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Aim: The aim of this article is to describe and compare the nurse educator competences in four European countries using three different evaluators: nurse educators (n = 329), heads of a nursing subject (n = 60) and student nurses (n = 1058). Design: The study was conducted as a comparative cross‐sectional survey in Finland, Malta, Slovakia and Spain between May 2021 and February 2022. Methods: The data were collected with an online survey. The instrument used was a 20‐item Tool for Evaluation of Requirements of Nurse Teachers, utilizing a 5‐point Likert‐type scale. The data were analysed statistically and reported according to STROBE guidelines. Results: Nurse educators' competence evaluated positively in all the groups of evaluators, with a mean of >3.5. The self‐evaluation of nurse educators' competence was higher than the other evaluators' evaluations. Having a degree in nursing, having completed some pedagogical studies and longer work experience as a nurse educator had a positive association with higher self‐evaluated competence among nurse educators. Conclusions: Nurse educator competence is at a good level in the selected European countries, but further studies are required to find the reasons behind the differences in evaluations. Public Contribution: Each participating educational institution named a contact person who distributed the surveys to the participants and returned the study's metadata to the researchers. [ABSTRACT FROM AUTHOR]

Background: Job satisfaction is a key factor for the successful transition of newly graduated nurses (NGNs) and for retaining NGNs in their workplaces. However, there is limited evidence of the relationship between satisfaction regarding the nursing education program and NGNs' job satisfaction in the first year after graduation. Therefore, this study aims to examine the association of the nursing education related factors and NGNs' job satisfaction. Methods: A cross-sectional study design with the utilization of data collected from the same respondents one year earlier as educational factors was applied. The data were collected from NGNs (n = 557) in 10 European countries using an electronic survey between February 2019 and September 2020, and analyzed in detail for four countries (n = 417). Job satisfaction was measured with three questions: satisfaction with current job, quality of care in the workplace, and nursing profession. Nursing education related factors were satisfaction with nursing education program, level of study achievements, nursing as the 1st study choice, intention to stay in nursing, and generic nursing competence. The data were analyzed statistically using logistic regression. Results: Most of the NGNs in the 10 countries were satisfied with their current job (88.3%), the quality of care (86.4%) and nursing profession (83.8%). Finnish, German, Lithuanian and Spanish NGNs' satisfaction with the nursing education program at graduation was statistically significantly associated with their job satisfaction, i.e., satisfaction with their current job, the quality of care, and the nursing profession. Moreover, NGNs who had fairly often or very often intention to stay in nursing at graduation were more satisfied with their current job, with the quality of care, and with the nursing profession compared with NGNs who had never or fairly seldom intention to stay in nursing at graduation. Conclusions: Nursing education plays a significant role in NGNs' job satisfaction one year after graduation, indicating the importance to start career planning already during nursing education. Both nursing education providers and healthcare organizations could plan in close collaboration a transition program for NGNs to ease the transition phase and thus increase the NGNs' job satisfaction and ultimately the high-quality care of the patients. [ABSTRACT FROM AUTHOR]

As future employers, nurse managers are in a key position to assess the correspondence between the competence of graduating nursing students and work life demands. The aim of the present study was to assess the competence of graduating nursing students from the perspective of managers, and analyze the factors linked to it. Among European managers in six countries, a cross-sectional survey design with a convenience sample was applied. Data were collected using the Nurse Competence Scale. The study was reported using the STROBE guidelines. Managers (n =538, 65.8%) assessed the level of competence of graduating nursing students as good, but there were statistically significant differences between countries. In a multivariable analysis, managers who had a Doctoral/Master’s degree and were dissatisfied with the nursing program in their country assessed the level of competence as lower. Overall, graduating nursing students seem to meet the competence demands of current work life rather well. Further research is needed to confirm the connection between the managers’ competence assessment and their individual background factors. [ABSTRACT FROM AUTHOR]

