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Purpose: The purpose of this study is to explore and theorise about the desistance process of Maltese mothers who previously used drugs. The study unpacks how initial and continued desistance from high-risk drug use (HRDU) is impacted by being a mother within the Maltese context and identifies contingencies for desistance and examines how they are negotiated along the desistance pathways. Design/methodology/approach: The study adopted a symbolic interactionist-inspired career framework and involved in-depth exploration of trajectories of mothering and desistance of eight Maltese women with a history of HRDU. Data were gathered through in-depth interviews and analysis used an evolved grounded theory methodology. Findings: Four explanatory categories were identified in the interview data to document the role of mothering in the various pathways to desistance recounted by the women. These are: becoming a mother; differing pathways of desistance in relation to mothering; the lived experience; identity negotiation and transformation. This study highlights how identity fluidity and transformation is central to the desistance process. Practical implications: The paper aims to inform policy and practice with mothers who use drugs and their families and has important implications for the development and delivery of gender transformative interventions. Originality/value: This study challenges taken-for-granted beliefs about the influence of mothering on desistance and identifies the complexities involved. [ABSTRACT FROM AUTHOR]

This paper analyses the variability of life expectancy at birth in Europe after 1950. It aims to assess the development of the East-West mortality gap and to identify the sub-regions or countries that most influenced mortality divergent and convergent trends in Europe. To achieve the goals, European countries are divided into Western and Eastern according to their political history, and the squared coefficient of variation is used for analysis of variability. This measure is further decomposed into between- and within-group components. The results of the study show that there were 4 divergent periods during the study period associated with the delayed cardiovascular revolution and mortality crisis in Eastern Europe and the COVID-19 pandemic. Variability of mortality in Europe during the pandemic was the highest in comparison to all previous divergent periods. Throughout the studied period, the between-group variability was influenced by both the continual progress of Western Europe and the lagging of Eastern Europe, with both regions contributing more or less similarly. However, since the 1990s, in case of within-group variability, a strong dominance of Eastern Europe can be observed, and therefore post-socialist countries deserve special attention. The results also suggest that some longer-term trends in behavior and attitudes towards health may persist in society, and that in the case of an unexpected crisis, there is a greater risk of mortality divergence reappearing. [ABSTRACT FROM AUTHOR]

Objective: To explore the availability and accessibility of medically assisted reproduction (MAR) for people living with HIV in Europe, including the feasibility of cross‐border care. Methods: We used a polymorphous engagement approach, primarily based on digital and email‐based interviews with representatives of national HIV organizations, clinical researchers (infectious disease and/or infertility specialists), European and national professional societies (fertility and/or infectious disease), national regulatory authorities and individual clinics in 14 countries in the WHO European region. The research design and results were also informed by two surveys and a review of the secondary literature, news articles and clinic websites. Results: Although MAR is possible for people living with HIV in 12 out of the 14 countries mapped, accessing services can be challenging for logistical or financial reasons. People living with HIV also face barriers to MAR independent of their HIV status, such as limitations on single women and same‐sex couples accessing services. Cross‐border care is available for most patients who are self‐financing but is limited for publicly funded patients. Conclusions: Even when MAR is available to and accessible for people living with HIV, there may still be barriers to treatment. Further research on patient experiences is needed to understand these discrepancies between availability and accessibility on paper and in practice. [ABSTRACT FROM AUTHOR]

Introduction: Due to the Covid-19 pandemic, making more use of remote medical solutions has been advertised. The purpose of this study was to assess the willingness of orthopedic trauma patients to conduct an online video consultation (OVC) during the coronavirus pandemic compared to before. Methods: A survey amongst orthopedic and trauma outpatients from three European trauma centers was conducted via paper-based questionnaires, composed of participants' demographics and five open and closed questions between June and November 2019 and between April and July 2020 during Covid-19. The main outcome was the difference between the cohorts regarding the willingness to use an OVC, reasons for and against usage as well as advantages and disadvantages. Sub-analysis was performed for gender, participants' occupation and three age groups (≤ 30 years; 31–55 years; > 55 years). Results: 1400 participants (780 preCovid-19 and 620 Covid-19) were included. There was no difference in willingness to conduct an OVC between the cohorts (57.6% versus 63.9%; p = 0.053). The highest disposition towards an OVC in both cohorts was seen in patients below 30 years of age, followed by 31–55 years and over 55 years. Women were significantly more likely in the Covid-19-group than in the preCovid-19-group to conduct an OVC (p = 0.032). Use of the OVC for "personal questions to the physician" was more often stated in the Covid-19-cohort (p = 0.007). "No danger of an infection" (p = 0.001) and "availability from anywhere" (p = 0.032) as advantages of an OVC were more often stated in the Covid-19-cohort. "No direct contact with the doctor" (p = 0.001) and "relationship to the doctor could change" (p = 0.024) as disadvantages of the OVC were less often stated in the Covid-19-cohort. Conclusion: The majority of the assessed outpatients would use an OVC. Fear of infections have increased, and direct physical contact is less important since the Covid-19 pandemic, but have not increased the disposition for an OVC significantly. [ABSTRACT FROM AUTHOR]

