Search

Background: Performing cardiovascular and cancer screenings in target populations can reduce mortality. Visiting a General Practitioner (GP) once a year is related to an increased likelihood of preventive care. The aim of this study was to analyse the influence of visiting a GP in the last year on the delivery of preventive services based on sex and household income. Methods: Cross-sectional study using data collected from the European Health Interview Survey 2013–2015 of individuals aged 40–74 years from 29 European countries. The variables included: sociodemographic factors (age, sex, and household income (HHI) quintiles [HHI 1: lowest income, HHI 5: more affluent]), lifestyle factors, comorbidities, and preventive care services (cardiometabolic, influenza vaccination, and cancer screening). Descriptive statistics, bivariate analyses and multilevel models (level 1: citizen, level 2: country) were performed. Results: 242,212 subjects were included, 53.7% were female. The proportion of subjects who received any cardiometabolic screening (92.4%) was greater than cancer screening (colorectal cancer: 44.1%, gynaecologic cancer: 40.0%) and influenza vaccination. Individuals who visited a GP in the last year were more prone to receive preventive care services (cardiometabolic screening: adjusted OR (aOR): 7.78, 95% CI: 7.43–8.15; colorectal screening aOR: 1.87, 95% CI: 1.80–1.95; mammography aOR: 1.76, 95% CI: 1.69–1.83 and Pap smear test: aOR: 1.89, 95% CI:1.85–1.94). Among those who visited a GP in the last year, the highest ratios of cardiometabolic screening and cancer screening benefited those who were more affluent. Women underwent more blood pressure measurements than men regardless of the HHI. Men were more likely to undergo influenza vaccination than women regardless of the HHI. The highest differences between countries were observed for influenza vaccination, with a median odds ratio (MOR) of 6.36 (under 65 years with comorbidities) and 4.30 (over 65 years with comorbidities), followed by colorectal cancer screening with an MOR of 2.26. Conclusions: Greater adherence to preventive services was linked to individuals who had visited a GP at least once in the past year. Disparities were evident among those with lower household incomes who visited a GP. The most significant variability among countries was observed in influenza vaccination and colorectal cancer screening. [ABSTRACT FROM AUTHOR]

Although leisure constraints that individuals have to cope with can negatively affect their social inclusion and satisfaction with life, little research has addressed the link between these variables. Therefore, the current paper examined the moderator role of leisure constraints on the relationship between satisfaction with life and leisure constraints among adults living in five different European countries. The respondents were 1,382 women and 877 men adults. The findings of analysis revealed that all factors used in the study accounted for 15% of the variance in satisfaction with life and social inclusion had a significant and positive impact on satisfaction with life. As a result, it can be said that leisure constraints had a moderating effect on the relationship between satisfaction with life and social inclusion. The present research study recommends that social inclusion should be encouraged through decreasing to leisure constraints to increase the life satisfaction. [ABSTRACT FROM AUTHOR]

Purpose: The previous studies have suggested that serum homocysteine (Hcy) and vitamin B levels are potentially related to autism spectrum disorder (ASD). However, the causality between their concentrations and ASD risk remains unclear. To elucidate this genetic association, we used a Mendelian randomization (MR) design. Methods: For this MR analysis, 47 single-nucleotide polymorphisms (SNPs)—13 related to Hcy, 13 to folate, 14 to vitamin B6, and 7 to vitamin B12—were obtained from a large-scale Genome-Wide Association Studies (GWAS) database and employed as instrumental variables (IVs). Our study used three approaches to calculate the MR estimates, including inverse-variance weighted (IVW) method, MR-Egger method, and weighted median (WM) method. Among these, the IVW method served as our primary MR method. False discovery rate (FDR) was implemented to correct for multiple comparisons. We also performed a series of sensitivity analyses, including Cochran's Q test, MR-Egger's intercept, MR-PRESSO, leave-one-out analysis, and the funnel plot. Results: Univariable Mendelian randomization (UVMR) analysis revealed a statistical association between serum vitamin B12 levels and ASD risk (OR = 1.68, 95% CI 1.12–2.52, P = 0.01) using the IVW method. However, neither the WM method (OR = 1.57, 95% CI 0.93–2.66, P = 0.09) nor the MR-Egger method (OR = 2.33, 95% CI 0.48–11.19, P = 0.34) was significantly association with higher levels of serum vitamin B12 and ASD risk. Additionally, we found no evidence of causal relationships between serum levels of vitamin B6, folate, Hcy, and ASD risk. After correcting for the FDR, the causality between serum vitamin B12 levels and ASD risk remained significant (q value = 0.0270). Multivariate Mendelian randomization (MVMR) analysis indicated an independent association between elevated serum vitamin B12 levels and the risk of ASD (OR = 1.74, 95% CI 1.03–2.95, P = 0.03) using the IVW method, but this finding was inconsistent when using the WM method (OR = 1.73, 95% CI 0.89–3.36, P = 0.11) and MR-Egger method (OR = 1.60, 95% CI 0.95–2.71, P = 0.08). Furthermore, no causal associations were observed for serum levels of vitamin B6 and folate in MVMR analysis. Sensitivity analyses confirmed that these results were reliable. Conclusion: Our study indicated that elevated serum vitamin B12 levels might increase the risk of ASD. The potential implications of our results for ASD risk warrant validation in randomized clinical trials. [ABSTRACT FROM AUTHOR]

Background: Nurses play an important role in interprofessional pharmaceutical care. Curricula related to pharmaceutical care, however, vary a lot. Mapping the presence of pharmaceutical care related domains and competences in nurse educational programs can lead to a better understanding of the extent to which curricula fit expectations of the labour market. The aim of this study was to describe 1) the presence of pharmaceutical care oriented content in nursing curricula at different educational levels and 2) nursing students' perceived readiness to provide nurse pharmaceutical care in practice. Methods: A quantitative cross-sectional survey design was used. Nursing schools in 14 European countries offering educational programs for levels 4–7 students were approached between January and April 2021. Through an online survey final year students had to indicate to what extent pharmaceutical care topics were present in their curriculum. Results: A total of 1807 students participated, of whom 8% had level 4–5, 80% level 6, 12% level 7. Up to 84% of the students indicated that pharmaceutical care content was insufficiently addressed in their curriculum. On average 14% [range 0–30] felt sufficiently prepared to achieve the required pharmaceutical care competences in practice. In level 5 curricula more pharmaceutical care domains were absent compared with other levels. Conclusions: Although several pharmaceutical care related courses are present in current curricula of level 4–7 nurses, its embedding should be extended. Too many students perceive an insufficient preparation to achieve pharmaceutical care competences required in practice. Existing gaps in pharmaceutical care should be addressed to offer more thoroughly prepared nurses to the labour market. [ABSTRACT FROM AUTHOR]

Understanding why patients seek informational and/or emotional support online is fundamental to providing patients with accurate and reliable support that is tailored to their needs, preferences, and personal situation. Based on the stress and coping theory and uses and gratifications theory (UGT), this study aimed to identify theoretically-founded profiles of cancer patients differing in their motives for seeking informational and/or emotional support online, and to compare the profiles in terms of patients' psychological and background characteristics, and perception of health care services. Hierarchical cluster analysis was conducted, using questionnaire data from patients visiting a large Dutch health website (N = 181). This revealed three distinctive profiles, i.e., overall seekers (n = 83, 46.0%), occasional information seekers (n = 83, 46.0%), and contact exchangers (n = 15, 8.0%). Patients across these profiles differed in their eHealth literacy, with the contact exchangers being more eHealth literate than the overall seekers and occasional information seekers. The results can be used to create awareness among health care providers, web designers, and patient organizations on different types of cancer patients with different motives for seeking informational and/or emotional support online, and help them to tailor recommendations to and development of (online) sources that fit patients' needs. Future research could further investigate the integration of stress and coping theory with UGT by acknowledging the interplay of different coping strategies and different gratifications. [ABSTRACT FROM AUTHOR]

Background: Amyotrophic lateral sclerosis (ALS) is a highly debilitating neurodegenerative condition. Despite recent advancements in understanding the molecular mechanisms underlying ALS, there have been no significant improvements in therapeutic options for ALS patients in recent years. Currently, there is no cure for ALS, and the only approved treatment in Europe is riluzole, which has been shown to slow the disease progression and prolong survival by approximately 3 months. Recently, tauroursodeoxycholic acid (TUDCA) has emerged as a promising and effective treatment for neurodegenerative diseases due to its neuroprotective activities. Methods: The ongoing TUDCA-ALS study is a double-blinded, parallel arms, placebo-controlled, randomized multicenter phase III trial with the aim to assess the efficacy and safety of TUDCA as add-on therapy to riluzole in patients with ALS. The primary outcome measure is the treatment response defined as a minimum of 20% improvement in the ALS Functional Rating Scale-Revised (ALSFRS-R) slope during the randomized treatment period (18 months) compared to the lead-in period (3 months). Randomization will be stratified by country. Primary analysis will be conducted based on the intention-to-treat principle through an unadjusted logistic regression model. Patient recruitment commenced on February 22, 2019, and was closed on December 23, 2021. The database will be locked in September 2023. Discussion: This paper provides a comprehensive description of the statistical analysis plan in order to ensure the reproducibility of the analysis and avoid selective reporting of outcomes and data-driven analysis. Sensitivity analyses have been included in the protocol to assess the impact of intercurrent events related to the coronavirus disease 2019. By focusing on clinically meaningful and robust outcomes, this trial aims to determine whether TUDCA can be effective in slowing the disease progression in patients with ALS. Trial registration: ClinicalTrials.gov NCT03800524. Registered on January 11, 2019. [ABSTRACT FROM AUTHOR]

