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There is an increased risk of GVHD and of non-relapse mortality (NRM) after allogeneic stem cell transplantations (alloSCT) when mismatched unrelated donors (MMUD) are used. In Europe, it is standard practice to use rabbit anti-thymocyte globulin (rATG) to reduce the high NRM and GVHD risks after MMUD alloSCT. As an alternative to rATG, post-transplantation Cyclophosphamide (PTCy) is in increasing clinical use. It is currently impossible to give general recommendations regarding preference for one method over another since comparative evidence from larger data sets is lacking. To improve the evidence base, we analyzed the outcome of rATG vs. PTCy prophylaxis in adult patients with hematologic malignancies undergoing first peripheral blood alloSCT from MMUD (9/10 antigen match) between Jan 2018 and June 2021 in the database of the European Society for Blood and Marrow Transplantation (EBMT). We performed multivariate analyses using the Cox proportional-hazards regression model. We included 2123 patients in the final analyses (PTCy, n = 583; rATG, n = 1540). p values and hazard ratios (HR) presented here are multivariate outcomes. Two years after alloSCT we found a lower NRM in the PTCy group of 18% vs. 24.9% in the rATG group; p = 0.028, HR 0.74. Overall survival in the PTCy cohort was higher with 65.7% vs. 55.7% in the rATG cohort; p < 0.001, HR 0.77. Progression-free survival was also better in the PTCy patients with 59.1% vs. 48.8% when using rATG; p = 0.001, 0.78. The incidences of chronic GVHD and acute GVHD were not significantly different between the groups. We found significantly lower NRM as well as higher survival in recipients of peripheral blood alloSCTs from MMUD receiving PTCy as compared to rATG. The results of the current analysis suggest an added value of PTCy as GVHD prophylaxis in MMUD alloSCT. [ABSTRACT FROM AUTHOR]

Objectives: The use of remdesivir (RDV) as the first drug approved for coronavirus disease 2019 (COVID-19) remains controversial. Based on the Lean European Open Survey on severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infected patients (LEOSS), we aim to contribute timing-focused complementary real-world insights to its evaluation. Methods: SARS-CoV-2 infected patients between January 2020 and December 2021 treated with RDV were matched 1:1 to controls considering sociodemographics, comorbidities and clinical status. Multiple imputations were used to account for missing data. Effects on fatal outcome were estimated using uni- and multivariable Cox regression models. Results: We included 9,687 patients. For those starting RDV administration in the complicated phase, Cox regression for fatal outcome showed an adjusted hazard ratio (aHR) of 0.59 (95%CI 0.41–0.83). Positive trends could be obtained for further scenarios: an aHR of 0.51 (95%CI 0.16–1.68) when RDV was initiated in uncomplicated and of 0.76 (95% CI 0.55–1.04) in a critical phase of disease. Patients receiving RDV with concomitant steroids exhibited a further reduction in aHR in both, the complicated (aHR 0.50, 95%CI 0.29–0.88) and critical phase (aHR 0.63, 95%CI 0.39–1.02). Conclusion: Our study results elucidate that RDV use, in particular when initiated in the complicated phase and accompanied by steroids is associated with improved mortality. However, given the limitations of non-randomized trials in estimating the magnitude of the benefit of an intervention, further randomized trials focusing on the timing of therapy initiation seem warranted. [ABSTRACT FROM AUTHOR]

Background and purpose -- Antibiotic-loaded bone cement (ALBC) and systemic antibiotic prophylaxis (SAP) have been used to reduce periprosthetic joint infection (PJI) rates. We investigated the use of ALBC and SAP in primary total knee arthroplasty (TKA). Patients and methods -- This observational study is based on 2,971,357 primary TKAs reported in 2010-2020 to national/regional joint arthroplasty registries in Australia, Denmark, Finland, Germany, Italy, the Netherlands, New Zealand, Norway, Romania, South Africa, Sweden, Switzerland, the UK, and the USA. Aggregate-level data on trends and types of bone cement, antibiotic agents, and doses and duration of SAP used was extracted from participating registries. Results -- ALBC was used in 77% of the TKAs with variation ranging from 100% in Norway to 31% in the USA. Palacos R+G was the most common (62%) ALBC type used. The primary antibiotic used in ALBC was gentamicin (94%). Use of ALBC in combination with SAP was common practice (77%). Cefazolin was the most common (32%) SAP agent. The doses and duration of SAP used varied from one single preoperative dosage as standard practice in Bolzano, Italy (98%) to 1-day 4 doses in Norway (83% of the 40,709 TKAs reported to the Norwegian arthroplasty register). Conclusion -- The proportion of ALBC usage in primary TKA varies internationally, with gentamicin being the most common antibiotic. ALBC in combination with SAP was common practice, with cefazolin the most common SAP agent. The type of ALBC and type, dose, and duration of SAP varied among participating countries. [ABSTRACT FROM AUTHOR]

We examine sex differences in quality of life (QoL) and depressive symptoms across age and European regions. We performed a large cross-sectional study based on 64,552 women and 53,647 men aged 50+ who participated in the Survey of Health, Ageing and Retirement in Europe (SHARE) from 2004-2020. Linear and logistic regression models were used to examine associations with QoL (CASP-12) and depressive symptoms (EURO-D). Women reported slightly lower QoL (coefficient −0.78, 95% CI −0.92; −0.65) and more depressive symptoms (odds ratio (OR) 2.23, 95% CI 2.13; 2.34) than men. Sex differences in QoL increased with advancing age, whereas sex differences in depressive symptoms were stable across age groups. No overall sex difference in QoL was found in Northern Europe, but women had lower QoL than men in Western (coefficient −0.49, 95% CI −0.69; −0.29), Southern (coefficient −1.35, 95% CI −1.61; −1.09) and Eastern (coefficient −0.72, 95% CI −1.05; −0.39) Europe. However, sex differences varied within the specific CASP-12 items, with women having overall lower control and autonomy, but more self-realisation, than men. Women reported more depressive symptoms than men in all regions, with the largest overall sex difference in Southern Europe (OR 2.62, 95% CI 2.40; 2.86). A female disadvantage was found for most of the EURO-D items, with the largest sex differences for 'tearfulness', 'depression' and 'sleep'. Middle-aged and elderly European women report lower QoL and more depressive symptoms than European men, lending support for the male-female health survival paradox. [ABSTRACT FROM AUTHOR]

