A critic's note: Shakespeare in Central Europe

PurposeThis paper aims to assess how a hotel geographical location in different parts of Central and Eastern Europe influences the complexity of perception of pro-environmental behavior.Design/methodology/approachTo find out, whether hotel location in a specific country influences the complexity of environmental practices, this study used two closely connected multivariate statistical techniques analyzing gradients: principal components analysis and partial redundancy analysis. The research comprises data collection from seven countries in Central and Eastern Europe. In all, 25 randomly selected hotels (based on star rating) from various countries were approached to complete a questionnaire. Environmental practices were studied based on motivations, perception of barriers, perception of support from different levels of public sector, will of managers to promote pro-environmental measures based on sufficient funding, perception of legislation and perception of various other important factors.FindingsThe study reveals significant differences between hotels in Central Europe and Eastern Europe in the perception of the complexity in implementation of the environmental practices by hotel managers. The character of the present study, however, needs to address the identification of particular aspects that are relevant to the geographical differences among the studied countries.Research limitations/implicationsResearch was limited to a selection of Central and Eastern European (CEE) countries. There is still probability that managers in hotels from Poland and Croatia could possess different preferences. Other limitation of this study is that only special part of hotels were asked – hotels certified by star grading, out of our scope remained other hotels. It is also known that important factor is precise location of hotel within country – hotels in established tourism destination behave other way that those outside recreational areas. These factors deserve further study within this topic. There are many aspects of sustainability and environmental protection regarding hotel industry. As we have found in our principal correspondence analysis, different environmental measures were different location in biplot – some were affected by country, the other by star grading and affiliation to hotel chain. The complexity deserves to be studied in depth.Practical implicationsThe importance lies first in the identification of the aspects that are governed by geographical differences among the countries studied. These aspects are the initiatives and support from the government and the local governments, which counteract the perception that there is a lack of financial resources and the return on investments is slow. So, based on the data, which included information from various types of hotels from seven CEE countries, the activities of national and local authorities were identified to be the main differentiating variable. The support of the environment-friendly conduct of business in the hotel industry is appreciated by hotel managers from Central Europe. On the other hand, hotel managers from Eastern Europe do not feel any significant support from either national or other public institutions. The second factor of differentiation is represented by the perception of the lack of funds. Hotel managers from Eastern Europe feel strongly about funds limitation. The coherence of both those factors is obvious in the results, as they show the same direction but opposite orientation. It has already been discussed above. When looking at the results, the authors find the perception of availability of funds to be a fundamental difference between hotel management in Central Europe and in Eastern Europe. The lack of funds is perceived more intensively in Eastern Europe than in Central Europe, particularly because of a stronger awareness of direct or indirect support for such activities by national and other public institutions in Central Europe.Social implicationsThe differentiation of the aspects mentioned above comes from the social and culture policies, company policies and business cultures between these two sub-realms. Pro-environmental actions are apparently promoted less publicly in Eastern European countries than in Central European countries. The reaction to the trend for demand of greener hotels is stronger in the West, and its hotels are more likely to have legislation requirements and public support as an incentive to adopt pro-environmental measures in their business operations.Originality/valueThe study is based on data obtained from seven countries. The results revealed a problem of the macro-environmental influence on hotels’ potential to implement environmentally sustainable approaches and procedures throughout the industry.

