion, of which nine met the inclusion criteria and were included in the review. The majority were randomised controlled trials (RCTs) (n = 6 [66.7%]). Four studies used computerised cognitive interventions, while five used traditional cognitive interventions. Most of the studies used multi‐domain cognitive training focusing on two or more domains (n = 7 [77.8%]) while two studies used single‐domain cognitive training. Memory (n = 7 [77.8%]) and attention (n = 5 [55.6%]) were the cognitive domains most often targeted during the intervention. Conclusions: The use of cognitive interventions demonstrated some efficacy in improving cognitive function after general anaesthesia, particularly those targeting memory. Relevance for clinical practice The findings of this review suggest that cognitive interventions show promise at improving cognitive performance in patients with POCD and could be usefully implemented in clinical practice to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Background Schizophrenia is a chronic disease associated with significant and long-lasting effects on health, and it is also a social and financial burden, not only for patients but also for families, other caregivers, and the wider society. It is essential to conduct the assessment of indirect costs, to understand all the effects of the disease on society. Our aim is to gain a better understanding of the indirect costs of schizophrenia in Europe. Methods We conducted a comprehensive systematic literature review covering EMBASE, Medline, and PsycINFO as well as reviewing Health Technology Assessment databases from different countries. We used a qualitative research synthesis for presenting information, as most of the studies were methodologically diverse, a quantitative analysis would have been impractical. Results Indirect cost adjusted to inflation ranged vastly between studies included in the review from 119 Euros to 62, 034 Euros annually. The average proportion of indirect costs of total costs was 44%. Studies highlighted important cost drivers as age, gender, and disease severity, explaining the variation in costs between treatment and patient groups. Conclusions Regardless of the methodological heterogeneity of the reviewed studies, there was an agreement about the significance of indirect costs of schizophrenia on the society. Considering the relatively high prevalence of schizophrenia in Europe, a need for more cost of illness studies especially from Central Eastern and Southern Europe is suggested. [ABSTRACT FROM AUTHOR]

This paper presents a meta-synthesis of the literature on community-based self-management to support experiences of people diagnosed with type 2 diabetes. The aim was to synthesise findings on both formal and informal self-management support with particular reference to the relevance and influence of the social context operating at different levels. The review forms part of EU- WISE, a project financed through EU's 7th Framework Programme. The review was performed by systematically searching MEDLINE, PubMed, EMBASE, CINAHL, Psyc INFO and Web of Science for English language publications between 2005 and 2014 presenting research conducted in Europe on the experiences and perspectives of self-management concerns of patients diagnosed with type 2 diabetes. The search yielded 587 abstracts, which were reduced through search strategy refinement and eligibility and quality criteria to 29 papers that were included in the review. This review highlights the relevance of contextual factors operating at micro- and macro-levels. The synthesis yielded six second-order thematic constructs relating to self-management: sense of agency and identity, the significance and meaning of social networks, minimal disruption of everyday life, economic hardship, the problem of assigning patients' responsibility and structural influences of primary care. Using a line of argument synthesis, these themes were revisited, and a third-order construct, connectivity emerged which refers to how links in daily life are interwoven with peoples' social networks, local communities, economic and ideological conditions in society in a way which support self-management activities. This meta-synthesis indicates a need to heed the notion of connectivity as a means of mobilising and supporting the self-management strategies of people with type 2 diabetes in everyday life. [ABSTRACT FROM AUTHOR]

The paper aims to identify and describe the European evidence on opportunities and barriers to access and utilization of palliative care among non- western migrants. A systematic review in accordance with PRISMA guidelines was conducted in June 2020, searching Medline, CINAHL, PsychINFO and EMBASE databases. PROSPERO# CRD42020193651. Studies included empirical research published between 2011 and 2020. Search words were, for example, ethnic groups and palliative care. Thematic analysis was used to analyze data. Twenty nine qualitative and six quantitative studies were included. Four main themes were identified: communication and language; knowledge and awareness; patient preferences, cultural and religious issues; and lack of resources at different levels of palliative care service provision. Migrants' access to palliative care is impeded at system, community and individual levels, yet, recommendations are mostly at the individual level. Closer attention is required to these different levels when designing future palliative interventions for migrants. [ABSTRACT FROM AUTHOR]

mcinnes e., seers k. & tutton l. (2011) Older people's views in relation to risk of falling and need for intervention: a meta-ethnography. Journal of Advanced Nursing 67(12), 2525-2536. Abstract Aim. This paper is a report of a meta-ethnography of qualitative studies of older peoples' views on risk of falling and need for intervention. Background. Falls and falls-related injuries in older people are worldwide problems. A conceptual understanding of older people's views about falls risk and need for intervention is useful for understanding factors likely to impact on acceptance of risk and recommended interventions. Data Sources. Seven electronic databases were searched 1999-2009. Reference lists of included articles were screened for eligible papers. Review Methods. Assessment of quality was carried out. Themes and concepts were extracted using a meta-ethnographic approach to compare similarities and differences across the retrieved studies. A line of argument was developed to produce an explanatory framework of the extracted themes and concepts. Results. Eleven relevant qualitative research articles of reasonable quality were identified. Six key concepts were identified: beyond personal control; rationalizing; salience; life-change and identity; taking control and self-management. A line of argument synthesis describes how older people approach self-appraisal of falls risk and intervention need, and how they cope and adapt to falls risk and intervention need. Conclusion. In response to having an elevated risk status and perceived associations with frailty and impact on an independent life-style, some prefer to adapt to this reality by taking control and implementing self-management strategies. Healthcare professionals should take into account beliefs about risk and negotiate choices for intervention, recognizing that some individuals prefer to drive the decision-making process to preserve identity as a competent and independent person. [ABSTRACT FROM AUTHOR]

Little is known about the use of Complementary and Alternative Medicine (CAM) among refugees, despite the common practice of CAM in many non-Western countries. We performed a systematic review of peer-reviewed literature using nine electronic databases. We included articles pertaining to refugees and CAM (whole medical systems, mind body medicine, herbal remedies, manipulative therapies, energy medicine). Qualitative and quantitative data were compiled and analyzed through descriptive statistics and chi square distribution tables. We reviewed 237 abstracts, and 47 publications met our inclusion criteria. Twenty-six papers documented whole medical systems; 11 mind-body medicine; 5 biologically based practices; 4 manipulative and body-based therapies; and 1 study documented the use of energy medicine. There were 3 clinical trials, 20 surveys, 12 case reports, 2 participant-observer qualitative papers, and 10 review papers. Most studies focused on Asian refugee populations (66%; n = 31). Mental problems related to trauma accounted for 36% of CAM use (17). Among included articles, methodological quality was extremely low. Our results show evidence that type of CAM used by refugees may vary based on ethnicity, yet this is most likely due to a bias in the medical literature. Efforts are needed to further explore these results and expand research within this field. [ABSTRACT FROM AUTHOR]

Objectives: In recent years, new technologies and new approaches to scale up HIV testing have emerged. The objective of this paper was to synthesize the body of recent evidence on strategies aimed at increasing the uptake and coverage of HIV testing outside of health care settings in the European Union (EU)/European Economic Area (EEA). Methods: Systematic searches to identify studies describing effective HIV testing interventions and barriers to testing were run in five databases (2010–2017) with no language restrictions; the grey literature was searched for similar unpublished studies (2014–2017). Study selection, data extraction and critical appraisal were performed by two independent reviewers following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Results: Eighty studies on HIV testing in non‐health care settings were identified, the majority set in Northern Europe. Testing was implemented in 65 studies, with men who have sex with men the risk group most often targeted. Testing coverage and positivity/reactivity rates varied widely by setting and population group. However, testing in community and outreach settings was effective at reaching people who had never previously been tested and acceptability of HIV testing, particularly rapid testing, outside of health care settings was found to be high. Other interventions aimed to increase HIV testing identified were: campaigns (n = 8), communication technologies (n = 2), education (n = 3) and community networking (n = 1). Conclusions: This review has identified several strategies with potential to achieve high HIV testing coverage outside of health care settings. However, the geographical spread of studies was limited, and few intervention studies reported before and after data, making it difficult to evaluate the impact of interventions on test coverage. [ABSTRACT FROM AUTHOR]

