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PubMed2004

Health-care system frailties and public health control of communicable disease on the European Union's new eastern border.

In May, 2004, the border of the European Union (EU) will shift eastward such that the new frontier will be made up by Ukraine, Belarus, and a considerably longer Russian border. Here, we discuss three issues: first, the factors that have contributed to the growth of communicable disease in Russia, Ukraine, and Belarus; second, how public health systems have responded to these challenges; and third, the implications for the EU as a whole. Since the break-up of the Soviet Union, Russia, Ukraine, and Belarus have witnessed substantial political, social, and economic changes. These events have been reflected in changes in the epidemiology of communicable diseases, including tuberculosis and HIV (ie, HIV-1). Moreover, public health systems, rooted in Soviet traditions, are struggling to respond effectively to the challenges of resurgent infectious diseases, such as tuberculosis, and newly emergent challenges such as HIV. The changing patterns of communicable diseases east of the EU's new border has implications for how the EU aids the strengthening of public health systems east of the new frontier. Transborder spread of communicable diseases also challenges communicable disease control systems within the EU. Concerted action is needed by member states and the EU, building on models of cooperation between institutions that have been successful in areas beyond health, if public health systems are to meet the emerging challenges to communicable disease control.

Communicable Disease Control↗
PubMed2004

The status of Spain's dental practices following the European Union directive concerning radiological installations.

OBJECTIVES: To assess the influence of new European Union (EU) legislation on dental radiology practices and the reduction in patient radiation exposure. STUDY DESIGN: A total of 7176 official reports from Spanish dental offices or clinics covering the period 1996 to 2001 were analyzed. RESULTS: Of the dental radiological installations inspected in 2001, 72.79% used the kilovoltage recommended by the EU (70 kVp) and 98.85% used at least 1.5 mm Al filtration. At least 90.11% of the installations had a focal film distance of 20 cm although there were no cases with a rectangular collimator as adapted to the size of film. Thirty percent of the installations showed a mechanical fault every year. In 17.62% of cases the radiological film was stored in the exposure room. Few clinics (10.24%) used high-speed films and only 11.95% of clinics employed digital systems. The mean dose received by patients fell during the 5 years studied by 18.75%. Radiological equipment fulfilling the EU specifications emitted significantly lower doses than other nonapproved equipment. CONCLUSIONS: The introduction of legislation has resulted in a gradual improvement in dental radiology practices.

Analysis of Variance↗
PubMed2002

Comparative approaches to pharmaceutical price regulation in the European Union.

AIM: To review pharmaceutical price regulation methods in countries of the European Union (EU), in terms of the anticipated impact of regulation on pharmaceutical expenditures and evidence of actual outcomes. METHOD: An extensive search was performed of medical and economic studies on regulatory interventions specifically targeting pharmaceutical prices in EU countries, published between January 1990 and April 2002. Both peer-reviewed and "gray" literature were systematically reviewed. RESULTS: Four principle approaches to pharmaceutical price regulation with some methodological differences were identified in EU countries, as follows: fixed pricing, cost-effectiveness pricing, profit controls, and reference pricing. Actual evidence of the impact of price regulation was limited in many of these countries. Cross-country comparisons suggested that limiting the rise of pharmaceutical prices did not equate to controlling the rise of pharmaceutical expenditures because of the volume effect of utilization. CONCLUSIONS: Supply-side regulation without the simultaneous use of demand-side incentives and volume controls does little to control the rise in pharmaceutical expenditures. The types of needed demand-side controls depend on the context of the individual country, on political priorities, and on the type of supply-side regulation in place.

Cost Control↗
PubMed2001

A challenge of veterinary public health in the European Union: human trichinellosis due to horse meat consumption.

Human trichinellosis in the European Union due to insufficiently cooked horse meat consumption has been reported in France and in Italy during the past 25 years. It occurred in several outbreaks totalling more than 3,000 patients during this period, with a low mortality and a high morbidity. Causative Trichinella species or phenotypes were determined by the International Reference Laboratory for Trichinellosis in Rome, Italy. They were: Trichinella spiralis, T. britovi and T. murelli. As the culinary habits and customs of populations cannot be changed by regulations, measures of protection of public health essentially depend on food inspection. Comprehensive studies having been conducted in the pathophysiology of Trichinella infection in horses; it was demonstrated that the localisation of larvae are quite different in horses and in pork. It resulted an instruction from the French Veterinary, Service recommending that: the sampling of muscles in horses carcasses has to be done at first in the tongue (apex), then in the diaphragm (pillars); at least 50 g have to be sampled in each site; examination for larvae has to be done with the digestion method. Such recommendations might be extended to other EU member countries then to the OIE Zoo-Sanitary Code.