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Background: Gastrointestinal nematode (GIN) control is traditionally achieved with the use of anthelmintic drugs, however due to regulations in organic farming and the rise in anthelmintic resistance, alternatives are sought after. A promising alternative is the use of bioactive plant feeding due to the presence of plant secondary metabolites (PSMs) such as proanthocyanidins (PAs). This study focussed on the perennial shrub heather (Ericaceae family), a plant rich in PAs, highly abundant across Europe and with previously demonstrated anthelmintic potential. Methods: In vitro assays were used to investigate heather's anthelmintic efficacy against egg hatching and larval motility. Heather samples were collected from five European countries across two seasons, and extracts were tested against two GIN species: Teladorsagia circumcincta and Trichostrongylus colubriformis. Polyphenol group-specific ultraperformance liquid chromatography-tandem mass spectrometry analysis was performed to identify relevant polyphenol subgroups present, including the PA concentration and size and ratio of the subunits. Partial least squares analysis was performed to associate efficacy with variation in PSM composition. Results: Heather extracts reduced egg hatching of both GIN species in a dose-dependent manner by up to 100%, while three extracts at the highest concentration (10 mg/ml) reduced larval motility to levels that were not significantly different from dead larvae controls. PAs, particularly the procyanidin type, and flavonol derivatives were associated with anthelmintic activity, and the particular subgroup of polyphenols associated with the efficacy was dependent on the GIN species and life stage. Conclusions: Our results provide in vitro evidence that heather, a widely available plant often managed as a weed in grazing systems, has anthelmintic properties attributed to various groups of PSMs and could contribute to sustainable GIN control in ruminant production systems across Europe. [ABSTRACT FROM AUTHOR]

Background: Countries vary in the number of qualified nurses employed in older adult services. Moreover, students' views of older people nursing as a career differ internationally. Studying future nurses and their career intentions for the field is warranted to meet the increased nurse workforce expectations in terms of quantity and competence. Aim: To analyse graduating nurse students' interest in older people nursing and the factors associated with it. Methods: A cross‐sectional multicountry survey design was applied. Data were collected between May 2018 and March 2019 from several educational institutions in Finland, Germany, Iceland, Ireland, Lithuania and Spain. Non‐probability convenience sampling was used to recruit graduating nurse students (n = 1796). The data were collected with a structured questionnaire comprising background factors and the Willingness sub‐scale (six items) of the Students' Interest in Nursing Older People Scale. Data were analysed using a linear mixed model including relevant background variables. Results: Overall, students' interest in older people nursing was low (score 20.5, on a 0‒100 scale). Among the studied countries, Spanish students scored the highest (38.8) and German students the lowest (3.6). Students' interest in older people nursing was associated with country (p <.001), the length of work experience (p =.006), plans for further study (p =.007), competence (p <.001) and the extent that nursing is valued by society (p <.001). The students who were most interested in older people nursing had higher self‐reported competence level (p <.001). Conclusion: In the studied sample of future nurse professionals, interest in older people nursing is low at a time when the field suffers from workforce shortage. As for quality workforce, it was promising that the students who considered working in the field also evaluated themselves as competent. Implications for practice: Multidimensional actions are required to promote interest in the field, including continued development of competence in both undergraduate education and workplaces, and investing in various career pathways to envisage potential opportunities. [ABSTRACT FROM AUTHOR]

