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The objectives of the study were: 1) Describe the thematic structure and evolution of the field of physical therapy; 2) identify the main research producers (i.e. countries and institutions); and 3) compare their research output and citation impact. Papers related to physical therapy indexed in Web of Science (2000–2018) were identified to delineate the field, using keywords, journals, and citation networks. VOSviewer software, advanced bibliometric text mining, and visualization techniques were used to evaluate the thematic structure. We collected data about the country and institutional affiliation of all the authors and calculated production and citation impact indicators. 85,697 papers were analyzed. Eleven thematic clusters were identified: 1) "health care and education"; 2) "biomechanics"; 3) "psychosocial, chronic pain and quality of life outcomes"; 4) "evidence-based physical therapy research methods"; 5) "traumatology and orthopedics"; 6) "neurological rehabilitation"; 7) "psychometrics and cross-cultural adaptation"; 8) "gait-balance analysis and Parkinson's disease"; 9) "exercise"; 10) "respiratory physical therapy"; and 11) "back pain." The United States, the United Kingdom, and Australia were the most productive countries. Netherlands, Norway, and Sweden had the highest citation impact. Our bibliometric visualization approach makes it possible to comprehensively study the thematic structure of physical therapy. The ranking of producers has evolved and now includes China and Brazil. High research production does not imply a high citation impact. [ABSTRACT FROM AUTHOR]

This paper explores trade union strategies to protect wages in the face of EU migration after the enlargement of the European Union. We argue that unions have three instruments at their disposal to deal with the risks linked to downward wage pressure: closure through immigration control, equalisation through collective bargaining and minimum wages, and the organisation of migrant workers. Using comparative case studies of Sweden, Germany and the UK, we show how different types of power resources shape union strategies: unions with substantial organisational resources (in Sweden) relied on a large membership to pursue an equalisation strategy and expected to be able to 'afford' openness. German unions with low membership but access to the political system pushed for a mix of closure and equality drawing on political intervention (e.g. minimum wages). British unions, unable to pursue either, focused their efforts on organisation. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to review marketing materials of surveillance products for people with dementia and their carers in three ageing countries, as part of a dementia-technology media analysis.Design/methodology/approach An online environmental scan was conducted using search terms for surveillance technologies (STs) and dementia through a Google search focussed on the UK, Sweden and the Netherlands. Data were extracted on the products' and websites' marketing messages from consumer and marketer perspectives.Findings Information was gathered for 382 product websites, of which 242 met eligibility criteria. The majority of products come from the UK. In the UK and Sweden, the companies behind the websites appeared to be mainly "cottage industries" which focus on selling ST. In contrast, sellers in the Netherlands included a more balanced mixture of small, medium and large companies. In all three countries, the website messaging focussed on the need to manage safety concerns, without considering privacy or consent.Social implications Contrary to the perception of future dependence on technology, the ST sector seems to be a niche market. The media messages, equating people with dementia with animals and children, are at odds with initiatives that strive for dignity and dementia friendliness.Originality/value No previous study is known to have explored media messages from websites that market ST for people with dementia. [ABSTRACT FROM AUTHOR]

Aims and objectives This systematic review aims to synthesise the existing research on how patients participate in patient safety initiatives. Background Ambiguities remain about how patients participate in routine measures designed to promote patient safety. Design Systematic review using integrative methods. Methods Electronic databases were searched using keywords describing patient involvement, nursing input and patient safety initiatives to retrieve empirical research published between 2007 and 2013. Findings were synthesized using the theoretical domains of Vincent's framework for analysing risk and safety in clinical practice: 'patient', 'healthcare provider', 'task', 'work environment', 'organisation & management'. Results We identified 17 empirical research papers: four qualitative, one mixed-method and 12 quantitative designs. All 17 papers indicated that patients can participate in safety initiatives. Conclusions Improving patient participation in patient safety necessitates considering the patient as a person, the nurse as healthcare provider, the task of participation and the clinical environment. Patients' knowledge, health conditions, beliefs and experiences influence their decisions to engage in patient safety initiatives. An important component of the management of long-term conditions is to ensure that patients have sufficient knowledge to participate. Healthcare providers may need further professional development in patient education and patient care management to promote patient involvement in patient safety, and ensure that patients understand that they are 'allowed' to inform nurses of adverse events or errors. A healthcare system characterised by patient-centredness and mutual acknowledgement will support patient participation in safety practices. Further research is required to improve international knowledge of patient participation in patient safety in different disciplines, contexts and cultures. Relevance to clinical practice Patients have a significant role to play in enhancing their own safety while receiving hospital care. This review offers a framework for clinicians to develop comprehensive practical guidelines to support patient involvement in patient safety. [ABSTRACT FROM AUTHOR]

