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Crop diversification can enhance farm economic sustainability while reducing the negative impact on the environment and ecosystem services related. Despite the market and non-market benefits of crop diversification, monocropping is a widely used dominant practice in Europe. In this context, this works aims to assess the overall economic impact of several crop diversification systems across Europe and compared it to the monocropping system. For this purpose, an economic valuation by integrating market and non-market values for eight case studies distributed across three different European pedoclimatic regions (Southern Mediterranean, Northern Mediterranean and Boreal) is proposed. The economic valuation was conducted both in the short and medium-long term. For the short-term we conducted a social gross margin analysis, while for the medium-long term a cost-benefit analysis is developed. The results show an improvement in social gross margins for most of the diversification scenarios assessed when environmental and socio-cultural benefits are considered in the short-term. In the medium and long-term the transformation of cropping towards a more diversified agriculture is encouraged by greater economic benefits. These results provide a first insight in global economic performance of diversified cropping systems, whose main contribution relies on the integration of market and non-market values of ecosystem services from crop diversification. They are expected to be useful for guiding policy makers to promote crop diversification practices as a key instrument for building resilience in farming systems for an adaptive management to climate change., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Due to the COVID-19 pandemic, the pressure on healthcare systems has been tremendous and it is having a huge economic impact. The objective of this paper is to carry out a systematic literature review of the publications that have analysed the costs derived from COVID-19 from the patient's perspective. Not only is this study aimed at measuring the impact of COVID-19 in economic terms, but also in qualitative terms, analysing, for instance, the types of costs (direct and indirect) and their variations depending on the geographical area under study. Searches were conducted in PubMed, Cochrane Library, Web of Science and Scopus. The time frame for the analysis was from the start of the pandemic until 9th December 2021. A total of 322 papers were found. The number of articles assessed for eligibility was 32, and after applying the exclusion criteria, 13 papers were included in the qualitative synthesis. Most of the studies analysed only direct costs (69.23%) and were focused on Asia (61.54%), where the larger indirect costs, as well as the greater total costs, were found. However, the higher costs per patient and year were shown for the United States. This investigation showed the importance of COVID-19 in national, regional and local budgets. More studies are to be developed in Europe due to both the existing differences in the health care systems and financing by country and the difference in the incidence of COVID-19 by country and wave., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Since the late 1990s, food safety certification has emerged as a prominent and influential regulatory mechanism in both the private and public spheres of the contemporary agri-food system. Food safety standards protect consumers from foodborne illnesses and help producers avoid the massive economic losses associated with food safety breaches. We empirically examine the relationship between foodborne disease outbreaks and certification adoption by utilizing the data on food safety certification adoption in the United States and Europe from 2015 through 2020. In our regression models, food safety certification along with select economic variables such as gross domestic product are used to explain the number of illnesses caused by foodborne disease outbreaks. For the United States at the state level, we found that certifications to SQF, PrimusGFS, BRC, or FSSC 22000 are negatively associated with the number of foodborne illnesses. For the case of Europe at the country level, certifications to ISO 22000 or FSSC 22000 are negatively associated with the number of foodborne illnesses. We then proceed to use machine learning techniques to examine how well we can use food safety certification data to predict foodborne disease outbreaks. Applying several algorithms (ordinary least squares, multinomial, decision tree, and random forest) to the U.S. data, we found that our models with food safety certification adoption can predict the number of U.S. foodborne illnesses or deaths with a relatively high degree of precision (testing accuracy at around 70% or better). Feature importance analysis allows us to inspect the relative importance of each explanatory variable (or feature) for making accurate predictions of the illness or death numbers. Through ranking the importance of explanatory variables, our study reveals that certification information could be the second most important variable (after gross domestic product) contributing to explain foodborne disease outbreaks., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