Aim: To describe nursing students' level of self‐directed learning abilities and identify possible factors related to it at graduation in six European countries. Design: A cross‐sectional comparative design across the countries. Methods: The study was conducted from February 2018 to September 2019. Nursing students (N = 4,135) from the Czech Republic, Finland, Italy, Portugal, Slovakia and Spain were invited to respond to the research instruments (the Self‐Rating Scale of Self‐Directed Learning and the Nurse Competence Scale) at graduation. The data were analysed using the chi‐square test, Pearson correlation coefficient and the linear model. Results: The nursing students' (N = 1,746) overall self‐directed learning abilities were at high level in all countries. Statistically significant differences occurred between countries. Spanish nursing students reported the highest level of self‐directed learning abilities while students from the Czech Republic reported the lowest. Higher level of self‐directed learning abilities was related to several factors, particularly with the self‐assessed level of competence and country. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to evaluate the medication calculation skills of graduating nursing students in six European countries and analyse the associated factors. Background: Medication calculation skills are fundamental to medication safety, which is a substantial part of patient safety. Previous studies have raised concerns about the medication calculation skills of nurses and nursing students. Design: As part of a broader research project, this study applies a multinational cross‐sectional survey design with three populations: graduating nursing students, nurse managers and patients. Methods: The students performed two calculations (tablet and fluid) testing medication calculation skills requiring different levels of conceptual understanding and arithmetic. The managers and patients answered one question about the students' medication kills. In total, 1,796 students, 538 managers and 1,327 patients participated the study. The data were analysed statistically. The STROBE guideline for cross‐sectional studies was applied. Results: Almost all (99%) of the students performed the tablet calculation correctly, and the majority (71%) answered the fluid calculation correctly. Older age, a previous degree in health care and satisfaction with their current degree programme was positively associated with correct fluid calculations. The patients evaluated the students' medication skills higher than the nurse managers did and the evaluations were not systematically aligned with the calculation skills tested. Conclusions: Nursing students have the skills to perform simple medication calculations, but a significant number of students have difficulties with calculations involving multiple operations and a higher level of conceptual understanding. Due to the variation in students' medication calculation skills and the unalignment between the managers' and patients' evaluations and the calculation tests, further research is needed. Relevance to clinical practice: Graduating nursing students enter clinical field as qualified professionals, but there is still room for improvement in their medication calculation skills. This calls for attention in the fields of clinical nursing, education and research. [ABSTRACT FROM AUTHOR]

Aims: The aim of the study was to examine the association between the characteristics of a nursing student's final clinical practicum and the success of transition of newly graduated nurses (NGNs) in six European countries. Design: A longitudinal design with two data collections points (pre‐ and post‐graduate). Methods: The data were collected with an online survey between May 2018 and April 2020 from graduating nursing students (n = 1796) in Finland, Germany, Iceland, Ireland, Lithuania and Spain. Altogether, 642 NGNs responded to the second questionnaire 1 year after graduation. Logistic and linear regression analyses were used to examine the associations between five clinical practicum characteristics and three indicators for the success of transition (ease of transition, turnover intentions and occupational commitment). Models were adjusted for demographic and background/workplace factors and professional competence. Results: Several associations were observed between the different clinical practicum characteristics and the indicators for a successful transition. Good pedagogical atmosphere and good supervisory relationship were associated with higher likelihood of an easy transition. Good leadership style of the ward manager, good premises of nursing care on the ward and a good supervisory relationship were associated with higher occupational commitment. No consistent association with turnover intention was found. Conclusion: Having a good final clinical practicum before graduation can contribute to an easier transition experience for newly NGNs and strengthen their commitment to the nursing profession. Impact: This study adds to the limited existing knowledge about the importance of final clinical practicums in shaping the transition process and occupational commitment of NGNs. Investing in creating a good final practicum experience could help healthcare organizations engage new nursing professionals and thus alleviate the existing shortage of nurses. [ABSTRACT FROM AUTHOR]

The purpose of this study was to explore nursing students' perceptions of their final clinical learning environment and its association with their self‐assessed competence, satisfaction with nursing education, and turnover intentions at graduation in six European countries. A multi‐country comparative cross‐sectional study was conducted with nursing students (n = 1746) from the Czech Republic, Finland, Italy, Portugal, Slovakia, and Spain using the Nurse Competence Scale and the Clinical Learning Environment and Supervision scale. Nursing students' overall perceptions of their final clinical learning environment and supervision were positive in all the countries studied. The correlation between the students' perceptions of their final clinical learning environment and competence was statistically significant and positive. Satisfaction with the nursing program and clinical practicum and no consideration of career change were related to positive perceptions of the final clinical learning environment. Highlighting the importance of the supervisory relationship and pedagogical atmosphere, nursing students' positive perceptions of the final clinical learning environment and supervision contribute to a better level of self‐assessed competence and satisfaction with the nursing program and clinical practicum, leading to lower turnover intentions. [ABSTRACT FROM AUTHOR]