Cervical cancer (CC) remains a crucial public health issue in Estonia, with high incidence and late diagnosis. The aim of this study was to examine time trends of stage-specific CC incidence in Estonia and factors associated with advanced-stage diagnosis of CC. This was a nationwide population-based retrospective study. Data on CC cases diagnosed in Estonia in 2007–2018 were obtained from the Estonian Cancer Registry, including tumour, nodes, metastases stage at diagnosis. Sociodemographic data were obtained from the Population Registry. To estimate the risk of advanced-stage diagnosis (stages II–IV vs stage I) associated with sociodemographic factors, Poisson regression with robust variance was used to calculate univariate and multivariate prevalence ratios (PR) with 95% confidence intervals (CIs). Time trends of stage-specific CC incidence for 2005–2019 were examined with joinpoint analysis. Incidence of stage I CC showed a significant decline of 4.9% per year since 2007, whereas no change was seen for other stages. Of the 2046 women diagnosed in 2007–2018, 1137 (55.6%) were diagnosed at an advanced stage; this proportion increased from 51% in 2007–2009 to 58% in 2015–2018 (P = 0.004). Multivariate regression analysis showed that advanced-stage diagnosis was associated with age (PR 2.16, 95% CI 1.87–2.49 for women aged ≥75 years compared with those aged 30–44 years), educational level (PR 1.32, 95% CI 1.15–1.51 for women with basic/primary education compared to university education) and marital status (PR 1.14, 95% CI 1.01–1.29 for single women compared to married/cohabiting women). No associations were observed by region of residence or nationality. To reduce CC mortality, it is crucial to improve prevention and early diagnosis of CC in Estonia through human papillomavirus vaccination and effective and quality-assured screening particularly targeting high-risk groups as well as encouraging symptom awareness and regular check-ups among older women. [ABSTRACT FROM AUTHOR]

Aims: To perform temporal validation of a risk prediction model for breast cancer‐related lymphoedema in the European population. Design: Temporal validation of a previously developed prediction model using a new retrospective cohort of women who had undergone axillary lymph node dissection between June 2018 and June 2020. Methods: We reviewed clinical records to identify women who did and did not develop lymphoedema within 2 years of surgery and to gather data regarding the variables included in the prediction model. The model was calibrated by calculating Spearman's correlation between observed and expected cases. Its accuracy in discriminating between patients who did versus did not develop lymphoedema was assessed by calculating the area under the receiver operating characteristic curve (AUC). Results: The validation cohort comprised 154 women, 41 of whom developed lymphoedema within 2 years of surgery. The value of Spearman's coefficient indicated a strong correlation between observed and expected cases. Sensitivity of the model was higher than in the derivation cohort, as was the value of the AUC. Conclusion: The model shows a good capacity to discriminate women at risk of lymphoedema and may therefore help in developing improved care pathways for individual patients. Implications for the Profession and/or Patient Care: Identifying risk factors for lymphoedema secondary to breast cancer treatment is vital given its impact on women's physical and emotional well‐being. Impact: What problem did the study address? Risk of BCRL. What were the main findings? The prediction model has a good capacity to discriminate women at risk of lymphoedema. Where and on whom will the research have an impact? In clinical practice with women at risk of BCRL. Reporting Method: STROBE checklist. What Does this Paper Contribute to the Wider Global Clinical Community?: It presents a validated risk prediction model for BCRL. No Patient or Public Contribution: There was no patient or public contribution in the conduct of this study. [ABSTRACT FROM AUTHOR]

Objectives While >50% of medical students and residents are women, their proportion drastically diminishes within higher ranks and leadership roles; this is known as the 'leaky pipeline'. We aimed to evaluate the leaky pipeline among rheumatologists across Europe and to assess determinants inducing rheumatologists to leave hospitals. Methods Experts in the field of economics developed a questionnaire with scientific focus on the leaky pipeline among rheumatologists, which was distributed electronically by national scientific societies of EULAR countries and by individual contacts. We performed common factor analysis, univariate t -tests and multivariate regression analyses to appraise our dataset. Results A total of 311 hospital-based rheumatologists from 23/45 EULAR countries (52.7% females, 47.3% males) answered the questionnaire. The presence of the leaky pipeline was evident for the entire sample. Of 64% female rheumatologists only 34.2% of departments' directors were female, with noteworthy regional differences. Female doctors reported higher intentions to leave their hospital (β = 0.28, P  < 0.05) and lower commitment towards their current organization (β = –0.34, P  < 0.05) when compared with males. Women reported lower levels of job satisfaction (β = –0.26, P  < 0.10), promotion justice (β = –0.55, P  < 0.01) and career perspectives (β = –0.26, P  < 0.10, one-tailed) than men, explaining their lower organizational commitment. Conclusion Female rheumatologists perceive worse job opportunities and satisfaction than males. Many reasons for the leaky pipeline are beyond the control of organizations. Based on our results, organizations should be encouraged to reconsider and adjust their performance management practices to enable an equitable work environment. [ABSTRACT FROM AUTHOR]

Reliable information on dietary trends is essential. We compared individual-level dietary estimates for total energy, carbohydrate, fat, and protein intake over time with national supply data from the Global Expanded Nutrient Supply Model (186 paired estimates from 1961 to 2011, 18 countries). We hypothesized that supply data would overestimate individual measures and that the two measures would be weakly correlated. Individual- and supply-level estimates were compared using Spearman correlation coefficients and linear mixed-effect models were used to estimate the differences between measures. Overall, the correlations between individual- and supply-level measures were moderate for energy (r s = 0.34) and carbohydrate (r s = 0.39), strong for fat (r s = 0.85), and protein (r s = 0.69). Trends in total energy measured by individual-level surveys and total energy supply were positively correlated in 38.9% of countries, whereas trends in macronutrients aligned between estimates in most countries. Supply-level dietary data overestimated individual-level intakes, especially in higher income countries in Europe and in the United States. In the United States, supply-level data exceeded individual-level estimates by 26.3% to 29.9% for energy, carbohydrate, and fat, whereas protein estimates were similar between measures. In Europe, supply-level estimates overestimated individual-level intake by 19.9% for energy, 17.0% for carbohydrate, 13.7% for fat, and 7.7% for protein, whereas estimates for energy and macronutrients were similar in Asia. In Asia and lower income countries, our findings generally support the use of supply-level data in the absence of individual-level data, though this finding may be related to smaller sample size and differences in underlying national statistics that inform supply data. This article compares individual-level diet measures of energy, carbohydrate, fat, and protein to national supply-level data in 18 countries. Time trends in macronutrient intake and, to a lesser degree, total energy, align between individual and supply data. Supply data overestimated individual intakes, especially in the United States and higher income countries. Supply data may be an appropriate alternative in Asia and in lower income settings that lack individual data. Abbreviation: 95% CI, 95% confidence interval. [Display omitted] [ABSTRACT FROM AUTHOR]

Purpose: Preventing weight regain can only be achieved by sustained changes in energy balance-related behaviors that are associated with weight, such as diet and physical activity. Changes in motivation and self-regulatory skills can support long-term behavioral changes in the context of weight loss maintenance. We propose that experiencing a supportive climate care is associated with enhanced satisfaction of basic psychological needs, intrinsic goals, and autonomous motivation. These factors are expected to be associate with the utilization of self-regulation skills, leading to more sustained behavior changes and ultimately preventing weight regain. This hypothesis was tested in this ancillary analysis of the NoHoW trial, where the study arms were pooled and followed for 12 months. Methods: The NoHoW was a three-center, large-scale weight regain prevention full factorial trial. In this longitudinal study, data were collected in adults who lost > 5% weight in the past year (N = 870, complete data only, 68.7% female, 44.10 ± 11.86 years, 84.47 ± 17.03 kg) during their participation in a 12-month digital behavior change intervention. Weight and validated measures of motivational- and self-regulatory skills-related variables were collected at baseline, six- and 12 months. Change variables were used in Mplus' path analytical models informed by NoHoW's logic model. Results: The bivariate correlations confirmed key mediators' potential effect on weight outcomes in the expected causal direction. The primary analysis showed that a quarter of the variance (r2 = 23.5%) of weight regain prevention was achieved via the mechanisms of action predicted in the logic model. Specifically, our results show that supportive climate care is associated with needs satisfaction and intrinsic goal content leading to better weight regain prevention via improvements in self-regulatory skills and exercise-controlled motivation. The secondary analysis showed that more mechanisms of action are significant in participants who regained or maintained their weight. Conclusions: These results contribute to a better understanding of the mechanisms of action leading to behavior change in weight regain prevention. The most successful participants used only a few intrinsic motivation-related mechanisms of action, suggesting that habits may have been learned. While developing a digital behavior change intervention, researchers and practitioners should consider creating supportive climate care to improve needs satisfaction and intrinsic goal contents. Trial registration: ISRCTN, ISRCTN88405328, registered 12/22/2016. [ABSTRACT FROM AUTHOR]

