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Purpose: To explore views of general practitioners (GPs) and occupational physicians (OPs) on the role of GPs in work guidance of cancer patients. Methods: Between 2016 and 2019, two focus groups with GPs (N = 17) and two focus groups with OPs (N = 10) were conducted. Focus group discussions were audiotaped and transcribed verbatim. Transcripts were analysed by data-driven analysis. Results: GPs generally indicated that they inquire about patients' occupations but do not structurally document these. GPs described offering support and advice to patients regarding their work, while other GPs stated they do not interfere with their patients' work or return to work (RTW) process. In general, GPs stated that they do not aspire a professional role in the work guidance of patients, due to lack of expertise and not having sufficient knowledge in work regulations and legislation. In contrast, OPs anticipated a proactive role from GPs concerning work guidance in cancer patients, and they expected GPs to refer cancer patients to the OP, when required. Moreover, they emphasised the importance of communication between GPs and OPs about patients' work-related problems to achieve common goals. Conclusions: GPs can contribute to cancer patients' RTW process by supporting patients, giving advice and providing referral to other health professionals. Better cooperation between GPs and OPs may improve work guidance in cancer patients. Implications for Cancer Survivors: When cancer patients with work-related issues get appropriate advice and support from GPs and referred in time to OPs, the RTW process and staying at work of cancer patients may be positively affected.

Harmful algal blooms (HABs) cause harm to human health or hinder sustainable use of the marine environment in Blue Economy sectors. HABs are temporally and spatially variable and hence their mitigation is closely linked to effective early warning. The European Union (EU) Interreg Atlantic Area project "PRIMROSE", Predicting Risk and Impact of Harmful Events on the Aquaculture Sector, was focused on the joint development of HAB early warning systems in different regions along the European Atlantic Area. Advancement of the existing HAB forecasting systems requires development of forecasting tools, improvements in data flow and processing, but also additional data inputs to assess the distribution of HAB species, especially in areas away from national monitoring stations, usually located near aquaculture sites. In this contribution, we review different novel technologies for acquiring HAB data and report on the experience gained in several novel local data collection exercises performed during the project. Demonstrations include the deployment of autonomous imaging flow cytometry (IFC) sensors near two aquaculture areas: a mooring in the Daoulas estuary in the Bay of Brest and pumping from a bay in the Shetland Islands to an inland IFC; and several drone deployments, both of Unmanned Aerial Vehicles (UAV) and of Autonomous Surface vehicles (ASVs). Additionally, we have reviewed sampling approaches potentially relevant for HAB early warning including protocols for opportunistic water sampling by coastguard agencies. Experiences in the determination of marine biotoxins in non-traditional vectors and how they could complement standard routine HAB monitoring are also considered.

BACKGROUND Although sudden cardiac death (SCD) is recognized as a high-priority public health topic, reliable estimates of the incidence of SCD or, more broadly, out-of-hospital cardiac arrest (OHCA), in the population are scarce, especially in the European Union. OBJECTIVES The study objective was to determine the incidence of SCD and OHCA in the European Union. METHODS The study examined 4 large (ie, >2 million inhabitants) European population-based prospective registries collecting emergency medical services (EMS)-attended (ie, with attempted resuscitation) OHCA and SCD (OHCA without obvious extracardiac causes) for >5 consecutive years from January 2012 to December 2017 in the Paris region (France), the North Holland region (the Netherlands), the Stockholm region (Sweden), and in all of Denmark. RESULTS The average annual incidence of SCD in the 4 registries ranged from 36.8 per 100,000 (95% CI: 23.5-50.1 per 100,000) to 39.7 per 100,000 (95% CI: 32.6-46.8 per 100,000). When extrapolating to each European country and accounting for age and sex, this yields to 249,538 SCD cases per year (95% CI: 155,377-343,719 SCD cases per year). The average annual incidence of OHCA in the 4 registries ranged from 47.8 per 100,000 (95% CI: 21.2-74.4 per 100,000) to 57.9 per 100,000 (95% CI: 19.6-96.3 per 100,000), corresponding to 343,496 OHCA cases per year (95% CI: 216,472-464,922 OHCA cases per year) in the European Union. Incidence rates of SCD and OHCA increased with age and were systematically higher in men compared with women. CONCLUSIONS By combining data from 4 large, population-based registries with at least 5 years of data collection, this study provided an estimate of the incidence of SCD and OHCA in the European Union. (C) 2022 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.