The EU supports agricultural policies to help farmers meet the challenges of climate change (CC) by promoting more sustainable and environmentally friendly practices. This study focuses on the European primary sector (agriculture, forestry, and fisheries), productive activities that meet humanity's basic needs, although this sector does not account for a dominant share of GDP. The analysis uses a panel data sample of 22 European countries for the period 2012-2019, and seeks to answer the following research questions: Is there a direct relationship between agricultural innovation efficiency and the technological advances implemented? What effect do GHG emissions and innovation efficiency have on CC? Which agricultural practices have the greatest effect on the volume of GHG emissions? The results indicate that the European primary sector has registered an average rise in productivity of 4%, mainly driven by technological improvements. This underscores the need for agricultural innovation policies that focus not only on improving aspects related to technology but also on making better use of existing resources. In addition, the econometric models estimated confirm that efficiency levels are the most influential determinants of temperature change, while GHG emissions are primarily explained by their own historical values. Ultimately, research and development is a tool that can be used to curb CC, along with the proper use of land and fertilizers. There is thus a need to foster novel agricultural practices that help reduce emissions while ensuring the efficiency of the sector., (© 2023. The Author(s).)

This article analyzes the relationship between per capita expenditure and financial and macroeconomic variables in the framework of mental health, in regions where the prevailing system is public healthcare governed by the state and in regions where the prevailing system is that of public ownership. The period 2006-2017 was analyzed. A simple linear regression analysis was carried out to determine the relationship between the expenditure per inhabitant and a series of relevant variables such as asset turnover, cash flow, and expenditure as a percentage of gross domestic product (GDP), applying statistical tests to validate the study. In regions where public-private co-financing prevails in the health system, two crucial variables to measure per capita expenditure on mental health were GDP per capita and cash flow of mental health providers. In the regions where management is direct, the crucial variables were asset turnover of mental health providers and expenditure on mental health as a percentage of GDP per capita. These elements are key to determining how to develop public investment policies in hospital systems in the different regions of Europe and the world., Competing Interests: The authors declare no conflict of interest.

Objective: During the ageing process the loss of family and social relationships is frequent which conditions loneliness, similarly the current COVID-19 pandemic has generated more social limitations in this age group and has increased the risk factors to trigger feelings of loneliness. This paper aimed to examine how loneliness among older people had been studied in Europe over the last ten years. Specific objectives were: i) to describe the methodological aspects; ii) to identify the scales or questions for the assessment of loneliness; iii) what were the main variables or dimensions that were related to loneliness in old age., Methods: A total of 1,591 articles were found in WoS and Scopus digital platforms. After initial assessment of titles and abstracts, full text reading and review of the established criteria, 42 scientific articles were finally included in the systematic review., Results: The countries that had carried out the most studies were the Netherlands and Spain. Most of the research was quantitative and uses the De Jong Gierveld Loneliness Scale (DJGLS) and the University of California at Los Angeles (UCLA) Loneliness Scale. The most analysed variables were: marital status, household structure, social support networks, social participation, depression, health problems, co-morbidity and physical functioning., Conclusions: The scientific interest in studying loneliness, with a focus on social support networks, in older people in Europe and strategically addressing loneliness as a public health problem is confirmed.

The Clean Development Mechanism (CDM), a partnership tool founded under the Kyoto Protocol, grants potential opportunities to help developing countries achieve sustainable development. The present research examines the CDM projects in Eastern Europe (Moldova, Serbia, Bosnia and Herzegovina, Montenegro, and Albania). Although there were far fewer projects in this region than, for instance, China or India, it has some specific features that make it worth studying. Major findings are that most CDM projects in Eastern Europe involved a changing combination of two or more sources of financing, and the distribution of projects in the region was uneven. Moreover, although there was a small number of projects overall, they were all cost-effective, long-term and large-scale. The findings of the research call for improvements to be made to the governance of the CDM, by strengthening the international and national regulation of projects and by aggregating the scales of decision-making and actions so that real multi-scalar transnational governance - from the global level down to the local level - is implemented in a coherent manner. It is also recommended to carry out ex-post project evaluations, following which readjustments could be made., (© 2022. The Author(s).)

