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In the past decade a large body of evidence has accumulated on risk factors for dementia, primarily from Europe and North America. Drawing on recent integrative reviews and a consensus workshop, the International Research Network on Dementia Prevention developed a consensus statement on priorities for future research. Significant gaps in geographical location, representativeness, diversity, duration, mechanisms, and research on combinations of risk factors were identified. Future research to inform dementia risk reduction should fill gaps in the evidence base, take a life-course, multi-domain approach, and inform population health approaches that improve the brain-health of whole communities. [ABSTRACT FROM AUTHOR]

The affordability of property‐level adaptation measures against flooding is crucial due to the movement toward integrated flood risk management, which requires the individuals threatened by flooding to actively manage flooding. It is surprising to find that affordability is not often discussed, given the important roles that affordability and social justice play regarding flood risk management. This article provides a starting point for investigating the potential rate of unaffordability of flood risk property‐level adaptation measures across Europe using two definitions of affordability, which are combined with two different affordability thresholds from within flood risk research. It uses concepts of investment and payment affordability, with affordability thresholds based on residual income and expenditure definitions of unaffordability. These concepts, in turn, are linked with social justice through fairness concerns, in that, all should have equal capability to act, of which affordability is one avenue. In doing so, it was found that, for a large proportion of Europe, property owners generally cannot afford to make one‐time payment of the cost of protective measures. These can be made affordable with installment payment mechanisms or similar mechanisms that spread costs over time. Therefore, the movement toward greater obligations for flood‐prone residents to actively adapt to flooding should be accompanied by socially accessible financing mechanisms. [ABSTRACT FROM AUTHOR]

Viticulture and winemaking are important socioeconomic sectors in many European regions. Climate plays a vital role in the terroir of a given wine region, as it strongly controls canopy microclimate, vine growth, vine physiology, yield, and berry composition, which together determine wine attributes and typicity. New challenges are, however, predicted to arise from climate change, as grapevine cultivation is deeply dependent on weather and climate conditions. Changes in viticultural suitability over the last decades, for viticulture in general or the use of specific varieties, have already been reported for many wine regions. Despite spatially heterogeneous impacts, climate change is anticipated to exacerbate these recent trends on suitability for wine production. These shifts may reshape the geographical distribution of wine regions, while wine typicity may also be threatened in most cases. Changing climates will thereby urge for the implementation of timely, suitable, and cost-effective adaptation strategies, which should also be thoroughly planned and tuned to local conditions for an effective risk reduction. Although the potential of the different adaptation options is not yet fully investigated, deserving further research activities, their adoption will be of utmost relevance to maintain the socioeconomic and environmental sustainability of the highly valued viticulture and winemaking sector in Europe. [ABSTRACT FROM AUTHOR]

The notion that insurance can play a significant role in risk reduction has recently gained increasing attention in the wake of rising losses from natural disasters. While this notion is accepted in theory, we notice that, in practice, little is known about if and how insurance promotes efforts to lower the occurrence probabilities of an event or reduce its impacts. Direct linkages between risk reduction and insurance appear lacking in most existing insurance schemes, and the risk reduction potential is usually not a recognised aspect when designing or reforming insurance schemes. In response, multisectoral partnerships are being developed as innovative mechanisms to address this shortfall. Our analysis seeks to determine how the risk reduction linkages of insurance can be assessed and developed further in a multisector partnership (MSP) setting. We consider four methodologies applied in previous studies and explore them for several European examples of insurance development. While very different in scope and history, our examples share one common feature: they can all be considered as MSPs designed to foster greater collaboration between different stakeholders. We use those examples to act as testing grounds for the assessment of the risk reduction implications of insurance. Our findings show that the potential for risk reduction of new or reformed schemes could be strengthened through multisectoral partnerships. We conclude with a discussion of how the four methods could assist in the development of innovative responses to natural hazard insurance in a multisectoral partnership context. [ABSTRACT FROM AUTHOR]