The constitutional framework of Brussels is characterized by a plethora of different governing bodies and an excessive fragmentation of competences. Leaving the EU aside, the Brussels territory is governed by no less than six governments with formal legislative power. The fragmented division of powers between the federal State, the Brussels-Capital Region and the Communities, and the 19 Brussels municipalities, impedes an efficient and coherent metropolitan governance. This chapter explores the relationship between different echelons of government in Brussels, the type and scope of autonomous powers of the Capital Region and its special position as the capital of Belgium. Section 4.2 elaborates on the main characteristics and some of the fundamental flaws of Brussels' constitutional framework. Section 4.3 proposes to simplify Brussels' complicated multilayered institutional framework by reinforcing the Brussels-Capital Region. The proposal consists of a combination of the transfer of certain community competences to the regional level and an integration of the municipalities in the Region, allowing the latter to develop a uniform and integrated policy for the entire territory of Brussels.

Background The use of anabolic androgenic steroids (AAS) and associated image and performance enhancing drugs (IPEDs) is now a global phenomenon. There is a need to develop evidence to support the development of interventions to prevent the commencement of use, to minimise the potential harms or to support those in their cessation of use. While the United Kingdom (UK) is no exception to this issue, its public health and legislative response to the phenomenon differs to other countries and requires the examination of research specific to the UK. Therefore, a scoping review has been conducted to examine the recent relevant literature to help inform the development and evaluation of effective interventions to reduce the harmful use of IPEDs. Methods A comprehensive search strategy was developed for multiple bibliographic databases, supported by and iterative citation searching process and complimented by expert input from the Anabolic Steroid UK Network. Research conducted by or UK academics or within the UK were eligible, if published in the previous five years. Results In total 87 eligible outputs were identified, including 26 review articles, 25 qualitative papers and 24 quantitative papers. together with small numbers of clinical studies/case reports (6) and commentaries/correspondence (6). The most common topics of research were public health, treatment and harm reduction (41), followed by studies focusing on epidemiology, sub-groups of people using IPEDs and motivations for use (34). The studies illustrated the diverse populations of people who use a range of enhancement drugs including concomitant psychoactive drug use. A number of papers focused on blood borne viruses and associated issues, while others reported on the uptake of needle and syringe programmes. No effectiveness evaluations related to any aspect of treatment, harm reduction or other intervention were published during study period. Conclusion There is a need for the development of effectiveness evaluations of current interventions and any future service provision for people using image and performance enhancing drugs. While there have been no studies of this nature to date, this review illustrates the rich data that has been gathered through diverse methodologies, that will assist in the development of future effectiveness evaluations.

The impacts of fisheries on ocean resources are no longer considered in isolation but should account for broader ecosystem effects. However, ongoing ecosystem-wide changes added to the inherent dynamics of marine ecosystems, create challenges for fisheries and fisheries management by affecting our ability to ensure future fishing opportunities and sustainable use of the seas. By reviewing a corpus of fisheries science literature, we contribute to informing managers and policymakers with considerations of the various threats to fisheries and the marine ecosystems that support them. We identify and describe 25 ecosystem challenges and 7 prominent families of management options to address them. We capture the challenges acting within three broad categories: (i) fishing impacts on the marine environments and future fishing opportunities, (ii) effects of environmental conditions on fish and fishing opportunities, and (iii) effects of context in terms of socioeconomics, fisheries management, and institutional set-up on fisheries. Our review shows that, while most EU fisheries are facing a similar array of challenges, some of them are specific to regions or individual fisheries. This is reflected in selected regional cases taking different perspectives to exemplify the challenges along with fishery-specific cases. These cases include the dramatic situation of the Baltic Sea cod, facing an array of cumulative pressures, the multiple and moving ecosystem interactions that rely on the North Sea forage fish facing climate change, the interaction of fishing and fish stocks in a fluctuating mixed fishery in the Celtic Sea, the bycatch of marine mammals and seabirds and habitat degradation in the Bay of Biscay, and finally the under capacity and lack of fundamental knowledge on some features of the EU Outermost Regions. In addition to these ecoregion specific findings, we discuss the outcomes of our review across the whole of European waters and we conclude by recognizing that there are knowledge gaps regarding the direction ...

