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Aim: To report the results of a mapping exercise by the European Federation of Nurses on current advanced practice nursing frameworks and developments across Europe. Design: Online, cross‐sectional, questionnaire study. Methods: An online questionnaire was distributed among 35 national nurses' associations across Europe in March 2021. The questionnaire solicited input on 60 items concerning key features of advanced practice nursing, intending to map existing developments and better understand the current state of advanced practice nursing in Europe. Data analysis used descriptive statistics, including counts and percentages, tabulation; open‐text responses were handled with thematic synthesis techniques. Results: The definition, sense‐making and operationalization of advanced practice nursing vary across Europe. Important variations were noted in the definition and requirements of advanced practice nursing, resulting in different views on the competencies and scope of practice associated with this role. Importantly, the level of education and training required to qualify and practice as an advanced practice nurse varies across European countries. Furthermore, only 11 countries reported the existence of a national legislation establishing minimum educational requirements. Conclusion: Significant variation exists in how countries define advanced practice nursing and how it is regulated at academic and practice levels. More research is needed to clarify whether this variation results from designing models of advanced practice nursing that work in different contexts; and what impact a standardized regulatory framework could have to grow the volume of advanced practice nurses across Europe. Impact: The current paper exposes the lack of clarity on the development and implementation of advanced practice nursing across Europe. We found significant variation in the definition, recognition, regulation and education of advanced practice nurses. Our data are essential to policymakers, professional associations and employers to ensure a coordinated and systematic effort in the consistency and ongoing development of advanced practice nurses across Europe. Patient or Public Contribution: No patient or public contribution applied; the participants were national nurses' associations. [ABSTRACT FROM AUTHOR]

Rationale, aims and objective: Substituting outpatient hospital care with primary care is seen as a solution to decrease unnecessary referrals to outpatient hospital care and decrease rising healthcare costs. This systematic review aimed to evaluate the effects on quality of care, health and costs outcomes of substituting outpatient hospital care with primary care-based interventions, which are performed by medical specialists in face-to-face consultations in a primary care setting. Method: The systematic review was performed using the PICO framework. Original papers in which the premise of the intervention was to substitute outpatient hospital care with primary care through the involvement of a medical specialist in a primary care setting were eligible. Results: A total of 14 papers were included. A substitution intervention in general practitioner (GP) practices was described in 11 papers, three described a joint consultation intervention in which GPs see patients together with a medical specialist. This study showed that substitution initiatives result mostly in favourable outcomes compared to outpatient hospital care. The initiatives resulted mostly in shorter waiting lists, shorter clinic waiting times and higher patient satisfaction. Costs for treating one extra patient seemed to be higher in the intervention settings. This was mainly caused by inefficient planning of consultation hours and lower patient numbers. Conclusions: Despite the fact that internationally a lot has been written about the importance of performing substitution interventions in which preventing unnecessary referrals to outpatient hospital care was the aim, only 14 papers were included. Future systematic reviews should focus on the effects on the Triple Aim of substitution initiatives in which other healthcare professions than medical specialists are involved along with new technologies, such as e-consults. Additionally, to gain more insight into the effects of substitution initiatives operating in a dynamic healthcare context, it is important to keep evaluating the interventions in a longitudinal study design. [ABSTRACT FROM AUTHOR]

The expansion of urban ecosystems and climate change, both outcomes of massive lifestyle changes, contribute to a series of side effects such as environmental deterioration, spread of diseases, increased greenhouse gas emissions and introduction of invasive species. In the case of the Athens metropolitan area, an invasive mosquito species—the Asian tiger mosquito (Aedes albopictus)–has spread widely in the last decade. This spread is favoured within urban environments and is also affected by changing climatic trends. The Asian tiger mosquito is accompanied by risks of mosquito-borne diseases, greater nuisance levels, and increased expenses incurring for its confrontation. The main aims of this paper are (i) to estimate the various costs associated with their control of this invasive species, as well as its health and nuisance impacts, (ii) to evaluate the level of citizens’ well-being from averting these impacts and (iii) to record citizens’ and experts’ perceptions regarding alternative control measures. Evidence shows that experts tend to place a high value on mosquito control when associated with serious health risks, while citizens are more sensitive and concerned about the environmental impacts of control methods. The synthesis of results produced by the current study could act as a preliminary guide for the estimation of societal welfare from the confrontation of similar problems in the context of a complex ecosystem. [ABSTRACT FROM AUTHOR]