• Wars are associated with an increase in TB burden • With the ongoing war, the risk of a massive deterioration of TB management is huge • Europe must find the resources to take care of the health needs of refugees • Scaling up screening of TB infection and disease and treatment is essential [ABSTRACT FROM AUTHOR]

This article examines which economic domains regional policy makers aim to develop in regional innovation strategies, focusing in particular on the complexity of those economic domains and their relatedness to other economic domains in the region. We build on the economic geography literature that advises policy makers to target related and complex economic domains, and assess the extent to which regions actually do this. The article draws on data from the smart specialization strategies of 128 NUTS-2 regions across Europe. While regions are more likely to select complex economic domains related to their current economic domain portfolio, complexity and relatedness figure independently, rather than in combination, in choosing priorities. We also find that regions in the same country tend to select the same priorities, contrary to the idea of a division of labor across regions that smart specialization implies. Overall, these findings suggest that smart specialization may be considerably less place based in practice than it is in theory. There is a need to develop better tools to inform regions' priority choices, given the importance of priority selection in smart specialization strategies and regional innovation policy more broadly. [ABSTRACT FROM AUTHOR]

Context. The European roe deer owes its ability to digest fibre to its microbiome. This is made up of many different species at different levels of abundance and with different differentiations. In Europe, the roe deer is often classified as a so-called 'concentrate selector'. This term has often been interpreted by different researchers to mean a selector of either protein- or energy-rich food. According to various studies, this selection behaviour is due to the low abundance of fibre-degrading microorganisms. Aims. The aim of the present study was to determine the concentration of crude nutrients in the rumen of roe deer, with the focus on the fibre fractions, and to show changes among seasons and between habitats. Furthermore, the aim was to find out how far the composition of the ruminal microbiota adapts to these changes. Methods. From 2011 to 2014, we collected the rumens of 245 roe deer in two Bavarian habitat types, a forest and an agricultural habitat. The crude nutrient contents and the size of the total microbiome and the proportions of individual genera were determined in the rumen content. Key results. The average annual concentration of crude fibre in the ingested food is 26–30% and this rises to 38% in certain months. The forest roe deer had the highest proportions of crude fibre in their food and the concentrations of other nutrients were also highly dependent on the season and habitat. Furthermore, the animals also have far less protein in their rumen content than often assumed. The total number of microorganisms in the rumens of the forest deer is significantly higher than in animals living in the agricultural area. The number of microorganisms was highest in the forest roe deer in winter, and in the roe deer from the agricultural area in summer. Clear connections can also be seen between individual groups of microorganisms and particular crude nutrients. The high crude-fibre concentration leads to a high number of fibre-degrading microorganisms, such as, for example, anaerobic fungi or the Ruminococcus flavefaciens. Conclusions. The results showed a high adaptability of the animals to a fibre-rich diet. The microbiome adapts very well to the respective nutrient availabilities. This, in turn, is what allows the roe deer to adapt so readily to diverse habitats and environmental conditions. Implications. Due to the generally high concentrations of fibre, combined with the high numbers of fibre-degraders in the rumen, we suggest that, from now on, we should talk of a roe deer as being a 'selector' or 'browser' rather than a 'concentrate selector'. European Roe deer are ruminants and are able to digest a variety of plant constituents, especially fibre. They owe their ability to do this to the microorganisms in their rumens, which make the nutrients in their food available to them. The composition of the microbiome changes continuously, depending on the given food and allows the animals to adapt very well to the changing food availability, conditioned by different seasons and habitats. [ABSTRACT FROM AUTHOR]

Background: Knowledge about the population's iodine status is important, because it allows adjustment of iodine supply and prevention of iodine deficiency. The validity and comparability of iodine-related population studies can be improved by standardization, which was one of the goals of the EUthyroid project. The aim of this study was to establish the first standardized map of iodine status in Europe by using standardized urinary iodine concentration (UIC) data. Materials and Methods: We established a gold-standard laboratory in Helsinki measuring UIC by inductively coupled plasma mass spectrometry. A total of 40 studies from 23 European countries provided 75 urine samples covering the whole range of concentrations. Conversion formulas for UIC derived from the gold-standard values were established by linear regression models and were used to postharmonize the studies by standardizing the UIC data of the individual studies. Results: In comparison with the EUthyroid gold-standard, mean UIC measurements were higher in 11 laboratories and lower in 10 laboratories. The mean differences ranged from −36.6% to 49.5%. Of the 40 postharmonized studies providing data for the standardization, 16 were conducted in schoolchildren, 13 in adults, and 11 in pregnant women. Median standardized UIC was <100 μg/L in 1 out of 16 (6.3%) studies in schoolchildren, while in adults 7 out of 13 (53.8%) studies had a median standardized UIC <100 μg/L. Seven out of 11 (63.6%) studies in pregnant women revealed a median UIC <150 μg/L. Conclusions: We demonstrate that iodine deficiency is still present in Europe, using standardized data from a large number of studies. Adults and pregnant women, particularly, are at risk for iodine deficiency, which calls for action. For instance, a more uniform European legislation on iodine fortification is warranted to ensure that noniodized salt is replaced by iodized salt more often. In addition, further efforts should be put on harmonizing iodine-related studies and iodine measurements to improve the validity and comparability of results. [ABSTRACT FROM AUTHOR]

