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PubMed1991

The unification of European optometry: how the profession will change after 1992.

The economic integration of the European Community (EC) targeted for 1992 has the potential to change the course of the development of the optometric profession in Europe. One of the goals of this integration is to create within Europe an environment free of professional barriers, such that European professionals will be able to practice their skill anywhere within the Community. Because optometry is practiced so differently among the 12 EC countries, the development of a system of reciprocity for optometric credentials in Europe will be a difficult task. Currently, there exists a strong movement, headed by the Association of European Schools and Colleges of Optometry (AESCO), to unify the profession by creating a European-wide examination for optometry. The implications of such an examination are tremendous in that it will establish a standard for the delivery of optometric care not only for the 320 million people within the EC, but also world-wide. The purpose of this paper is to examine the current status of optometry in Europe, to review efforts by both the EC and AESCO to unify the profession, and to discuss the impact of recent developments on the future of optometry not only in Europe, but throughout the world.

Certification↗
PubMed1997

An international questionnaire to explore neurotoxic symptoms.

EURONEST (European Neurotoxic Solvents Toxicity) is a concerted action within the European Communities to use standardized methods available in all countries. The product of this effort is a new symptom questionnaire, EUROQUEST (European Questionnaire). The original version was developed in English. To obtain transcultural reliability, the translation of questionnaires into other languages must be validated. We adopted a procedure with translation, back translation, and agreement between translators. Ten other European countries also followed the same translation procedure for EUROQUEST.

Hazardous Substances↗
PubMed2005

Orlistat for the treatment of obesity: cost utility model.

This study aimed to assess the cost utility of orlistat treatment based on (i) criteria from recent guidance from the National Institute for Clinical Excellence (NICE) for England and Wales (treatment discontinued if weight loss < 5% at 3 months; and < 10% at 6 months); and (ii) alternative criteria from the European Agency for the Evaluation of Medicinal Products (EMEA) licence for orlistat prescription in the European Community (treatment discontinued if weight loss < 5% at 3 months). Subjects were 1398 obese individuals who participated in three large European Phase III trials of orlistat treatment for adults (BMI: 28-47 kg m(-2)). Measures were: response to treatment in orlistat and placebo treatment groups; health benefit expressed as quality adjusted life years (QALYs) gained associated with weight loss; costs associated with orlistat treatment. In the cost utility model with multiway sensitivity analysis, the cost/QALY gained using the NICE criteria was estimated to be 24,431 pounds (sensitivity analysis range: 10,856 to 77,197 pounds). The cost/QALY gained using the alternative EMEA criteria was estimated to be 19,005 pounds (range: 8,840 to 57,798 pounds). In conclusion, NICE guidance for the continued use of orlistat was supported in this updated cost utility model, comparing favourably with a previously published estimate of 45,881 pounds per QALY gained. Moreover, the value for money of orlistat treatment is improved further if EMEA treatment criteria for continued orlistat treatment are applied. The EMEA criteria should be considered in any future changes to the NICE guidance or in guidance issued by similar agencies.

Anti-Obesity Agents↗
PubMedDate not supplied

A generic methodology for health care data security.

The aim is to outline the framework of a generic methodology for specifying countermeasures in health care environments. The method is specifically aimed at the enhancement of security in existing health care systems, and a key element is the use of predetermined 'profiles' by which these may be classified. Example scenarios are presented to illustrate how the concept could be applied in practice. The paper is based upon work that was initially carried out as part of the Commission of European Communities SEISMED (Secure Environment for Information Systems in MEDicine) project, the aim of which is to provide security recommendations for European health care establishments (HCEs).

Computer Security↗
PubMed2001

Public-health psychiatry in today's Europe: scope and limitations.