The Directive on Adequate Minimum Wages represents a watershed initiative adding substance to the EU's social dimension. It contains two ambitious objectives: establishing the minimum level of statutory minimum wages at 60% of the gross median wage, and increasing collective bargaining coverage (CBC) to at least 80% of workers. In this article, we assess how statutory minimum wages and collective bargaining coverage are associated with the likelihood of low pay. Using a time series cross-section of EU-SILC for income years 2004–2019, we identify and assess the absolute and relative size of 'effective wage floors' for full-time employees in 30 countries. We specify multilevel, random effects within-between regression models to assess the individual and joint associations of SMW and collective bargaining coverage with wage floors. Our results indicate that SMWs and CBC both have distinct roles in establishing the effective wage floor. First, higher collective bargaining coverage is on average associated with a lower share of workers earning below 60% gross median wages. Second, higher SMWs are strongly associated with higher effective wage floors. Third, both collective bargaining coverage and union density are strongly associated with higher wage floors. [ABSTRACT FROM AUTHOR]

Simple Summary: In this study, we analyzed 593 patients with NMIBC who underwent radical cystectomy via a robotic-assisted or open approach between 2015 and 2020. Patients with NMIBC who underwent RARC or ORC were matched 1:1 by age, sex, BMI, year of surgery and urinary diversion. We found that RARC + ICUD for patients with NMIBC is safe and associated with a lower blood loss, a lower transfusion rate and a shorter hospital stay compared to ORC. Complication rates were similar. Concerning oncologic outcomes, RARC appeared non-inferior to ORC with no significant difference in DFS, CSS and OS. These results must be confirmed with prospective randomized studies. Background: For non-muscle-invasive bladder cancer (NMIBC) requiring radical surgery, limited data are available comparing robotic-assisted radical cystectomy with intracorporeal urinary diversion (iRARC) to open radical cystectomy (ORC). The objective of this study was to compare the two surgical techniques. Methods: A multicentric cohort of 593 patients with NMIBC undergoing iRARC or ORC between 2015 and 2020 was prospectively gathered. Perioperative and pathologic outcomes were compared. Results: A total of 143 patients operated on via iRARC were matched to 143 ORC patients. Operative time was longer in the iRARC group (p = 0.034). Blood loss was higher in the ORC group (p < 0.001), with a consequent increased post-operative transfusion rate in the ORC group (p = 0.003). Length of stay was longer in the ORC group (p = 0.007). Post-operative complications did not differ significantly (all p > 0.05). DFS at 60 months was 55.9% in ORC and 75.2% in iRARC with a statistically significant difference (p = 0.033) found in the univariate analysis. Conclusion: We found that iRARC for patients with NMIBC is safe, associated with a lower blood loss, a lower transfusion rate and a shorter hospital stay compared to ORC. Complication rates were similar. No significant differences in survival analyses emerged across the two techniques. [ABSTRACT FROM AUTHOR]

Based on the findings of the international research on the complex development potential of Europe's Great Lakes (ESPON LAKES), the authors examine the environmental, social, economic and governance challenges of Europe's great-lake regions and their potential for feeding into European policy. Statistical analysis of the Lake Balaton, Lake Constance and Lake Vänern regions has shown that they have significant differences in natural, social and economic terms, but also commonalities that link them. These include their significant but fragile ecological values and their peripheral, partly border location in social and administrative terms. For these reasons, it is worth developing the great-lake regions in an integrated way, while taking into account the challenges of the given region. The results of the study are also useful for national spatial policy, as they illustrate the role and development potential of regions facing specific challenges. [ABSTRACT FROM AUTHOR]

The physical demands of soccer match-play have typically been assessed using a low-resolution whole match approach ignoring whether the ball is in or out of play (BIP/BOP) and during these periods which team has possession. This study investigated the effect of fundamental match structure variables (BIP/BOP, in/out of possession) on the physical demands, and especially intensity, of elite match-play. For 1083 matches from a major European league, whole match duration, and player physical tracking data, were divided into BIP/BOP, and in/out of possession periods throughout the match, using on-ball event data. These distinct phases were used to derive absolute (m) and rate (m·min−1) of distance covered in total and within six speed categories during BIP/BOP and in/out possession. The rate of distance covered, an index of physical intensity, was >2-fold greater during BIP vs BOP. Whole match total distance covered was confounded by BIP time and poorly associated with physical intensity during BIP (r = 0.36). Whole match rates of distance covered substantially underestimated those during BIP, particularly for higher running speeds (∼−62%). Ball possession markedly effected physical intensity, with the rates of distance covered running (+31%), at high-speed (+30%) and in total (+7%) greater out than in possession. Whole match physical metrics underestimated the physical intensity during BIP, and thus the rate(s) of distance covered during BIP are recommended for accurate measurement of physical intensity in elite soccer. The greater demands of being out of possession support a possession-based tactical approach to minimise fatigue and its negative consequences. This large-scale study utilising >1000 elite level competitive matches found profound differences in rate of distance covered between periods of BIP vs BOP, being 2-fold higher overall and 8- to 33-fold higher for the rates of distance covered within running, high-speed and sprinting speed categories. Consequently, commonly used whole match physical metrics, that incorporate both BIP and BOP, such as distances covered but even rates of distance covered, were not valid indices of physical intensity (rate of distance covered) during BIP. Thus a more valid and direct approach to quantifying physical intensity during elite soccer match-play as the rate of distance covered during BIP is proposed. Utilising a unique within-match analysis the effect of possession (i.e. in vs out) revealed that teams covered ≥30% more running and high-speed distance while out than in possession during BIP. [ABSTRACT FROM AUTHOR]

The circularity of polymer waste is an emerging field of research in Europe. In the present research, the thermal, surface, mechanical, and tribological properties of polypropylene (PP)-based composite produced by injection molding were studied. The pure PP matrix was reinforced with 10, 30, and 40% wt. of pure cotton, synthetic polyester, and polyethylene terephthalate post-consumer fibers using a combination of direct extrusion and injection molding techniques. Results indicate that PP-PCPESF-10% wt. exhibits the highest value of tensile strength (29 MPa). However, the values of tensile and flexural strain were lowered with an increase in fiber content due to the presence of micro-defects. Similarly, the values of modulus of elasticity, flexural modulus, flexural strength, and impact energy were enhanced due to an increase in the amount of fiber. The PP-PCCF-40% wt. shows the highest values of flexural constant (2780 MPa) and strength (57 MPa). Additionally, the increase in fiber loadings is directly proportional to the creation of micro-defects, surface roughness, abrasive wear, coefficient of friction, and erosive wear. The lowest average absolute arithmetic surface roughness value (Ra) of PP and PP-PCCF, 10% wt., were 0.19 µm and 0.28 µm. The lowest abrasive wear value of 3.09 × 10−6 mm3/Nm was found for pure PP. The erosive wear value (35 mm3/kg) of PP-PCCF 40% wt. composite material was 2 to 17 times higher than all other composite materials. Finally, the single-step analysis of variance predicts reasonable results in terms of the p-values of each composite material for commercial applications. [ABSTRACT FROM AUTHOR]

Background: The diagnosis of hypertension and hypertension-induced target organ injury by the 2022 American Heart Association (AHA) ambulatory blood pressure threshold as compared with 2014 AHA and 2016 European Society of Hypertension (ESH) thresholds has not been evaluated. Methods: In a cross-sectional study (n = 291, aged 5–18 years, at a tertiary care outpatient clinic), we compared 2022 AHA with 2014 AHA and ESH thresholds (revised with 2018 adult ESH thresholds where applicable) to diagnose ambulatory hypertension (AH), and detect ambulatory arterial stiffness index (AASI) and left ventricular target organ injury (LVTOI). Results: The 2022 AHA threshold diagnosed significantly more AH (53%) than the 2014 AHA (42%, p < 0.01) and ESH (36%, p < 0.001) thresholds. The 2022 AHA threshold demonstrated only a moderate agreement with the 2014 AHA (kappa (k) = 0.77) and ESH (k = 0.66) thresholds to diagnose AH. Adjusted logistic regression analysis found that only the 2022 AHA threshold predicted elevated AASI significantly (odds ratio 2.40, 95% CI 1.09, 5.25, p = 0.02; AUC 0.61, p < 0.01). In those with elevated AASI, more participants had AH by the 2022 AHA threshold (72%) than the 2014 AHA (46%, p = 0.02) and ESH (48%, p = 0.03) thresholds. AH defined by the 2022 AHA threshold continued to maintain higher odds, larger AUC, and higher sensitivity to identify LVTOI than the 2014 AHA and ESH thresholds; however, the difference did not reach a statistically significant level. Conclusions: AH defined by the 2022 AHA threshold diagnoses more children with hypertension and identifies more children with hypertension-induced target organ injury than the 2014 AHA and ESH thresholds. [ABSTRACT FROM AUTHOR]