Seafood can be a source of contaminants, which may raise health concerns. The aim of this study was to analyse the levels of inorganic contaminants in commercially available seafood products and assess consumer exposure. Commercially available samples were collected from 2015–2018 and analysed as composite samples for mercury, lead, arsenic, and cadmium, using accredited methods. Levels of cadmium, lead, and arsenic were low and human exposure of these metals would be minimal from consumption of the analysed seafood products. Mercury levels were well below the EU maximum limit for mercury in fish. However, children, who are high consumers, might be at risk of exceeding the tolerable weekly intake for methyl mercury, when eating products with the highest mercury levels. The collected data can be used for future risk-benefit assessments as intake of processed seafood products represent a large proportion of the populations' seafood intake in Europe. [ABSTRACT FROM AUTHOR]

Aims: The so-called 'Great Recession' in Europe triggered widespread concerns about population health, as reflected by an upsurge in empirical research on the health impacts of the economic crisis. A growing body of empirical studies has also been devoted to socioeconomic inequalities in health during the Great Recession. The aim of the current study is to summarise this health inequality literature by means of a scoping review. Methods : We have performed a scoping review of the research literature (English language) published in the years 2012–2017. Only empirical papers with (a) health status measured on the individual level, (b) information on socioeconomic position (i.e. employment status, educational level, income/wealth, and/or occupational class), and (c) data from European countries in both pre- and post-crisis years were considered relevant. In total, 49 empirical studies fulfilled these inclusion criteria. Results : The empirical findings in the 49 included studies predominantly show that socioeconomic inequalities in health either increased or remained stable from pre- to post-crisis years. Two-thirds (65%) of the studies found evidence of either increasing or partially increasing health inequalities. Thus, people in lower socioeconomic strata fared worse overall in terms of health during the Great Recession, compared to people with higher socioeconomic status. Conclusions : The Great Recession in Europe tends to be followed by increasing socioeconomic inequalities in health. Policymakers should take note of this finding. Widening socioeconomic inequalities in health is a major cause of concern, in particular if health deterioration among 'vulnerable groups' is caused by accelerating cumulative disadvantages. [ABSTRACT FROM AUTHOR]

The annual meeting of the European Association of Cardiovascular Imaging, EuroEcho-Imaging, was held in Milan, Italy, in December 2018. In the present paper, we report a summary of the 'Highlights' session. [ABSTRACT FROM AUTHOR]

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

Background: Although examining perspectives of patients on integrated palliative care organisation is essential, available literature is largely based on administrative data or healthcare professionals' perspectives. Aim: (1) Providing insight into the composition and quality of care networks of patients receiving palliative care and (2) describing perceived integration between healthcare professionals within these networks and its association with overall satisfaction. Design: Cross-sectional explorative design. Setting/participants: We recruited 157 patients (62% cancer, 25% chronic obstructive pulmonary disease, 13% chronic heart failure, mean age 68 years, 55% female) from 23 integrated palliative care initiatives in Belgium, Germany, the United Kingdom, Hungary and the Netherlands. Results: About 33% reported contact with a palliative care specialist and 48% with a palliative care nurse. Relationships with palliative care specialists were rated significantly higher than other physicians (p < 0.001). Compared to patients with cancer, patients with chronic obstructive pulmonary disease (odds ratio = 0.16, confidence interval (0.04; 0.57)) and chronic heart failure (odds ratio = 0.11, confidence interval (0.01; 0.93)) had significantly lower odds of reporting contact with palliative care specialists and patients with chronic obstructive pulmonary disease (odds ratio = 0.23, confidence interval (0.08; 0.71)) had significantly lower odds of reporting contact with palliative care nurses. Perceptions of main responsible healthcare professionals or caregivers in patient's care networks varied across countries. Perceived integration was significantly associated with overall satisfaction. Conclusion: Palliative care professionals are not always present or recognised as such in patients' care networks. Expert palliative care involvement needs to be explicated especially for non-cancer patients. One healthcare professional should support patients in understanding and navigating their palliative care network. Patients seem satisfied with care provision as long as continuity of care is provided. [ABSTRACT FROM AUTHOR]

Abstract: This paper investigates the association between the Great Recession and educational inequalities in self‐rated general health in 25 European countries. We investigate four different indicators related to economic recession: GDP; unemployment; austerity and a ‘crisis’ indicator signifying severe simultaneous drops in GDP and welfare generosity. We also assess the extent to which health inequality changes can be attributed to changes in the economic conditions and social capital in the European populations. The paper uses data from the European Social Survey (2002–2014). The analyses include both cross‐sectional and lagged associations using multilevel linear regression models with country fixed effects. This approach allows us to identify health inequality changes net of all time‐invariant differences between countries. GDP drops and increasing unemployment were associated with decreasing health inequalities. Austerity, however, was related to increasing health inequalities, an association that grew stronger with time. The strongest increase in health inequality was found for the more robust ‘crisis’ indicator. Changes in trust, social relationships and in the experience of economic hardship of the populations accounted for much of the increase in health inequality. The paper concludes that social policy has an important role in the development of health inequalities, particularly during times of economic crisis. [ABSTRACT FROM AUTHOR]

In Europe over the last two decades, marketization has become an important policy option in elder care. Comparative studies predominantly adopt an institutional perspective and analyze the politics and policies of marketization. This analysis takes a step back and examines the fundamental ideas underpinning the policies of marketization, using the 'What's the problem?' approach by Carol Bacchi. The central question is how the market was discursively framed as the solution to the perceived problems of three different systems of elder care, and how such processes are similar or different across the three countries. The analysis includes two extreme types of elder care systems, the Nordic public systems in Denmark and Finland, and the Southern European family-based model in Italy. Empirically, the analysis offers interesting insights into processes of constructing and legitimating markets at the level of discourse; this occurs by defining specific problem representations, underlying assumptions and silences. In all three countries, marketization is presented as a solution which builds on rather than challenges dominant ideas of care. Conceptually, in addition to its institutions, it is crucial to understand the ideas behind the marketization of elder care. Ideas emerge as a key leverage for making policies and practices of marketization acceptable and which decision makers and other influential political/societal actors use in policy and public debates. The importance of ideas is further underlined by the fact that they do not necessarily relate to the institutions of elder care systems in a linear way. [ABSTRACT FROM AUTHOR]