BACKGROUND: Public-health psychiatry is concerned, on the one hand, to ensure access to mental health services for all persons in need and, on the other hand, to advance knowledge of the social and environmental risk factors of mental disorders, and to establish a basis for preventive action. It is unclear how far current European Community (EC) policies will serve to achieve these objectives. This study aimed to review the mental health reform policies adopted in European countries since 1970, and to identify the main factors impeding progress in practice and research. METHOD: The relevant publications and statistical documentation for EC countries over the period in question were analysed. RESULTS: Despite a broad consensus on principles and aims, the implementation of mental health reforms in EC countries has been slow. Progress is subject to constraints imposed by service infrastructures, reductions in state responsibility, changing public attitudes, and growth of relative poverty. Much inferential evidence has accumulated on the importance of social risk factors such as unemployment and socio-economic deprivation, but most studies have had to rely on analysis of ecological correlations, based on administrative data, and there is an urgent need for more direct research making use of case- control and cohort study designs. CONCLUSIONS: EC harmonization will lead to improved mental health care only if the basic principles of public-health psychiatry are adopted and put into practice.

Community Psychiatry↗
PubMed1995

Factors affecting public attitudes towards mental health care.

This study presents a telephone survey of 501 randomly sampled residents of the Grand Duchy of Luxembourg older than 15 years of age. The interviewees were questioned on their attitudes and judgements towards mental health care in Luxembourg. The implementation of a community-based mental-health-services delivery system in Luxembourg is in its initial stages. Being the smallest member of the European Community Luxembourg offers the opportunity to analyze a whole catchment area in transition marked off clearly by national borders. As a general rule the people of Luxembourg are undecided when it comes to mental health care. Almost half of the sample answered "don't know" when asked about the quality of several sectors of mental health care, excluding inpatient care. The factors that had a significant influence on the attitude of the people of Luxembourg regarding mental health care were nationality, age, class and personal contact with mentally ill persons, with a tendency of worse judgements in younger age groups and in members of upper social classes. We fitted multivariate models including these variables. The results of our study point to entrenched prejudice. The findings suggest, however, that attitudes are changeable by direct or indirect contact with mentally ill persons. Possible strategies that could change public attitudes towards mental health care in a mental health care system that is in transition are discussed.

Adolescent↗
PubMed2000

European priorities for research to support legislation in the area of food contact materials and articles.

A strong science base is required to underpin the planning and decision-making process involved in determining future European community legislation on materials and articles in contact with food. Significant progress has been made in the past 5 years in European funded work in this area, with many developments contributing to a much better understanding of the migration process, and better and simpler approaches to food control. In this paper this progress is reviewed against previously identified work-areas (identified in 1994) and conclusions are reached about future requirements for R&D to support legislation on food contact materials and articles over the next 5 or so years.

Decision Making↗
PubMed1987

[Technical ambulatory ECG innovations in performance evaluation].

Evaluating the performances of the instrumentation for Ambulatory ECG (AECG) analysis is a need largely recognized by both manufacturers and users. The most generally accepted method is the beat-by-beat comparison with annotated data bases, representing the different ECG abnormalities. Available data bases are aimed at arrhythmias detection evaluation, while it is recognized that the AECG ST-T changes detection has a great relevance in the analysis of ischemic heart disease. A concerted action of the European Community on Ambulatory Monitoring has been approved for achieving a comprehensive reference standard for assessing the quality of AECG instrumentation. The European project has been concentrated on the problem of ST-T analysis. An annotated data base is being developed with the contribution of european experts. A pilot study has been performed for establishing the criteria related to the development and annotation; particularly the definition of significant ST-T changes has been established. The data base will include 2-hour double channel AECG records, which contain at least one ST-T episode. Each record is annotated beat by beat according to the established scheme, identifying arrhythmic beats, rhythm changes, ST-T changes and noisy segments. A coordinating center has been established for interacting with the participating groups and for performing the operations related to the generation and management of the data base. For the time being 14 Groups of 8 Countries are participating to the annotation of the data base. A minimum number of 100 records is planned within June 1988.

Algorithms↗
PubMedDate not supplied

Migration from food contact plastics. Part I. Establishment and aims of the PIRA project.