Perinatal mental health is a growing public health concern. Refugee and asylum-seeking women are particularly susceptible to experiencing perinatal mental illness and may encounter a range of challenges in accessing healthcare. This scoping review sought to identify the enablers of and barriers to healthcare access and healthcare provision for refugee and asylum-seeking women experiencing perinatal mental illness in the WHO European Region. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews was applied. Nine databases and six grey literature sources were initially searched in April 2022, and an updated search was completed in July 2023. The search identified 16,130 records, and after the removal of duplicates and the screening process, 18 sources of evidence were included in this review. A data extraction table was used to extract significant information from each individual source of evidence, which was then mapped to the seven dimensions of the candidacy framework. Empirical (n = 14; 77.8%) and non-empirical (n = 4; 22.2%) sources of evidence were included. The literature originated from seven countries within the WHO European Region, including the United Kingdom (n = 9; 50%), Germany (n = 3; 16.7%), Denmark (n = 2; 11.2%), Norway (n = 1; 5.6%), Greece (n = 1; 5.6%), Sweden (n = 1; 5.6%), and Switzerland (n = 1; 5.6%). The results indicate that, although enablers and barriers were apparent throughout the seven dimensions of candidacy, barriers and impeding factors were more frequently reported. There was also a notable overall lack of reported enablers at the system level. Unaddressed language barriers and lack of attention to the diversity in culturally informed perceptions of perinatal mental illness were the main barriers at the individual level (micro-level) to identifying candidacy, navigating healthcare systems, and asserting the need for care. The lack of culturally appropriate alignment of healthcare services was the key organizational (meso-level) barrier identified. The wider structural and political contexts (macro-level factors), such as lack of funding for consultation time, focus on Western diagnostic and management criteria, and lack of services that adequately respond to the needs of refugee and asylum-seeking women, negatively influenced the operating conditions and wider production of candidacy. It can be concluded that there are multilevel and interconnected complexities influencing access to and provision of perinatal mental healthcare for refugee and asylum-seeking women. [ABSTRACT FROM AUTHOR]

Background: In Europe, physical activity levels tend to be lower in ethnic minority groups than the general population. Interventions and policies based on research examining isolated determinants of physical activity have had limited success in increasing physical activity levels. This study used systems dynamics theory and the capability approach theoretical framework to develop a conceptual model of how individual characteristics, institutional and physical environments and the migration context may interact to promote or hinder physical activity in ethnic minority groups living in Europe. Methods: A systematic update of Langøien et al.'s 2017 review of the determinants of physical activity in ethnic minority groups living in Europe was conducted. Our target population included individuals of all ages who reported a familial migration background from any low- and middle-income countries or belonging to minority indigenous population in Europe. Outcomes pertaining to non-work related physical activity of light, moderate or vigorous intensity performed in any setting were included. Included studies provided an evidence base from which to derive the causal loop diagrams comprising our conceptual model. Sub-system causal loop diagrams were interpreted in co-author review sessions to explicate non-linear system mechanisms, such as reinforcing and balancing feedback loops. Results: Forty-one studies were identified, of which the majority was qualitative. The conceptual model consisted of 4 causal loop diagrams relating to psychosocial constructs; sociocultural constructs; health and health communication and social and material resources, in interaction with environmental/migration context. Four hypothetical mechanisms were identified, e.g. hypothesizing that participation in organised activities leads to increased self-efficacy, thereby enabling further participation. Conclusions: This study contributes an evidence-based conceptual systems model which elucidates how low levels of physical activity in ethnic minority groups in Europe could be supported by reinforcing and balancing mechanisms involving factors relating to physical and institutional environments, migration context and individuals. A pluralistic approach to literature review, integrating complexity methods such as CLDs into more conventional systematic literature review, supports novel insights into how factors could interact to support persistently low levels of activity, moving beyond the identification of potential relationships between isolated factors to indicating the ways in which these relationships are sustained and could be modified by intervention or policy. [ABSTRACT FROM AUTHOR]

Background: Freedom from discrimination is one of the key principles in a human rights-based approach to maternal and newborn health. Objective: To review the published evidence on discrimination against Romani women in maternity care in Europe, and on interventions to address this. Search strategy: A systematic search of eight electronic databases was undertaken in 2015 using the terms "Roma" and "maternity care". A broad search for grey literature included the websites of relevant agencies. Data extraction and synthesis: Standardised data extraction tables were utilised, quality was formally assessed and a line of argument synthesis was developed and tested against the data from the grey literature. Results: Nine hundred papers were identified; three qualitative studies and seven sources of grey literature met the review criteria. These revealed that many Romani women encounter barriers to accessing maternity care. Even when they are able to access care, they can experience discriminatory mistreatment on the basis of their ethnicity, economic status, place of residence or language. The grey literature revealed some health professionals held underlying negative beliefs about Romani women. There were no published research studies examining the effectiveness of interventions to address discrimination against Romani women and their infants in Europe. The Roma Health Mediation Programme is a promising intervention identified in the grey literature. Conclusions: There is evidence of discrimination against Romani women in maternity care in Europe. Interventions to address discrimination against childbearing Romani women and underlying health provider prejudice are urgently needed, alongside analysis of factors predicting the success or failure of such initiatives. [ABSTRACT FROM AUTHOR]

Background: This Scoping review (ScR) builds upon the 2017 review conducted by Hansen et al which contributed to evidence base shinrin-yoku (SY), also known as forest bathing (FB), has many positive health effects and is becoming a prescribed dose (specific time spent in nature) by health care providers. Practice and research regarding SY, has been historically based in Asian countries with a recent increase in Europe. The need and call for more research worldwide continues to further the evidence of SY as a health promotion modality. Through this ScR the authors identified programmatic components, health information monitored and screened, time spent in nature, geographical regions, trends, and themes in SY research worldwide. Methods: Following PRISMA-ScR guidelines we searched across 7 electronic databases for SY or FB research articles from 2017 through 2022. PubMed, CINAHL, PsycInfo, ScienceDirect, SCOPUS, Embase, JSTOR were included due to the interdisciplinary nature of SY or FB research. Each database provided unique strengths ensuring a capture of a wide range of articles. The resulting articles were screened and extracted through Covidence. Results: Database searches returned 241 results, with 110 references removed during the deduplication process, 131 were initially screened in the title and abstract review stage. Resulting in 82 unique results deemed relevant and screened in full text. During the final stage of the review, 63 articles met all inclusion criteria and were extracted for data. Conclusions: The practice of SY has physiological (PHYS) and psychological (PSYCH) benefits across age groups. Research findings indicate either the natural or the virtual environment (VW) has significant health benefits. Continued research is encouraged globally for short- and long-term health outcomes for all individuals. The connection with nature benefits the mind, body and soul and is supported by Henry David Thoreau's philosophy: "Our livesneed the relief of where the pine flourishes and the jay still scream." [ABSTRACT FROM AUTHOR]

