Suchergebnisse

Objectives: To estimate the prevalence, awareness, treatment and control of hypertension, diabetes and hypercholesterolaemia in an Angolan population aged 15 to 64 years and to determine relationships with sociodemographic, behavioural and anthropometric characteristics. Methods: A total of 2 354 individuals were assessed for behavioural, sociodemographic and physical characteristics in a cross-sectional, community-based survey. Post-stratification survey weights were applied to obtain prevalence levels. Adjusted odds ratios for each variable related to the conditions were calculated using logistic regression models. Results: Overall, the prevalence of hypertension was 18.0%, diabetes 9.2% and hypercholesterolaemia 4.0%. Among hypertensive individuals, the awareness rate was 48.5%; 15.8% were on treatment and 9.1% had their blood pressure controlled. Only 10.8% were aware they had diabetes, 4.5% were on treatment and 2.7% were controlled. The awareness level for hypercholesterolaemia was 4.2%, with 1.4% individuals on treatment and 1.4% controlled. Conclusion: The prevalence levels of hypertension and diabetes, which were higher than previous findings for the region, together with the observed low rates of awareness, treatment and control of all conditions studied, constitute an additional challenge to the regional health structures, which must rapidly adapt to the epidemiological shift occurring in this population. ; This study was funded by the promoters of the CISA as follows: Camões, Institute of Cooperation and Language, Portugal; Calouste Gulbenkian Foundation, Portugal; Government of Bengo Province, Angola; and the Angolan Ministry of Health. Also, the Eduardo dos Santos Foundation, Angola and the Institute of Public Health of the University of Porto, Portugal (ref UID/DTP/04750/2013) funded this study. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

There is concern about the potentially increasing use of tobacco in Angola. However, information on the frequency and determinants of this use is not systematised. This study aimed to estimate the prevalence of tobacco consumption and nicotine dependence among smokers in an Angolan population and considering individual socio-demographic and behavioural characteristics. A community-based survey with 2,472 respondents (age range: 15–64 years) was conducted in 2013–2014 in the country's Bengo Province. The collection methodology for assessing each type of tobacco consumption and its daily quantification followed the World Health Organization STEPwise approach to chronic disease risk factor surveillance. The Fagerström Test for Nicotine Dependence was also used to assess smokers. Mean values for prevalence of tobacco use and nicotine dependence were estimated by sex and by previously defined variables. Daily smoking (6.1%) was found to be higher for males (10.0%) them among females (2.6%), and the amount of ex-smokers (7.5%) was higher them smokers. Only 0.2% of those surveyed reported use of smokeless (chewing) tobacco. One-third of ever-smokers reported having started smoking daily before age 18. Nicotine dependence levels were classified as very low or low in 83.6% of the smokers. Daily smoking prevalence increased with age, and was higher in rural areas and among individuals with no formal education, lower incomes, and alcohol consumption. This population presented a low smoking prevalence, along with a low number of daily smoked cigarettes and low levels of nicotine dependency, despite the low prices of, and easy access to, manufactured cigarettes. These two factors conjugated with the current absence of an Angolan policy for tobacco control, enhance the susceptibility for rising overall tobacco use in the near future. ; This work was supported by the promoters of the CISA as follows: Camões, Institute of Cooperation and Language, Portugal (www.instituto-camoes.pt/en/); Calouste Gulbenkian Foundation, Portugal (https://gulbenkian.pt/en/); Government of Bengo Province; Angolan Ministry of Health (www.minsa.gov.ao), and also the Eduardo dos Santos Foundation, Angola (www.fesa.og.ao/) and the EPIUnit, Institute of Public Health, University of Porto, Portugal (http://ispup.up.pt; ref UID/DTP/04750/2013). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