Background Direct-to-consumer genetic tests (DTC-GTs) are genetic tests for a medical or non-medical trait that are sold directly to the public, usually ordered without the engagement of a healthcare professional. Our aim was to explore the knowledge, attitudes and behaviors toward DTC-GTs among European citizens. Methods We updated the most recent systematic review on citizens' perspectives toward DTC-GTs. Relevant English language studies were searched on PubMed, ISI Web of Science, Scopus, Embase and Google Scholar from October 2014 to April 2019. We extended our search on Scopus without publication date restriction, since it was not included in the former review. Eligible studies were conducted in European countries and reported original data. The quality of the studies was evaluated using a checklist developed by Kmet et al. Results We included six studies conducted in European countries between 2015 and 2018. The studies were performed among general population in the Netherlands, students in Italy and Greece, laypeople in Germany and older adults in Switzerland. The level of awareness, in overall low, differed by country and population group. Most of the participants were interested in undergoing a DTC-GT, mainly for knowing the risk predisposition to a common disease. Concerns were raised about tests' validity and utility and data privacy. Conclusions Our review shows that European citizens, overall, have a low level of knowledge on DTC-GTs and a high interest in their purchase. This understanding might contribute to the development of educational programs in order to the increase of general public capabilities to make appropriate health decisions. [ABSTRACT FROM AUTHOR]

Citizens' attitudes towards their national healthcare are important indicators of satisfaction and of political perspectives. In this article we summarise individual and national level patterns in healthcare evaluations across Europe. An innovative feature of our analysis is that we demonstrate that assessing healthcare evaluations in relative terms (relative to citizens' views about the performance of national institutions in other domains), offers new insights about individual and national level variations in attitudes. Thus, we introduce an indicator of relative attitudes towards healthcare and contrast it to an absolute measure in a cross-national analysis. We use a larger dataset than previous studies of healthcare evaluations including countries from all regions of Europe and spanning eight rounds of the European Social Survey (2002–2017, N = 342,000). We find that Europeans' healthcare evaluations are multidimensional, with different patterns sometimes operating at an absolute and a relative level. When comparing countries, for instance, several nations in Southern and Eastern Europe compare poorly to other nations in their absolute ratings of healthcare but compare favourably if assessed in relative terms. Likewise, using a relative measure, most Scandinavian countries compare less favourably to other countries, but score positively when evaluations are measured in absolute terms. [ABSTRACT FROM AUTHOR]

Background The coronavirus disease 2019 (COVID-19) pandemic increased multiple risk factors for mental health. Evidence-based, intersectoral public mental health responses are therefore critical. The primary aim of this study was to collate public mental health responses from across Europe. Methods We conducted a cross-sectional survey in March 2021. Participants were public and mental health professionals from across Europe. We developed an online instrument exploring five domains: changes in mental health supports during the pandemic; mental health support for vulnerable groups; multi-sectoral and service-user involvement; published mental health response plans; and perceived quality of overall country response. Results Fifty-two individuals from 20 European nations responded. Reported changes in mental health supports included an increase in online mental health supports (n  = 18); but no change in long-term mental health funding (n  = 13); and a decrease in access to early interventions (n  = 9). Responses indicated mental health support for vulnerable groups was limited, as was multi-sectoral and service-user involvement. Few national mental health response plans existed (n  = 9) and 48% of respondents felt their countries mental health response had been 'poor' or 'very poor'. Conclusions Our results give insights into the changes in mental health support at a country level across Europe during the COVID-19 pandemic. They indicate countries were not prepared to respond and people with existing vulnerabilities were often neglected in response planning. To be prepared for future pandemics and environmental disasters Public Mental Health preparedness plans are highly needed. These must be developed cross-departmentally, and through the meaningful inclusion of vulnerable groups. [ABSTRACT FROM AUTHOR]