Background and purpose -- Routine outcome measurement has been shown to improve performance in several fields of healthcare. National spine surgery registries have been initiated in 5 Nordic countries. However, there is no agreement on which outcomes are essential to measure for adolescent and young adult patients with a spinal deformity. The aim of this study was to develop a core outcome set (COS) that will facilitate benchmarking within and between the 5 countries of the Nordic Spinal Deformity Society (NSDS) and other registries worldwide. Material and methods -- From August 2015 to September 2016, 7 representatives (panelists) of the national spinal surgery registries from each of the NSDS countries participated in a modified Delphi study. With a systematic literature review as a basis and the International Classification of Functioning, Disability and Health framework as guidance, 4 consensus rounds were held. Consensus was defined as agreement between at least 5 of the 7 representatives. Data were analyzed qualitatively and quantitatively. Results -- Consensus was reached on the inclusion of 13 core outcome domains: "satisfaction with overall outcome of surgery", "satisfaction with cosmetic result of surgery", "pain interference", physical functioning", "health-related quality of life", "recreation and leisure", "pulmonary fatigue", "change in deformity", "selfimage", "pain intensity", "physical function", "complications", and "re-operation". Panelists agreed that the SRS-22r, EQ-5D, and a pulmonary fatigue questionnaire (yet to be developed) are the most appropriate set of patient-reported measurement instruments that cover these outcome domains. Interpretation -- We have identified a COS for a large subgroup of spinal deformity patients for implementation and validation in the NSDS countries. This is the first study to further develop a COS in a global perspective. [ABSTRACT FROM AUTHOR]

Regulatory approval of the first biosimilar insulin in Europe, LY2963016 insulin glargine (Abasaglar®), in 2014 expanded the treatment options available to people with diabetes. As biosimilar insulin products come to market, it is important to recognize that insulin products are biologicals manufactured through complex biotechnology processes, and thus biosimilar insulins cannot be considered identical to their reference products. Strict regulatory guidelines adopted by authorities in Europe, the USA and some other countries help to ensure that efficacy and safety profiles of biosimilar insulins are not meaningfully different from those of the reference products, preventing entry of biological compounds not meeting quality standards and potentially affecting people's glycaemic outcomes. This review explains the concept of biosimilar medicines and outlines regulatory requirements for registration of biosimilar insulins in Europe, which is illustrated by the successful development of LY2963016 insulin glargine and MK-1293 insulin glargine (Lusduna®). Preclinical and clinical comparative studies of the biosimilar insulin glargine programmes include in vitro bioassays for insulin and insulin-like growth factor 1 receptor binding, assessment of in vitro biological activity, evaluation of pharmacokinetic/pharmacodynamic profiles in phase I studies and assessment of long-term safety and efficacy in phase III studies. The emergence of biosimilar insulins may help broaden access to modern insulins, increase individualized treatment options and reduce costs of insulin therapy. [ABSTRACT FROM AUTHOR]

Aims: Based on the ideal type classification of European countries done in Part I of this paper, Part II explores whether the real ‘danger’ to public health is the interplay between austerity and crisis, rather than recession itself. Methods: We constructed two fuzzy sets of changes in population health based on a pooled file of European Union Statistics on Income and Living Conditions (EU-SILC) data (2008 and 2013) including 29 European countries. The linear probability analyses of ‘limiting long-standing illness’ and ‘less than good’ health were restricted to the age group 20–64 years. We performed fuzzy set qualitative comparative analysis (fsQCA) and studied whether configurations of ‘severe crisis’ and ‘austerity’ were linked to changes in population health. Results: Overall, the results of this fsQCA do not support the ‘crisis–austerity’ thesis. Results on ‘less than good’ health were highly inconsistent, while results on ‘limiting long-standing illness’, contrary to the thesis, showed a two-path model. Countries with either no severe crisis or no austerity were subsets of the set of countries that experienced deteriorated health. Results also show that several countries combined both paths. Conclusions: This fuzzy set analysis does not support Stuckler and Basu’s ‘crisis–austerity’ thesis, as those European countries that experienced recession and austerity were not consistently the countries with deteriorating health. There may be multiple reasons for this result, including analytical approach and operationalization of key concepts, but also resilient forces such as family support. We suggest more research on the topic based on more recent data and possibly other, or more, dimensions of austerity. [ABSTRACT FROM AUTHOR]

Aims: This is the first part of a two-part paper that takes an explorative approach to assess crisis and austerity in European countries during the Great Recession. The ultimate aim of this two-part paper is to explore the “crisis–austerity” thesis by Stuckler and Basu and assess whether it is the interplay between austerity and crisis, rather than the current economic crisis per se, that can led to deterioration in population health. In Part I of this paper we offer one way of operationalizing crisis severity and austerity. We examine countries as specific configurations of crisis and policy responses and classify European countries into “ideal types.” Methods: Cases included were 29 countries participating in the European Union Statistics on Income and Living Conditions (EU-SILC) surveys. Based on fuzzy set methodology, we constructed two fuzzy sets, “austerity” and “severe crisis.” Austerity was measured by changes in welfare generosity; severe crisis was measured by changes in gross domestic product (GDP) per capita growth. Results: In the initial phase of the Great Recession, most countries faced severe crisis combined with no austerity. From 2010–2011 onward, there was a divide between countries. Some countries consistently showed signs of austerity policies (with or without severe crisis); others consistently did not. Conclusions: The fuzzy set ideal-type analysis shows that the European countries position themselves, by and large, in configurations of crisis and austerity in meaningful ways that allow us to explore the “crisis–austerity” thesis by Stuckler and Basu. This exploration is the undertaking of Part II of this paper. [ABSTRACT FROM AUTHOR]

