Western Europe Research Articles

Emergence of highly pathogenic avian influenza viruses H5N1 and H5N5 in white-tailed eagles, 2021-2023.

Highly pathogenic avian influenza (HPAI) poses a substantial threat to several raptors. Between 2021 and 2023, HPAI viruses (HPAIVs) of the Goose/Guangdong lineage H5 clade 2.3.4.4b became widespread in wild birds in Norway, and H5N1 and H5N5 viruses were detected in 31 white-tailed eagles (Haliaeetus albicilla, WTEs). Post-mortem examinations of four WTEs revealed no macroscopic pathological findings. Microscopic examinations showed the presence of myocardial and splenic necroses and a few lesions in the brain. In situ hybridization revealed the presence of the virus in several organs, suggesting a multisystemic infection. The detection of HPAIV H5N5 in a WTE in February 2022 marked the first recorded occurrence of this subtype in Norway. Since then, the virus has persisted, sporadically being detected in WTEs and other wild bird species. Phylogenetic analyses reveal that at least two distinct incursions of HPAIV H5N1 Eurasian (EA) genotype C affected WTEs, likely introduced by migratory birds from Eurasia and seabirds entering from Western and Central Europe. Some WTE isolates from 2021 to 2022 clustered with those from Canada and Ireland, aligning with the transatlantic spread of H5N1. Others were related to the 2021 mass mortality of great skuas in the UK or outbreaks in seabird populations, including gannets, gulls and terns, during 2022 in the North Sea region. This suggests that the WTEs were likely preying on the affected birds. Our study highlights that WTEs can act as sentinels for some HPAIV strains, but the absence of several known circulating genotypes in WTEs suggests varying pathogenic effects on this species.

Virtual Aunts and Uncles: Identity and Community in a Diasporic National Minority

Abstract The past decade has seen mass emigration of Hungarians from Serbia to the kin-state and Western European countries. This has resulted in new ways of understanding what it means to belong to the community, both empirically and in terms of theorizing it, and both for those in Serbia and those abroad. This article claims that there are virtual platforms where members of this ethnic community (re)create their identities, and that this happens through relating to certain common themes. For this reason, I analyze the common themes of two humorous Facebook pages – namely, rurality, food, language use, ethnic others, and crossing borders – popular among Vojvodina Hungarians. The article argues that these elements of identity connect members of the community who live in Vojvodina and those who have emigrated to the kin-state or diaspora. Therefore, in order to unpack the complex dynamics of identification of a national minority community with high diasporic tendencies, an approach that connects the above topics to the concepts of community, nostalgia, home, minority, and borders, and in more general terms the lens of national minority and diaspora studies is needed.

Redefining global entrepreneurship: shifting focus from China to Central and Eastern Europe

Purpose The purpose of this paper is to explore the viability of shifting foreign direct investment (FDI) from China to Central and Eastern European (CEE) countries in light of recent geopolitical and economic challenges. By analyzing case studies, it argues that CEE nations offer a compelling alternative for Western European businesses, with stronger intellectual property protection, political stability and alignment with European Union (EU) sustainability goals. The paper provides insights for firms and policymakers on mitigating risks and enhancing business operations by pivoting toward the CEE region, offering practical recommendations for adapting to shifting global trade dynamics. Design/methodology/approach The design methodology uses the case study approach to analyze the shift of FDI from China to CEE. This method examines the geopolitical, economic and legal contexts influencing business decisions, using real-world examples of Western European companies that have made this transition. The case studies highlight key factors in decision-making and the benefits of relocating investments to the CEE region. Findings The study identifies several advantages of the CEE region over China for Western European firms. These include geographic proximity, similarities in business values and purposes, environmental accountability, trustworthiness in business, enforceable noncompetition rules, lower risks of counterfeiting, reduced political and administrative risks, lower risks of intellectual property theft and reduced risks of negative publicity. Practical implications The findings suggest that Western European firms should consider redirecting their FDI to the CEE region to mitigate risks associated with investing in China. This move could offer long-term benefits despite short-term complications. Originality/value This paper contributes to the FDI theoretical framework by enhancing the cultural, administrative, geographic and economic (CAGE) distance framework. It provides a unique perspective on the shifting dynamics between Europe and China and highlights the potential of the CEE region as a viable alternative for FDI.