In this article, we aim to achieve a better understanding of reintegration in Belgian sentence implementation. In concreto, we ask the question if Belgian sentence implementation courts ‘are doing reintegration’. Our analyses suggest the existence of a reintegrated-oriented decision-making process emphasising the strengthening of the social capital of the offender and enabling reintegration. Notwithstanding, we identify some barriers to reintegration. Firstly, we describe how the quest for reintegration is constantly interwoven with a more risk-based approach. As a result, ‘doing reintegration’ becomes subordinated by risk, wherefore the fundamental social right of reintegration is reduced to a conditional right only applicable if the offender displays certain needs, poses an acceptable risk and/or is prepared to take responsibility for this actions. Secondly, we argue how the members of the sentence implementation courts believe in ‘psychological individualism’ and project their middle class values and expectations of how someone should live on the offender, further narrowing the scope of this concept. We finish our analysis by identifying some external and structural aspects withholding the sentence implementation courts in ‘doing reintegration’, leading to a nuanced argument arguing that Belgian sentence implementation courts are not doing reintegration, although they believe they are (trying)… [ABSTRACT FROM AUTHOR]

Background/aim: Hereditary tumors are estimated to account for approximately 5-10% of all tumors. In Europe and the United States, multi-gene panel testing (MGPT) is the standard method used for identifying potential causative genes. However, MGPT it is still not widely used in Japan. The aim of this study was to assess the risk of hereditary tumors in Japanese cancer patients using germline MGPT and provide an overview of MGPT in the Japanese medical system., Patients and Methods: We used the myRiskTM, a 35-gene panel that determines the risk for eight hereditary cancers: breast, ovarian, gastric, colorectal, prostate, pancreatic, malignant melanoma, and endometrial cancers., Results: From June 2019 to March 2020, 21 patients who were suspected to have hereditary tumors were included, based on their family or medical history. Pathogenic variants were found in 7 patients [BRCA1 (5), MSH6 (1), TP 53 (1)]., Conclusion: In this study, despite the small number of participants, we were able to show the significance of MGPT in Japan. Therefore, MGPT should be used for evaluating hereditary tumors in clinical practice., (Copyright © 2022 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Abstract: Climate change impacts on the hydrological cycle, e.g. leading to changes of precipitation patterns, have been observed over several decades. Higher water temperatures and changes in extremes hydrometeorological events (including floods and droughts) are likely to exacerbate different types of pressures on water resources with possible negative impacts on ecosystems and human health. In addition, sea-level rise is expected to extend areas of salinisation of groundwater and estuaries, resulting in a decrease of freshwater availability for humans and ecosystems in coastal areas. Furthermore, climate-related changes in water quantity and quality are expected to affect food availability, water access and utilisation, especially in arid and semi-arid areas, as well as the operation of water infrastructure (e.g. hydropower, flood defences, and irrigation systems). This paper serves as an introduction to the special issue of Environment Science & Policy dealing with climate change impacts on water-related disasters. It provides a brief background about relevant EU water policies and examples of EU-funded research trends which illustrate on-going efforts to improve understanding and modelling of climate changes related to the hydrological cycles at scales that are relevant to decision making (possibly linked to policy). [Copyright &y& Elsevier]

This paper examines the legitimacy, viability and efficiency of the European Union Solidarity Fund by asking whether the Fund meets its stated purpose of providing solidarity within the EU, whether it is sufficiently capitalized and if it promotes disaster risk reduction in Europe. In examining these questions, we make use of ADAM models of disaster risks throughout Europe. We conclude that the Solidarity Fund falls short on all three counts, and we suggest possible alternatives. Most far-reaching, we explore whether the EUSF could support insurance systems in Europe by, among other possible activities, capitalizing national public-private insurance programs and providing support for government risk transfer. This would leverage the Fund's capital and would overcome barriers to the provision of private and public sector insurance in uncertain catastrophe markets. It would also make insurance more affordable to Europe's most vulnerable communities. Finally, it would reduce the disincentives for risk reduction inherent in post-disaster assistance. [ABSTRACT FROM AUTHOR]

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Objective - The objective of the study was to gain better insight into how general practitioners (GPs) perceive risk reduction and the way this perception may be influenced by healthcare environment. Design - Questionnaires with clinical episodes were sent to Danish and Polish GPs, who were randomised into four groups, each receiving the same case story with differently phrased information about risk reduction achieved through medical treatment. The GPs were asked whether they would recommend medical treatment, knowing the case story and expected risk reduction. Subjects - Danish and Polish GPs. Results - A greater proportion of Polish GPs than Danish GPs would definitely or probably recommend treatment (93% versus 72%; p < 0.001). Both groups of doctors were more inclined to recommend treatment when the achievable benefits were presented in terms of relative risk reduction rather than absolute risk reduction or number needed to treat. Conclusion - Neither information on number needed to treat nor relative risk reduction alone provides doctors with all the information they need to recommend treatment or prevention to their patients. The present study showed that the professional handling of risk information is affected by differences produced by healthcare cultures. [ABSTRACT FROM AUTHOR]