REVIEWS I65 translation by Humphrey Tonkin. It provides details of daily life under the Nazis that have not frequentlybeen illuminated, especially the actions of the Arrow Cross; and it details how one family managed to escape deportation and death through both adhering to strict principles and deft improvisation- primarilythrough avoiding capturewith forged documents. It is, at bottom, a record of the impressions and even prejudices of its author: 'The Russians were a generally a good lot [. . .] and there was no reason to fear them, because they were decent guys, even if sometimes they were quick to anger' (p. 20I); the French in Hungary 'were devilishly smart and full of ideas' (p. I72). There are some outright historical errors, such as Soros's statement that Adolf Eichmann 'learned Yiddish and Hebrew' (p. I35) and that the attempted assassinationof Hitler on 20 July I944 'showed that the Germanpeople themselveshad had enough of the Hitler regime'(p. I23). Yet despite its occasional errors of fact, Maskerado is a fascinating glimpse of Hungarian Jewry as it was hunted and trapped by the Nazis and their accomplices. Above all Soros revealsthe bizarreentanglement of Hungarians andJews: A new decree from the Arrow Cross government required spouses of Aryans to move to the ghetto. In Hungary therewas a high level of assimilationand over time this had resultedin a great many mixed marriageswhere one partnerwas Christian and the other a converted or active Jew. The Jewish partner was known in Hungarian as an 'Aryan-spouse'(4ja-pada).Even Mrs Horthy was a descendant of such a Jewish-Gentile marriage, and so was the infamous anti-Semitic politician Bla Imredy. Up to now, members of mixed marriages had been exempted from the anti-Jewishregulations, but this now changed. New tragedies ensued. Sometimes , out of solidaritywith a marriage partner, the Gentile partner moved to the ghetto too, but therewas also a wave of suicides.(pp. I63-64) The Soros family succeeded in 'dancing around death,' but the vast majority of their co-religionists faced extermination. The fact that such a 'dance' was possible, however, makes Hungarian Jewry one of the more intriguing components of East Central European Jewry before the Holocaust. Department ofHebrew andJfewishStudies M. BERKOWITZ University College London Pynsent, Robert B. (ed). ThePhoney Peace.PowerandCulture in Central Europe I945-49. SSEES Occasional Papers, 46. School of Slavonic and East European Studies, London, 2000. xiv + 536 pp. Notes. Tables.Appendices .Index.?52.00 (paperback). SINCEI989 withtheopeningof archivesin CentralandEasternEuropethe possibilities forresearch intotheimmediate post-war yearsintheregionhave expanded enormously.Increasinglyhistoriesdominatedby politics and international relationsare beingcomplemented by workthatexaminesthe social dimensionsof war, reconstruction and dictatorshipin the region. Furthermore undertheimpactofthe'newcultural history'andthe'linguistic turn'in historicalwritingthe culturalhistoryof thisperiodhas receiveda good deal of attention. This large and extremely varied book reflects, in its i66 SEER, 8o, I, 2002 own way, the degree to which the studyof the immediatepost-waryearsin the region is changing. The book takesthe form of publishedconferenceproceedings ratherthan a coherent edited collection. Publishedby University College London's School of Slavonic and East European Studies it is based on a conference held in I998 called 'Another Transition. Politics and Culture in Central Europe, I945-49'. The organizer of the conference and editor of this volume has assembled an impressive and genuinely international team of authors. The voices of young and more established scholars from the region itself can be heard within the essays the books contains, alongside the work of North American and WesternEuropeans. The volume concentratesnot on Central and Eastern Europe, but on 'Central Europe' which is defined essentiallyas consistingof Germany, Polandand the formerterritoriesof Austria-Hungary. This ensuresthat statessuch asAustriaand what laterbecame WestGermany are given consideration, creating opportunities for comparisons to be developed. They are rarelydeveloped within the essaysthemselves,however, as most tend to concentrate on one aspect of an individual country. Furthermore little is done by the editor to tie the essays together in the introduction. This reviewer was left wondering whether the term 'Central Europe' was the best term to describe the region in the period between I945 and I949 given that most of the region was underRed Army occupation, part of the Soviet-sphereof influence and where, by I949, most of the stateswere ruled by dictatorships that sought to transform the...