Influenza immunization policies in Europe primarily target at-risk and vulnerable subjects. Healthcare workers (HCWs) are a key focus of vaccination campaigns. Our systematic review and meta-analysis aim to evaluate the role of the COVID-19 pandemic on influenza vaccine uptake among HCWs since the 2020/21 influenza season. Fourteen studies were included in the meta-analysis and systematic review, selected from scientific articles available in MEDLINE/PubMed, ISI Web of Knowledge, and Scopus databases between 1 January 2021 and 15 January 2023 The analysis revealed a significant relationship between influenza vaccine uptake and COVID-19 related determinants, such as willingness to receive COVID-19 vaccination, fear of COVID-19, and differentiating between influenza and COVID-19 symptoms (OR = 5.70; 95%CI = 2.08–15.60). Several studies reported higher vaccination coverages in the 2020/21 season compared to previous seasons, with VC values ranging from + 17% to + 38% compared to the 2019/20 season. The included studies identified a shift in HCWs' attitudes toward influenza vaccination, attributed to increased awareness due to the COVID-19 pandemic. Vaccine hesitancy is common among HCWs in Europe, necessitating mutual strategies across all European countries. So far, mandatory vaccination policies have shown the most potential in achieving high and sustainable influenza vaccination rates among HCWs. [ABSTRACT FROM AUTHOR]

Users show a growing interest in expanding the implementation of digital tools as a support of technical and management issues in healthcare. This medical care has focused on telemedicine but does not include the recognition of needs as an important part of patient-centred healthcare. Nurses interact with patients at critical times in their life journeys, including birth and death, which are historical events linked with religious beliefs. Furthermore, large migration flows have led to multicultural societies in which religion and spirituality are experienced in distinct ways by different people. Finally, most healthcare professionals lack the proper skills to handle the spiritual needs of their patients, especially for core and digital competences. This article shows the results of qualitative research applying as a research tool an open-ended questionnaire, which allows detecting the educational needs for nurses' interventions aimed at providing spiritual support to their patients using digital tools. The results obtained reveal that nurses need education and training on fundamental spiritual concepts and digital competencies to meet the multiple demands of their patients' spiritual needs. Finally, we present an open digital educational proposal for the development of competencies for nurses and other health professionals to provide spiritual care with the support of digital tools. [ABSTRACT FROM AUTHOR]

Background Although older adults are more vulnerable to the COVID-19 virus, a significant proportion of them do not follow recommended guidelines concerning preventive actions during the ongoing pandemic. This article analyses the role of biased health beliefs for adaptive health behaviour such as reduced mobility, protection in public spaces and hygiene measures, for the population aged 50 and older in 13 European countries. Methods Health perception is measured based on the difference between self-reported health and physical performance tests for over 24 000 individuals included in the most recent Survey of Health, Ageing and Retirement in Europe. Logistic regressions are employed to explore how over- and underestimating health are related to preventive behaviours. Results Results suggest that older adults who underestimate their health are more likely to show adaptive behaviour related to mobility reductions. In particular, they are more likely to stay at home, shop less and go for walks less often. In contrast, overestimating health is not significantly associated with reduced mobility. Protective behaviour in public spaces and adopting hygiene measures do not vary systematically between health perception groups. Conclusion As health beliefs appear relevant for the adoption of preventive health behaviours related to mobility, they have serious consequences for the health and well-being of older Europeans. Although adaptive behaviour helps to contain the virus, exaggerated mobility reduction in those who underestimate their health might be contributing to the already high social isolation and loneliness of older adults during the ongoing pandemic. [ABSTRACT FROM AUTHOR]

