Reconciling the EU forest, biodiversity, and climate strategies.

Forests provide important ecosystem services (ESs), including climate change mitigation, local climate regulation, habitat for biodiversity, wood and non-wood products, energy, and recreation. Simultaneously, forests are increasingly affected by climate change and need to be adapted to future environmental conditions. Current legislation, including the European Union (EU) Biodiversity Strategy, EU Forest Strategy, and national laws, aims to protect forest landscapes, enhance ESs, adapt forests to climate change, and leverage forest products for climate change mitigation and the bioeconomy. However, reconciling all these competing demands poses a tremendous task for policymakers, forest managers, conservation agencies, and other stakeholders, especially given the uncertainty associated with future climate impacts. Here, we used process-based ecosystem modeling and robust multi-criteria optimization to develop forest management portfolios that provide multiple ESs across a wide range of climate scenarios. We included constraints to strictly protect 10% of Europe's land area and to provide stable harvest levels under every climate scenario. The optimization showed only limited options to improve ES provision within these constraints. Consequently, management portfolios suffered from low diversity, which contradicts the goal of multi-functionality and exposes regions to significant risk due to a lack of risk diversification. Additionally, certain regions, especially those in the north, would need to prioritize timber provision to compensate for reduced harvests elsewhere. This conflicts with EU LULUCF targets for increased forest carbon sinks in all member states and prevents an equal distribution of strictly protected areas, introducing a bias as to which forest ecosystems are more protected than others. Thus, coordinated strategies at the European level are imperative to address these challenges effectively. We suggest that the implementation of the EU Biodiversity Strategy, EU Forest Strategy, and targets for forest carbon sinks require complementary measures to alleviate the conflicting demands on forests.

Psychosocial dimensions of vaccine hesitancy: A systematic review.

Despite widely recognised effectiveness against the spread of COVID-19, vaccine hesitancy persists. This systematic literature review aimed to clarify the definition and the operationalisation of the term 'vaccine hesitancy' and disclose the various psychosocial factors underlying this phenomenon. The results of studies conducted in European countries and in the United States after the vaccines became available were taken into account. The review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analyses statement. Twelve studies met the inclusion criteria and were reviewed. efinitions and measures of vaccine hesitancy differed across the studies, limiting their comparison. Nonetheless, by drawing on theoretical frameworks, we were able to identify several psychosocial variables in determining vaccine hesitancy. Our findings point to the need for a transdisciplinary approach to understanding the antecedents of vaccine hesitancy. A better understanding of the phenomenon may help to develop interventions and social policies to address a complex challenge such as vaccination hesitancy.

Gomphonemavancampianum sp. nov. (Gomphonemataceae, Bacillariophyceae), a new large Gomphonema species from Europe.

During a French biomonitoring survey of the lakes in the region Rhône-Méditerranée-Corse, a large, unknown Gomphonema taxon was observed in a lake in the vicinity of the City of Lyon (Département du Rhône, France), that could not be identified using the currently available literature. Detailed light and scanning electron microscopy investigations revealed the presence of two types of valves, one bearing a thick marginal crest and valves lacking the crest. Following comparison with similar, mostly tropical Gomphonema species, the unknown taxon is described as new: Gomphonemavancampianum sp. nov. Discriminating features of the new species include the peculiar valve shape resembling a Chinese spoon, the broad upper valve part with acuminate tip, the presence of shallow depressions in the axial area, distinctly punctate striae and the occasional presence of the marginal crest. The new species was observed in several samples collected in an oligo- to mesotrophic, calcium-carbonate rich lake with a high ecological quality.

Archetypal typology of European forest ecosystems integrating management intensity and naturalness.

The crises of climate change and biodiversity loss have pushed the aim for increasing the resilience of forest ecosystems high on the agenda of foresters and policymakers. At the same time, synergistic opportunities for restoring forests and biodiversity are emerging to safeguard these ecosystems. Naturalness is a key characteristic of forest ecosystems, which should be considered when estimating benchmarks for resilience and biodiversity conservation. The naturalness of forest ecosystems is highly dependent on the intensity of human activity, as different levels of management intensity can change the original traits of forest ecosystems. This paper presents an archetypal typology of forest ecosystems, describing the association between management and naturalness. Both features are represented as gradients covering the full spectrum observed in European forests. The array of forest ecosystem archetypes was verified using case studies across Europe. The typology provides useful information for setting targets for resilience and restoration of forest ecosystems.