Background: Multiple sclerosis has both high healthcare and social impacts., Objective: The purpose of this article is to analyse the available literature describing the economic burden of multiple sclerosis and to compare costs among studies examining main cost drivers., Methods: A literature search on studies published in English on cost-of-illness of multiple sclerosis included in this review using PubMed, the Cochrane Library, SCOPUS and Web of Science includes a retrospective horizon and it describes direct and indirect costs in patients categorized into severity groups., Results: Several papers were obtained from the database search (n=37). Additionally, results from "hand searching" were also included, where a wider horizon was considered. Cost estimates were compared among studies that used a societal perspective on costs, time-period studied, and year of price level used. The estimated total annual cost per patient in Europe is on average 40,300€ (n=20). In addition, differences by geographic areas and severity groups are also considered. All in all, the higher the severity, the higher the associated costs., Conclusions: This systematic review provides one clear finding: multiple sclerosis places a huge economic burden on healthcare models and societies due to productivity losses and caregiver burden. Moreover, costs of drugs were main cost determinants for less severe cases of multiple sclerosis and informal care and production losses for the most severe cases of multiple sclerosis., Competing Interests: Declaration of Competing Interest None of the authors has financial interest related to this study to disclose., (Copyright © 2020 Elsevier B.V. All rights reserved.)

It is hypothesised that tree distributions in Europe are largely limited by their ability to cope with the summer drought imposed by the Mediterranean climate in the southern areas and by their competitive potential in central regions with more mesic conditions. We investigated the extent to which leaf and plant morphology, gas exchange, leaf and stem hydraulics and growth rates have evolved in a coordinated way in oaks (Quercus) as a result of adaptation to contrasting environmental conditions in this region. We implemented an experiment in which seedlings of 12 European/North African oaks were grown under two watering treatments, a well-watered treatment and a drought treatment in which plants were subjected to three cycles of drought. Consistent with our hypothesis, species from drier summers had traits conferring more tolerance to drought such as small sclerophyllous leaves and lower percent loss of hydraulic conductivity. However, these species did not have lower growth rates as expected by a trade-off with drought tolerance. Overall, our results revealed that climate is an important driver of functional strategies in oaks and that traits have evolved along two coordinated functional axes to adapt to different precipitation and temperature regimes., (© 2019 The Authors New Phytologist © 2019 New Phytologist Trust.)

Balancing access to antibiotics with the control of antibiotic resistance is a global public health priority. At present, antibiotic stewardship is informed by a 'use it and lose it' principle, in which antibiotic use by the population is linearly related to resistance rates. However, theoretical and mathematical models suggest that use-resistance relationships are nonlinear. One explanation for this is that resistance genes are commonly associated with 'fitness costs' that impair the replication or transmissibility of the pathogen. Therefore, resistant genes and pathogens may only gain a survival advantage where antibiotic selection pressures exceed critical thresholds. These thresholds may provide quantitative targets for stewardship-optimizing the control of resistance while avoiding over-restriction of antibiotics. Here, we evaluated the generalizability of a nonlinear time-series analysis approach for identifying thresholds using historical prescribing and microbiological data from five populations in Europe. We identified minimum thresholds in temporal relationships between the use of selected antibiotics and incidence rates of carbapenem-resistant Acinetobacter baumannii (Hungary), extended-spectrum β-lactamase-producing Escherichia coli (Spain), cefepime-resistant E. coli (Spain), gentamicin-resistant Pseudomonas aeruginosa (France) and methicillin-resistant Staphylococcus aureus (Northern Ireland) in different epidemiological phases. Using routinely generated data, our approach can identify context-specific quantitative targets for rationalizing population antibiotic use and controlling resistance. Prospective intervention studies that restrict antibiotic consumption are needed to validate these thresholds.

Introduction: EU legislation established the factors that should be applied for the setting of maximum levels of vitamins and minerals in food supplements and other foods enriched with these nutrients, considering the different sensitivity of the population groups, in order to minimize the risks of an excessive intake. A decade and a half later, these maximum levels have not yet been set. Because of this delay, in many European countries maximum daily amounts have been established for food supplements, with great differences from one country to another. In France, these maximum levels have just been updated taking into account the age, the physiological situation and the state of health of the population groups: children of 1-3 years, children of 3-10 years, adolescents of 11-17 years, adults, women with probability of pregnancy, pregnant women, lactating women, menopause, old people, smokers, patients receiving anticoagulant treatment, renal patients, etc.