POST-COMMUNIST TRANSFORMATION CONFRONTS all countries involved with questions of state redefinition. The strains that can be generated by these questions have been most evident, and most examined, in states newly emerged from the Czechoslovak, Soviet or Yugoslav federations and/or those with significant ethnic minorities. However, even in relatively old and ethnically homogeneous states, these issues cannot be tackled without engaging varying understandings of the national identity and the relationship between state and nation.! This article investigates the conceptions of the nature and purpose of the state presented by party political elites in one such state, Hungary. Hungary's relative ethnic homogeneity means that there has been no significant practical contestation about which national group the post-communist state is 'of and for', in Brubaker's terms.2 That is, questions have not arisen about public language use, for example (as between the language of the state's titular nationality and another, minority, national group), as has occurred in several other post-communist countries with larger and less assimilated minorities. Similarly, Hungary's well-established status has obviated any need to excavate a little-known national past to legitimate the state's existence. As then Prime Minister Viktor Orbtin commented in 1999, Hungarians could 'forget the word, invent Hungary. Hungary was invented quite well enough a thousand years ago, by St Stephen himself'.3 However, a 'national question' has consistently been identified as the single dominant dimension of the country's post-communist party competition.4 Partly, this dimension comprises familiar left-right differences over secularism and progressivism versus religiosity and cultural and social traditionalism. However, in the Hungarian context, as in many others, these differences also encompass divergent understandings of the national identity and of the nature and value of nationhood in general." In this respect, elite political competition since 1990 in part continues a central debate of modem Hungarian political and intellectual life, about what the Hungarian nation is and what its relationship to the Hungarian state should be.6 Prior to the 1920 Treaty of Trianon this debate indeed partly concerned the relationship between Hungarians, groups by then identified as being of other nationalities, and the Hungarian state. Since the

Background/objectives: Inadequate HIV care for hard-to-reach populations may result in failing the UNAIDS 90–90–90 goal. Therefore, we aimed to review the HIV continuum of care and hard-to-reach populations for each step of the continuum in Central, Eastern and South Eastern Europe.Methods: Euro-guidelines in Central and Eastern Europe (ECEE) Network Group were created in February 2016. The aim of the network was to review the standards of HIV care in the countries of the region. Information about each stage of HIV continuum of care and hard-to-reach populations for each stage was collected through on-line surveys. Respondents were ECEE members chosen based on their expertise and involvement in national HIV care. Data sources (year 2016) used by respondents included HIV Clinics electronic databases, Institutes of Public Health, Centres for AIDS Prevention, and HIV Programme Reviews.Results: The percentage of people living with HIV (PLHIV) linked to HIV care after HIV diagnosis was ranged between 80% and 96% in Central Europe, 51% and 92% in Eastern Europe and 80% and 100% in South-Eastern Europe. The percentage of PLHIV who are on ART was ranged from 80% to 93% in Central Europe, 18% to 92% in Eastern Europe and 80% to 100% in South-Eastern Europe. The percentage of people virologically suppressed while on ART was reported as 70–95%, 12–95% and 62–97% in Central, Eastern, and South Eastern Europe, respectively. All three regions reported people who inject drugs (PWID) as hard-to-reach population across all HIV continuum stages. Migrants were the second most reported hard-to-reach population. The proportion of late presenters among newly diagnosed ranged between 20% and 55%, 40% and 55% and 48% and 60% in Central, Eastern and South Eastern Europe, respectively. Four countries reported ARVs’ delivery delays resulting in treatment interruptions in 2016: two (25%) in South-Eastern, one (20%) in Central and 1 (16.7%) in Eastern Europe.Conclusion: Irrespective of the diversity in national HIV epidemics, countries from all three regions reported PWIDs as hard-to-reach population across all HIV continuum stages. Some countries are close to the UNAIDS 2020 goals, others need to strive for progress. However, differences in data sources and variations in definitions limit the utility of continuum of care as a comparative tool.