In the field of Arctic health, "resilience" is a concept used to describe the capacity to recover from adversities. The term is widely used in Arctic policy contexts; however, Arctic peoples and communities question whether "resilience" is an appropriate term to describe the human dimensions of health and wellbeing in the Arctic as it is currently applied. A scoping review of peer-reviewed and gray literature was conducted. We used searchable databases, Google Scholar, and Dartmouth College Library Services, to select studies conducted between 2000 and 2019 and key documents from the Arctic Council and other relevant organization and government entities. A scoping review framework was followed, and consultation among the authors provided initial scope, direction, and verification of findings. Analyses identified over- and underrepresented key thematic areas in the literature on human resilience in Arctic communities. Areas of overrepresentation in the literature included ecosystem, climate change, and environmental sciences. Areas that were underrepresented in the literature included health, medicine, wellness or well-being, and community voices on the topic of human resilience. Results indicated that "resilience" as a concept was applied across a diversity of contexts and subject areas in the Arctic and that this may have repercussions for understanding the human dimension of "resilience" and community expressions of well-being. Alternative terms and concepts with which Northern community members more closely identify could be used to more respectfully and accurately advance research in areas such as epidemiology, community health and well-being, and particularly Indigenous peoples' health.

BackgroundOverweight and obesity are problems that are increasing globally in both children as well as adults, and may be prevented by adopting a healthier lifestyle. Lifestyle coaches counsel overweight and obese children (and their parents) as well as adults in initiating and maintaining healthier lifestyle behaviours. It is currently unclear whether this novel professional in the Dutch health care system functions as a linchpin in networks that evolve around lifestyle-related health problems. The aim of the present study is to investigate the formation and development of networks of lifestyle coaches and their positions within these networks.MethodsIn this longitudinal study, key professionals and professionals within relevant organisations in the Coaching on Lifestyle (CooL) care networks were asked to fill in three online questionnaires. Respondents were asked to indicate whether they collaborated with each of the specified professionals in the context of CooL. The overall network structures and the central role of the lifestyle coaches were examined by using network analysis.ResultsThe results showed that the networks in three out of four regions were relatively centralised, but that none of the networks were dense, and that the professionals seemed to collaborate less with others over time. Half of the lifestyle coaches had a high number of collaborations and a central position within their networks, which also increased over time. In half of the regions, the lifestyle coaches had increased their role as consultants, while their role as gatekeeper and liaison decreased over time. In most regions, the sector of lifestyle coaches had a central position in their networks in just one measurement. Other central sectors were the local sports organisation, public health services, youth health care and the municipal government.ConclusionsOverall, we cannot conclude that more central and denser networks were formed during the study period. In addition, the lifestyle coaches were not often positioned as a central ...

Objectives: To describe and compare euthanasia and physician-assisted suicide (EAS) practice in Flanders, Belgium (BE), the Netherlands (NL) and Switzerland (CH). Methods: Mortality follow-back surveys among attending physicians of a random sample of death certificates. Results: We studied 349 EAS deaths in BE (4.6% of all deaths), 851 in NL (4.6% of all deaths) and 65 in CH (1.4% of all deaths). People who died by EAS were mostly aged 65 or older (BE: 81%, NL: 77% and CH: 71%) and were mostly diagnosed with cancer (BE: 57% and NL: 66%). Home was the most common place of death in NL (79%), while in BE and CH, more variation was found regarding to place of death. The decision to perform EAS was more frequently discussed with a colleague physician in BE (93%) and NL (90%) than in CH (60%). Conclusions: EAS practice characteristics vary considerably in the studied countries with legal EAS. In addition to the legal context, cultural factors as well as the manner in which legislation is implemented play a role in how EAS legislation translates into practice.