The Innovative Medicines Initiative (IMI) is making great strides in promoting patient and public involvement (PPI) in health research across Europe, supporting patient organisations to be involved in the projects that it funds. Despite this, the literature around PPI in health services and research originating from European countries appears less than from the United Kingdom (UK), where PPI is well established. Therefore, we conducted a systematic review to explore the attitudes and approaches to PPI across Europe. Eight scientific databases were systematically searched and data extracted. Data quality was assessed using a checklist based on the Guidance for Reporting Involvement of Patients and the Public (GRIPP2) (Staniszewska et al., Research, Involvement and Engagement, 3, 13, 2017) and the critical appraisal guidelines developed by Wright et al. (Health Expectations, 13, 359, 2010). We included all studies reporting PPI activity in both public and private health services and research institutions in the World Health Organization European region, excluding the UK, published in the English language from 1996 to 2018. Forty studies in total were included in the analysis. The studies imply a growing interest and support for the idea of PPI in health services and, to a lesser extent, in health research. There seems to be a convergence of conceptualisations of PPI across Europe, with internationally significant areas of innovative work taking place in countries such as the Netherlands and the Scandinavian countries. However, the implementation of PPI is highly uneven, and PPI is not yet firmly embedded or adequately formalised in European healthcare systems and research, possibly due to a lack of infrastructure, guidance and support. In order to try to get a better understanding of what is happening on the ground, we are carrying out a survey with potential follow‐up interviews as the next part of this research project. This work is currently on hold due to the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Sedentary behaviour (SB) has emerged as a potential risk factor for metabolic health in youth. Knowledge on the determinants of SB in youth is necessary to inform future intervention development to reduce SB. A systematic review was conducted to identify predictors and determinants of SB in youth. Pubmed, Embase, CINAHL, PsycINFO and Web of Science were searched, limiting to articles in English, published between January 2000 and May 2014. The search strategy was based on four key elements and their synonyms: (a) sedentary behaviour, (b) determinants, (c) types of sedentary behaviours, (d) types of determinants. The full protocol is available from PROSPERO (PROSPERO 2014:CRD42014009823). Cross-sectional studies were excluded. The analysis was guided by the socio-ecological model. 37 studies were selected out of 2654 identified papers from the systematic literature search. Most studies were conducted in Europe (n = 13), USA (n = 11), and Australia (n = 10). The study quality, using the Qualsyst tool, was high with a median of 82 % (IQR: 74-91 %). Multiple potential determinants were studied in only one or two studies. Determinants were found at the individual, interpersonal, environmental and policy level but few studies examined a comprehensive set of factors at different levels of influences. Evidence was found for age being positively associated with total SB, and weight status and baseline assessment of screen time being positively associated with screen time (at follow-up). A higher playground density and a higher availability of play and sports equipment at school were consistently related to an increased total SB, although these consistent findings come from single studies. Evidence was also reported for the presence of safe places to cross roads and lengthening morning and lunch breaks being associated with less total SB. Future interventions to decrease SB levels should especially target children with overweight or obesity and should start at a young age. However, since the relationship of many determinants with SB remains inconsistent, there is still a need for more longitudinal research on determinants of SB in youth. [ABSTRACT FROM AUTHOR]

Background: Emerging research suggests that physical activity among children and adolescents decreased during the COVID-19 pandemic. However, a differentiated overview of European youth is lacking. In particular, no systematic analysis has been conducted to date on the impact of heterogeneous pandemic restrictions and school closures within European countries, and with regard to potentially vulnerable groups. Methods: We searched seven databases and included studies for children and adolescents (≤ 19 years) of the WHO European Region that compared physical activity during the COVID-19 pandemic with a pre-pandemic baseline using validated measurement instruments. We used the Oxford Stringency Index and School Closure Index as indicators of restriction stringency. Screening for eligibility, data extraction, assessment of the study risk of bias (using the 'Risk of Bias in Non-randomized Studies - of Exposure' [ROBINS-E]) and certainty grading of evidence (using the GRADE approach), were all done in duplicate. Unpublished data was requested from study authors. Data were pooled in random effects models. An a priori protocol was published, reporting is carried out in accordance with the 'Preferred Reporting Items for Systematic Review and Meta-Analyses' (PRISMA) statement. Results: Of 14,897 non-duplicate records, 26 publications (n = 15,038 pre-pandemic, n = 13,041 during pandemic) met full inclusion criteria. Comparison before and during the COVID-19 pandemic revealed a significant reduction in total physical activity (standardized mean difference [SMD], -0.57 [95%CI, -0.95; -0.20]) and moderate-to-vigorous physical activity (SMD, -0.43 [95% CI, -0.75; -0.10]), corresponding to a decrease of 12 min per day (a 20% reduction of the WHO recommendation). A decrease in sporting activity was also recorded. Subgroup analyses suggested that middle childhood (aged 8–12) and adolescents were particularly affected by the decline. School closures were associated with a reduction in physical activity. The certainty of evidence for all outcomes was low. Conclusions: A sharp decline in all forms of physical activity was recorded among European children and adolescents during the COVID-19 pandemic. This decline was higher during periods of school closure and mainly affected younger schoolchildren and adolescents. Immediate action by policy-makers and practitioners, as well as evidence-based public health strategies, are imperative in reversing this trend. Trial registration: PROSPERO: CRD42023395871 [ABSTRACT FROM AUTHOR]

Background: research in care home settings is often negatively focused, portraying life as sterile and devoid of meaningful experiences. Care homes have the potential to influence people's lives socially, physically and psychologically. It is important to understand what factors contribute to this.Objective: to conduct a systematic qualitative review of care home life and provide practical recommendations to enhance residents' quality of life.Methods: the following databases were searched: PsycINFO, Medline, Web of Science, EMBASE, Allied and Complementary Medicine Database and Cumulative Index to Nursing and Allied Health Literature. References from appropriate journals and individual articles were checked. Papers that fitted our selection criteria were selected. Two independent reviewers assessed methodological study quality. Thematic analysis and meta-ethnographic methods were adapted to synthesise findings.Results: thirty-one studies were identified. People in care homes voiced concerns about lack of autonomy and difficulty in forming appropriate relationships with others. Four key themes were identified: (i) acceptance and adaptation, (ii) connectedness with others, (iii) a homelike environment, (iv) caring practices.Conclusion: positive experiences in care homes can occur and are important for residents' quality of life. The review supports literature highlighting the need for relationship-centred approaches to care and emphasises the importance of understanding the resident's attitude towards living in care homes. [ABSTRACT FROM AUTHOR]

Epidemiological evidence suggests that regular physical activity (PA) positively impacts individuals' mental health (MH). The PA-MH relationship may be critical among immigrants owing to psycho-social-cultural influences. This scoping review of 61 studies employed a holistic bio-psycho-socio-cultural framework to thoroughly investigate the complex relationship between PA (across life domains) and immigrants' MH in Western countries. A systematic search of five electronic databases (Medline, PubMed, Embase, PsycINFO and Anthropology Plus) was conducted to locate relevant articles. No limitations were applied to study design, age, gender, home country, MH condition or PA type. A bio-psycho-socio-cultural-informed conceptual model guided the analysis of the multi-domain PA-MH relationship. Immigrant PA-MH studies were conducted and reported most commonly in the USA (38%), Australia (18%), and Canada (11%). Overall, PA was positively related to MH. Each domain-specific PA appeared to be associated with unique MH-promoting pathways/mechanisms. Leisure-related PA may support MH by enhancing self-agency and minimizing risky behaviors, whilst travel- and domestic-related PA may promote self-accomplishment and physical engagement. Ethnic sports appeared to enhance resilience. Occupational-related PA was associated with either positive or negative MH, depending on the type of occupation. A bio-psycho-socio-cultural-informed model is required to gain an encompassing and integrated understanding of immigrants' health. The first iteration of such a model is presented here, along with an illustration of how the model may be used to deepen analysis and understanding of the multi-domain PA-MH relationship among immigrants and inform public health planners and practitioners. [ABSTRACT FROM AUTHOR]