In the last decade, substantial differences in the epidemiology of, antiretroviral therapy (ART) for, cascade of care in and support to people with HIV in vulnerable populations have been observed between countries in Western Europe, Central Europe (CE) and Eastern Europe (EE). The aim of this study was to use a survey to explore whether ART availability and therapies have evolved in CE and EE according to European guidelines. The Euroguidelines in Central and Eastern Europe (ECEE) Network Group conducted two identical multicentre cross-sectional online surveys in 2019 and 2021 concerning the availability and use of antiretroviral drugs (boosted protease inhibitors [bPIs], integrase inhibitors [INSTIs] and nucleoside reverse transcriptase inhibitors [NRTIs]), the introduction of a rapid ART start strategy and the use of two-drug regimens (2DRs) for starting or switching ART. We also investigated barriers to the implementation of these strategies in each region. In total, 18 centres participated in the study: four from CE, six from EE and eight from Southeastern Europe (SEE). Between those 2 years, older PIs were less frequently used and darunavir-based regimens were the main PIs (83%); bictegravir-based and tenofovir alafenamide-based regimens were introduced in CE and SEE but not in EE. The COVID-19 pandemic did not significantly interrupt delivery of ART in most centres. Two-thirds of centres adopted a rapid ART start strategy, mainly in pregnant women and to improve linkage of care in vulnerable populations. The main obstacle to rapid ART start was that national guidelines in several countries from all three regions did not support such as strategy or required laboratory tests first; an INSTI/NRTI combination was the most commonly prescribed regimen (75%) and was exclusively prescribed in SEE. 2DRs are increasingly used for starting or switching ART (58%), and an INSTI/NRTI was the preferred regimen (75%) in all regions and exclusively prescribed in SEE, whereas the use of bPIs declined. Metabolic disorders and adverse drug reactions were the main reasons for starting a 2DR; in the second survey, HIV RNA <500 000 c/ml and high cluster of differentiation (CD)-4 count emerged as additional important reasons. In just 2 years and in spite of the emergence of the COVID-19 pandemic, significant achievements concerning ART availability and strategies have occurred in CE, EE and SEE that facilitate the harmonization of those strategies with the European AIDS Clinical Society guidelines. Few exceptions exist, especially in EE. Continuous effort is needed to overcome various obstacles (administrative, financial, national guideline restrictions) in some countries.

IN HIS RECENT ARTICLE 'The Maquiladora Syndrome and Central Europe' Ellingstad compares the role of foreign multinationals in Hungary with their role in Mexico.1 In Hungary, as in northern Mexico, multinationals have achieved substantial increases in productivity, without providing matching increases in real earnings; wage levels remain very much lower than in neighbouring countries. High value added components are imported or produced in the country by other foreign-owned firms. This inward investment results in increased regional disparities in income and wealth, uneven development. Central and Eastern Europe (CEE) thus provides a geographically convenient low-wage labour force, attractive to Western multinationals seeking competitive advantage internationally through cost leadership, to use Porter's terms.2 Hungary and Mexico are recognised to be very different economic environments, with Hungary possessing a long entrepreneurial tradition and a highly educated labour force, and with very different political traditions.3 Historically the ties between Western and Central Europe have been very different from those between the USA and Mexico. Nevertheless, despite its empirical limitations, the comparison pinpoints a central need in understanding developments in Central and Eastern Europe, the critical importance of viewing the region from an international business perspective, and in particular the perspective of multinational production strategies. This article addresses a similar issue to that raised by Ellingstad, but from a different perspective, that of globalisation theory. In doing so it attempts to bridge two literatures-management and CEE studies.

Over the past years, the concept of 'Central Europe' has been revived by Hungarian political elites and this study aims to find out how and why. It is based on a content analysis of political speeches and communications, compared with actual policies and statistical data. It is observed that the government is the only political force to engage in the new discourse of 'Central Europe'. The study finds that both the geographic extension and the connotations of 'Central Europe' have changed fundamentally. Often associated with the territories of the Dual monarchy up until the early 2000s, the notion today appears to be used synonymously with the likewise reinvigorated Visegrad Four. Yet while the latter has kept its geographic confines intact, 'Central Europe' has no clear boundaries. Such a malleable concept can more flexibly serve various geopolitical goals, such as Hungary's intention to include Croatia and Serbia. The meanings associated with 'Central Europe' have changed just as much. Not long ago a symbol for Hungary's (and its neighbours') 'return to Europe', Central Europe has re-emerged as a 'channel of protest' vis-a-vis the West. Disillusioned by the EU following the financial and refugee crises, Hungarian political elites have been envisioning 'Central Europe' as the continent's new growth hub and a safe space free from migrants. Economic data contradict the former vision. As Euroscepticism and a hard-line stance against refugees are no (longer) unique stands of the Visegrad Four, the question is what remains of 'Central Europe'.

