Eligibility for renal denervation: experience at 11 European expert centers.

Based on the SYMPLICITY studies and CE (Conformité Européenne) certification, renal denervation is currently applied as a novel treatment of resistant hypertension in Europe. However, information on the proportion of patients with resistant hypertension qualifying for renal denervation after a thorough work-up and treatment adjustment remains scarce. The aim of this study was to investigate the proportion of patients eligible for renal denervation and the reasons for noneligibility at 11 expert centers participating in the European Network COordinating Research on renal Denervation in treatment-resistant hypertension (ENCOReD). The analysis included 731 patients. Age averaged 61.6 years, office blood pressure at screening was 177/96 mm Hg, and the number of blood pressure-lowering drugs taken was 4.1. Specialists referred 75.6% of patients. The proportion of patients eligible for renal denervation according to the SYMPLICITY HTN-2 criteria and each center's criteria was 42.5% (95% confidence interval, 38.0%-47.0%) and 39.7% (36.2%-43.2%), respectively. The main reasons of noneligibility were normalization of blood pressure after treatment adjustment (46.9%), unsuitable renal arterial anatomy (17.0%), and previously undetected secondary causes of hypertension (11.1%). In conclusion, after careful screening and treatment adjustment at hypertension expert centers, only ≈40% of patients referred for renal denervation, mostly by specialists, were eligible for the procedure. The most frequent cause of ineligibility (approximately half of cases) was blood pressure normalization after treatment adjustment by a hypertension specialist. Our findings highlight that hypertension centers with a record in clinical experience and research should remain the gatekeepers before renal denervation is considered.

National Implementation Group (NIG) - European Working Time Directive & Non Consultant Hospital Doctors - Final Report December 2008

National Implementation Group (NIG) - European Working Time Directive & Non Consultant Hospital Doctors - Final Report December 2008  

European Schools Survey Project on Alcohol and other drugs (ESPAD)

ESPAD is a collaborative effort of independent research teams in about forty European countries and the largest cross-national research project on adolescent substance use in the world. Data are collected every fourth year with 1995 as the starting point. The fourth data collection was carried out in 35 countries during the spring of 2007 and the results were published March 26, 2009 The overall purpose of the ESPAD project is to study adolescent substance use in Europe from a comparative and longitudinal perspective. The basic goal is to collect comparable data on the use of alcohol, tobacco and other drugs among students throughout European countries. Data should be collected in cooperation between countries using a strictly standardised methodology, in order to offer as comparable results as possible. In the long run the most important aim is to monitor the of trends of the adolescent substance use in European countries and to compare trends between countries. This includes the mapping of differences and the monitoring of trends for policy purposes as well as the scientific study of the context, predictors and consequences of adolescent substance use. In relation to the EU action plan on drugs and the WHO Europe declaration about young people and alcohol, ESPAD-data can provide information for the evaluation of these charters. It is intended to repeat the surveys every fourth year. All European countries are welcome to join the ESPAD study, in the effort of making the coverage across Europe as complete as possible. Click here to download PDF 2.1mb

Department of Health and Children Six Monthly Report to the Oireachtas on Developments in the European Union July-December, 2008

Department of Health and Children Six Monthly Report to the Oireachtas on Developments in the European Union July-December, 2008 Click here to download PDF 119kb

Review of Undergraduate Nursing and Midwifery Degree Programmes - Consultation Report

The Department of Health has commenced a review of the undergraduate nursing and midwifery degree programmes in order to establish their efficiency and effectiveness in preparing nurses and midwives to practice in the Irish healthcare system now and into the future (referred to as the Review throughout this report). The undergraduate degree programmes have been in place since 2002 for nursing (general, psychiatric and intellectual disability nursing) and 2006 for midwifery and integrated children and general programmes.   Click here to download PDF 342kb

Report of the Review of Undergraduate Nursing and Midwifery Degree Programmes

Ireland has a strong reputation for delivering excellence in nursing and midwifery education and for providing highly qualified, competent and motivated nurses and midwives. Over the last ten years the educational system has undergone significant change, particularly with the move of undergraduate nursing and midwifery education into the universities and higher education sector. Click here to download PDF 1.4mb

European collaborative study of early-onset bipolar disorder: Evidence for genetic heterogeneity on 2q14 according to age at onset.