Background: Changes over time in self-rated health (SRH) are increasingly documented during the current economic crisis, though whether these are due to selection, causation, or methodological artefacts is unclear. This study accordingly investigates changes in SRH, and social inequalities in these changes, before and during the economic crisis in 23 European countries. Methods: We used balanced panel data, 2005-2011, from the European Union Statistics on Income and Living Conditions (EU-SILC). We included the working-age population (25-60 years old) living in 23 European countries. The data cover 65,618 respondents, 2005-2007 (pre-recession cohort), and 43,188 respondents, 2008-2011 (recession cohort). The data analyses used mixed-effects ordinal logistic regression models considering the degree of recession (i.e., pre, mild, and severe). Results: Individual-level changes in SRH over time indicted a stable trend during the pre-recession period, while a significant increasing trend in fair and poor SRH was found in the mild- and severe-recession cohorts. Micro-level demographic and socio-economic status (SES) factors (i.e., age, gender, education, and transitions to employment/unemployment), and macro-level factors such as welfare generosity are significantly associated with SRH trends across the degrees of recession. Conclusions: The current economic crisis accounts for an increasing trend in fair and poor SRH among the general working-age population of Europe. Despite the general SES inequalities in SRH, the health of vulnerable groups has been affected the same way before and during the current recession. [ABSTRACT FROM AUTHOR]

Background: Access to many controlled medicines is inadequate in a number of European countries. This leads to deficits in the treatment of moderate to severe pain as well as in opioid agonist therapy. Objective: The study objective was to elaborate the reasons for this inadequacy. The work plan of the Access to Opioid Medication in Europe (ATOME) project included two six-country workshops. These workshops comprised a national situational analysis, drafting tailor-made recommendations for improvement and developing action plans for their implementation. Methods: In total, 84 representatives of the national Ministries of Health, national controlled substances authorities, experts representing regulatory and law enforcement authorities, leading health care professionals, and patient representatives from 13 European countries participated in either one of the workshops. The delegates used breakout sessions to identify key common challenges. Content analysis was used for the evaluation of protocols and field notes. Results: A number of challenges to opioid accessibility in the countries was identified in the domains of knowledge and educational, regulatory, legislative, as well as public awareness and training barriers that limit opioid prescription. In addition, short validity of prescriptions and bureaucratic practices resulting in overregulation impeded availablity of some essential medicines. Stigmatization and criminalisation of people who use drugs remained the major impediment to increasing opioid agonist program coverage. Conclusions: The challenges identified during outcomes of the workshops were used as the basis for subsequent dissemination and implementation activities in the ATOME project, and in some countries the workshop proceedings already served as a stepping-stone for the first changes in regulations and legislation. [ABSTRACT FROM AUTHOR]

The article presents a study on the work commitment comparison between immigrant workers from Poland and native workers in Norway. It states that a survey was conducted through questionnaire distribution among Polish migrant workers in cleaning and construction business. It mentions that the survey results has been compared earlier native workers study. It says that migrant workers have higher job stress, more mental health problems, and more over-commitment that native workers. It adds that immigrant's personal ambition has been determined as the cause of their higher level of over-commitment.

We present findings from an anthropological field study on the role of language and language policy in migration from Poland to Norway, and the larger implications for emerging language and immigration policy in Europe. Initial fieldwork in Norway found that Polish workers without knowledge of the Norwegian language struggled to secure employment in the formal economy. The 2008 financial crisis intensified competition in the labour market and underscored fluency in Norwegian as a means of discriminating among workers. Comparative case studies of language schools revealed that these organizations are active participants in channeling Polish migrants' movements into a segmented labour market, often in ways that involve cooperation between private companies and the State. We frame the Norwegian case within the larger context of Europe and the trend there toward favoring integration over multiculturalism. The emergence of restrictive language policies in Europe may be interpreted as a legally and culturally acceptable means for discouraging access to rights associated with permanent residency or citizenship by work migrants from CEE countries, while at the same time permitting them access to the labour market for temporary work. The long-term consequences of such policies for European society are uncertain. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this paper was to investigate the association between health, social position, social participation and the welfare state. Extending recent research on the social consequences of poor health, we asked whether and how welfare generosity is related to the risk of social exclusion associated with combinations of poor health, low education and economic inactivity. Methods: Our analyses are based on data from the European Social Survey, round 3 (2006/7), comprising between 21,205 and 21,397 individuals, aged 25--59 years, within 21 European welfare states. The analyses were conducted by means of multilevel logistic regression analysis in STATA 12. Results: The results demonstrated that the risk of non-participation in social networks decreased as welfare generosity increased. The risk of social exclusion, i.e. non-participation in social networks among disadvantaged groups, seldom differed from the overall association, and in absolute terms it was invariably smaller in more generous welfare state contexts. Conclusions: The results showed that there were no indications of higher levels of non-participation among disadvantaged groups in more generous welfare states. On the contrary, resources made available by the welfare state seemed to matter to all individuals in terms of overall lower levels of non-participation. As such, these results demonstrate the importance of linking health related social exclusion to the social policy context. [ABSTRACT FROM AUTHOR]

