Changes in chlamydia control activities in Europe between 2007 and 2012: a cross-national survey.

BACKGROUND In 2012, the levels of chlamydia control activities including primary prevention, effective case management with partner management and surveillance were assessed in 2012 across countries in the European Union and European Economic Area (EU/EEA), on initiative of the European Centre for Disease Control (ECDC) survey, and the findings were compared with those from a similar survey in 2007. METHODS Experts in the 30 EU/EEA countries were invited to respond to an online questionnaire; 28 countries responded, of which 25 participated in both the 2007 and 2012 surveys. Analyses focused on 13 indicators of chlamydia prevention and control activities; countries were assigned to one of five categories of chlamydia control. RESULTS In 2012, more countries than in 2007 reported availability of national chlamydia case management guidelines (80% vs. 68%), opportunistic chlamydia testing (68% vs. 44%) and consistent use of nucleic acid amplification tests (64% vs. 36%). The number of countries reporting having a national sexually transmitted infection control strategy or a surveillance system for chlamydia did not change notably. In 2012, most countries (18/25, 72%) had implemented primary prevention activities and case management guidelines addressing partner management, compared with 44% (11/25) of countries in 2007. CONCLUSION Overall, chlamydia control activities in EU/EEA countries strengthened between 2007 and 2012. Several countries still need to develop essential chlamydia control activities, whereas others may strengthen implementation and monitoring of existing activities.

Assessment of the Hong Kong Liver Cancer Staging System in Europe.

BACKGROUND & AIMS European and American guidelines have endorsed the Barcelona Clinic Liver Cancer (BCLC) staging system. The aim of this study was to assess the performance of the recently developed Hong Kong Liver Cancer (HKLC) classification as a staging system for hepatocellular carcinoma (HCC) in Europe. METHODS We used a pooled set of 1693 HCC patients combining three prospective European cohorts. Discrimination ability between the nine substages and five stages of the HKLC classification system was assessed. To evaluate the predictive power of the HKLC and BCLC staging systems on overall survival, Nagelkerke pseudo R2, Bayesian Information Criterion and Harrell's concordance index were calculated. The number of patients who would benefit from a curative therapy was assessed for both staging system. RESULTS The HKLC classification in nine substages shows suboptimal discrimination between the staging groups. The classification in five stages shows better discrimination between groups. However, the BCLC classification performs better than the HKLC classification in the ability to predict OS. The HKLC treatment algorithm tags significantly more patients to curative therapy than the BCLC. CONCLUSIONS The BCLC staging system performs better for European patients than the HKLC staging system in predicting OS. Twice more patients are eligible for a curative therapy with the HKLC algorithm, whether this translates in survival benefit remains to be investigated. This article is protected by copyright. All rights reserved.

Sport clubs in Europe. A cross-national comparative perspective

​This book presents an up-to-date portrait of the characteristics of sport clubs in various European countries and their role in society and the national sport system. Furthermore, it offers a cross-national comparative perspective of sport clubs in twenty European countries. Containing both empirical data and information on the political and historical backgrounds of sport clubs, the book is organized in three parts. First, the authors provide an overview of the theoretical approach of the book and a description of the framework used for the country chapters. Second, the country chapters, written by experts within the field, provide a systematic overview of the available information on sport clubs in each country. These chapters are structured to answer the following questions: (1) What is the position of sport clubs within the national sport structure? (2) Which role do they fulfil in policy and society? (3) What are their basic characteristics and what factors influence the development of sport clubs? The book is concluded with a systematic comparison of the participating countries with the purpose of forging a clear link between the functioning of policy systems, observed problems, and possible solutions, and with a future research agenda on sport clubs. In an era of increased collaboration between European states, sport provides a natural vehicle through which to compare changes in culture, economics, and policy across nations. Sport Clubs in Europe will appeal to scholars of nonprofit management, sports management and sports sociology as well as administrators and policy makers in the international sports community.

