Awareness of sunburn in childhood, use of sunbeds and change of moles in Denmark, Northern Ireland, Norway and Sweden

Background: Malignant melanoma (MM) is increasing rapidly in Northern Europe. To reduce incidence and mortality through earlier diagnosis, public awareness of MM is important. Thus, we aim to examine awareness of risk factors and a symptom of MM, and how awareness varies by country and socio-demographic factors in Denmark, Northern Ireland (NI), Norway and Sweden.

Methods: Population-based telephone interviews using the ‘Awareness and Beliefs about Cancer’ measure were conducted in 2011 among 8355 adults ≥50 years as part of the International Cancer Benchmarking Partnership Module 2. Prevalence ratios (PRs) with 95% confidence intervals were calculated.

Results: In these four countries, lowest awareness was found for ‘sunburn in childhood’ (63%), whereas awareness was high for ‘use of sunbeds’ (91%) and ‘mole change’ (97%). Lack of awareness of ‘sunburn in childhood’ was more prevalent among respondents from Norway [PR = 1.38 (1.28–1.48)] but less prevalent among respondents from Northern Ireland (NI) [PR = 0.78 (0.72–0.85)] and Sweden [PR = 0.86 (0.79–0.93)] compared with respondents from Denmark. Lack of awareness of ‘use of sunbeds’ was more prevalent among respondents from Norway [PR = 2.99 (2.39–3.74)], Sweden [PR = 1.57 (1.22–2.00)], and NI [PR = 1.65 (1.30–2.10)] compared with respondents form Denmark. Being a man, age ≥70, living alone, and having lower education, were each independently associated with lack of MM-awareness.

Conclusions: The results indicate relatively low awareness of ‘sunburn in childhood’ as a risk factor for MM, and important disparities in MM-awareness across countries and socio-demographic groups. Improved and more directed initiatives to enhance public MM-awareness, particularly about ‘sunburn in childhood’, are needed.

Prognoses and improvement for head and neck cancers diagnosed in Europe in early 2000s: The EUROCARE-5 a population-based study.

BACKGROUND: Head and neck (H&N) cancers are a heterogeneous group of malignancies, affecting various sites, with different prognoses. The aims of this study are to analyse survival for patients with H&N cancers in relation to tumour location, to assess the change in survival between European countries, and to investigate whether survival improved over time.
METHODS: We analysed about 250,000 H&N cancer cases from 86 cancer registries (CRs). Relative survival (RS) was estimated by sex, age, country and stage. We described survival time trends over 1999-2007, using the period approach. Model based survival estimates of relative excess risks (RERs) of death were also provided by country, after adjusting for sex, age and sub-site.
RESULTS: Five-year RS was the poorest for hypopharynx (25%) and the highest for larynx (59%). Outcome was significantly better in female than in male patients. In Europe, age-standardised 5-year survival remained stable from 1999-2001 to 2005-2007 for laryngeal cancer, while it increased for all the other H&N cancers. Five-year age-standardised RS was low in Eastern countries, 47% for larynx and 28% for all the other H&N cancers combined, and high in Ireland and the United Kingdom (UK), and Northern Europe (62% and 46%). Adjustment for sub-site narrowed the difference between countries. Fifty-four percent of patients was diagnosed at advanced stage (regional or metastatic). Five-year RS for localised cases ranged between 42% (hypopharynx) and 74% (larynx).
CONCLUSIONS: This study shows survival progresses during the study period. However, slightly more than half of patients were diagnosed with regional or metastatic disease at diagnosis. Early diagnosis and timely start of treatment are crucial to reduce the European gap to further improve H&N cancers outcome.