Social contact patterns following the COVID-19 pandemic: a snapshot of post-pandemic behaviour from the CoMix study.

The COVID-19 pandemic led to unprecedented changes in behaviour. To estimate if these persisted, a final round of the CoMix social contact survey was conducted in four countries at a time when all societal restrictions had been lifted for several months. We conducted a survey on a nationally representative sample in the UK, Netherlands (NL), Belgium (BE), and Switzerland (CH). Participants were asked about their contacts and behaviours on the previous day. We calculated contact matrices and compared the contact levels to a pre-pandemic baseline to estimate R0. Data collection occurred from 17 November to 7 December 2022. 7477 participants were recruited. Some were asked to undertake the survey on behalf of their children. Only 14.4 % of all participants reported wearing a facemask on the previous day. Self-reported vaccination rates in adults were similar for each country at around 86 %. Trimmed mean recorded contacts were highest in NL with 9.9 (95 % confidence interval [CI] 9.0-10.8) contacts per person per day and lowest in CH at 6.0 (95 % CI 5.4-6.6). Contacts at work were lowest in the UK (1.4 contacts per person per day) and highest in NL at 2.8 contacts per person per day. Other contacts were also lower in the UK at 1.6 per person per day (95 % CI 1.4-1.9) and highest in NL at 3.4 recorded per person per day (95 % CI 43.0-4.0). The next-generation approach suggests that R0 for a close-contact disease would be roughly half pre-pandemic levels in the UK, 80 % in NL and intermediate in the other two countries. The pandemic appears to have resulted in lasting changes in contact patterns expected to have an impact on the epidemiology of many different pathogens. Further post-pandemic surveys are necessary to confirm this finding.

Association between depression and incident dementia: Longitudinal findings from the share study.

BACKGROUND: The association between depression and dementia is still unclear, particularly regarding depression as a potential risk factor preceding dementia. Therefore, we aimed to verify if the presence of depression at baseline may increase the risk of dementia and cognitive impairment during 15 years of follow-up in the SHARE (Survey of Health, Aging and Retirement in Europe) study. METHODS: Depressive symptoms were defined using the EURO-D, with a score ≥4 indicative of depression. Incident dementia was ascertained using self-reported data and caregivers' information, cognitive impairment using objective cognitive tests. Cox regression analysis, adjusted for 10 baseline confounders, was run and hazard ratios (HRs), with their 95% confidence intervals, were estimated. RESULTS: In total 22,789 participants were included in the present analysis (mean age 64.2 years) and were predominantly female. The prevalence of depression at baseline was 24.9%. Over 15 years of follow-up, the onset of dementia occurred a median 2 years earlier in people with depression compared to those without. Depression at the baseline significantly increased the risk of dementia in the overall sample (HR = 1.74; 95% CI: 1.54-1.95) and the risk of cognitive impairment (HR = 1.15; 95% CI: 1.06-1.25). For dementia, the association was stronger in people less than 60 years (HR = 2.07; 95% CI: 1.42-3.02) than in participants aged ≥80 years (HR = 1.47; 95% CI: 1.14-1.91). A similar trend was observed for cognitive impairment. Among the single items of the EURO-D, loss of concentration was the strongest individual variable predicting the onset of dementia. CONCLUSIONS: Depression increased the risk of dementia and cognitive impairment, particularly in younger adults, whereas loss of concentration was the strongest individual predicting variable of dementia. These findings demonstrate the need for early detection of depression for preventing future cognitive worsening.

Vacation in Egypt associated with Shiga toxin-producing Escherichia coli infection in children and adolescents, northern Italy, 2023.

BackgroundHaemolytic uremic syndrome (HUS) is a severe complication of infection with Shiga toxin-producing Escherichia coli (STEC). Although the reservoirs of STEC are known, the source of the infection of sporadic cases is often unknown. In 2023, we observed several cases of bloody diarrhoea with STEC infection in children and adolescents returning from vacations.AimWe aimed to explore the association between travel and bloody diarrhoea with STEC infection in children and adolescents.MethodsWe included all children and adolescents with bloody diarrhoea with STEC infection identified in 2023 by the ItalKid-HUS Network surveillance system in northern Italy. We interviewed children's families and sent a questionnaire on recent travels abroad. The exposure time was between 3 days after arrival abroad and 5 days after return home. A self-controlled case series (SCCS) design was used in the analysis.ResultsOf the 43 cases, 11 developed HUS. Twenty-three cases did not travel abroad, while 20 had travelled to several destinations. The incidence rate ratio (IRR) associated with travel to Egypt was 88.6 (95% confidence interval (CI): 17.0-462). Serotype analysis excluded the possibility of a single strain causing the infections. We did not find the source of the infections.ConclusionThere is an elevated risk of acquiring STEC infection with bloody diarrhoea and HUS associated with travel to Egypt. Specific investigations to identify the source are needed to implement effective preventive measures.