THE ARS MORIENDI, MANUALS FOR A GOOD DEATH IN WESTERN EUROPE FROM THE 15TH TO THE 16TH CENTURIES

The subject of death has been studied since ancient times, although the last moment of a human being's life has not always been interpreted from the same perspective. This article studies the spirituality of the 15th-16th centuries in western Europe and describes the change in attitude towards death. Since the Council of Constance, death, far from being considered a reason to instill fear, comes to be understood as a necessary transit. After the particular judgment that confronts the forces of good and evil, the eternal salvation or the condemnation of the soul is debated in the room of the dying. Based on the influence that Jean Gerson's work had on the Council of Constance, editions and translations were printed in various languages in Europe, some of which were typographic and others included figures with the intention of serving as a guide to the contemplation of the faithful, among which the literary translation of Bernardí Vallmanya’s Cordial de l’ànima stands out.

THE ARS MORIENDI, MANUALS FOR A GOOD DEATH IN WESTERN EUROPE FROM THE 15TH TO THE 16TH CENTURIES

The subject of death has been studied since ancient times, although the last moment of a human being's life has not always been interpreted from the same perspective. This article studies the spirituality of the 15th-16th centuries in western Europe and describes the change in attitude towards death. Since the Council of Constance, death, far from being considered a reason to instill fear, comes to be understood as a necessary transit. After the particular judgment that confronts the forces of good and evil, the eternal salvation or the condemnation of the soul is debated in the room of the dying. Based on the influence that Jean Gerson's work had on the Council of Constance, editions and translations were printed in various languages in Europe, some of which were typographic and others included figures with the intention of serving as a guide to the contemplation of the faithful, among which the literary translation of Bernardí Vallmanya’s Cordial de l’ànima stands out.

‘The Shipwreck of the Turks’: Sovereignty, Barbarism and Civilization in the Legal Order of the Eighteenth-Century Mediterranean

Abstract This article focuses on the consequences of a single major international affair — the shipwreck of a French ship carrying 165 Muslim pilgrims along the southern shores of Sicily in 1716 — to address two pivotal issues in the reordering of eighteenth-­century legal and political systems: the limits of domestic sovereignty in absolutist states and the status of non-Christian polities in the theory and practice of the law of nations. Both the time and place of this episode, which had a vast resonance at the time, have broad implications for how we write about the development of modern international law. While much of the debate on the maritime dimension of the eighteenth-century law of nations focuses on the Atlantic and the Indian Oceans, we spotlight the Mediterranean, where endemic corsairing activities coexisted with age-old diplomatic and day-to-day practices of accommodation and mutual recognition between Christian and Muslim polities. Here we draw attention to shipwrecks that occurred in foreign territorial waters and their heuristic potential for better understanding controversial issues of maritime law, such as the status of shorelines, neutrality and the law of the flag. Even after the Peace of Utrecht (1713–15), which is often regarded as a watershed moment in the history of international law, these rules were far from settled and shipwrecks continued to fuel legal and philosophical battles that extended well beyond the confines of the famous controversy between supporters of mare liberum and advocates of mare clausum. The close examination of the 1716 shipwreck leads us to challenge the land/sea divide as constructed by Carl Schmitt and demonstrate that territorial waters were objects of sovereign disputes in much the same way as land territories. We also show how the emerging Eurocentric discourse about the ‘barbarity’ of non-Christian peoples and nations coexisted with intellectual, economic and diplomatic forces interested in establishing formal agreements between Western European nations, the Ottoman Empire and its North African provinces.

Dying for What? Secular Transformations of Martyrdom

This article studies different forms of martyrdom in secular contexts, tracing their roots back to Western European Christian traditions. The article argues that distinct trajectories of martyrdom have emerged: (a) the more passive martyr, who refuses to acknowledge sovereign power and dies for a transcendent truth, and (b) the more assertive martyr, who sacrifices their life fighting for God and the sovereign. In secular contexts, this assertive martyr fights for secular ideals such as ‘freedom’ or ‘nation’ and represents the symbolic body of the sovereign. The historical distinction between divine truth and state falsehood has been turned into differentiations between democratic rule and threats like terrorism. To further study this transition, this article studies discourses following the deaths of Pim Fortuyn and Jaques Hamel, as both were strongly labeled as martyrs. This results in the final part of the article that examines the cult of commemoration surrounding soldiers in the US and the Netherlands. It argues that the assertive martyr has reached its fully secularized form in these contexts. The transcendent imagery of state sovereignty is evident in the sacrificial discourses around fallen soldiers. At this point of death, the state’s power is reinforced as a transcendent norm and reveals itself in those who ‘sacrifice’ their lives for the freedom of many.