Background: Moral courage is defined as courage to act according to one's own ethical values and principles even at the risk of negative consequences for the individual. In a complex nursing practice, ethical considerations are integral. Moral courage is needed throughout nurses' career. Aim: To analyse graduating nursing students' moral courage and the factors associated with it in six European countries. Research design: A cross-sectional design, using a structured questionnaire, as part of a larger international ProCompNurse study. In the questionnaire, moral courage was assessed with a single question (visual analogue scale 0–100), the questionnaire also covered several background variables. Participants and research context: The sample comprised graduating nursing students (n = 1796) from all participating countries. To get a comprehensive view about graduating nursing students' moral courage, the views of nurse managers (n = 538) and patients (n = 1327) from the same units in which the graduating nursing students practised were also explored, with parallel questionnaires. Ethical considerations: Ethical approvals and research permissions were obtained according to national standards in every country and all participants gave their informed consent. Results: The mean of graduating nursing students' self-assessed moral courage was 77.8 (standard deviation 17.0; on a 0–100 scale), with statistically significant differences between countries. Higher moral courage was associated with many factors, especially the level of professional competence. The managers assessed the graduating nursing students' moral courage lower (66.5; standard deviation 18.4) and the patients slightly higher (80.6; standard deviation 19.4) than the graduating nursing students themselves. Discussion and conclusions: In all countries, the graduating nursing students' moral courage was assessed as rather high, with differences between countries and populations. These differences and associations between moral courage and ethics education require further research. [ABSTRACT FROM AUTHOR]

Lyme borreliosis is a tick‐borne disease caused by Borrelia burgdorferi sensu lato spirochetes (Lyme borreliae). When the disease affects the central nervous system, it is referred to as neuroborreliosis. In Europe, neuroborreliosis is most often caused by Borrelia garinii. Although it is known that in the host Lyme borreliae spread from the tick bite site to distant tissues via the blood vasculature, the adherence of Lyme borreliae to human brain microvascular endothelial cells has not been studied before. Decorin binding proteins are adhesins expressed on Lyme borreliae. They mediate the adhesion of Lyme borreliae to decorin and biglycan, and the lysine residues located in the binding site of decorin binding proteins are important to the binding activity. In this study, we show that lysine residues located in the canonical binding site can also be found in decorin binding proteins of Borrelia garinii, and that these lysines contribute to biglycan and decorin binding. Most importantly, we show that the lysine residues are crucial for the binding of Lyme borreliae to decorin and biglycan expressing human brain microvascular endothelial cells, which in turn suggests that they are involved in the pathogenesis of neuroborreliosis. [ABSTRACT FROM AUTHOR]

Aim: To analyse graduating nursing students' self‐assessed competence level in Europe at graduation, at the beginning of nursing career. Design: An international cross‐sectional evaluative design. Methods: Data were collected in February 2018–July 2019 from graduating nursing students in 10 European countries. Competence was assessed with a validated instrument, the Nurse Competence Scale (NCS). The sample comprised 3,490 students (response rate 45%), and data were analysed statistically. Results: In all countries, graduating nursing students assessed their competence as good (range 50.0–69.1; VAS 0–100), albeit with statistically significant differences between countries. The assessments were highest in Iceland and lowest in Lithuania. Older students, those with working experience in health care, satisfied with their current degree programme, with excellent or good study achievements, graduating to 1st study choice and having a nursing career plan for future assessed their competence higher. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this study is to identify the different research strands concerning studies related to human resource management (HRM) and ageing employees. More specifically, the paper analyses how age and gender are understood and conceptualized in these studies. Design/methodology/approach – An integrative literature review concerning ageing employees and HRM with special reference to gender is the approach taken in this paper. Findings – Recent studies relating to HRM and ageing employees were categorized and analysed. The paper concludes that there is a need for a more holistic understanding of the concept of age in studies related to ageing employees and HRM and also argues that the intersection of age and gender is under-researched in the field of HRM. Practical implications – Based on literature review the paper outlined directions for how gender-neutral age management studies may be extended. A pluralist understanding of age and gender would help to understand the different needs and expectations that ageing employees may have in terms of HR practices and policies. Institutional practices and legislation can promote equality, but organizational contexts, both internal and external, should be scanned in order to recognize possible ageist or age-blind practices. Ageing women in particular have the burden of being recognized in terms of chronological stereotyped changes that might damage their work and career. Originality/value – Research on ageing employees and HRM with special reference to gender is limited and therefore an integrative literature review is needed. [ABSTRACT FROM AUTHOR]