Central and Eastern European Migrants in the United Kingdom: A Scoping Review of the Reasons for Utilisation of Transnational Healthcare.

BACKGROUND: An estimated 2.2 million people from Central and Eastern Europe (CEE) live in the United Kingdom. It has been documented that CEE migrants underutilise health services in the United Kingdom and, as an alternative, seek healthcare in their home country. However, reasons for seeking healthcare abroad are not always clear. This review aims to identify the reasons for the uptake of transnational healthcare among CEE migrants resident in the United Kingdom. METHODS: Informed by discussions with community members, medical stakeholders and academics, a systematic scoping review was undertaken following the nine-stage Joanna Briggs Institute framework for scoping reviews. A search strategy with MeSH terms, where relevant, was used and adapted in five academic databases, two grey literature databases and Google Scholar. Included records encompassed four concepts: migration, CEE nationalities, UK nations and healthcare utilisation, which were written in English and published between May 2004 and 2022. Data from the literature were coded, grouped and organised into themes. RESULTS: A total of 16 publications fulfilled the inclusion criteria. There is evidence that some CEE migrants exclusively use healthcare services in the United Kingdom. However, many CEE migrants utilise healthcare both in the United Kingdom and their country of origin. Four themes were identified from the literature as to why migrants travelled to their country of origin for healthcare: cultural expectations of medical services, distrust in the UK NHS, barriers and transnational ties. CONCLUSION: Push factors led CEE migrants to seek healthcare in their country of origin, facilitated by ongoing transnational ties. CEE migrants frequently combine visits to their country of origin with medical appointments. Utilising healthcare in their country of origin as opposed to the United Kingdom can result in fragmented and incomplete records of medications, medical tests and surgeries and risk of unnecessary treatments and complications. This review highlights the need for more targeted health outreach with CEE groups within the United Kingdom, as well as the need for further research on the impact of national events, for example, COVID-19 and Brexit, on transnational healthcare-seeking behaviours. PATIENT OR PUBLIC CONTRIBUTION: The concept for this scoping review was informed by discussions with community members, medical professionals and academics, who identified it as a current issue. The results of this scoping review were discussed with healthcare stakeholders.

Subjective household poverty as a moderator for the association between employment precariousness and mental health across five european welfare state types.

Objectives: To create better understanding of the mechanisms underlying the association between employment precariousness (EP) and mental health by considering household poverty as a moderator while stratifying for gender across welfare state types (WSTs): Scandinavian, South European, Central- and East European, Bismarckian and Anglo-Saxon. Methods: Data from the sixth wave of the European Working Conditions Survey (N = 18,725) was used. The Employment Precariousness Scale was used to assess EP on a continuous scale. Mental health was measured using the WHO-5 Well-Being Index. A binary variable for subjective household poverty was created. We estimated gender-stratified, multi-level models with a random intercept at country-level for the association between EP and mental health, with an interaction term between EP and subjective household poverty, for each WST separately. Models were adjusted for age, education, having a partner and having children under age 18 in the household. Results: In all WSTs, among men as well as women, we found a negative relation between EP and mental health. Among women, this relation was not moderated by household poverty. Among men in the Anglo-Saxon WST, the negative relation between EP and mental health was stronger among employees that reported household poverty compared to those who did not report household poverty. Conclusions: Evidence of a moderating effect of household poverty on the association between EP and mental health was only found amongst men in the Anglo-Saxon WSTs and the combined full sample. Other factors that might affect the association between EP and mental health should be investigated.

Earliest evidence of human occupations and technological complexity above the 45th North parallel in Western Europe. The site of Lunery-Rosieres la-Terre-des-Sablons (France, 1.1 Ma).