A Synoptic Scale Perspective of Solar Forcing on Extreme Precipitation and Floods Over Europe During Summer

AbstractThe relationship between total solar irradiance (TSI) forcing and summer extreme precipitation and flood frequency over western Europe is investigated from a synoptic‐scale perspective, with a focus on the role of Rossby wave packets (RWPs). Utilizing observational, model, and proxy data, we reveal a significant increase in RWP frequency along a zonal band centered around 50°N, extending from North America to western Europe, during periods of low TSI. This anomaly in RWP frequency is consistent with a significant increase in the frequency of extreme precipitation events recorded over western Europe. Sensitivity experiments conducted with a state‐of‐the‐art chemistry‐climate model corroborate our findings based on observational data. Additionally, a flood record from western Europe demonstrates a significant increase in flood frequency during low TSI years, a relationship that persists across timescales. We argue that the frequency patterns associated with TSI forcing presented in this study are robust and, therefore, valuable for estimating the frequency of extreme precipitation events over western Europe under various solar irradiance scenarios. Moreover, our findings indicate that the North Atlantic sector is more responsive to changes in solar forcing during the boreal summer than previously thought, with this effect manifesting primarily on synoptic timescales rather than the long‐term climatological mean.

Strip cropping increases yield and revenue: multi-year analysis of an organic system in the Netherlands

Intercropping is proposed as a promising strategy to meet future food demand while reducing agriculture’s environmental impact by re-diversifying agricultural fields. Strip cropping, a form of intercropping, has a potential to simultaneously deliver multiple ecosystem services including productivity, while facilitating management as strip width can be adjusted to the working width of available machines. While the yield performance of strip cropping systems is influenced by the interaction between neighboring crops, to date, empirical studies on the performance of various crop combinations in strip cropping systems are limited. Here we used three-year data (2020–2022) from a 64-ha organic strip cropping system in the Netherlands to (1) evaluate the effects of crop neighbors and strip cropping on yield and (2) explore if optimizing the allocation of crop neighbors in alternative strip cropping configurations can improve yield and revenue performances. We analyzed the edge effect and strip cropping effect on yield of six crops grown in strips, each neighboring a total of five crops. The yield data was then used to evaluate the performance of the current and alternative strip configurations in terms of LER and relative revenue. Results showed that except for the positive effect observed on potato when neighboring celeriac or broccoli, edge effects lacked statistical significance. Strip cropping effect varied per crop: positive for faba bean and parsnip, neutral for celeriac and potato, and negative for oat and onion. Analysis across crops showed an overall significant positive strip cropping effect on yield. These findings highlighted the value of analysis at the cropping system level in developing designs aimed at unlocking the potential of strip cropping. The positive but variable strip cropping effects observed in the current experimental design and the two alternative configurations suggests prioritizing an overall increased crop diversity over optimizing their spatial arrangement. While we demonstrated increased productivity with strip cropping, further research is needed to expand the database on optimal crop combinations, extending the evaluation beyond yield and revenue performances to facilitate broader adoption of strip cropping in the Netherlands and Western Europe.

Culture goes East: Mapping the shifting geographies of urban cultural capital through major cultural buildings

Culture has become a major component of policies to put cities on the global map. This article traces the shifting geographies of urban cultural capital using the lens of major cultural buildings, such as the Guggenheim Bilbao Museum and the Louvre Abu Dhabi, which cities often mobilise to compete for attention, reputation, tourists and investment. Based on a custom-built database containing 438 major cultural buildings opened worldwide between 1990 and 2019, this article finds a strong growth in the number and total cost of these buildings throughout the three decades, far exceeding global GDP growth. What is more, there is a geographical shift from the established cities of high culture in North America and Western Europe towards Asia, with a particular concentration in China and the Gulf region. The growth of investment in culture and its fast-changing urban geographies urge a more profound integration of culture in urban studies and a deeper consideration of the role of cultural capital in making global cities.

Do gender quotas increase political knowledge?