Bipolar disorder has a genetic component, but the mode of inheritance remains unclear. A previous genome scan conducted in 70 European families led to detect eight regions linked to bipolar disease. Here, we present an investigation of whether the phenotypic heterogeneity of the disorder corresponds to genetic heterogeneity in these regions using additional markers and an extended sample of families. The MLS statistic was used for linkage analyses. The predivided sample test and the maximum likelihood binomial methods were used to test genetic homogeneity between early-onset bipolar type I (cut-off of 22 years) and other types of the disorder (later onset of bipolar type I and early-onset bipolar type II), using a total of 138 independent bipolar-affected sib-pairs. Analysis of the extended sample of families supports linkage in four regions (2q14, 3p14, 16p23, and 20p12) of the eight regions of linkage suggested by our previous genome scan. Heterogeneity testing revealed genetic heterogeneity between early and late-onset bipolar type I in the 2q14 region (P = 0.0001). Only the early form of the bipolar disorder but not the late form appeared to be linked to this region. This region may therefore include a genetic factor either specifically involved in the early-onset bipolar type I or only influencing the age at onset (AAO). Our findings illustrate that stratification according to AAO may be valuable for the identification of genetic vulnerability polymorphisms.

African migrants in Asian and European football: hopes and realities

This paper analyses the integration of Africa in the global labour market of football through the study of players' migrations to Asia and Europe. The presence of African footballers in the latter continent is analysed via a statistical survey carried out in September and October 2008 on a sample of 456 top division clubs in 30 European countries. The article emphasizes that the aspirations placed on football by male African youth, as a means of upward social mobility, are often too high when compared to the harsh realities of a transfer market based on commercial logics, which each year push many footballers away from the professional game.

Human immunodeficiency virus type 1 Brazilian subtype B variant showed an increasing avidity of the anti-V3 antibodies over time compared to the subtype B US/European strain in São Paulo, Brazil

The Brazilian variant of human immunodeficiency virus type 1 (HIV-1) subtype B, (serotype B"-GWGR), has a tryptophan replacing the proline in position 328 the HIV-1 envelope. A longer median time period from infection to acquired immunodeficiency syndrome (AIDS) for serotype B (B"-GWGR) infected subjects compared to the B-GPGR US/European strain was reported. In a cohort study, in São Paulo city, 10 B"-GWGR patients had a statistically significant increased avidity of the anti-V3 antibodies, from 79% ± 33% to 85% ± 75%, versus from 48% ± 59% to 32% ± 17% for the 10 B-GPGR subjects (p = 0.02). The T CD4+ cells showed a mean increase of + 0.45 cells/month for the B-GPGR subjects and for B"-GWGR the slope was + 1.24 cells/month (p = 0.06), for 62 and 55 months of follow up, respectively. RNA plasma viral load decreased from 3.98 ± 1.75 to 2.16 ± 1.54 log10 in the B"-GWGR group while B-GPGR patients showed one log10 reduction in viral load from 4.09 ± 0.38 to 3.17 ± 1.47 log10 over time (p = 0.23), with a decreasing slope of 0.0042 ± log10,/month and 0.0080 ± log10/month, for B-GPGR and B"-GWGR patients, respectively (p = 0.53). Neither group presented any AIDS defining events during the study, according to Center for Diseases Control criteria. Although the sample size is small, these results may indicate that differences in the pathogenicity of the 2 HIV-1 B serotypes which co-circulate in Brazil may be correlated to the avidity of anti-V3 antibodies.