Background: Birthing individuals experience various postpartum symptoms which have been associated with adverse health outcomes. Previous systematic reviews have focused on the examination of individual symptoms and their impact on health, which have limited our understanding of postpartum symptom clusters. Objective: To examine the compositions of symptom clusters, analytic methodologies and predictors of symptom clusters in birthing individuals up to 1 year postpartum. Design: Systematic review. Methods: This systematic review was reported following the PRISMA. Five databases were searched: PubMed, Embase, CINAHL Complete, PsycINFO and Scopus. Two reviewers performed title and abstract and full‐text screening independently. Standard Quality Assessment Criteria were used to assess the articles' qualities. Key information was extracted into evidence table, which was checked for accuracy and completeness. A narrative synthesis was conducted. Results: A total of 30 articles were included. Studies were conducted in 16 countries, mostly in Europe (n = 9) and North America (n = 7). The majority were quantitative (n = 27) and cross‐sectional (n = 27). Factor analysis was the most frequently used analytic methodology (n = 21). All three qualitative studies used grounded theory. Taking into consideration the variations among the studies, stress (n = 15, infant or partner‐related and from other sources), depression (n = 12), somatic (n = 12) and anxiety clusters (n = 10) were most frequently identified. Symptom cluster predictors were examined in less than half of the included studies (n = 13). Among these, most were focused on how individual postpartum symptoms influence symptom clusters. Conclusions: Stress, depression, somatic and anxiety clusters are the most frequently identified postpartum symptom clusters. Future studies should examine the consistency, stability and clinical meaningfulness of these four symptom clusters. Relevance to clinical practice: The identification and management of the four symptom clusters should be of particular interest to clinicians and researchers. No patient or public contribution: This systematic review did not directly involve patient or public contribution to the manuscript. [ABSTRACT FROM AUTHOR]

Management of critically ill patients is changing due a rise in population age, comorbidity and complexity. To accommodate these changes, the demand is increasing for advanced practice nurses. More knowledge is needed regarding the role of advanced practice critical care nurses in European countries. The aim of the study was to review the literature describing skills and competencies required for advanced practice critical care nursing in Europe and to investigate related policy. We performed a scoping review including papers published in 1992–2019 targeting policy and the intersection of advanced practice nursing (level of practice), critical care nursing (specialty area) and Europe (geographical origin). Main sources of evidence were PubMed, EMBASE, PsycINFO, CINAHL, Cochrane Library, SweMed+, Scopus, ERIC and Social Sciences Citation Index. We also searched grey literature, webpages, reference lists and performed hand-search. The search identified 11,478 papers/references of which 42 were included. Four levels of practice were identified with unclear boundaries: professional nurse, specialized nurse, advanced practice nurse and advanced critical care practitioner (nurse or other). Most skills and competencies described in the literature were generic to advanced practice and only few were area specific to critical care. Advanced practice critical care nurses were often unable to fulfil their role because education, supportive policy and legislation were lacking. This scoping review informs the policy makers and the INACTIC study of existing advanced practice in critical care nursing in Europe. The advanced role in critical care nursing is characterized by inconsistency regarding policy, education, titles, roles, scope of practice, skills and competencies. Levels of practice and areas of specialization need to be clarified. Most skills and competencies identified were generic for advanced practice nursing and many were generic for any profession. Task-shifting from physician to nurse needs to be more clearly defined and patient outcomes described. Given the scarcity of papers in our target area, we believe it might be too early to conduct a systematic review at this time. [ABSTRACT FROM AUTHOR]

The relationship between adverse individual socio-economic circumstances and suicidal behaviour is well established. However, the impact of adverse collective circumstances – such as the socio-economic context where people live - is less well understood. This systematic review explores the extent to which area-level socioeconomic disadvantage is associated with inequalities in suicidal behaviour and self-harm in Europe. We performed a systematic review (in MEDLINE, Embase, PsycINFO, EconLit and Social Sciences Citation Index) from 2005 to 2015. Observational studies were included if they were based in Europe and had a primary suicidal behaviour and self-harm outcome, compared at least two areas, included an area-level measure of socio-economic disadvantage and were published in the English language. The review followed The Joanna Briggs Institute guidelines for quality appraisal. We identified 27 studies (30 papers) from 14 different European countries. There was a significant association (in 25/27 studies, all of which were rated as of medium or high quality) between socioeconomic disadvantage and suicidal behaviour (and self-harm), particularly for men, and this was a consistent finding across a variety of European countries. Socio-economic disadvantage was found to have an independent effect in several studies whilst others found evidence of mediating contextual and compositional factors. There is strong evidence of an association between suicidal behaviours (and self-harm) and area-level socio-economic disadvantage in Europe, particularly for men. Suicide prevention strategies should take this into account. [ABSTRACT FROM AUTHOR]

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

Background: Europe has a growing population of ethnic minority groups whose dietary behaviours are potentially of public health concern. To promote healthier diets, the factors driving dietary behaviours need to be understood. This review mapped the broad range of factors influencing dietary behaviour among ethnic minority groups living in Europe, in order to identify research gaps in the literature to guide future research. Methods: A systematic mapping review was conducted (protocol registered with PROSPERO 2014: CRD42014013549). Nine databases were searched for quantitative and qualitative primary research published between 1999 and 2014. Ethnic minority groups were defined as immigrants/populations of immigrant background from low and middle income countries, population groups from former Eastern Bloc countries and minority indigenous populations. In synthesizing the findings, all factors were sorted and structured into emerging clusters according to how they were seen to relate to each other. Results: Thirty-seven of 2965 studies met the inclusion criteria (n = 18 quantitative; n = 19 qualitative). Most studies were conducted in Northern Europe and were limited to specific European countries, and focused on a selected number of ethnic minority groups, predominantly among populations of South Asian origin. The 63 factors influencing dietary behaviour that emerged were sorted into seven clusters: social and cultural environment (16 factors), food beliefs and perceptions (11 factors), psychosocial (9 factors), social and material resources (5 factors), accessibility of food (10 factors), migration context (7 factors), and the body (5 factors). Conclusion: This review identified a broad range of factors and clusters influencing dietary behaviour among ethnic minority groups. Gaps in the literature identified a need for researchers to explore the underlying mechanisms that shape dietary behaviours, which can be gleaned from more holistic, systems-based studies exploring relationships between factors and clusters. The dominance of studies exploring 'differences' between ethnic minority groups and the majority population in terms of the socio-cultural environment and food beliefs suggests a need for research exploring 'similarities'. The evidence from this review will feed into developing a framework for the study of factors influencing dietary behaviours in ethnic minority groups in Europe. [ABSTRACT FROM AUTHOR]

Context North American medical students are more depressed and anxious than their peers. In the UK, the regulator now has responsibility for medical students, which may potentially increase scrutiny of their health. This may either help or hinder medical students in accessing appropriate care. The prevalences of anxiety, depression and psychological distress in medical students outside North America are not clear. A better understanding of the prevalence of, risk factors for and results of psychological distress will guide the configuration of support services, increasingly available for doctors, for medical students too. Objectives The aim of this study was to examine the prevalences of depression, anxiety and psychological distress in students in medical schools in the UK, Europe and elsewhere in the English-speaking world outside North America. Methods A systematic review was conducted using search terms encompassing psychological distress amongst medical students. Ovid SP was used to search the following databases: Ovid MEDLINE (R) from 1948 to October 2013; Psyc INFO from 1806 to October 2013, and EMBASE from 1980 to October 2013. Results were restricted to medical schools in Europe and the English-speaking world outside North America, and were evaluated against a set of inclusion criteria including the use of validated assessment tools. Results The searches identified 29 eligible studies. Prevalences of 7.7-65.5% for anxiety, 6.0-66.5% for depression and 12.2-96.7% for psychological distress were recorded. The wide range of results reflects the variable quality of the studies. Almost all were cross-sectional and many did not mention ethical approval. Better-quality studies found lower prevalences. There was little information on the causes or consequences of depression or anxiety. Conclusions Prevalences of psychological distress amongst medical students outside North America are substantial. Future research should move on from simple cross-sectional studies to better-quality longitudinal work which can identify both predictors for and outcomes of poor mental health in medical students. [ABSTRACT FROM AUTHOR]