BackgroundThe WHO identified the importance of macro-socioeconomic determinants and political context as interlinked key factors affecting healthcare quality and health equity. As a response to the recent economic and financial crisis, Portugal approved in 2011 the Economic Adjustment Programme (EAP) to obtain financial assistance from the Troika in order to reduce public debt. This study aims to analyse the impact of the economic crisis and the EAP on perinatal healthcare quality for very preterm (VPT) and/or very low birth weight (VLBW) infants, as perceived by healthcare professionals and experts, within the health administrative regions of the two major metropolitan areas in Portugal.MethodsA qualitative approach was applied to receive an in-depth understanding and accomplish perspective variability. A purposive sampling technique was used. Semi-structured interviews were conducted with twenty-one healthcare professionals and experts between October 2018-July 2019. Inductive thematic analysis was performed which encompassed a five-step categorization procedure. Data analysis was undertaken by utilizing Nvivo2011 software. Evolved themes were then associated with WHO's Quality Standards on Maternal and New-born Care. A framework on the impact of macro-socioeconomic determinants on perinatal health care quality was developed.ResultsAlthough participants did not perceive the quality of perinatal care had deteriorated, the analysis of their accounts on work experience revealed that it was indeed adversely modified in all WHO Quality Standards. Health care provision was perceived as detrimental in five main areas: 1) Availability of human resources; 2) Functional referral systems; 3) Competent and motivated human resources; 4) Emotional support; and 5) Essential physical resources available. Policy reforms by the EAP resulted in reduced timeliness of care, increased waiting times, cuts in sequence and duration of consultations, and deficiencies in follow-up care for VPT/VLBW infants and their mothers. The EAP ...

Background: The World Health Organization recommends exclusive breast milk feeding until 6 months and continuing up to 2 years of age; little is known about whether very preterm infants are fed in accordance with these recommendations. We aimed to describe the prevalence and duration of breast milk feeding in very preterm children and to systematically review internationally published data. Methods: We evaluated breast milk feeding initiation and duration in very preterm children born in 2 Portuguese regions (2011‐2012) enrolled in the EPICE cohort and followed‐up to the age of 3 (n = 466). We searched PubMed® from inception to January 2017 to identify original studies reporting the prevalence and/or duration of breast milk feeding in very preterm children. Results: 91.0% of children received some breast milk feeding and 65.3% were exclusively breast fed with a median duration of 2 months for exclusive and 3 months for any breast milk; only 9.9% received exclusive breast milk for at least 6 months, 10.2% received any breast milk for 12 months or more, and 2.0% for up to 24 months. The literature review identified few studies on feeding after hospital discharge (n = 9); these also reported a low prevalence of exclusive breast milk feeding at 6 months (1.0% to 27.0%) and of any breast milk at 12 months (8.0% to 12.0%). Conclusions: The duration of breast milk feeding among Portuguese very preterm infants was shorter than recommended. However, this appears to be common globally. Research is needed to inform strategies to promote continued breast milk feeding. ; This study was funded by the European Union Seventh Framework Programme (FP7/2007‐2013) under grant agreement no. 259882. This study was also funded by FEDER through the Operational Programme Competitiveness and Internationalization and national funding from the Foundation for Science and Technology—FCT (Portuguese Ministry of Science, Technology and Higher Education), under the Unidade de Investigação em Epidemiologia—Instituto de Saúde Pública da ...