Tuberculosis-related mortality in people living with HIV in Europe and Latin America: an international cohort study

BACKGROUND Management of tuberculosis in patients with HIV in eastern Europe is complicated by the high prevalence of multidrug-resistant tuberculosis, low rates of drug susceptibility testing, and poor access to antiretroviral therapy (ART). We report 1 year mortality estimates from a multiregional (eastern Europe, western Europe, and Latin America) prospective cohort study: the TB:HIV study. METHODS Consecutive HIV-positive patients aged 16 years or older with a diagnosis of tuberculosis between Jan 1, 2011, and Dec 31, 2013, were enrolled from 62 HIV and tuberculosis clinics in 19 countries in eastern Europe, western Europe, and Latin America. The primary endpoint was death within 12 months after starting tuberculosis treatment; all deaths were classified according to whether or not they were tuberculosis related. Follow-up was either until death, the final visit, or 12 months after baseline, whichever occurred first. Risk factors for all-cause and tuberculosis-related deaths were assessed using Kaplan-Meier estimates and Cox models. FINDINGS Of 1406 patients (834 in eastern Europe, 317 in western Europe, and 255 in Latin America), 264 (19%) died within 12 months. 188 (71%) of these deaths were tuberculosis related. The probability of all-cause death was 29% (95% CI 26-32) in eastern Europe, 4% (3-7) in western Europe, and 11% (8-16) in Latin America (p<0·0001) and the corresponding probabilities of tuberculosis-related death were 23% (20-26), 1% (0-3), and 4% (2-8), respectively (p<0·0001). Patients receiving care outside eastern Europe had a 77% decreased risk of death: adjusted hazard ratio (aHR) 0·23 (95% CI 0·16-0·31). In eastern Europe, compared with patients who started a regimen with at least three active antituberculosis drugs, those who started fewer than three active antituberculosis drugs were at a higher risk of tuberculosis-related death (aHR 3·17; 95% CI 1·83-5·49) as were those who did not have baseline drug-susceptibility tests (2·24; 1·31-3·83). Other prognostic factors for increased tuberculosis-related mortality were disseminated tuberculosis and a low CD4 cell count. 18% of patients were receiving ART at tuberculosis diagnosis in eastern Europe compared with 44% in western Europe and 39% in Latin America (p<0·0001); 12 months later the proportions were 67% in eastern Europe, 92% in western Europe, and 85% in Latin America (p<0·0001). INTERPRETATION Patients with HIV and tuberculosis in eastern Europe have a risk of death nearly four-times higher than that in patients from western Europe and Latin America. This increased mortality rate is associated with modifiable risk factors such as lack of drug susceptibility testing and suboptimal initial antituberculosis treatment in settings with a high prevalence of drug resistance. Urgent action is needed to improve tuberculosis care for patients living with HIV in eastern Europe. FUNDING EU Seventh Framework Programme.

Abies – Circum-Mediterranean firs in Europe: distribution, habitat, usage and threats

Most European firs occur predominantly in small to medium-sized populations in the Mediterranean region, sometimes with fragmented and limited distributions, except for silver fir (Abies alba). They all are genetically closely related and can easily hybridise, perhaps as a consequence of late speciation during the late Quaternary. Circum-Mediterranean firs occur principally in mountain areas with medium to high precipitations rates which are mostly concentrated during the winter period. The species are able to tolerate long droughts in summer and tend to form pure stands when in optimal habitats. In the past firs have been extensively logged for construction and fire wood and their stands were replaced by other more disturbance adapted species or converted into rural areas. Nowadays with the exception of silver fir and Caucasian fir (Abies nordmanniana), circum-Mediterranean firs do not have a wide commercial interest. In Turkey they are still exploited for timber wood, while other firs have an ornamental use in gardening. Great importance is given to their preservation, especially to those populations which have very limited areas and specimens, with the creation of protected reserves and conservation programmes. Wild fires, livestock grazing and genetic drift represent actually their main threats.

Castanea sativa in Europe: distribution, habitat, usage and threats

The sweet chestnut (Castanea sativa Mill.) is the only native species of the genus in Europe. The broad diffusion and active management by man resulted in the establishment of the species at the limits of its potential ecological range, which makes it difficult to trace its original natural area. The present distribution ranges from North-Western Africa (e.g. Morocco) to North-Western Europe (southern England, Belgium) and from south-western Asia (e.g. Turkey) to Eastern Europe (e.g. Romania), the Caucasus (Georgia, Armenia) and the Caspian Sea. In Europe the main chestnut forests are concentrated in a few countries such as Italy, France and the Iberian Peninsula. The sweet chestnut has a remarkable multipurpose character, and may be managed for timber production (coppice and high forest) as well as for fruit production (traditional orchards), including a broad range of secondary products and ecosystem services.

