Uses of cancer registries for public health and clinical research in Europe : results of the European Network of Cancer Registries survey among 161 population-based cancer registries during 2010-2012

AIM: To provide insight into cancer registration coverage, data access and use in Europe. This contributes to data and infrastructure harmonisation and will foster a more prominent role of cancer registries (CRs) within public health, clinical policy and cancer research, whether within or outside the European Research Area. METHODS: During 2010-12 an extensive survey of cancer registration practices and data use was conducted among 161 population-based CRs across Europe. Responding registries (66%) operated in 33 countries, including 23 with national coverage. RESULTS: Population-based oncological surveillance started during the 1940-50s in the northwest of Europe and from the 1970s to 1990s in other regions. The European Union (EU) protection regulations affected data access, especially in Germany and France, but less in the Netherlands or Belgium. Regular reports were produced by CRs on incidence rates (95%), survival (60%) and stage for selected tumours (80%). Evaluation of cancer control and quality of care remained modest except in a few dedicated CRs. Variables evaluated were support of clinical audits, monitoring adherence to clinical guidelines, improvement of cancer care and evaluation of mass cancer screening. Evaluation of diagnostic imaging tools was only occasional. CONCLUSION: Most population-based CRs are well equipped for strengthening cancer surveillance across Europe. Data quality and intensity of use depend on the role the cancer registry plays in the politico, oncomedical and public health setting within the country. Standard registration methodology could therefore not be translated to equivalent advances in cancer prevention and mass screening, quality of care, translational research of prognosis and survivorship across Europe. Further European collaboration remains essential to ensure access to data and comparability of the results.

Assessing chronic disease management in European health systems : concepts and approaches

This book comprises two volumes and builds on the findings of the DISMEVAL project (Developing and validating DISease Management EVALuation methods for European health care systems), funded under the European Union's (EU) Seventh Framework Programme (FP7) (Agreement no. 223277). DISMEVAL was a three-year European collaborative project conducted between 2009 and 2011. It contributed to developing new research methods and generating the evidence base to inform decision-making in the field of chronic disease management evaluation (www.dismeval.eu). In this book, we report on the findings of the project's first phase, capturing the diverse range of contexts in which new approaches to chronic care are being implemented and evaluating the outcomes of these initiatives using an explicit comparative approach and a unified assessment framework. In this first volume, we describe the range of approaches to chronic care adopted in 12 European countries. By reflecting on the facilitators and barriers to implementation, we aim to provide policy-makers and practitioners with a portfolio of options to advance chronic care approaches in a given policy context.

Concentrations of resveratrol and derivatives in foods and estimation of dietary intake in a Spanish population: European Prospective Investigation into Cancer and Nutrition (EPIC)-Spain cohort

Resveratrol has been shown to have beneficial effects on diseases related to oxidant and/or inflammatory processes and extends the lifespan of simple organisms including rodents. The objective of the present study was to estimate the dietary intake of resveratrol and piceid (R&P) present in foods, and to identify the principal dietary sources of these compounds in the Spanish adult population. For this purpose, a food composition database (FCDB) of R&P in Spanish foods was compiled. The study included 40 685 subjects aged 35-64 years from northern and southern regions of Spain who were included in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Spain cohort. Usual food intake was assessed by personal interviews using a computerised version of a validated diet history method. An FCDB with 160 items was compiled. The estimated median and mean of R&P intake were 100 and 933 mg/d respectively. Approximately, 32% of the population did not consume RΠ The most abundant of the four stilbenes studied was trans-piceid (53·6 %), followed by trans-resveratrol (20·9 %), cis-piceid (19·3 %) and cis-resveratrol (6·2 %). The most important source of R&P was wines (98·4 %) and grape and grape juices (1·6 %), whereas peanuts, pistachios and berries contributed to less than 0·01 %. For this reason the pattern of intake of R&P was similar to the wine pattern. This is the first time that R&P intake has been estimated in a Mediterranean country.

Health care usage among immigrants and native-born elderly populations in eleven European countries: results from SHARE

Differences in health care utilization of immigrants 50 years of age and older relative to the native-born populations in eleven European countries are investigated. Negative binomial and zero-inflated Poisson regression are used to examine differences between immigrants and native-borns in number of doctor visits, visits to general practitioners, and hospital stays using the 2004 Survey of Health, Ageing, and Retirement in Europe database. In the pooled European sample and in some individual countries, older immigrants use from 13 to 20% more health services than native-borns after demographic characteristics are controlled. After controlling for the need for health care, differences between immigrants and native-borns in the use of physicians, but not hospitals, are reduced by about half. These are not changed much with the incorporation of indicators of socioeconomic status and extra insurance coverage. Higher country-level relative expenditures on health, paying physicians a fee-for-service, and physician density are associated with higher usage of physician services among immigrants.