Framing has previously been studied in the field of pandemic preparedness and global health governance and influenza pandemics have usually been framed in terms of security and evidence-based medicine on a global scale. This paper is based on the pandemic preparedness plans, published after 2009, from eight European countries. We study how pandemic preparedness is framed and how pandemic influenza in general is narrated in the plans. All plans contain references to ‘uncertainty’, ‘pandemic phases’, ‘risk management’, ‘vulnerability’ and ‘surveillance’. These themes were all framed differently in the studied plans. The preparedness plans in the member states diverge in ways that will challenge the ambition of the European Union to make the pandemic preparedness plans interoperable and to co-ordinate the member states during future pandemics. [ABSTRACT FROM PUBLISHER]

A child's disability, long-term illness, or mental ill-health is known to affect siblings' health, social life, school engagement, and quality of life. This article addresses a research gap by its focus on young sibling carers and the impact of providing care to a sibling. A cross-national survey study was conducted in 2018–2019 (Italy, the Netherlands, Slovenia, Sweden, Switzerland, the UK) to examine the incidence of adolescent sibling carers, the extent of care they provide, and their self-reported health, well-being, and school situation. The survey was completed by 7146 adolescents, aged 15–17, and 1444 of them provided care to family members with health-related conditions. Out of these, 286 were identified as Sibling Carers and 668 as Parent Carers, while 181 had both sibling(s) and parent(s) with health-related conditions, and thus were identified as Sibling–Parent Carers. Sibling Carers and Sibling–Parent Carers carried out higher levels of caring activities compared to Parent Carers. They reported both positive aspects of caring, such as increased maturity, and negative aspects, such as mental ill-health, impact on schooling and a lack of support. To reduce the negative aspects of a sibling carer role, it is important to recognise them and to implement early preventive measures and formal support. [ABSTRACT FROM AUTHOR]

This paper focusses on coping strategies employed by children and adolescents with diagnosed short stature, assesses the impact of socio-demographic and clinical characteristics on coping, examines the relationship between coping and health related quality of life (QoL) and investigates the role of coping strategies in mediating the relationship between height and QoL. Coping with a disease (CODI) and quality of life in short stature youth (QoLISSY-QoL) questionnaires were completed by 137 short-statured children and adolescents between 8 and 18 years, participating in the crosssectional European QoLISSY study. Clinical and socio-demographic data were collected to examine differences in coping via variance and regression analyses, associations between CODI and QoLISSY were inspected using correlation and mediation analyses. Most frequently employed coping strategies in the CODI were 'Acceptance' and 'Wishful Thinking', with 'Emotional Reaction' used least. Significant effects of age, diagnosis and treatment status on coping strategies were detected. CODI scales 'Acceptance' and 'Distance' were associated with higher QoLISSY-QoL scores, 'Emotional Reaction' and 'Wishful Thinking' with lower scores. Coping strategies predicted 60 % of the QoLISSY-QoL variance. Relationships between height deviation and QoLISSY-QoL were mediated by the coping strategies of 'Wishful Thinking' and 'Distance'. Findings suggest that coping efforts vary with socio-demographic and clinical characteristics, that protective coping strategies in terms of QoL can be identified and that coping mediates the relationship between short stature and QoL. Future longitudinal research should focus on the adaptive function of coping in relation to QoL over time. [ABSTRACT FROM AUTHOR]

The article discusses that after screening for breast or colorectal cancer, what is the time lag needed before cancer deaths are seen. According to a research paper by Sei J Lee and colleagues, cancer screening does help in preventing cancer deaths in the future, the time to benefit from is unclear. The paper adds that the screening prevents one cancer death per 1000 patients screened at 10 years, and it should be carried out on patients who have a life expectancy of more than 10 years.

Total water intake is seldom reported in dietary surveys and hydration status is rarely measured. Although adequate intake (AI) levels have been suggested by the European Food Safety Authority, the World Health Organization and the Institute of Medicine, uncertainties and confused messages abound regarding optimum intake. This paper reviews data on water intake internationally and examines associations with beverage consumption habits of adults in the UK, as determined from secondary analysis of individual diet records. On average, total water intake among British adults was equivalent to the European AI (2 l/day for women, 2.5 l/day for men) and 75% of this was derived from beverages. Factors that correlated with high total water intake included the consumption of a variety of beverages and drinking in the evening. Total water intake (and the contribution from soft drinks) is markedly higher in the USA than in Europe. Beverage consumption habits and trends were also reviewed. In the past 10 years, water beverages have become more popular and as such the overall energy contribution from beverages has declined slightly. Most people could be encouraged to drink a variety of beverages to maintain adequate hydration and to balance the energy content according to their needs. However, further work is needed to refine recommendations for water intake, as basing these on observational epidemiological data is essentially a circular argument. A standardized measurement tool, validated against biomarkers of hydration status, would be a step forward in assessing the adequacy of water intakes at a population level. Research may also be warranted to explore the context of drinking occasions (including time of day, weekdays weekends, lifestyle and meal patterns) as these may have an impact on water intake, hydration and also energy balance. [ABSTRACT FROM AUTHOR]