Disagreements among cohabiting and married couples in 22 European countries

Background: Cross-national research suggests that married people have higher levels of well-being than cohabiting people. However, relationship quality has both positive and negative dimensions. Researchers have paid little attention to disagreements within cohabiting and married couples. Objective: This study aims to improve our understanding of the meaning of cohabitation by examining disagreements within marital and cohabiting relationships. We examine variations in couples' disagreements about housework, paid work and money by country and gender. Methods: The data come from the 2004 European Social Survey. We selected respondents living in a heterosexual couple relationship and aged between 18 and 45. In total, the study makes use of data from 22 European countries and 9,657 people. Given that our dependent variable was dichotomous, we estimated multilevel logit models, with (1) disagree and (0) never disagree. Results: We find that cohabitors had more disagreements about housework, the same disagreements about money, but fewer disagreements about paid work than did married people. These findings could not be explained by socio-economic or demographic measures, nor did we find gender or cross-country differences in the association between union status and conflict. Conclusions: Cohabiting couples have more disagreements about housework but fewer disagreements about paid work than married people. There are no gender or cross-country differences in these associations. The results provide further evidence that the meaning of cohabitation differs from that of marriage, and that this difference remains consistent across nations.

Good quality parenting programmes and the home to school transition

Evidence Review 1 - Good quality parenting programmes and the home to school transition Briefing 1a - Good Quality Parenting Programmes Briefing 1b - Improving the Home to School Transition This set of documents, commissioned by Public Health England (PHE£0, and written by the UCL Institute of Health Equity, address the effects of parenting and good transition on the health and wellbeing of children aged 0-5. They also provide case studies, and examples of good practice for local areas. Evaluations from the UK and other countries show a positive effect of parenting interventions on outcomes and behaviours that we know are linked to positive health and development outcomes for children. Home to school transition programmes can be effective in improving the outcomes for children from more disadvantaged socio-economic groups more than for children from more advantaged socio-economic groups, although longer term impact on health inequalities can only be inferred because the impact on health has not been studied. The full evidence review and two shorter summary briefings are available to download above. This document is part of a series. An overview document which provides an introduction to this and other documents in the series, and links to the other topic areas, is available on the ‘Local Action on health inequalities’ project page. A video of Michael Marmot introducing the work is also available on our videos page.

The policy-making structure of European regulatory networks and the domestic adoption of standards

European regulatory networks (ERNs) constitute the main governance instrument for the informal co-ordination of public regulation at the European Union (EU) level. They are in charge of co-ordinating national regulators and ensuring the implementation of harmonized regulatory policies across the EU, while also offering sector-specific expertise to the Commission. To this aim, ERNs develop 'best practices' and benchmarking procedures in the form of standards, norms and guidelines to be adopted in member states. In this paper, we focus on the Committee of European Securities Regulators and examine the consequences of the policy-making structure of ERNs on the domestic adoption of standards. We find that the regulators of countries with larger financial industries tend to occupy more central positions in the network, especially among newer member states. In turn, network centrality is associated with a more prompt domestic adoption of standards.

A Seroprevalence Study of HIV among Childbearing Women and Women having Termination of Pregnancy, and a Discussion of HIV Testing Programmes for Pregnant Women including their Merits and Demerits

Ninety-one percent of antenatal clinic attenders and 97% of women having a termination of pregnancy agreed to HIV testing on a named or anonymous basis. HIV period prevalence's for Antenatal clinic attenders, and women having termination of pregnancy tested in Dundee were 0.13% and 0.85% respectively and for antenatal clinic attenders in Edinburgh, 0.26%. For those at "low risk", rates for antenatal clinic attenders and women having termination of pregnancy in Dundee were 0.11% and 0.13%, and for antenatal clinic attenders in Edinburgh, 0.02%. In dundee HIV prevalence among women having a termination of pregnancy (0.85%) was significantly greater (p< 0.001) than that among antenatal clinic attenders (0.13%). The investigation's findings show that HIV undoubtedly is occurring among women at "low risk" and it is clear that a policy of selective voluntary testing of those at "high risk" only, is inadequate for pregnant women living in areas of high prevalence such as Edinburgh and Dundee. Moreover, when studying pregnant populations in such areas there is a need to include those having a termination of pregnancy.This resource was contributed by The National Documentation Centre on Drug Use.