Alcohol control strategies vary between countries and reflect differences in drinking cultures. This study explored how perceived effectiveness of alcohol control strategies varies according to individual characteristics and country of residence. A cross-sectional online survey was completed by 1910 university students in Denmark, England, Germany, Italy, Portugal, and Switzerland. It assessed the perceived effectiveness of 11 alcohol control strategies. Correlates included sensation-seeking, alcohol outcome expectancies, drink refusal self-efficacy, and Alcohol Use Disorders Identification Test (AUDIT) scores. Bivariate analysis using mixed-measures MANOVA and Pearson correlations were followed by linear regression to identify multivariate correlates. These analyses revealed that educational strategies (e.g. teaching people skills to resist peer pressure) were considered more effective than restrictive strategies (e.g. raising the legal drinking age). Perceived effectiveness was greater among women and lighter drinkers. Country of residence also explained unique variance. The findings highlight the need to consider the potential impact of drinking culture in alcohol-related harm-reduction strategies. [ABSTRACT FROM AUTHOR]

The analysis of the current state of fire statistics and data collection in Europe and other countries is needed to increase awareness of how fire incidents affect buildings and to support pan-European fire prevention and fire mitigation measures. The terminology and data collected regarding fire incidents in buildings in the EU Member States were mapped to obtain meaningful datasets to determine common terminology, collection methodology, and data interpretation system. An extensive literature review showed that fire data collection systems have been instrumental in informing firefighting strategies, evidence-based planning, prevention, and educational programmes. Differences and similarities between fire data collection systems were also investigated. The amount and quality of the information in fire statistical recording systems appear to be influenced by the complexity and structure with which the data are collected. The analysis also examined the existing fire statistics in the EU Member States and a few other countries. Finally, a detailed investigation of the number of fires, fire deaths, and injuries from 2009 to 2018 in several countries was examined based on data from a report by CTIF. The trends showed differences attributable to the existing fire statistical practices in terms of terminology and data collection, and interpretation. Part II proposes a common terminology for selected fire statistical variables. The results provide relevant information regarding fire safety at the European level and should be used to guide the development of more uniform fire statistics across Europe. [ABSTRACT FROM AUTHOR]

Disease-specific studies on the impact of Hodgkin lymphoma (HL) on education or work interruption and resumption are lacking. In a cross-sectional study conducted among long-term HL survivors enrolled from 1964 to 2004 in nine randomised EORTC-LYSA trials, the interruption and resumption of education/work was investigated. Survivors alive 5–44 years after diagnosis who were studying or working at time of diagnosis were included (n = 1646). Patient and treatment characteristics were obtained from trial records. Education and work outcomes were collected using the Life Situation Questionnaire. Logistic regression was used to model education or work interruption; Cox regression was used to study resumption rates. Among survivors studying at time of diagnosis (n = 323), 52% (95% CI: 46–57%) interrupted their education; however, it was resumed within 24 months by 92% (95% CI: 87–96%). The probability of interruption decreased with time: the more recent the treatment era, the lower the risk (OR 0.70 per 10 years, 95% CI: 0.49–1.01). Treatment with radiotherapy (yes vs. no) was associated with a higher education resumption rate (HR 2.01, 95% CI 1.07–3.78) whereas age, sex, stage, radiotherapy field and chemotherapy were not. Among survivors working at time of diagnosis (n = 1323), 77% (95% CI: 75–79%) interrupted their work. However, it was resumed within 24 months by 86% (95% CI: 84%-88%). Women were more likely to interrupt their work as compared to men (OR 1.90, 95% CI: 1.44–2.51) and, when interrupted, less likely to resume work (HR 0.70, 95% CI: 0.61–0.80). Survivors with a higher educational level were less likely to interrupt their work (OR 0.68 for university vs. no high school, 95% CI: 0.46–1.03); and when interrupted, more likely to resume work (HR 1.50 for university vs. no high school, 95% CI: 1.21–1.86). Increasing age was also associated with lower resumption rates (HR 0.62 for age ≥50 vs. 18–29 years, 95% CI: 0.41–0.94). An interruption in education/work was common among long-term HL survivors. However, most of the survivors who interrupted their studies or work had resumed their activities within 24 months. In this study, no associations between survivors' characteristics and failure to resume education were observed. Female sex, age ≥50 years, and a lower level of education were found to be associated with not resuming work after treatment for HL. [ABSTRACT FROM AUTHOR]

Inter-variable correlations (e.g., between daily temperature and precipitation) are key statistical properties to characterise probabilities of simultaneous climate events and compound events. Their correct simulations from climate models, both in values and in changes over time, is then a prerequisite to investigate their future changes and associated impacts. Therefore, this study first evaluates the capabilities of one 11-single run multi-model ensemble (CMIP6) and one 40-member single model initial-condition large ensemble (CESM) over Europe to reproduce the characteristics of a reanalysis dataset (ERA5) in terms of temperature–precipitation correlations and their historical changes. Next, the ensembles' correlations for the end of the 21st century are compared. Over the historical period, both CMIP6 and CESM ensembles have season-dependent and spatially structured biases. Moreover, the inter-variable correlations from both ensembles mostly appear stationary. Thus, although reanalysis displays significant correlation changes, none of the ensembles can reproduce them, with internal variability representing only 30% on the inter-model variability. However, future correlations show significant changes over large spatial patterns. Yet, those patterns are rather different for CMIP6 and CESM, reflecting a large uncertainty in changes. In addition, for historical and future projections, an analysis conditional on atmospheric circulation regimes is performed. The conditional correlations given the regimes are found to be the main contributor to the biases in correlation over the historical period, and to the past and future changes of correlation. These results highlight the importance of the large-scale circulation regimes and the need to understand their physical relationships with local-scale phenomena associated to specific inter-variable correlations. [ABSTRACT FROM AUTHOR]

Using data from a cross-national survey conducted on representative samples of populations from 10 European countries (n = 10,766), the present study is the first one to empirically measure the validity of Christie's influential ideal victim model. We use a range of scenarios built around common types of anti-LGBT violence to verify the extent to which the public's empathy for victims is contingent on the victim's identity and the circumstances of the crime. The results provide strong evidence that, when applied to this group of victims, the rules of the ideal victim work, adequately moderating the public's emotional reactions. We found that all victims receive relatively high levels of empathy, but the further the victim is from the ideal, the less support they can count on. Thus, even though no victim is "rejected," a clear hierarchy of victimization emerges. As a group, LGBT people suffer from an empathy deficit, but there also are considerable variations within this group, with a lesbian attacked by extremists receiving the most, and a drunk transgender person receiving the least empathy from the public. The study contributes to the development of theory by embedding the ideal victim model in a broader sociological paradigm of dramaturgical analysis. Since our research shows that the victim's LGBT status decreases the levels of empathy (being seen as a type of stigma), we call for more attention to be paid to the actor's identity in Goffman's framework. Implications for practice and further research are offered. [ABSTRACT FROM AUTHOR]

We analyzed the European countries participation in clinical trials addressing to new drug development focused on rare diseases in women comparing to more prevalent diseases as breast cancer. Participation was not associated with type of healthcare system neither socio-economic features, but it was associated with population size. Protocol ratios focused on breast cancer vs. orphan drugs and rare diseases was 15:1 and 9:1, respectively, mainly focused on ovarian cancer. Protocol number was insufficient to evaluate the success of Regulation (EC) 141/2000, it is necessary to increase the scientific quality and the number of really new molecules. [ABSTRACT FROM AUTHOR]

This paper uses data from Eurobarometer for the years 2007 and 2015 to investigate the determinants of trust in official statistics across 28 countries and 2 regions in Europe. Our estimation follows a multilevel modelling approach, which allows us to distinguish within-country and between-country variation in individual trust in official statistics. Our estimation results show that the within-country variation is mainly explained by individual-level statistical literacy and education, as well as occupational status. With respect to the variation between countries, we show that neither the level of GPD nor the index of inequality are important in explaining cross-country variation. Instead, EU membership history, i.e. the 'acquis communautaire', is the main macro variable that explains the increase in trust for the official statistics across Europe. [ABSTRACT FROM AUTHOR]

Summary: In this post hoc analysis, we assessed romosozumab efficacy and safety in European patients enrolled in FRAME. Romosozumab treatment through 12 months, followed by denosumab for a further 24 months, resulted in early and sustained risk reduction for major fracture categories, associated with large gains in bone mineral density. Introduction: In the multinational FRAME phase 3 trial of romosozumab in postmenopausal women with osteoporosis, marked differences between clinical and non-vertebral fracture outcomes were observed among patients from Central and Southern America versus rest of world. This post hoc analysis assessed romosozumab efficacy and safety in European patients enrolled in the FRAME trial and extension study. Methods: In FRAME (NCT01575834), patients were randomised 1:1 to romosozumab 210 mg or placebo monthly (QM) for 12 months, followed by open-label denosumab 60 mg Q6M to month 36, including a 12-month extension study. We report incidence of major fracture outcomes, bone mineral density (BMD) change from baseline and safety for European patients enrolled in FRAME. Results: In FRAME, 3013/7180 (41.96%) patients were European; 1494 received romosozumab and 1519 received placebo. Through 12 months, romosozumab reduced fracture risk versus placebo for non-vertebral fracture (1.4% versus 3.0%; p = 0.004), clinical fracture (1.4% versus 3.6%; p < 0.001), new vertebral fracture (0.4% versus 2.1%; p < 0.001) and major osteoporotic fracture (0.9% versus 2.8%; p < 0.001), with results sustained through 36 months following transition to denosumab. Hip fractures were numerically reduced with romosozumab at month 12 (0.2% versus 0.6%; p = 0.092). Romosozumab increased BMD versus placebo at month 12; all patients in the romosozumab and placebo groups experienced further increases by month 36 after transition to denosumab. Adverse events were balanced between groups. Conclusions: Among European patients in FRAME, romosozumab resulted in early and sustained risk reduction for all major fracture categories, associated with large BMD gains that continued after transition to denosumab. [ABSTRACT FROM AUTHOR]