Background/Objectives:Mini nutritional assessment (MNA) is the most frequently used screening test for malnutrition in elderly populations in continental Europe and Asia. Most studies on MNA's ability to predict mortality have only included persons admitted to hospital, living in nursing homes or at home with professional help with activities of daily living. The aim of this cohort study was to examine if MNA can predict 10-year mortality in the general elderly female population.Subjects/Methods:Of the 584 free-living elderly women invited, 351 agreed to participate and were tested with MNA between 1999 and 2000. A 10-year follow-up was conducted in 2010 with dates of death obtained from the Swedish death register.Results:Participants whose MNA score was 23.5 points at inclusion had a significantly higher age-adjusted 10-year mortality risk than participants with a MNA score of >23.5 points. The hazard ratio was 2.36 (95% confidence interval 1.25-4.46), P <0.01.Conclusions:Participants with a MNA score, indicating an increased risk for malnutrition, were more than twice as likely to die during the 10-year follow-up as participants whose MNA score indicated normal nutritional status. Hence, MNA can predict mortality in a general, free-living, elderly female population. [ABSTRACT FROM AUTHOR]

The aim of this study was to analyse the patients' role in clinical education in terms of facilitative student-patient relationship in Finland, Germany, Iceland, Ireland, Lithuania and Spain and factors promoting a more facilitative relationship in clinical education. Nursing students' bedside learning is reliant on patients and the establishment of a person-centred approach develops from the relationships with patients. A multi-country, cross-sectional design was implemented. Survey data were collected from graduating nursing students and patients between May 2018 and March 2019. The survey consisted of a 13-item facilitative sub-scale of the Student-Patient Relationship Scale as the main outcome measure, which was identical for both populations. In addition, background factors were surveyed with single questions and other scales. Associations between facilitative relationship and background factors were studied with linear models. Altogether, 1796 students and 1327 patients answered the survey. Overall, both students and patients regarded their relationship as facilitative, but students' (median 4.23, 95% confidence interval 4.15–4.23) evaluations were higher than patients' (median 3.75, 95% confidence interval 3.69–3.77). The students' and patients' evaluations differed from each other significantly in all other countries except in Ireland and Lithuania. Corresponding associations for both populations were found in terms of the country and students' cultural confidence. Results signal favourable grounds for students' bedside learning and patient participation in clinical education with the potential to foster a person-centred approach. [ABSTRACT FROM AUTHOR]

This literature review aims to grasp an overall understanding of European research related to assistive technology for disabled children during the period 2000–2005. Electronic and manual searches of six databases, AAATE conference publications, and issues of the journal Technology and Disability yielded 27 articles and 40 conference papers that met the inclusion criteria, which were studies of European origin and involving assistive technology that conforms to the ISO 9999 classification. The review showed that existing research studies are very limited in number and are focused on ICT-related assistive technology, while a lack of research exists in relation to lower technologies or dealing with the whole assistive environments. Methodologically there is a need to improve child participation and the use of psychosocial theories in research and development. On the whole, this research area is methodologically very challenging. [ABSTRACT FROM AUTHOR]