Background: OECD countries over the past two decades have implemented a range of labour market integration initiatives to improve the employment chances of disabled and chronically ill individuals. This article presents a systematic review and evidence synthesis on effectiveness of government interventions to influence employers’ employment practices concerning disabled and chronically ill individuals in five OECD countries. A separate paper reports on interventions to influence the behaviour of employees. Methods: Electronic and grey literature searches to identify all empirical studies reporting employment effects and/or process evaluations of government policies aimed at changing the behaviour of employers conducted between 1990 and 2008 from Canada, Denmark, Norway, Sweden and the UK. Results: Few studies provided robust evaluations of the programmes or their differential effects and selection of participants into programmes may distort the findings of even controlled studies. A population-level effect of legislation to combat discrimination by employers could not be detected. Workplace adjustments had positive impacts on employment, but low uptake. Financial incentives such as wage subsidies can work if they are sufficiently generous. Involving employers in return-to-work planning can reduce subsequent sick leave and be appreciated by employees, but this policy has not been taken up with the level of intensity that is likely to make a difference. Some interventions favour the more advantaged disabled people and those closer to the labour market. Conclusions: Future evaluations need to pay more attention to differential impact of interventions, degree of take-up, non-stigmatizing implementation and wider policy context in each country. [ABSTRACT FROM AUTHOR]

Aim: To analyse the current scientific knowledge and research lines focused on environmentally sustainable health systems, including the role of nurses. Background: There seem to be differences between creating interventions focused on environmentally sustainable health systems, including nurses, and the scarcity of research on this topic, framed on the Sustainable Development Goals. Methods: A bibliometric analysis was carried out, via three databases (Web of Science, Scopus and Pubmed), and the guideline recommendations were followed to select bibliometric data. Results: The search resulted in 159 publications, significantly increasing the trends from 2017 to 2021 (p =.028). The most relevant countries in this area were the United States, the United Kingdom and Sweden. Also, the top articles were from relevant journals, indexed in Journal Citation Report, and the first and the second quartiles linked to the nursing field and citations (p <.001). Conclusion: Education is key to achieving environmentally sustainable health systems via institutions and policies. Implications for Nursing Management: There is a lack of experimental data and policies on achieving or maintaining environmentally sustainable health care systems, indicating that nurses have an important role and should be consulted and included in decision‐making policies regarding sustainability in the health care systems. [ABSTRACT FROM AUTHOR]

We question why child poverty still prevails even in high-income countries, such as Japan, Sweden and the United Kingdom. We address the intersection between social relations and individual experiences that should be considered when optimising children's capability. The study is therefore aimed at exploring compensatory societal actions taken to optimise children's capability among these affluent countries. In order to do so, we operationalised children's capability by including key societal domains along with statistical indicators and variables from relevant sources. A secondary quantitative method was adopted by drawing upon data sources from 2000 up to almost 2020 from the Organisation for Economic Co-operation and Development, the World Bank and the United Nations Children's Fund, with these being complemented by governmental data. Given a lack of currently available and comparable data for those three countries, four key societal domains were explored in an absolute descriptive analysis. It is obvious that child poverty prevailed over the focal 20 years in these three high-income countries. Also, the exploratory data analysis revealed a lack of sufficient supporting social services in each societal domain. This demonstrates that optimising children's capability should not just be about subsidising economic resources, but also supporting all initiatives aimed at addressing the lack of interactions between each domain of children's capability. The study shows how essential it is to consider societal compensatory measures along with supporting the financial circumstances. We therefore argue that optimising children's capability should not only be about subsidising economic resources, but also ensuring adequate social resources and relations. [ABSTRACT FROM AUTHOR]

Objective: This study was undertaken to identify susceptibility loci for cluster headache and obtain insights into relevant disease pathways.Methods: We carried out a genome-wide association study, where 852 UK and 591 Swedish cluster headache cases were compared with 5,614 and 1,134 controls, respectively. Following quality control and imputation, single variant association testing was conducted using a logistic mixed model for each cohort. The 2 cohorts were subsequently combined in a merged analysis. Downstream analyses, such as gene-set enrichment, functional variant annotation, prediction and pathway analyses, were performed.Results: Initial independent analysis identified 2 replicable cluster headache susceptibility loci on chromosome 2. A merged analysis identified an additional locus on chromosome 1 and confirmed a locus significant in the UK analysis on chromosome 6, which overlaps with a previously known migraine locus. The lead single nucleotide polymorphisms were rs113658130 (p = 1.92 × 10-17 , odds ratio [OR] = 1.51, 95% confidence interval [CI] = 1.37-1.66) and rs4519530 (p = 6.98 × 10-17 , OR = 1.47, 95% CI = 1.34-1.61) on chromosome 2, rs12121134 on chromosome 1 (p = 1.66 × 10-8 , OR = 1.36, 95% CI = 1.22-1.52), and rs11153082 (p = 1.85 × 10-8 , OR = 1.30, 95% CI = 1.19-1.42) on chromosome 6. Downstream analyses implicated immunological processes in the pathogenesis of cluster headache.Interpretation: We identified and replicated several genome-wide significant associations supporting a genetic predisposition in cluster headache in a genome-wide association study involving 1,443 cases. Replication in larger independent cohorts combined with comprehensive phenotyping, in relation to, for example, treatment response and cluster headache subtypes, could provide unprecedented insights into genotype-phenotype correlations and the pathophysiological pathways underlying cluster headache. ANN NEUROL 2021;90:193-202. [ABSTRACT FROM AUTHOR]