AbstractDo gender quotas increase political knowledge? While some studies suggest that quotas can positively impact women's political engagement and participation, others find null or negative effects. This paper focuses on Western Europe and argues that the implementation of quotas serves as an attention and consciousness‐raising event, potentially enhancing awareness of the political sphere. To investigate this, I propose a novel research design that capitalizes on the (quasi) exogenous shock resulting from the introduction of gender quotas. By influencing symbolic representation, quotas may enhance women's sense of empowerment, equality and willingness to engage in politics. Furthermore, the impact is expected to be more pronounced among younger women due to the heightened political socialization experienced during adolescence. Thus, the institutional change brought about by quotas is anticipated to particularly boost political knowledge among (younger) women and subsequently narrow the gender gap. To examine this hypothesis, I analyse data from 1992 to 2018 from 12 countries, of which six implemented gender quotas. Using a hierarchical Bayesian model, I assess respondents' answers to knowledge questions. The findings indicate that the introduction of gender quotas in parliamentary systems has a positive effect on reducing the gender gap in political knowledge among younger individuals, while the effects are statistically insignificant for older citizens.

Private banking market developments: Evidence from Hungary

Private banking institutions serve the financial sector’s wealthiest clientele via a dedicated value proposition. Based on the relevant tendencies and statistics, a remarkable expansion can be outlined since the mid-1990s. The aim of this study is to elaborate the Hungarian private banking market’s development as a case study. The paper also intends to add to the literature on this unique segment of the financial market. Based on the available statistics, the analysis primarily focuses on the Hungarian private banking market’s rapid development process. This can be underpinned by the clientele’s savings, number of accounts and respective segmentation limits of the institutions. Referring to the amount of savings, a correlation analysis indicates significant co-movements with specific social and economic variables. The growth rate of the Hungarian clientele’s savings outperformed the respective indicator in Western Europe during the review time period (2007–2020). The current paper also includes a section that summarises general challenges that private banking managers need to address during the development process. Generally, the literature on private banking can still be considered scarce, whereas there is a lack of studies on the Central-Eastern European region. The analysis of the Hungarian sector’s development path can serve with relevant information to any financial expert in the field.

Buddhism as ‘Chinese Philosophy’: Buddhism in Hegel's History of Philosophy1

AbstractThe question of Hegel's views on Buddhism and its place within his system must be asked again as the history of effects, transmission, and reception continues to unfold. This unfolding highlights not only Hegel's effect on the Western European reception and understanding of Buddhism (and its sharp orientalist critique), but also the canny use of Hegel's philosophy by certain members of the so‐called Kyoto School of Japanese neo‐Buddhist philosophy, who, though primarily concerning themselves with Heidegger, were notable in their creative use of Hegel's philosophy of spirit (especially Nishida, Nishitani, Tanabe, and Abe). Our present task is likewise to look back to Hegel's own writing on Buddhism through the lens of the history of its effects—that is, to read Hegel again with his legacy in mind—so that we might, as strange as it may perhaps seem, see things more clearly. Our goal is relatively modest, as it aims only to seek out and coordinate Buddhism within Hegel's history of philosophy. Thus, as we have a proximate goal in mind, we also have an order of importance with respect to Hegel's texts, which, of course, brings the Lectures on the History of Philosophy to the fore.

Scoping Review of Health Literacy Interventions among Migrant Communities in Europe

Abstract Background The increase in migration trends in Europe has brought attention to the significant health disparities between migrant and native populations, which are largely rooted in social determinants of health such as economic difficulties, language barriers, and limited access to services. Tailored health literacy (HL) interventions can serve as an intermediate factor between social determinants of health and health outcome, thereby holding great potential for addressing these disparities. Despite a growing body of research on migrant health, there remains a gap in our understanding of effective HL interventions for this population. Methods A scoping review was conducted following the Joanna Briggs Institute (JBI) updated guidelines and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. Electronic searches were carried out across five databases (PubMed, SCOPUS, Web of Science, PsychINFO, and CINHAL) and supplemented by a manual search. We included European studies on migrant HL interventions, conducted between 2011 and 2023, and published in English or Portuguese language. Results Out of 1018 records, 7 studies met eligibility criteria. Predominantly situated in Northern and Western Europe (85.5%), interventions primarily targeted female migrants (71.4%) through in-person courses (42.9%). Identified intervention strengths included culturally adapted content, migrant engagement, and access to written materials. Gaps included mental health interventions and community outreach. Conclusions This scoping review provides a comprehensive overview of HL interventions targeting migrant populations, highlighting their characteristics, strengths, and gaps. These findings serve as a foundational step towards developing guidelines for effective HL interventions within migrant communities. Key messages • Most European health literacy interventions for migrants target women and are conducted in North or West Europe. • Cultural adaptation and community engagement are key strengths of migrant health literacy interventions, yet gaps remain in mental health support and community outreach efforts.