In 2011 a working group of the European Society for the Study of Tourette Syndrome (ESSTS) has developed the first European assessment guidelines for Tourette syndrome (TS). Now, we present an updated version 2.0 of these European clinical guidelines for Tourette syndrome and other tic disorders, part I: assessment. Therefore, the available literature has been thoroughly screened, supplemented with national guidelines across countries and discussions among ESSTS experts. Diagnostic changes between DSM-IV and DSM-5 classifications were taken into account and new information has been added regarding differential diagnoses, with an emphasis on functional movement disorders in both children and adults. Further, recommendations regarding rating scales to evaluate tics, comorbidities, and neuropsychological status are provided. Finally, results from a recently performed survey among ESSTS members on assessment in TS are described. We acknowledge that the Yale Global Tic Severity Scale (YGTSS) is still the gold standard for assessing tics. Recommendations are provided for scales for the assessment of tics and psychiatric comorbidities in patients with TS not only in routine clinical practice, but also in the context of clinical research. Furthermore, assessments supporting the differential diagnosis process are given as well as tests to analyse cognitive abilities, emotional functions and motor skills. [ABSTRACT FROM AUTHOR]

Current data on the prevalence of prior illicit drug use among the prison population in Europe is scarce. The aim of this study is to identify the prevalence of illicit drug use prior to incarceration, as reported by studies conducted in 30 European countries. A comprehensive literature review was conducted from the 5–31 of March 2018 using the databases Cochrane Library, Embase, MEDLINE, PsychINFO and PubMed. After the deletion of duplications, 2607 articles meeting the eligibility criteria for review were identified. In total, 26 studies from 12 different countries have been included in this review. The review found that the lifetime prevalence of illicit drug use before imprisonment ranged from 30 to 93%; last year prevalence from 51 to 69%; last 6 months prevalence from 13 to 75% and last month prevalence from 58 to 62%. The prevalence of illicit drug use was especially high among women. The rates varied across the 26 studies although high prevalence values are reported in most studies and variations are partly related to methodological differences in the reviewed studies. The high levels of prior involvement with drugs, necessitates prisons to develop clear strategies to deal with illicit drug use. [ABSTRACT FROM AUTHOR]

brereton l., gardiner c., gott m., ingleton c., barnes s. & carroll c. (2011) The hospital environment for end of life care of older adults and their families: an integrative review. Journal of Advanced Nursing 68(5), 981-993. Abstract Aim. This article is a report of an integrative review to identify key elements of the physical hospital environment for end of life care of older adults and their families as reported by patients, relatives, staff and policy makers. Background. Globally ageing populations and increases in long-term illness mean that more people will need palliative care in the future. Despite policy initiatives to increase end of life care in the community, many older adults prefer, and will require, end of life care in hospital. Providing an appropriate physical environment for older adults requiring end of life care is important given concerns about hospital environments for this group. Data sources. Thirteen databases from 1966 to 2010 were searched including ASSIA, BNI, Cochrane Library, CINAHL, EMBASE, MEDLINE, PsycINFO, Social Science Citation Index, the Science Citation Index, HMIC and the National Research Register. Reference and citation tracking was performed on included publications. Review methods. An integrative review was conducted. Two reviewers independently screened titles and abstracts for inclusion and completed data extraction. Study quality is not reported as this poses methodological difficulties in integrative reviews. Data synthesis involved thematic analysis informed by the findings of included literature. Results. Ten articles were included. Four themes were identified: privacy as needed; proximity (physically and emotionally) to loved ones, home and nature; satisfaction with the physical environment; and deficiencies in physical environment. Conclusion. Little evidence exists about physical hospital environments for end of life care of older adults and their families. More research is required in this field. [ABSTRACT FROM AUTHOR]

Background: Multiple sclerosis (MS) is a chronic disabling, demyelinating disease of the central nervous system and is often associated with psychiatric comorbidities. Some studies suggest increased prevalence of bipolar disorder (BD) in MS. Objective: To conduct a systematic review and meta-analysis assessing the prevalence of BD in adults with MS. Methods: We registered this review with PROSPERO and searched electronic databases (Ovid MEDLINE, Central, Embase, PsycINFO and Scopus) for eligible studies from earliest inception to October 2020. Prevalence data of BD in adult patients with MS were extracted. Meta-analysis was conducted using random-effects model. Findings: Of the 802 articles that were screened, 23 studies enrolling a total of 68 796 patients were included in the systematic review and meta-analysis. The pooled prevalence rate of BD in patients with MS was 2.95% (95% CI 2.12% to 4.09%) with higher prevalence in the Americas versus Europe. The lifetime prevalence of BD was 8.4% in patients with MS. Subgroup analysis showed a higher prevalence of BD in MS in females (7.03%) than in males (5.64%), which did not reach statistical significance (p=0.53). Conclusions: This meta-analysis suggests a high lifetime prevalence of BD in patients with MS. Patients with MS should be routinely screened for BD. Further assessment of bipolar comorbidity in MS through prospective studies may help in developing effective management strategies and may improve treatment outcomes in patients with MS. [ABSTRACT FROM AUTHOR]

Introduction: Tom Kitwood's theoretical framework of person‐centred care is extensively and internationally referred to in healthcare services. However, despite the broad use of Kitwood's approach in clinical practice, the research examining experiences with the approach has not been mapped. Aim: To map the available literature on current empirical experiences in clinical practice of Kitwood's approach to person‐centred care for people with dementia, living in institutional settings in primary health care. Methods: A total of 154 studies concerning the experiences of people with dementia and their formal caregivers' use of Kitwood's framework of person‐centred care for residents living in institutional settings in primary health care were compiled from scientific databases. All three authors engaged in a systematic selection process, leading to nineteen articles being included in the review. Results: The results showed an overall tendency towards positive experiences gained from applying person‐centred approaches in clinical practice influenced by Kitwood's theoretical framework. Through the synthesis of data from the selected studies, six categories related to our research aim were identified 'Theoretical evaluation of Tom Kitwood's model of care', 'Models and frameworks', 'Interventions', 'Communication', 'Dementia Care Mapping' and 'Environment'. Conclusion: The present review included nineteen studies published from 1998 to 2016 and consisted mainly of peer‐reviewed scientific articles, followed by dissertations, conference posters and nonpeer‐reviewed articles. All studies were undertaken in Western countries. The vast majority of the studies considered Kitwood's theoretical framework to be beneficial and useful in practice. [ABSTRACT FROM AUTHOR]

Aims This study aims to explore the feasibility of using routine hospital discharge data, at the level of countries within Europe, to estimate the general population prevalence of alcohol dependence (AD). Methods We utilised the European Core Health Indicators data tool to extract the annual rate of hospital discharges due to any wholly attributable alcohol condition as defined by the ICD-10. For those counties with data available, we systematically searched Medline, EMBASE, PsychINFO and Google for studies reporting an estimate of the prevalence of AD from national cross-sectional surveys. We compared these prevalence estimates with those developed from prediction models based on hospital discharge data. Results The rate of hospital discharges due to any condition from the F10 diagnostic category (mental and behavioural disorders due to alcohol) was moderately correlated with AD prevalence (r  = 0.56), while the rate due to any condition from the K70 diagnostic category (alcoholic liver disease) was weakly correlated with AD prevalence (r  = 0.21). Two-thirds of the estimates from cross-sectional surveys were not significantly different to those generated using the F10 discharge rate prediction model. Conclusions Country-level AD prevalence estimates generated using annual F10 hospital discharge rates are likely to provide information of some utility, particularly when limited other sources of information are available or when examining relative trends over time or between regions. There is, however, currently insufficient evidence to make a definitive recommendation to use hospital discharge data to estimate the absolute prevalence of AD per country in Europe. [ABSTRACT FROM AUTHOR]