'Incorrigibly Plural’: New Histories of Ulster and Northern Ireland’

Review article of Carson’s Army: The Ulster Volunteer Force, 1910–22. By Timothy Bowman. Manchester University Press, Manchester, 2007. 256 pp. ISBN 0719073715, £55. A History of the Northern Ireland Labour Party: Democratic Socialism and Sectarianism. By Aaron Edwards. Manchester University Press, Manchester, 2009. xiii + 240 pp. ISBN 0719078741, £60. Catholic Belfast and Nationalist Ireland in the Era of Joe Devlin 1871–1934. By A.C. Hepburn. Oxford University Press, Oxford, 2008. xix +307 pp. ISBN 019929884X, £55. The Big House in the North of Ireland: Land, Power and Social Elites, 1878–1960. By Olwen Purdue. University College Dublin Press, Dublin, 2009. xv + 297 pp. ISBN 978-1-906359-25-6, £24.

Variability in the summer season hydrological cycle over the Atlantic-Europe region 1979-2007

Variability in aspects of the hydrological cycle over the Europe-Atlantic region during the summer season is analysed for the period 1979-2007, using observational estimates, reanalyses and climate model simulations. Warming and moistening trends are evident in observations and models although decadal changes in water vapour are not well represented by reanalyses, including the new European Centre for Medium Range Weather Forecasts (ECMWF) Interim reanalysis. Over the north Atlantic and northern Europe, observed water vapour trends are close to that expected from the temperature trends and Clausius-Clapeyron equation (7% K-1), larger than the model simulations. Precipitation over Europe is dominated by large-scale dynamics with positive phases of the North Atlantic Oscillation coinciding with drier conditions over north Europe and wetter conditions over the Mediterranean region. Evaporation trends over Europe are positive in reanalyses and models, especially for the Mediterranean region (1-3% per decade in reanalyses and climate models). Over the north Atlantic, declining precipitation combined with increased moisture contributed to an apparent rise in water vapour residence time. Maximum precipitation minus evaporation over the north Atlantic occurred during summer 1991, declining thereafter.

Development-led archaeology in north-west Europe

Many countries in northern Europe have seen a huge expansion in development-led archaeology over the past few decades. Legislation, frameworks for heritage management and codes of practice have developed along similar but different lines. The Valetta Convention has had considerable impact on spatial planning and new legislation on archaeological heritage management within EC countries as well as on the funding, nature and distribution of archaeological fieldwork. For the first time these 12 papers bring together data on developer-led archaeology in Britain, Ireland, France, the Low Countries, Germany and Denmark in order to review and evaluate key common issues relating to organisation, practice, legal frameworks and quality management.

Modelling predicts that heat stress, not drought, will increase vulnerability of wheat in Europe

New crop cultivars will be required for a changing climate characterised by increased summer drought and heat stress in Europe. However, the uncertainty in climate predictions poses a challenge to crop scientists and breeders who have limited time and resources and must select the most appropriate traits for improvement. Modelling is a powerful tool to quantify future threats to crops and hence identify targets for improvement. We have used a wheat simulation model combined with local-scale climate scenarios to predict impacts of heat stress and drought on winter wheat in Europe. Despite the lower summer precipitation projected for 2050s across Europe, relative yield losses from drought is predicted to be smaller in the future, because wheat will mature earlier avoiding severe drought. By contrast, the risk of heat stress around flowering will increase, potentially resulting in substantial yield losses for heat sensitive cultivars commonly grown in northern Europe.

Future change of precipitation extremes in Europe: intercomparison of scenarios from regional climate mode

An analysis of the climate of precipitation extremes as simulated by six European regional climate models (RCMs) is undertaken in order to describe/quantify future changes and to examine/interpret differences between models. Each model has adopted boundary conditions from the same ensemble of global climate model integrations for present (1961–1990) and future (2071–2100) climate under the Intergovernmental Panel on Climate Change A2 emission scenario. The main diagnostics are multiyear return values of daily precipitation totals estimated from extreme value analysis. An evaluation of the RCMs against observations in the Alpine region shows that model biases for extremes are comparable to or even smaller than those for wet day intensity and mean precipitation. In winter, precipitation extremes tend to increase north of about 45°N, while there is an insignificant change or a decrease to the south. In northern Europe the 20-year return value of future climate corresponds to the 40- to 100-year return value of present climate. There is a good agreement between the RCMs, and the simulated change is similar to a scaling of present-day extremes by the change in average events. In contrast, there are large model differences in summer when RCM formulation contributes significantly to scenario uncertainty. The model differences are well explained by differences in the precipitation frequency and intensity process, but in all models, extremes increase more or decrease less than would be expected from the scaling of present-day extremes. There is evidence for a component of the change that affects extremes specifically and is consistent between models despite the large variation in the total response.