The site of LuneryRosieres la-Terre-des-Sablons (Lunery, Cher, France) comprises early evidence of human occupation in mid-latitudes in Western Europe. It demonstrates hominin presence in the Loire River Basin during the Early Pleistocene at the transition between an interglacial stage and the beginning of the following glacial stage. Three archaeological levels sandwiched and associated with two diamicton levels deposited on the downcutting river floor indicate repeated temporary occupations. Lithic material yields evidence of simple and more complex core technologies on local Jurassic siliceous rocks and Oligocene millstone. Hominins availed of natural stone morphologies to produce flakes with limited preparation. Some cores show centripetal management and a partially prepared striking platform. The mean ESR age of 1175 ka ± 98 ka obtained on fluvial sediments overlying the archaeological levels could correspond to the transition between marine isotopic stages (MIS) 37 and 36, during the normal Cobb Mountain subchron, and in particular at the beginning of MIS 36. The Lunery site shows that hominins were capable of adapting to early glacial environmental conditions and adopting appropriate strategies for settling in mid-latitude zones. These areas cannot be considered as inhospitable at that time as Lunery lies at some distance from the forming ice cap.

Real-World Patients' Diagnosis-to-Treatment Journey with Nontuberculous Mycobacterial Pulmonary Disease: A Cross-Sectional Survey.

INTRODUCTION: The incidence and prevalence of nontuberculous mycobacterial pulmonary disease (NTM-PD) are increasing globally. Approximately 80% of NTM-PD cases in Japan and five countries within Europe (Eur5; France, Germany, Italy, Spain, and the UK) are caused by Mycobacterium avium complex (MAC). This study describes the clinical decision-making process associated with the management of patients with NTM-PD in Japan and the Eur5. METHODS: We analyzed data from a survey conducted between July 2013 and October 2013 among physicians treating patients with NTM-PD in clinical practice to compare the healthcare settings, clinical presentation, and patient management in Japan and the Eur5. RESULTS: Overall, 619 physicians (Japan, 173; Eur5, 446) participated in the survey. Most patients in Japan (85%) and the Eur5 (79%) were diagnosed with MAC-PD. Patients were managed generally in hospital-based outpatient clinics (117/173, 68%) in Japan and research/teaching hospitals affiliated with medical schools (140/446, 31%) in the Eur5. The most common reason for delaying treatment was the patient's symptoms not being considered serious enough for treatment (55/128, 43%) in Japan and awaiting results of antimicrobial susceptibility testing (44/151, 29%) in the Eur5. Culture negativity was less commonly achieved after treatment in patients in Japan versus those in the Eur5 (31% [73/238] vs. 70% [300/426], p < 0.0001). In treatment phases that were either completed or discontinued, the primary goal was symptomatic improvement, followed by achieving culture conversion, in both Japan and the Eur5. Overall, 19% (16/85) of physicians in Japan and 43% (220/511) in the Eur5 were "entirely satisfied" with their patients' treatment outcomes. CONCLUSIONS: Similarities and differences exist in the healthcare settings, clinical presentation, and management of patients with NTM-PD in Japan and the Eur5. Insufficient consideration of culture status by physicians, delayed treatment initiation, and symptom-based cessation emphasize the need for educational efforts on the guideline-based strategies.

Mycobacteria are microorganisms that cause a disease in the lungs known as nontuberculous mycobacterial pulmonary disease (NTM-PD). The number of people with NTM-PD is increasing globally. This study was a survey of doctors who treated people with NTM-PD in Japan and Europe and aimed to understand geographical similarities and differences in the management, treatment, and health of people with NTM-PD. In the survey, treatment for NTM-PD was found to be often delayed or not started. In Japan, this was most commonly because the individual's symptoms were not thought to be serious enough and in Europe because of delays in laboratory testing needed to decide which antibiotic treatment should be used. The most common treatment goal in both Japan and Europe was improvement in the individual's symptoms. Clinical guidelines recommend continuing treatment for at least 12 months after the person with NTM-PD has tested negative for mycobacteria. There were similarities and differences in the healthcare settings, clinical presentation, and management of people with NTM-PD between Japan and Europe. It is important to ensure uniform implementation of the treatment guidelines for NTM-PD in each clinical setting so that people with NTM-PD experience better health outcomes.

Optimizing short-term in-class process evaluation: analyzing the effectiveness of teaching interventions in pharmaceutical education using repeated measures analysis.