Introduction: Even under normal circumstances, anxiety is quite common among nursing students. Therefore, this study compared nursing students' health and coronavirus anxiety in two European countries. Method: The sample of the descriptive, cross-sectional study consisted of 685 undergraduate students studying at two different nursing schools in Turkey and Portugal. The study data were collected with the Personnel Data Collection Form, Coronavirus Anxiety Scale, and Short Health Anxiety Inventory. Results: While there was no difference between the Coronavirus Anxiety Scale scores of Turkish and Portuguese nursing students (p >.05), a statistically significant difference was found between the Short Health Anxiety Inventory total scores and negative consequences scores (p <.05). Discussion: Against the pandemic that the whole world is experiencing, it is recommended to compare nursing students in a cultural context and take precautions. [ABSTRACT FROM AUTHOR]

IMbrave150 has established the superiority of atezolizumab plus bevacizumab over sorafenib in patients with unresectable hepatocellular carcinoma (HCC). We generated a prospectively maintained database including patients treated with atezolizumab plus bevacizumab for unresectable HCC across Europe, Asia and USA. Clinico-pathologic characteristics were assessed for their prognostic influence on overall survival (OS) and progression-free survival (PFS) in univariable and multivariate analyses. Overall response rate by RECIST v1.1 and treatment-related adverse events (TRAEs) per CTCAE v.5.0 were reported. Out of 433 patients, 296 Child-Pugh A and ECOG performance status01 patients received atezolizumab plus bevacizumab in first line and were included. Patients were mostly male (82.7%), cirrhotic (75%) with history of viral hepatitis (65.9%). Overall, 68.9% had Barcelona Clinic Liver Cancer C-stage HCC with portal vein tumour thrombosis (PVTT, 35%) and extrahepatic spread (EHS, 51.7%). After a median follow-up of 10.0 months (95% confidence interval (CI): 9.4–10.4), median OS and PFS were 15.7 (95% CI: 14.5-NE) and 6.9 months (95% CI: 6.1–8.3), respectively. In the response-evaluable patients (n = 273), overall response rate was 30.8%. Overall, 221 patients (74.6%) developed TRAEs, with 70 (23.6%) reporting grade 3 or higher TRAEs; 25 (8.4%) patients had bleeding events. OS was independently associated with baseline Albumin-bilirubin (ALBI) grade and PVTT. Shorter PFS was associated with AFP≥ 400 ng/ml, worse ALBI and presence of EHS. This global observational study confirms the reproducible safety and efficacy of atezolizumab plus bevacizumab in routine clinical practice. Within Child-Pugh-A criteria, the presence of PVTT and higher ALBI grade identify patients with poorer survival. • Atezolizumab plus bevacizumab (A + B) is the standard of care for patients with unresectable hepatocellular carcinoma. • We report data from a large cohort of patients treated with A + B in real-life. • Effectiveness and safety of the combination is reproducible in daily practice. • Liver function and macro-vascular invasion is with overall survival. • Radiological response predicts better outcomes. [ABSTRACT FROM AUTHOR]

Background: Bacterial contamination in platelets remain a major public health concern, which prompted the US Food and Drug Administration guidance for bacterial contamination mitigation. Pathogen reduction technology (PRT) is one mitigation strategy that has shown success in Europe over the last decade. Therefore, our center sought to transition from a dual system of bacterial culturing (BacT) and PRT to full PRT.Methods: A 1 month pilot study was conducted to simulate 100% PRT conditions. Our center also collected baseline data on key platelet production metrics in the 4 months prior to 100% PRT and compared it to the 4 months post-implementation.Results: The pilot study showed no statistical differences in split rate, proportion of low-yield products, or proportion of single, double, and triple collections. The only observed difference was an 11 min increase in the average duration of double collections. Our baseline versus post-implementation monitoring showed no difference in split rate, discard rate, percentage of low-yield units, and average yield of low yield units. Statistical differences were detected in the proportion of single, double, and triple collections, as well as the average yield of full dose products. Roughly 20% of our inventory consisted of low-yield products.Discussion: With suitable mitigation strategies, transitioning to a full PRT inventory may result in higher net margins while not adversely affecting overall platelet production. A pilot study is a good way to project potential effects of switching from a dual BacT and PRT inventory to full PRT, and can be adopted by other centers aiming to make the transition. [ABSTRACT FROM AUTHOR]

Background. The problem of the ageing population has resulted in attitudes towards aging in different age groups becoming a subject of increased academic interest. Objectives. To provide comparative characteristics of the prevalence of manifestations of gerontological ageism among university students in five European countries. Material and methods. The sample consisted of university students (n = 2493) aged 18–25 from Belarus (n = 827), Russia (n = 528), Poland (n = 798), Lithuania (n = 223) and Ukraine (n = 117). The prevalence of gerontological ageism among respondents was evaluated according to the Fraboni Ageism Scale. Results. The prevalence and manifestations of gerontological ageism vary depending on the country. The maximum total indicator, displaying the highest overall level of ageism, was noted among Belarusian students, the minimum – in Lithuania (p < 0.05). The final indicators of gerontological ageism were found to be the following: the level of age discrimination and negative emotional attitude towards the elderly was increased in one fifth of the respondents in all five groups. The observation found the level of ageism averaging at 60%, evenly distributed in all groups. The predominant attitudes towards older people were found to be neutral or positive (84.6%). Conclusions. The manifestations of ageism are international in nature and can explain 20% of the total variety of answers characterising the differences in ranked attributes and degree of ageism. The total indicator showed the highest degree of gerontological ageism among students in Belarus, the lowest – among those in Lithuania, with levels of gerontological ageism among students in Russia, Poland and Ukraine distributed in between. [ABSTRACT FROM AUTHOR]

In response to the COVID-19 outbreak, governments in European countries adopted a wide range of containment measures to prevent the spread of the virus. These measures led to unprecedented short-term economic loss for national economies, to which governments responded with support measures targeting both households and businesses. In this article, we argue that official statistics are a key source for robust comparisons of the economic impact of COVID-19 and subsequent support measures across countries. In particular, we use Eurostat's quarterly non-financial sector accounts and supplementary information provided by countries to estimate and compare the support received by households in 18 European countries. We focus our analysis on the second and third quarter of 2020, when national economies in Europe were impacted mostly by the containment measures. The results show some heterogeneity in the type and extent of support provided. Interestingly, while in some countries support interventions were far from making up for the loss of income, in others they far outweighed it. [ABSTRACT FROM AUTHOR]

Objectives To investigate time trends in baseline characteristics and retention, remission and response rates in bio-naïve axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) patients initiating TNF inhibitor (TNFi) treatment. Methods Prospectively collected data on bio-naïve axSpA and PsA patients from routine care in 15 European countries were pooled. Three cohorts were defined according to year of TNFi initiation: A (1999–2008), B (2009–2014) and C (2015–2018). Retention, remission and response rates were assessed at 6, 12 and 24 months. Results In total, 27 149 axSpA and 17 446 PsA patients were included. Cohort A patients had longer disease duration compared with B and C. In axSpA, cohort A had the largest proportion of male and HLA-B27 positive patients. In PsA, baseline disease activity was highest in cohort A. Retention rates in axSpA/PsA were highest in cohort A and differed only slightly between B and C. For all cohorts, disease activity decreased markedly from 0 to 6 months. In axSpA, disease activity at 24 months was highest in cohort A, where also remission and response rates were lowest. In PsA, remission rates at 6 and 12 months tended to be lowest in cohort A. Response rates were at all time points comparable across cohorts, and less between-cohort disease activity differences were seen at 24 months. Conclusion Our findings indicate that over the past decades, clinicians have implemented more aggressive treatment strategies in spondyloarthritis. This was illustrated by shorter disease duration at treatment initiation, decreased retention rates and higher remission rates during recent years. [ABSTRACT FROM AUTHOR]

Introduction: Helping professionals are at high risk of being affected by the negative aspects of helping such as compassion fatigue. To date, no study has provided a comprehensive overview of compassion fatigue and compared the prevalence among different helping professions. Objectives: The aim of this study was to explore the prevalence and differences in compassion fatigue among different helping professions. We also wanted to explore the relationship between compassion, self‐compassion, self‐criticism and compassion fatigue. Methods: Six hundred and seven participants working in the helping professions were recruited. The sample consisted of 102 nurses, 44 doctors, 57 paramedics, 39 home nurses, 66 teachers, 103 psychologists, 40 psychotherapists and coaches, 76 social workers, 39 priests and pastors and 41 police officers. The data were collected using an online questionnaire battery measuring levels of compassion, self‐compassion, self‐criticism, compassion fatigue and compassion satisfaction. Results: We found significant differences in compassion fatigue levels among various helping professions. No large differences were found in the compassion and self‐compassion levels exhibited by professionals with medium versus low compassion fatigue scores. However, participants with higher levels of compassion fatigue scored higher in self‐criticism. Self‐criticism was found to be the best predictor of compassion fatigue. The effect of profession on compassion fatigue as mediated by self‐criticism and self‐compassion was significant. Conclusions: Based on the results, we recommend designing programs to combat compassion fatigue that teach helping professionals to better manage their work time and workload (hours per week with clients/patients) and learn healthier inner talk (less self‐critical and more self‐compassionate). [ABSTRACT FROM AUTHOR]