An evaluation of the simulated water balance of Eurasia and northern Africa at 6000 yr B.P. using lake status data

Changes in the water balance of Eurasia and northern Africa in response to insolation forcing at 6000 y BP simulated by five atmospheric general circulation models have been compared with observations of changes in lake status. All of the simulations show enhancement of the Asian summer monsoon and of the high pressure cells over the Pacific and Central Asia and the Middle East, causing wetter conditions in northern India and southern China and drier conditions along the Chinese coast and west of the monsoon core. All of the models show enhancement of the African monsoon, causing wetter conditions in the zone between ca 10–20 °N. Four of the models show conditions wetter than present in southern Europe and drier than present in northern Europe. Three of the models show conditions similar to present in the mid-latitude continental interior, while the remaining models show conditions somewhat drier than present. The extent and location of each of the simulated changes varies between the models, as does the mechanism producing these changes. The lake data confirm some features of the simulations, but indicate discrepancies between observed and simulated climates. For example, the data show: (1) conditions wetter than present in central Asia, from India to northern China and Mongolia, indicating that the simulated Asian monsoon expansion is too small; (2) conditions wetter than present between ca. 10–30 °N in Africa, indicating that the simulated African monsoon expansion is too small; (3) that northern Europe was drier, but the area of significantly drier conditions was more localized (around the Baltic) than shown in the simulations; (4) that southern Europe was wetter than present, apparently consistent with the simulations, but pollen data suggest that this reflects an increase in summer rainfall whereas the models show winter precipitation, and (5) that the mid-latitude continental interior was generally wetter than present.

Late Quaternary lake-level record from northern Eurasia

Lake records from northern Eurasia show regionally coherent patterns of changes during the late Quaternary. Lakes peripheral to the Scandinavian ice sheet were lower than those today but lakes in the Mediterranean zone were high at the glacial maximum, reflecting the dominance of glacial anticyclonic conditions in northern Europe and a southward shift of the Westerlies. The influence of the glacial anticyclonic circulation attenuated through the late glacial period, and the Westerlies gradually shifted northward, such that drier conditions south of the ice sheet were confined to a progressively narrower zone and the Mediterranean became drier. The early Holocene shows a gradual shift to conditions wetter than present in central Asia, associated with the expanded Asian monsoon, and in the Mediterranean, in response to local, monsoon-type circulation. There is no evidence of mid-continental aridity in northern Eurasia during the mid-Holocene. In contrast, the circum-Baltic region was drier, reflecting the increased incidence of blocking anticyclones centered on Scandinavia in summer. There is a gradual transition to modern conditions after ca. 5000 yr B.P. Although these broad-scale patterns are interrupted by shorter term fluctuations, the long-term trends in lake behavior show a clear response to changes in insolation and glaciation.

A Lateglacial archaeological site in the far north-west of Europe at Rubha Port an t-Seilich, Isle of Islay, western Scotland: Ahrensburgian-style artefacts, absolute dating and geoarchaeology

The exact pattern, process and timing of the human re-colonization of northern Europe after the end of the last Ice Age remain controversial. Recent research has provided increasingly early dates for at least pioneer explorations of latitudes above 54°N in many regions, yet the far north-west of the European landmass, Scotland, has remained an unexplained exception to this pattern. Although the recently described Hamburgian artefacts from Howburn and an assemblage belonging to the arch-backed point complex from Kilmelfort Cave have established at least a sporadic human presence during earlier stages of the Lateglacial Interstadial, we currently lack evidence for Younger Dryas/Greenland Stadial 1 (GS-1) activity other than rare stray finds that have been claimed to be of Ahrensburgian affiliation but are difficult to interpret in isolation. We here report the discovery of chipped stone artefacts with technological and typological characteristics similar to those of the continental Ahrensburgian at a locality in western Scotland. A preliminary analysis of associated tephra, pollen and phytoliths, along with microstratigraphic analysis, suggest the artefacts represent one or more episodes of human activity that fall within the second half of GS-1 and the Preboreal period