Vitamin D time profile based on the contribution of non-genetic and genetic factors in HIV-infected individuals of European ancestry.

BACKGROUND: Vitamin D deficiency is prevalent in HIV-infected individuals and vitamin D supplementation is proposed according to standard care. This study aimed at characterizing the kinetics of 25(OH)D in a cohort of HIV-infected individuals of European ancestry to better define the influence of genetic and non-genetic factors on 25(OH)D levels. These data were used for the optimization of vitamin D supplementation in order to reach therapeutic targets. METHODS: 1,397 25(OH)D plasma levels and relevant clinical information were collected in 664 participants during medical routine follow-up visits. They were genotyped for 7 SNPs in 4 genes known to be associated with 25(OH)D levels. 25(OH)D concentrations were analysed using a population pharmacokinetic approach. The percentage of individuals with 25(OH)D concentrations within the recommended range of 20-40 ng/ml during 12 months of follow-up and several dosage regimens were evaluated by simulation. RESULTS: A one-compartment model with linear absorption and elimination was used to describe 25(OH)D pharmacokinetics, while integrating endogenous baseline plasma concentrations. Covariate analyses confirmed the effect of seasonality, body mass index, smoking habits, the analytical method, darunavir/ritonavir and the genetic variant in GC (rs2282679) on 25(OH)D concentrations. 11% of the inter-individual variability in 25(OH)D levels was explained by seasonality and other non-genetic covariates, and 1% by genetics. The optimal supplementation for severe vitamin D deficient patients was 300,000 IU two times per year. CONCLUSIONS: This analysis allowed identifying factors associated with 25(OH)D plasma levels in HIV-infected individuals. Improvement of dosage regimen and timing of vitamin D supplementation is proposed based on those results.

External Location Factors of Finnish Direct Investment in Central and Eastern European Transitional Economies

Tutkimuksen päätavoitteena oli selvittää suomalaisten suorien investointien maan valintaan vaikuttavia tekijöitä Itä- ja Keski-Euroopan kymmenessä siirtymätaloudessa. Empiirisessä osuudessa tarkasteltiin suomalaisten yritysten tärkeimpiä sijaintitekijöitä alueella ja yrityskohtaisten tekijöiden vaikutusta sijaintitekijöihin. Tutkimuksessa selvitettiin myös yritysten päämotiiveja investoida maihin. Laaditun investointikriteeristön mukaan maat pystyttiin laittamaan paremmuusjärjestykseen suomalaisen investoijan kannalta. Empiirisen osuuden aineisto kerättiin postikyselylomakkeella yrityksiltä, joilla on tai jotka ovat suunnittelemassa investointeja näihin maihin. Tutkimusote oli kvantitatiivinen. Tutkimustulokset osoittavat, että suomalaiset investoijat valitsevat Itä- ja Keski-Euroopan maan investointikohteeksi pääasiassa markkinapotentiaalin ja edullisten kustannusten perusteella. Myös infrastruktuuri vaikuttaa maan valintaan. Eri aloilla toimivien yritysten sijaintitekijöiden painotuksissa havaittiin eroja. Yrityksen koko ja päämotiivi vaikuttivat sijaintitekijöiden painotuksiin. Investointikriteereiden mukaan kaksi parasta investointimaata suomalaisille investoijille ovat Puola ja Viro. Vertailtaessa investointikriteereitä toteutuneisiin investointeihin voidaan todeta, että suomalaiset investoijat eivät ole hyödyntäneet investoinneilla saatavia etuja kaikissa kohdemaissa.

Effect of biogeographic history on population vulnerability in European amphibians.