The European Commission supports several routes for incorporating the gender perspective. The Commission currently supports the new Horizon 2020 program, and also funds projects such as "gendered innovations", which show how gender innovations increase the quality of research and professional practice for health and welfare. One of the policy instruments is the Recommendation on Gender, Science and Innovation. Against this background, the international European Cooperation in Science and Technology (COST) network genderSTE (Gender, Science, Technology and Environment) was created, which seeks to: 1) promote structural changes in institutions to increase the number of women researchers; 2) identify the gender dimensions relevant to the environment; and 3) improve the integration of a gender perspective in research and technology. COST GenderSTE supports networking and the dissemination of knowledge with a gender perspective. All these tools provide an opportunity to incorporate a gender perspective in research in Europe., (Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.)

Researchers, stakeholders and policy makers agree about the importance of the population ageing in modern societies, so a broad analysis of current research strategies is in progress, such as FUTURAGE, a network for drawing a map for future research on ageing. This document presents the Spanish contribution to this map following FUTURAGE guidelines, drawn from the debates held in the 'Ageing. Research in Spain and Europe' Workshop. The first part consists of general ideas seeking to define future challenges on research using a multidisciplinary approach, in which the theoretical and methodological debate, the comparative and multilevel perspective, the transfer of knowledge and involvement of the older people would be essential to consider. Some of the main issues according to FUTURAGE structure are, the bio-gerontology of ageing, healthy and active ageing, and the socioeconomic and environmental resources of ageing. The interaction between these contents is pivotal to understand the research on ageing. Finally, the document provides some methodological and instrumental ideas to reinforce the need for cross-sectional research initiatives, integrating different data and combining methods in order to develop assessment and intervention strategies. Other aspects look into the mechanisms to coordinate research within a European context. The map on ageing research has been published after the consultation process in Europe (http://futurage.group.shef.ac.uk/road-map.html) and is now ready to be considered for integration into future European and Spanish research programs., (Copyright © 2012 SEGG. Published by Elsevier Espana. All rights reserved.)

Objective: To study the relationship between formal and informal care for the dependent population in a number of European countries., Method: Data from the Survey of Health, Aging and Retirement in Europe for 2004 were used and a bivariate probit model was estimated. Unlike other studies, the present analysis includes the institutional features of the various long-term care systems, in addition to the demographic, health and environmental characteristics of the individual receiving care., Results: A significant correlation was found between the two options, which reveals that, conditional on receiving care, there was a preference for the combination of both types of care. The results show the importance of health status and living arrangements for defining the combination of formal and informal care. There were substantial differences in the likelihood of the two types of care among European countries. A notable finding was the importance of informal care in Spain in comparison with other countries., Conclusions: The probability of receiving formal or informal care is higher in countries where families have a legal obligation to look after dependent relatives and where institutionalization rates are higher. This finding should be considered in the design of long-term care policies. Therefore, to control growth of public expenditure and, at the same time, improve caregiver satisfaction, policies that combine distinct formal services should be promoted over the implementation of care allowances., (Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.)

This paper has contributed to confirming the link between education and health in developed countries. The analysis is based on 11 European Union countries. We estimate country-specific health functions, where the dependent variable is self-reported health status and the education attainment is one of the main inputs. All eight waves (1994-2001) of the European Community Household Panel are deployed. A random effects ordered probit is estimated in order to control, to a given extent, for unobserved heterogeneity. Explanatory variables are both time invariant (education attainment and gender) and time varying (gross wages, hours of work, age and living alone). Results confirm the positive impact of secondary education on health in most cases and tertiary education in all cases, even after controlling for other inputs in the health function and taking unobserved heterogeneity into account. Secondary education has an impact on health in all countries in the sample except for The Netherlands and UK. The effect does not differ between secondary and tertiary education in France, Ireland and Greece. The correlation between education and health is interpreted in different but complementary ways by diverse approaches and we may not disentangle the precise mechanism that connects health with education from our results. Anyway, it seems clear that better coordination is needed between education and health policies to effectively improve health literacy. Other relevant results from our study are that women register poorer health than men, age contributes to worsening health status and wages contribute positively to health.