Walking in a winter wonderland? Strategies for Early and Middle Pleistocene survival in mid-latitude Europe

Any occupation of northern Europe by Lower Palaeolithic hominins, even those occurring during full interglacials, must have addressed the challenges of marked seasonality and cold winters. These would have included the problems of: wind-chill and frostbite; duration, distribution and depth of snow-cover; reduced daylight hours; and distribution and availability of animal and plant foods. Solutions can essentially be characterised as a ‘stick or twist’ choice: i.e. year-round presence on a local scale vs. extensive annual mobility. However these options, and the ‘interim’ strategies that lie between them, present various problems, including maintaining core body temperature, meeting the energetic demands of mobility, coping with reduced resource availability and increasing patchiness, and meeting nutritional requirements. The feasibility of different winter survival strategies are explored with reference to Lower Palaeolithic palaeoenvironmental reconstructions and on-site behavioural evidence. Emphasis is placed upon possible strategies for (i) avoiding the excessive lean meat protein problem of ‘rabbit starvation’ (e.g. through exploitation of ‘residential’ species with significant winter body fat and/or by targeting specific body parts, following modern ethnographic examples, supplemented by the exploitation of winter plants); and (ii) maintaining body temperatures (e.g. through managed pyrotechnology, and/or other forms of cultural insulation). The paper concludes with a suggested winter strategy.

The ancient Britons: groundwater fauna survived extreme climate change over tens of millions of years across NW Europe

Global climate changes during the Cenozoic (65.5–0 Ma) caused major biological range shifts and extinctions. In northern Europe, for example, a pattern of few endemics and the dominance of wide-ranging species is thought to have been determined by the Pleistocene (2.59–0.01 Ma) glaciations. This study, in contrast, reveals an ancient subsurface fauna endemic to Britain and Ireland. Using a Bayesian phylogenetic approach, we found that two species of stygobitic invertebrates (genus Niphargus) have not only survived the entire Pleistocene in refugia but have persisted for at least 19.5 million years. Other Niphargus species form distinct cryptic taxa that diverged from their nearest continental relative between 5.6 and 1.0 Ma. The study also reveals an unusual biogeographical pattern in the Niphargus genus. It originated in north-west Europe approximately 87 Ma and underwent a gradual range expansion. Phylogenetic diversity and species age are highest in north-west Europe, suggesting resilience to extreme climate change and strongly contrasting the patterns seen in surface fauna. However, species diversity is highest in south-east Europe, indicating that once the genus spread to these areas (approximately 25 Ma), geomorphological and climatic conditions enabled much higher diversification. Our study highlights that groundwater ecosystems provide an important contribution to biodiversity and offers insight into the interactions between biological and climatic processes.

Geographical partitioning of goat diversity in Europe and the Middle East

Thirty microsatellite markers were analysed in 1426 goats from 45 traditional or rare breeds in 15 European and Middle Eastern countries. In all populations inbreeding was indicated by heterozygosity deficiency (mean FIS = 0.10). Genetic differentiation between breeds was moderate with a mean FST value of 0.07, but for most (c. 71%) northern and central European breeds, individuals could be assigned to their breeds with a success rate of more than 80%. Bayesian-based clustering analysis of allele frequencies and multivariate analysis revealed at least four discrete clusters: eastern Mediterranean (Middle East), central Mediterranean, western Mediterranean and central/northern Europe. About 41% of the genetic variability among the breeds could be explained by their geographical origin. A decrease in genetic diversity from the south-east to the north-west was accompanied by an increase in the level of differentiation at the breed level. These observations support the hypothesis that domestic livestock migrated from the Middle East towards western and northern Europe and indicate that breed formation was more systematic in north-central Europe than in the Middle East. We propose that breed differentiation and molecular diversity are independent criteria for conservation.