The genetic diversity of populations, which contributes greatly to their adaptive potential, is negatively affected by anthropogenic habitat fragmentation and destruction. However, continental-scale losses of genetic diversity also resulted from the population expansions that followed the end of the last glaciation, an element that is rarely considered in a conservation context. We addressed this issue in a meta-analysis in which we compared the spatial patterns of vulnerability of 18 widespread European amphibians in light of phylogeographic histories (glacial refugia and postglacial routes) and anthropogenic disturbances. Conservation statuses significantly worsened with distances from refugia, particularly in the context of industrial agriculture; human population density also had a negative effect. These findings suggest that features associated with the loss of genetic diversity in post-glacial amphibian populations (such as enhanced fixation load or depressed adaptive potential) may increase their susceptibility to current threats (e.g., habitat fragmentation and pesticide use). We propose that the phylogeographic status of populations (i.e., refugial vs. post-glacial) should be considered in conservation assessments for regional and national red lists.

The reform of the European Energy Tax Directive reform : effect on prices

[spa] Para hacer frente a los riesgos relacionados con la contaminación atmosférica, es ampliamente aceptada la necesidad de instrumentos de política encaminados a reducir las emisiones. La intervención tiene por objeto reducir las conductas contaminantes y incentivar una conducta más respetuosa y el uso de tecnologías más eficientes. La Unión Europea cuenta con dos importantes mecanismos económicos para el control de emisiones a escala europea: la directiva sobre los impuestos energéticos, un instrumento de fiscalidad ambiental aprobado en 2003 que afecta el precio de los productos energéticos, y el sistema de comercio de los derechos de emisiones, introducido en 2005, que afecta directamente a la cantidad de emisiones de CO2. En 2011, la Comisión Europea propuso una nueva versión de la directiva sobre los impuestos energéticos. El objetivo principal de la propuesta es aumentar la eficacia del instrumento a través de una mayor presión fiscal sobre los productos energéticos y de coordinar este instrumento de fiscalidad medioambiental con el sistema de comercio de los derechos de emisiones, para establecer una señal de precio de CO2 coherente para todos los sectores. Sin embargo, en mayo de 2012 el Parlamento Europeo bloqueó la propuesta de la nueva versión del impuesto, y el proceso de actualización se detuvo. La preocupación principal parecía ser el efecto de dicha propuesta en la competitividad, en particular para los sectores que serían los más afectados dado el uso intensivo de los productos energéticos, como el sector del transporte. El objetivo de este estudio es analizar el efecto que la reforma de la directiva sobre los impuestos energéticos podría tener sobre el nivel de precios, en particular en los países de la Unión Europea donde esta reforma implicaría un aumento de los impuestos energéticos. Utilizando datos del proyecto “World Input-Output Database”, la principal conclusión es que el nuevo sistema de impuestos energéticos tendría un impacto muy bajo sobre los precios. Por lo tanto, dado que los precios no serían fuertemente afectados por la reforma, no habrá inconvenientes para la competitividad y implicaciones en términos de distribución, pero, por otro lado, este resultado también implica una baja capacidad de esta reforma para provocar cambios en el consumo y la producción hacia menos presiones ambientales.

Timeframe of speciation inferred from secondary contact zones in the European tree frog radiation (Hyla arborea group).

BACKGROUND: Hybridization between incipient species is expected to become progressively limited as their genetic divergence increases and reproductive isolation proceeds. Amphibian radiations and their secondary contact zones are useful models to infer the timeframes of speciation, but empirical data from natural systems remains extremely scarce. Here we follow this approach in the European radiation of tree frogs (Hyla arborea group). We investigated a natural hybrid zone between two lineages (Hyla arborea and Hyla orientalis) of Mio-Pliocene divergence (~5 My) for comparison with other hybrid systems from this group. RESULTS: We found concordant geographic distributions of nuclear and mitochondrial gene pools, and replicated narrow transitions (~30 km) across two independent transects, indicating an advanced state of reproductive isolation and potential local barriers to dispersal. This result parallels the situation between H. arborea and H. intermedia, which share the same amount of divergence with H. orientalis. In contrast, younger lineages show much stronger admixture at secondary contacts. CONCLUSIONS: Our findings corroborate the negative relationship between hybridizability and divergence time in European tree frogs, where 5 My are necessary to achieve almost complete reproductive isolation. Speciation seems to progress homogeneously in this radiation, and might thus be driven by gradual genome-wide changes rather than single speciation genes. However, the timescale differs greatly from that of other well-studied amphibians. General assumptions on the time necessary for speciation based on evidence from unrelated taxa may thus be unreliable. In contrast, comparative hybrid zone analyses within single radiations such as our case study are useful to appreciate the advance of speciation in space and time.