In the European Community regulatory approaches adopted by individual Member States to the control of food contact plastics differ markedly and, as a result, the European Commission has identified a need for harmonized legislation in this sector. The Commission requested its Scientific Committee for Food to advise on the toxicity of monomers and other starting substances used in the production of such plastics and the Committee's report has recently been published. It is apparent that, although some monomers have been studied in depth, for many little or no information was available to the Committee on either the levels migrating into food or their likely toxic effects. The Committee has requested that such information be provided within 3 years. Following discussions between the UK Ministry of Agriculture, Fisheries and Food, PIRA and companies involved in either the manufacture or use of food contact plastics, a Project has been established at PIRA to develop sensitive analytical procedures for the relevant UK-required monomers and to provide the required migration data. As a second part to this project the methodology for determining overall migration is being examined with a view to resolving existing experimental difficulties. The first analytical methods to be developed in the project are those for the determination or terephthalic acid and isophthalic acid. Residual levels of these monomers in plastics and the quantities migrating into food simulants and food have been shown to be very low.

Food↗
PubMed2000

Post-exposure prophylaxis after occupational and non-occupational exposures to HIV: an overview of the policies implemented in 27 European countries.

The aim of this survey, which was part of an English-French project supported by the Commission of the European Communities, was to compare access to HIV post-exposure prophylaxis (PEP) in the occupational and non-occupational contexts in 27 European countries. A protocol was designed in May 1998 in collaboration with all country consultants. Data were collected at country level by each consultant through interviews, review of local and national recommendations and results of national or local surveys. The final comparative analysis was carried out from the individual country reports and a review of the literature. The large majority of European countries have detailed procedures regarding occupational PEP: 20/27 have produced national guidelines, three have adopted the US CDC recommendations and only four have no official recommendations. Although no standard protocol exists, the more common one is a four-week implementation of a triple combination therapy. In the context of non-occupational exposure to HIV, only five countries have guidelines with specific recommendations and one country has adopted the CDC recommendations. In the majority of cases (13 countries), PEP is never recommended but is only available in a few circumstances, sometimes with major limitations. In the last eight countries, such PEP is not currently available. Although the estimations of HIV transmission risks in occupational and non-occupational contexts are really comparables, easy access to PEP after accidental sexual or blood exposures is not guaranteed for the general population in the majority of European countries.

Anti-HIV Agents↗
PubMed1975

The use of clinical gestational age assessment in the construction of standards for birthweight in a rural nigerian community.

The management of low birthweight infants in the developing world is complicated by the lack of criteria for distinguishing between preterm and small gestational age newborns. Clinical gestational age assessment has been applied to 850 normal singleton neonates in a rural Nigerian community. The technique used was sufficiently accurate to enable centile curves for birthweight and gestational age to be constructed. Comparison with a European community showed that in the African babies weight gain was reduced in late pregnancy and had ceased by 40 weeks gestation but that the median birthweight was less at each week of gestation studied. The preparation and use of such reference curves for birthweight and gestational age for the study of the reasons for these differences is discussed.

Birth Weight↗
PubMed1992

Bioethics as a new human rights emphasis in European research policy.

Although issues of morals and ethics remain largely a national matter, the European Community (EC) and the Council of Europe have taken an increasing interest in identifying and harmonizing the often conflicting policies of the European countries on bioethical matters. This article examines the role these organizations are playing and identifies some of the initiatives that have been taken in specific areas.

Abortion, Induced↗
PubMed1995

Vision screening of preschool children in Italy.

Vision screening of preschool children is designed and performed to identify those affected by amblyopia or related, predisposing visual defects. In order to determine the prevalence of preschool vision screening in Italy, a questionnaire was mailed to the 635 regional health offices in which the country's national health system was organized at the time of the study. Results of this survey demonstrated that in 61.3% of the regions which responded, some form of preschool vision screening is performed. However, individual, non-standardized methods are used by the physicians or health care professionals responsible in each regional program. It is evident from this study that standardized procedures for preschool vision testing are lacking in Italy, and that the existing European Community guidelines should be disseminated and applied on a greater scale for the development of such a program on the national and European level.