The environmental risk, defined as the possibility of impairment of biotic or abiotic components of the environment, derived from geological sources was estimated for the whole of Europe. The assessment was based on data obtained from the Geochemical Atlas of Europe and included measured total concentrations of: Al, As, B, Cd, Cr, Cu, Ni, Pb, Se, Zn, Fe, Mn, Cl, NO3 and SO4 in stream water; As, Ba, Cd, Co, Cr, Cu, Hg, Mo, Ni, Pb, V and Zn in topsoil; and As, Cd, Cr, Cu, Hg, Ni, Pb and Zn in stream and floodplain sediments. The number of sampling sites varied from 741 (stream water) to 847 (subsoil). The assessment method was based on the calculation of two-step environmental risk index values (IER) for individually analysed water, soil and sediment samples. Environmental risk quotients are first calculated for each analysed chemical element or compound that exceeds the limit for risk values, and their sum is then calculated. The risk at each site was defined and classified as negligible, low, medium, high, very high or extremely high. The results are presented as risk maps covering the 26 countries of Europe. Stream waters show a high to extremely high risk value in large areas of southern Finland and Sweden, and sporadically in Spain, southern Italy, the Netherlands, northern Germany and Denmark. Stream sediments show high risk values in Greece, Albania, Sardinia and northern Italy. The risk areas for floodplain sediment differ from those for stream sediment, with no high risk values in Sardinia, but instead in Belgium. The highest risk levels in topsoils were detected in Greece, Albania and northern Italy. The combination of all materials shows a medium-level risk throughout Europe and a high to extremely high risk in Greece, Albania, Sicily and Sardinia, and sporadically in Spain, Belgium and the Netherlands. The calculated maps delineate regions where high elevated concentrations pose a risk to the environment, or where the action limits for soil, sediment or water contamination should be revised using the high local baseline. [ABSTRACT FROM AUTHOR]

There is public concern that use of mobile phones could increase the risk of brain tumours. If such an effect exists, acoustic neuroma would be of particular concern because of the proximity of the acoustic nerve to the handset. We conducted, to a shared protocol, six population-based case-control studies in four Nordic countries and the UK to assess the risk of acoustic neuroma in relation to mobile phone use. Data were collected by personal interview from 678 cases of acoustic neuroma and 3553 controls. The risk of acoustic neuroma in relation to regular mobile phone use in the pooled data set was not raised (odds ratio (OR) = 0.9, 95% confidence interval (CI): 0.7-1.1). There was no association of risk with duration of use, lifetime cumulative hours of use or number of calls, for phone use overall or for analogue or digital phones separately. Risk of a tumour on the same side of the head as reported phone use was raised for use for 10 years or longer (OR = 1.8, 95% CI: 1.1-3.1). The study suggests that there is no substantial risk of acoustic neuroma in the first decade after starting mobile phone use. However, an increase in risk after longer term use or after a longer lag period could not be ruled out. [ABSTRACT FROM AUTHOR]

Presents an update on the efforts and events organized by the Association of the Advancement of Assistive Technology in Europe, as of winter 2004/2005.

The variation of baseline levels of uranium in soil and stream sediments over Europe is described, based on new data prepared by the Forum of European Geological Surveys (FOREGS). The samples have been collected and analysed according to the protocols established for the International Union of Geological Sciences/International Association of Geochemistry and Cosmochemistry (IUGS/IAGC) Working Group on Global Geochemical Baselines. The baseline levels of U vary between 0·21 to 53 mg kg[sup -1] in topsoils, 0·19 to 30 mg kg[sup -1] in subsoils and < 1 to 59 mg kg[sup -1] in stream sediments. There is generally good agreement between the levels of U in the three sample types, and the median concentration in all three media is approximately 2 mg kg[sup -1]. The most anomalous baseline levels occur over the Variscan orogen, especially areas into which late postorogenic radiothermal high heat production (HHP) granites were emplaced. Spiderdiagrams based on trace element levels and rare earth element (REE) plots, confirm the association between the highest U anomalies and evolved radiothermal granites. High values are also associated with parts of the Alpine terrain especially in Slovenia, where there are historical U workings, and Southern Italy, where high values of U reflect contemporary volcanism. In contrast, much of the Caledonides of North West Europe and the Precambrian of the Baltic Shield and East European craton and its overlying sedimentary cover have very low values, generally < 4 mg kg[sup -1]. The results suggest that the main concern for the environment and human health from U, and the Th and K with which it is generally associated, is the naturally occurring total gamma radiation and radon potential associated with radiothermal granites. This is likely to be especially important where the granites are mineralised and have been worked historically, for example in the North West of the Iberian Peninsula where U and its decay products are likely to be more dispersed in the surface environment. The study also indicates the value of multielement data in distinguishing between anthropogenic and naturally occurring anomalies. [ABSTRACT FROM AUTHOR]