Background Carrot is a frequent cause of food allergy in Europe. The objective of this study was to evaluate a panel of carrot allergens for diagnosis of carrot allergy in Spain, Switzerland and Denmark. Methods Forty-nine carrot allergic patients, 71 pollen allergic but carrot-tolerant patients and 63 nonatopic controls were included. Serum Ig E to carrot extract, recombinant carrot allergens (r Dau c 1.0104; r Dau c 1.0201; r Dau c 4; the isoflavone reductase-like proteins r Dau c I FR 1, r Dau c IFR 2; the carrot cyclophilin r Dau c Cyc) were analyzed by Immuno CAP. Results The sensitivity of the carrot extract-based test was 82%. Use of the recombinant allergens increased the sensitivity to 90%. The Dau c 1 isoforms were major allergens for Swiss and Danish carrot allergic patients, the profilin r Dau c 4 for the Spanish patients. The r Dau c IFR 1 and r Dau c IFR 2 were recognized by 6% and 20% of the carrot allergics, but did not contribute to a further increase of sensitivity. Among pollen allergic controls, 34% had Ig E to carrot extract, 18% to each of r Dau c 1.0104, r Dau c 1.0201 and r Dau c 4, 8% to r Dau c IFR 1 and 7% to r Dau c IFR 2. Sensitization to r Dau c Cyc occurred in one carrot allergic patient and one nonatopic control. Conclusion Component-resolved in vitro analyses revealed a significant difference in Ig E sensitization pattern between geographical regions and in the prevalence of sensitization to carrot components between carrot allergic and carrot-tolerant but pollen sensitized patients. [ABSTRACT FROM AUTHOR]

The authors reflect on testicular cancer and on testicular germ cell tumors. They suggest that a large geographical variation in the incidence of testicular germ cell cancers has puzzled researchers who are interested in testicular cancer epidemiology. They argue that in 2012 there are still many questions which need to be answered regarding testicular cancer and its treatment and that medical professionals should be encouraged by progress which has been made in the area since 1982.

Abstract: The aim of this paper is to examine educational inequalities in the risk of non-employment among people with illnesses and how they vary between European countries with different welfare state characteristics. In doing so, the paper adds to the growing literature on welfare states and social inequalities in health by studying the often overlooked ‘sickness’-dimension of health, namely employment behaviour among people with illnesses. We use European Union Statistics on Income and Living Conditions (EU-SILC) data from 2005 covering 26 European countries linked to country characteristics derived from Eurostat and OECD that include spending on active labour market policies, benefit generosity, income inequality, and employment protection. Using multilevel techniques we find that comprehensive welfare states have lower absolute and relative social inequalities in sickness, as well as more favourable general rates of non-employment. Hence, regarding sickness, welfare resources appear to trump welfare disincentives. [Copyright &y& Elsevier]

Ovarian cancer (OVCA) and soft tissue sarcoma (STS) are cancers that cause low survival rates when diagnosed at advanced disease stage and patients with these cancers usually suffer from recurrent disease. Trabectedin, an alkaloid of marine origin has recently demonstrated improvement in managing advanced recurrent OVCA and STS. It is currently approved as a single therapeutic agent for second line therapy of STS in the USA and Europe. It is also approved in combination with pegylated liposomal doxorubicin as a second line therapy for OVCA in Europe. This review summarizes recent clinical data demonstrating the efficacy of using trabectedin as a second line therapy in OVCA and in STS. [ABSTRACT FROM AUTHOR]

What has been the quantitative effect on productivity growth of information and communication technology (ICT) in Europe after 1995? Based on a multi-country sectoral panel data set, the authors provide econometric evidence of positive and significant productivity effects of ICT in Europe, mainly due to advances in total factor productivity. The impact of ICT in Europe has happened against a negative macro economic shock not related to ICT. This is in contrast to the established evidence for the US. Our main results challenge the consensus in the growth-accounting literature that there has been no acceleration of productivity growth in Europe, mainly due to a dismal performance of ICT-using sectors. [ABSTRACT FROM AUTHOR]

We hypothesize that fundamental features that distinguish European capital markets have predictably influenced emerging national differences in bank capitalization and loan growth. Using bank-level data from 13 European countries, 1998 to 2004, we find evidence of positive effects of “equity-friendly” market features on bank capitalization and positive effects of both “equity-friendly” and “credit-friendly” market features on loan growth. The findings are strongest in small banks and in banks with cooperative charters. Our results suggest that ongoing and prospective integration of European banking markets is mitigated by relatively static features of the equity and credit markets on which banks rely. [ABSTRACT FROM AUTHOR]

Abstract: Gaucher disease is the first lysosomal disorder for which clinically effective enzyme replacement therapy has been introduced. Lifelong treatment with imiglucerase, the recombinant glucocerebrosidase manufactured by the Genzyme Corporation (MA, USA), is administered intravenously — usually at biweekly intervals. An acute shortage of imiglucerase (to 20% of prior global supply) has occurred as a result of viral contamination of the production facility; production was halted, and a full supply of imiglucerase is not anticipated until January 2010. An urgent meeting of physicians, researchers, and patients was convened through the agency of the European Working Group for Gaucher Disease; this was instigated by patients internationally represented by the European Gaucher Alliance. Here we present a position statement based on the findings of the group, with key recommendations about identification and monitoring of at-risk patients threatened by the abrupt withdrawal of treatment, the equitable distribution of residual imiglucerase — and access to alternative treatments including those that have completed phase III clinical trials but have not yet been licensed. [Copyright &y& Elsevier]