Phylogeography of xerothermic Carlina acanthifolia subsp. utzka in Central Europe

The impact of solar cycles on forest stands, while important in the development of the forest environment during climate change, has not yet been sufficiently researched. This work evaluates the radial growth of European beech (Fagus sylvatica L.) in the mountain areas of southern Italy and central Europe (Czech Republic, Poland) in correlation to solar cycles (sunspot number), extreme climatic events, air temperatures and precipitation totals. This research is focused on the evaluation of the radial growth of beech (140 dendrochronological samples with 90–247 years of age) from 1900 to 2019. The time span was divided into the following three periods: (1) a period of regular harvesting (1900–1969), (2) a period of air pollution crisis (1970–1985) and (3) a period of forest protection (1986–2019). The results indicate that the solar cycle was significantly involved in radial growth on all research plots. With regard to the evaluated precipitation totals, seasonal temperatures and the sunspot number, the latter was the most significant. Temperatures had a positive effect and precipitation had a negative effect on the radial increment of beech in central Europe, while in southern Italy, the effect of temperature and precipitation on the increment is reversed. In general, the limiting factor for beech growth is the lack of precipitation during the vegetation season. The number of negative pointer years (NPY) with an extremely low increment rose in relation to the decreasing southward latitude and the increasing influence of climate change over time, while a higher number of NPY was found in nutrient-richer habitats compared to nutrient-poorer ones. Precipitation and temperature were also reflected in the cyclical radial growth of European beech. The relationship between solar cycles and the tree ring increment was reversed in southern Italy and central Europe in the second and third (1970–2019) time periods. In the first time period (1900–1969), there was a positive relationship of the increment to solar cycles on all research plots. In the tree rings of European beech from southern Italy and central Europe, a relationship to the 11-year solar cycle has been documented. This study will attempt to describe the differences in beech growth within Europe, and also to educate forest managers about the relevant influence of solar cycles. Solar activity can play an important role in the growth of European beech in central and southern Europe, especially during the recent years of global climate change.

The region called ‘Eastern Europe’ in Korea lies between three European seas - the Adriatic Sea, the Baltic Sea, and the Black Sea. In the Polish academic world, this region was called Central Europe, Central-Eastern Europe, Central and Eastern Europe, Central and Southern Europe, or several other ways, depending on time and conditions. And each of these names had justification to be called that. In this paper, the authors will focus on the use of the term ‘Central Europe’ and make the argument. Based on the research achievements of the Institute of Political Studies, the Polish Academy of Sciences, the current discourse in Polish academic world is the subject of this thesis. Numerous attempts have been made to define the concept of Central Europe in Polish literature on international relations. In this process, controversy often arose over which countries should be included in the Central European region. In this paper, while developing the thesis on Central European terminology, it was divided into four stages by period. With the outbreak of the Russian-Ukrainian War in 2022, the concept of ‘Central-Eastern Europe’, which was widely used in Polish academic world, began to lose its reason for existence. In the authors’ opinion, it seems logical to refer to the territory of the Three Seas Initiative as Central Europe. In other words, we conclude that it is reasonable to call Central Europe the group of 12 countries of the Three Seas Initiative, which are members of the European Union.

Introduction: There has been wide recognition of the health divide between Western Europe and the former socialist countries from Central and Eastern Europe. However, these have not been assessed in terms of burden of disease, and the effect of stroke has not been fully elucidated, especially in terms of time trends. Methods: The West-Eastern European stroke burden was analysed using data from the Global Burden of Stroke (GBD) Study 2019 in terms of disability-adjusted life years lost (DALYs) and years of life lost (YLL) over the period 1990–2019 by gender. Data were extracted on a regional (West, Central, and East Europe) and country level for the twenty former socialist countries from Central and East Europe according to GBD regional definitions. We focused on the trends of age-standardized stroke DALY rates across the three decades and compared them with the average rates for West Europe. Main Findings: All Central and East European countries experienced a decline in all-cause disease burden between 1990 and 2019, and a gap was confirmed between the East, the Central, and the West European region for men but not for women. The age-standardized stroke DALY rates declined in the three European regions and in all twenty Central and East European countries but at a different pace. The stroke DALY rates among women exhibited the greatest decline in the West −59% (95% UI [−60; −57]) followed by the Central European region −48% (95% UI [−53; −42]) and lowest among women in East Europe −37% (95% UI [−43; −29]). The decline in men was even higher than among women −61% (95% UI [−63; −60]), while in Central Europe it was −43% (95% UI [−50; −37]) and in the East −25% (95% UI [−34; −14]), leading to widening of the gap between East, Central, and West Europe in relation to stroke burden. YLL represented more than 70% of stroke DALYs and more than 90% of DALYs for men in East European countries. Conclusions: The burden of stroke contributes to the European health gap through preventable premature stroke deaths. There are some very successful countries in stroke burden management from both Central (Slovenia, Czech Republic, and Hungary) and East Europe (Estonia), suggesting that closing the health gap between East and West is a realistic aim.