We retrospectively investigated the role of (neo)adjuvant chemotherapy in patients with primary, localized angiosarcoma. We selected all patients with primary, localized angiosarcoma, who had received radical surgery between January 2005 and December 2019 at 33 European sarcoma reference centers. The primary objective was to compare the outcome of patients who received (neo)adjuvant chemotherapy versus those who did not, in terms of overall survival (OS), disease-free survival (DFS) and distant metastasis-free survival (DMFS). To reduce the risk of confounding due to imbalance, a propensity-score matching(PSM) was performed. Finally, subgroups analysis was performed according to tumor site, tumor size (< 50 mm or ≥ 50 mm) and patients predicted 10-years OS according to the nomogram sarculator (two different cutoff-values were applied: ≤ 33% or > 33% and < 60% or ≥ 60%). 362 patients were analyzed: 149 (41.2%; treated group) received (neo) adjuvant chemotherapy and 213 (58.6%; control group) did not. The median follow-up for the OS endpoint was 5.1 years (95% CI: 4.0–5.5). The OS-HR was 0.58 (95%CI: 0.40–0.83; p-value = 0.003) in the univariate analysis and 0.74 (95% CI: 0.38–1.43; p = 0.367) in the PSM analysis. The DFS-HR was 0.75 (95% CI: 0.57–0.98; p-value = 0.036) in the univariate analysis, and 0.91 (95% CI:0.56–1.48; p-value = 0.7) in the PSM analysis. The DMFS-HR was 0.75 (95% CI: 0.55–1.02; p-value = 0.065) in univariate analysis and 0.92 (95% CI: 0.53–1.61; p-value = 0.769) in the PSM analysis. Subgroup analysis revealed no heterogeneity of results in strata of tumor site. On the contrary, there was a trend for heterogeneity according to tumor size and patient's risk of death. For all the endpoints analyzed, patients with tumors smaller than 50 mm or at lower risk of death seem to have no benefit from chemotherapy, while patients with larger tumors or at higher risk of death at 10 years seem to derive substantial benefit. This large, retrospective study suggests that patients affected by > 50 mm and/or high-risk primary, localized angiosarcoma could benefit from (neo)adjuvant chemotherapy. • Localized angiosarcoma of any site. • Effectiveness of (neo)adjuvant chemotherapy. • High risk angiosarcoma. [ABSTRACT FROM AUTHOR]

Context.--The histologic features in patients with acuteon- chronic liver failure (ACLF) are evolving, and histologic indicators of patients' poor prognosis are not yet fully established. Objective.--To evaluate the independent histologic predictors of 28-day mortality in ACLF patients on coreneedle liver biopsies. Design.--Core-needle biopsies from patients with a diagnosis of ACLF (n = 152) as per the European Association for the Study of the Liver criteria were included during 8 years. Liver biopsies from 98 patients with compensated chronic liver disease were included as disease controls for histologic comparison. Features of ongoing changes, such as hepatic necrosis, hepatic apoptosis, cholestasis, hepatocyte degeneration, bile ductular proliferation, Mallory-Denk bodies, steatosis, and extent of liver fibrosis, were analyzed for predicting short-term mortality (28 days). A P value of,.05 was considered significant. Results.--In our cohort of ACLF patients, the following etiologies for acute decompensation were identified: alcohol, 47 of 152 (30.9%); sepsis, 24 of 152 (15.7%); hepatotropic viruses, 20 of 152 (13.1%); drug-induced liver injury, 11 of 152 (7.2%); autoimmune flare, 9 of 152 (5.9%); mixed etiologies, 5 of 152 (3.2%); and cryptogenic, 36 of 152 (23.6%). On histologic examination, hepatic necrosis (P < .001), dense lobular inflammation (P = .03), cholestasis (P < .001), ductular reaction (P = .001), hepatocyte degeneration (P < .001), and absence of advanced fibrosis stages (P < .001) were identified significantly more othen in ACLF patients than in disease controls on univariate analysis. On multivariate Cox regression analysis, the absence of advanced Ishak histologic activity index fibrosis stages (P = .02) and the presence of dense lobular inflammation (P = .04) were associated with increased 28-day mortality in ACLF patients. After adjusting the clinical causes of acute decompensation, only dense lobular inflammation was found as an independent predictor of short-term mortality (P = .04) in ACLF patients. Conclusions.--Dense lobular necroinflammatory activity is a clinically independent histologic predictor of 28-day short-term mortality in patients with ACLF. [ABSTRACT FROM AUTHOR]

Introduction: In addition to the functional aspects of healthcare integration, an understanding of its normative aspects is needed. This study explores the importance of values underpinning integrated, people-centred health services, and examines similarities and differences among the values prioritised by actors across Europe. Methods: Explorative cross-sectional design with quantitative analysis. A questionnaire of 18 values was conducted across Europe. A total of 1,013 respondents indicated the importance of each of the values on a nine-point scale and selected three most important values. Respondents were clustered in four actor groups, and countries in four European sub-regions. Results: The importance scores of values ranged from 7.62 to 8.55 on a nine-point scale. Statistically significant differences among actor groups were found for ten values. Statistically significant differences across European sub-regions were found for six values. Our analysis revealed two clusters of values: 'people related' and 'governance and organisation'. Discussion and conclusion: The study found that all 18 values in the set are considered important by the respondents. Additionally, it revealed distinctions in emphasis among the values prioritised by actor groups and across sub-regions. The study uncovered two clusters of values that contribute to a conceptually based definition of integrated, people-centred health services. [ABSTRACT FROM AUTHOR]

Background: Maternal perception of child weight status in children with overweight or obesity has received a lot of attention but data on paternal perception of children from presumably healthy cohorts are lacking. Objective: We aimed to investigate paternal and maternal perception of child weight status at the age of 8 years in a cohort of 591 children from 5 European countries. Material and Methods: Included were 8-year-old children and their parents participating in the European Childhood Obesity Project (EU CHOP). Weight and height of children and parents were measured and Body Mass Index (BMI, kg/m2) was calculated. Both parents were asked to assess their perception of child weight status using Eckstein scales and their concern about child overweight. The agreement between mother and father perceptions was assessed by Cohen kappa coefficient and their relationship was analyzed by linear mixed effects models based on ordinal logistic regression, accounting for country, child gender and BMI, parental BMI, level of education, concern and type of feeding during first year of life. Results: Data from children and both parents were available for 432 girls and boys. Mean BMI was comparable in boys and girls (16.7 ± 2.31 vs. 16.9 ± 2.87 kg/m2, P = 0.55). In total, 172 children (29.3%) were overweight or obese. There was a high degree of agreement between mother and father perceptions of their child's weight status (Cohen kappa 0.77). Multivariate modelling showed that perception levels significantly increased with child BMI but were globally lower than assessed. They differed between countries, gender and types of feeding during first year of life, were influenced by education level of the father but were not related to parental BMI and concern about childhood overweight. Conclusions: The study showed no overall differences between mothers and fathers in rating their child's weight status but both parents had a propensity to underestimate their child's actual weight, particularly in boys. The EU CHOP trial registered at clinicaltrials.gov as NCT00338689. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease (CKD) progression is presumably related to inflammatory response. The modified Glasgow prognostic score (mGPS), based on a combination of albumin and C‐reactive protein, has been derived from oncology and validated in multiple diseases. Aims: To evaluate the relationship between the mGPS and CKD progression. Methods: The present retrospective unicentric cohort study included 547 CKD patients (age 60.2 years; 53% male; estimated glomerular filtration (eGFR) 42.0 mL/min; mean change −2 mL/min/year) admitted between 1 January 2007 and 31 December 2012. Patients' records were reviewed from the CKD diagnosis to one of the four outcomes: end‐stage kidney disease (ESKD), death, loss to follow up or until 31 July 2017. Results: The mGPS score was 0 for 420 (78%), 1 for 110 (19%) and 2 for 17 (3%) patients. More patients with rapid CKD progression were found in the group with the highest mGPS (P = 0.05). mGPS was negatively correlated with baseline eGFR and positively with albuminuria. In the multivariate analysis, mGPS was associated with the eGFR slope. During the study period, 130 (24%) patients died and 109 (20%) reached ESKD. The mean kidney survival time was 8.1 (95% confidence interval 7.9–8.4) years. Patients with zero mGPS had better kidney survival than those with the score of 1 and 2 (Kaplan–Meier, P = 0.02). However, the kidney survival differences were not present after adjusting for CKD progression risk factors. Conclusion: The inflammation‐based mGPS score was associated with eGFR decline in CKD patients. Therefore, could prove useful in improving risk stratification of CKD patients. [ABSTRACT FROM AUTHOR]