Objectives: Research has suggested beneficial effects of self‐regulated learning (SRL) for medical students' and residents' workplace‐based learning. Ideally, learners go through a cyclic process of setting learning goals, choosing learning strategies and assessing progress towards goals. A clear overview of medical students' and residents' successful key strategies, influential factors and effective interventions to stimulate SRL in the workplace is missing. This systematic review aims to provide an overview of and a theoretical base for effective SRL strategies of medical students and residents for their learning in the clinical context. Methods: This systematic review was conducted according to the guidelines of the Association for Medical Education in Europe. We systematically searched PubMed, EMBASE, Web of Science, PsycINFO, ERIC and the Cochrane Library from January 1992 to July 2016. Qualitative and quantitative studies were included. Two reviewers independently performed the review process and assessed the methodological quality of included studies. A total of 3341 publications were initially identified and 18 were included in the review. Results: We found diversity in the use of SRL strategies by medical students and residents, which is linked to individual (goal setting), contextual (time pressure, patient care and supervision) and social (supervisors and peers) factors. Three types of intervention were identified (coaching, learning plans and supportive tools). However, all interventions focused on goal setting and monitoring and none on supporting self‐evaluation. Conclusions: Self‐regulated learning in the clinical environment is a complex process that results from an interaction between person and context. Future research should focus on unravelling the process of SRL in the clinical context and specifically on how medical students and residents assess their progress towards goals. [ABSTRACT FROM AUTHOR]

Background: Nurses are pivotal in the provision of high quality care in acute hospitals. However, the optimal dosing of the number of nurses caring for patients remains elusive. In light of this, an updated review of the evidence on the effect of nurse staffing levels on patient outcomes is required. Aim: To undertake a systematic review and meta-analysis examining the association between nurse staffing levels and nurse-sensitive patient outcomes in acute specialist units. Methods: Nine electronic databases were searched for English articles published between 2006 and 2017. The primary outcomes were nurse-sensitive patient outcomes. Results: Of 3429 unique articles identified, 35 met the inclusion criteria. All were cross-sectional and the majority utilised large administrative databases. Higher staffing levels were associated with reduced mortality, medication errors, ulcers, restraint use, infections, pneumonia, higher aspirin use and a greater number of patients receiving percutaneous coronary intervention within 90 minutes. A meta-analysis involving 175,755 patients, from six studies, admitted to the intensive care unit and/or cardiac/cardiothoracic units showed that a higher nurse staffing level decreased the risk of inhospital mortality by 14% (0.86, 95% confidence interval 0.79–0.94). However, the meta-analysis also showed high heterogeneity (I2=86%). Conclusion: Nurse-to-patient ratios influence many patient outcomes, most markedly inhospital mortality. More studies need to be conducted on the association of nurse-to-patient ratios with nurse-sensitive patient outcomes to offset the paucity and weaknesses of research in this area. This would provide further evidence for recommendations of optimal nurse-to-patient ratios in acute specialist units. [ABSTRACT FROM AUTHOR]

As the human immunodeficiency virus continues to devastate large parts of Africa, particularly the Sub-Saharan region, the number of immigrants migrating from these areas to European nations continues to grow. African men and women leave their countries for Europe because of armed conflicts, unemployment, or poverty. Thus, these migration patterns combined with newly contracted infections have resulted in a large and growing number of HIV-positive diagnoses among African immigrants living in Europe. Using the disclosure process model, this systematic review examines the reasons for HIV status disclosure and nondisclosure among African immigrants residing in Europe. PubMed, PsycINFO, Embase, Global Health, and Web of Science were searched. Bibliographies of retrieved studies were also reviewed for other relevant citations. Studies were eligible if they: (1) focused on HIV-positive immigrants from SSA residing in Europe; and (2) described or measured HIV status disclosure. Out of 166 articles found, a total of 17 articles and 1 brief report met the inclusion criteria. Factors such as stigma and social implications of disclosure contribute to avoidance goals leading to nondisclosure while approach goals or disclosure reasons were found to include health status and behaviors such as seeking support, and helping others. The findings highlight the importance of understanding the avoidance and approach goals involved in HIV status disclosure among African immigrants in Europe. Interventions and future research directed at increasing HIV disclosure among African immigrants in Europe should move beyond individual-level to consider multilevel factors including country-specific social behaviors. [ABSTRACT FROM AUTHOR]

Background: Physical activity and sedentary behaviour are associated with health and wellbeing. Studies indicate that ethnic minority groups are both less active and more sedentary than the majority population and that factors influencing these behaviours may differ. Mapping the factors influencing physical activity and sedentary behaviour among ethnic minority groups living in Europe can help to identify determinants of physical activity and sedentary behaviour, research gaps and guide future research. Methods: A systematic mapping review was conducted to map the factors associated with physical activity and sedentary behaviour among ethnic minority groups living in Europe (protocol PROSPERO ID = CRD42014014575). Six databases were searched for quantitative and qualitative research published between 1999 and 2014. In synthesizing the findings, all factors were sorted and structured into clusters following a data driven approach and concept mapping. Results: Sixty-three articles were identified out of 7794 returned by the systematic search. These included 41 quantitative and 22 qualitative studies. Of these 58 focused on physical activity, 5 on both physical activity and sedentary behaviour and none focused on sedentary behaviour. The factors associated with physical activity and sedentary behaviour were grouped into eight clusters. Social & cultural environment (n = 55) and Psychosocial (39) were the clusters containing most factors, followed by Physical environment & accessibility (33), Migration context (15), Institutional environment (14), Social & material resources (12), Health and health communication (12), Political environment (3). An important finding was that cultural and religious issues, in particular those related to gender issues, were recurring factors across the clusters. Conclusion: Physical activity and sedentary behaviour among ethnic minority groups living in Europe are influenced by a wide variety of factors, especially informed by qualitative studies. More comparative studies are needed as well as inclusion of a wider spectrum of the diverse ethnic minority groups resettled in different European countries. Few studies have investigated factors influencing sedentary behaviour. It is important in the future to address specific factors influencing physical activity and sedentary behaviour among different ethnic minority groups in order to plan and implement effective interventions. [ABSTRACT FROM AUTHOR]

Background: Autism spectrum disorders (ASDs), once considered to be rare, are now reaching prevalence estimates of 1% and higher. Studies conducted in North America indicate large racial/ethnic disparities in the diagnosis of ASDs. Others show, that immigrant children have similar prevalence rates of ASDs as native children, although they are diagnosed later compared with native children. In relation to a EU funded network action, Enhancing the Scientific Study of Early Autism, it was considered important to review the literature on this subject. Method: A comprehensive literature search was undertaken for original articles reporting on prevalence and risk for ASD in Europe among immigrants and ethnic minorities and data across studies were compared. Results: Seventeen studies conducted in Europe concerning immigrants and ethnic minorities were found. Fifteen studies suggest a higher prevalence rate of ASDs among children of immigrants in comparison to native children (RR = 1.02-1.74; OR =0.6-10.5). One study revealed higher prevalence of autism (OR = 2.2; 95% CI 1.6-3.1) and lower prevalence of Asperger syndrome in immigrants (OR = 0.6; 95% CI 0.3-0.97). One study showed a lower prevalence of Asperger syndrome in immigrants (aOR = 0.1, 95% CI 0.01-0.5). The majority of those analyses involved immigrants from outside Europe, e.g. from Africa and South America. Conclusion: After analysing the results of studies conducted in Europe, it is unclear if higher prevalence estimates of ASDs among immigrants in this region reflect true differences, especially considering many potential confounding factors, e.g. genetic, biological, environmental and cultural. Considering the number of people migrating within Europe there is a substantial need to study further the prevalence of ASDs in immigrant groups. [ABSTRACT FROM AUTHOR]