Aim To test the hypothesis that animal communities within environmentally relatively uniform lowland forests are characterized by low beta diversity, both in tropical and in temperate areas. Location Lowland forests in the basins of the Sepik and Ramu rivers in New Guinea, the Amazon river in Bolivia, and the Elbe and Dyje rivers in the Czech Republic. Methods A network of 5–6 study sites spanning distances from 20–80 to 300–500 km in each study area was systematically surveyed for all frogs, using visual detection and call tracking. The community data were analysed for alpha and beta diversity. Results Local (alpha) diversity of frog communities was similar in the two tropical areas, New Guinea (mean ± SE of 22 ± 1.4 species per site) and Amazonia (24 ± 1.7 species), but was significantly lower in Europe (8 ± 0.8 species). In Amazonia, 36 of the total of 70 species were recorded from single sites. In contrast, widespread species dominated in Europe, whereas New Guinea exhibited an intermediate pattern with both local and widespread species well represented. The rate of species accumulation across different sites was lowest in Europe, intermediate in New Guinea and highest in Amazonia. The regional species diversity, expressed as the combined number of species from five study sites, was 1.5 times higher than the local species diversity at a single site in Europe, 2.0 times higher in New Guinea and 2.7 times higher in Amazonia. The proportion of species shared between communities decreased with geographic distance in New Guinea and Europe, but not in Amazonia. Main conclusions Frog communities in the lowland tropical rain forests of New Guinea and Amazonia had similar numbers of species, but differed in their beta diversity. More species in Amazonia had restricted distributions than in New Guinea. Both tropical areas had markedly higher alpha and beta diversity than the temperate area in Europe. [ABSTRACT FROM AUTHOR]

In the acceleration phase transitions often increase in depth and scope, and thereby create knock-on effects for wider system structures. In the renewable energy transition, for example, higher shares of intermittent renewable energy sources call for new grid technologies to increase flexible grid operation. At the same time, there are different ways of achieving renewable energy transitions and providing flexibility. In Europe, important tensions exist over how centralised or decentralised a renewable energy electricity system should be. This paper explores to what extent and how European framework programmes for research and development have addressed and supported innovation in transmission grid (centralised system) and distribution grid (decentralised) technologies. We analyse European R&D projects that studied electricity grid planning, development and innovation over 2002–2020. We apply social network analysis of the collaboration partners in these projects, and analyse the calls for proposals issued by three European Framework Programmes: FP6, FP7 and Horizon 2020. The framework programmes have addressed energy-related issues, but the priorities have changed over time, reflecting the ongoing energy transition. We ask if the importance of transmission grid vs. distribution grid has changed over time, and if and how the collaboration patterns have changed. [ABSTRACT FROM AUTHOR]

Opinions, rankings and evaluations of states' performances are proliferating. In the context of the transformation and EU accession of Central and East European (CEE) states, there were many organizations involved in the scrutiny of their efforts to become accepted as modern and European. A main argument is that by evaluating and reporting on states, the European Commission can be analyzed as an "auditor" of transformations in applicant states. The empirical base consists of interviews with officials of the national administrations in Estonia, Latvia and Lithuania as well as at the European Commission. The European Commission Regular Reports are also studied. The findings are analyzed by using audit concepts combined with ideas from the field of transnational regulation of states. The monitoring of the Commission is described as producing comfort and as creating a mutual base of interest. [ABSTRACT FROM AUTHOR]

Allergology and Clinical Immunology (ACI) is an area of clinical medicine with a precise identity, relevant recent scientific achievements and well-defined educational and professional needs. In spite of the high individual and socio-economic impact of allergic diseases in Europe, the organization of ACI services is imperfect and varies among countries according to their health policies and priorities. In the firm belief of the role of ACI specialists in addressing clinical issues related to the involvement of the immune system in health and diseases—such as vaccination, immunodeficiencies, susceptibility and response to microbial agents, autoimmune and allergic diseases, immune aspects of transplantation and malignancies, in vivo and in vitro immunological tests, vaccinations, immuno-modifiers—the European Academy of Allergology and Clinical Immunology appointed an ad hoc Task Force to produce standards for ACI Services in Europe. The resulting position paper should be used as a consulting reference for National Health Services as a necessary pre-requisite for the free circulation to patients and health care professionals. [ABSTRACT FROM AUTHOR]

Global climate change impacts can already be tracked in many physical and biological systems; in particular, terrestrial ecosystems provide a consistent picture of observed changes. One of the preferred indicators is phenology, the science of natural recurring events, as their recorded dates provide a high-temporal resolution of ongoing changes. Thus, numerous analyses have demonstrated an earlier onset of spring events for mid and higher latitudes and a lengthening of the growing season. However, published single-site or single-species studies are particularly open to suspicion of being biased towards predominantly reporting climate change-induced impacts. No comprehensive study or meta-analysis has so far examined the possible lack of evidence for changes or shifts at sites where no temperature change is observed. We used an enormous systematic phenological network data set of more than 125 000 observational series of 542 plant and 19 animal species in 21 European countries (1971–2000). Our results showed that 78% of all leafing, flowering and fruiting records advanced (30% significantly) and only 3% were significantly delayed, whereas the signal of leaf colouring/fall is ambiguous. We conclude that previously published results of phenological changes were not biased by reporting or publication predisposition: the average advance of spring/summer was 2.5 days decade−1 in Europe. Our analysis of 254 mean national time series undoubtedly demonstrates that species' phenology is responsive to temperature of the preceding months (mean advance of spring/summer by 2.5 days°C−1, delay of leaf colouring and fall by 1.0 day°C−1). The pattern of observed change in spring efficiently matches measured national warming across 19 European countries (correlation coefficient r=−0.69, P<0.001). [ABSTRACT FROM AUTHOR]

Objectives: Brachytherapy is emerging as a new treatment option for prostate cancer, and is increasingly being used in Europe and North America.Methods: A systematic review of studies that compared clinical or cost effectiveness of prostate brachytherapy with radical prostatectomy or external beam radiation for patients with localised prostate cancer.Results: No randomised controlled trials were identified, but five observational studies with comparable patient groups were included in the review. There were no valid data on overall or disease-free survival. There was no difference in disease-free survival based on PSA as a surrogate measure, or in rates of complications. No cost effectiveness studies were found. Based on Norwegian data, the one-year cost of the three treatment options seem fairly similar, while long term cost data are lacking due to lack of data on long term clinical outcome.Conclusion: The evidence on the clinical effectiveness of therapies for localised prostate cancer is scarce, but the outcome appears to be comparable for radical prostatectomy, external beam radiotherapy and brachytherapy. [Copyright &y& Elsevier]