Epidemiology of obesity during pregnancy in Europe: a systematic review

Abstract Background Obesity during pregnancy poses inter-generational health risks and places added burden on healthcare systems. Characterising levels of obesity during pregnancy is necessary to guide future research, policy and practice. Methods The systematic review was performed according to PRISMA guidelines. PubMed, Embase and Web of Science were searched. Studies published between 2009 and 2023 that report the prevalence of obesity during pregnancy in countries in the World Health Organization (WHO) European region were eligible. The Joanna Briggs Institute Prevalence Critical Appraisal tool was used. Two reviewers screened studies independently. A single reviewer completed data extraction and quality assessments, a second checked 20% of extractions and a third resolved disagreements. Narrative synthesis was completed. Results 100 studies reporting the prevalence of obesity during pregnancy in the WHO European region were identified. 59% from Western Europe, 36% Northern, 4% Southern and 1% Eastern. Data within the studies was collected between 1950 and 2019. 35% of studies reported national estimates, 65% regional. 39% studies had measured height and weight, 34% did not report how either were ascertained, 6% used self-report for both, 17% had self-reported height but measured weight, 4% a mixture of self-report and measurement. The smallest sample was 157 while the largest was 1,891,097. Estimated prevalence of obesity during pregnancy ranged from 2.3% (Sweden, data collected 1982-1989) to 28.3% (England, 2007). Conclusions This review identifies variation in the prevalence of obesity during pregnancy in the WHO European region. This may reflect diverse sociocultural contexts, different methodological approaches and temporal trends. There was limited evidence available for Southern and Eastern Europe. Key messages • There are high levels of obesity during pregnancy within the WHO European region. • Enhanced primary prevention and resourcing of obstetric services is needed.

Extreme Saharan dust events expand northward over the Atlantic and Europe, prompting record-breaking PM10 and PM2.5 episodes

Abstract. Unprecedented extreme Saharan dust (duxt) events have recently expanded northward from subtropical NW Africa to the Atlantic and Europe, with severe impacts on the Canary Islands, mainland Spain and continental Portugal. These six historic duxt episodes occurred on 3–5 and 22–29 February 2020, 15–21 February 2021, 14–17 January 2022, 29 January–1 February 2022, and 14–20 March 2022. We analyzed data of 341 governmental air quality monitoring stations (AQMSs) in Spain (330) and Portugal (11), where PM10 and PM2.5 are measured with European norm (EN) standards, and found that during duxt events PM10 concentrations are underestimated due to technical limitations of some PM10 monitors meaning that they can not properly measure extremely high concentrations. We assessed the consistency of PM10 and PM2.5 data and reconstructed 1690 PM10 (1 h average) data points of 48 and 7 AQMSs in Spain and Portugal, respectively, by using our novel “duxt-r” method. During duxt events, 1 h average PM10 and PM2.5 concentrations were within the range 1000–6000 µg m−3 and 400–1200 µg m−3, respectively. The intense winds leading to massive dust plumes occurred within meteorological dipoles formed by a blocking anticyclone over western Europe and a cutoff low located to the southwest, near the Canary Islands and Cape Verde, or into the Sahara. These cyclones reached this region via two main paths: by deviating southward from the Atlantic mid-latitude westerly circulation or northward from the tropical belt. The analysis of the 2000–2022 PM10 and PM2.5 time series shows that these events have no precedent in this region. The 22–29 February 2020 event led to (24 h average) PM10 and PM2.5 concentrations within the range 600–1840 and 200–404 µg m−3, respectively, being the most intense dust episode ever recorded on the Canary Islands. The 14–20 March 2022 event led to (24 h average) PM10 and PM2.5 values within the range 500–3070 and 100–690 µg m−3 in southeastern Spain, 200–1000 and 60–260 µg m−3 in central Spain, 150–500 and 75–130 µg m−3 in the northern regions of mainland Spain, and within the ranges 200–650 and 30–70 µg m−3 in continental Portugal, respectively, being the most intense dust episode ever recorded in these regions. All duxt events occurred during meteorological anomalies in the Northern Hemisphere characterized by subtropical anticyclones shifting to higher latitudes, anomalous low pressure expanding beyond the tropical belt and amplified mid-latitude Rossby waves. New studies have reported on recent record-breaking PM10 and PM2.5 episodes linked to dipole-induced extreme dust events from North Africa and Asia in a paradoxical context of a multidecadal decrease in dust emissions, a topic that requires further investigation.