Animal Husbandry↗
PubMed2003

The risk of the introduction of classical swine fever virus at regional level in the European Union: a conceptual framework.

Recent classical swine fever (CSF) epidemics in the European Union (EU) have clearly shown that preventing the introduction of CSF virus (CSFV) deserves high priority. Insight into all the factors contributing to the risk of CSFV introduction is a prerequisite for deciding which preventive actions are cost-effective. The relations between virus introduction and spread, prevention and control, and economic losses have been described using the conceptual framework presented in this paper. A pathway diagram provides insight into all the pathways contributing to the likelihood of CSFV introduction (LVI_CSF) into regions of the EU. A qualitative assessment based on this pathway diagram shows that regions with high pig densities generally have a higher LVI_CSF, although this cannot be attributed to pig density only. The pathway diagram was also used to qualitatively assess the reduction in LVI_CSF achieved by restructuring the pig production sector. Especially integrated chains of industrialised pig farming reduce the LVI_CSF considerably, but are also difficult and costly to implement. Quantitative assessment of the LVI_CSF on the basis of the pathway diagram is needed to support the results of the qualitative assessments described.

Animal Husbandry↗
PubMed2005

The number of consultant clinical chemists in the 15-nation European Union.

The number of consultant clinical chemists (NCCC) in the 15-nation European Union (EU) (Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, The Netherlands, Portugal, Spain, Sweden, United Kingdom) has been ascertained. These data were analysed in relation to several established national parameters, including demographics, gross domestic product (GDP), cost of healthcare, cost of in vitro diagnostic (IVD) testing and the number of physicians and pharmacists. Large differences in the population-corrected costs of IVD testing (range approximately 2.4-fold) and NCCC (range approximately 30-fold) were observed between the countries, which could not be satisfactorily explained by any of the parameters assessed. The differences in IVD testing and NCCC might reflect different practices in laboratory medicine across the EU, but could not be estimated independently. In recognition of the different scope of laboratory medicine practised under the title of clinical chemistry, a simple staffing model was derived in an attempt to give a better estimate of the appropriate number of consultant laboratory medicine specialists. This model allocated a fixed number of laboratory specialists per million inhabitants for the five disciplines: clinical chemistry, 10; haematology, 10; serology, 7.5; microbiology, 12.5; and blood banking, 2. The staffing model also allowed for the contribution of the primary care sector by including one full-time consultant laboratory medicine specialist for each small private laboratory and two extra consultant laboratory specialists per million inhabitants where there are not large numbers of private laboratories. Application of the model to the available data helped to reduce the variation observed in the primary analysis of NCCC (range approximately 9-fold) but still revealed important differences between countries. These differences could arise from the poor quality of published data as much as from true differences in laboratory medicine practice. We conclude that a more sophisticated analysis of laboratory practice and of all professionals working in laboratory medicine disciplines would be required before any conclusions could be drawn about relative staffing, efficiency or cost effectiveness. The staffing model derived is a first step towards objective estimation of the number of consultant laboratory specialists in the EU.

Chemistry, Clinical↗
PubMed2001

A bibliometric evaluation of European Union research of the respiratory system from 1987-1998.

This study analyses the evolution of the bibliometric indicators of productivity and repercussion of European Union (EU) research into the respiratory system during the period from 1987-1998, describing the geographical distribution. Using MedLine, a selection was made of those articles by EU authors published between 1987-1998 in 38 respiratory system journals (classification from the Institute for Scientific Information). The journals, country of origin, number of articles and the relation to socioeconomic data, productivity index, visibility index, expected impact factor (EIF) and relative impact factor (RIF) were all analysed. The number of EU publications in respiratory system journals experienced an exponential increase, going from 606 articles (14.3% of world production) in 1987, to 2,325 (33.2%) in 1998. During this same period, the EIF increased from 1,258 to 2,111. The greatest gross productivities were those of the UK, France, Italy and Germany, although when corrected for number of inhabitants, Sweden, the Netherlands, Belgium and Denmark headed the list. The countries with the greatest mean EIF were the Netherlands, the UK, Spain and Belgium. In conclusion, productivity and repercussions of European Union research of the respiratory system experienced an important increase during this period.