Several stereotactic irradiation techniques, using Linacs with the patient in lying and sitting position and a Gamma Knife Unit, were compared with regard to mono-isocentric three-dimensional dose distributions. Three types of target volumes, a sphere and two ellipsoids, were used for the comparisons. All three targets were centered on a real head, reconstructed from transversal CT scans. The ARTEMIS 3D Treatment Planning System, developed by the Tenon Hospital, Paris, was used for the dosimetry and the dose-volume histogram (DVH) calculation. For the comparative study, several quantitative parameters were used, derived from the dose-volume histogram calculation. Differential DVHs were plotted for each target volume and beam arrangement. Irradiation techniques were compared by deriving quantitative parameters from the DVHs such as mean and integral dose delivered to the target and normal tissue irradiated, as well as by the relative volume of the examined areas. All techniques used in this study produced very similar dose distributions. The small differences confirm the capability of the studied techniques to produce the same irradiation effects. By changing from the spherical target shape to a more elliptical shape, more of the normal tissue was irradiated with higher doses. For elliptical cases we therefore identified a need for more conformal stereotactic planning. [ABSTRACT FROM AUTHOR]

Sentinel lymph node (SLN) biopsy has emerged as an alternative staging approach in women with assumed early-stage endometrial carcinoma. Through image-guided surgery and pathologic ultrastaging, the SLN approach is introducing "precision medicine" to the surgical management of gynecologic cancers, providing a comprehensive evaluation of high-yield lymph nodes. This approach improves the surgeons' ability to detect small-volume metastatic disease while reducing intraoperative and postoperative morbidity associated with lymphadenectomy. Although the majority of clinicians in Europe and the USA have recognized the value of SLN biopsy in endometrial carcinoma and introduced this as part of clinical practice, there is ongoing debate regarding its role in very low-risk patients as well as in patients at high risk of nodal metastasis. The significance of low-volume metastasis is not fully understood, and there is no consensus in regard to how the presence of isolated tumor cells should guide adjuvant therapy. Standardized protocols for histopathologic evaluation of SLNs are lacking. In this review article we aim to provide a framework for the introduction of SLN biopsy in endometrial cancer, give an updated overview of the existing literature, as well as discuss potential controversies and unanswered questions regarding this approach and future directions. [ABSTRACT FROM AUTHOR]

Presents the status of clinical hyperthermia in Western Europe. Relationship of the effect of hyperthermia to thermal parameters achieved in malignant tumor; Improvement of the clinical outcome of radiation therapy and anticancer drugs; Use of advanced hyperthermia machines .

The use of antibiotic drugs was studied in university teaching hospitals in Tartu, Estonia, Huddinge, Sweden and Badajoz, Spain. Data on drug deliveries to hospital wards during 1992 are presented in defined daily doses (DDD) per 100 bed-days (DDD/100 bed-days). In addition, the time trends of antibiotic use in Tartu University Hospital from 1992 to 1995 are shown. The total amount of antibiotic drugs used for systemic treatment in 1992 was similar in the 3 hospitals, 41 DDD/100 bed-days in Tartu vs. 51 DDD/100 bed-days in Badajoz and 47 DDD/100 bed-days in Huddinge. The antibiotics used most frequently were tetracyclines and aminoglycosides in Tartu, broad-spectrum penicillins and cephalosporins in Badajoz and narrow-spectrum penicillins and cephalosporins in Huddinge. Injectable preparations accounted for one-half of the antibiotics used. Among the medical departments, the total use of antibiotics varied up to 3-fold (from 19 to 61 DDD/100 bed-days), less than among the surgical departments (18-94 DDD/100 bed-days). The frequency of antibiotic use was very similar in departments of similar profile in the 3 hospitals (i.e. in departments of neurology, urology, etc.). The use of antibiotic drugs in intensive care units was twice as high in Huddinge (243 DDD/100 bed-days) as in Badajoz (106 DDD/100 bed-days) and Tartu (135 DDD/100 bed-days) in 1992. In conclusion, the international differences in the use of antibiotics in hospital were not in the frequency of use, but in the predominant prescription preferences in the hospital. [ABSTRACT FROM AUTHOR]

Discusses democratic dilemmas in Europe. Historical background on transformations to democracy; External influences; Economic and strategic limits; Influence of transnational actions; Consequences for democracy; Effects of internationalization on the potentialities of a country; Autonomy to transnational institutions; Contributions to the democratic values and the European community.

The article discusses the state intervention and social control originated in the last decades of the 19th century in Europe. The key concept of 19th century bourgeois ideologies was liberty. Contradiction between theory and practice of laissez-faire has led historians in recent years to re-examine the character of the age of laissez-faire itself. Most authors who have described the human miseries of industrialization, dwell on economic poverty as the main source of vices such as crime, alcoholism and prostitution. The discussion between pessimists and optimists with regard to the standards of living has dealt with the problem by emphasizing the difference between economic and social aspects to the worker. Riots and mass actions were frequent in the 18th century. The last three decades of the 19th century saw the beginning of the increase in the use of law as an instrument for public social control. The activities of the state increased in schooling, health services, social service, factory regulation and land reform. With the entry of criminologists into the law-making process, thorough scientification of public social control took place in Western Europe. Positivism in criminology was followed by evolution from the early adoption of the method in the physical and natural sciences.

The article offers the insights of professional organizations in the U.S. regarding planned home births, on how to help women make a choice, and guidelines for improving patient safety. The organizations that offered their views include the National Center for Health Statistics, the American College of Obstetricians and Gynecologists (ACOG), and the American College of Nurse Midwives. Topics include the role of nurses in home births, informed consent, and criteria for planned home birth.