Health at a glance: Europe 2012.

This second edition of Health at a Glance: Europe presents a set of key indicators of health and health systems in 35 European countries, including the 27 European Union member states, 5 candidate countries and 3 EFTA countries. The selection of indicators is based largely on the European Community Health Indicators (ECHI) shortlist, a list of indicators that has been developed by the European Commission to guide the development and reporting of health statistics. It is complemented by additional indicators on health expenditure and quality of care, building on the OECD expertise in these areas. Contents: Introduction 12 Chapter 1. Health status 15 1.1. Life expectancy and healthy life expectancy at birth 1.2. Life expectancy and healthy life expectancy at age 65 1.3. Mortality from all causes 1.4. Mortality from heart disease and stroke 1.5. Mortality from cancer 1.6. Mortality from transport accidents 1.7. Suicide 1.8. Infant mortality 1.9. Infant health: Low birth weight 1.10. Self-reported health and disability 1.11. Incidence of selected communicable diseases 1.12. HIV/AIDS 1.13. Cancer incidence 1.14. Diabetes prevalence and incidence 1.15. Dementia prevalence 1.16. Asthma and COPD prevalence Chapter 2. Determinants of health 49 2.1. Smoking and alcohol consumption among children 2.2. Overweight and obesity among children 2.3. Fruit and vegetable consumption among children 2.4. Physical activity among children 2.5. Smoking among adults 2.6. Alcohol consumption among adults 2.7. Overweight and obesity among adults 2.8. Fruit and vegetable consumption among adults Chapter 3. Health care resources and activities 67 3.1. Medical doctors 3.2. Consultations with doctors 3.3. Nurses 3.4. Medical technologies: CT scanners and MRI units 3.5. Hospital beds 3.6. Hospital discharges 3.7. Average length of stay in hospitals 3.8. Cardiac procedures (coronary angioplasty) 3.9. Cataract surgeries 3.10. Hip and knee replacement 3.11. Pharmaceutical consumption 3.12. Unmet health care needs Chapter 4. Quality of care 93 Care for chronic conditions 4.1. Avoidable admissions: Respiratory diseases 4.2. Avoidable admissions: Uncontrolled diabetes Acute care 4.3. In-hospital mortality following acute myocardial infarction 4.4. In-hospital mortality following stroke Patient safety 4.5. Procedural or postoperative complications 4.6. Obstetric trauma Cancer care 4.7. Screening, survival and mortality for cervical cancer 4.8. Screening, survival and mortality for breast cancer 4.9. Screening, survival and mortality for colorectal cancer Care for communicable diseases 4.10. Childhood vaccination programmes 4.11. Influenza vaccination for older people Chapter 5. Health expenditure and financing 117 5.1. Coverage for health care 5.2. Health expenditure per capita 5.3. Health expenditure in relation to GDP 5.4. Health expenditure by function. 5.5. Pharmaceutical expenditure 5.6. Financing of health care 5.7. Trade in health services Bibliography 133 Annex A. Additional information on demographic and economic context 143 Most European countries have reduced tobacco consumption via public awareness campaigns, advertising bans and increased taxation. The percentage of adults who smoke daily is below 15% in Sweden and Iceland, from over 30% in 1980. At the other end of the scale, over 30% of adults in Greece smoke daily. Smoking rates continue to be high in Bulgaria, Ireland and Latvia (Figure 2.5.1). Alcohol consumption has also fallen in many European countries. Curbs on advertising, sales restrictions and taxation have all proven to be effective measures. Traditional wine-producing countries, such as France, Italy and Spain, have seen consumption per capita fall substantially since 1980. Alcohol consumption per adult rose significantly in a number of countries, including Cyprus, Finland and Ireland (Figure 2.6.1).This resource was contributed by The National Documentation Centre on Drug Use.