BACKGROUND: The assessment of the effectiveness of teaching interventions in enhancing students' understanding of the Pharmaceutical Care Network Europe (PCNE) Classification System is crucial in pharmaceutical education. This is especially true in regions like China, where the integration of the PCNE system into undergraduate teaching is limited, despite its recognized benefits in addressing drug-related problems in clinical pharmacy practice. Therefore, this study aimed to evaluate the effectiveness of teaching interventions in improving students' understanding of the PCNE Classification System in pharmaceutical education. METHODS: Undergraduate pharmacy students participated in a series of sessions focused on the PCNE system, including lectures (t1), case analyses (t2), and practical implementation (t3). The levels of understanding were evaluated using time-course questionnaires. Initially, paired samples t-Tests were used to compare understanding levels between different time points. Subsequently, Repeated Measures Analysis (RMA) was employed. Pearson correlation analysis was conducted to examine the relationship between understanding levels and the usability and likelihood of using the PCNE system, as reported in the questionnaires. RESULTS: The paired samples t-Tests indicated insignificant differences between t2 and t3, suggesting limited improvement following the practical implementation of the PCNE system. However, RMA revealed significant time effects on understanding levels in effective respondents and the focused subgroup without prior experience (random intercept models: all p < 0.001; random slope models: all p < 0.001). These results confirmed the effectiveness of all three teaching interventions. Pearson correlation analysis demonstrated significant positive correlations between understanding levels and the usability and likelihood of using the PCNE system at all examined time points. This finding highlighted the reliability of the understanding levels reported in the questionnaires. The homework scores were used as external calibration standards, providing robust external validation of the questionnaire's validity. CONCLUSION: The implementation of RMA provided robust evidence of the positive impact of time on understanding levels. This affirmed the effectiveness of all teaching interventions in enhancing students' comprehension of the PCNE Classification System. By utilizing RMA, potential errors inherent in common statistical methods, such as t-Tests, were mitigated. This ensured a more comprehensive and accurate assessment of the effectiveness of the teaching interventions.

Being yourself is a defect: analysis of documented rights violations related to sexual orientation, gender identity and HIV in 2022 using the REAct system in six eastern European, Caucasus and Central Asian countries.

INTRODUCTION: Removing legal barriers to HIV services is crucial for the global 2030 goal of ending the HIV and AIDS epidemic, particularly in eastern Europe, the Caucasus and central Asia. Despite state commitments to uphold human rights, gay, bisexual and other men who have sex with men (gbMSM), along with transgender people (TP) still face stigma and discrimination. This article presents an analysis of rights violations based on sexual orientation and gender identity (SOGI) and HIV reported in 2022 across six countries, highlighting features and their links to legislation and law enforcement practices. METHODS: We examined documented cases of rights violations among gbMSM and TP in Armenia, Kazakhstan, Kyrgyzstan, Tajikistan, Uzbekistan and Ukraine in 2022 using the REAct system, a tool for documenting and responding to rights violations against key populations. Initially, we employed directed content analysis based on Yogyakarta Principles to analyse narratives of violations. A codebook was developed through contextual, manifest and latent coding, with themes, categories and codes converted into quantitative variables for statistical analysis. Descriptive statistics were used to identify the characteristics of violations. RESULTS: A total of 456 cases of rights violations related to SOGI and HIV were documented, ranging from 22 cases in Tajikistan to 217 in Ukraine. Most violations concerned gbMSM (76.5%), with one-fifth involving TP, predominantly transgender women. Complex violations with multiple perpetrators or infringements were documented in Armenia and central Asia. Privacy rights were commonly violated, often through outing. Cases of violations of the right to the highest attainable standard of health (13.6%) and protection from medical abuses (2.6%) were also documented. Other rights violations were sporadic, with each country exhibiting distinct patterns of violated rights and types of violations. In Ukraine, the full-scale war in 2022 influenced the nature of documented cases, reflecting the challenges faced by gbMSM and TP. CONCLUSIONS: Monitoring rights violations proved effective for assessing the situation of gbMSM and TP, particularly in the insufficiently studied and diverse eastern Europe, Caucasus and central Asia regions. As rights violations are linked to both legislation and law enforcement practices, comprehensive interventions to minimize structural and interpersonal stigma are essential.

Prevalence of sarcopenia among people living with HIV defined by the revised European working group on sarcopenia in older people.

