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Reports developments on medicine in Europe as of January 1988. Negotiation between the General Medical Services Committee and the Department of Health on primary health care; Access of the district health authorities to family practitioner committees; Derivation of circular of community nursing services and community health care teams.

Telephone based tobacco cessation services, or quitlines, have become central components of many comprehensive tobacco control programmes. This paper provides an overview of their history, noting milestones in the growth of quitlines. Key factors in their worldwide adoption were solid evidence from clinical trials with large community samples and strong backing from public health officials. Quitlines are now available throughout most of North America, Europe, Australia and in many other locations around the world. The paper also offers several recommendations for future directions in quitline practice and research. Benchmarks should be established for key areas of quitline implementation, such as accessibility, quality and cost efficiency. Advances in pharmacotherapy, telephony and web based applications should be investigated for opportunities to expand service offerings. Research and development are needed to determine how best to serve a diverse clientele in the most cost effective manner. Funding should be expanded and diversified to enable quitlines to serve much larger numbers of users. Healthcare providers should be targeted for quitline promotion, to engage them in a broad effort to increase the number of patients receiving cessation messages from clinicians. The goal of quitline promotion should expand to include an increase in unaided quit attempts in the population. Early research findings were quickly adopted in quitline practice, and future research to answer questions that have arisen through the implementation of quitlines will probably also find quick adoption. [ABSTRACT FROM AUTHOR]

Broad terms such as Black, African, or Black African are entrenched in scientific writings although there is considerable diversity within African descent populations and such terms may be both offensive and inaccurate. This paper outlines the heterogeneity within African populations, and discusses the strengths and limitations of the term Black and related labels from epidemiological and public health perspectives in Europe and the USA. This paper calls for debate on appropriate terminologies for African descent populations and concludes with the proposals that (1) describing the population under consideration is of paramount importance (2) the word African origin or simply African is an appropriate and necessary prefix for an ethnic label, for example, African Caribbean or African Kenyan or African Surinamese (3) documents should define the ethnic labels (4) the label Black should be phased out except when used in political contexts. [ABSTRACT FROM AUTHOR]

Presents a paper which focuses on the medical ethics in support of the policy of voluntary, unpaid donation of blood, in light of Article 3.4 of the European Community directive 39/381. What Article 3.4 requires; Arguments highlighted in the paper; Conclusions reached.

Background and study aims: There is widespread consensus on the need for better indicators of the effectiveness of healthcare. We carried out an analysis of the validity of amenable mortality as an indicator of the effectiveness of healthcare, focusing on the potential use in routine surveillance systems of between-country variations in rates of mortality. We assessed whether the introduction of specific healthcare innovations coincided with declines in mortality from potentially amenable causes in seven European countries. In this paper, we summarise the main results of this study and illustrate them for four conditions. Data and methods: We identified 14 conditions for which considerable declines in mortality have been observed and for which there is reasonable evidence in the literature of the effectiveness of healthcare interventions to lower mortality. We determined the time at which these interventions were introduced and assessed whether the innovations coincided with favourable changes in the mortality trends from these conditions, measured using Poisson linear spline regression. All the evidence was then presented to a Delphi panel. Main results: The timing of innovation and favourable change in mortality trends coincided for only a few conditions. Other reasons for mortality decline are likely to include diffusion and improved quality of interventions and in incidence of diseases and their risk factors, but there is insufficient evidence to differentiate these at present. For most conditions, a Delphi panel could not reach consensus on the role of current mortality levels as measures of effectiveness of healthcare. Discussion and conclusions: Improvements in healthcare probably lowered mortality from many of the conditions that we studied but occurred in a much more diffuse way than we assumed in the study design. Quantification of the contribution of healthcare to mortality requires adequate data on timing of innovation and trends in diffusion and quality and in incidence of disease, none of which are currently available. Given these gaps in knowledge, between-country differences in levels of mortality from amenable conditions should not be used for routine surveillance of healthcare performance. The timing and pace of mortality decline from amenable conditions may provide better indicators of healthcare performance. [ABSTRACT FROM AUTHOR]

Background The new EU Registration, Evaluation, Authorisation and Restriction of Chemical Substances (REACH) Regulation to control the trade and use of chemicals has a great potential to reduce worker exposure to hazardous substances and therefore reduce chemical-related occupational diseases. REACH requires manufacturers of substances of very high concern (SVHC) to request an authorisation for each use of these substances in order to continue marketing them. There are between 1500 and 2000 SVHC on the European market; however, to date, the European Chemicals Agency has published only 29 substances as candidates for the authorisation procedure. This work aims to contribute to the practical implementation of REACH by proposing a list of SVHC which, from a union's perspective, should have priority for inclusion in the authorisation procedure. Methods In a first stage, SVHC for prioritisation were identified, prioritisation criteria were established, and scores for each criterion were defined for finally developing the Trade Union List. Results Through previously presented criteria, the Trade Union List includes 305 high-production-volume chemicals that meet the requirements of the authorisation process under REACH. 190 of these substances are associated with recognised occupational diseases, and 22 have been included in the REACH Candidate List. Conclusions In this paper, we present a precautionary but scientifically aligned process for identifying, scoring and ranking SVHC, including categories of substances not currently considered in other approaches to the REACH Regulation. This proposed methodology is advocated by Trade Unions to coherently prioritise SVHC in order to implement and enforce REACH in a way that will more effectively protect the health of the European working and general population. [ABSTRACT FROM PUBLISHER]

