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Objective: Regarding the use of lung ultrasound (LU) in neonatal intensive care units (NICUs) across Europe, to assess how widely it is used, for what indications and how its implementation might be improved., Design and Intervention: International online survey., Results: Replies were received from 560 NICUs in 24 countries between January and May 2023. LU uptake varied considerably (20%-98% of NICUs) between countries. In 428 units (76%), LU was used for clinical indications, while 34 units (6%) only used it for research purposes. One-third of units had <2 years of experience, and only 71 units (13%) had >5 years of experience. LU was mainly performed by neonatologists. LU was most frequently used to diagnose respiratory diseases (68%), to evaluate an infant experiencing acute clinical deterioration (53%) and to guide surfactant treatment (39%). The main pathologies diagnosed by LU were pleural effusion, pneumothorax, transient tachypnoea of the newborn and respiratory distress syndrome. The main barriers for implementation were lack of experience with technical aspects and/or image interpretation. Most units indicated that specific courses and an international guideline on neonatal LU could promote uptake of this technique., Conclusions: Although LU has been adopted in neonatal care in most European countries, the uptake is highly variable. The main indications are diagnosis of lung disease, evaluation of acute clinical deterioration and guidance of surfactant. Implementation may be improved by developing courses and publishing an international guideline., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Knowledge of seasonal variation in hunting pressure and the demographic composition of hunting bags is likely to be important for the effective management of quarry species. Such knowledge is particularly important where regulatory mechanisms aim to avoid the over-exploitation of quarry species having unfavourable conservation status. We compiled information on the age composition of harvested European Turtle-doves (Streptopelia turtur), and the daily numbers of doves shot and retrieved from 68 hunting estates spread across four Spanish regions. We use these data to describe temporal variation, and identify factors affecting daily hunting bags, age composition and crippling losses. We found that more juvenile doves were hunted than adults (and more than expected in a stable population) especially at the beginning of the hunting season, suggesting greater vulnerability of juveniles to hunting. The number of doves hunted each day declined through the hunting season and increased with the number of hunters present. Crippling losses averaged 9.6 % of all doves shot; applying this rate to recent Spanish government hunting statistics suggests under-recording of approximately 90,000 doves annually for the entire country. Our data on age composition and crippling losses can serve as direct inputs into future models of sustainable harvest for Turtle Dove in Europe. Our results highlight the importance of improving knowledge about the variables influencing take at the hunting event level for designing more efficiency regulatory measures., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Helicobacter pylori is a common component of the human stomach microbiota, possibly dating back to the speciation of Homo sapiens. A history of pathogen evolution in allopatry has led to the development of genetically distinct H. pylori subpopulations, associated with different human populations, and more recent admixture among H. pylori subpopulations can provide information about human migrations. However, little is known about the degree to which some H. pylori genes are conserved in the face of admixture, potentially indicating host adaptation, or how virulence genes spread among different populations. We analyzed H. pylori genomes from 14 countries in the Americas, strains from the Iberian Peninsula, and public genomes from Europe, Africa, and Asia, to investigate how admixture varies across different regions and gene families. Whole-genome analyses of 723 H. pylori strains from around the world showed evidence of frequent admixture in the American strains with a complex mosaic of contributions from H. pylori populations originating in the Americas as well as other continents. Despite the complex admixture, distinctive genomic fingerprints were identified for each region, revealing novel American H. pylori subpopulations. A pan-genome Fst analysis showed that variation in virulence genes had the strongest fixation in America, compared with non-American populations, and that much of the variation constituted non-synonymous substitutions in functional domains. Network analyses suggest that these virulence genes have followed unique evolutionary paths in the American populations, spreading into different genetic backgrounds, potentially contributing to the high risk of gastric cancer in the region.

Unlabelled: Advances in perinatal medicine have dramatically improved neonatal survival. End-of-life decision making for newborns with adverse prognosis is an ethical challenge, the ethical issues are controversial and little evidence exists on attitudes and values in Europe., Objective: to assess the attitudes of the neonatal departments in perinatal clinical practice in the hospitals of European countries., Methods: a questionnaire was send to 55 NICUs from 19 European countries., Results: Forty five (81.8%) NICUs were Level III. Religion was Christian in 90.7% and we observed that in north countries the religion is more influent on clinical decisions (p = 0.032). Gestational age was considered with no significant difference for clinical investment. North countries consider birth weight (p = 0.011) and birth weight plus gestational age (p = 0.024) important for clinical investment. In north countries ethical questions should not prevail when the decision is made (p = 0.049) and from an ethical point of view, there is no difference between withdraw a treatment and do not initiate the treatment (p = 0.029). More hospitals in south countries administer any analgesia (p = 0.007). When the resuscitation is not successful 96.2% provide comfort care., Conclusion: Our study reveals that cultural and religious differences influenced ethical attitudes in NICUs of the European countries.

Background: Rabbit haemorrhagic disease virus (RHDV) is a highly virulent calicivirus, first described in domestic rabbits in China in 1984. RHDV appears to be a mutant form of a benign virus that existed in Europe long before the first outbreak. In the Iberian Peninsula, the first epidemic in 1988 severely reduced the populations of autochthonous European wild rabbit. To examine the evolutionary history of RHDV in the Iberian Peninsula, we collected virus samples from wild rabbits and sequenced a fragment of the capsid protein gene VP60. These data together with available sequences from other Western European countries, were analyzed following Bayesian Markov chain Monte Carlo methods to infer their phylogenetic relationships, evolutionary rates and demographic history., Results: Evolutionary relationships of RHDV revealed three main lineages with significant phylogeographic structure. All lineages seem to have emerged at a common period of time, between ~1875 and ~1976. The Iberian Peninsula showed evidences of genetic isolation, probably due to geographic barriers to gene flow, and was also the region with the youngest MRCA.Overall, demographic analyses showed an initial increase and stabilization of the relative genetic diversity of RHDV, and a subsequent reduction in genetic diversity after the first epidemic breakout in 1984, which is compatible with a decline in effective population size., Conclusions: Results were consistent with the hypothesis that the current Iberian RHDV arose from a single infection between 1869 and 1955 (95% HPD), and rendered a temporal pattern of appearance and extinction of lineages. We propose that the rising positive selection pressure observed throughout the history of RHDV is likely mediated by the host immune system as a consequence of the genetic changes that rendered the virus virulent. Consequently, this relationship is suggested to condition RHDV demographic history.

On the 21st of June 2002, in Copenhagen, the Regional Commission for the Certification of Poliomyelitis Eradication, declared the European Region of the World Health Organization (WHO) as polio-free. The last case (not imported) of poliomyelitis in Europe had occurred in November 1998. The health impact is enormous. In Portugal, the last case of poliomyelitis caused by the wild poliovirus, had occurred in December 1986. The path to eradication in Portugal had begun with a vaccination campaign in 1965/1966, with the oral polio vaccine (Sabin). High vaccination coverage has been maintained since then. The Portuguese program to eliminate poliomyelitis follows the strategic recommendations of WHO, with three components: vaccination; surveillance of acute placid paralysis (AFP); laboratory containment of wild polioviruses. Global eradication has not yet been achieved but is likely to happen till 2005. Keeping the high levels of motivation among Portuguese health workers is essential, in order not to loose what has been achieved. High vaccination coverage has to be maintained. Surveillance of AFP has to be improved and the prompt notification of cases by hospital clinicians, sending stool samples to the reference laboratory, is essential for the success of this activity. The laboratory containment programme is important to prevent the accidental reintroduction of poliomyelitis from laboratories.