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

This article puts contemporary debates about the relationship between immigration policy and the welfare state in historical perspective. Relying on new historical data, the article examines the relationship between immigration policy and social policy in Western Europe in the late 19th and early 20th centuries, when the modern welfare state emerged. Germany already had comparably strict immigration policies when the German Empire introduced the world's first national social insurances in the 1880s. Denmark, another early social-policy adopter, also pursued restrictive immigration policies early on. Almost all other countries in Western Europe started out with more liberal immigration policies than Germany's and Denmark's, but then adopted more restrictive immigration policies and more generous social policies concurrently. There are two exceptions, Belgium and Italy, which are discussed in the article. [ABSTRACT FROM AUTHOR]

Children who have parents with any kind of illness may become young carers who take a responsibility not expected of children for household tasks, or personal or emotional care for parents and siblings. So far, little is known about children in Sweden who are at risk of becoming young carers. The aim of this article is therefore to explore the extent and impact of children's caring activities as reported in a pilot study by a sample of children in Sweden. A number of international questionnaires measuring the amount of caring activities, impact of caring, quality of life, and psychological well‐being were translated and combined into a survey. The pilot survey was completed by 30 children 10–18 years of age. Also, when completing the survey, the children were interviewed concerning their experiences of caregiving. The participants report on a group level emotional symptoms such as fear and nervousness above the clinical cut‐off value. They also rate a lower level of caring compared with findings from the United Kingdom, but they report a higher degree of negative impact of caring than young carers in the United Kingdom. [ABSTRACT FROM AUTHOR]

When investigating the association between brain tumors and use of mobile telephones, accurate data on tumor position are essential, due to the highly localized absorption of energy in the human brain from the radio-frequency fields emitted. We used a point process model to investigate this association using information that included tumor localization data from the INTERPHONE Study (Australia, Canada, Denmark, Finland, France, Germany, Israel, Italy, Japan, New Zealand, Norway, Sweden, and the United Kingdom). Our main analysis included 792 regular mobile phone users diagnosed with a glioma between 2000 and 2004. Similar to earlier results, we found a statistically significant association between the intracranial distribution of gliomas and the self-reported location of the phone. When we accounted for the preferred side of the head not being exclusively used for all mobile phone calls, the results were similar. The association was independent of the cumulative call time and cumulative number of calls. However, our model used reported side of mobile phone use, which is potentially influenced by recall bias. The point process method provides an alternative to previously used epidemiologic research designs when one is including localization in the investigation of brain tumors and mobile phone use. [ABSTRACT FROM AUTHOR]

Objectives: To examine whether the mix of community and institutional long-term care (ILTC) for people with dementia (PwD) in Europe could be improved; assess the economic consequences of providing alternative services for particular groups of ILTC entrants and explore the transnational application of the ‘Balance of Care’ (BoC) approach. Method:A BoC study was undertaken in Estonia, Finland, France, Germany, the Netherlands, Spain, Sweden, and the UK as part of theRightTimePlaceCareproject. Drawing on information about 2014 PwD on the margins of ILTC admission, this strategic planning framework identified people whose needs could be met in more than one setting, and compared the relative costs of the possible alternatives. Results:The findings suggest a noteworthy minority of ILTC entrants could be more appropriately supported in the community if enhanced services were available. This would not necessarily require innovative services, but more standard care (including personal and day care), assuming quality was ensured. Potential cost savings were identified in all countries, but community care was not always cheaper than ILTC and the ability to release resources varied between nations. Conclusions: This is believed to be the first transnational application of the BoC approach, and demonstrates its potential to provide a consistent approach to planning across different health and social care systems. Better comparative information is needed on the number of ILTC entrants with dementia, unit costs and outcomes. Nevertheless, the findings offer important evidence on the appropriateness of current provision, and the opportunity to learn from different countries' experience. [ABSTRACT FROM AUTHOR]

The article discusses the population based cohort study that determined possible association between inter-hospital variation in using guideline recommended treatments and acute myocardial infarction clinical outcomes in Sweden and Great Britain, based on clinical registries. Findings discussed include higher between hospital variation in 30 day mortality for acute myocardial infarction in Great Britain, associated and partly attributed to greater variation in practice in British hospitals.