Introduction: Cardiovascular risk (CVR) assessment and management in patients with inflammatory arthritis (IA) is recommended but European nurses' involvement in this role has not been well studied. Aim: The aim of the present study was to explore European nurses' role in assessing and managing CVR, in order to suggest topics for practice development and research in this area regarding persons with IA. Methods: We searched Embase, Cinahl, Cochrane, PsycInfo and PubMed databases and included European articles from the past ten years if they described how nurses assess and/or manage CVR. In addition to the systematic review, we provided case studies from five different countries to illustrate national guidelines and nurses' role regarding CVR assessment and management in patients with IA. Results: Thirty-three articles were included. We found that trained nurses were undertaking CVR assessment and management in different settings and groups of patients. The assessments include blood pressure, body mass index, waist circumference, glucose and lipid-profile, adherence to medication and behavioural risk factors (unhealthy diet, physical inactivity, alcohol and smoking). Different tools were used to calculate patients' risk. Risk management differed from brief advice to long-term follow-up. Nurses tended to take a holistic and individually tailored approach. Clinical examples of inclusion of rheumatology nurses in these tasks were scarce. Conclusion: Nurses undertake CVR assessment, communication and management in different types of patients. This is considered to be a highly relevant task for rheumatology nursing, especially in patients with IA. Further studies are needed to assess patients' perspective, effectiveness and cost-effectiveness of nurse-led CVR. [ABSTRACT FROM AUTHOR]

The purpose of this scoping review is to identify cardiovascular interventions that are designed to address the needs of immigrant women across North America and Europe. The articles retrieved were reviewed independently by both the first author and a trained research assistant. Although the search revealed many articles and resources related to supporting cardiovascular self-management behaviors among individuals, few focused on interventions designed for immigrant women who were diagnosed and living with cardiovascular disease. Also, it was difficult to determine the quality of the literature retrieved, as the main goal of this scoping review was to assess the body of literature and categorize materials by common themes and topics. A more in-depth structured systematic review is needed to determine the quality of evidence being presented and to serve as a rationale for the design and implementation of future culturally sensitive interventions delivered to immigrant women diagnosed with cardiovascular disease. [ABSTRACT FROM AUTHOR]

Background: Sedentary behaviour is increasingly recognized as a public health risk that needs to be monitored at the population level. Across Europe, there is increasing interest in assessing population levels of sedentary time. This systematic literature review aims to provide an overview of all existing cross-European studies that measure sedentary time in adults, to describe the variation in population levels across these studies and to discuss the impact of assessment methods. Methods: Six literature databases (PubMed, EMBASE, CINAHL, PsycINFO, SportDiscus and OpenGrey) were searched, supplemented with backward- and forward tracking and searching authors' and experts' literature databases. Articles were included if they reported on observational studies measuring any form of sedentary time in the general population in two or more European countries. Each record was reviewed, extracted and assessed by two independent researchers, and disagreements were resolved by a third researcher. The review protocol of this review is registered in the PROSPERO database under registration number CRD42014010335. Results: Of the 9,756 unique articles that were identified in the search, twelve articles were eligible for inclusion in this review, reporting on six individual studies and three Eurobarometer surveys. These studies represented 2 to 29 countries, and 321 to 65,790 participants. Eleven studies focused on total sedentary time, while one studied screen time. The majority of studies used questionnaires to assess sedentary time, while two studies used accelerometers. Total sedentary time was reported most frequently and varied from 150 (median) to 620 (mean) minutes per day across studies and countries. Conclusions: One third of European countries were not included in any of the studies. Objective measures of European adults are currently limited, and most studies used single-item self-reported questions without assessing sedentary behaviour types or domains. Findings varied substantially between studies, meaning that population levels of sedentary time in European adults are currently unknown. In general, people living in northern Europe countries appear to report more sedentary time than southern Europeans. The findings of this review highlight the need for standardisation of the measurement methods and the added value of cross-European surveillance of sedentary behaviour. [ABSTRACT FROM AUTHOR]

Background: Physical inactivity is a well-known public health risk that should be monitored at the population level. Physical activity levels are often surveyed across Europe. This systematic literature review aims to provide an overview of all existing cross-European studies that assess physical activity in European adults, describe the variation in population levels according to these studies, and discuss the impact of the assessment methods. Methods: Six literature databases (PubMed, EMBASE, CINAHL, PsycINFO, SportDiscus and OpenGrey) were searched, supplemented with backward- and forward tracking and searching authors' and experts' literature databases. Articles were included if they reported on observational studies measuring total physical activity and/or physical activity in leisure time in the general population in two or more European countries. Each record was reviewed, extracted and assessed by two independent researchers and disagreements were resolved by a third researcher. The review protocol of this review is registered in the PROSPERO database under registration number CRD42014010334. Results: Of the 9,756 unique identified articles, twenty-five were included in this review, reporting on sixteen different studies, including 2 to 35 countries and 321 to 274,740 participants. All but two of the studies used questionnaires to assess physical activity, with the majority of studies using the IPAQ-short questionnaire. The remaining studies used accelerometers. The percentage of participants who either were or were not meeting the physical activity recommendations was the most commonly reported outcome variable, with the percentage of participants meeting the recommendations ranging from 7 % to 96 % across studies and countries. Conclusions: The included studies showed substantial variation in the assessment methods, reported outcome variables and, consequently, the presented physical activity levels. Because of this, absolute population levels of physical activity in European adults are currently unknown. However, when ranking countries, Ireland, Italy, Malta, Portugal, and Spain generally appear to be among the less active countries. Objective data of adults across Europe is currently limited. These findings highlight the need for standardisation of the measurement methods, as well as cross-European monitoring of physical activity levels. [ABSTRACT FROM AUTHOR]

Background: Regular physical activity is associated with physical, social and mental health benefits, whilst insufficient physical activity is associated with several negative health outcomes (e.g. metabolic problems). Population monitoring of physical activity is important to gain insight into prevalence of compliance to physical activity recommendations, groups at risk and changes in physical activity patterns. This review aims to provide an overview of all existing studies that measure physical activity in youth, in cross-European studies, to describe the variation in population levels of physical activity and to describe and define challenges regarding assessment methods that are used. Methods: A systematic search was performed on six databases (PubMed, EMBASE, CINAHL, PsycINFO, SportDiscus and OpenGrey), supplemental forward- and backward tracking was done and authors' and experts' literature databases were searched to identify relevant articles. Journal articles or reports that reported levels of physical activity in the general population of youth from cross-European studies were included. Data were reviewed, extracted and assessed by two researchers, with disagreements being resolved by a third researcher. The review protocol of this review is published under registration number CRD42014010684 in the PROSPERO database. Results: The search resulted in 9756 identified records of which 30 articles were included in the current review. This review revealed large differences between countries in prevalence of compliance to physical activity recommendations (i.e. 60 min of daily moderate- to vigorous-intensity physical activity (MVPA)) measured subjectively (5-47 %) and accelerometer measured minutes of MVPA (23-200 min). Overall boys and children were more active than girls and adolescents. Different measurement methods (subjective n = 12, objective n= 18) and reported outcome variables (n = 17) were used in the included articles. Different accelerometer intensity thresholds used to define MVPA resulted in substantial differences in MVPA between studies conducted in the same countries when assessed objectively. Conclusions: Reported levels of physical activity and prevalence of compliance to physical activity recommendations in youth showed large variation across European countries. This may reflect true variation in physical activity as well as variation in assessment methods and reported outcome variables. Standardization across Europe, of methods to assess physical activity in youth and reported outcome variables is warranted, preferably moving towards a pan-European surveillance system combining objective and self-report methods. [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]