Authorship↗
PubMed2004

Validation of a confirmatory method for the determination of sulphonamides in muscle according to the European Union regulation 2002/657/EC.

A simple multiresidue method is described for assaying 10 sulphonamides (SAs) (sulfadiazine, sulfathiazole, sulfapyridine, sulfamerazine, sulfamethazine, sulfamonomethoxine, sulfachlorpyridazine, sulfamethoxazole, sulfaquinoxaline and sulfadimethoxine) in muscle samples. Samples were prepared by homogenizing the tissue, extracting with ethyl acetate and cleaning up with a cation-exchange solid-phase extraction (SPE) column. The detection of analytes was achieved by HPLC-diode array detection (DAD) at 270 nm. The procedure was validated according to the European Union regulation 2002/657/EC determining specificity, decision limit, detection capability, trueness and precision. The results of validation process demonstrate that the method is suitable for application in European Union statutory veterinary drug residue surveillance programmes.

Animals↗
PubMed2001

Challenges in harmonising controls on the radioactivity of building materials within the European Union.

Possibilities for harmonising controls on the radioactivity of building materials within the European Union are being discussed in a Working Party on Natural Radiation Sources established by the Article 31 Group of Experts (Euratom Treaty). The Working Party is preparing a document to aid the Article 31 Expert Group and the European Commission in considering possible recommendations and technical guidance to the Member States for the implementation of the new Basic Safety Standards Directive concerning the radioactivity of building materials. The discussions in the working party have demonstrated several challenges in the possible harmonisation of controls, many of them arising from some significant differences in national circumstances.

Air Pollutants, Radioactive↗
PubMed2006

Acceptability of domestic violence against women in the European Union: a multilevel analysis.

STUDY OBJECTIVE: The acceptability of domestic violence against women (DVAW) plays an important part in shaping the social environment in which the victims are embedded, which in turn may contribute either to perpetuate or to reduce the levels of DVAW in our societies. This study analyses correlates of the acceptability of DVAW in the European Union (EU). DESIGN: Three level ordinal logistic regression of 13 457 people nested within 212 localities (cities), nested within 15 countries of the EU. Sampling is multistage with random probability. All interviews were face to face in people's homes. The outcome variable was acceptability of DVAW. Multiple correlates at the individual, locality, and country level were analysed. SETTING: European Union, 1999. PARTICIPANTS: National data were used of residents 15 years old and above of all member states in 1999 (n = 13 457). Average response rate was 47%, although it varied across countries (23%-73%). MAIN RESULTS: Higher levels of acceptability were reported by those who perceived DVAW as less severe and less frequent. Acceptability is higher among men who know a perpetrator and lower among men who know a victim. Victim blaming attitude is associated with higher levels of acceptability. In countries with higher gender empowerment measure the difference in acceptability among those who blame and those who do not blame the victim is greater. CONCLUSIONS: There are still widespread attitudes in the EU such as victim blaming that condone DVAW, contributing to a climate of social acceptability of DVAW. Further efforts to reduce the acceptability of DVAW are still needed.

Adolescent↗
PubMed1998

Household scenarios for the European Union.

"This article reports on three Household Scenarios for the countries of the European Union.... These scenarios predict the numbers of persons living alone, living with a partner, living as a child at the parental home and living in another household position, as well as the institutional population. The period covered is 1995-2025. In all three scenarios, the number of persons living alone will grow.... The total number of households increases in all scenarios, whereas the average household size will decline in all scenarios."

Demography↗
PubMed2005

The European Union of Medical Specialties core training curriculum in infectious diseases: overview of national systems and distribution of specialists.