AbstractFunctional health is arguably one of the most important health indicators for older adults, because it assesses physical, cognitive and social functions in combination. However, life-course circumstances may impact this multidimensional construct. The aim of the present study was to assess the relationship between life-course socio-economic status (SES) and different dimensions of functional health in older adults. Data on 821 Portuguese adults aged 50 years and over in 2013–2015 were analysed. Life-course SES was computed using participants' paternal occupation (non-manual (nm); manual (m)) and own occupation (nm; m), resulting in four patterns: stable high (nm + nm), upward (m + nm), downward (nm + m) and stable low (m + m). Functional health included physical and mental functioning, cognitive function, handgrip strength, and walking speed. Linear (beta coefficients) and logistic regressions (odds ratios) were used to estimate the association between life-course SES and functional health.Overall, those who accumulated social disadvantage during life-course presented worse functional health than those with stable high SES (stable low – SF-36 physical functioning: β = −9.75; 95% CI: −14.34; −5.15; SF-36 mental health: β = −7.33; 95% CI: −11.55; −3.11; handgrip strength: β = −1.60; 95% CI: −2.86; −0.35; walking time, highest tertile: OR = 5.28; 95% CI: 3.07; 9.09). Those with an upward SES were not statistically different from those in the stable high SES for most of the health outcomes; however, those with an upward SES trajectory tended to have higher odds of cognitive impairment (OR = 1.75; 95% CI: 0.96; 3.19). A downward SES trajectory increased the odds of slower walking speed (OR = 4.62; 95% CI: 1.78; 11.95). A disadvantaged life-course SES impacts older adults' physical and mental functioning. For some outcomes, this was attenuated by a favourable adulthood SES but those with a stable low SES consistently presented worse functional health.

Background: The WHO identified the importance of macro-socioeconomic determinants and political context as interlinked key factors affecting healthcare quality and health equity. As a response to the recent economic and financial crisis, Portugal approved in 2011 the Economic Adjustment Programme (EAP) to obtain financial assistance from the Troika in order to reduce public debt. This study aims to analyse the impact of the economic crisis and the EAP on perinatal healthcare quality for very preterm (VPT) and/or very low birth weight (VLBW) infants, as perceived by healthcare professionals and experts, within the health administrative regions of the two major metropolitan areas in Portugal. Methods: A qualitative approach was applied to receive an in-depth understanding and accomplish perspective variability. A purposive sampling technique was used. Semi-structured interviews were conducted with twenty-one healthcare professionals and experts between October 2018–July 2019. Inductive thematic analysis was performed which encompassed a five-step categorization procedure. Data analysis was undertaken by utilizing Nvivo2011 software. Evolved themes were then associated with WHO's Quality Standards on Maternal and New-born Care. A framework on the impact of macro-socioeconomic determinants on perinatal health care quality was developed. Results: Although participants did not perceive the quality of perinatal care had deteriorated, the analysis of their accounts on work experience revealed that it was indeed adversely modified in all WHO Quality Standards. Health care provision was perceived as detrimental in five main areas: 1) Availability of human resources; 2) Functional referral systems; 3) Competent and motivated human resources; 4) Emotional support; and 5) Essential physical resources available. Policy reforms by the EAP resulted in reduced timeliness of care, increased waiting times, cuts in sequence and duration of consultations, and deficiencies in follow-up care for VPT/VLBW infants and their mothers. The EAP directly influenced working environment of healthcare professionals by causing stress, burnout, work absence, and brain drain. Conclusion: An interrelation between macro-socioeconomic determinants and perinatal health care quality was disclosed. The economic crisis and EAP have adversely modified equitable perinatal health care quality for VPT/VLBW infants and their mothers. Our findings underlined the negative impact of austerity policies on vulnerable populations.