Background: Knowledge about influenza transmission in the workplace and whether staying home from work when experiencing influenza-like illness can reduce the spread of influenza is crucial for the design of efficient public health initiatives. Aim: This review synthesizes current literature on sickness presenteeism and influenza transmission in the workplace and provides an overview of sick leave recommendations in Europe for influenza. Methods: A search was performed on Medline, Embase, PsychINFO, Cinahl, Web of Science, Scopus and SweMed to identify studies related to workplace contacts, -transmission, -interventions and compliance with recommendations to take sick leave. A web-based survey on national recommendations and policies for sick leave during influenza was issued to 31 European countries. Results: Twenty-two articles (9 surveys; 13 modelling articles) were eligible for this review. Results from social mixing studies suggest that 20-25% of weekly contacts are made in the workplace, while modelling studies suggest that on average 16% (range 9-33%) of influenza transmission occurs in the workplace. The effectiveness of interventions to reduce workplace presenteeism is largely unknown. Finally, estimates from studies reporting expected compliance with sick leave recommendations ranged from 71 to 95%. Overall, 18 countries participated in the survey of which nine (50%) had issued recommendations encouraging sick employees to stay at home during the 2009 A(H1N1) pandemic, while only one country had official recommendations for seasonal influenza. Conclusions: During the 2009 A(H1N1) pandemic, many European countries recommended ill employees to take sick leave. Further research is warranted to quantify the effect of reduced presenteeism during influenza illness. [ABSTRACT FROM AUTHOR]

The article presents the research that explores on the perspectives of African Americans and ethnic minority patients on the self-management of diabetes in Great Britain. The topics discussed include the barriers they experienced in managing their ailments and the importance of their insights in improving the healthcare services and policies.

Aims To determine the efficacy of acamprosate and naltrexone in the treatment of those who are alcohol-dependent in reducing lapse/relapse to alcohol consumption and treatment discontinuation, and to examine whether a proportion of the variance in study outcome can be explained by the country in which the trials have taken place. Method A systematic review and meta-analysis of randomized controlled trials published before September 2013 was conducted. The primary outcome measures were the efficacy of acamprosate or naltrexone in reducing lapse/relapse compared to placebo in the treatment of alcohol dependence and treatment discontinuation. Twenty-two randomized controlled trials (RCTs) of the efficacy of acamprosate met inclusion criteria for the meta-analysis, with a total of 2649 participants in the acamprosate group and 2587 in the placebo group. Twenty-seven RCTs of the efficacy of naltrexone met inclusion criteria for the meta-analysis, with a total of 2253 participants in the naltrexone group and 1946 in the placebo group. A random-effects model using a Mantel-Haenszel method was applied to conduct the meta-analysis. Variance in study outcomes was explored using subgroup analysis of Europe versus the rest of the world (ROW). Results The risk of returning to any drinking at 6 months was significantly lower for acamprosate [risk ratio (RR) = 0.83, 95% confidence interval (CI) = 0.78-0.89]. There was little difference in the risk of participants discontinuing treatment for any reason (RR = 0.91, 95% CI = 0.83-1.00) or due to adverse events (RR = 1.30, 95% CI = 0.96-1.75) for the acamprosate compared to placebo groups. The risk of individuals returning to any drinking at approximately 3 months was reduced significantly for the naltrexone group (RR = 0.92, 95% CI = 0.86-1.00), as was the risk of individuals relapsing to heavy drinking at 3 months (RR = 0.85, 95% CI = 0.78-0.93). There was no significant difference between naltrexone and placebo for the risk of individuals discontinuing treatment for any reason (RR = 0.94, 95% CI = 0.84-1.05). There was a significantly greater risk of participants in the naltrexone group discontinuing treatment due to adverse events compared to placebo (RR = 1.72, 95% CI = 1.10-2.70). Subgroup analysis by country (Europe versus ROW) revealed no difference in risk between acamprosate and placebo for the outcomes returning to any drinking at 6 months and discontinuing treatment due to adverse events. For the outcome discontinuation of treatment for any reason, there was a significant difference in RR between Europe and the ROW (χ2 = 11.65, P <0.001) for acamprosate. Acamprosate was associated with a reduction in risk of discontinuing treatment for Europe (RR = 0.86, 95% CI = 0.79-0.95), but an increase in risk of discontinuing treatment for ROW (RR = 1.23, 95% CI = 1.03-1.48). Conclusions Both acamprosate and naltrexone appear to reduce the risk of individuals returning to drinking alcohol in those who are alcohol-dependent. The country in which a randomized control trial (RCT) for the efficacy of acamprosate and naltrexone is completed does not appear to explain the variance in trial outcomes for returning to drinking alcohol or discontinuing drinking due to adverse effects. However, the country in which the RCT of acamprosate are completed may be important for explaining the variance between studies for the outcome 'discontinuing treatment for any reason'. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives Given the increasing emphasis being placed on managing patients with chronic diseases within primary care, there is a need to better understand which primary care organizational attributes affect the quality of care that patients with chronic diseases receive. This study aimed to identify, summarize and compare data collection tools that describe and measure organizational attributes used within the primary care setting worldwide. Methods Systematic search and review methodology consisting of a comprehensive and exhaustive search that is based on a broad question to identify the best available evidence was employed. Results A total of 30 organizational attribute data collection tools that have been used within the primary care setting were identified. The tools varied with respect to overall focus and level of organizational detail captured, theoretical foundations, administration and completion methods, types of questions asked, and the extent to which psychometric property testing had been performed. The tools utilized within the Quality and Costs of Primary Care in Europe study and the Canadian Primary Health Care Practice- Based Surveys were the most recently developed tools. Furthermore, of the 30 tools reviewed, the Canadian Primary Health Care Practice- Based Surveys collected the most information on organizational attributes. Conclusions There is a need to collect primary care organizational attribute information at a national level to better understand factors affecting the quality of chronic disease prevention and management across a given country. The data collection tools identified in this review can be used to establish data collection strategies to collect this important information. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2013; 27; 184-194 Patients' lived experiences of a reduced intake of food and drinks during illness: a literature review Aim: This study aims to identify patients' lived experiences of having a reduced intake of food and drink during illness, through a literature review. Methods: Scientific studies were selected through a systematic search of CINAHL, PubMed, SweMed, British Nursing Index, Psycinfo and EMBASE. A deductive thematic analysis was performed on the studies included. The analysis provided three main themes: (i) serving of food and drink - patient experiences. (ii) Modifications related to illness - patient experiences. (iii) Nutritional care provided by healthcare professionals nutritional care - patient experiences. Findings: Generally speaking, the findings showed high satisfaction with the food served at hospitals. However, patients' individual tastes and preferences as to when and where to eat were found to affect their intake of food and drink. Physical changes because of illness were stated as the main reason for the patients' lived experiences of a reduced intake of food and drink. These experiences seemed to be related to negative feelings, such as anxiety and shame during meals. Furthermore, the literature review revealed a lack of professional assistance during meals and insufficient guidance on how to handle specific nutritional problems. Conclusions: Patients expect committed nursing care in regard to nutritional advice during illness and assistance in meal-related situations. Nurses need to refocus on fundamental caring. [ABSTRACT FROM AUTHOR]

The article discusses a study reviewing the literature on palliative care research in long-term care facilities, such as nursing homes (NH), in Europe, using PubMed, Embase and PsychINFO databases. Few studies reporting on patient outcome data using different measurement instruments were published in ten years. Majority showed symptoms, especially pain, the most frequent measured out-come. The authors suggest more multidimensional research, high quality trails and intervention studies.