People with limiting longstanding illness and low education may experience problems in the labor market. Reduced employment protection that maintains economic security for the individual, known as “flexicurity,” has been proposed as a way to increase overall employment. We compared the development of labor market policies and employment rates from 1990 to 2010 in Denmark and the Netherlands (representing flexicurity), the United Kingdom, and Sweden. Employment rates in all countries were much lower in the target group than for other groups over the study period. However, “flexicurity” as practiced in Denmark, far from being a “magic bullet,” appeared to fail low-educated people with longstanding illness in particular. The Swedish policy, on the other hand, with higher employment protection and higher economic security, particularly earlier in the study period, led to higher employment rates in this group. Findings also revealed that economic security policies in all countries were eroding and shifting toward individual responsibility. Finally, results showed that active labor market policies need to be subcategorized to better understand which types are best suited for the target group. Increasing employment among the target group could reduce adverse health consequences and contribute to decreasing inequalities in health. [ABSTRACT FROM AUTHOR]

Background: The Seven Countries Study in the 1960s showed very low mortality from coronary heart disease (CHD) in Japan, which was attributed to very low levels of total cholesterol. Studies of migrant Japanese to the USA in the 1970s documented increase in CHD rates, thus CHD mortality in Japan was expected to increase as their lifestyle became Westernized, yet CHD mortality has continued to decline since 1970. This study describes trends in CHD mortality and its risk factors since 1980 in Japan, contrasting those in other selected developed countries.Methods: We selected Australia, Canada, France, Japan, Spain, Sweden, the UK and the USA. CHD mortality between 1980 and 2007 was obtained from WHO Statistical Information System. National data on traditional risk factors during the same period were obtained from literature and national surveys.Results: Age-adjusted CHD mortality continuously declined between 1980 and 2007 in all these countries. The decline was accompanied by a constant fall in total cholesterol except Japan where total cholesterol continuously rose. In the birth cohort of individuals currently aged 50-69 years, levels of total cholesterol have been higher in Japan than in the USA, yet CHD mortality in Japan remained the lowest: >67% lower in men and > 75% lower in women compared with the USA. The direction and magnitude of changes in other risk factors were generally similar between Japan and the other countries.Conclusions: Decline in CHD mortality despite a continuous rise in total cholesterol is unique. The observation may suggest some protective factors unique to Japanese. [ABSTRACT FROM AUTHOR]

Aims: To determine the relation between existing levels of alcohol screening and brief intervention rates in five European jurisdictions and role security and therapeutic commitment by the participating primary healthcare professionals. Methods: Health care professionals consisting of, 409GPs, 282 nurses and 55 other staff including psychologists, social workers and nurse aids from 120 primary health care centres participated in a cross-sectional 4-week survey. The participants registered all screening and brief intervention activities as part of their normal routine. The participants also completed the Shortened Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ), which measure role security and therapeutic commitment. Results: The only significant but small relationship was found between role security and screening rate in a multilevel logistic regression analysis adjusted for occupation of the provider, number of eligible patients and the random effects of jurisdictions and primary health care units (PHCU). No significant relationship was found between role security and brief intervention rate nor between therapeutic commitment and screening rate/brief intervention rate. The proportion of patients screened varied across jurisdictions between 2 and 10%. Conclusion: The findings show that the studied factors (role security and therapeutic commitment) are not of great importance for alcohol screening and BI rates. Given the fact that screening and brief intervention implementation rate has not changed much in the last decade in spite of increased policy emphasis, training initiatives and more research being published, this raises a question about what else is needed to enhance implementation. [ABSTRACT FROM AUTHOR]

Background: Diversity in Europe has both increased and become more complex posing challenges to both national and local welfare state regimes. Evidence indicates specific barriers for migrant, faith and minority ethnic groups when accessing healthcare. However, previous studies of health in diverse cities in European countries have mainly adopted an ethno-national focus. Taking into account the new complexity of diversity within cities, a deeper and multi-faceted understanding of everyday health practices in superdiverse contexts is needed to support appropriate healthcare provision. Methods/Design: This protocol describes a mixed method study investigating how residents in superdiverse neighbourhoods access healthcare. The study will include participant observation and qualitative interviewing as well as a standardised health survey and will be carried out in eight superdiverse neighbourhoods - with varying deprivations levels and trajectories of change - in four European countries (Germany, Portugal, Sweden and UK). In each neighbourhood, trained polylingual community researchers together with university researchers will map formal and informal provision and infrastructures supportive to health and healthcare. In-depth interviews with residents and healthcare providers in each country will investigate local health-supportive practices. Thematic analysis will be used to identify different types of help-seeking behaviours and support structures across neighbourhoods and countries. Using categories identified from analyses of interview material, a health survey will be set up investigating determinants of access to healthcare. Complex models, such as structural equation modelling, will be applied to analyse commonalities and differences between population groups, neighbourhoods and countries. Discussion: This study offers the potential to contribute to a deeper understanding of how residents in superdiverse neighbourhoods deal with health and healthcare in everyday practices. The findings will inform governmental authorities, formal and informal healthcare providers how to further refine health services and how to achieve equitable access in diverse population groups. [ABSTRACT FROM AUTHOR]