Objective: The main aims of this paper are to analyse the monetary value of informal care time using different techniques and to identify significant variables associated with the number of caregiving hours. Data and methods: A multicentre study in two Spanish regions in adult caregivers was conducted. A total sample of 604 people was available. A multivariate analysis was performed to identify the variables associated with the number of hours of caregiving time. In the monetary valuation of informal care provided, three approaches were used: replacement cost method, opportunity cost and contingent valuation (willingness to pay and willingness to accept). Results: The main determinants of the amount of time of informal care provided were age, gender, the level of care receiver´s dependence and the professional care services received (at home and out of home). The value estimated for informal care time ranges from EUROS 80,247 (replacement cost method) to EUROS 14,325 (willingness to pay), with intermediate values of EUROS 27,140 and EUROS 29,343 (opportunity cost and willingness to accept, respectively). Several sensitivity analyses were performed over the base cases, confirming the previous results. Conclusions: Time of informal care represents a great social value, regardless of the applied technique. However, the results can differ strongly depending on the technique chosen. Therefore, the choice of technique of valuation is not neutral. Among the determinants of informal care time, the professional care received at home has a complementary character to informal care, while the formal care outside the home has a substitute character. [ABSTRACT FROM AUTHOR]

Background: Patient and public involvement (PPI) is a requirement for UK health and social care research funding. Evidence for how best to implement PPI in research programmes, such as National Institute for Health Research (NIHR) Collaborations for Applied Health Research and Care (CLAHRCs), remains limited. This paper reports findings from an action research (AR) project called IMPRESS, which aims to strengthen PPI within CLAHRC East of England (EoE). IMPRESS combines AR with Normalisation Process Theory (NPT) to explore PPI within diverse case study projects, identifying actions to implement, test and refine to further embed PPI. Methods: We purposively selected CLAHRC EoE case study projects for in-depth analysis of PPI using NPT. Data were generated from project PPI documentation, semi-structured qualitative interviews with researchers and PPI contributors and focus groups. Transcripts and documents were subjected to abductive thematic analysis and triangulation within case. Systematic across case comparison of themes was undertaken with findings and implications refined through stakeholder consultation. Results: We interviewed 24 researchers and 13 PPI contributors and analysed 28 documents from 10 case studies. Three focus groups were held: two with researchers (n = 4 and n = 6) and one with PPI contributors (n = 5). Findings detail to what extent projects made sense of PPI, bought in to PPI, operationalised PPI and appraised it, thus identifying barriers and enablers to fully embedded PPI. Conclusion: Combining NPT with AR allows us to assess the embeddedness of PPI within projects and programme, to inform specific local action and report broader conceptual lessons for PPI knowledge and practice informing the development of an action framework for embedding PPI in research programmes. To embed PPI within similar programmes teams, professionals, disciplines and institutions should be recognised as variably networked into existing PPI support. Further focus and research is needed on sharing PPI learning and supporting innovation in PPI. [ABSTRACT FROM AUTHOR]

Background: NEETs (young people not in employment, education or training) are at higher risk for poorer mental and physical health. In France, the Missions locales (MLs) are the only social structures dedicated to this population. We sought to determine whether the systematic offer of a social and preventive medicine consultation at a ML might increase NEET participants’ access to training in the 12 months following the intervention. Methods: This intervention research was a parallel randomised controlled interventional study conducted at five MLs in mainland France in 2011–2012. It included 976 NEETs aged 18 to 25 years who attended one of the five MLs. At inclusion, participants were randomly assigned (1:1:1) to three groups: those in the first group were invited to see a social worker (not studied in this paper), those in the second group were invited to see a doctor and a social worker (intervention group), and the third was a control group. The primary outcome was participation in at least one training session during the year following study inclusion. Results: Among the 976 participants, 504 were randomly assigned to the intervention group and 472 to the control group; 704 (72.1%) were included in the analyses. A significantly higher proportion of the participants in the intervention group participated in a training session in the 12 months following the intervention than of those in the control group (63.3% vs 55.6%; p = 0.04). This difference was significantly greater for women, those less than 21 years of age, those unstably housed and those with a lower level of education. Conclusions: Social and preventive medicine consultations that are fully integrated into the social services for NEETs have an impact on their access to training and contribute to changing some of their health-related behaviours. This may improve their access to the labour market. [ABSTRACT FROM AUTHOR]