(1) Background: Cardiometabolic diseases are the most common cause of death worldwide. As part of a collaborative European study, this paper aims to explore the implementation of primary care selective-prevention services in five European countries. We assessed the implementation process of the selective-prevention services, participants' cardiometabolic profile and risk and participants' evaluation of the services, in terms of feasibility and impact in promoting a healthy lifestyle. (2) Methods: Eligible participants were primary care patients, 40-65 years of age, without any diagnosis of cardiometabolic disease. Two hundred patients were invited to participate per country. The extent to which participants adopted and completed the implementation of selective-prevention services was recorded. Patient demographics, lifestyle-related cardiometabolic risk factors and opinions on the implementation's feasibility were also collected. (3) Results: Acceptance rates varied from 19.5% (n = 39/200) in Sweden to 100% (n = 200/200) in the Czech Republic. Risk assessment completion rates ranged from 65.4% (n = 70/107) in Greece to 100% (n = 39/39) in Sweden. On a ten-point scale, the median (25-75% quartile) of participant-reported implementation feasibility ranged from 7.4 (6.9-7.8) in Greece to 9.2 (8.2-9.9) in Sweden. Willingness to change lifestyle exceeded 80% in all countries. (4) Conclusions: A substantial variation in the implementation of selective-prevention receptiveness and patient risk profile was observed among countries. Our findings suggest that the design and implementation of behavior change cardiometabolic programmes in each country should be informed by the local context and provide some background evidence towards this direction, which can be even more relevant during the current pandemic period.

• Markets need reform to offer financial protection and incentives for risk reduction. • Average risk-based flood insurance premium could double between 2015 and 2055. • Affordability of flood insurance is improved through Public-Private Partnerships. • Support on-going reforms in Europe and abroad that move towards risk-based premiums. Flood risk will increase in many areas around the world due to climate change and increase in economic exposure. This implies that adequate flood insurance schemes are needed to adapt to increasing flood risk and to minimise welfare losses for households in flood-prone areas. Flood insurance markets may need reform to offer sufficient and affordable financial protection and incentives for risk reduction. Here, we present the results of a study that aims to evaluate the ability of flood insurance arrangements in Europe to cope with trends in flood risk, using criteria that encompass common elements of the policy debate on flood insurance reform. We show that the average risk-based flood insurance premium could double between 2015 and 2055 in the absence of more risk reduction by households exposed to flooding. We show that part of the expected future increase in flood risk could be limited by flood insurance mechanisms that better incentivise risk reduction by policyholders, which lowers vulnerability. The affordability of flood insurance can be improved by introducing the key features of public-private partnerships (PPPs), which include public reinsurance, limited premium cross-subsidisation between low- and high-risk households, and incentives for policyholder-level risk reduction. These findings were evaluated in a comprehensive sensitivity analysis and support ongoing reforms in Europe and abroad that move towards risk-based premiums and link insurance with risk reduction, strengthen purchase requirements, and engage in multi-stakeholder partnerships. [ABSTRACT FROM AUTHOR]

Background: Non-communicable diseases (NCDs) remain a major challenge in the 21st century. High-income countries (HICs) populations are ethnically and culturally diverse due to international migration. Evidence suggests that NCDs rates differ between migrants and the host populations in HICs. This paper presents a review of NCDs burden among migrant groups in HICs in Europe, North America and Australia with a major focus on cardiovascular diseases (CVDs), cancer and diabetes.Methods: We performed a narrative review consisting of scholarly papers published between 1960 until 2018.Results: CVD risk differs by country of origin, country of destination and duration of residence. For example, stroke is more common in sub-Sahara African and South-Asian migrants, but lower in North African and Chinese migrants. Chinese migrants, however, have a higher risk of haemorrhagic stroke despite the lower rate of overall stroke. Coronary heart disease (CHD) is more common in South-Asian migrants, but less common in sub-Saharan and north African migrants although the lower risk of CHD in these population is waning. Diabetes risk is higher in all migrants and migrants seem to develop diabetes at an earlier age than the host populations. Migrants in general have lower rates of overall cancer morbidity and mortality than the host populations in Europe. However, migrants have a higher infectious disease-related cancers than the host populations in Europe. In North America, the picture is more complex. Data from cross-national comparisons indicate that migration-related lifestyle changes associated with the lifestyle of the host population in the country of settlement may influence NCDs risk among migrants in a very significant way.Conclusion: With exception of diabetes, which is consistently higher in all migrant groups than in the host populations, the burden of NCDs among migrants seems to depend on the migrant group, country of settlement and NCD type. This suggests that more work is needed to disentangle the key migration-related lifestyle changes and contextual factors that may be driving the differential risk of NCDs among migrants in order to assist prevention and clinical management of NCDs in these populations. [ABSTRACT FROM AUTHOR]