Background: The WHO identified the importance of macro-socioeconomic determinants and political context as interlinked key factors affecting healthcare quality and health equity. As a response to the recent economic and financial crisis, Portugal approved in 2011 the Economic Adjustment Programme (EAP) to obtain financial assistance from the Troika in order to reduce public debt. This study aims to analyse the impact of the economic crisis and the EAP on perinatal healthcare quality for very preterm (VPT) and/or very low birth weight (VLBW) infants, as perceived by healthcare professionals and experts, within the health administrative regions of the two major metropolitan areas in Portugal. Methods: A qualitative approach was applied to receive an in-depth understanding and accomplish perspective variability. A purposive sampling technique was used. Semi-structured interviews were conducted with twenty-one healthcare professionals and experts between October 2018–July 2019. Inductive thematic analysis was performed which encompassed a five-step categorization procedure. Data analysis was undertaken by utilizing Nvivo2011 software. Evolved themes were then associated with WHO's Quality Standards on Maternal and New-born Care. A framework on the impact of macro-socioeconomic determinants on perinatal health care quality was developed. Results: Although participants did not perceive the quality of perinatal care had deteriorated, the analysis of their accounts on work experience revealed that it was indeed adversely modified in all WHO Quality Standards. Health care provision was perceived as detrimental in five main areas: 1) Availability of human resources; 2) Functional referral systems; 3) Competent and motivated human resources; 4) Emotional support; and 5) Essential physical resources available. Policy reforms by the EAP resulted in reduced timeliness of care, increased waiting times, cuts in sequence and duration of consultations, and deficiencies in follow-up care for VPT/VLBW infants and their mothers. The EAP directly influenced working environment of healthcare professionals by causing stress, burnout, work absence, and brain drain. Conclusion: An interrelation between macro-socioeconomic determinants and perinatal health care quality was disclosed. The economic crisis and EAP have adversely modified equitable perinatal health care quality for VPT/VLBW infants and their mothers. Our findings underlined the negative impact of austerity policies on vulnerable populations. ; info:eu-repo/semantics/publishedVersion

Purpose: Elder abuse is an issue of great concern world‐wide, not least in Europe. Older people are increasingly vulnerable to physical, psychological, financial maltreatment and sexual coercion. However, due to complexities of measurement, psychological abuse may be underestimated. The purpose of this study is to investigate the prevalence of psychological abuse toward older persons within a 12 month period. Design/methodology/approach: The study design was cross‐sectional and data were collected during January‐July 2009 in the survey "Elder abuse: a multinational prevalence survey, ABUEL". The participants were 4,467 randomly selected persons aged 60‐84 years (2,559 women, 57.3 per cent) from seven EU countries (Germany, Greece, Italy, Lithuania, Portugal, Spain, Sweden). The sample size was adapted to each city according to their population of women and men aged 60‐84 years (albeit representative and proportional to sex‐age). The participants answered a structured questionnaire either through a face‐to‐face interview or a mix of interview/self‐response. The data were analysed using descriptive statistics and regression methods. Findings: The prevalence of overall psychological abuse was 29.7 per cent in Sweden, followed by 27.1 per cent in Germany; 24.6 per cent in Lithuania and 21.9 per cent in Portugal. The lowest prevalence was reported in Greece, Spain and Italy with 13.2 per cent, 11.5 per cent and 10.4 per cent, respectively. Similar tendencies were observed concerning minor/severe abuse. The Northern countries (Germany, Lithuania, Sweden) compared to Southern countries (Greece, Italy, Portugal, Spain) reported a higher mean prevalence (across countries) of minor/severe abuse (26.3 per cent/11.5 per cent and 12.9 per cent/5.9 per cent, respectively). Most perpetrators (71.2 per cent) were spouses/partners and other relatives (e.g. children). The regression analysis indicated that being from Greece, Italy, Portugal and Spain was associated with less risk of psychological abuse. Low social support, living in rented housing, alcohol use, frequent health care use, and high scores in anxiety and somatic complaints were associated with increased risk of psychological abuse. Social implications: Psychological abuse was more prevalent in Northern than Southern countries and factors such as low social support and high anxiety levels played an important role. Further studies are warranted to investigate the prevalence of psychological abuse and risk factors among older persons in other EU countries. Particular attention should be paid to severe abuse. Such research may help policy makers and health planers/providers in tailoring interventions to tackle the ever growing problem of elder abuse. Originality/value: The paper reports data from the ABUEL Survey, which collected population based data on elderly abuse.

This is the final evaluation report of the Missed Opportunities in Maternal and Infant Health (MOMI) project, funded under the European Union (EU) 7th Framework Prograame (FP7). The project took place from February 2011 to January 2016.