Background: The chiropractic profession both in the past and presently has diverse opinions concerning different health care approaches and the science or otherwise that underpins them. Previous research has reported that adherence to unorthodox descriptions of chiropractic were associated with types of practice behavior considered outside of acceptable evidence-based guidelines in Canada. However, this type of investigation has not been repeated in a European context and such relationships may be different. Methods: A survey was disseminated amongst European chiropractors during early 2017. Dissemination was through an on-line platform with links to the survey being sent to all European chiropractic associations regardless of European Chiropractors' Union (ECU) membership and additionally through the European Academy of Chiropractic (EAC). Social media via Facebook groups was also used to disseminate links to the survey. Results: One thousand three hundred twenty and two responses from chiropractors across Europe representing approximately 17.2% of the profession were collected. Five initial self-determined chiropractic identities were collapsed into 2 groups categorised as orthodox (79.9%) and unorthodox (20.1%). Analysis of responses to a range of questions stratified by such groups was carried out. When comparing the percentage of new patients chiropractors x-rayed, 23% of the unorthodox group x-rayed > 50% of their new patients compared to 5% in the orthodox group. Furthermore, the proportion of respondents reporting > 150 patient encounters per week in the unorthodox group were double compared to the orthodox (22 v 11%). Lastly the proportion of those respondents disagreeing or strongly disagreeing with the statement "In general, vaccinations have had a positive effect on global public health" was 57 and 4% in unorthodox and orthodox categories respectively. Logistic regression models identified male gender, seeing more than 150 patients per week, no routine differential diagnosis, and not strongly agreeing that vaccines have generally had a positive impact on health as highly predictive of unorthodox categorisation. Conclusions: Despite limitations with generalisability in this survey, the proportion of respondents adhering to the different belief categories are remarkably similar to other studies exploring this phenomenon. In addition, and in parallel with other research, this survey suggests that key practice characteristics in contravention of national radiation guidelines or opposition to evidence based public health policy are significantly more associated with non-orthodox chiropractic paradigms. [ABSTRACT FROM AUTHOR]

The article focuses on the targeted approach for universal immunisation to make it beneficial for the countries with low endemicity and emphasizes the priority of the antenatal hepatitis B virus (HBV) screening programme should be universal in Europe.

Yacon (Smallanthus sonchifolius) is a root-based fruit type which has been used for centuries as a staple food among the Andean population. In South America it is a traditional food, but in the European Union it is considered novel. It has a long history of safe use in South America and even elsewhere with potential health-promoting properties including prebiotic, antidiabetic, antioxidative and antimicrobial effects. Due to its status in Europe, yacon has to be assessed for its safety before being introduced on the European market. Since the latest novel food regulations accept history of safe use data from outside Europe, research has been conducted to establish whether yacon meets the regulatory requirements and can be authorized in Europe. Yacon has a well-documented and unambiguous history of safe use and its composition involves no obvious concerns in terms of detrimental effects, toxic substances or antinutrients. [ABSTRACT FROM AUTHOR]

Catchment/floodplain sediment geochemical datasets from three continental-scale geochemical projects in Australia (AU), China (CH) and Europe (EU) were studied by comparing sample media, sample preparation, elements determined, analytical methods, detection limits and proportions of reportable values, and certified reference materials used. Twenty six elements (Ba, Ce, Co, Cr, Cu, Mo, Nb, Ni, Pb, Rb, Sr, Th, V, Y, Zn, Zr, Al 2 O 3 , CaO, K 2 O, MgO, MnO, Na 2 O, P 2 O 5 , SiO 2 , Fe 2 O 3 (total), TiO 2 ) were considered comparable among the 35 determined by all three projects, according to the criteria for global comparability of elements proposed in this paper. The median concentrations of all elements (except Co, Y, Zr, SiO 2 and TiO 2 ) in the three datasets increase in the following order: AU < EU ≤ CH, and the median CH/EU ratios for all elements range from 0.98 to 1.94, while the median CH/AU and EU/AU ratios for elements, such as CaO, Na 2 O, MgO and Zn are generally greater than 2 (and up to 7), which could be explained partly by protracted weathering in Australia, and partly by the smaller grain size fraction analysed of the CH dataset (< 1 mm) compared to AU and EU (< 2 mm). In conclusion, a unified sample medium should be collected and unified sample preparation techniques should be followed. Key elements related to mineral resources and the environment should be determined and international or exchanged internal standard materials inserted in new national or global geochemical mapping projects in order to generate globally comparable datasets for establishing global geochemical baselines. [ABSTRACT FROM AUTHOR]