Many studies have shown that childhood circumstances can have long term consequences that persist until old age. To better understand the transmission of early life circumstances, this paper analyses the effects of health and financial situation during childhood on quality of life after retirement as well as the mediating role of later life health, educational level, and income in this association. Moreover, this study is the first to compare these pathways across European regions. The analyses are based on data of 13,092 retirees aged ≥ 60 and ≤ 85 years from the fifth wave of the Survey of Health, Aging, and Retirement in Europe (SHARE) with full information on childhood and later life measures of health, educational level, financial situation, and quality of life as well as relevant covariates. Five European regions are studied: Central-Western Europe (Austria, Germany), Central-Eastern Europe (Czech Republic, Estonia, Slovenia), Northern Europe (Denmark, Sweden), Southern Europe (Italy, Spain), and Western Europe (Belgium, France, The Netherlands). Path analysis is used to identify the direct and indirect effects of childhood measures on quality of life. We find retirees’ quality of life to be associated with childhood finances and health in all five European regions. While both the direct and indirect effects of childhood health are rather moderate and homogeneous across regions, especially the direct effects of childhood finances on quality of life after retirement display a distinct North-South gradient being strongest in Southern Europe. Potential explanations for the regional variations are differences in the countries’ welfare systems. [ABSTRACT FROM AUTHOR]

Background: Due to changes in Polish society resulting from a significant inflow of immigrants to Poland, the need to develop the cultural competences of various professional groups who have contact with immigrants in their work has increased. These groups should include healthcare professionals, especially because of the significant increase in the number of culturally diverse patients. Therefore, medical education in Poland has had to rapidly adapt to this novel situation. For instance, the teaching process should be now more focused on the development and evaluation of the cultural competences of prospective health care workers. However, there is still a lack of standardized, valid and reliable instruments to assess cross-cultural competences among healthcare professionals. The purpose of the present paper was to describe, for the first time, the translation, adaptation, and psychometric evaluation of the Polish version of the Cross-Cultural Competence Inventory. Methods: Across two studies, we examined psychometric properties of the Cross-Cultural Competence Inventory (CCCI) such as reliability (i.e. internal consistency, test-retest reliability, factor structure) and validity (i.e. theoretical, criteria, convergent). In the first study, 408 participants (75% were healthcare professionals) completed the Polish version of the CCCI and the Positive/Negative Attitude Towards Culturally Divergent People Questionnaire. In the second study, 317 participants (97% were healthcare professionals) completed the CCCI twice, with an interval of at least 22 days. In addition, across two study sessions, participants completed questionnaires constructed to measure (a) cultural intelligence, (b) need for cognitive closure, (c) emphatic sensitiveness, (d) emotional intelligence, (e) self-esteem, (f) social desirability, and (g) personality. Finally, to additionally examine the theoretical validity, 36 professional cross-cultural competence trainers completed the CCCI during a one-session study. Results: Our findings confirm the reliability and validity of the CCCI. More precisely, in study 1 we proved the theoretical validity and reliability (i.e. internal consistency) of the CCCI. While the assumed structure did not fit the data well, all items were significantly related to the general factor, thus providing strong support for the usage of the total score of the CCCI. In study 2, we additionally estimated the test-retest reliability and theoretical, criterion and convergent validity. Across two studies we were able to successfully confirm these psychometric properties. The reliability was satisfactory and ranged from .83 to .86. We also observed a high and significant positive correlation between CCCI and the Cultural Intelligence Scale, which measures a concept similar to the one measured by CCCI. In addition, a significant relationship between intercultural competences (CCCI) and other variables such as personality, empathic sensitivity, emotional intelligence, self-esteem (positive correlations) and the need for cognitive closure (mainly negative correlation) were demonstrated. Conclusions: The obtained results support the usage of the CCCI questionnaire in scientific research, such as, for example, among healthcare professionals (nurses, doctors) and students of medical fields (nursing, medicine). [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives: Online modified Delphi (OMD) panel approaches can be used to engage large and diverse groups of clinical experts and stakeholders in developing health services performance measures. Such approaches are increasing in popularity among health researchers. However, information about their acceptability to participating experts and stakeholders is lacking but important to determine before recommending widespread use of online approaches. Therefore, the objective of this paper is to explore acceptability of the OMD panel approach from the participants' perspective. Method: We use data from participants in three OMD panels designed to develop performance measures for use in arthritis research and quality improvement efforts. At the end of each online panel, we surveyed clinical experts and stakeholders who shared their experiences with the OMD process by answering 13 close-ended questions using 7-point Likert-type scales. A mean of 5 or higher on a given question was treated as an indication of acceptability. Results: Ninety-eight clinical experts and stakeholders (92% participation rate) answered survey questions about the online process. They considered the OMD panel approach to be acceptable, particularly the ease of using the online system (mean = 5.3, standard deviation = 1.3) and the understanding gained from online discussions (mean = 5.2, standard deviation = 1.0). Participants also felt that participation in the Delphi study was interesting (mean = 5.6, standard deviation =1.1). Conclusion: These findings illustrate likely acceptability and a potential for a more widespread use of OMD panel approaches by stakeholders in developing health services performance measures. [ABSTRACT FROM AUTHOR]