Customer Research on a Group of European Book Publishers: Trends, Modes of Operation and Decision-Making Processes

Työn päätarkoitus oli tuottaa Stora Enson käyttöön tietoa kirjakustantajista, yhdestä yrityksen asiakassegmentistä. Yritys oli kiinnostunut useista asioista, jotka koskivat asiakkaita ja heidän mielipiteitään. Tarkoitus on, että Stora Enso voi käyttää tutkimuksella koottua tietoa oman toimintansa suunnittelun tukena. Kerätty sekundääritieto esittelee eurooppalaisen kirjakustantamisen nykytilaa ja tulevaisuutta sekä teorioita, jotka tukevat tutkittuja aihealueita. Primääritieto kerättiin henkilökohtaisilla haastatteluilla. Otanta koostui kymmenestä kirjakustantajasta, jotka toimivat Suomessa sekä Stora Enson päämarkkina-alueilla. Tutkimus tarjoaa päivitetyn kuvauksen kirjakustantamisesta. Haastateltavien mielipiteet alan trendeistä olivat yhteneviä yleisen mielipiteen kanssa, eikä suuria mielipide-eroavaisuuksia havaittu. Kustantajien toimintatapoja ja päätöksentekoprosesseja voidaan kuvata monimutkaisiksi, koska useat asiat vaikuttavat kirjan syntyyn ja paperin ostoprosessiin. Lisäksi tutkimus esittelee haastateltavien mielipiteitä paperin merkityksestä heidän liiketoiminnassaan.

The reform of the European Energy Tax Directive reform : effect on prices

[spa] Para hacer frente a los riesgos relacionados con la contaminación atmosférica, es ampliamente aceptada la necesidad de instrumentos de política encaminados a reducir las emisiones. La intervención tiene por objeto reducir las conductas contaminantes y incentivar una conducta más respetuosa y el uso de tecnologías más eficientes. La Unión Europea cuenta con dos importantes mecanismos económicos para el control de emisiones a escala europea: la directiva sobre los impuestos energéticos, un instrumento de fiscalidad ambiental aprobado en 2003 que afecta el precio de los productos energéticos, y el sistema de comercio de los derechos de emisiones, introducido en 2005, que afecta directamente a la cantidad de emisiones de CO2. En 2011, la Comisión Europea propuso una nueva versión de la directiva sobre los impuestos energéticos. El objetivo principal de la propuesta es aumentar la eficacia del instrumento a través de una mayor presión fiscal sobre los productos energéticos y de coordinar este instrumento de fiscalidad medioambiental con el sistema de comercio de los derechos de emisiones, para establecer una señal de precio de CO2 coherente para todos los sectores. Sin embargo, en mayo de 2012 el Parlamento Europeo bloqueó la propuesta de la nueva versión del impuesto, y el proceso de actualización se detuvo. La preocupación principal parecía ser el efecto de dicha propuesta en la competitividad, en particular para los sectores que serían los más afectados dado el uso intensivo de los productos energéticos, como el sector del transporte. El objetivo de este estudio es analizar el efecto que la reforma de la directiva sobre los impuestos energéticos podría tener sobre el nivel de precios, en particular en los países de la Unión Europea donde esta reforma implicaría un aumento de los impuestos energéticos. Utilizando datos del proyecto “World Input-Output Database”, la principal conclusión es que el nuevo sistema de impuestos energéticos tendría un impacto muy bajo sobre los precios. Por lo tanto, dado que los precios no serían fuertemente afectados por la reforma, no habrá inconvenientes para la competitividad y implicaciones en términos de distribución, pero, por otro lado, este resultado también implica una baja capacidad de esta reforma para provocar cambios en el consumo y la producción hacia menos presiones ambientales.

Creating CRM Concept for Internet Gaming Business - Case: European Game & Entertainment Technology