Recently new European policies on ambient air quality—namely, the adoption of new standards for fine particulate matter (PM2.5), have generated a broad debate about choosing the air quality standards that can best protect public health. The Apheis network estimated the number of potential premature deaths from all causes that could be prevented by reducing PM2.5 annual levels to 25 μg/m³, 20 μg/m³, 15 μg/m³ and 10 μg/m³ in 26 European cities. The various PM2.5 concentrations were chosen as different reductions based on the limit values proposed by the new European Directive, the European Parliament, the US Environmental Protection Agency and the World Health Organization, respectively. The Apheis network provided the health and exposure data used in this study. The concentration-response function (CRF) was derived from the paper by Pope et al (2002). If no direct PM2.5 measurements were available, then the PM10 measurements were converted to PM2.5 using a local or an assumed European conversion factor. We performed a sensitivity analysis using assumptions for two key factors—namely, CRF and the conversion factor for PM2.5. Specifically, using the "at least" approach, in the 26 Apheis cities with more than 40 million inhabitants, reducing annual mean levels of PM2.5 to 15 μg/m³ could lead to a reduction in the total burden of mortality among people aged 30 years and over that would be four times greater than the reduction in mortality that could be achieved by reducing PM2.5 levels to 25 μg/m³ (1.6% vs 0.4% reduction) and two times greater than a reduction to 20 μg/m³. The percentage reduction could grow by more than seven times if PM2.5 levels were reduced to 10 μg/m³ (3.0% vs 0.4%). This study shows that more stringent standards need to be adopted in Europe to protect public health, as proposed by the scientific community and the World Health Organization. [ABSTRACT FROM AUTHOR]

Objective: To systematically review and critically appraise the economic evaluations of one to one interventions to reduce sexually transmitted infections (STIs) and teenage conceptions. Design: Systematic review. Data Sources: Search of four electronic bibliographic databases from 1990 to January 2006. Search keywords included teenage, pregnancy, adolescent, unplanned, unwanted, cost benefit, cost utility, economic evaluation, cost effectiveness and all terms for STIs, including specific diseases. Review Methods: We included studies that evaluated a broad range of one to one interventions to reduce STIs. Outcomes included major outcomes averted, life years and quality adjusted life years (QALY). All studies were assessed against quality criteria. Results: Of 3,190 identified papers, 55 were included. The majority of studies found one to one interventions to be either cost saving or cost effective, although one highlighted the need to target the population to receive post-exposure prophylaxis to reduce transmission of HIV. Most studies used a static approach that ignores the potential re-infection of treated patients. Conclusion: One to one interventions have been shown to be cost saving or cost effective but there are some limitations in applying this evidence to the UK policy context. More UK research using dynamic modelling approaches and QALYs would provide improved evidence, enabling more robust policy recommendations to be made about which one to one interventions are cost effective in reducing STIs in the UK setting. The results of this review can be used by policy makers, health economists and researchers considering further research in this area. [ABSTRACT FROM AUTHOR]

Radical changes are taking place in the United Kingdom in relation to the classification of, and access to, medicines. More and more medicines are being made available over the counter both in local pharmacies and in supermarkets. The provision of more open access to medicines may be hailed as a triumph for patient autonomy. This paper examines whether such a claim is real or illusory. It explores the ethical and legal implications of deregulating medicines. Do patients benefit? What is the impact on pharmacists? Are the true beneficiaries of change largely the pharmaceutical industries? [ABSTRACT FROM AUTHOR]

This paper reports a European Forum for Good Clinical Practice workshop held in 2011 to consider a research ethics committee training syllabus, subsequent training needs and resources. The syllabus that was developed was divided into four competencies: committee working; scientific method; ethical analysis and the regulatory framework. Appropriate training needs for each, with possible resources, were discussed. Lack of funding for training was reported as a major problem but affordable alternatives were debated. Strengths and weaknesses of this approach were discussed and the resultant proposal will be disseminated through the European Forum for Good Clinical Practice and the research ethics committees of member states. [ABSTRACT FROM AUTHOR]

Presents views about the paper of authors Graham Dukes and Inga Lunde on the comparison of two areas in Europe. Definition of area in terms of the religions over the past centuries; Tendency of Dukes and Lunde to exaggerate; Effect of the Reformation on the mentality of the people.