The COVID-19 pandemic placed hygiene at the centre of disease prevention. Yet, access to the levels of water supply that support good hand hygiene and institutional cleaning, our understanding of hygiene behaviours, and access to soap are deficient in low, middle and high income countries. This paper reviews the role of water, sanitation and hygiene (WaSH) in disease emergence, previous outbreaks, combatting COVID-19, and in preparing for future pandemics. We consider settings where these factors are particularly important and identify key preventive contributions to disease control and gaps in the evidence base. Urgent substantial action is required to remedy deficiencies in WaSH, particularly the provision of reliable, continuous piped water on-premises for all households and settings. Hygiene promotion programmes, underpinned by behavioural science, must be adapted to high risk populations (such as the elderly and marginalised) and settings (such as health care facilities, transport hubs and workplaces). WaSH must be better integrated in preparation plans and with other sectors in prevention efforts. More finance and better use of financing instruments would extend and improve WaSH services. The lessons outlined justify no-regrets investment by government in response to and recovery from the current pandemic; to improve day-to-day lives and as preparedness for future pandemics.

This paper focuses on the availability of economic indicators and metrics to assess effects of marine aquaculture production in the North Atlantic area (the EU, Norway, Canada and USA), including also social and environmental effects. We consider how aquaculture planning and management is organised in the different countries and the usefulness of economic information to address different aquaculture-related policies. We find that the most relevant economic data for aquaculture management should be at the local and regional levels rather than nationally. The availability of such economic data is mapped for national, regional and local level. The focus is on data that are publicly available from authorities or research institutions. The availability of data is generally fairly good for national and regional data on the direct economic effects of aquaculture. Data on how aquaculture-related products or input markets are affected are however poorly available, as are economic data on external effects from aquaculture. Countries with a larger aquaculture sector tend to have better availability of aquaculture-related economic data than those with a smaller sector. An index is developed and calculated to show more specifically where the countries have relatively good or poor data availability compared to their needs. While it will not always be cost-effective or meaningful to collect economic data on the effects of aquaculture, our study indicates that several countries could benefit from expanding such data collection. It can make trade-off decisions more consistent and easier to perform, and aquaculture policies and measures can be better tailored to specific contexts.

Background: While effective interventions have been developed to support families where a parent has a mental illness in Adult Mental Health Services, embedding and sustaining them is challenging resulting in families not having access to support. This study developed an explanatory model of influencers that had enabled sustainability of the Let's Talk intervention in one service. Methods: A participatory case study was used to build an explanatory model of sustainability at the service using theoretical frameworks. Qualitative and quantitative data was collected about practitioner's practice and the organisation's implementation process and capacity to support practice. A local research group worked with the researcher using a transforming data approach through description, analysis and interpretation. Results: Influencers were grouped into four major categories: (1) External social, political and financial context, (2) Resources, (3) Prior organisational capacity and (4) Sustainability Factors. The last category, Sustainability factors, was divided into three subcategories: (4.1) Practitioner (4.2) Organisation and (4.3) Parent-Client. These categories form part of an explanatory model for the key influencers of continued practitioner practice and organisational capacity to support practice. Conclusions and implications for practice: In this case study, the pre-existing organisational context along with practitioner, organisation and parent-client factors operated together to influence sustainability. The results suggest that sustainability is more likely to be supported by both linking Let's Talk to existing organisational identity, capacity, structures and relationships and by supporting mutual adaptations to improve the fit. Additionally, by understanding that setbacks are common and ongoing adjustments are needed, implementers are able to have realistic expectations of sustainability.