Background: With an increasing number of cardiac implantable electronic devices (CIEDs), there has been a paralleled increase in demand for transvenous lead extraction (TLE). Cardiac surgeons (CS) and cardiologists perform TLE; however, data comparing the two groups of operators is scarce. Objective: We compared the outcomes of TLE performed by cardiologists and CS from six European lead extraction units. Method: Data was collected retrospectively of 2205 patients who had 3849 leads extracted (PROMET) between 2005 and 2018. Patient demographics and procedural outcomes were compared between the CS and cardiologist groups, using propensity score matching. A multivariate regression analysis was also performed for variables associated with 30‐day mortality. Results: CS performed the majority of extractions (59.8%), of leads with longer dwell times (90 [57–129 interquartile range (IQR)] vs. 62 [31–102 IQR] months, CS vs. cardiologists, p <.001) and with pre‐dominantly non‐infectious indications (57.4% vs. 50.2%, CS vs. cardiologists, p <.001). CS achieved a higher complete success per lead than the cardiologists (98.1% vs. 95.7%, respectively, p <.01), with a higher number of minor complications (5.51% vs. 2.1%, p <.01) and similar number of major complications (0.47% vs. 1.3%, p =.12). Thirty‐day mortality was similarly low in the CS and cardiologist groups (1.76% vs. 0.94%, p =.21). Unmatched data multivariate analysis revealed infection indication (OR 6.12 [1.9–20.3], p <.01), procedure duration (OR 1.01 [1.01–1.02], p <.01) and CS operator (OR 2.67, [1.12–6.37], p =.027) were associated with 30‐day mortality. Conclusion: TLE by CS was performed with similar safety and higher efficacy compared to cardiologists in high and medium‐volume lead extraction centers. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To investigate nurses' intention in accepting COVID‐19 vaccination and the factors affecting their decision. Background: COVID‐19 vaccination has started in most European countries with healthcare personnel being the first group receiving the vaccine shots. Their attitude towards vaccination is of paramount significant as their role in the frontline could help in the awareness of general population. Methods: A study was conducted in Albania, Cyprus, Greece, Spain and Kosovo with the use of an online questionnaire. The Fear of COVID‐19 Scale was used. The STROBE checklist was followed for this cross‐sectional study. Results: Study population consisted of 1135 nurses. Mean age of the participants was 38.3 years, while most of them were female gender (84.7%) and married (53.1%). Acceptance of a safe and effective COVID‐19 vaccine was higher among Greek (79.2%) and Spanish (71.6%) nurses, followed by Cypriot (54%), Albanian (46.3%) and Kosovo (46.2%) nurses. Key factors for willingness to get vaccinated were male gender, living in a country with a high mortality rate in comparison with low mortality, being not infected with COVID‐19, having high level of knowledge about COVID‐19 vaccines and having been vaccinated for influenza in the last 2 years. Moreover, trusting the government and doctors regarding the information about the COVID‐19 and having high level of fear about this virus were key factors for willingness to get vaccinated. Conclusion: Vaccination of healthcare personnel is a crucial issue not only for their own safety but also for their patients'. Healthcare acceptance to get vaccinated can work as a role model for general population. Relevance to clinical practice: Gender, country, mortality rate, trust in government and health professionals and the level of fear were key factors that should be managed in clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to describe ultra-processed food and drinks (UPFDs) consumption, and associations with intake of total sugar and dietary fibre, and high BMI in adults across Europe. Methods: Using food consumption data collected by food records or 24-h dietary recalls available from the European Food Safety Authority (EFSA) Comprehensive European Food Consumption Database, the foods consumed were classified by the level of processing using the NOVA classification. Diet quality was assessed by data linkage to the Dutch food composition tables (NEVO) and years lived with disability for high BMI from the Global Burden of Disease Study 2019. Bivariate groupings were carried out to explore associations of UPFDs consumption with population intake of sugar and dietary fibre, and BMI burden, visualised by scatterplots. Results: The energy share from UPFDs varied markedly across the 22 European countries included, ranging from 14 to 44%, being the lowest in Italy and Romania, while the highest in the UK and Sweden. An overall modest decrease (2–15%) in UPFDs consumption is observed over time, except for Finland, Spain and the UK reporting increases (3–9%). Fine bakery wares and soft drinks were most frequently ranked as the main contributor. Countries with a higher sugar intake reported also a higher energy share from UPFDs, as most clearly observed for UPF (r = 0.57, p value = 0.032 for men; and r = 0.53, p value = 0.061 for women). No associations with fibre intake or high BMI were observed. Conclusion: Population-level UPFDs consumption substantially varied across Europe, although main contributors are similar. UPFDs consumption was not observed to be associated with country-level burden of high BMI, despite being related to a higher total sugar intake. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to explore mentoring competence in nursing student mentors during clinical practice by identifying different mentor profiles and connections between different competence areas among five European countries and Japan. Methods: The study implemented a cross‐sectional design in Finland, Italy, Lithuania, Slovenia, Spain, and Japan during 2016 and 2019. In total, 6208 mentors were invited, and 1862 participated from 58 healthcare organizations. The data were collected with a survey questionnaire by including background question items with the Mentor Competence Instrument. K‐clustering and structural equation modeling were used for data analysis. Results: Four mentor profiles, A (43%), B (30%), C (18%), and D (9%), were identified according to the seven mentoring competence areas with high statistical significance (p < 0.001). Higher mentoring competence (mean >3.50) was observed among Finnish, Lithuanian, and Slovenian mentors with university education in nursing, older ages, more work experience, and previous education in mentoring. Lower competence (mean <2.49) was observed among Japanese and Italian mentors with diplomas in nursing, younger ages, less work experience, and no previous education in mentoring. Conclusion: Mentoring requires motivated, highly competent mentors since mentoring is a critical aspect of nursing education. Mentoring roles should be given to nurses with higher education and mentoring training. Younger, less experienced nurses without formal mentoring training may need support from senior nurses when performing mentoring roles and could also facilitate a more balanced workload between patient care and mentoring for senior nurses. [ABSTRACT FROM AUTHOR]

Aims Sudden death is a leading cause of mortality in heart failure with reduced ejection fraction (HFrEF). In PARADIGM-HF, sacubitril/valsartan reduced the incidence of sudden death. The purpose of this post hoc study was to analyse the effect of sacubitril/valsartan, compared to enalapril, on the incidence of ventricular arrhythmias. Methods and results Adverse event reports related to ventricular arrhythmias were examined in PARADIGM-HF. The effect of randomized treatment on two arrhythmia outcomes was analysed: ventricular arrhythmias and the composite of a ventricular arrhythmia, implantable cardioverter defibrillator (ICD) shock or resuscitated cardiac arrest. The risk of death related to a ventricular arrhythmia was examined in time-updated models. The interaction between heart failure aetiology, or baseline ICD/cardiac resynchronization therapy-defibrillator (CRT-D) use, and the effect of sacubitril/valsartan was analysed. Of the 8399 participants, 333 (4.0%) reported a ventricular arrhythmia and 372 (4.4%) the composite arrhythmia outcome. Ventricular arrhythmias were associated with higher mortality. Compared with enalapril, sacubitril/valsartan reduced the risk of a ventricular arrhythmia (hazard ratio [HR] 0.76, 95% confidence interval [CI] 0.62-0.95; p = 0.015) and the composite arrhythmia outcome (HR 0.79, 95% CI 0.65-0.97; p = 0.025). The treatment effect was maintained after adjustment and accounting for the competing risk of death. Baseline ICD/CRT-D use did not modify the effect of sacubitril/valsartan, but aetiology did: HR in patients with an ischaemic aetiology 0.93 (95% CI 0.71-1.21) versus 0.53 (95% CI 0.37-0.78) in those without an ischaemic aetiology (p for interaction = 0.020). Conclusions Sacubitril/valsartan reduced the incidence of investigator-reported ventricular arrhythmias in patients with HFrEF. This effect may have been greater in patients with a non-ischaemic aetiology. [ABSTRACT FROM AUTHOR]

Objective: This study assessed associations between severity of, and prescription medication use for, chronic low back pain (CLBP) and health‐related quality of life, health status, work productivity, and healthcare resource utilization. Methods: This cross‐sectional study utilized SF‐12, EQ‐5D‐5L, and work productivity and activity impairment (WPAI) questionnaires, and visits to healthcare providers among adults with self‐reported CLBP participating in the National Health and Wellness Survey in Germany, France, UK, Italy, and Spain. Respondents were stratified into four groups according to pain severity (mild or moderate/severe) and prescription medication use (Rx‐treated or Rx‐untreated). Differences between groups were estimated using generalized linear models controlling for sociodemographics and health characteristics. Results: Of 2086 respondents with CLBP, 683 had mild pain (276 Rx‐untreated, 407 Rx‐treated) and 1403 had moderate/severe pain (781 Rx‐untreated, 622 Rx‐treated). Respondents with moderate/severe pain had significantly worse health‐related quality of life (SF‐12v2 physical component summary), health status (EQ‐5D‐5L), and both absenteeism and presenteeism compared with those with mild pain, including Rx‐untreated (moderate/severe pain Rx‐untreated vs. mild pain Rx‐untreated, p ≤ 0.05) and Rx‐treated (moderate/severe pain Rx‐treated vs. mild pain Rx‐treated, p ≤ 0.05) groups. Significantly more visits to healthcare providers in the last 6 months were reported for moderate/severe pain compared with mild pain for Rx‐treated (least squares mean 13.01 vs. 10.93, p = 0.012) but not Rx‐untreated (8.72 vs. 7.61, p = 0.072) groups. Health‐related quality of life (SF‐12v2 physical component summary) and health status (EQ‐5D‐5L), as well as absenteeism and presenteeism, were significantly worse, and healthcare utilization was significantly higher, in the moderate/severe pain Rx‐treated group compared with all other groups (all p ≤ 0.05). Conclusion: Greater severity of CLBP was associated with worse health‐related quality of life, health status, and absenteeism and presenteeism, irrespective of prescription medication use. Greater severity of CLBP was associated with increased healthcare utilization in prescription medication users. [ABSTRACT FROM AUTHOR]