A UK literacy intervention – Paired Reading – was replicated in seven Swedish local authorities, with 81 foster children aged 8–12 participating in a 16-week trial. Ability was measured pre/post intervention with age-standardised literacy tests and a short version of the WISC-IV. Results confirm and expand findings from the UK, namely that: almost all foster carers and children completed the programme (attrition 2.4%), average improvement in reading age was 11 months, basically the same as in the UK; younger children (aged 8–9) improved significantly on all four administered standardised reading tests, and on the WISC-IV Vocabulary subtest. Older children (aged 10–12) improved significantly on three of five literacy tests and on the WISC-IV Vocabulary subtest. On the short version of WISC-IV, vocabulary improvements over time reduced the proportion of children who could be classified as having ‘weak cognitive skills’ (IQ<85) from 54% to 36%. This finding is in line with results from other studies, indicating that scores from cognitive tests of pre-teen children in out-of-home care should not be regarded as fixed and can be improved by effective interventions. [ABSTRACT FROM AUTHOR]

Objectives To analyse the tobacco industry’s use of international trade agreements to oppose policies to strengthen health warning labels (HWLs). Design A review of tobacco industry documents, tobacco control legislation and international treaties. Results During the early 1990s, the tobacco industry became increasingly alarmed about the advancement of HWLs on cigarettes packages. In response, it requested legal opinions from British American Tobacco’s law firms in Australia and England, Britain’s Department of Trade and Industry and the World Intellectual Property Organisation on the legality of restricting and prohibiting the use of their trademarks, as embodied in cigarette packages. The consistent legal advice, privately submitted to the companies, was that international treaties do not shield trademark owners from government limitations (including prohibition) on the use of their trademarks. Despite receiving this legal advice, the companies publicly argued that requiring large HWLs compromised their trademark rights under international treaties. The companies successfully used these arguments as part of their successful effort to deter Canadian and Australian governments from enacting laws requiring the plan packaging of cigarettes, which helped delay large graphic HWLs, including ‘plain’ packaging, for over a decade. Conclusions Governments should not be intimidated by tobacco company threats and unsubstantiated claims, and carefully craft HWL laws to withstand the inevitable tobacco industry lawsuits with the knowledge that the companies’ own lawyers as well as authoritative bodies have told the companies that the rights they claim do not exist. [ABSTRACT FROM AUTHOR]

We examine theoretical and methodological issues associated with the roles of individual and group-normative importance in self-esteem determination. Critical issues include multicollinearity among the physical self-subdomains, which may have affected previous results, and the need for a multidimensional perspective on importance models. We apply state-of-the-art methodologies, including exploratory structural equation modelling and the product-of-indicators approach to latent interactions. Positive interactions would be required to support the individually importance-weighted average model, but none were observed in the multidimensional model estimated on the full sample. Nonetheless, some interaction effects were found in the country-specific version of the model. Rather, we found support for the alternative group importance-weighted average model. We conclude that domain-specific self-concepts are weighted differently and thus differentially affect self-esteem, but these weights do not seem to depend on individual differences in importance. Although awaiting confirmation from further studies, our results suggest the idea that individuals use mainly normative importance processes based on cultural factors in weighting each domain-specific component of self-concept. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Children have a right to effective pain management and up to date guidelines are available to promote this. Despite this, many reports state that children's pain in hospital settings is not managed well, and many children are left to suffer unnecessarily. Nearly a quarter of children surveyed said they were in pain all or most of the time they were in hospital (Picker, 2005). However, this is not the whole picture; many areas deliver effective and innovative pain management for children. Aim: The aim of this travel scholarship was to undertake a study to identify innovations and learn from examples of good practice in the management of children's pain by visiting three areas of excellence in the UK, Sweden and Australia. Methods: The study took an Appreciative Inquiry approach, focusing on learning from good practice, and follows four stages: • Discovery (the best of what is): this involved visits to the three study areas and meeting practitioners, educators and researchers to explore innovations in their pain management practice Dream (what might be): this involved meeting with the host at the end of each study week to present to them identified examples of good practice for confirmation • Design (what should be): this involved writing up the findings of the three visits, exploring what innovations could be introduced to improve pain management practice across the UK • Destiny: this is dissemination and implementation of the best practice examples identified Conclusions: In each area visited, confident practitioners identified innovations in their pain management practice that have improved children's pain experience in hospital. Innovations ranged from environmental adjustments to reduce anxiety related to pain, to standardising children's observation charts to promote the regular assessment of pain. Effective leadership was apparent at each study site. Implications for practice: • Appreciative Inquiry is about identifying what works so that it can be repeated • Confidence and self-belief underpin the practice of effective pain management teams • An effective leader with a vision is needed to drive continuous improvement in the management of children's pain. [ABSTRACT FROM AUTHOR]