Objective To investigate the variation in severe neonatal morbidity among very preterm (VPT) infants across European regions and whether morbidity rates are higher in regions with low compared with high mortality rates. Design Area-based cohort study of all births before 32 weeks of gestational age. Setting 16 regions in 11 European countries in 2011/2012. Patients Survivors to discharge from neonatal care (n=6422). Main outcome measures Severe neonatal morbidity was defined as intraventricular haemorrhage grades III and IV, cystic periventricular leukomalacia, surgical necrotizing enterocolitis and retinopathy of prematurity grades ≥3. A secondary outcome included severe bronchopulmonary dysplasia (BPD), data available in 14 regions. Common definitions for neonatal morbidities were established before data abstraction from medical records. Regional severe neonatal morbidity rates were correlated with regional in-hospital mortality rates for live births after adjustment on maternal and neonatal characteristics. Results 10.6% of survivors had a severe neonatal morbidity without severe BPD (regional range 6.4%–23.5%) and 13.8% including severe BPD (regional range 10.0%–23.5%). Adjusted inhospital mortality was 13.7% (regional range 8.4%–18.8%). Differences between regions remained significant after consideration of maternal and neonatal characteristics (P<0.001) and severe neonatal morbidity rates were not correlated with mortality rates (P=0.50). Conclusion Severe neonatal morbidity rates for VPT survivors varied widely across European regions and were independent of mortality rates. ; The research leading to these results received funding from the European Union's Seventh Framework Programme (FP7/2007-2013) under grant agreement n°259882. Additional funding is acknowledge from the following regions: France (French Institute of Public Health Research/Institute of Public Health and its partners the French Health Ministry, the National Institute of Health and Medical Research, the National Institute of Cancer, ...

Objective: To explore international variations in the management and survival of extremely low gestational age and birthweight births. Design Area-based prospective cohort of births: Setting 12 regions across Belgium, France, Italy, Portugal and the UK. Participants: 1449 live births and fetal deaths between 22+0 and 25+6 weeks gestation born in 2011–2012. Main outcome measures: Percentage of births; recorded live born; provided antenatal steroids or respiratory support; surviving to discharge (with/without severe morbidities). Results: The percentage of births recorded as live born was consistently low at 22 weeks and consistently high at 25 weeks but varied internationally at 23 weeks for those weighing 500 g and over (range 33%–70%) and at 24 weeks for those under 500 g (range 5%–71%). Antenatal steroids and provision of respiratory support at 22–24 weeks gestation varied between countries, but were consistently high for babies born at 25 weeks. Survival to discharge was universally poor at 22 weeks gestation (0%) and at any gestation with birth weight <500 g, irrespective of treatment provision. In contrast, births at 23 and 24 weeks weighing 500 g and over showed significant international variation in survival (23 weeks: range: 0%–25%; 24 weeks range: 21%–50%), reflecting levels of treatment provision. Conclusions: Wide international variation exists in the management and survival of extremely preterm births at 22–24 weeks gestation. Universally poor outcomes for babies at 22 weeks and for those weighing under 500 g suggest little impact of intervention and support the inclusion of birth weight along with gestational age in ethical decision-making guidelines. ; The research leading to these results received funding from the European Union's Seventh Framework Programme ((FP7/2007–2013)) under grant agreement n°259882. Additional funding was received in the following region: France (French Institute of Public Health Research/Institute of Public Health and its partners the French Health Ministry, the National Institute of Health and Medical Research, the National Institute of Cancer and the National Solidarity Fund for Autonomy; grant ANR-11-EQPX-0038 from the National Research Agency through the French Equipex Program of Investments in the Future and the PremUp Foundation). UK (funding for The Neonatal Survey from Neonatal Networks for East Midlands and Yorkshire and Humber regions). The funders had no role in study design; in the collection, analysis and interpretation of data; in the writing of the report or in the decision to submit the article for publication. LKS is funded by a National Institute for Health Research Career Development Fellowship. This article presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR or the Department of Health.