BACKGROUND: Sarcopenia is a progressive and systemic skeletal muscle disorder associated with an increased risk of hospitalization and adverse effects on survival. This study aims to investigate the prevalence and related risk factors of sarcopenia in people living with HIV using the revised European Working Group on Sarcopenia in Older People (EWGSOP2) definition. METHODS: This cross-sectional study comprising 379 patients with confirmed HIV infection evaluated the appendicular skeletal muscle mass by employing the bioelectrical impedance analysis method. Muscle strength and functional mobility were analyzed using the five-time sit-to-stand test and the timed "Up and Go" test. RESULTS: The prevalence rates of pre-sarcopenia and sarcopenia among people living with HIV were 3.4 % and 2.1 % according to the revised EWGSOP2 definition. Advanced age (Odds Ratio 1.07, p = .03), lower body mass index (Odds Ratio 0.79, p = .012) and CD4+ T-cell count below 500/µl (Odds Ratio 2.22, p = .007) were identified as significant factors associated with sarcopenia. Sarcopenia was also identified as a significant correlate of frailty (p < .001). CONCLUSION: This is the first study examining the prevalence of sarcopenia in people living with HIV according to the revised EWGSOP2 clinical algorithm. Advanced age, lower body mass index and a poor immune status are determined as promoting factors of sarcopenia. Sarcopenia significantly correlates with frailty. Standardized clinical algorithms are essential for reliable sarcopenia diagnosis in people living with HIV in order to promote intervention strategies and to prevent adverse health outcomes.

Fitting consistent knowledge into the planning process: An integrated database on adaptation and mitigation measures in Europe.

Climate action is far from meeting the internationally agreed adaptation and mitigation goals. Even though climate action planning has increased since the Paris Agreement in 2015, the implementation rate of those plans remains low. Climate planning literature claims that accounting for long-term planning and implementation times, accurately estimating costs, identifying synergies and trade-offs between measures, or considering justice and equity issues might increase the quality of climate plans and facilitate the further implementation of climate actions. Also, there is no uniform way of responding to the climate crisis. Existing climate action databases typically focus on a particular type of response, sector, hazard, or type. In parallel, national governments and international initiatives provide tools and guidelines to facilitate the development of climate action plans. However, the primary climate action recording and monitoring initiatives and projects do not share the same framework as those tools, resulting in a lost opportunity to improve climate actions' knowledge transferability. Thus, we reviewed nine existing databases of adaptation and five mitigation databases, comprising a total of 7.130 adaptation actions and 11.409 mitigation actions, and detected a lack of alignment with climate planning practices and claims. Furthermore, we revealed a lack of coherency regarding the level of abstraction of climate actions and their role in the implementation process. Not all climate actions are meant to operate similarly from a planning perspective: while some had a direct outcome on the target indicators, others are thought to facilitate their implementation. Ultimately, we created a new integrated database of adaptation and mitigation measures in Europe, focusing exclusively on climate planning and implementation practices. First, we identified specific and transferable mitigation and adaptation measures and instruments through an originally designed decision tree. Second, we harmonised the collection of climate actions in a unique framework based on one of the biggest climate planning initiatives: the Sustainable and Energy Climate Action Plans by the Covenant of Mayors. Our integrated database of adaptation and mitigation measures (1) classifies and relates the different types of climate actions; (2) provides data that may improve the quality of climate plans and facilitate implementation; (3) allows a better perspective of systematic problems by identifying potential synergies and trade-offs; and (4) defines and characterises measures using a framework that draws on actual practice. The database compiles a total of 191 adaptation measures, 188 mitigation measures, and 97 measures that account for each, and a total of 609 associated instruments. For monitoring their outcomes, 93 Sustainable Development Goals relevant indicators are included.

Negative effects of high public debt on health systems facing pandemic crisis: Lessons from COVID-19 in Europe to prepare for future emergencies.

The investigation goal here was to analyze how the level of public debt affects preparedness of health systems to face emergencies. In particular, this study examined the negative effects of high public debt on health systems of European countries in the presence of the COVID-19 pandemic crisis. Empirical evidence revealed that European countries with a lower level of government debt as a percentage of GDP both in 2009 and 2019 (the period before the arrival of the pandemic) had lower COVID-19 fatality rates compared to countries with higher levels of public debt. The explanation is that high levels of public debt in countries trigger budget constraints that limit their ability to allocate resources to healthcare systems (e.g., health expenditures and investments), weakening health system performance and causing systemic vulnerability and lower preparedness during emergencies, such as with the COVID-19 pandemic. Implications of health policies are suggested to improve strategies of crisis management.