The COVID-19 pandemic placed hygiene at the centre of disease prevention. Yet, access to the levels of water supply that support good hand hygiene and institutional cleaning, our understanding of hygiene behaviours, and access to soap are deficient in low, middle and high income countries. This paper reviews the role of water, sanitation and hygiene (WaSH) in disease emergence, previous outbreaks, combatting COVID-19, and in preparing for future pandemics. We consider settings where these factors are particularly important and identify key preventive contributions to disease control and gaps in the evidence base. Urgent substantial action is required to remedy deficiencies in WaSH, particularly the provision of reliable, continuous piped water on-premises for all households and settings. Hygiene promotion programmes, underpinned by behavioural science, must be adapted to high risk populations (such as the elderly and marginalised) and settings (such as health care facilities, transport hubs and workplaces). WaSH must be better integrated in preparation plans and with other sectors in prevention efforts. More finance and better use of financing instruments would extend and improve WaSH services. The lessons outlined justify no-regrets investment by government in response to and recovery from the current pandemic; to improve day-to-day lives and as preparedness for future pandemics.

The scope and potential of personalised health care are underappreciated and underrealised, often because of resistance to change. The consequence is that many inadequacies of health care in Europe persist unnecessarily, and many opportunities for improvement are neglected. This article identifies the principal challenges, outlines possible approaches to resolving them, and highlights the benefits that could result from greater adoption of personalised health care. It locates the discussion in the context of European policy, focusing particularly on the most recent and authoritative reviews of health care in the EU Member States, and on the newly acquired spirit of readiness and pragmatism among European officials to embrace change and innovative technologies in a new decade. It highlights the attention now being given by policymakers to incentives, innovation, and investment as levers to improve European citizens' prospects in a rapidly evolving world, and how these distinct and disruptive themes contribute to a renaissance in thinking about delivering optimal health care in Europe. It explores the chances offered to patients by specific initiatives in health domains such as cancer and antimicrobial resistance, and by innovative science, novel therapies, earlier diagnosis tools, and deeper understanding of health promotion and prevention. And it reflects on how health care providers could benefit from a shift towards better primary care and towards deploying health data more effectively, including the use of artificial intelligence, coupled with a move to a smoother organisational/regulatory structure and realigned professional responsibilities. The conclusion is that preparing Europe's health care systems for the inevitable strains of the coming years is both possible and necessary. A more courageous approach to embracing personalised health care could guarantee the sustainability of Europe's health care systems before rising demands and exponential costs overwhelm them - an exercise in future-proofing, in ensuring that they are equipped to withstand whatever lies ahead. A focus on the potential and implementation of personalised care would permit more efficient use of resources and deliver better quality health-preserving care.

The Sustainable Development Goals (SDGs) adopted by the United Nations General Assembly in September 2015 include a target on land degradation neutrality (LDN) (SDG 15.3). Attaining and maintaining LDN requires addressing a land governance challenge to steer land management towards avoiding, reducing and reversing land degradation. Uptake of LDN can be catalysed by creating an enabling environment for LDN and by designing and implementing measures that achieve multiple benefits through safeguarding and enhancing well-being and livelihoods of people affected by land degradation while improving a range of environmental conditions. This report provides science-based evidence on the configuration of the enabling environment for LDN and the opportunities for multiple benefits. Three approaches are used to delineate the evidence base. First, a literature review summarizes contemporary trends in land governance and land markets, and assesses the implications for LDN. Second, a survey among practitioners and experts involved in the LDN process gauges their perceptions and expectations about the enabling environment, multiple benefits and general progress of LDN. Third, a review of LDN Target Setting Programme (TSP) country reports contextualizes the results from the survey. Insights from these sources are triangulated to formulate key messages and policy options. These highlight the multidimensional nature of the LDN enabling environment, which requires enhanced vertical and horizontal integration of institutions and governance mechanisms. Further, land governance and secure land tenure need to be adapted to local conditions. Evidence highlights the dynamics of land governance and the increasing impacts of global value chains on local land management, providing both challenges and opportunities for LDN implementation. LDN stakeholders have high expectations for multiple well-being and livelihood benefits to be attained through LDN implementation. Evidence indicates that the level of achieved multiple benefits strongly depends on contextual conditions. Therefore, making assessments of the prevailing political, social, economic and cultural dimensions that characterize a target area or country is needed to better align LDN with other national targets.