Objective: To analyse the use of part-time work among older workers with disabilities compared with their non-disabled counterparts within a European context., Study Design: Cross-sectional., Methods: Data were drawn from the 2004 Survey of Health, Ageing and Retirement in Europe. The key advantage of this dataset is that it provides a harmonized cross-national dimension, and contains information for European individuals aged 50 years or over on a wide range of health indicators, disability, socio-economic situation, social relations, etc., Results: Older people with disabilities (aged 50-64 years) are more likely to have a part-time job compared with their non-disabled counterparts. Although there is an important employment gap between the two groups, many older workers with disabilities use part-time work to achieve a better balance between their health status and working life. The econometric analysis corroborated that being disabled has a positive effect on the probability of working on a part-time basis, although this effect varies by country., Conclusions: Policy makers must encourage part-time employment as a means of increasing employment opportunities for older workers with disabilities, and support gradual retirement opportunities with flexible and reduced working hours. It is crucial to change attitudes towards older people with disabilities in order to increase their labour participation and reduce their levels of poverty and marginalization.

Objective: To describe self-perceived health status and health-related quality of life (HRQoL) in healthy individuals of working age, to measure changes due to influenza infection, and to evaluate the effect of influenza infection on HRQoL in monetary terms., Method: We performed a descriptive observational study through questionnaires administered to 50 patients of working age infected with the influenza virus during the epidemiologic year 2004-2005 and living in private homes of the city of Logroño (Spain). The patients completed the questionnaires twice: with and without influenza. The dimensions and HRQoL indicators of the European Quality of Life-5 Dimensions (EQ-5D) questionnaire were evaluated. HRQoL utility indices were used to calculate lost quality-adjusted life years (QALYs)., Results: On average, the reduction in the HRQoL utility index caused by influenza infection was between 0.37 and 0.65, on a scale from 0 (death) to 1 (perfect health). An influenza epidemic in 100,000 individuals could imply a loss of 137 QALYs, which in monetary terms could represent 2,722,609euro., Conclusions: The EQ-5D dimension most negatively affected by influenza was <> while the least affected dimension was <>. Influenza causes substantial losses in HRQoL among the population of working age. The results of the sensitivity analysis of the monetary effects of influenza infection yielded intervals showing a range of more than 5 times the mean value.

Purpose: The purpose of this article is to analyse the incidence of part-time employment among people with disabilities within a European context. Particular attention is paid to the type of part-time employment (voluntary vs. involuntary) and the levels of job satisfaction that people with disabilities report., Method: Using data from the European Community Household Panel for the period 1995-2001, we estimate part-time rates, preferences and levels of job satisfaction for people with and without disabilities for 13 European countries., Results: The results show that a higher number of people with disabilities work part-time, compared to non-disabled workers. This is mainly due to disabled part-time workers having a much higher preference for part-time working than people without disability. This finding is corroborated when we analyse the levels of job satisfaction for disabled part-time workers., Conclusions: Part-time employment becomes a relevant instrument for policy makers and employers to improve the social inclusion, income and labour conditions of the people with disabilities because it allows these people to achieve a much better balance between their personal and health needs and working life.

Objectives: Innovations in public health services promote increases in the health status of the population. Therefore, it is a major concern for health policy makers to understand the drivers of innovation processes. This paper focuses on the differences in behaviour of managers and front-line employees in the pro-innovative provision of public health services., Methods: We utilize a survey conducted on front-line employees and managers in public health institutions across six European countries. The survey covers topics related to satisfaction, or attitude towards innovation or their institution. We undertake principal components analysis and analysis of variance, and estimate a multinomial ordered probit model to analyse the existence of different behaviour in managers and front-line employees with respect to innovation., Results: Perception of innovation is different for managers and front-line employees in public health institutions. While front-line employees' attitude depends mostly on the overall performance of the institution, managers feel more involved and motivated, and their behaviour depends more on individual and organisational innovative profiles., Conclusion: It becomes crucial to make both managers and front-line employees at public health institutions feel participative and motivated in order to maximise the benefits of technical or organisational innovative process in the health services provision.

This paper discusses some of the proposals regarding the improvement of the efficiency in the delivery of health care services. Several countries have implemented different strategies based on the experience of the Health Maintenance Organizations, which have used the market to stimulate competition between providers and insurance companies. One of the proposals includes the creation of agencies that would compete in quality and in price. Another one implies the creation of a National Health Service capable of hiring public or private services from local agencies. The ideal strategy would enable a consumer to choose between insurance companies and public and private providers, and would hopefully create cost conditions reasonably correlated with the efficiency and quality of the rendered services.