Different lifestyle patterns across Europe may influence plasma concentrations of B-vitamins and one-carbon metabolites and their relation to chronic disease. Comparison of published data on one-carbon metabolites in Western European regions is difficult due to differences in sampling procedures and analytical methods between studies. The present study aimed, to compare plasma concentrations of one-carbon metabolites in Western European regions with one laboratory performing all biochemical analyses. We performed the present study in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort among 5446 presumptively healthy individuals. Quantile regression was used to compare sex-specific median concentrations between Northern (Denmark and Sweden), Central (France, Germany, The Netherlands and United Kingdom) and Southern (Greece, Spain and Italy) European regions. The lowest folate concentrations were observed in Northern Europe (men, 10·4 nmol/l; women, 10·7 nmol/l) and highest concentrations in Central Europe. Cobalamin concentrations were slightly higher in Northern Europe (men, 330 pmol/l; women, 352 pmol/l) compared with Central and Southern Europe, but did not show a clear north–south gradient. Vitamin B2 concentrations were highest in Northern Europe (men, 22·2 nmol/l; women, 26·0 nmol/l) and decreased towards Southern Europe (Ptrend< 0·001). Vitamin B6 concentrations were highest in Central Europe in men (77·3 nmol/l) and highest in the North among women (70·4 nmol/l), with decreasing concentrations towards Southern Europe in women (Ptrend< 0·001). In men, concentrations of serine, glycine and sarcosine increased from the north to south. In women, sarcosine increased from Northern to Southern Europe. These findings may provide relevant information for the study of regional differences of chronic disease incidence in association with lifestyle. [ABSTRACT FROM PUBLISHER]

Background Childhood growth affects long-term health and could contribute to health inequalities that persist throughout life. Methods We compared growth data of 4-year-old to 6-year-old children born 1997–2002 in UK (n=15 168), Sweden (n=6749) and rural China (n=10 327). SD scores (SDS) were calculated against the WHO Growth Standard. Obesity and overweight were defined by the International Obesity Taskforce cut-offs, and stunting, underweight and thinness by height, weight or body mass index (BMI)<−2 SDS. Associations with maternal education were standardised by calculating the Slope Index of Inequality (SII). Results Mean SDS height, weight and BMI in the UK (−0.01, 0.42, 0.62, respectively) and Sweden (0.45, 0.59, 0.45) were higher than in China (−0.98, −0.82, −0.29). Higher maternal education was consistently associated with taller offspring height SDS (SII: UK 0.25; Sweden 0.17; China 1.06). Underweight and stunting were less common in the UK (prevalence: 0.6% and 2.2%, respectively) and Sweden (0.3% and 0.6%) than in China (9.5% and 16.4%), where these outcomes were inversely associated with maternal education (SII: −25.8% and −12.7%). Obesity prevalence in the UK, Sweden and China was 4.8%, 3.7% and 0.4%, respectively. Maternal education was inversely associated with offspring obesity in the UK (SII: −3.3%) and Sweden (−2.8%), but not in China (+0.3%). Conclusions Higher maternal education was associated with more favourable growth in young children: lower obesity and overweight in the UK and Sweden, and lower stunting and underweight in rural China. Public health strategies to optimise growth in early childhood need to acknowledge socioeconomic factors, but possibly with a different emphasis in different settings. [ABSTRACT FROM AUTHOR]

Aims and objectives. The aim of this study was to investigate, using Rasch model analysis, the measurement invariance of the item ratings of the Individualised Care Scale. Background. Evidence of reliability is needed in cross-cultural comparative studies. To be used in different cultures and languages, the items must function the same way. Design. A methodological and comparative design. Methods. Secondary analysis of data, gathered in 2005-2006 from a cross-cultural survey using the Individualised Care Scale from Finnish, Greek, Swedish and English predischarge hospitalised orthopaedic and trauma patients ( n = 1093), was used. The Rasch model, which produces calibrations (item locations and rank) and item fit statistics, was computed using the Winstep program. Results. The rank of average Individualised Care Scale item calibrations (−2·26-1·52) followed a generally similar trend (Infit ≤ 1·3), but slight differences in the item rank by country were found and some item misfit was identified within the same items. There was some variation in the order and location of some Individualised Care Scale items for individual countries, but the overall pattern of item calibration was generally corresponding. Conclusions. The Rasch model provided information about the appropriateness, sensitivity and item function in different cultures providing more in-depth information about the psychometric properties of the Individualised Care Scale instrument. Comparison of the four versions of the Individualised Care Scale - patient revealed general correspondence in the item calibration patterns although slight differences in the rank order of the items were found. Some items showed also a slight misfit. Based on these results, the phrasing and targeting of some items should be considered. Relevance to clinical practice. The Individualised Care Scale - Patient version can be used in cross-cultural studies for the measurement of patients' perceptions of individualised care. Information obtained with the use of the Individualised Care Scale in clinical nursing practice is important, and valid measures are needed in evaluating patients' assessment of individualised care, one indicator of care quality. [ABSTRACT FROM AUTHOR]