Throughout Europe and within various historical and socio-economic conditions, Slovaks have formed many enclaves and diasporas. In order to investigate common cultural and ethnic characteristics and/or differences between Slovaks in Slovakia and the various diasporas that they formed in relationship with majorities of their host countries, we suggest the usage of the cartographic method. Namely, during the 1997-1999 the Institute of Ethnology of the Slovakian Academy of Science used the cartographic method to analyze various complex questions relating to the traditional culture and ethnic history of many Slovakian minorities in the countries of Central Europe: in Poland, Ukraine, Romania and Hungary. The project was named Traditional Culture of Slovakian Minorities in Central Europe - the application of ethno-cartographic method in research and comparison of cultural manifestation. The project yield positive results and in 2000-2002 proceeded with yet another scientific project: Traditional Culture of Slovakian Minorities in Southeastern Europe - the application of the cartographic method in research and comparison of cultural manifestations once more, the data were obtained on the traditional folk culture of the Slovakian enclaves in Vojvodina and Croatia. The cartographic method used in both projects enabled researchers to document relevant data in a relatively short period of time. A solid foundation was created for a scientific synthesis of selected topics that deal with the traditional culture of Slovakian minorities in Central and Southeastern Europe, and its comparisons with the parent country culture. The cartographic method is widely used in Slovakia, in some 250 sites. Further, the scientific project of the Institute of Ethnology of the Slovakian Academy of Science named Traditional Culture of Slovakian Minorities in Central and Southern Europe as an integral part of their cultural inheritance (In between cultural stability and acculturation) that started in 2003, should document various mutual influences between the Slovakian minorities and socio-cultural systems of their host populations. That is, the project should establish a degree of the Slovakian minorities' assimilation or cultural stability in a given region.

Simple SummaryMutations in the FANCM gene may cause a particular type of breast cancer known as ER-negative. In this study, we describe the geographic distribution of 66 different FANCM mutations identified in 44,803 female breast cancer cases from Europe, USA, Canada and Australia. We found that the FANCM:p.Gln1701* mutation is most common in Northern Europe and has lower frequencies in Southern European countries. In contrast, the FANCM:p.Gly1906Alafs*12 mutation is most common in Southern Europe and rarer in Central and Northern Europe. We found that the FANCM:p.Arg658* mutation is most prevalent in Central Europe and that the FANCM:p.Gln498Thrfs*7 mutation originates from Lithuania. Finally, we showed that many and varied FANCM mutations are present in Southwestern and Central Europeans while a much more limited range of mutations is present in Northeastern Europeans. The knowledge of this geographic distribution of FANCM mutations is important to establish more efficient genetic testing strategies in specific populations.FANCM germline protein truncating variants (PTVs) are moderate-risk factors for ER-negative breast cancer. We previously described the spectrum of FANCM PTVs in 114 European breast cancer cases. In the present, larger cohort, we report the spectrum and frequency of four common and 62 rare FANCM PTVs found in 274 carriers detected among 44,803 breast cancer cases. We confirmed that p.Gln1701* was the most common PTV in Northern Europe with lower frequencies in Southern Europe. In contrast, p.Gly1906Alafs*12 was the most common PTV in Southern Europe with decreasing frequencies in Central and Northern Europe. We verified that p.Arg658* was prevalent in Central Europe and had highest frequencies in Eastern Europe. We also confirmed that the fourth most common PTV, p.Gln498Thrfs*7, might be a founder variant from Lithuania. Based on the frequency distribution of the carriers of rare PTVs, we showed that the FANCM PTVs spectra in Southwestern and Central Europe were much more heterogeneous than those from Northeastern Europe. These findings will inform the development of more efficient FANCM genetic testing strategies for breast cancer cases from specific European populations.