The European Reference Network on Rare Multisystemic Vascular Diseases (VASCERN), is dedicated to gathering the best expertise in Europe and provide accessible cross-border healthcare to patients with rare vascular diseases. Infantile Hemangiomas (IH) are benign vascular tumors of infancy that rapidly growth in the first weeks of life, followed by stabilization and spontaneous regression. In rare cases the extent, the localization or the number of lesions may cause severe complications that need specific and careful management. Severe IH may be life-threatening due to airway obstruction, liver or cardiac failure or may harbor a risk of functional impairment, severe pain, and/or significant and permanent disfigurement. Rare IHs include syndromic variants associated with extracutaneous abnormalities (PHACE and LUMBAR syndromes), and large segmental hemangiomas. There are publications that focus on evidence-based medicine on propranolol treatment for IH and consensus statements on the management of rare infantile hemangiomas mostly focused on PHACES syndrome. The Vascular Anomalies Working Group (VASCA-WG) decided to develop a diagnostic and management pathway for severe and rare IHs with a Nominal Group Technique (NGT), a well-established, structured, multistep, facilitated group meeting technique used to generate consensus statements. The pathway was drawn following two face-to-face meetings and in multiple web meetings to facilitate discussion, and by mail to avoid the influence of most authoritative members. The VASCA-WG has produced this opinion statement reflecting strategies developed by experts and patient representatives on how to approach patients with severe and rare IH in a practical manner; we present an algorithmic view of the results of our work. [ABSTRACT FROM AUTHOR]

Background: Although guidelines exist for advanced and variant bladder cancer management, evidence is limited/conflicting in some areas and the optimal approach remains controversial., Objective: To bring together a large multidisciplinary group of experts to develop consensus statements on controversial topics in bladder cancer management., Design: A steering committee compiled proposed statements regarding advanced and variant bladder cancer management which were assessed by 113 experts in a Delphi survey. Statements not reaching consensus were reviewed; those prioritised were revised by a panel of 45 experts before voting during a consensus conference., Setting: Online Delphi survey and consensus conference., Participants: The European Association of Urology (EAU), the European Society for Medical Oncology (ESMO), experts in bladder cancer management., Outcome Measurements and Statistical Analysis: Statements were ranked by experts according to their level of agreement: 1-3 (disagree), 4-6 (equivocal), 7-9 (agree). A priori (level 1) consensus was defined as ≥70% agreement and ≤15% disagreement, or vice versa. In the Delphi survey, a second analysis was restricted to stakeholder group(s) considered to have adequate expertise relating to each statement (to achieve level 2 consensus)., Results and Limitations: Overall, 116 statements were included in the Delphi survey. Of these, 33 (28%) statements achieved level 1 consensus and 49 (42%) statements achieved level 1 or 2 consensus. At the consensus conference, 22 of 27 (81%) statements achieved consensus. These consensus statements provide further guidance across a broad range of topics, including the management of variant histologies, the role/limitations of prognostic biomarkers in clinical decision making, bladder preservation strategies, modern radiotherapy techniques, the management of oligometastatic disease and the evolving role of checkpoint inhibitor therapy in metastatic disease., Conclusions: These consensus statements provide further guidance on controversial topics in advanced and variant bladder cancer management until a time where further evidence is available to guide our approach., (© The Author(s) 2019. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)