The European Union of Medical Specialities (UEMS) Section of Infectious Diseases agreed on an infectious disease training programme in 1999, which was updated in 2002. Although the provision of infection services throughout Europe is not uniform, with variation in the roles of infectious disease physicians and microbiologists, there are, nonetheless, physicians with a predominant responsibility for clinical infectious diseases (and tropical medicine) in most countries. However, infectious diseases is formally recognised as a specific discipline by most, but not yet all, European countries. There has been consensus from national representatives to the UEMS on the content of the published curriculum. There are clear areas of overlap in training between different infection disciplines, and exploration of possible areas for closer liaison and collaboration between them has been initiated. The increased movement of medical staff within Europe will place greater demands on those responsible for training, monitoring and quality assurance. The Board and Section of Infectious Diseases have established core training programmes with a generic logbook to assist those countries without a written curriculum or record book and facilitate the development of common standards of training. The duration of training varies across Europe; 4 years is the UEMS standard, or longer if the training is combined with general internal medicine. The numbers of infection specialists (infectious diseases and microbiology) per million population show considerable variation. The UEMS Sections have recognised the importance of working closely with European specialist societies involved with training. The Section for Infectious Diseases has, in partnership with the ESCMID, established a Board for the accreditation of continuing medical education/continuing professional development.

Communicable Disease Control↗
PubMed1997

When can the European Union restrict trade on grounds of public health?

The reaction in Britain to the European Union ban on the world-wide export of British beef has highlighted a lack of awareness of the role of European law in restricting trade on grounds of public health. This paper seeks to bring the legal arguments underlying such action to a wider public health audience by exploring the basis for such action in general and for the ban on British beef in particular. In European law, the obstruction of intra-community trade on grounds of public health is extremely limited although, in the case of British beef, there seems little doubt that it is lawful. In contrast, the stated basis for the ban to other countries is more questionable, although it may be acceptable to the European Court because of the objectives it seeks to achieve.

Animals↗
PubMed2006

Burden of rotavirus disease in European Union countries.

Two new rotavirus vaccines are expected to be introduced in the European Union (EU) in coming years. A human rotavirus vaccine has already been licensed in several countries worldwide, and a pentavalent bovine vaccine has been submitted for licensure in the United States and the EU. Few data exist on the burden of rotavirus disease and its associated costs within the EU. To estimate the burden of rotavirus disease in the EU, we adapted a model based on the approach developed by the Centers for Disease Control and Prevention to the European situation and applied it to recent population and mortality data from European countries. Country-specific estimates were added to obtain a global estimate of rotavirus episodes treated at home, clinic visits, hospitalization and death. We estimate that 3.6 million episodes of rotavirus disease occur annually among the 23.6 million children younger than 5 years of age in the EU. Every year, rotavirus accounts for 231 deaths, >87,000 hospitalizations and almost 700,000 outpatient visits. Rotavirus disease constitutes a large public health burden in the EU. Except for deaths, the burden of disease is not dissimilar to that in the developing world. Country-specific studies are required to more accurately understand the burden of disease caused by rotavirus. With the introduction of new rotavirus vaccines in sight, rotavirus gastroenteritis may be regarded as the single most frequent vaccine-preventable disease among children in the EU.

Child, Preschool↗
PubMed1995

Towards European Union standards in hospital infection control.

Some providers of health care within the European Union (EU)--whether public or private--seem to give little priority to the establishment of quality control and common standards for infection control. Though uniform practice of infection control in hospitals was recommended by The Council of Europe no formal declaration about conformity or quality assessment of this important area seems to have been actively promoted within the EU. This is the setting against which local, and even international infection control protocols are promoted and discussed mainly by dedicated individuals and within informal groups, which may be endorsed by professional societies. So far no definite attempt to formulate European coordination has been recognized apart from initiatives taken by the World Health Organization (WHO) regional office for Europe. We may have a long way to go towards EU standards for infection control even though the benefits of European cooperation in the field of infection control have been recognized, and there are still serious doubts within the medical profession as to the feasibility of harmonization of these activities. EU standards in hospital infection control should be based on the best documented evidence and set at an appropriate level allowing wide participation. The medical profession must be involved and the inclusion of indicators of outcome must be considered.

Accreditation↗
PubMed2006

Establishing the health and economic impact of influenza vaccination within the European Union 25 countries.