Amblyopia↗
PubMed1998

Effect of the method of administration, mail or telephone, on the validity and reliability of a respiratory health questionnaire. The Spanish Centers of the European Asthma Study.

The European Community Respiratory Health Survey (ECRHS), a multinational survey, assesses and compares the prevalence of asthma among subjects, aged 20 to 44, in several European areas. In Spain, some participating centers have used mail and telephone as methods of questionnaire administration. The objective of the present study was to determine whether the validity and reliability of the questionnaire differed by method of administration. Reliability of the questionnaire was measured with the kappa index and the odds ratio of agreement, and validity with the sensitivity and specificity. This study found differences in the reliability of the questionnaires although these differences were more related to the questions themselves than to the method of administration. Among men, but not women, mailed questionnaires were more sensitive and telephone questionnaires more specific. We hypothesize that these differences in validity were due to the self-selection to more severe symptomatic subjects replying earlier and therefore to the mailed questionnaire. Combining different methods of administration was useful as it increased participation and was an adequate procedure to obtain information of good quality.

Adult↗
PubMed2004

Evaluation of specific occupational asthma risks in a community-based study with special reference to single and multiple exposures.

OBJECTIVES: To compare two job exposure matrices (JEMs) for the evaluation of asthma risks related to specific occupational exposures in a community-based study. METHODS: A questionnaire on self-reported asthma, respiratory symptoms and current occupation was sent to the participants of the European Community Respiratory Health Survey in five areas in Spain. Both an asthma-specific JEM, including expert judgment steps and a general JEM, were applied to occupational codes. Risks of current asthma symptoms and wheeze in the last year associated with the obtained exposure estimates were evaluated. Correlations between specific exposures were investigated using explanatory factor analysis. RESULTS: Occupational exposures to the high-molecular-weight (MW) agents flour dust, enzymes, mites and animal-derived proteins as obtained by the asthma-specific JEM were positively associated with asthma outcomes. The effect of additional expert judgment steps was limited. High exposures to biological dust assessed by the general JEM without expert judgment was also associated with asthma. Many of the exposed individuals worked in environments with multiple exposures. CONCLUSIONS: Asthma risks associated with occupational exposures to specific high-MW agents could be identified from a population-based study using an asthma-specific JEM. Application of JEMs can be a useful tool to estimate asthma risks attributable to specific occupational exposures in the general population. However, these specific exposure risks should be interpreted in connection with the whole of concomitant exposures constituting the work environment.

Adult↗
PubMed2001

The demographic situation in the European Union.

This article draws selected material from the annual Yearbook on Demography (2000 edition) published by Eurostat, the Statistical Office of the European Communities. Some key comparisons with other regions of the world are included, together with a broad picture of the demographic situation in the European Union. Topic coverage is selective.

Adolescent↗
PubMed2001

The ethics of biotechnology.

Ethical considerations pertaining to biotechnology have progressively been introduced into European community law, especially with regard to research, the environment, patents, animal welfare and medicine. This article addresses the ethics of biotechnology at the European Union (EU) level. It provides insight into the European Group of Ethics and describes how European ethical values concerning science and technology are defined by law and intimately connected to Europe's cultural and political identity. In addition, this article highlights the critical need for an independent and permanent international body to spearhead discussion and collaboration so that views between the different cultures of the world can be exchanged, and, to assure access to experts whose legitimacy and accountability are universally recognized.

Advisory Committees↗
PubMed1993

European research efforts in medical knowledge-based systems.

This article describes the major projects going on in Europe in the field of Artificial Intelligence in Medicine. The important role of the Commission of the European Communities in providing the needed resources is stressed throughout the paper. Particular attention is given to the methodological and technological issues addressed by the European research teams, since the results which these teams accomplish are fundamental for a more extensive diffusion of knowledge-based systems in real medical settings. The variety of medical problems tackled shows that there is no field of medicine where the potential of advanced informatics technologies has not yet been assessed.

Artificial Intelligence↗