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Background: Many studies have shown that low health literacy (HL) is associated with several adverse outcomes. In this study, we systematically reviewed the prevalence of low HL in Europe. Methods: PubMed, Embase, and Scopus were searched. Cross-sectional studies conducted in the European Union (EU), published from 2000, investigating the prevalence of low HL in adults using a reliable tool, were included. Quality was assessed with the Newcastle-Ottawa Scale. Inverse-variance random effects methods were used to produce pooled prevalence estimates. A meta-regression analysis was performed to assess the association between low HL and the characteristics of the studies. Results: The pooled prevalence of low HL ranged from of 27% (95% CI: 18–38%) to 48% (95% CI: 41–55%), depending on the literacy assessment method applied. Southern, Western, and Eastern EU countries had lower HL compared to northern Europe (β: 0.87, 95% CI: 0.40–1.35; β: 0.59, 95% CI: 0.25–0.93; and β: 0.72, 95% CI: 0.06–1.37, respectively). The assessment method significantly influenced the pooled estimate: compared to word recognition items, using self-reported comprehensions items (β: 0.61, 95% CI: 0.15–1.08), reading or numeracy comprehensions items (β: 0.77, 95% CI: 0.24–1.31), or a mixed method (β: 0.66, 95% CI: 0.01–1.33) found higher rates of low HL. Refugees had the lowest HL (β: 1.59, 95% CI: 0.26–2.92). Finally, lower quality studies reported higher rates of low HL (β: 0.56, 95% CI: 0.06–1.07). Discussion: We found that low HL is a public health challenge throughout Europe, where one in every three to almost one in every two Europeans may not be able to understand essential health-related material. Additional research is needed to investigate the underlying causes and to develop remedies. PROSPERO Registration: CRD42019133377 [ABSTRACT FROM AUTHOR]

Pharmaceuticals in surface waters have raised significant concern in recent years for their potential environmental effects. This study identified that at present a total of 477 substances (including 66 metabolites and transformation products) have been analyzed in European surface waters. Around 60% (284) of these compounds belonging to 16 different therapeutic groups were positively detected in one or more of 33 European countries. To conveniently and effectively prioritize potential high-risk compounds, an optimized method that considers the frequency of concentrations above predicted no effects levels was developed on the basis of the traditional method, and it was then used to identify and screen candidate priority pollutants in European surface waters. The results proved the feasibility and advantages of the optimized method. Pharmaceuticals detected in European surface waters were classified into 5 categories (high, moderate, endurable, negligible and safe) depending on their potential environmental effects and the distribution of pharmaceuticals. Circa 9% (45 out of 477) analyzed compounds showed a potential environmental risk to aquatic ecosystems. Among these 45 compounds, 12 compounds were indicated to have high environmental risk in aquatic environments, while 17 and 7 compounds showed moderate and small-scale environmental risks, respectively., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)