BACKGROUND: In 2003, the World Health Assembly (WHA) issued a resolution for prevention and control of influenza pandemics and annual epidemics, which urges the European Union 25 (EU-25) Member States to (1) establish and implement strategies to increase vaccination coverage of all people at high risk, including the elderly and people with underlying disease, with the goal of attaining vaccination coverage of the elderly population of at least 50% by 2006 and 75% by 2010; (2) to assess the disease burden and economic impact of annual influenza epidemics as a basis for framing and implementing influenza prevention policies. This resolution was reinforced by the European Union (EU), where Member States agreed to make additional efforts to improve uptake on their territory in accordance with their own recommendations and to achieve the World Health Organisation (WHO) target of 75% in high risk groups before 2010. It was also noted that the changing demographic profile of the EU population would result in an increasing number of elderly people falling within the current target groups. OBJECTIVES: To establish the number of people who may be eligible for influenza vaccination in the EU, and estimate the costs and consequences of not vaccinating this population for five EU Member States, France, Germany, Italy, Spain, and the UK. METHODS: A mathematical model has previously been developed, in which vaccine distribution data are combined with demographic and health economics data to model the public health consequences of influenza and possible intervention strategies. We have extended that model using specific EU-25 demographic data on populations at risk of influenza during the inter-pandemic period. For each country, the total population and age breakdown was calculated to estimate the percentage of the population that falls under the WHA recommendations. Other target groups for influenza vaccination were identified by analysing estimating the proportion of the population with respiratory or cardiovascular related diseases, diabetes, AIDS or transplantation, as well as health care professionals. Target population size and possible vaccination coverage rates across the EU-25 Member States, along with the potential cost and health consequence impact is estimated. RESULTS: For the EU-25, it was estimated that up to 49.1% of the population (or 223.4 million people) should be vaccinated against influenza. This ranged from 41.6% in Cyprus to 56.4% in the UK. There were, on average, 174 vaccine doses distributed per 1000 population within the EU-25, which leads to an average vaccination rate of the target population of 35.4% based on current supply constraints. As a consequence, up to 144.4 million people who could be considered "at risk" may not currently be vaccinated. Implementing a 100% vaccination rate programme for all risk groups across the EU-25 would lead to an estimated reduction of number of influenza cases of 7.22 million, 1.96 million reduced PCP visits for influenza treatment, 796,743 less hospital admissions and 68,537 fewer influenza related deaths for all EU-25 countries. The implementation of a 100% vaccination rate programme for all risk groups in France, Germany, Italy, Spain and UK would require an additional 1.52 billion Euro. This would result in estimated savings of 39.45 million Euro of reduced primary care visits and further savings of 1.59 billion Euro in reduced hospitalisations respectively in these countries. CONCLUSIONS: There is a gap between current vaccination coverage and the EU recommendations. The public health consequences of low vaccination coverage include increased morbidity, hospitalisations and mortality associated with influenza-related complications. This model is a powerful tool to: (1) support EU public health officials in implementing recommendations; (2) to visualize the need for increased vaccination rates for better influenza control; (3) the consequences of low vaccine coverage.

Adolescent↗
PubMed2004

Food safety and functional foods in the European Union: obesity as a paradigmatic example for novel food development.

Since 1997, the European Union has undergone deep changes in the scientific assessment of food-related problems. Among the immediate challenges in the near future are the scientific and technological developments and regulatory measures for the so-called "functional foods," which can positively affect the health and well- being of consumers. Obesity, whose genetic and molecular basis are increasingly understood, is now foreseen as one of the key targets for novel functional foods developments, and offers a paradigmatic example of the complexity of a biological system as a target to be controlled.

Consumer Product Safety↗
PubMed1999

Factors that may influence recruitment into academic obstetrics and gynaecology in European Union countries.

Factors that may influence recruitment into academic obstetrics and gynaecology in European Union countries were studied by a questionnaire method. The survey attracted responses from 15 professors and nine clinical obstetricians and gynaecologists. The majority considered a clinical academic to be one who worked in public hospitals. Although 15 of 16 respondents did not think that the academics had a high status in society, 75% felt that young obstetricians and gynaecologists wished to pursue an academic career. Despite the fact that there was a reasonable prospect of promotion and reasonable salary many did not pursue academic medicine because of several factors. They were no governmental support, relatively lower pay compared with clinical colleagues, long hours of work, much severe competition because of few posts and poor condition of work.

Career Mobility↗