Fraxinus excelsior in Europe: distribution, habitat, usage and threats

Common ash (Fraxinus excelsior L.) is a medium-sized deciduous tree with large compound leaves that develop relatively late in spring. It flowers before leaf-buds burst and trees can carry male, female, or hermaphrodite flowers, or different combinations of the flower types. It grows throughout the European temperate zone, but is absent from the driest Mediterranean areas because it does not tolerate extended summer drought, and from the northern boreal regions, with its seedlings in particular being vulnerable to late spring frost. Soils exert a strong control on common ash distribution locally. The species grows best on fertile soils where soil pH exceeds 5.5. It rarely forms pure stands, more often it is found in small groups in mixed stands. Ash trees produce high quality timber that combines light weight, strength, and flexibility. Before the mass use of steel, it was used for a wide range of purposes, from agricultural implements to construction of boat and car frames. Today

Picea abies in Europe: distribution, habitat, usage and threats

Among the coniferous species, Norway spruce (Picea abies (L.) Karst.) is one of the most important trees in Europe both for economic and ecological aspects, with a long tradition of cultivation. It can be a big tree, reaching 50-60 m in height with a straight and regular trunk, particularly used for timber constructions, pulpwood for paper and furniture. This widespread species dominates the Boreal forests in Northern Europe and the subalpine areas of the Alps and Carpathian Mountains. Thanks to its high performances in different site conditions, it can also be found outside its natural distribution on lower elevations in more temperate forests. Norway spruce has been massively planted up to its niche limits, where it is particularly susceptible to heat and drought, due to its shallow root system. For this reason it is expected to be severely affected under global warming conditions. Disturbed and weakened plants can be easily attacked by rot fungi such as Heterobasidion annosum and Armillaria, or by the bark beetles Ips typographus, one of the most destructive spruce forest pests.

Juglans regia in Europe: distribution, habitat, usage and threats

Juglans regia L., commonly known as common, English or Persian walnut, is an economically very important tree species, prized both for its nuts and for its attractive high-quality timber. It is the most widespread nut tree worldwide.

Ophthalmic epidemiology in Europe: the "European Eye Epidemiology" (E3) consortium.

The European Eye Epidemiology (E3) consortium is a recently formed consortium of 29 groups from 12 European countries. It already comprises 21 population-based studies and 20 other studies (case-control, cases only, randomized trials), providing ophthalmological data on approximately 170,000 European participants. The aim of the consortium is to promote and sustain collaboration and sharing of data and knowledge in the field of ophthalmic epidemiology in Europe, with particular focus on the harmonization of methods for future research, estimation and projection of frequency and impact of visual outcomes in European populations (including temporal trends and European subregions), identification of risk factors and pathways for eye diseases (lifestyle, vascular and metabolic factors, genetics, epigenetics and biomarkers) and development and validation of prediction models for eye diseases. Coordinating these existing data will allow a detailed study of the risk factors and consequences of eye diseases and visual impairment, including study of international geographical variation which is not possible in individual studies. It is expected that collaborative work on these existing data will provide additional knowledge, despite the fact that the risk factors and the methods for collecting them differ somewhat among the participating studies. Most studies also include biobanks of various biological samples, which will enable identification of biomarkers to detect and predict occurrence and progression of eye diseases. This article outlines the rationale of the consortium, its design and presents a summary of the methodology.

The Secular State Under Siege: Religion and Politics in Europe and America

Throughout human history, religion and politics have entertained the most intimate of connections as systems of authority regulating individuals and society. While the two have come apart through the process of secularization, secularism is challenged today by the return of public religion. This cogent analysis unravels the nature of the connection, disconnection, and attempted reconnection between religion and politics in the West. In a comparison of Western Europe and North America, Christianity and Islam, Joppke advances far-reaching theoretical, historical, and comparative-political arguments. With respect to theory, it is argued that only a “substantive” concept of religion, as pertaining to the existence of supra-human powers, opens up the possibility of a historical-comparative perspective on religion. At the level of history, secularization is shown to be the distinct outcome of Latin Christianity itself. And at the level of comparative politics, the Christian Right in America which has attacked the “wall of separation” between religion and state and Islam in Europe with the controversial insistence on sharia law and other “illiberal” claims from some quarters are taken to be counterpart incarnations of public religion and challenges to the secular state. This clearly argued, sweeping book will provide an invaluable framework for approaching an array of critical issues at the intersection of religion, law and politics for advanced students and researchers across the social sciences and legal studies, as well as for the interested public.