Differences and similarities in adolescents accessing emergency care for acute alcohol intoxication in three urban regions in Italy, Belgium, and The Netherlands

Abstract Background Excessive drinking among adolescents in Western Europe is prevalent, posing significant health risks and societal costs. Early initiation of alcohol use and binge drinking are associated with adult alcohol use disorders. Collecting comprehensive data on adolescent drinking patterns is crucial for developing effective prevention strategies. Methods To gain insight into the demographic and clinical characteristics of acute alcohol intoxication (AAI), we analysed emergency department access data of adolescents aged 14-17 years presenting with AAI symptoms from 2015-2023. Three urban regions were included: the Reinier de Graaf Gasthuis in Delft (The Netherlands), eight combined hospitals in Antwerp (Belgium) and the IRCCS San Martino Hospital in Genoa (Italy). Results A total of 1841 patients with symptoms of AAI were included. The mean age of patients in the Netherlands was statistically significant younger than in Italy and Belgium (15.7 compared to 15.9 and 16.0 years old, respectively). Moreover, the blood alcohol concentration was higher in the Netherlands and Belgium compared to Italy (2.0‰ compared to 1.95‰ and 1.8‰ respectively). The distribution of sex was nearly equal in the Netherlands, while statistically significant differences were observed with a higher proportion of males in Italy (54.8%) and Belgium (56.8%). Combined drug use was lower in Belgium with 10.0%, compared to 13.4% in The Netherlands and 14.7% in Italy. The most common reason for admission was ‘reduced consciousness’ in the total population (45.2%). Conclusions This is one of the first international studies which combines data on AAI in minors. In the future, efforts should be made to establish a common European database where records of AAI can be stored and analysed more efficiently for prevention purposes.

Heterogeneous courses of cardiovascular disease incidence in Europe 2000-2019 – what are the causes?

Abstract Background Data from the Global Burden of Disease (GBD) project distributed by the Institute for health metrics and evaluation (IHME) include incidence and prevalence data for almost all countries in the world. In course of own research, the data on cardiovascular disease (CVD) incidence in Western European countries were analysed and revealed great variation in the course of CVD incidence, that is difficult to interpret. We want to present the different courses of CVD incidence for selected countries and discuss possible reasons for this diversity with the audience. Methods GBD data on CVD incidence and mortality for 25 European countries from 2000-2019 for men and women were to graphically display courses of CVD incidence for visual analysis. Results The course of CVD incidence in Western Europe is country-specific - and, within a country, even sex-specific. Yet, in many countries besides the Baltic states and Czechia, CVD incidence reaches a minimum in 2010, increasing afterwards again. Different patterns of incident courses were visible: a) wave-shaped courses which increase e.g. in Austria, Belgium, France and in males in Finland only, but decrease for both sexes Germany, Norway, Portugal and Poland, and in males in Denmark b) u-shaped courses in Spain, Great Britain, France, Italy, and for Finnish and Dutch females c) linearly increasing for both sexes in Czechia, the Baltic states and in Swiss males d) linearly decreasing for women Norway, Belgium, Denmark and Austria. Conclusions The patterns of CVD incidence in Europe are multitude and country-specific even between sexes, reaching a minimum in 2010 in most countries. The validity of analyses combining these different patterns for regional analyses of CVD incidence such as in GBD reports do not take account for this diversity. Unless these differences can be explained by country-specific prevention or risk factor profile, the validity of data on CVD incidence seems to be limited. Key messages • CVD incidence in Europe between 2000 and 2019 is country-specific changing and very heterogeneous. • Analyses summarizing data for (Western/Eastern) Europe will miss this heterogeneity and might come to invalid conclusions regarding the development of CVD incidence.