Background: The clinical relevance of increasing an allergic individual's peanut sensitivity threshold by immunotherapy, that is, eliciting dose (ED) to 300 or 1000 mg peanut protein, has not been previously characterized in a European population. In this study, we quantify the clinical benefits of an increased threshold of reaction following immunotherapy for the peanut-allergic individual., Methods: Quantitative risk assessments incorporated numerous inputs to predict the risk of an allergic reaction after exposure to residual peanut protein in packaged foods. The three primary inputs for the risk assessment were the peanut-allergic individual's clinical threshold value, the amount of food consumed per eating occasion of selected packaged foods, and the concentration of peanut protein in the consumed product. Individual risk reductions were calculated for both children and adolescents-adults., Results: Using available consumption and packaged food contamination data, children reaching an ED of 300 mg (if initial ED ≤ 100 mg) or 1000 mg (if initial ED 300 mg) achieved >99.99% risk reduction. Adolescents-adults also achieved >99.99% risk reduction in all cases but one. Adolescents-adults who reached an ED of 300 mg (if initial ED ≤ 100 mg) achieved 99.3%-99.9% risk reduction when consuming ice cream., Conclusions: It is concluded that an increase in threshold following immunotherapy which achieves an eliciting dose of 300 or 1000 mg peanut protein is clinically relevant for the European peanut-allergic population. Benefits of an increased threshold include a significant reduction in risk due to traces of peanut protein., (© 2018 The Authors. Pediatric Allergy and Immunology Published by John Wiley & Sons Ltd.)

The literature on the costing of mitigation measures for reducing impacts of natural hazards is rather fragmented. This paper provides a concise overview of the current state of knowledge in Europe on the costing of mitigation measures for the reduction of natural hazard risks (droughts, floods, storms and induced coastal hazards as well as alpine hazards) and identifies knowledge gaps and related research recommendations. Furthermore, it provides a taxonomy of related mitigation options, classifying them into nine categories: (1) management plans, land-use planning, and climate adaptation; (2) hazard modification; (3) infrastructure; (4) mitigation measures (stricto sensu); (5) communication in advance of events; (6) monitoring and early warning systems; (7) emergency response and evacuation; (8) financial incentives; and (9) risk transfer (including insurance). It is found that the costing of mitigation measures in European and in other countries has almost exclusively focused on estimating direct costs. A cost assessment framework that addresses a range of costs, possibly informed by multiple stakeholders, would provide more accurate estimates and could provide better guidance to decision makers. [ABSTRACT FROM AUTHOR]

Chief Medical Officers, or others directly responsible for the health of a population, have difficulty in dealing with alcohol. They must decide where to draw the line to minimize harm, as there is no doubt that alcohol abuse has serious adverse personal and social effects. The prohibition of alcohol, however, would likely be both unacceptable and unenforceable. In certain countries, unhealthy drinking habits, especially among the young (as in the United Kingdom) or among older adults (as in Russia), may call for more stringent harm-reduction strategies than in other countries. In Australia, drink driving rates have dropped markedly in recent decades, but excessive drinking by the young is increasing. Recommendations by health agencies have included increased taxation, training of health professionals, dealing with advertising, and improved regulation of licensed premises. In a setting where the public continually hears of the adverse effects of alcohol, there is little chance that potentially beneficial effects of moderate drinking will be considered in policy decisions. No society has yet solved the riddle of achieving the ideal balance where the majority can enjoy the social and health benefits of moderate drinking, while the harm that alcohol causes is minimized. [Copyright &y& Elsevier]