Breast milk feeding (BMF) is associated with lower neonatal morbidity in the very preterm infant (<32 weeks gestation) and breastfeeding is beneficial for maternal health. Previous studies show large variations in BMF after very preterm birth and recognize the need for targeted breastfeeding support in the neonatal intensive care units (NICU). In a European collaboration project about evidence‐based practices after very preterm birth, we examined the association between maternal, obstetric, and infant clinical factors; neonatal and maternal care unit policies; and BMF at discharge from the NICU. In multivariable analyses, covariates associated with feeding at discharge were first investigated as predictors of any BMF and in further analysis as predictors of exclusive or partial BMF. Overall, 58% (3,826/6,592) of the infants received any BMF at discharge, but there were large variations between regions (range 36–80%). Primiparity, administration of antenatal corticosteroids, first enteral feed <24 hr after birth, and mother's own milk at first enteral feed were predictors positively associated with any BMF at discharge. Vaginal delivery, singleton birth, and receiving mother's own milk at first enteral feed were associated with exclusive BMF at discharge. Units with a Baby Friendly Hospital accreditation improved any BMF at discharge; units with protocols for BMF and units using donor milk had higher rates of exclusive BMF at discharge. This study suggests that there is a high potential for improving BMF through policies and support in the NICU. ; European Union's Seventh Framework Program ([FP7/2007‐2013]). Grant Number: n°259882; Stockholm County Council Clinical Research appointment (AKEB); Swedish Order of Freemasons in Stockholm, Sweden (EW); The Portuguese Foundation for Science and Technology funds the Epidemiology Research Unit of the Institute of Public Health of the University of Porto (UID/DTP/04750/2013), Portugal. Grant Number: SFRH/BD/111794/2015 (CR)

Aggregated data from the Euro-Peristat project can be downloaded from the project's website: www.europeristat.com. A full list of contributors to the European Perinatal Health Report: Health and Care of Pregnant Women and Babies in Europe in 2010 can be found online. ; Background International comparisons of stillbirth allow assessment of variations in clinical practice to reduce mortality. Currently, such comparisons include only stillbirths from 28 or more completed weeks of gestational age, which underestimates the true burden of stillbirth. With increased registration of early stillbirths in high-income countries, we assessed the reliability of including stillbirths before 28 completed weeks in such comparisons. Methods In this population-based study, we used national cohort data from 19 European countries participating in the Euro-Peristat project on livebirths and stillbirths from 22 completed weeks of gestation in 2004, 2010, and 2015. We excluded countries without national data for stillbirths by gestational age in these periods, or where data available were not comparable between 2004 and 2015. We also excluded those countries with fewer than 10 000 births per year because the proportion of stillbirths at 22 weeks to less than 28 weeks of gestation is small. We calculated pooled stillbirth rates using a random-effects model and changes in rates between 2004 and 2015 using risk ratios (RR) by gestational age and country. Findings Stillbirths at 22 weeks to less than 28 weeks of gestation accounted for 32% of all stillbirths in 2015. The pooled stillbirth rate at 24 weeks to less than 28 weeks declined from 0·97 to 0·70 per 1000 births from 2004 to 2015, a reduction of 25% (RR 0·75, 95% CI 0·65–0·85). The pooled stillbirth rate at 22 weeks to less than 24 weeks of gestation in 2015 was 0·53 per 1000 births and did not significantly changed over time (RR 0·97, 95% CI 0·80–1·16) although changes varied widely between countries (RRs 0·62–2·09). Wide variation in the percentage of all births occurring at 22 weeks to less than 24 weeks of gestation suggest international differences in ascertainment. Interpretation Present definitions used for international comparisons exclude a third of stillbirths. International consistency of reporting stillbirths at 24 weeks to less than 28 weeks suggests these deaths should be included in routinely reported comparisons. This addition would have a major impact, acknowledging the burden of perinatal death to families, and making international assessments more informative for clinical practice and policy. Ascertainment of fetal deaths at 22 weeks to less than 24 weeks should be stabilised so that all stillbirths from 22 completed weeks of gestation onwards can be reliably compared. Funding EU Union under the framework of the Health Programme and the Bridge Health Project. ; The Euro-Peristat project received funding from the European Union under the framework of the Health Programme (grant numbers: 20101301, 2007114, 2003131) and the Bridge Health Project (665691). LKS is funded by a National Institute for Health Research Career Development Fellowship. This Article presents independent research funded by the National Institute for Health Research (NIHR). ; Peer-reviewed ; Post-print