Psychosocial Well-Being Differences Between the Young Old, Old-Old, and Oldest Old: A Global Comparison.

OBJECTIVES: We investigate global differences in psychosocial well-being between older adult age groups. METHODS: Using multinomial logistic regression, we analyzed 2018 data (n = 93,663) from 9 countries/regions in the Health and Retirement Study international family of studies to compare age group differences in depression, loneliness, and happiness. RESULTS: Compared to the young old, the old-old reported more depression in Southern Europe, while the oldest old had higher risk in India and Southern Europe but lower risk in the United States. The old-old reported less loneliness in the United States but more in Southern Europe, while the oldest old had greater risk in Southern Europe. The old-old reported less happiness in Korea, while the oldest old had lower reports in Korea but higher reports in the United States. DISCUSSION: The psychosocial well-being of the oldest old is exceptionally good in the United States but exceptionally poor in Southern Europe.

PM10-bound trace elements in pan-European urban atmosphere.

Although many studies have discussed the impact of Europe's air quality, very limited research focused on the detailed phenomenology of ambient trace elements (TEs) in PM10 in urban atmosphere. This study compiled long-term (2013-2022) measurements of speciation of ambient urban PM10 from 55 sites of 7 countries (Switzerland, Spain, France, Greece, Italy, Portugal, UK), aiming to elucidate the phenomenology of 20 TEs in PM10 in urban Europe. The monitoring sites comprised urban background (UB, n = 26), traffic (TR, n = 10), industrial (IN, n = 5), suburban background (SUB, n = 7), and rural background (RB, n = 7) types. The sampling campaigns were conducted using standardized protocols to ensure data comparability. In each country, PM10 samples were collected over a fixed period using high-volume air samplers. The analysis encompassed the spatio-temporal distribution of TEs, and relationships between TEs at each site. Results indicated an annual average for the sum of 20 TEs of 90 ± 65 ng/m3, with TR and IN sites exhibiting the highest concentrations (130 ± 66 and 131 ± 80 ng/m3, respectively). Seasonal variability in TEs concentrations, influenced by emission sources and meteorology, revealed significant differences (p < 0.05) across all monitoring sites. Estimation of TE concentrations highlighted distinct ratios between non-carcinogenic and carcinogenic metals, with Zn (40 ± 49 ng/m3), Ti (21 ± 29 ng/m3), and Cu (23 ± 35 ng/m3) dominating non-carcinogenic TEs, while Cr (5 ± 7 ng/m3), and Ni (2 ± 6 ng/m3) were prominent among carcinogenic ones. Correlations between TEs across diverse locations and seasons varied, in agreement with differences in emission sources and meteorological conditions. This study provides valuable insights into TEs in pan-European urban atmosphere, contributing to a comprehensive dataset for future environmental protection policies.

Short-Term vs. Long-Term: A Critical Review of Indoor Radon Measurement Techniques.

Radon is a known carcinogen, and the accurate assessment of indoor levels is essential for effective mitigation strategies. While long-term testing provides the most reliable data, short-term testing (STT) offers a quicker and more cost-effective alternative. This review evaluated the accuracy of STT in predicting annual radon averages and compared testing strategies in Europe (where long-term measurements are common) and the United States (where STT is prevalent). Twenty (20) studies were systematically identified through searches in scientific databases and the grey literature, focusing on STT accuracy and radon management. This review revealed several factors that influence the accuracy of STT. Most studies recommended a minimum four-day test for initial screening, but accuracy varied with radon levels. For low levels (<75 Bq/m3), a one-week STT achieved high confidence (>95%) in predicting annual averages. However, accuracy decreased for moderate levels (approximately 50% success rate), necessitating confirmation with longer testing periods (3 months). High radon levels made STT unsuitable due to significant fluctuations. Seasonality also played a role, with winter months providing a more representative picture of annual radon averages. STT was found to be a useful method for screening low-risk areas with low radon concentrations. However, its limitations were evident in moderate- and high-level scenarios. While a minimum of four days was recommended, longer testing periods (3 months or more) were crucial for achieving reliable results, particularly in areas with potential for elevated radon exposure. This review suggests the need for further research to explore the possibility of harmonizing radon testing protocols between Europe and the United States.