Low employment rates of chronically ill and disabled people are of serious concern. Being out of work increases the risk of poverty and social exclusion, which may further damage the health of these groups, exacerbating health inequalities. Macro-level policies have a potentially tremendous impact on their employment chances, and these influences urgently need to be understood as the current economic crisis intensifies. In Part I of this two-part study, the authors examine employment trends for people who report a chronic illness or disability, by gender and educational level, in Canada, Denmark, Norway, Sweden, and the United Kingdom in the context of economic booms and busts and deindustrialization. People with the double burden of chronic illness and low education have become increasingly marginalized from the labor market. Deindustrialization may have played a part in this process. In addition, periods of high unemployment have sparked a downward trend in employment for already marginalized groups who did not feel the benefits when the economy improved. Norway and Sweden have been better able to protect the employment of these groups than the United Kingdom and Canada. These contextual differences suggest that other macro-level factors, such as active and passive labor market polices, may be important, as examined in Part II. [ABSTRACT FROM AUTHOR]

Overweight and obese people appear to be at greater risk of suboptimal vitamin and mineral status compared with people of a healthy weight. Nutrients most affected include vitamin D, vitamin B, carotenoids, folate, vitamin C and iron. The reasons are unknown but may be caused by poor diets, increased requirements or obesity-related changes to nutrient absorption, excretion or metabolism, or a combination of these. Sequestration of fat-soluble vitamins by adipose tissues is also a major factor. Although dietary assessment in obese populations is hampered by under-reporting, there is evidence that dietary patterns characterised by energy-dense, processed foods are more common in groups with a higher body mass index. Dieting practices, bariatric surgery and the use of anti-obesity drugs may compound the risk of nutrient inadequacy, although sustained weight loss helps to improve vitamin D status. A poor nutrient status could accentuate the risk of chronic diseases already experienced by overweight people on account of their excessive fat mass. There is evidence that the use of dietary supplements can improve nutrient status and have a favourable impact on disease risk markers such as lipid profiles and insulin resistance. Whether currently dieting or not, overweight people may benefit from safeguarding vitamin and mineral adequacy by taking a multi-nutrient supplement alongside an increased intake of nutrient-rich foods. [ABSTRACT FROM AUTHOR]

Background: Healthy life years have superseded life expectancy (LE) as the most important indicator for population health. The most common approach to separate the total number of life years into those spent in good and poor health is the Sullivan method which incorporates the health dimension to the classic period life table, thus transforming the LE indicator into the health expectancy (HE) indicator. However, life years derived from a period life table and health prevalence derived from survey data are based on different conceptual frameworks. Method: We modify the Sullivan method by combining the health prevalence data with the conceptually better fitting cross-sectional average length of life (CAL). We refer to this alternative HE indicator as the "cross-sectional average length of healthy life" (HCAL). We compare results from this alternative indicator with the conventional Sullivan approach for nine European countries. The analyses are based on EU-SILC data in three empirical applications, including the absolute and relative level of healthy life years, changes between 2008 and 2014, and the extent of the gender gap. Results: HCAL and conventional HE differ in each of these empirical applications. In general, HCAL provides larger gains in healthy life years in recent years, but at the same time greater declines in the proportion of healthy life years. Regarding the gender gap, HCAL provides a more favourable picture for women compared to conventional HE. Nonetheless, the extent of these differences between the indicators is only of minor extent. Conclusions: Albeit the differences between HE and HCAL are small, we found some empirical examples in which the two indicators led to different conclusions. It is important to note, however, that the measurement of health and the data quality are much more important for the healthy life years indicator than the choice of the variant of the Sullivan method. Nonetheless, we suggest to use HCAL in addition to HE whenever possible because it widens the spectrum of empirical analyses and serves for verification of results based on the highly sensitive HE indicator. [ABSTRACT FROM AUTHOR]

Background: In most developed countries, governments are implementing policies encouraging older persons to work past 65 years to reduce the burden on societies related to disability benefits and pension payments. Despite this push to extend working lives, we know little about who already works past this age and any inequalities that may exist. Our study investigates the employment rates of those aged 65-75 years of age by educational level, health status and sex in Canada (CAN), Denmark (DK), Sweden (SE) and the United Kingdom (UK). Secondly, we aim to relate findings on employment rates to prevailing policies in the different countries, to increase the understanding on how to further extend working lives.Methods: We used nationally representative cross-sectional survey data from the 2012-2013 Canadian Community Health Survey, 2013/14 Survey of Health, Ageing and Retirement in Europe for Denmark and Sweden and the 2013 English Longitudinal Study of Ageing to examine employment rates for those aged 65-75 years by sex, educational level and health status (having limiting longstanding illness (LLI) or not).Results: Employment rates decline by age, but we see a linear decline in CAN and the UK compared to an initial decline then a plateau of employment rates from 66 to 68 years in DK and SE. Employment rates among persons aged 65-75 years were lower in the UK than in CAN, DK and SE. Among women, employment rates were highest in SE. Women with low education and a LLI had considerably lower employment rates than men with low education and a LLI (employment rates for men ranged from 27% to 12% compared with employment rates for women which ranged from 12% to 0%).Conclusions: Our results suggest that educational level, sex and health all play a role in extending working lives. The variation in employment rates between the four countries implies that policies do matter, but that social differentials show that policies cannot be 'one size fits all'. Policy-makers must consider different groups (i.e. low-educated women with a LLI) when designing policies to extend working lives. [ABSTRACT FROM AUTHOR]