Cluster-specific predictors of early rhythm control in contemporary European cohort of patients with atrial fibrillation: The EHRA-PATHS Project

Abstract Background Early rhythm control (ERC) using antiarrhytmic drugs, electrical cardioversion or catheter ablation for AF within a year from first diagnosis of atrial fibrillation (AF) has been shown to reduce the risk of major adverse outcomes compared to usual care, and the effects of ERC have been suggested to be consistent across all AF subgroups with different risk profiles. We aimed to identify cluster-specific predictors of ERC in pre-defined AF clusters in contemporary European EHRA-PATHS AF cohort. Methods The EHRA-PATHS AF cohort was derived from the three prospective EurObservational Research Programme (EORP) AF registries - General Pilot, General Long-term, and AF III registry. A two-step cluster analysis was performed. A hierarchical cluster analysis with 18 variables was used to identify the optimal number of clusters, followed by a K-means cluster analysis to determine variable cluster association. Cluster-specific predictors of ERC were identified using univariate and multivariate logistic regression analyses. Results Of 18,799 patients, AF was diagnosed within 1 year in 8088 (43.0%), and 3913/8088 patients (48.4%) were treated with ERC. Among the three clusters - Cluster 1 (younger healthier AF patients) compared with Cluster 2 (Elderly with less comorbidity, mostly non-cardiovascular) and Cluster 3 (Elderly with more comorbidity, mostly cardiovascular), see Table, ERC was significantly more often used in Cluster 1 compared with Cluster 2 and Cluster 3 (both P<0.001), and in Cluster 2 compared with Cluster 3. Cluster-specific multivariable predictors of ERC are shown in Table. In all three clusters, asymptomatic AF (EHRA score I) and Northern Europe residence were inversely associated with ERC, while Western Europe residence was positively associated with ERC in Cluster 2 and 3. In Cluster 1, low stroke risk and hypertension were positively associated with ERC, while dilated left atrium (LA) and reduced left ventricular ejection fraction (LV EF) were negative predictors of ERC. In Cluster 2, age ≥80 years, enlarged LA, and CHA2DS2-VASc ≥2 for males and ≥3 for females were negatively associated with ERC. In Cluster 3, age ≥75 years, cardiomyopathy, liver disease, dementia and reduced LV EF were negative predictors of ERC. Conclusion Our study of a large European AF cohort showed that likelihood for ERC was greater in younger and healthier AF patients, as well as in elderly from Western Europe, while ERC was significantly less likely with increasing age and comorbidity (especially cardiovascular diseases). These findings likely reflect the lack of high-quality evidence supporting aggressive ERC in high-risk patients with AF. With increasing body of evidence favouring ERC such patients, a shift towards less selective consideration of ERC in daily practice may be expected.

Extreme Heat and Specific-Cause Mortality during Summer 2018 in Mainland Portugal

Abstract Climate change has led to increased frequency and duration of extreme heat periods, impacting human health and mortality. During the 2003 heatwave, it was estimated that there were between 25,000 and 70,000 excess deaths in Western Europe. Specific-cause mortality analysis was conducted in Portugal that year and has not been assessed since. The goal of this study is to estimate the impact of an extreme heat period in 2018 on specific-cause mortality in mainland Portugal. An ecological study was conducted comparing observed and expected deaths, from August 2 to 9, 2018, in Portugal. Two comparison periods were chosen: from July 19 to 26, 2018 (C1) and the average deaths from August 2 to 9 in 2017 and 2019 (C2). Excesses, ratios, and respective 95% confidence intervals were calculated in R. Analyses were stratified by sex, age group, and district. Consistent excess deaths were observed between comparators, showing a greater impact in circulatory diseases (C1: 283, 95% CI: 210; 356 and C2: 239, 95% CI: 164; 314) and respiratory diseases (C1: 98, 95% CI: 55; 141 and C2: 95, 95% CI: 52; 138). Regarding death ratios, with C1, the highest death ratios were observed for exposure to excessive natural heat (50.00, 95% CI: 37.11; 65.92) and ischemic stroke (4.00, 95% CI: 2.07; 6.99). With C2, the highest death ratios were observed for exposure to excessive natural heat (50.00, 95% CI 37.11; 65.92) and atherosclerosis (2.71, 95% CI 1.63; 4.24). The excesses and ratios of deaths were higher in more urbanized districts, females, and age groups above 75 years. The results suggest that the extreme heat in 2018 had an impact on mortality. Elevated death ratios and excesses were observed for various causes of death with considerable statistical magnitude and significance. These findings align with other national and international studies. Public health action is increasingly critical to mitigate the observed rise in mortality during periods of extreme heat. Key messages • Specific-cause mortality analysis during extreme heat suggests a greater impact in circulatory and respiratory diseases, in residents of urbanized districts, females, and individuals of 75+ years. • Understanding these specific causes can better inform public health actions and planning, thereby mitigating the adverse effects of extreme heat.