Governments across Europe are required to make decisions about how best to allocate scarce health care resources. There are legitimate arguments for eliciting societal vales in relation to health care resource allocation given the roles of the general public as payers and potential patients. However, relatively little is known about the views of the general public on general principles which could guide these decisions. In this paper we present five societal viewpoints on principles for health care resources allocation and develop a new approach, Q2S, designed to investigate the extent to which these views are held across a range of European countries. An online survey was developed, based on a previously completed study Q methodology, and delivered between November 2009 and February 2010 across nine countries to 33,515 respondents. The largest proportion of our respondents (44%), were found to most associate themselves with an egalitarian perspective. Differences in views were more strongly associated with countries than with socio-demographic characteristics. These results provide information which could be useful for decision makers in understanding the pluralistic context in which they are making health care resource allocation decisions and how different groups in society may respond to such decisions. [ABSTRACT FROM AUTHOR]

Objectives Given the impact of the global economic crisis, delivering better health care with limited finance grows more challenging. Through the lens of institutional theory, this paper explores pressures experienced by hospital leaders to improve quality and constrain spending, focusing on how they respond to these often competing demands. Methods An in-depth, multilevel analysis of health care quality policies and practices in five European countries including longitudinal case studies in a purposive sample of ten hospitals. Results How hospitals responded to the financial and quality challenges was dependent upon three factors: the coherence of demands from external institutions; managerial competence to align external demands with an overall quality improvement strategy, and managerial stability. Hospital leaders used diverse strategies and practices to manage conflicting external pressures. Conclusions The development of hospital leaders’ skills in translating external requirements into implementation plans with internal support is a complex, but crucial, task, if quality is to remain a priority during times of austerity. Increasing quality improvement skills within a hospital, developing a culture where quality improvement becomes embedded and linking cost reduction measures to improving care are all required. [ABSTRACT FROM AUTHOR]

The percentage of elderly people in European countries is increasing. Such conjuncture affects socio-economic structures and creates demands for resourceful solutions, such as Ambient Assisted Living (AAL), which is a possible methodology to foster health care for elderly people. In this context, sensor-based devices play a leading role in surveying, e.g., health conditions of elderly people, to alert care personnel in case of an incident. However, the adoption of such devices strongly depends on the comfort of wearing the devices. In most cases, the bottleneck is the battery lifetime, which impacts the effectiveness of the system. In this paper we propose an approach to reduce the energy consumption of sensors' by use of local sensors' intelligence. By increasing the intelligence of the sensor node, a substantial decrease in the necessary communication payload can be achieved. The results show a significant potential to preserve energy and decrease the actual size of the sensor device units. [ABSTRACT FROM AUTHOR]

An invitational conference organized by the Netherlands Society of Physicians for Persons with Intellectual Disabilities (NVAVG) and the European Association of Intellectual Disability Medicine (MAMH), in collaboration with the Erasmus Medical Center's Department of Specialist Training for Physicians for People with Intellectual Disabilities, had as its aim the development and issuance of an European manifesto on adequate health care for people with intellectual disabilities (ID). This paper provides an overview of the basis for the conference and the manifesto and lays out recommendations for the implementation of the manifesto's main points. The group's product, the European Manifesto on Basic Standards of Health Care for People with Intellectual Disabilities, summarizes the core elements of adequate health care for individuals with ID, and offers guidance on how Europe's nations may address deficiencies in health provision for people with ID. The manifesto's main points include a call for greater available and accessible health care, increasing the competencies in ID of health professionals, educators, and researchers, a greater reliance on a multidisciplinary approach to health care, more specialist services, and a proactive emphasis on personal health management. [ABSTRACT FROM AUTHOR]