Having grandchildren is known to reduce individuals' labour supply. However, it is unclear whether there is a negative association between grandchild care provision and employment among grandparents. Moreover, we do not know how the magnitude of any association between the two activities may vary across countries characterised by different child-care policy regimes. Using data from the Survey of Health, Ageing and Retirement in Europe, this paper investigates the association between daily grandchild care provision and two employment outcomes for grandmothers and grandfathers aged 50–69: the probability of being employed and the average weekly working hours. Recursive bivariate models are used to account for the potential selection of grandparents with different unobserved traits into work and family care. Estimates are compared across four country groups characterised by different child-care policy orientations: optional de-familisation, service de-familisation, supported familism and familism by default. On average, across 20 European countries, grandparents looking after grandchildren daily are no less likely to work than grandparents who do not; however, employed grandfathers work eight hours less per week if providing daily child care. Evidence of a negative association between daily grandchild care and employment is strongest in countries with familistic approaches to child care, with no association in countries characterised by optional de-familisation. This suggests that public support to child care may help retain grandparents in the labour force. [ABSTRACT FROM AUTHOR]

Objective To identify the parameters associated with self-reported diagnostic delay (DD) in axial spondyloarthritis (axSpA) patients across Europe. Methods Data from 2652 patients from 13 countries who participated in the European Map of Axial Spondyloarthritis (EMAS) were collected through an online survey (2017–2018). DD was calculated as the difference between age at diagnosis and age at symptom onset reported by participants. Associations between DD and sociodemographic characteristics, as well as disease-related factors were explored through univariable and multivariable linear regression analysis. Results Average DD was 7.4  (8.4) years with a variation between countries. The variables associated with longer DD in the final multivariable regression model were: younger age at symptom onset (b = −0.26; 95% CI: −0.28, −0.23), female gender (b  = 1.34; 95% CI: 0.73, 1.96) and higher number of health-care professionals (HCPs) seen before diagnosis (b  = 1.19; 95% CI: 0.95, 1.43). There was a significant interaction between the female gender and the number of HCPs seen before diagnosis. A substantial variation of the DD across European countries was observed. Conclusion In this sample of axSpA patients, average DD was greater than 7 years. Younger age at symptom onset, female gender, higher number of HCPs seen before diagnosis, and being diagnosed by rheumatologist were the parameters associated with a longer DD in axSpA. These findings indicate a need for continuing efforts dedicated to recognition of patients with a high probability of axSpA on the level of non-rheumatology specialists and facilitating referral to a rheumatologist for timely diagnosis. [ABSTRACT FROM AUTHOR]

Europe has experienced a major boom of new breweries over the last thirty years, with thousands of new breweries being set up, even in regions where brewing has no history. So far, however, this microbrewing wave has not been systematically mapped. This paper presents a unique database of European breweries from 1990–2020. Using a series of maps and statistical analyses, it shows how breweries have gradually spread across Europe. Initially, microbreweries were being established in countries that are in a declining stage of the beer life-cycle from industrial breweries. After 2005 (and particularly in the 2010s), breweries reached other regions through neighbouring and hierarchical spatial diffusion. [ABSTRACT FROM AUTHOR]

African American (AA) and European American (EA) women often exhibit differences in hemoglobin (Hb) and 25-hydroxyvitamin D [25(OH)D], both of which can be altered by calorie restriction leading to weight loss. Given these known differences, it is of clinical interest to examine the potential for race-specific, adverse responses to weight loss. Sixty-four overweight (BMI 27-29.9 kg/²), premenopausal women consumed a standardized, very-low calorie diet to reduce BMI < 25 kg/². Ancestry informative markers provided estimates of African admixture, an objective mean of expressing race. Blood sampling and anthropometric measures were performed at baseline and upon meeting target BMI. At baseline, in the overweight state, Hb (g/dL) (AA, 11.7 ± 0.9 vs. EA, 12.5 ± 0.8; p < .01) and 25(OH)D (nmol/L) (AA, 35.7 ± 12.9 vs. EA, 57.0 ± 20.0; p < .01) were lower in AAs. After weight loss, Hb decreased (AA, -0.5 ± 0.7 vs. EA, -0.4 ± 0.6; p = .48) to a similar extent among races. Conversely, 25(OH)D increased (AA, 43.4 ± 14.0 vs. EA 68.2 ± 24.3; p < .01) though the magnitude of change (Δ) was not different (AA, +7.8 ± 13.5 vs. EA,+11.2 ± 16.7;p = .37) between races. Multiple linear regression revealed a positive association between ΔHb and Δ25(OH)D (r = .386; p < .01) adjusted for African admixture, Δtestosterone, and Δbody fat%. Path analyses revealed a significant indirect effect of Δbody fat% on ΔHb through Δ25(OH)D, β =-0.023, CI [-0.06, -0.004]. Following 15% weight loss, participants with the largest increase in serum 25(OH)D exhibited the smallest decrease in Hb. Future research should clarify the optimal degree of calorie restriction to stimulate weight loss while mitigating the potential risk of anemia associated with dieting efforts. [ABSTRACT FROM AUTHOR]

The purpose of the study was to identify trends in research abstracts published in the books of abstracts of the European Congress of Adapted Physical Activity from 2004 to 2012. A documentary analysis of the contents of 459 abstracts was completed. Data were coded based on subcategories used in a previous study by Zhang, deLisle. and Chen (2006) and by Porretta and Sherrill (2005): number of authors, data source, sample size, type of disability, data analyses, type of study, and tocus of study. Descriptive statistics calculated for each subcategory revealed an overall picUire of the state and trends of scientific inquiry in adapted physical activity research in Europe. [ABSTRACT FROM AUTHOR]

The objectives of this study were to evaluate physical therapists' shared-decision-making behaviour in a rehabilitation centre and a private practice, to determine agreement between patients' preferred levels of involvement in shared-decision-making and therapists' assumptions of patients' preferences, and to examine predictors of shared-decision-making behaviour. Thirty initial physical therapy consultations were audio-recorded. Shared-decision-making behaviour was observed using the observing patient involvement (OPTION) instrument. A pre-defined threshold of ≥35/100 points was considered to represent good shared-decision-making behaviour. The Control Preferences Scale was used to measure patients' preferred levels of involvement in shared-decision-making and therapists' assumptions. Shared-decision-making behaviour was analysed using descriptive statistics. Predictors of shared-decision-making behaviour were analysed by multiple regression. Shared-decision-making OPTION ratings were a median of 50.5/100 (25th, 75th percentiles 44.0, 66.0). Agreement between patients and physical therapists regarding shared-decision-making was poor (weighted kappa −0.26 (95% confidence interval −0.51 to −0.01). Therapy settings, education and the interaction of education and work experience predicted shared-decision-making behaviour (b = 15.76, p < 0.001; b = 8.05, p < 0.05; b = −0.33, p < 0.05). Shared-decision-making behaviour was good, and predicted by therapy setting, education and the interaction of education with work experience. Because of the limited number of institutions and therapists with MSc or PhD qualifications in this study, further research is required into the relationship between education and communication skills. [ABSTRACT FROM AUTHOR]

Enzalutamide combined with androgen deprivation therapy (ADT) significantly prolonged metastasis-free survival and overall survival (OS) versus ADT alone in patients with non-metastatic castration-resistant prostate cancer (nmCRPC) with rapidly rising prostate-specific antigen (PSA). The objective of this post hoc analysis of the PROSPER trial is to evaluate OS benefit and safety of enzalutamide in patients across age and regional subgroups. Eligible men with nmCRPC, PSA doubling time ≤10 months and PSA ≥2 ng/mL with continued ADT use were randomised 2:1 to enzalutamide 160 mg or placebo. OS and safety were examined by age (<70 vs ≥70 years) and region (North America, Europe, Asia or the rest of the world). The impact of prior and subsequent therapy was also examined. In total, 1401 men were enrolled (median age, 74 years). Enzalutamide plus ADT reduced the risk of death, independent of age or region. Multivariate analyses identified Eastern Cooperative Oncology Group (ECOG) status (P < 0.0001), log (PSA; P = 0.0002) and subsequent therapy (P < 0.0001) as statistically significant factors impacting OS. Safety was consistent across age and regional subgroups. Any grade treatment-emergent adverse events were similar across age groups, were more common in the placebo group and had regional variation. In men with nmCRPC and rapidly rising PSA, the benefit and safety of enzalutamide were consistent across age and regional subgroups. Variables impacting OS included ECOG status, log (PSA) and subsequent therapy. NCT02003924. [Display omitted] • Enzalutamide plus androgen deprivation therapy reduced the risk of death in non-metastatic castration-resistant prostate cancer. • Overall survival with enzalutamide was similar across age and geographical regions. • Three factors were identified that improved overall survival. • The safety of enzalutamide was similar across age but varied with geography. [ABSTRACT FROM AUTHOR]