Työn tavoitteena oli luoda asiakassuhteidenhallintakonsepti Internetpelijärjestelmälle sekä luoda asiakassuhteidenhallintaprosessi keskittyen viestintä- ja personointiominaisuuksiin. Lisäksi työssä määritettiin CRM järjestelmän ominaisuudet ja toiminnallisuudet. Työ toteutettiin kvalitatiivisena case tutkimuksena. Tiedot empiiristä tutkimusta varten kerättiin haastattelemalla kohderyhminä olleita asiakkaita sekä case-yrityksen avainhenkilöitä. Työssä selvitettiin ensin suhdemarkkinoinnin perusteet, konsepti sekä asiakassuhteen arvo. Yhteys peliliiketoimintaan sekä Internet peliliiketoiminnan perusteet esitettin. CRM konsepti määriteltiin teoriassa sekä CRM prosessi määritettin perustuen teoreettiseen tutkimukseen sekä empiirisiin tuloksiin. Seuraavaksi luotiin CRM konsepti case-yritykselle perustuen CRM prosessin tuottamaan informaatioon ja asiakastarpeisiin. Asiakassuhteiden hallinta voidaan jakaa kolmeen tasoon - strategiseen, analyyttiseen ja toiminnalliseen. CRM konseptin luominen on tapauskohtainen prosessi. Siihen vaikuttaa voimakkaasti toimiala, millä yritys toimii. Myös asiakastarpeiden kartoituksella on tärkeä merkitys onnistuneen konseptin luomisessa. Sekä kirjallisuuteen perustuvat, että empiiriset havainnot painottivat personoinnin ja viestinnän vaikutusta CRM konseptissa.

Human Capital Questionnaire (PHCQ): Assessment of European nurses' perception as indicators of human capital quality

Healthcare accreditation models generally include indicators related to healthcare employees' perceptions (e.g. satisfaction, career development, and health safety). During the accreditation process, organizations are asked to demonstrate the methods with which assessments are made. However, none of the models provide standardized systems for the assessment of employees. In this study, we analyzed the psychometric properties of an instrument for the assessment of nurses' perceptions as indicators of human capital quality in healthcare organizations. The Human Capital Questionnaire was applied to a sample of 902 nurses in four European countries (Spain, Portugal, Poland, and the UK). Exploratory factor analysis identified six factors: satisfaction with leadership, identification and commitment, satisfaction with participation, staff well-being, career development opportunities, and motivation. The results showed the validity and reliability of the questionnaire, which when applied to healthcare organizations, provide a better understanding of nurses' perceptions, and is a parsimonious instrument for assessment and organizational accreditation. From a practical point of view, improving the quality of human capital, by analyzing nurses and other healthcare employees' perceptions, is related to workforce empowerment.

The determinants of CAP reform: learning from the European financial crisis and CAP 2013

There is an ongoing debate on which are the determinants of CAP reform. The economic environment has not been contemplated as a direct determinant of CAP reform but its proxy, the budget, has not only been looked at as such but underlined as a key cause of CAP reform. This paper argues, however, that the budget does not affect the modus operandi of the CAP. It affects the quantity of support each farmer is going to get and sometimes even the timing of the reform, but not the form it is going to receive it. Other CAP determinants and international negotiations in particular, have an impact on the substance of CAP reform. This hypothesis is not contradicted by an analysis of CAP 2013 changes.

Fruit and vegetables and cancer risk : a review of southern European studies

High intakes of fruit and vegetables may reduce the risk of cancer at several sites. Evidence has been derived mainly from case-control studies. We reviewed the relationship between consumption of vegetables and fruit and the risk of several common cancers in a network of Italian and Swiss case-control studies including over 10 000 cases of fourteen different cancers and about 17 000 controls. Data were suggestive of a protective role of vegetable intake on the risk of several common epithelial cancers. OR for the highest compared with the lowest levels of consumption ranged from 0·2 (larynx, oral cavity and pharynx) to 0·9 (prostate). Inverse associations were found for both raw and cooked vegetables, although for upper digestive tract cancers the former were somewhat stronger. Similar inverse associations were found for cruciferous vegetables. Frequent consumption of allium vegetables was also associated with reduced risk of several cancers. Fruit was a favourable correlate of the risk of several cancers, particularly of the upper digestive tract, with associations generally weaker than those reported for vegetables. A reduced risk of cancers of the digestive tract and larynx was found for high consumption of citrus fruit. Suggestive protections against several forms of cancer, mainly digestive tract cancers, were found for high consumption of apples and tomatoes. High intakes of fibres, flavonoids and proanthocyanidins were inversely related to various forms of cancer. In conclusion, data from our series of case-control studies suggested a favourable role of high intakes of fruit and vegetables in the risk of many common cancers, particularly of the digestive tract. This adds evidence to the indication that aspects of the Mediterranean diet may have a favourable impact not only on CVD, but also on several common (epithelial) cancers, particularly of the digestive tract.