Purpose The purpose of this paper is to evaluate socio-economic inequalities in the use, accessibility and satisfaction with health services amongst 60-84 year old people from seven European urban communities. Design/methodology/approach Data for this study were collected in 2009. The target population was people aged 60-84 years from Stuttgart (Germany), Athens (Greece), Ancona (Italy), Kaunas (Lithuania), Porto (Portugal), Granada (Spain) and Stockholm (Sweden). The total sample comprised 4,467 respondents with a mean response rate across these countries of 45.2 per cent. Findings The study demonstrated that the majority of respondents had contact with a health care provider within the last 12 months. The highest percentages were reported by respondents from Spain (97.8 per cent) and Portugal (97.7 per cent). The results suggest that 13.0 per cent of respondents had refrained from seeking care services. The highest rates were amongst seniors from Lithuania (24.0 per cent), Germany (16.2 per cent) and Portugal (15.4 per cent). Logistic regression suggests that seniors who refrained from seeking health care was statistically significant associated with those with higher levels of education (odds ratios (OR)=1.21; 95 per cent confidence intervals (CI)=1.01-1.25) and financial strain (OR=1.26; 95 per cent CI=1.16-1.37). Furthermore, the majority of respondents were satisfied with health care services. Originality/value The findings from the "Elder Abuse: a multinational prevalence survey" study indicate the existence of significant variations in use, accessibility and satisfaction with health services by country and for socio-economic factors related to organizing and financing of care systems.

Objective: To investigate changes in maternity and neonatal unit policies towards extremely preterm infants (EPTIs) between 2003 and 2012, and concurrent trends in their mortality and morbidity in ten European regions. Design: Population-based cohort studies in 2003 (MOSAIC study) and 2011/2012 (EPICE study) and questionnaires from hospitals. Setting: 70 hospitals in ten European regions. Population: Infants born at <27 weeks of gestational age (GA) in hospitals participating in both the MOSAIC and EPICE studies (1240 in 2003, 1293 in 2011/2012). Methods: We used McNemar's Chi2 test, paired t-tests and conditional logistic regression for comparisons over time. Main outcomes measures: Reported policies, mortality and morbidity of EPTIs. Results: The lowest GA at which maternity units reported performing a caesarean section for acute distress of a singleton non-malformed fetus decreased from an average of 24.7 to 24.1 weeks (P < 0.01) when parents were in favour of active management, and 26.1 to 25.2 weeks (P = 0.01) when parents were against. Units reported that neonatologists were called more often for spontaneous deliveries starting at 22 weeks GA in 2012 and more often made decisions about active resuscitation alone, rather than in multidisciplinary teams. In-hospital mortality after live birth for EPTIs decreased from 50% to 42% (P < 0.01). Units reporting more active management in 2012 than 2003 had higher mortality in 2003 (55% versus 43%; P < 0.01) and experienced larger declines (55 to 44%; P < 0.001) than units where policies stayed the same (43 to 37%; P = 0.1). Conclusions: European hospitals reporting changes in management policies experienced larger survival gains for EPTIs. ; The EPICE study received funding from the European Union's Seventh Framework Programme (FP7/2007–2013) under grant agreement n°259882. The MOSAIC study received funding from the European Union's Fifth Framework Programme (QLG4-CT-2001-01907).