There has been much discussion recently that better healthcare systems lead to increased service access and utilisation. However, there are still concerns raised among the refugee and immigrant communities about barriers to access and utilisation of primary healthcare services in the UK. This study aimed to explore with refugee and immigrant community health champions (CHCs) their perceptions about such barriers based on feedback in their own discussions with fellow refugees, asylum-seekers and immigrants in the West Midlands, UK. A total of 42 refugees and immigrants were recruited. Qualitative design-focused group discussions were conducted among purposively selected participants. These discussions were conducted between May and September 2019, and data were analysed using thematic analysis. The barriers to service access and utilisation are categorised into four themes: (i) knowledge about health issues that most affected refugees and immigrants; (ii) community indications of factors that obstructed service access; (iii) challenges in identifying local teams involved in service provision; and (iv) accurate knowledge about the different teams and their roles in facilitating access. This study higlighted that the levels of service access and utilisation would depend on the competence and effectiveness of the health system. Urgency and seriousness of individuals' healthcare needs were the factors that were perceived to strongly influence refugees and immigrants to seek and utilise local services. We identified a number of potential barriers and challenges to service access and utilisation that should be overcome if primary healthcare service is to be planned and delivered effectively, efficiently and equitably in the West Midlands. [ABSTRACT FROM AUTHOR]

Background: Respiratory medicine (RM) and palliative care (PC) physicians' management of chronic breathlessness in advanced chronic obstructive pulmonary disease (COPD), fibrotic interstitial lung disease (fILD) and lung cancer (LC), and the influence of practice guidelines was explored via an online survey.Methods: A voluntary, online survey was distributed to RM and PC physicians via society newsletter mailing lists.Results: 450 evaluable questionnaires (348 (77%) RM and 102 (23%) PC) were analysed. Significantly more PC physicians indicated routine use (often/always) of opioids across conditions (COPD: 92% vs. 39%, fILD: 83% vs. 36%, LC: 95% vs. 76%; all p < 0.001) and significantly more PC physicians indicated routine use of benzodiazepines for COPD (33% vs. 10%) and fILD (25% vs. 12%) (both p < 0.001). Significantly more RM physicians reported routine use of a breathlessness score (62% vs. 13%, p < 0.001) and prioritised exercise training/rehabilitation for COPD (49% vs. 7%) and fILD (30% vs. 18%) (both p < 0.001). Overall, 40% of all respondents reported reading non-cancer palliative care guidelines (either carefully or looked at them briefly). Respondents who reported reading these guidelines were more likely to: routinely use a breathlessness score (χ2 = 13.8; p < 0.001), use opioids (χ2 = 12.58, p < 0.001) and refer to pulmonary rehabilitation (χ2 = 6.41, p = 0.011) in COPD; use antidepressants (χ2 = 6.25; p = 0.044) and refer to PC (χ2 = 5.83; p = 0.016) in fILD; and use a handheld fan in COPD (χ2 = 8.75, p = 0.003), fILD (χ2 = 4.85, p = 0.028) and LC (χ2 = 5.63; p = 0.018).Conclusions: These findings suggest a need for improved dissemination and uptake of jointly developed breathlessness management guidelines in order to encourage appropriate use of existing, evidence-based therapies. The lack of opioid use by RM, and continued benzodiazepine use in PC, suggest that a wider range of acceptable therapies need to be developed and trialled. [ABSTRACT FROM AUTHOR]

Background older people remain underrepresented in clinical trials, and evidence generated in younger populations cannot always be generalized to older patients. Objective to identify key barriers and to discuss solutions to specific issues affecting recruitment and retention of older participants in clinical trials based on experience gained from six current European randomised controlled trials (RCTs) focusing on older people. Methods a multidisciplinary group of experts including representatives of the six RCTs held two networking conferences and compiled lists of potential barriers and solutions. Every item was subsequently allocated points by each study team according to how important it was perceived to be for their RCTs. Results the six RCTs enrolled 7,612 older patients. Key barriers to recruitment were impaired health status, comorbidities and diverse health beliefs including priorities within different cultural systems. All trials had to increase the number of recruitment sites. Other measures felt to be effective included the provision of extra time, communication training for the study staff and a re-design of patient information. Key barriers for retention included the presence of severe comorbidities and the occurrence of adverse events. Long study duration, frequent study visits and difficulties accessing the study site were also mentioned. Solutions felt to be effective included spending more time maintaining close contact with the participants, appropriate measures to show appreciation and reimbursement of travel arrangements. Conclusion recruitment and retention of older patients in trials requires special recognition and a targeted approach. Our results provide scientifically-based practical recommendations for optimizing future studies in this population. [ABSTRACT FROM AUTHOR]