Mortality from HIV and TB coinfections is higher in Eastern Europe than in Western Europe and Argentina

BACKGROUND AND OBJECTIVES: Tuberculosis (TB) is a leading cause of death in HIV-infected patients worldwide. We aimed to study clinical characteristics and outcome of 1075 consecutive patients diagnosed with HIV/TB from 2004 to 2006 in Europe and Argentina. METHODS: One-year mortality was assessed in patients stratified according to region of residence, and factors associated with death were evaluated in multivariable Cox models. RESULTS: At TB diagnosis, patients in Eastern Europe had less advanced immunodeficiency, whereas a greater proportion had a history of intravenous drug use, coinfection with hepatitis C, disseminated TB, and infection with drug-resistant TB (P < 0.0001). In Eastern Europe, fewer patients initiated TB treatment containing at least rifamycin, isoniazid, and pyrazinamide or combination antiretroviral therapy (P < 0.0001). Mortality at 1 year was 27% in Eastern Europe, compared with 7, 9 and 11% in Central/Northern Europe, Southern Europe, and Argentina, respectively (P < 0.0001). In a multivariable model, the adjusted relative hazard of death was significantly lower in each of the other regions compared with Eastern Europe: 0.34 (95% confidence interval 0.17-0.65), 0.28 (0.14-0.57), 0.34 (0.15-0.77) in Argentina, Southern Europe and Central/Northern Europe, respectively. Factors significantly associated with increased mortality were CD4 cell count less than 200 cells/microl [2.31 (1.56-3.45)], prior AIDS [1.74 (1.22-2.47)], disseminated TB [2.00 (1.38-2.85)], initiation of TB treatment not including rifamycin, isoniazid and pyrazinamide [1.68 (1.20-2.36)], and rifamycin resistance [2.10 (1.29-3.41)]. Adjusting for these known confounders did not explain the increased mortality seen in Eastern Europe. CONCLUSION: The poor outcome of patients with HIV/TB in Eastern Europe deserves further study and urgent public health attention.

Risk Factors and Outcomes for Late Presentation for HIV-Positive Persons in Europe: Results from the Collaboration of Observational HIV Epidemiological Research Europe Study (COHERE)

Background Few studies have monitored late presentation (LP) of HIV infection over the European continent, including Eastern Europe. Study objectives were to explore the impact of LP on AIDS and mortality. Methods and Findings LP was defined in Collaboration of Observational HIV Epidemiological Research Europe (COHERE) as HIV diagnosis with a CD4 count <350/mm3 or an AIDS diagnosis within 6 months of HIV diagnosis among persons presenting for care between 1 January 2000 and 30 June 2011. Logistic regression was used to identify factors associated with LP and Poisson regression to explore the impact on AIDS/death. 84,524 individuals from 23 cohorts in 35 countries contributed data; 45,488 were LP (53.8%). LP was highest in heterosexual males (66.1%), Southern European countries (57.0%), and persons originating from Africa (65.1%). LP decreased from 57.3% in 2000 to 51.7% in 2010/2011 (adjusted odds ratio [aOR] 0.96; 95% CI 0.95–0.97). LP decreased over time in both Central and Northern Europe among homosexual men, and male and female heterosexuals, but increased over time for female heterosexuals and male intravenous drug users (IDUs) from Southern Europe and in male and female IDUs from Eastern Europe. 8,187 AIDS/deaths occurred during 327,003 person-years of follow-up. In the first year after HIV diagnosis, LP was associated with over a 13-fold increased incidence of AIDS/death in Southern Europe (adjusted incidence rate ratio [aIRR] 13.02; 95% CI 8.19–20.70) and over a 6-fold increased rate in Eastern Europe (aIRR 6.64; 95% CI 3.55–12.43). Conclusions LP has decreased over time across Europe, but remains a significant issue in the region in all HIV exposure groups. LP increased in male IDUs and female heterosexuals from Southern Europe and IDUs in Eastern Europe. LP was associated with an increased rate of AIDS/deaths, particularly in the first year after HIV diagnosis, with significant variation across Europe. Earlier and more widespread testing, timely referrals after testing positive, and improved retention in care strategies are required to further reduce the incidence of LP.