Introduction: Ischemic stroke accounts for approximately 80% of all stroke cases and remains a major cause of morbidity and mortality among adults. At the beginning of the 21st century, the age-standardized incidence of stroke in Europe ranged from 95 to 290 cases per 100,000 population. Objective: Our aim was to examine trends in the incidence of ischemic stroke in Europe between 1991 and 2021, by country group, gender, and age group. Method: In our retrospective, quantitative study, we analyzed data from 44 countries in three European country groups (Eastern, Central, and Western Europe) per 100 000 people based on the Global Burden of Disease 2021 database. Descriptive statistics, time series analysis and Kruskal–Wallis test were performed. Results: Between 1991 and 2021, the age-standardized incidence per 100 000 population in men decreased from 206.7 to 147.1 (−28.8%) in Eastern Europe, from 172.1 to 123.8 (−28.1%) in Central Europe, and from 120.7 to 62.3 (−48.4%) (p<0.05) in Western Europe. In women, during the same period, it decreased from 169.8 to 113.9 (−32.9%) in Eastern Europe, from 142.4 to 106.0 (−25.6%) in Central Europe, and from 89.5 to 47.2 (−47.3%) in Western Europe (p<0.05). Significant differences were found between Eastern and Western European countries and between Central and Western European countries for both sexes (1991, 2001, 2011, 2021: p<0.05). The incidence was higher in men than in women every year, especially in the age groups over 55. The largest decrease for both sexes was observed in the 65–69 age group. Based on the analysis by country, the largest decrease was in Portugal (men: –71.1%; women: –69.9%), while in Montenegro, increases of +4.1% for men and +6.3% for women were observed. Conclusion: During the study period, the incidence of ischemic stroke decreased in all three country groups, but the improvement was greater in the Western European country group, which had lower (more favorable) baseline values, than in Central or Eastern Europe. Nevertheless, in 2021, the incidence in Eastern and Central Europe still exceeded the level measured in Western European countries in 1991. Orv Hetil. 2025; 166(42): 1642–1652.

Aims: Although socioeconomic status is a recognized independent risk factor for CVD mortality, the recommended European risk prediction equation for primary prevention does not consider it; an approach criticized by previous results in the UK and US. We aim to assess whether the SCORE project equation adequately estimates the risk in different educational classes, across several European populations. Methods: We considered 47 prospective population-based surveys from Nordic Countries (Finland, Denmark, Sweden), UK (Belfast and Scotland), Central Europe (France, Germany and Italy) and East Europe (Lithuania, Poland) and Russia. Baseline data collection and mortality follow-up (median time 10 years) adhered to standardized MONICA-like procedures. Three educational classes were derived from population-, sex- and birth year-specific tertiles of years of schooling. The individual SCORE risk was computed from age, total cholesterol, systolic blood pressure and smoking; the risk was recalibrated to the average observed risk in each population. We estimated age- and traditional risk factors-adjusted hazard ratios (HR) for 10 year CVD mortality (highest education as the reference), from Cox models. Moreover, the observed number of fatal CVD events by educational class was compared to the expected number, as estimated by the recalibrated SCORE function. Results: The cohorts summed-up 39,215 men and 29,240 women 40 to 64 years old and free from CVD event at baseline. Education was associated with CVD mortality in men (pooled age-adjusted HR for low vs high education: 1.6, 95% CI 1.4–1.9); the hazard ratios ranged from 1.3 (95%CI: 0.9–1.8) in Central Europe to 2.1 (1.6–2.7) in East Europe and Russia. The association attenuated after adjustment for SCORE risk factors and HDL-cholesterol. Among women, the association was significant in Nordic Countries only (age-adjusted HR for low vas high education: 1.7, 95% CI 1.1–2.6), but it was no more significant after adjustment for multiple risk factors. The original SCORE equation overestimated the risk at a population level, both in men and in women, except in East Europe and Russia. After recalibration, the SCORE equation overestimated the risk among the more educated men by 20% to 50% (in Central Europe, East Europe and Russia, respectively), but underestimated it in the less educated men by 7% to 23% (in Central Europe, East Europe and Russia, respectively). Conclusions: Our results, based on a well-harmonized study comprising several European populations, suggest the need to include country-specific socioeconomic status in the risk estimation equations.